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P Vergnes

Publications and source records attributed to P Vergnes.

At least 55 records · Page 3Linked to original sources
PubMed1990

[Prenatal diagnosis of sacro-coccygeal teratomas].

Seventeen sacrococcygeal teratomas with prenatal diagnosis are studied. The diagnosis was made at 27 weeks. Three fetuses died in utero, two of them from the evolution of the tumor. Two died post-natally from hemorrhage and one post natally because of his prematurity. From the eleven long term survivors, one developed a recurrence and five sequelae. This study confirms the poor prognosis of fetal sacrococcygeal teratomas. The 2 major prognosis factors are the growth of the tumor and the occurrence of fetal congestive heart failure. That congestive heart failure is diagnosed by Doppler echocardiography before hydrops and placentomegaly who are of very poor prognosis. The extraction of the fetus is mandatory if these features appeared after 30 weeks. Before this term fetal surgery is the only effective treatment. At a long term, the risk of recurrence is low but implies a long term surveillance of the level of alfa foeto protein.

Female↗
PubMed1990

[Intraperitoneal testicular fetus in fetu].

A 5-month-old boy presented with a right flank abdominal mass. Plain film of the abdomen showed a vertebral column within the mass. Surgery confirmed the diagnosis of fetus in fetu developed within an ectopic intraperitoneal right testicle. Fetus in fetu differs from teratoma by the presence of axial skeleton and organogenesis. When intratumoral axial skeleton is present, plain films are sufficient for the diagnosis.

Axis, Cervical Vertebra↗
PubMed1990

[Extrahepatic biliary tract atresia and a common biliopancreatic canal. Review of the literature apropos of a case].

The authors report the case of an 3 months old caucasian boy which had an extrahepatic biliary atresia associate with a congenital biliary cyst and an anomalous pancreaticobiliary junction. The patency between gallbladder and duodenum permits the operative opacification of this long common pancreaticobiliary channel. The congenital biliary cyst was located on the upper part of the common bile duct and was obstructed by biliary concretions. Unfortunately, no patency between intrahepatic bile ducts and this cyst was found. Because this long common pancreaticobiliary channel may cause biliary dilatation or biliary cancer, we performed an hepatic portoenterostomy rather an hepatic portocholecystostomy. A few weeks later, the bile flow was restored and the jaundice decreased. With a follow up of 18 months, this boy is currently anicteric, despite the hepatic fibrosis found on the operative biopsy. The association extrahepatic biliary atresia-long common pancreaticobiliary channel is uncommon and only 20 cases were reported. In our case, the pancreatic juice reflux into the biliary tract might have caused the dilatation of the common bile duct and the biliary atresia by chronic obstructive cholangiopathy.

Biliary Atresia↗
PubMed1989

[Antenatal diagnosis of lung malformations. Apropos of 9 case reports].

The authors report 9 cases of prenatal diagnosis of lung malformations. The diagnoses was performed between 17 to 33 weeks amenorrhea (mean = 25.5 weeks). The clinical findings were: 7 cystic adenomatoid malformations of the lung, 1 intralobar sequestration and 1 bronchogenic cyst associated with extralobar sequestration and esophageal duplication. In two cases of cystic adenomatoid malformation of the lung with polyhydramnios and fetal hydrops death occurred at 27 and 32 weeks amenorrhea. In the seven other cases surgery was performed shortly after birth, before any serious complications occurred. No problems were encountered following the surgical intervention and the remaining lung inflated after a few days. All these children are currently alive and well, without pulmonary or thoracic disorder. The authors first explain the echographic findings in each malformation and later discuss the sonographic criteria of the diagnoses. The antenatal diagnosis permits early recognition and thus adequate management using a team of neonatologists, radiologists and pediatric surgeons. This type management involves: --normal vaginal delivery if there are no obstetrical problems; --if it is possible, artificial ventilation should be avoided as it may increase respiratory distress. If however, it is necessary, the healthy lung should be intubated; --the surgical procedure should be performed as soon as possible, before complications as respiratory distress or recurring pulmonary infections occur; --the major risk of this surgery is respiratory and heart failure when the child is placed in the operating position. A rapid thoracotomy permits the extraction of the compressed lung and the resuscitation of the patient.

Cystic Adenomatoid Malformation of Lung, Congenita↗
PubMed1989

[Primary volvulus of the small intestine without malrotation. Apropos of 7 cases].

