Biomedical subjects
Publications and source records attributed to S Daoud.
The authors report two cases of urinary ascites in neonates secondary to posterior urethral valves. They insist on the fact that the treatment is an emergency and should be as simple as possible. The resection of the urethral valves is done to allow a good bladder drainage. The leak of urine avoids the renal damage due to hydrostatic pressure. This explains the usual good prognosis of this pathology.
From six cases of brachial arterial injuries following supracondylar fractures in children, a simple management is proposed. Vascular exploration must be done in absence of radial pulse after bony reduction. If non macroscopic lesion exist, it could be a transitory spasm. On the contrary macroscopic lesion of artery point out injury of its layers that requires an arteriotomy with vascular restoration by resection anastomosis.
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The authors have observed an eleven-year-old boy with an unusual example of dysplasia epiphysealis hemimelica. Initially there was an intra-articular cartilaginous loose body in the knee. A discrepancy in limb length was noted, which corrected spontaneously. After an eight year follow-up, knee destruction was severe despite surgical treatment on three occasions. A tibio-tarsal arthrodesis was also performed.
The authors report a case of total bladder duplication by frontal septum. The anterior bladder was functional. The posterior bladder was non-functional, and drained a destroyed kidney. Analysis of the rare cases reported in the literature suggests that this malformation should be differentiated from other bladder duplications, because it may be a giant ureterocele. In conclusion, the authors stress the simplicity of the management, consisting of resection of the septum and nephrectomy of the non-functional kidney.
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Twenty-eight children with abdominal tumors were examined ultrasonically. Real-time ultrasonography proved particularly useful in infants. In most cases ultrasonography shortened the diagnostic procedure by giving accurate images of the tumor's limits, size, contents, and origin. The method yielded an overall diagnostic accuracy rate of 89%. Moreover, ultrasonography is a reliable and safe means of monitoring abdominal tumors during and after therapy. In 1981, plain roentgenograms, intravenous urography with cavography and ultrasonography should be sufficient in the standard radiologic approach of most children with abdominal tumors.
Thirty cases of duplication of the thumb have been seen during a period of 8 years. Twenty-four children underwent surgery for a total of 25 operations, and these are reviewed after a follow-up of at least a year. Wassel's type IV was the most frequent type, occurring in 14 cases. There were 23 primary operations, and 2 reoperations for frontal deviation, which were secondary to operations done elsewhere. The average age at the time of operation was 16 months, the mean follow-up is 4 years (1 to 8 years). The results are analyzed according to Wassel's criteria. Regardless of the location of the duplication, function is unaffected, the structure of the thumb is good, and the parents are satisfied. However, examination revealed some loss of mobility in 10 cases, shortening of the thumb in 5 cases, instability of the collateral ligament in 3 cases and axis deviation in 10 cases. Six of these were clinodactyly at the IP, 1 a clinodactyly at the MP and 3 Z-shaped deformities at the IP and MP. The two reoperations were done to correct a significant loss of alignment, and in each the result was upgraded from "poor" to "fair". It seems that the end results are determined at the original operation which should be done before the 18th month. The thumb with the least function, usually on the radial side, is resected and the remaining component reconstructured. This includes centralization of the insertions of the extrinsic muscles, and reinsertion of the thenar muscles. Immobilization by pinning is usually done due to the need for an osteotomy during the surgery for realignment of the axis of the thumb. It must, however, always be remembered that this surgery is cosmetic rather than functional.
The discovery of a dislocation of the upper cervical rachis through corporeal hypoplasia of the C3 ans listhesis of the C2 gives rise, at the age of 18 months, to a stabilization by means of surgery due to the threat of compression myelithis. A review of relevant literature brings to emphasis the ill-knowledge of spinal damage and the wide variety of its different types in cases of the Larsen syndrome.
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The authors report the case of a 4 1/2-year-old boy with a localized xanthogranulomatous pyelonephritis. Review of the literature shows that this rare condition is often misdiagnosed before surgery, a preoperative diagnosis of Wilms' tumor being proposed instead of the exact one which is of benign prognosis. The pathogenesis is unknown.
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Fifteen cases of PCT were followed up during 1-4 years after the chloroquine treatment with 250 mg daily for 5 days. Clinical improvement was noted in 10 patients, and in 7 there was a full remission. The levels of uroporphyrins in the urine did not correlate with the clinical response whereas characteristic immunopathological findings in the skin became negative in six. The immunofluorescence tests on the skin biopsies of patients with PCT may be not only of supplementary significance for the diagnosis, but also in the evaluation of the course of the disease and the effects of the chloroquine treatment.
After observing a sternal failure of closure, the authors indicate how rare this anastomic defect is, and explain its embryo-genic formation. Besides the use of early postnatal operations they emphasize the benefit of a delayed operation and the use of a silactic plate. This method is easy, its functional and anesthetic results are stressed.
Concerning a congenital diaphragmatic hernia with abnormal systemic artery, the authors point out the classification of Pryce concerning pulmonary sequestrations and also the new classification proposed by M. Merlier and his collaborators. Their opinion is that in the case of sequestration of type I cutting and stitching of the artery must be carried out as a matter of course in order to prevent accidents which can be serious.
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The incorrect position of the anterior tibial tuberosity responsible for the pushing into jagged shape of the extensor apparatus of the knee has various causes. Among these, "knock-kneed"walking may induce some children to compensate by a hyper rotation of the legs in order to reestablish a normal walking position. Other origins may also be pointed out : --an outward twist of the leg bones --hyper rotation in outward turning sometimes as a result of accident but more often hereditary. The closing of angle Q of the extensor system modifies the pressure vectors on the femur patellar connection leading eventually to disturbances in the growth of its outer side and to a distension of the inner stabilizing elements leading to partial dislocation of the patella. This physiopathological conception should lead to a selective therapeutic orientation based on a clinical examination. In this field much can be said for dynamic interventions (lowering of the vastus medialis transferring of the pes cornivus muscles, etc...) aimed at correcting the imbalance.