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1.
Eur Urol ; 81(1): 64-72, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34563412

RESUMO

BACKGROUND: Boys with posterior urethral valves (PUVs) have an increased risk of febrile urinary tract infections (fUTIs). Circumcision is believed to reduce the risk of fUTIs in boys, although there are no randomized trials demonstrating this. OBJECTIVE: To determine the effect of circumcision on the risk of fUTIs in boys with PUVs. DESIGN, SETTING, AND PARTICIPANTS: A clinical randomized trial that ran between August 2012 and July 2017 was conducted. The trial was multicentric, including 13 referral centers for pediatric urology. Male boys, aged 1-28 d, diagnosed with posterior urethral valves, confirmed by voiding cystogram, were included. The exclusion criteria included presence of a genital malformation contraindicating performing a circumcision. INTERVENTION: Participants were randomized to neonatal circumcision + antibiotic prophylaxis (CATB) or antibiotic prophylaxis alone (ATB), and followed for 2 yr. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcome was a risk of presenting fUTIs in each group. An fUTI was defined as fever (>38.5 °C) with evidence of pyuria and culture-proven infection on urinalysis, obtained by urethral catheterization or suprapubic aspiration. A bivariate analysis of the primary outcome was performed using the Kaplan-Meier method. RESULTS AND LIMITATIONS: In total, 91 patients were included: 49 in group CATB and 42 in group ATB. The probability of presenting an fUTI was 20% in group ATB versus 3% in group CATB. The hazard ratio of presenting an fUTI within 2 yr in the ATB group compared with that in the CATB group was 10.3 (95% confidence interval: 1.3-82.5). Sixty-four children (70.3%) had a complete follow-up at 2 yr of age. CONCLUSIONS: Circumcision significantly decreases the risk of presenting an fUTI in boys with PUVs. PATIENT SUMMARY: In this report, we compared, in a multicentric trial, the number of febrile urinary tract infections (UTIs) in boys with posterior urethral valves who had either antibiotic prophylaxis alone or antibiotic prophylaxis and circumcision. We found that those who had a circumcision had a significantly lower risk of febrile UTIs.


Assuntos
Circuncisão Masculina , Infecções Urinárias , Antibioticoprofilaxia , Criança , Circuncisão Masculina/efeitos adversos , Feminino , Humanos , Recém-Nascido , Masculino , Modelos de Riscos Proporcionais , Cateterismo Urinário , Infecções Urinárias/etiologia , Infecções Urinárias/prevenção & controle
2.
Cancer Epidemiol ; 49: 61-65, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28575782

RESUMO

The aim of this study is to describe childhood cancer incidence and survival in the French islands of Reunion and Mayotte for the period 2005-2011. Data were taken from the population-based Cancer Registry of Reunion Island. All incident cases of malignant tumours and benign tumours of the Central Nervous System diagnosed between 2005 and 2011 in children under the age of 15 and living in Reunion or Mayotte were included. A total of 236 cases were registered (176 in Reunion, 60 in Mayotte). Age-standardised incidence rates (ASRs, world standard) for all cancers were 125.0 and 101.8 per million for Reunion and Mayotte, respectively. ASRs for the main cancer groups were lower than those described in mainland France for the same period. The 5-year overall survival rate for all patients was 78.5% (95%CI 71.9- 83.7), slightly lower than that reported in mainland France.


Assuntos
Neoplasias/epidemiologia , Adolescente , Criança , Pré-Escolar , Comores/epidemiologia , Feminino , Humanos , Incidência , Lactente , Masculino , Neoplasias/mortalidade , Sistema de Registros , Reunião/epidemiologia , Taxa de Sobrevida
3.
Arch Dis Child ; 100(7): 643-7, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25688099

