Reconstruction with antibiotic loaded single-side gore-tex "Tartine" methyl-methacrylate cementoplasty for pediatric chest wall reconstruction: A 10-case series.

INTRODUCTION: Chest wall reconstruction in children after large resection of tumors may be performed with rigid or soft materials. Cementoplasty is commonly used with the "Sandwich" method i.e. gore-tex meshes surrounding both faces of the cement. HYPOTHESIS: Is antibiotic loaded single-side gore-tex "Tartine" methyl-methacrylate cementoplasty an interesting alternative to the double-side "sandwich" method for chest wall reconstruction? MATERIAL AND METHODS: Consecutive patients who were treated from 2011 to 2023 in our hospital were included. RESULTS: Among the ten children treated with a median 5.6 years follow-up, there were no surgical complications related to the reconstruction, loss of function, infections, post operative complications (versus 22.7% in meta-analysis encompassing the 50 rigid reconstructions reported worldwide) nor scoliosis (versus 25%). Three patients have an asymmetric chest wall appearance. DISCUSSION: "Tartine" cementoplasty is a simple, low-cost technique for pediatric chest wall reconstruction. It is well tolerated and checks key demands for chest wall reconstructions. LEVEL OF EVIDENCE: IV; retrospective case series.

Analysis of a multifaceted interactive pedagogy program in an upper limb anatomy course: A time series study.

Many new methods have contributed to the learning of anatomy, including several interactive methods, increasing the effectiveness of educational programs. The effectiveness of an educational program involving several interactive learning methods such as problem-based learning and reciprocal peer teaching was researched in this study. A quasi-experimental before-after study on three consecutive groups of second-year students at the Grenoble School of Medicine was conducted. The lectures were replaced by an educational program based on the problem-based learning method and reciprocal peer teaching. The first session was dedicated to reading clinical cases illustrating the medical concept, so that the learning objectives for the second session could be set. Then, after viewing digital courses, the second session was dedicated to a synthetic presentation by the students themselves, followed by an interactive summary with the teacher. The analysis of 630 students showed a significant increase in the theory test results for those who took part in the intervention: 9.71 versus 9.19 (ß = 0.57, P = 0.036). Moreover, satisfaction was high after the intervention (mean = 4.5/5), and when comparing the two pedagogical approaches the students showed a clear preference for the program implemented with the concepts highlighted such as interactivity, in-depth work, group work, and autonomy. A multifaceted interactive pedagogy program could have a significant impact on the results of the theoretical concepts presented and on satisfaction as well as increased investment by students in learning anatomy.

Exploring the impact of interactive movement-based anatomy learning in real classroom setting among kinesiology students.

Descriptive and functional anatomy is one of the most important sciences for kinesiology students. Anatomy learning requires spatial and motor imagery abilities. Learning anatomy is complex when teaching methods and instructional tools do not appropriately develop spatial and motor imagery abilities. Recent technological developments such as three-dimensional (3D) digital tools allow to overcome those difficulties, especially when 3D tools require strong interactions with the learners. Besides interactive digital tools, embodied learning or learning in motion is an effective method for a wide variety of sciences including anatomy. The aim of this study was to explore the impact of combining movement execution with 3D animation visualization on anatomy learning in a real classroom teaching context. To do so, the results of two groups of kinesiology students during three official assessments were compared. The experimental group (n = 60) learned functional anatomy by combining movement execution with traditional knowledge acquisition (e.g., 3D animations visualization, problem-based learning exercises). The control group (n = 61) had the same material but did not execute the movements during problem-solving exercises. Although no differences were found between both groups on early and mid-semester examinations, significant difference appeared at the end of the semester with an advantage for the experimental group. This exploratory study suggests that embodied learning is beneficial in improving functional anatomy learning. Therefore, it would be interesting to integrate such type of pedagogical approach within the kinesiology curriculum.

Isolated MPFL reconstruction with soft tissue femoral fixation technique in 54 skeletally immature patients: Clinical outcomes at 2 years follow-up. A French multicenter retrospective study.

