Biomedical subjects
Publications and source records attributed to P Vrsansky.
The authors refer a case report of the Peutz-Jeghers tumour localised in transverse colon found during a systematic clinical examination of the 4-day-old newborn, without any signs of intestinal occlusion. The end-to-end colic resection was made. Post-operative course was without any complications. The observation is rarely due to the tumour's atypical localisation as well as its presence in the newborn.
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In the literature, many articles refer to the DUHAMEL technique or some of its modifications in the treatment of Hirschsprung's disease, however, no complete review of all of them has been published to date. The authors present an analysis of the principal modifications of this technique based on the results of an international retrospective survey that evaluated a series of 2,430 patients as well as data from the literature. The important role of the internal anal sphincter in the physiology of continence is emphasized; understanding its function is an imperative prerequisite for a successful Duhamel procedure. The original technique, which used two crushing Kocher clamps as proposed by Duhamel in 1956, as well as a majority of the modifications with various spur-crushing instruments are no longer in use. At present, surgeons generally use staplers for the colorectal anastomosis.
Closure of the embryonic bladder based on the results of the study of 25 human embryos (Crown-Rump length: 5mm-60mm) and 8 Born's reconstructions, is presented. It is a complex but well regulated stage of organogenesis. Division of the cloaca depends on caudal regression, development of the genital tubercle and growth of the urorectal fold which joins the cloacal membrane. The didermal cloacal membrane (composed of the ecto and endodermal layers) opens on its caudal part. On the cranial part, there is a cloacal plug, composed of packed cells, which strengthens the inferior part of the genital tubercle. After progressive vacuolation, this plug is colonized by mesodermal tissue derived from the urorectal fold, which assumes the development of the anterior perineum. This stage depends on cranial growth of the genital tubercle. On a human embryo (31 mm Crown-Rump length, 52 days, 10 Weeks of amenorrhea), the bladder is closed, urachus obturated and urethra patent. The vesico-ureteral junction, and prostatic utricle are present and the colliculus seminalis is well developed. A temporary obstruction (caused by asynchronism between urachus closure and urethral opening) can induce antenatal vesicoureteral reflux which could regress after birth. However if urethral obstruction is definitive (posterior urethral valves or atresia), reflux persists. Antenatal sonographic bladder identification is possible after 10 weeks of amenorrhea with visualisation of the two umbilical arteries by color duplex ultrasound. If the urachus remains patent, it can be visualized inside the arterial umbilical triangle, on a transverse view.
Over a period of 5 years, four cases of incarcerated (one strangulated) umbilical hernia (UH) in children were observed and treated in Saint-Denis, France. In a review of the literature, only 45 descriptions of complicated UHs in children were found worldwide. Incarceration of UHs is considered to be very rare in children, however, it appears to occur more frequently than it is generally believed. Therefore, a more active therapeutic approach is recommended even in smaller hernias, from more than an aesthetic point of view.
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The authors present the results of an international retrospective study evaluating the present situation in using Duhamel's technique or its modifications in the treatment of Hirschsprung's disease on the basis a series of 2430 patients. After evaluation of all important criteria and discussion with data from the literature it is concluded that the techniques is simple, fast, less shocking, logical, reliable, respecting the rectal anatomy and physiology, ingenious in its principle, without serious complications. The rectum is preserved in place with all its vascular drainage and innervation. This technique can be performed by every sufficiently experienced surgeon.
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To determine the usefulness of antral bladder controlled by the pyloric sphincter denervated for urological applications, bladder replacement was performed in 17 dogs using the antral segment with its own sphincter, initially with the pylorus supplied by the left gastro-epiploic artery, and later by the right gastro-epiploic artery. The smooth pyloric muscle was denervated to obtain permanent spasm and pulled through the striated anterior abdominal muscle. Both ureters were anastomosed by a Cohen's procedure. The best results were obtained with a gastric pouch supplied by the right gastro-epiploic artery; dissection and reimplantation of the ureters in the gastric wall are difficult. IVP and cystography indicated good function of the antral pouch, with no reflux. The antral bladder controlled by the denervated pyloric sphincter could be a possible alternative in the surgical management of neurogenic or exstrophic bladder.
We report our 12 years' experience with the treatment of 308 fractures of the long bones in children using the flexible stable intramedullary pinning technique (FSIMP). This technique is a simple, rapid, and reliable procedure with minimal complications. It assures correct reposition and sufficient stable fixation of fragments, needs only small incisions, and most of all, allowed early mobilization of a child, thus avoiding long hospitalization and permitting his rapid normal activity and return to the school. The results are very encouraging for children up to age 5 years. The age limit is caused by the volume of the intramedullary space.