RESUMO

BACKGROUND: In humans the ratio of the index finger to the ring finger is sexually dimorphic, with the mean ratio being larger in women than in men. It has been suggested that this difference is related to prenatal androgen exposure. This has been further demonstrated in children with congenital adrenal hyperplasia. Normal development of the male external genitalia is linked to androgen-mediated events during gestation. We therefore wanted to determine if the 2D:4D digit ratio was normal in boys with cryptorchidism or hypospadias. METHODS: We prospectively enrolled all prepubertal patients seen in the outpatient clinic for cryptorchidism or hypospadias between September and December 2012. We then compared their 2D:4D digit ratio with two control groups made up of normal boys and normal girls. Interobserver and intraobserver variability was evaluated. RESULTS: We included 57 boys with hypospadias and/or cryptorchidism, 79 boys without genital abnormalities and 25 girls without genital abnormalities. The mean 2D:4D ratio for both hands was significantly different between the three groups, with the digit ratio for boys with genital anomalies being lower than for normal boys and normal girls (p<0.0001). CONCLUSIONS: It appears that boys with genital abnormalities (cryptorchidism and/or hypospadias) have a lower 2D:4D digit ratio than boys without genital anomalies.


Assuntos
Criptorquidismo/patologia , Dedos/patologia , Hipospadia/patologia , Antropometria/métodos , Estudos de Casos e Controles , Criança , Pré-Escolar , Criptorquidismo/embriologia , Feminino , Dedos/embriologia , Humanos , Hipospadia/embriologia , Lactente , Masculino , Variações Dependentes do Observador , Gravidez , Efeitos Tardios da Exposição Pré-Natal , Estudos Prospectivos , Reprodutibilidade dos Testes , Caracteres Sexuais
4.
Clin Nutr ; 34(3): 428-35, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25015836

RESUMO

BACKGROUND & AIMS: Chronic intestinal failure (CIF) requires long term parenteral nutrition (PN) and, in some patients, intestinal transplantation (ITx). Indications and timing for ITx remain poorly defined. In the present study we aimed to analyze causes and outcome of children with CIF. METHODS: 118 consecutive patients referred to our institution were assessed by a multidisciplinary team and four different categories were defined retrospectively based on their clinical course: Group 1: patients with reversible intestinal failure; group 2: patients unsuitable for ITx, group 3: patients listed for ITx; group 4: patients stable under PN. Analysis involved comparison between groups for nutritional status, central venous catheter (CVC) related complications, liver disease, and outcome after transplantation by using non parametric tests, Mann-Whitney tests, Kruskal-Wallis, Wilcoxon signed rank tests and chi square distribution for percentage. RESULTS: 118 children (72 boys) with a median age of 15 months at referral (2 months-16 years) were assessed. Etiology of IF was short bowel syndrome [n = 47], intractable diarrhea of infancy [n = 37], total intestinal aganglionosis [n = 18], and chronic intestinal pseudoobstruction [n = 17]. Most patients (89.8%) were totally PN dependent, with 48 children (40.7%) on home-PN prior to admission. Nutritional status was poor with a median body weight at -1.5 z-score (ranges: -5 to +2.5) and median length at -2.0 z-score (ranges: -5.5 to +2.3). The mean number of CVC inserted per patient was 5.2 (range 1-20) and the mean number of CRS per patient was 5.5 (median: 5; range 0-12) Fifty-five patients (46.6%) had thrombosis of ≥2 main venous axis. At admission 34.7% of patients had elevated bilirubin (≥50 µmol/l), and 19.5% had platelets <100,000/ml, and 15% had both. Liver biopsy performed in 79 children was normal (n = 4), or showed F1 or F2 fibrosis (n = 29), bridging fibrosis F3 (n = 20), or cirrhosis (n = 26). Group 1 included 10 children finally weaned from PN (7-years survival: 100%). Group 2 included 12 children with severe liver disease and associated disorders unsuitable for transplantation (7-years survival: 16.6%). Group 3 included 66 patients (56%) who were listed for small bowel or liver-small bowel transplantation, 62/66 have been transplanted (7 years survival: 74.6%). Factors influencing outcome after liver-ITx were body weight (p < .004), length (p < .001), pre-Tx bilirubin plasma level (p < .001) and thrombosis (p < .01) for isolated ITx, Group 4 included 30 children (25.4%) with irreversible IF considered as potential candidates for isolated ITx. Four children were lost from follow up and 3 died within 2 years (survival 88.5%). Among potential candidates, the following parameters improved significantly during the first 12 months of follow up: Body weight (p.0001), length (p < .0001) and bilirubin (p < .0001). CONCLUSIONS: many patients had a poor nutritional status with severe complications especially liver disease. PN related complications were the most relevant indication for ITx, but also a negative predictor for outcome. Early patient referral for Tx-assessment might help to identify and separate children with irreversible IF from children with transient IF or uncomplicated long-term PN, allowing to adapt a patient-based treatment strategy including or not ITx.


