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T Merrot

Publications and source records attributed to T Merrot.

33 records · Page 2Linked to original sources
PubMed1999

Umbilical one-puncture laparoscopic-assisted appendectomy in children.

To perform a laparoscopic appendectomy, three trocars are usually needed. In order to reduce abdominal wall trauma, we have adopted an umbilical one-puncture laparoscopic-assisted appendectomy (UOPLAA). We did a retrospective study of UOPLAA performed during last 2 years on 200 children aged from 5 to 18 years (median, 9 years). The patients were selected after clinical examination. No child with advanced generalized peritonitis or an abscess with a palpable mass was a candidate for this technique. UOPLAA was successful in 184 patients (92%). In 16 cases (8%), an additional trocar was required to manage perforated or retrocecal appendicitis. The mean operative time was 15 min, and the mean hospital stay was 2 days. There were no intraoperative complications. There were 10 (5%) postoperative complications (three parietal and seven intraabdominal). Four patients (2%) needed reoperation under general anesthesia. The UOPLAA is our preference in cases of acute nonperforated appendicitis because it is simple and fast, with good cosmetic results; but in 8% of our cases, an intraoperative difficulty (retrocecal location, abnormal adhesive band, peritonitis, etc.) arose that required the introduction of additional devices to ensure the safety of the laparoscopic procedure.

Acute Disease↗
PubMed1999

[Abdominal cystic lymphangiomas in children. Clinical, diagnostic and therapeutic aspects: apropos of 21 cases].

Twenty-one abdominal cystic lymphangiomas were observed in paediatric patients during a 15-year period, in 11 boys and 10 girls. Diagnosis was prenatal in 2 cases; the mean age of the other 19 children was 4.7 years (range: 3 months-8 years). Tumours were intraperitoneal in 16 cases and retroperitoneal in 5 cases. Symptoms were variable: abdominal pain in 15 cases, palpable tumour in 6 cases (excluding the two cases of prenatal diagnosis). Complications included obstruction in 7 cases (including 3 by volvulus), infection in 6 cases, and intracystic haemorrhage in 3 cases. Abdominal ultrasonography correctly established the diagnosis in all children. Surgical treatment included 20 complete resections and one incomplete resection, including 6 with bowel resections. With a follow-up ranging from 6 months to 10 years, one recurrence occurred and was successfully reoperated. Intraabdominal cystic lymphangioma in childhood is a rare tumour with a variable presentation. An accurate diagnosis can be established by abdominal ultrasound. Complete resection should be performed whenever possible.

Abdominal Neoplasms↗
PubMed1999

[Exceptions to the rule concerning conservative treatment of polycystic renal dysplasia in children].

The authors report three cases of antenatally diagnosed polycystic renal dysplasia (PRD) associated with homolateral anomalies of the ureter and vas deferens requiring surgical exploration. The antenatal and postnatal diagnosis of polycystic renal dysplasia is based on ultrasound. It is recommended to look for associated vesicoureteric reflux by retrograde cystography. Conservative management is advised due to the natural involution of PRD. The authors emphasize the need for a more detailed ultrasound analysis of the lower genitourinary tract during the antenatal and postnatal period in order to identify an abnormal ureteric orifice, constituting the cause of the dysplasia. As dysplasia is predominant and the only anomaly detected on the antenatal examination, the associated lower tract anomalies will probably only be identified at birth. A better understanding and neonatal detection of associated lower urinary tract malformations probably justify a review of the current, systematic conservative approach, in a certain number of cases.

Abnormalities, Multiple↗
PubMed1998

Anterior approach versus posterior approach to surgical treatment of children's supracondylar fractures: comparative study of thirty cases in each series.

The purpose of this study was to consider the surgical treatment of severe supracondylar fractures of the elbow in children, and to compare the anterior approach with the posterior approach used in two homogeneous groups of 30 cases each by two experienced surgeons. Control procedures were maintained with the children of both groups when the plaster was removed, during the fourth month after surgery, and throughout the follow-up that continued for more than 1 year. A posterior approach to surgery is simpler than an anterior approach, but it creates supplementary anatomic damage that can cause circulatory disorders in the external condyle and a higher percentage of limitation in articulation mobility. Thus, although the anterior approach is more technically demanding, it gives better functional results. Because this approach concerns a zone already damaged by the trauma, it eliminates hematoma in the anterior brachial muscle and again places the fragments in the untouched shell of the periosteum.

