[Meconium periorchitis. Two case reports]. / Epanchement méconial péritesticulaire. A propos de deux cas.

CASE REPORTS: Two cases of meconium periorchitis respectively in a ten-day- and a five-month-old infant are reported. The presenting symptom was a scrotal mass, isolated in one case and associated with pain and inflammation in the other case. Intraoperative histological diagnosis allowed conservative surgery in one case. COMMENTS: About 40 cases of scrotal manifestations of an intrauterine perforation of the gastrointestinal tract are reported in the literature. In cases with associated intraperitoneal calcifications, the diagnosis is easy and surgical exploration may be avoided, spontaneous resolution being the rule. However, in half of the cases, a scrotal mass is the only manifestation and raises the question of a testicular tumor. CONCLUSION: Unfamiliarity with this unusual entity may lead to unnecessary orchiectomy.

[Scoliosis and congenital diaphragmatic agenesis]. / Scolioses associées aux aplasies de coupole diaphragmatique.

PURPOSE OF THE STUDY: Diaphragmatic agenesis is the most extreme anatomic form of congenital diaphragmatic defects. Clinically this pathology is not different from posterolateral diaphragmatic hernia described by Bochdalek. We describe our observations of scoliosis in 16 neonates with diaphragmatic agenesis. MATERIAL AND METHODS: Between 1987 and 1996, 69 neonates underwent surgery for a congenital diaphragmatic hernia (CDH) at our institution. Sixteen of these patients had the most extreme form of CDH. Ten of these 16 patients survived. Spinal and/or chest wall deformities were observed in nine patients, including isolated scoliosis in two patients, scoliosis associated with a chest wall deformity in three, and isolated chest wall deformity (pectus excavatum or pectus carnium) in four. These deformities developed between 13 months and three and a half years of age (mean: two years). RESULTS: For two patients the deformity was mild (Cobb angle<15 degrees ) and required only observation. A Milwaukee brace was used in three patients that had severe kyphoscoliosis. Isolated chest wall deformities were treated with observation. No patient required operative treatment for these skeletal deformities. DISCUSSION: The preliminary results of this study indicate that chest wall deformities and scoliosis frequently occur during surgery for diaphragmatic agenesis. Nonoperative treatment is usually sufficient, however, follow-up of these patients until adulthood is recommended.

[Anterior urethral duplication in a male child. A case report]. / Duplications sagittales antérieures de l'urètre chez le garçon. A propos d'un cas.

Urethra duplication is a rare anomaly with numerous anatomic variations. These fall into four main groups: epispadiac, hypospadiac, fusiform, and Y-type. We report on one case of sagittal incomplete hypospadiac anterior duplication of the urethra. Surgical repair consisted of incision of the septum between the two urethras and hypospadias repair at the same setting. Follow-up was characterized by the occurrence of some complications.

[Modified Duplay technique in the treatment of hypospadias. Report of 585 cases]. / Technique de Duplay modifiée dans le traitement de l'hypospadias. A propos de 585 cas.

The surgical repair of anterior hypospadias depends on the surgeon's custom and the anatomical variations of this anomaly. However, most publications agree nowadays on the one-stage surgery. We report on 585 hypospadias operated in our department. Our procedure is based on the Duplay technique, in addition to personal modifications in order to correct the frequently associated penis anomalies. The procedure is described herein. Aesthetic and functional results are reported and seem to be very satisfactory in comparison with the literature and permit the homologation of our technique.

[Surgical aspects of kidney transplantation in children (study of 148 cases)]. / Aspects chirurgicaux de la greffe rénale chez l'enfant (étude de 148 cas).

OBJECTIVE: Kidney transplantation is the best treatment for end-stage renal disease. This procedure is by now routinely used and permits children survival and rehabilitation. We describe the surgical complications of kidney graft in our paediatric experience. MATERIALS AND METHODS: From April 1987 to August 2000, 175 kidney transplantation were proceeded in the department of urology and transplantation in Edouard Herriot Hospital (Lyon). Twenty-nine kidneys (17%) were from living related donors and 146 (83%) were from cadaveric donors. We evaluated 148 kidney transplantation (132 patients) in 79 male and 53 female children. Mean age was ten years (range: seven months to 18 years). Twelve allografts were from living related donors and 136 cadaveric donors. RESULTS: Twelve patients died of various medical complications. One patient was lost of sight. Surgical complications were postoperative bleeding, lymphocele, urologic and digestive troubles. The rest of our patients had uneventful evolution. CONCLUSION: A general commitment is the only way to promote organ donation and enable patients with terminal renal failure to have access to renal transplantation.

[Total nephrectomy in children: 11 years of experience in 80 cases]. / Les néphrectomies totales chez l'enfant: une expérience de 11 ans sur 80 cas.

