Biomedical subjects
Y Chavrier
Publications and source records attributed to Y Chavrier.
[Non traumatic acute suppurative mediastinitis].
Acute mediastinitis is uncommon. When it occurs, it usually follows an esophageal perforation or thoracic surgery. We report on a case of a 2-year-old girl with non traumatic mediastinitis secondary to a pharyngitis, due to Staphylococcus aureus. The anatomic pathways that connect the cervical region with the mediastinum explains how the infection can spread within the cervicothoracic spaces. Knowledge of this anatomy is also important in evaluating the possible causes of symptoms and signs in this area, and the possible complications of infections in these regions. The treatment associates antibiotics and drainage of the abscess by either surgical procedure or computed tomography guided selective needle aspirations.
[Development of the operative and non-operative treatment of acute intestinal intussusception in children].
A review of 152 cases of acute intestinal intussusception shows a dramatic evolution in its management within the last 15 years. Ultrasound is the main procedure utilized, and in the hands of a trained-radiologist, it allows a safe non-surgical treatment via barium or pneumatic reduction. Surgery is now limited to the rare cases of failure of the above treatment, and to advanced or complicated cases.
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.
[Esophageal stenosis and bullous epidermolysis. Endoscopic treatment].
Esophageal lesions are often present in congenital epidermolysis bullosa. Bullae formation, ulceration and oedema ultimately will lead to stricture formation. Surgery is useful only for slowly evolutive forms. To prevent the risk of developing complete occlusion to the human of the esophagus, dilatations are performed under endoscopic control, that allows through nutrition without risk of local complication.
Laparoscopic appendectomy in children: report of 465 cases.
The authors present a retrospective analysis of 465 pediatric laparoscopic appendectomies. The ages of these patients ranged from 3 to 16 years, with a mean age of 10 years. The diagnosis of acute appendicitis was based on one or more of the following: the initial or repeated physical examination, abdominal radiographs, leukocyte blood count, and ultrasonography. On gross examination, 90% of appendices appeared inflamed, while on microscopic examination, 93% showed evidence of acute inflammation. There was a 3.6% incidence of minor intraoperative incidents and a 3.0% postoperative complication rate with 1.3% of patients requiring a subsequent laparotomy or repeat laparoscopic procedure. There were no deaths. The advantages of laparoscopic appendectomy include easy and rapid localization of the appendix, regardless of its location, the ability to explore the entire abdominal cavity through the same laparoscopic portals used for appendix removal, the ability to lavage completely the contaminated peritoneal cavity, a reduction in the incidence of intraperitoneal abscesses, and a probable reduction in postoperative adhesions. In addition, laparoscopic appendectomy is associated with less cutaneous scarring and a more rapid return of intestinal function and normal activities. In our experience, these results are better than those obtained with classical surgery.
Multicenter survey of endoscopic treatment of vesicoureteral reflux in children.
17 centers answered an inquiry on the endoscopic treatment of vesicoureteral reflux. 844 children were reviewed representing 1,290 ureters treated by endoscopic injection of Teflon. The first results in cases of primary or secondary reflux showed a success rate of 82.3%. All authors report low morbidity and excellent tolerance of this technique. In view of the long-term prognosis, these results should be reanalyzed, the median follow-up presently being 1 year. The next logical step should be the development of implant material with a higher biocompatibility but the identical physical properties as Teflon.
[Value of the use of a vicryl-collagen tape for the treatment of cleft palate. Experimental study in dogs].
The purpose of this study was to evaluate the bone forming capacity of a Vicryl/collagene tape, placed in a defect of the palatal bone. In order to decrease the rate of bucco-nasal fistulaes after primary closure of a cleft palate, the authors carried out an experiment on dogs. First of all, we had to demonstrate the good tolerance of the tape in the buccal cavity. The first group of 5 dogs redieved the tape between buccal mucosae and palatal bone. The tolerance was excellent concerning the 12 biopsies on the mucosae after 1 month; 10 were totally normal and 2 revealed signs of inflammation on the medial incision. Concerning the second group, we needed to know the delay of bone formation of a "neo-palatal" defect; for that reason a 2 cm2 bone resection and a histological observation after 1 month and 1,5 months, in the right palatal bone was performed. Then we performed the same resection in 5 other dogs, and let the vicryl tape in the defect before closing the mucosae. The histological results of the second group showed that the ossification began after 1 month, and after 1.5 months the defect was totally covered by bone. The good results we obtained led us to go on with this experiment even if the low number of dogs included in this series does not allow us to a statistical evaluation. Exact responsibility of both, vicryl and collagene, has to be determined by a longer experiment, before realising the device in child's cleft palate.
[Oculocerebrocutaneous syndrome or Delleman-Oorthuys syndrome].