Assuntos
Enteropatias/cirurgia , Intestinos/fisiopatologia , Intestinos/transplante , Adolescente , Bilirrubina/sangue , Cateteres Venosos Centrais/efeitos adversos , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Hepatopatias/complicações , Hepatopatias/patologia , Masculino , Estado Nutricional , Nutrição Parenteral Total/efeitos adversos , Nutrição Parenteral Total/métodos , Estudos Retrospectivos , Síndrome do Intestino Curto/cirurgia , Resultado do Tratamento
5.
J Pediatr Urol ; 9(6 Pt B): 1054-8, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23602207

RESUMO

INTRODUCTION: Postnatal management of prenatally detected hydronephrosis remains controversial. It has been suggested that cortical transit time (CTT) could successfully predict deterioration in children with pelvi-ureteric junction (PUJ) obstruction. We decided to conduct a retrospective study in our hydronephrosis population to evaluate whether initial CTT was significantly correlated with the need for surgery. PATIENTS AND METHOD: We reviewed the charts of all our patients managed for significant PUJ obstruction (>12 mm) between 2007 and 2010 and determined CTT retrospectively, on the first diuretic scan of each of these patients. We then determined the relationship between initial CTT and the need for surgery. RESULTS: We identified 37 patients with hydronephrosis (pelvic size >12 mm) of which 26 were diagnosed prenatally. Out of 22 patients with an initial abnormal CTT, 20 underwent surgery. Out of 15 children with a normal initial CTT, 4 underwent surgery (OR 27.5 (IC95%: 4.3-174.9)). CONCLUSION: Initial CTT could be a reliable prognostic factor for future evolution of renal function in children with hydronephrosis. CTT is easy to determine on diuretic renal scan. A prospective trial is being devised to confirm what role it could have in the management of children with hydronephrosis.


Assuntos
Hidronefrose/congênito , Pelve Renal/metabolismo , Rim Displásico Multicístico , Ureter/metabolismo , Obstrução Ureteral , Adolescente , Biomarcadores/metabolismo , Criança , Feminino , Humanos , Hidronefrose/diagnóstico por imagem , Hidronefrose/metabolismo , Hidronefrose/cirurgia , Lactente , Recém-Nascido , Pelve Renal/diagnóstico por imagem , Masculino , Rim Displásico Multicístico/diagnóstico por imagem , Rim Displásico Multicístico/metabolismo , Rim Displásico Multicístico/cirurgia , Projetos Piloto , Valor Preditivo dos Testes , Cuidados Pré-Operatórios/métodos , Prognóstico , Cintilografia , Estudos Retrospectivos , Tecnécio Tc 99m Mertiatida , Ureter/diagnóstico por imagem , Obstrução Ureteral/diagnóstico por imagem , Obstrução Ureteral/metabolismo , Obstrução Ureteral/cirurgia
6.
J Pediatr Urol ; 9(1): e94-7, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23141002

RESUMO

Conventional and robotic-assisted laparoscopy is being used for more and more complex urological procedures in children. There have recently been reports of laparoscopic or laparoscopic-assisted appendicovesicostomies in children. We report a case of combined laparoscopic-assisted nephrectomy, augmentation ureterocystoplasty and Mitrofanoff appendicovesicostomy in a 5-year-old boy with valve bladder syndrome.


Assuntos
Cistostomia/métodos , Laparoscopia/métodos , Nefrectomia/métodos , Doenças Ureterais/cirurgia , Doenças da Bexiga Urinária/cirurgia , Derivação Urinária/métodos , Apêndice/cirurgia , Pré-Escolar , Humanos , Masculino , Robótica/métodos
7.
Arch Pediatr ; 19(5): 497-500, 2012 May.
Artigo em Francês | MEDLINE | ID: mdl-22463954

