Ligation of the patent ductus arteriosus in premature infants--indications and procedures.

Premature newborns with patent ductus arteriosus can be managed by prostaglandin inhibition, but this medical treatment carries a high risk of renal failure, and other complications such as necrotizing enterocolitis and hematologic disorders have been described. Echocardiography gives an early confirmation of shunt and surgical treatment may be proposed. The aortic arch anatomy in the premature infant may not be as simple to determine as the anatomy of an older child. In the premature infant the use of a clip for patent ductus arterious closure seems the best technique, avoiding circular dissection of the ductus. We report our experience of 68 cases operated upon.

[Peripubertal longitudinal study by echocardiography of left heart development in a group of ice hockey players]. / Etude longitudinale péripubertaire, par échographie, du développement cardiaque gauche d'un groupe de hockeyeurs sur glace.

The modalities of left ventricular (LV) adaptation (dilatation and/or hypertrophy) to exercise are not as well known in children as in adults. Therefore, the authors followed up 11 national ice hockey players, initially aged 10, following an eight hour per week training schedule for a period of 5 years. M mode echocardiographic studies were carried out each year during the training period to measure LV internal dimensions, wall thickness, myocardial mass and contractility (fractional shortening and systolic stress index). The evolution of these parameters was evaluated (Student's test) by two year peripubertal periods (10-12 years: 12-14 years) and compared in absolute values and in rate of growth with the standardised values indexed to body surface area reported by Henry. Between 10 and 12 years of age, the LV internal dimensions (a good indicator of LV volume in healthy children) increased significantly (p less than 0.05) and LV mass increased very significantly (p less than 0.01). The LV internal dimensions were normal at the outset and remained in the upper limits of normality reported by Henry with a normal rate of growth. Myocardial mass was normal at the age of 10 and its rate of growth was also normal. Between 12 and 14 years of age, the increase in LV internal dimensions was not statistically significant but myocardial mass increased very significantly (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

[Current aspects of the complications of acute appendicitis in children]. / Aspects actuels des complications de l'appendicite aiguë de l'enfant.

One thousand four hundred and ninety-one cases of acute appendicitis during infancy and childhood are reviewed, 137 were revealed by peritonitis. Complications following appendicitis with perforation (15%) are higher than acute appendicitis (2%). Many complications are reported, but the most serious of them are the 5th day syndrome after appendectomy. Early diagnosis, often difficult in infancy, and early operation before diffusion are the only means of prevention. Ultrasonography may reveal pelvic or intraperitoneal abscess. Treatment is a large drainage with antibiotics; enteral or parenteral nutrition may be associated.

[Restraint during craniocerebral scannography. A new method of restraint for the newborn and infants (author's transl)]. / Contention en scanographie crânio-encéphalique. Une méthode nouvelle de contention chez le nouveau-né et le nourrisson.

A newly designed apparatus for head restraint, adapted for the newborn and infants, can frequently avoid the administration of a general anaesthetic during craniocerebral scannography examinations. The infant is placed in a block of expanded polystyrene, ensuring both restraint and maintenance of an isothermic regimen.

[Vascular injuries during percutaneous catheterization of the lower neck in children]. / Plaies vasculaires au décours des cathétérismes per-cutanés par voie cervicale basse chez l'enfant.

Four cases of vascular injuries of subclavian artery in children are reported after 414 percutaneous catheterization between 1980 and 1986. The first case reported is a 2 month old child with a right subclavian aneurysm after punction, witch be treated by a successful resection-anastomosis. Three others children, 12, 13, and 14 years old have been catheterized by a jugular approach for one and by a subclavian approach in the others. In this three cases the diagnosis was made by an important hemothorax requiring a drainage. In one case, the recovery was obtain only by drainage, in the two others a surgical approach was necessary with a suture of the subclavian artery in one and a ligation in the other case. The diagnosis of these vascular lesion is difficult = an hemothorax must be drained quickly and a persistent bleeding require a surgical treatment by a cervical route associated with a cleidotomy for the subclavian control. All catheterization in children must be realized by operator with a good practice and an adapted material. The jugular route must be preferred to the subclavian route in children.

Hemodynamic and echocardiographic effects of hemofiltration performed during cardiopulmonary bypass.