Adolescent↗
PubMed1998

Is diffuse xanthogranulomatous pyelonephritis a contraindication to retroperitoneoscopic nephroureterectomy? A case report.

Diffuse xanthogranulomatous pyelonephritis (XGP) is a rare form of chronic infection of the child's kidney. The clinical presentation is nonspecific, and investigation often reveals a nonfunctional kidney. Preoperative diagnosis is very difficult even with ultrasonography and computed tomography. Total nephrectomy is the treatment of choice, but it is considered very difficult and is usually contraindicated for laparoscopic or retroperitoneoscopic techniques. Reported here is a case of retroperitoneal laparoscopic nephroureterectomy for XGP.

Adolescent↗
PubMed1997

[Drug-resistant genito-urinary rhabdomyosarcoma in children with primary psoas abscess. Apropos of a case].

We report an unusually uncommon case of genitourinary rhabdomyosarcoma in a child which was chemoresistant and complicated by a primary psoas abscess which presented as a pelvic mass associated with an abscess of the right iliac fossa. Ultrasound and CT investigations suggested the diagnosis of a centropelvic tumor which was confirmed at puncture-aspiration. MRI was most contributive giving a precise description of the local extension. Intensive multi-drug chemotherapy would appear to have improved outcome in patients with poor-prognosis Maurer group III tumors. In exceptional cases when no tumor response is obtained, carcinological surgery with large dissection, possibly with adjuvant radiotherapy, is indicated. Percutaneous drainage of the deep psoas abscess is as effective as classical surgery and spares the abdominal wall, particularly important if a second operation should be needed. Multidisciplinary management is required for the treatment of this highly malignant tumor.

Adolescent↗
PubMed1996

The choice of treatment for simple bone cysts of the upper third of the femur in children.

A retrospective study of a series is presented of 19 simple cysts of the upper third of the femur in children of a mean age of 7 years. The patients included 4 adolescents and 15 children under the age of 10. Mean recurrence was 6 years. Different treatment methods were utilized: - surgical treatment: curettage-bone grafting with or without osteosynthesis, - intra-cystic corticoid injection, - orthopedic treatment. Cysts may be small with a low lytic potential, in this case intra-cystic corticoid injections are very effective; or bigger in size with a risk of fracture or have already caused a fracture, the treatment is then surgical but should always be combined with osteosynthesis.

Anti-Inflammatory Agents↗
PubMed1996

X-ray transparency interpositions after reduction of traumatic dislocations of the hip in children.

Traumatic dislocations of the hip are much less frequent in children than in adults. If some complications are well known (avascular necrosis of the femoral head, recurrent dislocation), the lateralization of the head by x-ray transparency interposition is less appreciated. We report 4 cases of x-ray transparency interposition in 15 reductions of incomplete traumatic dislocation of the hip. These 4 dislocations were posterior in non-pathological hips, three on the left side and one on the right. Our reductions have been easy and the hips remained stable. However, the post-reduction roentgenogram shows the same unusual enlarged joint space corresponding to the lateralization of the femoral head. Four arthrotomies were performed, tracing a cartilaginous fragment free or fixed to the articular capsule into the femoral joint. We have found a concentric reduction of the hip in 4 cases and enlargement from 1 to 3 mm of the joint space of the hip. After several years, articular function of the four hips is normal, nevertheless, they have shown a coxa valga with a femoral elongation to 10 mm, a coxa magna with an articular space wider than 1 mm, 2 very good concentric reductions of the hip. The lateralization of the head after reduction had to be detected as soon as the first radiographic control because it can cause immediate instability or arthrosis of the hip. Because of the cartilaginous or capsular composition and the size of the interposition, an arthrotomy is performed in front of a radiological enlarging of the space joint, or a loss of parallelism of osteochondral acetabulum bone. Computerized tomography and MRI can reveal the nature, the place of the included fragment, as well as the surgical approach. An arthrogram is not absolutely indispensible. Surgical exploration should avoid degenerative arthrosis after a lateralisation left untreated.

Adolescent↗
PubMed1996

[Closed traumas of the kidney in children. Conservative treatment].

Therapeutic approach to 36 children with blunt trauma of the kidney is reported. Generally, conservative attitude was applied. In case of type II or type III lesions, according to the Hodges classification, or when a urohematoma does not regress or worsens, we propose endoscopic drainage to avoid complications. Seventy percent of the patients, seen 2 years after the trauma, were free of complications. These patients will be reassessed again, many years after the initial trauma in order to determine the long-term results of this conservative attitude.