RESUMO

Liver abscess in the pediatric population remains uncommon in developed countries, except in cases of septicemia or in children with major debilitating diseases, granulocyte dysfunction, or immunosuppression. Although much is known about the etiopathogenesis of liver abscess, the gold standard of investigations and treatment is still debatable in developing countries. We report the case of a 6-year-old child living in Reunion Island, with no medical history, presenting with right and pyretic abdominal pain in the right upper quadrant. Ultrasound and CT scan showed a large hypodense nonenhanced area in segment IV. Final diagnosis was, by exclusion, pyogenic liver abscess based on negative serology, recent liver lesion, and normal tumor test results, even if blood culture remained negative. No percutaneous puncture was done because of positive outcome after 4 days of antibiotics. Treatment consisted in three intravenous antibiotics (ceftriaxone, aminoxide, and metronidazole) until complete biological normalization. Ultrasound remained normal 3 months later. Even if liver abscess is uncommon in developing countries, the diagnosis must be raised in cases of isolated liver tumor with fever. Management in the nonimmunosuppressed child must be discussed associating parenteral antibiotic therapy, percutaneous drainage, or surgery in very uncommon cases, according to the liver location and first day's progression. Etiological investigation such as colonoscopy in adults must be adapted to pediatric data.


Assuntos
Abscesso Hepático , Criança , Feminino , Humanos , Abscesso Hepático/diagnóstico , Abscesso Hepático/tratamento farmacológico
8.
J Neonatal Surg ; 1(2): 22, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-26023381

RESUMO

With modern prenatal imaging, liver cysts are being diagnosed more often. Although large cysts are usually asymptomatic, they may present as an abdominal emergency requiring surgery in the first weeks of life. We report a series of 3 patients with prenatal diagnosis of isolated cystic liver lesions diagnosed at 22, 31 and 33 weeks of gestational age. The hepatic origin of the cysts was confirmed prenatally by a MRI in 2 cases, with visualization of a normal gallbladder. The prenatal course was uneventful. Postnatal ultrasound confirmed the diagnosis of liver cyst, showed normality of the biliary tract and in one case, rupture of the cyst during delivery. Because of an uncommon rapid increase in size, the 3 children underwent surgical excision of the cysts within the first weeks of life. These were non-bile-containing intrahepatic cysts arising from segment IV. Long-term follow up was uneventful.

9.
J Pediatr Urol ; 7(5): 534-7, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20869919

RESUMO

PURPOSE: To assess what is done and what is recommended concerning fixation of the solitary testis. MATERIAL AND METHOD: We conducted an e-mail survey of current practices in 28 pediatric surgery departments in 28 university or general hospitals in France. We then reviewed what evidence could be found in the literature. RESULTS: All surgeons fix the contralateral solitary testis following intravaginal torsion. Sixteen out of 28 fix the contralateral solitary testis following extravaginal torsion, 13/28 in cases of monorchia, and 8/28 following orchiectomy for trauma or tumour. Five surgeons have observed one case each of torsion of a solitary testis, and three have witnessed testicular necrosis following orchiopexy. CONCLUSION: There is no consensus regarding fixation of the remaining testis in the literature. Scientific evidence does not show clearly whether fixation is necessary, regardless of the clinical situation. However, if fixation is performed it should be done using the dartos pouch sutureless technique.


Assuntos
Orquiectomia/métodos , Orquidopexia/métodos , Torção do Cordão Espermático/prevenção & controle , Testículo/anormalidades , Testículo/cirurgia , Atitude do Pessoal de Saúde , Humanos , Masculino , Inquéritos e Questionários
10.
Ann Fr Anesth Reanim ; 29(5): 387-90, 2010 May.
Artigo em Francês | MEDLINE | ID: mdl-20399596

RESUMO

Abdominal vascular injuries following a serious falling out are quite rare in children. They can lead to haemorrhagic shock whose etiological diagnosis may be difficult in children in case of multiple trauma. The current management of abdominal injuries in the child is usually conservative, surgery being indicated in haemodynamically unstable patients. We report the case of a 7-year-old girl who presented with abdominal trauma with rupture of the hepatic artery and shredding of the splenic vein following a falling out of 10 meters. Aggressive resuscitation associated with early laparotomy for haemostasis, contrary to usual practices advocated in such a context, have helped control the hemorrhagic shock and stabilize the haemodynamic status of the child. The subsequent evolution was favourable, with full recovery. While a conservative attitude usually prevails in the management of traumatic intra abdominal bleeding in children an interventional attitude with emergency surgery must be sometimes considered.