BACKGROUND: Medial patello-femoral ligament (MPFL) reconstruction is one of the therapeutic options to treat patellofemoral instability. Classically, a à la carte treatment of skeletal and ligament abnormalities is described. This option is difficult to achieve in children because bony procedures can damage the femoral and/or tibial growth plate. The objective was to evaluate a strategy for isolated reconstruction of the MPFL in the treatment of objective patellar instabilities in children, in a large cohort. The return to sport, knee function and pain or discomfort were studied as secondary endpoints. METHODS: This French multicenter retrospective study included 54 pediatric patients with objective patellofemoral instability. Patients were included if they had presented at least 2 episodes of objective patella dislocation. A Deie-like technique with gracilis tendon graft, soft tissue femoral fixation and patellar bone tunnels for patellar fixation was used. Recurrence of dislocation was studied as the primary endpoint, and the recurrence rate was compared with the literature. A comparison of functional scores (Kujala, Lille femoro-patellar instability score or LFPI Score and Tegner activity score) and NRS between pre- and postoperative was studied as a secondary objective. RESULTS: A recurrence of femoro-patellar instability was observed for five patients within 2 years follow up (9%). A significant improvement of the Kujala, LFPI score, Tegner and NRS scores was observed (p<0.001). CONCLUSION: Isolated reconstruction of the MPFL presents a risk of recurrence of 9% at 2years follow-up. This technique significantly improves the functional scores of the knee. This modified Deie technique provides good clinical and functional results, allowing return to sports with an acceptable risk of recurrence of patellar dislocation, similar to those observed in the literature. Isolated MPFL reconstruction as a first-line treatment appears to be a reliable and effective technique in terms of recurrence of dislocation and functional scores. It allows early recovery and rehabilitation and has lower morbidity than procedures requiring bone gestures. LEVEL OF EVIDENCE: III, retrospective comparative study.

Nutritional status at age 1 year in patients born with esophageal atresia: A population-based, prospective cohort study.

Objective: Despite recent progress in caring for patients born with esophageal atresia (EA), undernutrition and stunting remain common. Our study objective was to assess nutritional status in the first year after birth with EA and to identify factors associated with growth failure. Study design: We conducted a population-based study of all infants born in France with EA between 2010 and 2016. Through the national EA register, we collected prenatal to 1 year follow-up data. We used body mass index and length-for-age ratio Z scores to define patients who were undernourished and stunted, respectively. Factors with P < 0.20 in univariate analyses were retained in a logistic regression model. Results: Among 1,154 patients born with EA, body mass index and length-for-age ratio Z scores at 1 year were available for about 61%. Among these, 15.2% were undernourished and 19% were stunted at the age of 1 year. There was no significant catch-up between ages 6 months and 1 year. Patients born preterm (41%), small for gestational age (17%), or with associated abnormalities (55%) were at higher risk of undernutrition and stunting at age 1 year (P < 0.05). Neither EA type nor surgical treatment was associated with growth failure. Conclusion: Undernutrition and stunting are common during the first year after birth in patients born with EA. These outcomes are significantly influenced by early factors, regardless of EA type or surgical management. Identifying high-risk patient groups with EA (i.e., those born preterm, small for gestational age, and/or with associated abnormalities) may guide early nutritional support strategies.

Esophageal Atresia and Respiratory Morbidity.

BACKGROUND AND OBJECTIVES: Respiratory diseases are common in children with esophageal atresia (EA), leading to increased morbidity and mortality in the first year. The primary study objective was to identify the factors associated with readmissions for respiratory causes in the first year in EA children. METHODS: A population-based study. We included all children born between 2008 and 2016 with available data and analyzed factors at birth and 1 year follow-up. Factors with a P value <.10 in univariate analyses were retained in logistic regression models. RESULTS: Among 1460 patients born with EA, 97 (7%) were deceased before the age of 1 year, and follow-up data were available for 1287 patients, who constituted our study population. EAs were Ladd classification type III or IV in 89%, preterm birth was observed in 38%, and associated malformations were observed in 52%. Collectively, 61% were readmitted after initial discharge in the first year, 31% for a respiratory cause. Among these, respiratory infections occurred in 64%, and 35% received a respiratory treatment. In logistic regression models, factors associated with readmission for a respiratory cause were recurrence of tracheoesophageal fistula, aortopexy, antireflux surgery, and tube feeding; factors associated with respiratory treatment were male sex and laryngeal cleft. CONCLUSIONS: Respiratory morbidity in the first year after EA repair is frequent, accounting for >50% of readmissions. Identifying high risk groups of EA patients (ie, those with chronic aspiration, anomalies of the respiratory tract, and need for tube feeding) may guide follow-up strategies.