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[Solid tumors of the adrenal gland in children (excluding neuroblastomas). A study of a series of 18 cases].
This is a survey of the French South-East Group of Research in Pediatric Surgery (GRECPSE) concerning 18 Solid Adrenal Tumors, observed during a 20-years period (1969-1989) in 11 boys and 8 girls. 13 are tumors of the adrenal cortex (9 adenomas and 4 carcinomas). Clinical virilization is found in 7, cushing's syndrome in 3; while feminizing tumor, Conn's syndrome and non hormone-secreting form are quite exceptional (1 case each, respectively). 5 are adrenal pheochromocytomas (4 benign tumors and 1 malignant with local invasion). Ultrasonography, CT Scan and MIBG Scintigraphy are modern procedures which permit localization of the small and non palpable tumors with high accuracy. They make easier surgical management. Differentiation between benign and malignant tumors of the adrenal glands still remains the main problem. The course of the disease is surely the only distinguishing parameter. However weight tumor and selective histopathological characteristics are useful in predicting the prognosis and behavior of such tumors = Mitotic activity for adrenocortical tumors, extensive areas of necrosis and small cells for pheochromocytomas have the highest discriminating value.
[Endoscopic treatment of vesico-ureteral reflux using a sub-mucous injection of Teflon paste in children. Apropos of 337 patients (491 ureters)].
We reviewed our experience with endoscopic sub-ureteral injection of polytetrafluoroethylene (PTFE) in 337 children (84% females, 16% males). Four hundred and ninety one refluxing ureters were injected (93% primary reflux, 7% secondary reflux after reimplantation, correction of exstrophy of the bladder or neurogenic bladder). Reflux was: - stage I: 7.8% - stage II: 32% - stage III: 38% - stage IV: 20% - stage V: 2.2% Follow-up cystograms were performed one 428 ureters, 6 to 30 months after injection. 80% of children are cured after one injection while 4% required two injections in order to attain the same result. Improvement in the grade of reflux (minimal residual disease) was noted in 10% of the patients and in 6% the procedure failed. In the latter group, 16 children were operated on without difficulty; lymphatic migration of PTFE was noted in two cases. In the 33 patients with secondary reflux, the endoscopic treatment was associated with an 80% cure rate, in the 26 patients presenting a reflux on duplex systems, cure rate was 65%. This is a simple procedure performed on an outpatient basis; in our experience with 491 injections there were no complications at the time of injection nor there any postoperative ureteric obstruction. Endoscopic PTFE injections are less efficient than surgical reimplantation in the treatment of vesico-ureteral reflux. Teflon paste may not be the ideal material, other substances are presently being investigated. This technic is limited by the caliber of the urethra in young boys (Charrière 14).
[Renal tumors in children, excluding Wilms' tumor. Apropos of 29 cases].
The authors present a multisource study of 29 kidneys tumors (Wilms excepted) in children. The most common types (18 cases) are tumors from metanephrogen blastema (congenital mesoblastic nephroma, nephroblastomatosis and nodular renal blastema, multilocular cystic nephromas. Mature kidney tumors are much more rare in childhood (8 cases): they are epithelial tumors (adenoma or adenocarcinoma) or mesenchymal neoplasms. In one case, histological study don't permit to list a malignant tumor to one of previous categories. Finely, among secondary tumors, two localisations of hemopathy are reported. After a limited exposure of cases and review of the literatures the authors emphasize the anatomo-clinical aspects, the value of paraclinical exams and the treatment of each type of tumor.
[Chest wall abcess by Actinomyces. About two cases in childhood (author's transl)].
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[Human celosomias].
Definition and nomenclature of celosomia are based on a historical review which provides a system of classification. Morphology and organogenesis of celosomia were studied on 64 embryonic and foetal bodies. The anatomical study of 6 cases of human celosomia provided a definition of the characteristics of major celosomia, by showing the constant elements of the syndrome (particularly the parietal malformation) and the anomalies frequently found in each of the different types:--anterior (or superior) celosomia;--middle celosomia, including laparoschisis;--posterior (or inferior) celosomia, among which exstrophy of the bladder may be either one of the constant elements of the syndrome, or a limited form of the inferior celosomia;--total celosomia, of which one case was studied for this report, and of which the major forms, the schistosomia, chelinosomia and strophosomia types, seem to constitute forms of transition with other types of monstruosity. With improved knowledge of anatomy and organogenesis the possibilities of treatment have improved over the past few years, but still remain limited in the more monstrous forms of celosomia.
[Deformations of the anterior thoracic wall (author's transl)].
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[Present status of the treatment of funnel chest].
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[Oesophagus-airway fistulas in children (author's transl)].
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[Aseptic osteonecrosis following corticoid therapy and immunodepressive agents in children. Apropos of 3 observations].
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