Assuntos
Traumatismos Abdominais/complicações , Traumatismos Abdominais/cirurgia , Artéria Hepática/lesões , Choque Hemorrágico/etiologia , Choque Hemorrágico/cirurgia , Veia Esplênica/lesões , Criança , Feminino , Humanos , Escala de Gravidade do Ferimento
11.
Ann Endocrinol (Paris) ; 71(3): 231-6, 2010 May.
Artigo em Francês | MEDLINE | ID: mdl-20362960

RESUMO

Malignant tumors account for 1% of childhood cancers. The incidence is to the order of 122 cases per million children. The five-year survival after cancer before the age of 16years has improved from 50 to 80% in 40years. Assessment of potential for preservation of fertility should thus be a systematic element of care for children treated for a malignant tumor (high-dose chemotherapy with alkylizing agents, radiation therapy including the gonads) or those receiving hematopoietic stem cell grafts for malignant or benign disease (sickle-cell anemia, immune deficit). Among the techniques proposed, cryopreservation of ovarian tissue appears to be the most promising, or perhaps the only one available before puberty with encouraging result. Nevertheless the uncertainties, or even risks, related to these treatments, should not be neglected.


Assuntos
Fertilidade/fisiologia , Puberdade/fisiologia , Adolescente , Animais , Criança , Criopreservação/métodos , Feminino , Humanos , Infertilidade/etiologia , Infertilidade/prevenção & controle , Camundongos , Neoplasias/tratamento farmacológico , Neoplasias/epidemiologia , Neoplasias/fisiopatologia , Ovário/fisiologia , Ovário/cirurgia , Especificidade da Espécie , Taxa de Sobrevida
12.
Horm Res ; 71 Suppl 1: 82-6, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19153513

RESUMO

BACKGROUND: As a result of advances in treatment, almost 80% of children and adolescents who currently receive a diagnosis of cancer become long-term survivors. Potential adverse consequences of treatment include impaired puberty and fertility due to gonadal removal, genital tract injury or damage to germ cells from adjuvant therapy. In recent years, treatment of solid tumors and hematological malignancies has been modified in an attempt to minimize damage to the reproductive system. Simultaneously, advances in assisted reproductive technologies have led to new possibilities for the prevention and treatment of infertility. We review experimental data in animal models and clinical experience in adults and discuss strategies to preserve fertility in prepubertal children. CONCLUSIONS: Fertility preservation should now be considered in children facing cancer treatment that has a high risk of gonadal toxicity including high-dose chemotherapy and bilateral irradiation of the gonads at toxic doses.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Fertilidade/efeitos dos fármacos , Infertilidade/prevenção & controle , Neoplasias/terapia , Puberdade/fisiologia , Adulto , Animais , Criança , Criopreservação/métodos , Fertilidade/fisiologia , Genitália , Gônadas , Humanos , Infertilidade/induzido quimicamente , Neoplasias/fisiopatologia , Neoplasias/reabilitação , Puberdade/efeitos dos fármacos , Preservação de Tecido/métodos
13.
Eur J Pediatr Surg ; 18(6): 368-71, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19023853

RESUMO

UNLABELLED: Intestinal transplantation (IT) is the newest and most difficult of organ transplantations. The first ever (1987) and the longest surviving (1989) IT were performed in our institution. However, IT still has to demonstrate its benefit to children on long-term parenteral nutrition (PN). We tried to clarify this aspect by looking back at our 13 years' experience. PATIENTS: From 1994 to December 2007, 74 IT were performed in 69 children, 39 with an isolated small bowel (IT), 35 combined with a liver transplant (LITx). The indications were: short bowel syndrome (n = 25), congenital mucosal diseases (n = 22), and motility disorders (n = 22). Median age at transplantation was 5 years (1 - 17 years). Follow-up was 1 to 12 years (median 5 years). RESULTS: Thirty-one children have a functioning graft (42 %), 15/39 IT, 16/35 LITx. They are at home without PN, with a good quality of life. One child is PN-dependent 1.5 years post IT. Post IT, 16 children were detransplanted: 12 early on (1 for mechanical complications, 11 because of resistant rejection; 3 less than 3 years, one 9 years post SBT (chronic rejection). In 2 noncompliant teenagers, PN was reintroduced (one was detransplanted later on). Several years post LITx, 2 children underwent bowel detransplantation due to an acute viral infection complicated with rejection. Twenty-two children died (32 %, 8 IT, 14 LITx), 18 early on from infectious or surgical complications, 4 more than 1 year post IT, 3 after retransplantation (1 in another unit). Bad prognostic factors are multiple previous surgeries, an older age (> 7 y), and chronic intestinal pseudo-obstruction. DISCUSSION: Complications post IT are frequent and life-threatening, especially early on: rejection (IT), infections (LITx). Later on, the rate of complications decreases but remains significant, especially in noncompliant patients. However we describe here a 13-year learning curve; the recent results are encouraging with regard to control of rejection and viral infections. CONCLUSION: Intestinal transplantation is indicated only in selected patients in whom long-term PN cannot be performed safely any more. In every child with intestinal insufficiency, the therapeutic strategy must be discussed early on in order to perform IT at the right time under optimal conditions. IT should evolve from being a "rescue" procedure to becoming a true therapeutic option.


