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P Takvorian

Publications and source records attributed to P Takvorian.

At least 19 recordsLinked to original sources
PubMed1997

[Malformations of Wolffian duct derived male genital organs (epididymis, vas deferens, seminal vesicules, ejaculatory ducts)].

OBJECTIVES: To analyse embryological phenomena, in order to define a practical approach to management. METHODS: The authors reviewed the files of eight boys with an abnormality of Wolffian duct derived genital organs, consisting of three cases of vas deferens agenesis, two of which were accompanied by homolateral renal agenesis, one case of ectopic vas deferens with contralateral renal agenesis, three cases of duplicated vas deferens and one congenital seminal vesicle cyst with renal agenesis. DISCUSSION: Congenital malformations of the epididymis consist of cysts and agenesis or partial atresia. Cysts essentially raise a problem of differential diagnosis. Treatment is only required in the case of severe discomfort. Vas deferens agenesis is the commonest lesion, an incidental finding in children. An experimental treatment is proposed in adults. Duplications, interdeferential communications and deferentomegaly are much rarer lesions. Seminal vesicle cysts are well visualized by transrectal ultrasonography and should be treated surgically. Lastly, ejaculatory ducts may present urethroseminal reflux or may be ectopic. CONCLUSION: The possibility of absent or ectopic vas deferens should be considered in the case of unilateral renal agenesis. Vas deferens agenesis justifies examination of the contralateral side and investigation to exclude renal agenesis. Congenital cysts of the epididymis only require surgery when they are symptomatic. The presence of ipsilateral renal agenesis should be investigated in the case of cystic dilatation of the seminal vesicle.

Adolescent↗
PubMed1995

[Analysis of the failure of endoscopic treatment of vesico-renal reflux in children using injections of teflon and collagen and the preliminary results of injections of Macroplastic].

This study of 785 cases of vesicorenal reflux in 494 children treated endoscopically over a 7-year period was designed to evaluate the results obtained with three products used successively: Teflon, collagen and Macroplastic. Following Teflon injection, despite a 90% short-term success rate, recurrent reflux was subsequently observed in 16.71% of the ureters reviewed. The failure rate was 52.63% after collagen injection and 11.77% after Macroplastic. After one or two injections, complete resolution of reflux was obtained in 48% of children treated with collagen, versus 85.72% with Teflon and 93.33% with Macroplastic. In one half of cases, failure was related to the quality of the product and its modifications after injection. The marked resorption of collagen accounts for the poor results despite the large doses injected. Apart from one case of partial resorption of Teflon paste, the failures with this product were due to lateralisation or secondary elimination of the product from the injection site due to its fluidity. Macroplastic, due to its higher viscosity and absence of retraction, currently provides the best results with doses of less than 0.20 ml in children.

Anuria↗
PubMed1994

[High frequency ventilation in neonatal surgery].

High frequency oscillatory ventilation (HFOV) is one of the artificial ventilation techniques used for the treatment of severe respiratory distress in the neonatal period. We studied (between 1987 and 1992) 57 newborn infants ventilated by HFOV during surgery. The aim was to facilitate the surgical procedure without having any deleterious effects on the gas exchange or the hemodynamic state of the infant. Three groups were studied. Group I (thoracic procedures: oesophageal atresia and pulmonary malformations, n = 25), group II (diaphragmatic hernia, n = 22), group III (abdominal procedures, n = 10). In the thoracic surgery group, no deleterious effect related to the HFOV was reported. The hyperventilation noticed after anaesthetic induction was rapidly corrected by placing the patient in a lateral position. In the three groups, no intraoperative complications related to the HFOV were observed. The diaphragmatic hernia group was divided into two subgroups according to the timing of surgery (emergency surgery, surgery after stabilization). In the latter subgroup, surgery was performed when the ventilation and gas exchange conditions had significantly improved. This subgroup showed the highest survival rate. This technique of peroperative ventilation is specifically used in the thoracic and diaphragmatic procedures of term and preterm newborn infants. It achieves a more stable operative field with less pulmonary expansions and diaphragmatic movements. In spite of the fact that HFOV is seldom used during anaesthesia, this study confirms its safety as well as the simplicity of its monitoring.

Birth Weight↗
PubMed1994

[Treatment of hypospadias apropos of 557 cases. Evolution of techniques in a care unit of pediatric surgery in a period of 18 years, and current indications].