We report seven cases of complete volvulus of the small bowel without malrotation seen from 1973 through 1986. The clinical setting is always the same in this condition: the infant exhibits no clinical anomalies during the symptom-free interval between birth and the volvulus (4 h to 35 d, m = 7 d in our series). Onset is extremely sudden, with a complete, proximal obstruction, early and abundant passage of blood per rectum, and above all a severe shock that fails to respond to resuscitation. Roentgenograms contribute little to the diagnosis and surgery should never be delayed to perform complementary investigations of any kind. Indeed, the only effective treatment is unwinding the volvulus within the first six hours following onset, for beyond that time irreversible necrosis of the entire small bowel and occasionally colon occurs. Five infants died because they were seen too late and operated on 36 hours on average after the onset of symptoms. The two survivors had an early operation that prevented total necrosis of the small bowel. However, this pattern seems to vary according to the degree of cecum anchorage: a fixed cecum results in a very tight volvulus with complete, early ischemia and usually irreversible necrosis of the small bowel beyond the sixth hour (9/9 published cases); an even slightly mobile cecum results in a looser volvulus, with less severe ischemia, more delayed necrosis, and a possibility of complete recovery (5/6 published cases).(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1989

[Primary ulcero-necrotizing enterocolitis of the newborn. Advancements in management. Improvement in prognosis].

We report our experience acquired over the last seven years with the management of necrotizing enterocolitis in neonates. This condition occurs mainly in small-for-dates, premature, critically ill infants. Diagnosis rests on the combination of clinical evidence of intestinal obstruction with non-specific signs of a decline in general health and suggestive roentgenographic findings. Mortality has fallen from 80% to 24% over the last eight years as a result of advances in the medical management of low-birth-weight infants, earlier treatment of bowel ischemia suspected on the basis of inconspicuous manifestations, and improvements in neonatal intensive care and surgical techniques.

Enterocolitis, Pseudomembranous↗
PubMed1988

[The association of a dysplastic kidney with a single vaginal ectopic ureter and a homolateral genital abnormality in a girl. Comments based on 3 case reports].

We recently treated one female infant and two young girls with coincidence of three anomalies: --hypoplastic ectopic kidney; --single vaginal ectopic ureter; --ipsilateral genital abnormality. Clinical presentation was lifelong wetting, "multicystic" kidney, urinary tract infection, or abdominal pain. The diagnostic studies include ultrasonography, excretory urography, cystography and vaginoscopic examination with retrograde catheterization, rarely radionuclide scanning. This study failed in two cases, with non visualization of the hypoplastic and dysplastic kidney, and diagnosis was done at laparotomy. Genital anomalies were unilateral hydrocolpos with uterus didelphys in one case, dilated or cystic Gärtner's duct in the other two. The anomaly may be caused by a maldevelopment of the wolffian and müllerian ducts in early fetal life, between 5 and 6 weeks of gestation. A review of the literature revealed only 6 similar instances in childhood. The combination of lifelong wetting, pelvic mass or pain in girl with "solitary" kidney on excretory urography and ultrasonography should alert to this syndrome. Meticulous search for the hypoplastic kidney, the genital abnormality and the ectopic ureteral orifice are keys to early accurate diagnosis and treatment.

Abnormalities, Multiple↗
PubMed1987

[Primary isolated vesico-ureteral reflux in children].

The advantages, complications or sequelae of surgical treatment of primary vesico-ureteral reflux in children are discussed in the light of 382 cases operated upon between 1971 and 1984. Changes in ideas on the fate of primary reflux and its consequences make it necessary to modify our therapeutic strategy, as shown by a study of our records and an exhaustive review of the literature. As a result, we suggest that reflux into a non-dilated ureter should not be operated, whereas reflux into a widely dilated ureter requires surgery. The operation should take place at an early stage in cases with severe renal lesions with pronounced radiological and biochemical alterations. In children with reflux of medium severity, the decision to operate or treat medically must rest on such criteria as age and severity, frequency and resistance of episodes of urinary infection, radiological and endoscopic data and signs of renal tissue functional damage.

Child↗
PubMed1987

[Blunt injuries of the pancreas in children. Diagnostic and therapeutic approach apropos of 8 cases].