Anal canal duplication in children: a monocentric experience of 12 cases.

PURPOSE: Anal canal duplication is a rare malformation characterized by a second perineal opening positioned behind the anus, which is generally observed at 6 o'clock in the lithotomy position. The purpose was to describe six new cases of anal canal duplication (in addition to our previously reported series of six patients) with the aim of providing further clinical information about this anomaly. METHODS: We described 6 new cases of anal canal duplication in terms of symptoms, anatomical disposition, imaging results, and histopathology. Clinical details of these cases and those already reported (n = 12) were summarized and compared to existing literature. RESULTS: A total of 12 cases were reported over 34 years. 17% of the patients were male, constituting the only subgroup to present a communication with the digestive tract. A single patient, diagnosed at 12 years, was symptomatic. Half of the patients had at least one associated malformation. All patients underwent surgery, either with a posterior sagittal or perineal approach. CONCLUSION: Diagnosis of anal canal duplication should be suspected when a perineal opening positioned behind the anus is present, and necessitates further exploration by a comprehensive clinical examination and imaging. Surgery is always required, typically performed via a posterior sagittal approach. The postoperative course is usually uncomplicated.

External versus endoscopic ultrasound: Non-inferiority assessment for visualization of various structures of interest in the shoulder.

INTRODUCTION: Certain structures and pathologies can be difficult to reveal under videoscopy alone during arthroscopic surgery. Ultrasound can be a useful contribution in arthroscopic diagnostic and therapeutic procedures. The main aim of the present study was to assess equivalence between endoscopic and external ultrasound for shoulder exploration. Secondary objectives comprised qualitative assessment of endoscopic ultrasound images and comparative assessment of acquisition time between the two techniques. MATERIAL AND METHODS: An anatomic non-inferiority study was conducted on 6 shoulders from 3 subjects with a mean age of 84 years. After ultrasound examination by a radiologist specializing in osteoarticular imaging, shoulder arthroscopy was performed by a single specialized surgeon, using an ultrasound endoscope. Number of visualized structures and image quality were assessed by independent observers. RESULTS: Ten of the 11 structures of interest (91%) were visualizable on endoscopic ultrasound, versus 4 (36%) on external ultrasound (p<0.05). Mean endoscopic acquisition time was 9.5±6.3minutes [range, 5;22]. In the 11 structures, image quality was better on endoscopic than external ultrasound, except for the acromioclavicular joint, where quality was better on external ultrasound, and the lateral side of the rotator cuff, where quality was equivalent. CONCLUSION: The present study demonstrated equivalence between endoscopic and external ultrasound for shoulder exploration. LEVEL OF EVIDENCE: IV, Non-inferiority cadaver study.

Outcomes of laparoscopic and open surgical treatment of intestinal malrotation in children.

BACKGROUND: The safety of the laparoscopic treatment of intestinal malrotation remains controversial. This study compared the outcomes of laparoscopic and open surgical treatment of intestinal malrotation. METHODS: A multicentric retrospective study included pediatric cases of intestinal malrotation operated on between 2005 and 2016. RESULTS: This study included 227 children with a median age of 17 days (0-17.2 years), including 161 with a midgut volvulus. Forty-six(20.3%) procedures were started by laparoscopy and 181(79.7%) by laparotomy. Laparoscopy was more frequent for elective surgery (45.9%) than for emergency procedures (10.8%, p < 0.001). Conversions were significantly more frequent during emergency procedures (66.7% vs 17.9%)(p = 0.001). Considering only 61 elective surgeries, the mean hospital stay was significantly shorter after laparoscopy (5.3 days +/-5.2 vs 10.1 days +/-13, p = 0.01), the overall complication rate was comparable (15.8% vs 21.7%, p = 0.7) but post-operative volvulus was significantly more frequent after laparoscopy (13% vs 0%, p = 0.04). Outcomes of the two approaches were not significantly different after 166 emergency procedures. CONCLUSION: Laparoscopy can be performed by experienced team for the treatment of selected cases of intestinal malrotation. Conversion to open surgery should be done with a low threshold, as the rate of volvulus recurrence is concerning. LEVEL OF EVIDENCE: Level III.