Child↗
PubMed1995

[Surgical treatment of the rupture of the inferior tendon of the biceps. Apropos of 6 cases].

INTRODUCTION: The purpose of this study is to compare the results of direct reinsertion of the distal bicipital tendon to the bicipital tuberosity, with other methods described in the literature. MATERIAL AND METHOD: This study is based on six athletic patients, all male, ranging in age from 42 to 62 years old. The rupture of the biceps occurred during an unusually violent effort in flexion and forced supination of the arm at a 90 degree of flexion. The surgical procedure which took place between a week and a month after the accident, consisted in a direct reattachment of the detached tendon. RESULTS: No paralysis in the area of the radial nerve occurred. All patients regained normal range of motion of the joints with maintained strength. DISCUSSION: Faced with a recent lesion in a young patient, a reinsertion on the bicipital tuberosity is desirable in order to maximize the strength and movement of the biceps. This simple technique uses a single approach. It does not weaken the bicipital tuberosity nor the muscular function of the biceps.

Adult↗
PubMed1995

[Tenotomy of the psoas muscle in slow reduction of congenital hip dislocations].

PURPOSE OF THE STUDY: The aim of this study was to relate the efficacy of cutting the psoas tendon in case of high congenital hip dislocation treated by slow reduction according to Somerville-Petit. MATERIAL: Twenty psoas tenotomies were realised between 1982 and 1992. The average age was 11 months 15 days old, they were 15 girls and 5 boys. Among them, only 9 patients had never been treated. METHOD: By a short surgical approach close to the lateral lip of Scarpa's triangle, we cut the psoas tendon at the musculotendinous junction doing this suppresses the obstacle that interferes with the femoral head coming down. RESULTS: Results have been evaluated on clinically and especially radiologically. All hips remain stable except one case. A graduated subluxation of the hip occured after removal of the plaster. 18 hips have been revised between the third and fifth year. Clinical results were excellent, on radiological controls 5 hips were considered flawless, 11 satisfying, and 2 were imperfect. Only 2 children have been seen ten years later with excellent clinical and radiological results. DISCUSSION: The hypertrophic psoas tendon interposes between the femoral head and the acetabulum creasing the capsule and the limbus. Cutting tendon of the psoas will decrease the numerous unexplained failures that occured during slow reduction according to Sommerville-Petit method. The use of these surgical techniques may make more outstanding the tenotomies time. CONCLUSION: Tenotomy of the psoas tendon realized by a short surgical approach without any articular effraction, allowed us to obtain complete reduction of the hips dislocation in these 20 patients.

Casts, Surgical↗
PubMed1993

[Adenocarcinoma of the kidney in children. Apropos of 2 cases with 8 and 17 years of follow-up].

The authors report on two cases of renal cell carcinoma in boys of 8 and 13 years of age revealed by gross hematuria. Following nephrectomy the evolution remains good after 8 and 17 years of follow-up. Despite the fact that renal cell carcinoma is rare in children, it must be evoked as a possible etiology in the presence of spontaneous and relapsing hematuria in a child older than 8 years of age. Early nephro-ureterectomy with regional lymph nodes resection is the only efficient treatment, chemotherapy and radiotherapy having not yet demonstrated their efficiency.

Adenocarcinoma↗
PubMedDate not supplied

[Tracheal agenesis: CT diagnosis].

Tracheal agenesis is an exceptional congenital malformation of the airway with fatal consequences. A case of a newborn infant presenting with respiratory distress is reported. Laryngoscopy and helical CT of the airway confirmed the diagnosis of tracheal agenesis with tracheo-esophageal fistula and laryngeal agenesis.

Abnormalities, Multiple↗
PubMedDate not supplied

[Bilateral persistence of the common mesonephric duct in children. Apropos of a case. Review of the literature].

We report a case of bilateral persistence of the common mesonephric duct in a child. This anomaly is an error of implantation of the vas deferens in the distal part of the Wolffian duct. This abnormality is extremely rare (6 cases have been reported in the world literature). The diagnosis is usually incidental during laparotomy or on retrograde cystography (vesico-ureteric and vesico-deferential reflux). It is simple to treat: bilateral deferential ligation in view of the context of multiple malformations, in order to prevent ascending genital infections (prostatitis, epididymitis, testicular abscess). Only one case has been reported in adults, presenting in the form of a septic complication. This diagnosis must be considered in a context of atypical urogenital infection in a subject with other congenital abnormalities.

Abnormalities, Multiple↗