Nephrectomy in childhood is an ultimate indication. It is realised in case of severe deterioration of the renal function or neoplastic affection of the kidney. We report a retrospective study on a series of 80 patients. Mean age was 5 years with extremes from 2 months to 14 years. Abdominal mass, pain, infection and haematuria were the mostly encountered revealing symptoms. The main aetiology was nephroblastoma. No laparoscopic nephrectomy was realised. Follow-up was uneventful except for the troubles existing prior to surgery.

[Two rare case reports of ureteral triplication]. / A propos de deux cas rares de triplication urétérale.

Triplication of the upper urinary tract is rare. It is classified according to its extent and four types have been documented. Since the first description of ureteral triplication by Wrany only about a hundred cases have been reported in the literature. Paediatric cases are very few and female patients seem more concerned. The embryological event resulting in ureteral triplication derives from multiple ureteral buds arising from the Wolffian duct with fissuring of one or more of them. We report on two cases of ureteral triplication. The first one associated with an extravesical ectopic ureter and a dysplasic kidney. Diagnosis was particularly difficult and treatment consisted of total nephrectomy. The second case was associated with an upper pole hydronephrosis and a partial nephrectomy was realized.

[Endoscopic treatment of vesicorenal reflux in children: short- and long-term results of polytetrafluoroethylene (Teflon) injections]. / Traitement endoscopique du reflux vésico-rénal chez l'enfant: résultats à court et à long terme des injections de polytétrafluoroéthylène (Téflon).

OBJECTIVE: To retrospectively evaluate the short-term and long-term efficacy and safety of endoscopic treatment of vesicorenal reflux in children by polytetrafluoroethylene injection, based on the largest series published in the literature. MATERIAL AND METHODS: Six hundred and fifty ureters in 402 children were by subureteric injection of polytetrafluoroethylene from 1986 to 1993. The short-term results were evaluated one month and one year after treatment by physical examination, urine culture, bladder and renal ultrasonography and retrograde cystography. The long-term results were evaluated with a mean follow-up of 116 months by physical examination, renal ultrasonography, questionnaire for the patient's family and urine culture. RESULTS: 86.6% refluxing ureters in 82.1% of children were cured after endoscopic treatment. No serious short-term complications were observed. In the long-term, 97% of children never presented an episode of pyelonephritis. Ultrasonographic assessment did not reveal any dilatation of the upper urinary tract, no any suspicious lesions of the bladder wall. Continuing reflux nephropathy due to chronic pyelonephritis was observed in 4.4% of treated kidneys, despite satisfactory correction of reflux. No local complications related to the biomaterial and no signs suggestive of distant diseases induce by migration of Teflon particles were observed. No malignant degeneration was reported. CONCLUSIONS: Review of this series demonstrates the short-term efficacy and long-term maintenance of the good results of endoscopic treatment of reflux. No local complication and no complications due to migration of Teflon were observed in this series. This procedure avoided the need for conventional ureteric reimplantation in 92% of treated children.

Factors and motives of unsafe behaviors of road users.

A questionnaire to measure factors and motives of unsafe behaviors of road users was constructed. This study tool was applied on a final sample of 5586 drivers in twelve out of forty eight districts in Algeria. The aim of the present study was to sort out the different factors and motives that make road users opt for the unsafe behaviors. The latter were determined mainly on the results of a previous study carried out on a final sample of 7058 drivers in twelve out of forty eight districts in Algeria in order to find the most frequent and dangerous unsafe behaviors of road users. The main unsafe and dangerous behaviors were then used in the present study. Friedman ranking means test was applied to rank the factors and motives selected under each unsafe behavior of road users. The whole results were summarised in seven axes of factors and motives causing: dangerous manoeuvrings by drivers, aggressive behaviors by drivers, negligence and ignorance of maintenance principals by drivers, lack of responsibility and engagement by drivers, cyclists and motorcyclists and their companions, as well as pedestrians and workers of road maintenance. The results are discussed in view of the previous studies and many recommendations have been made.

[Mesenchymal hamartoma of the liver in a child: a case report]. / Hamartome du foie chez l'enfant : à propos d'un nouveau cas.

Mesenchymal hamartoma of the liver is a rare, benign tumor that presents mostly before the age of 2 years. Its pathogenesis is poorly understood. We present the case of a 2.5-year-old female patient who had a large cystic mass of the liver of which the hamartomatous nature was confirmed by the pathological examination of the surgical specimen. We discuss the clinicopathological, imaging, and histological features of this unusual tumor through a review of the literature.

A new technique of bladder enlargement and continent urinary diversion using the ceco-appendicular unit.

The authors developed a new technique using the cecum with in-situ appendix to simultaneously achieve bladder enlargement and continent urinary diversion (CUD) in five cases of neuropathic bladder or serious complications of abdominopelvic trauma. The cecoplasty provides a large-capacity, low-pressure reservoir; the submucosally-embedded appendix gives complete continence with 3 to 5 intermittent catheterizations daily. It is an alternative to the Mitrofanoff principle when bladder augmentation and CUD are necessary, and easier to achieve when faced with a neuropathic bladder where the thickness of the detrusor makes appendicular implantation difficult.