Study of abdominal wall muscle innervation applied to large-defect closure in congenital diaphragmatic hernia.

In large congenital diaphragmatic hernias (CDHs), direct suture of the diaphragm is impossible. Surgeons can use a triangular internal oblique muscle (IOM) plus transverse abdominis muscle (TAM) flap. Its caudal limit faces the medial extremity of the 11th rib. Clinical studies show that the flap is not hypotonic but that the procedure could expose patients already presenting a hypoplastic lung to external oblique muscle (EOM) hypotonia. The aims of this study were to study EOM innervation by the 10th intercostal nerve (ICN) and ICN innervation to the IOM and TAM. Forty cadaveric abdominal hemi-walls were dissected. The number of branches and the trajectory of each specimen's 10th ICN were studied medially to the medial extremity of the 11th rib (MEK11) using surgical goggles and a microscope (Carl Zeiss®). The 10th ICN was consistently found between the IOM and TAM. There was a median of nine branches from the 10th ICN to the EOM, 77% of them medial to the MEK11. Median values of nine and 12 branches for the IOM and TAM were found, 60% and 51%, respectively, medial to the MEK11. These results argue in favor of good innervation to the IOM plus TAM flap but also indicate postoperative abdominal weakness exposing patients to herniation risks, as more than 75% of the branches from the 10th ICN to the EOM were sectioned or pulled away during flap detachment. Clin. Anat., 33:759-766, 2020. © 2019 Wiley Periodicals, Inc.

Endoscopic management of primary obstructive megaureter in pediatrics.

AIMS: The aims of this study were to evaluate the efficacy and safety of endoscopic treatment of primary obstructive megaureter in children, and to assess its long-term outcome. METHODS: Case files of 35 children who had endoscopic treatment of symptomatic primary obstructive megaureter between 2006 and 2016 were retrospectively analyzed. All children had ureterovesical junction dilatation with one or more ureteral dilators, and insertion of a JJ stent. An analysis of the case files and a comparison between pre- and postoperative ultrasound and scintigraphy findings were performed. RESULTS: The study population consisted of 22 boys and 13 girls aged between 2 months and 16 years. The follow-up period ranged from 8 months to 10 years. Twenty-one children (60%) were under 2 years at the time of treatment. The average duration of JJ stenting was 7 weeks (3-16 weeks). Thirty-four of 35 children (97%) were considered definitively cured, that is, asymptomatic with preserved renal function. Two children required open surgery for a failed endoscopic treatment procedure. Secondary reimplantation surgery was only necessary in one case (1/35) after technically satisfactory endoscopic treatment. Twelve of 35 children had a complication, including two Clavien III complications. Comparison of pre- and postoperative ultrasonography showed a significant decrease in ureteral diameter in 31 cases. Postoperative scintigraphy showed a significant improvement in the ureteral leaking curve in 20 children. CONCLUSION: In our experience, endoscopic treatment of congenital obstructive megaureter in pediatrics seems to be safe and effective. It is proposed as a first-line treatment for children requiring an intervention, even for young children under 2 years.

Evaluation of the management of severe trauma kidney injury and long-term renal function in children.