The authors report their experience with surgical treatment of hypospadias about 557 cases. From 1974 to 1981, only 84 cases were cured by classical procedures (Mathieu, Van der Meulen, Perlemutter, Duplay-Fèvre, Leveuf-Cendron), sometimes with Cahuzac uretroplasty). The age when correction depended from the type of hypospadias and several times were after necessary. From 1981 to 1992, 463 cases were operated, always between 18 month to two years of age, with only one operative with therapeutic indications are actually such proposed: distal meatotomy or modified MAGPI procedure for glandular hypospadias; Duplay uretroplasty for coronal form; Mathieu or onlay island flap for anterior and medial penil types without curvature; Mollard or Duckett uretroplasty for penil forms with chordee; Then, for posterior types, complementary posterior Duplay uretroplasty, or vesical ou buccal grafts.

Adolescent↗
PubMed1993

220 cases of distal hypospadias: results of MAGPI and Duplay procedures. Respective place of glanduloplasty and urethroplasty.

220 distal hypospadias have been operated over a period of 10 years: 53 glandular, 144 coronal and 23 anterior penile subcoronal hypospadias with no chordee. Although with 131 MAGPI procedures we had only 3 urethral complications (one fistula, one total and one partial disunion), it does not seem to be a well adapted procedure for the correction of coronal and anterior penile hypospadias: the new meatus is not exactly apical, the glans remains short on its inferior side, and we often noticed a distal curvature at the end of the intervention. The urethroplasty technique that we performed 89 times avoids these disadvantages: the urethra is reconstructed in 2 layers as far as the summit of the glans according to Duplay's procedure, the urethrocutaneous adhesions are freed down the penis, the distal thin urethra is covered by an intermediate layer and the shortage of ventral skin is compensated for by the formation of a circular esthetic mucous annulus. There have been no complications with glandular hypospadias (7 cases), 4 with coronal hypospadias (64 cases) and 4 with anterior penile hypospadias (18 cases). While the MAGPI procedure remains an excellent technique for the correction of glandular hypospadias, the Duplay's procedure is better adapted for the correction of coronal hypospadias, in spite of the occurrence of more frequent (easily treated) fistula (6.25%). The juxta coronal position of some anterior penile hypospadias is still better repaired by the Mathieu's or the Snyder's procedures.

Child↗
PubMed1991

Single-stage correction of posterior hypospadias (178 cases). Comparison of three techniques: free skin graft, free bladder mucosal graft, transverse pedicle preputial graft.

Three techniques have been developed for single-stage repair of posterior hypospadias: free skin grafts, free bladder mucosal grafts, and pedicle preputial grafts. This multicenter retrospective study of 178 children who underwent surgery for posterior hypospadias was designed to compare the results achieved with these procedures. Free skin grafts (15 cases) resulted in the most frequent complications, and in particular the most severe strictures; in our opinion this technique should be abandoned. Pedicle preputial grafts (133 cases) gave the greatest number of successes from the outset, and should be preferred whenever the dimensions of the prepuce are sufficient for urethroplasty. Results with bladder mucosal grafts (30 cases) were not as good as with preputial grafts, but this technique remains the only solution when the meatus is in a very posterior position, and for children who have already undergone multiple operations.

Adolescent↗
PubMed1991

[Congenital mega-urethra. A case].

Congenital megalo-urethra is a malformation of the male urethra with a major dilatation of its penile part without obstruction downwards. It is either due to hypoplasia or agenesia of spongy tissue. Two types are described, scaphoid and fusiform types, according to the presence or the absence of erectile tissue. Megalo-urethra is a rare condition, and 56 cases were previously reported until 1987. A new case of this severe anomaly is reported and management discussed.

Humans↗
PubMed1991

[Improved prognosis and treatment of hydronephrosis due to ureteropelvic junction syndrome in children].

Ureteropelvic junction obstruction in children: evolution of diagnosis and treatment. 180 hydronephrosis due to ureteropelvic junction obstruction in 162 patients have been referred to our hospital. The patients were all infants and children with an age ranging between 1 day to 15 years. Out of 9 abstinences (grade I or 11) and 7 nephrectomies for destroyed kidneys (3 of them after temporary nephrostomy), we performed 164 ureteropelvic junction resections and anastomosis, 51 of them with associated pyeloplasty. The use of a stenting catheter passing through the anastomosis and coming out as a nephrostomy in 81 cases gave us 5 mechanical complications while the complete absence of drainage gave only 3 fistulaes. 2 of these fistulaes had a spontaneous rapid healing after endoscopic ureteral catheterism. Out of 160 follow-up cases, we reoperated 6 failures with success: 5 ureteropelvic reanastomoses and one ureterocalycostomy. This study shows us that the early treatment due to antenatal ultrasound diagnosis improves the prognosis. Renal scanning with furosemide test permits to specify the surgical indication in limited cases and the presence of a residual obstruction in case of persistance of renal pelvis dilatation in the postoperative period. The posterior approach and the absence of internal drainage simplify the treatment, improve the patient comfort and limit the hospitalisation period to 5 days.