From 1970 to 1985, eight severe blunt pancreatic traumas were admitted. There is significant difference in morbidity between early pancreatectomy with or without splenectomy (a mean hospital stay of 23 days, low loss of weight) and initial simple external pancreatic drainage with delayed partial pancreatectomy or pancreato-cystojejunostomy Roux-en-Y (mean hospital stay of 45 days, 24% loss of weight, one death two years later). Thus it seems essential to diagnose the pancreatic injury and particularly rupture of the pancreatic duct. Aiming to evaluate these lesions, biology, ultrasonography or computerized axial tomography proved insufficient. As a result, in the last two patients, an endoscopic retrograde pancreatography was performed confirming total transection of the pancreatic duct, one case with fistula, the other with a contrast fluid stop. The surgical approach was guided by these X-ray findings and a distal pancreatectomy performed preserving spleen. The authors propose the following protocol: endoscopic pancreatography if an evident improvement in recent pancreatic injury is not obtained in 48 hours, or in the case of former complicated pancreatic trauma; in the event of total rupture of pancreatic duct, operation should be carried out: abdominal exploration guided by the X-rays findings, distal pancreatectomy or, rarely, repair of the pancreatic duct; when no pancreatic duct lesion is found, but ultrasonographic blunt trauma patent, the surgical decision depends on the amount of peripancreatic reaction: medical treatment or external drainage; when lesion of the head of pancreas is detected, conservative treatment is to be preferred to pancreatoduodenectomy.

Adolescent↗
PubMed1987

[Antenatal diagnosis of 2 cases of intra-abdominal solitary cyst].

On the occasion of 2 cases, torsion of an ovarian cyst and volvulus of a cystic intestinal duplication, the authors emphasize the usual benignity of fetal intra-abdominal solitary cystic pictures, among which the most frequent are the ovarian cysts. Antenatal diagnosis allows for detection of complications, especially torsions and for early neonatal management always leading to surgical treatment.

Cysts↗
PubMed1986

A contribution to the study of the facial artery, its branches and anastomoses; application to the anatomic vascular bases of facial flaps.

The authors present the results of dissection of 40 facial arteries and their collaterals. The study of the collaterals is specifically for the cervical portion of this artery and especially for the three segments of its facial portion. The artery and its collaterals are extremely variable as regards its mode of termination. 4 types of artery are presented: labial, angular, nasal and abortive. The global description of the vascularization of the face and the principal anastomoses leads on to a study of the facial flaps and the plastic surgery of the face.

Arteries↗
PubMed1986

[Giant Meckel's diverticulum presenting as tumor].

The authors report a case of giant Meckel's diverticulum, presenting as a subumbilical abdominal mass, associated with an infectious picture and anemia in a 16 month-old boy. Epidemiologic, pathologic and clinical features of this rare disorder are reviewed as are the diagnostic means. The differential diagnosis with other cystic masses of the umbilical area (omphalo-mesenteric duct cyst, urachal cyst, mesenteric cyst, duplication) is discussed.

Abdominal Neoplasms↗
PubMed1986

[An aid toward decision in congenital hip dislocation. Value of decision trees in the determination and treatment of hips at risk (preliminary study)].

Well established procedures exist for treatment of congenital dislocation of hip, whereas unanimity is lacking with respect to management of a hip at risk during the neonatal period. Based on a homogeneous series of 720 case-reports of neonates at risk a decision tree has been developed to determine essential risk factors and to demonstrate preferential pathways when evaluating appropriate therapy.

Algorithms↗
PubMed1985

Anatomical basis of inguinal surgery in children.

This paper begins with a review of the embryology of the inguinal region. The authors then point out the special morphological and topographical features of the inguinal canal in male children. These observations were based on the study of 50 inguinal canals from male children. From the anatomical observations described in this study guidelines are proposed for the surgical approach and dissection of the spermatic cord used in the treatment of congenital hernias or abnormal descent of the testis.

Child↗
PubMed1985

[Possibilities for surgical excision of diffuse hepatoblastomas. Contribution and limitations of chemotherapy].

Four children with major hepatoblastoma were treated with extensive surgical excision and chemotherapy. Two right lobectomies and two left extended hepatectomies were performed. The first patient only received postoperative chemotherapy. The others three had preoperative chemotherapy for unresectable hepatoblastoma. All these children exhibited an initial response with marked reduction in size of their primary tumor. The only child who died during operation had disease involving both lobes of the liver, inferior vena cava and lungs metastasis. The follow up of the three other children is 26 to 32 months. Two of them are free of all disease. The third had lung isolated metastasis removed and is actually free of disease with follow up of 32 months. Authors discuss chemotherapy interest and limits in major hepatoblastoma.

Carcinoma, Hepatocellular↗