BACKGROUND: To evaluate the management and long-term renal function with DMSA scintigraphy in pediatric severe traumatic kidney injury grade IV and V at the trauma center of Grenoble Teaching Hospital. METHODS: This is a single-center observational retrospective study between 2004 and 2014. All children younger than 15 years and managed at the Grenoble teaching Hospital for a severe trauma kidney injury grade IV or V were included. The trauma grade was radiologically diagnosed on arrival at hospital, using the classification of the American Association for Surgery of Trauma. The management followed the algorithm in effect in the establishment. The assessment of the renal function was performed by a DMSA scintigraphy after at least 6 months from the injury. RESULTS: Twenty-one children were managed for a severe renal trauma (16 IV and 5 V). The diagnosis was initially made by an ultrasonography (eight cases) or a computed tomography scan (13 cases). A child with a severe renal trauma IV underwent nephrectomy on day 6 of the trauma. Eleven children needed a therapeutic procedure (three embolizations, four double J stents, one arterial stent, one peritoneal lavage for a splenic hemoperitoneum, four pleural drainages). A DMSA scintigraphy was performed in 15 patients to assess the function of the injured kidney: 11 of 16 severe renal trauma IV with an average of 39.4%, and 17% in 4 of 5 severe renal trauma V analyzed. CONCLUSION: Among the 21 children managed for a severe kidney trauma injury IV or V, 11 required a therapeutic procedure, one of them a nephrectomy. The DMSA scintigraphy performed after at least 6 months from the trauma found an injured renal function at 39.4% in 11 of 16 severe renal trauma IV analyzed, and 17% in 4 of 5 severe renal trauma V analyzed, which confirms the currently conservative management. LEVEL OF EVIDENCE: Type of study: original article, retrospective observational study, level IV.

Congenital lumbar kyphosis with skin ulceration and osteomyelitis in a myelomeningocele child: a case report.

INTRODUCTION: Kyphosis is a frequent problem in children with spina bifida, and this deformity may cause different complications as respiratory insufficiency, bowel dysfunction, and skin ulcers. CASE REPORT: We report on a 13-year-old myelomeningocele male with a lumbar kyphoscoliosis associated to a septic skin ulceration that resulted in an acute sepsis. An X-ray revealed a kyphosis of 110° and a scoliosis of 25° between T9 and L5. The wound and blood cultures showed Staphylococcus aureus colonization, and an appropriate antibiotic therapy was started. An MRI showed a wedged vertebra at T12, a laminae defects from T8 to the sacrum, and a spondylitis at T12-L1. Ulcer resection and kyphectomy from T12 to L3 were performed "en bloc," and the spine was instrumented fromT7 to S1. After the surgery, the kyphosis was corrected to 10°, and the scoliosis was corrected to 0°. At an 18-month follow-up, a solid bony fusion was obtained, and no recurrence of skin ulcer was reported. CONCLUSION: Antibiotherapy associated to one-step "en-bloc" surgical debridement and kyphectomy should be considered as a valid option to eradicate the infection and to correct the spine deformity in kyphosis due to myelomeningocele associated to septic skin ulcer and spondylitis.

My Corporis Fabrica Embryo: An ontology-based 3D spatio-temporal modeling of human embryo development.

BACKGROUND: Embryology is a complex morphologic discipline involving a set of entangled mechanisms, sometime difficult to understand and to visualize. Recent computer based techniques ranging from geometrical to physically based modeling are used to assist the visualization and the simulation of virtual humans for numerous domains such as surgical simulation and learning. On the other side, the ontology-based approach applied to knowledge representation is more and more successfully adopted in the life-science domains to formalize biological entities and phenomena, thanks to a declarative approach for expressing and reasoning over symbolic information. 3D models and ontologies are two complementary ways to describe biological entities that remain largely separated. Indeed, while many ontologies providing a unified formalization of anatomy and embryology exist, they remain only descriptive and make the access to anatomical content of complex 3D embryology models and simulations difficult. RESULTS: In this work, we present a novel ontology describing the development of the human embryology deforming 3D models. Beyond describing how organs and structures are composed, our ontology integrates a procedural description of their 3D representations, temporal deformation and relations with respect to their developments. We also created inferences rules to express complex connections between entities. It results in a unified description of both the knowledge of the organs deformation and their 3D representations enabling to visualize dynamically the embryo deformation during the Carnegie stages. Through a simplified ontology, containing representative entities which are linked to spatial position and temporal process information, we illustrate the added-value of such a declarative approach for interactive simulation and visualization of 3D embryos. CONCLUSIONS: Combining ontologies and 3D models enables a declarative description of different embryological models that capture the complexity of human developmental anatomy. Visualizing embryos with 3D geometric models and their animated deformations perhaps paves the way towards some kind of hypothesis-driven application. These can also be used to assist the learning process of this complex knowledge. AVAILABILITY: http://www.mycorporisfabrica.org/.