OBJECTIVE: To evaluate the effects of hemofiltration performed during rewarming before emergence from cardiopulmonary bypass on hemodynamic and echocardiographic parameters. DESIGN: Prospective randomized study; blind analysis of echocardiographic parameters and hemodynamic parameters. SETTING: Single-center study performed in a university hospital. PARTICIPANTS: Two groups of 13 adult patients undergoing coronary artery bypass graft surgery. INTERVENTION: Patients were randomized to conventional procedure or hemofiltration performed with a polysulfone hemofilter. Hemofiltration, started at the time of rewarming on cardiopulmonary bypass, was performed with a flow rate adjusted to achieve an ultrafiltrate volume of 15 mL/kg on completion of rewarming. MEASUREMENTS AND MAIN RESULTS: Hemodynamic (systemic mean arterial pressure, right atrial pressure, heart rate) and echocardiographic parameters (shortening fraction, segmental kinetic score, cardiac output, systemic vascular resistance) were measured before and after hemofiltration and on arrival in the intensive care unit. Heart rate and cardiac index were increased significantly in both groups during the postoperative period. In the control group, systemic vascular resistance was decreased significantly, and cardiac index was increased during the postoperative period, together with significant alterations of segmental kinetic score and shortening fraction. In the hemofiltration group, systemic vascular resistance remained unchanged, associated with a significantly improved segmental kinetic score compared with the control group. CONCLUSIONS: Hemofiltration performed during rewarming before emergence from cardiopulmonary bypass is associated with stability of hemodynamic parameters and improved segmental myocardial kinetics.

[Development of a safe technique for central venous access in pediatrics. Our experience with 700 percutaneous central catheters]. / Elaboration d'une technique sûre d'accès veineux central en pédiatrie. Notre expérience de 700 cathéters centraux percutanés.

Since 1977, the authors have performed 708 percutaneous catheterizations of superior vena cava in pediatric patients (from premature infant of 15 year old children). The greater part of these catheterizations concerns the internal jugular vein. Subclavian catheterization was rapidly abandoned because it is judged too dangerous in children. The evolution of the quality of materials, and the increasing technical experience of operators, both allowed to enlarge indications of percutaneous catheterization. That suppose a nearly total suppression of mechanical and infectious complications. The analysis of 7 severe vascular injuries in 445 patients made the authors change their technics and apply a very strict method: choice of a frontal access to internal jugular vein; catheterization performed in operating room, under anesthesia; percutaneous puncture with a lew diameter short catheter (external diameter: 9/10 mm); Seldinger technic and radioscopy; silicone catheters with or without a cuff, systematic tunellisation; operators having a very good practice of venous access in children. The analysis of the three last years shows no immediate mechanical complication and very little infections among 263 catheterizations.

[Surgical treatment of subvalvular aortic obstructions. A new approach]. / Cure chirurgicale des obstacles sous-valvulaires aortiques. Voie d'abord nouvelle.

Approaching the region below the aortic valve is notoriously difficult. The new technique described, derived from the Konno-Restan technique, provides wide exposure of the infra-aortic canal through the right ventricle, the aorta and the septum. Experiments on animals have shown that it entails no risk of heart damage. This technique was used on one patient with sub-aortic fibromuscular tunnel with excellent post-operative results.

[Gardner syndrome treated by total colectomy with preservation of the internal sphincter. Apropos of 3 cases]. / Syndrome de Gardner traité par colectomie totale avec conservation du sphincter interne. A propos de trois cas.

Familial polyposis and more particularly Gardner's syndrome is a difficult affection to treat in children, due to the risk of degeneration of polyps. Two factors are accepted by all authors as being of major importance: the need for early treatment to avoid degeneration; the advantage of maximum mucosal excision to avoid repeated follow up examinations and removal of further polyps from the remaining rectum. Three cases of familial polyposis and Gardner's syndrome were treated by either total colectomy and rectal mucosectomy (2 cases) or a partial Reifferscheid procedure (1 case). Two problems related to prognosis appear to be solved by this procedure: the need to operate on a child lacking clinical symptoms, and to obtain valid continence with a minimum of suveillance after surgery.