Adolescent↗
PubMed1990

Treatment of vesicoureteral reflux in children by endoscopic injection of Teflon. Review of 2 years of experience.

Endoscopic subureteral injection of Teflon was performed in 113 children (217 ureters) to correct all types of vesicoureteral reflux. In all cases immediate disappearance of the reflux was noted on an operative cystogram. Two-hundred and thirteen ureters were controlled at 1 month. Reflux had disappeared in 85.11% of the cases after a single injection and after 2 injections in 89.3% of the cases. The results remained stable in 93.22% of the cases at 1 year. Most relapses were explained by an insufficient quantity of Teflon and difficult anatomical conditions. Indications for this technique and the safety of the paste used are discussed.

Child↗
PubMed1990

[Endoscopic treatment of vesicorenal reflux in children. Review of three years experience and prospects for the future].

Endoscopic injection of teflon paste, used since 1984, represents an alternative to the surgical treatment of vesico-renal reflux. The success rate varies from 75 to 89% after a single injection and from 85 to 95% after two injections, according to the teams. The results are less satisfactory for the high grades and for refluxes on duplicity (25 to 45% failure rate). This technique is particularly attractive in the case of a difficult surgical intervention, notably when a reimplantation has failed, in the case of reflux on neurological bladder, urethral valves or exstrophy. Various causes of failure or relapse are considered. The advantages of the technique are obvious (low morbidity, very short hospital stay) and surgery is always possible in the case of failure. After one or two years, the reflux reappears in 2 to 9% cases. Long term results cannot be assessed as the follow-up period is too brief at the present time. For this reason, and although the endoscopic and surgical findings are reassuring, tolerance to teflon both locally and at a distance requires confirmation and other products such as collagen are now being used.

Adolescent↗
PubMed1990

[Development of the diagnosis and treatment of pyelo-ureteral duplication in children. Reflections on 179 cases].

The method of diagnosis and therapeutic rules for pathological ureteral duplicity has been highly developed over the last few years. Recent advances in fetal ultrasonography sometimes allow an early diagnosis of renal or intravesical cystic structure to be appraised before complications (urinary tract infection or pyelonephritis, prolapsed ureterocele, recurrent orchitis, primary diurnal and nocturnal urinary incontinence with conserved micturation for a young girl). However, the basis of therapeutic rules remain unchanged, the superior pyelocaliceal system is not preserved in most cases of ureterocele with ureteral duplicity or ectopic ureter, because of major cystic dysplasia; although, in some cases when an earlier diagnosis is made, conservative treatment (primary endoscopy followed by a surgical intervention if necessary) can be proposed. Likewise, the endoscopic injection of Teflon causes the vesico-ureteral reflux to disappear in most cases (70%).

Child, Preschool↗
PubMed1989

[Correction of posterior hypospadias by a transverse vascular preputial graft, evolution of technics and results. Apropos of 42 cases].

During more than seven years 42 hypospadias were treated in on stage with different technics of urethroplasty by transverse preputial gauntlet grafts. With original Duckett's technic only 21,5% of patients had a good result. The authors reduced the risk of devascularisation first time by a personal modification then by using the double face flap described by Duckett himself; then the percentage of success after one operation overtake 75%. The different complications and their treatment are described and some operative details are pointed out to prevent complications.

Adolescent↗
PubMed1989

[Closed thorax esophagectomy in caustic stenosis of the esophagus].

The technique of oesophagectomy without thoracotomy using a stripper for oesophageal eversion has been applied to 6 cases of caustic stenosis of oesophagus in infants. This technic has been realized 6 to 18 months after the initial lesion in 5 cases, 13 years in a case. There is neither morbidity nor mortality. This procedure seems well adapted to pediatric indications of oesophagectomy.

Burns, Chemical↗
PubMed1989

[Congenital mega-urethra. Comments apropos of a case report].

Congenital megalourethra is a malformation of the male urethra with a major dilatation of its penile part without obstruction downwards. It is either due to hypoplasia ore agenesia of spongy tissue. Two types are described, scaphoide and fusiform types, according to the presence or the absence of erectile tissue. Megalourethra is a rare condition, and 55 cases were previously reported until 1987. A new case of this severe anomaly is reported and management discussed.

Humans↗
PubMed1989

[Treatment of vesico-ureteral reflux in children by endoscopic injection of teflon. Evaluation of 2 years' experience].

Authors treated 131 children with vesicoureteric reflux by endoscopic injection of teflon (217 ureters). At one month follow-up, 88.04% of cases were treated successfully after the first injection, 93.22% of these good results were effective one year later. A complete correction was obtained in 89.3% after one or two injections. Most of recurrence was attributed to insufficient amounts of Teflon and to difficult anatomical conditions. Indications of this procedure and safety of the paste used are discussed.

Adolescent↗