Assuntos
Anormalidades do Sistema Digestório/cirurgia , Enteropatias/cirurgia , Intestinos/transplante , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Rejeição de Enxerto , Humanos , Lactente , Mucosa Intestinal/anormalidades , Transplante de Fígado , Síndromes de Malabsorção/cirurgia , Masculino , Seleção de Pacientes , Complicações Pós-Operatórias , Análise de Sobrevida , Resultado do Tratamento
14.
J Pediatr Adolesc Gynecol ; 21(4): 201-6, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18656074

RESUMO

INTRODUCTION: The authors describe and discuss the clinical and therapeutic features of 40 ovarian torsions (OT) in children with its urgent treatment that has advanced in recent years. MATERIALS AND METHODS: A retrospective study of 40 cases of OT in 38 children under 16 years of age, excluding adnexal torsions in neonates. RESULTS: Abdominal and/or pelvic pain was the presenting symptom ; 8 of these children had pain between 2 to 9 months prior to surgery and 27/40 (67.5%) had associated vomiting. Before the procedure, ultrasound (US) diagnosed 29 ovarian lesions, related to 14 mature teratomas (MTE) and 10 cystadenomas (CA), one association of MTE and CA in the same ovary, 2 functional cysts and 2 malignant neoplasms. 19/40 torsions could benefit from conservative management. Eleven torsions occurred, 10/11 of these ovaries had an increased volume, and 5/11 had US evidence of small subcortical cysts. Three detorsions with incomplete removal of CA were followed by enlargement of the tumor and re-torsion in 2 of them. Five children had bilateral ovarian pathology which led to unilateral ovariectomy, while the other benefited from conservative treatment. CONCLUSIONS: In any girl presenting with abdominal pain, the diagnosis of an ovarian torsion must be considered. US is performed emergently, but only surgery, most often a laparoscopic procedure, assures diagnosis. The treatment of the torsion is an emergency and must be as conservative as possible in order to preserve the ovarian function. Bilateral torsions are not unusual.


Assuntos
Doenças Ovarianas/cirurgia , Neoplasias Ovarianas/cirurgia , Anormalidade Torcional/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Recidiva Local de Neoplasia/cirurgia , Doenças Ovarianas/complicações , Neoplasias Ovarianas/complicações , Ovariectomia , Estudos Retrospectivos
15.
Gut ; 57(4): 455-61, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18079282

RESUMO

OBJECTIVE: Small bowel (SB) transplantation (Tx), long considered a rescue therapy for patients with intestinal failure, is now a well recognised alternative treatment strategy to parental nutrition (PN). In this retrospective study, we analysed graft functions in 31 children after SBTx with a follow-up of 2-18 years (median 7 years). PATIENTS: Twelve children had isolated SBTx, 19 had combined liver-SBTx and 17 received an additional colon graft. Growth, nutritional markers, stool balance studies, endoscopy and graft histology were recorded every 2-3 years post-Tx. RESULTS: All children were weaned from PN after Tx and 26 children remained PN-free. Enteral nutrition was required for 14/31 (45%) patients at 2 years post-Tx. All children had high dietary energy intakes. The degree of steatorrhoea was fairly constant, with fat and energy absorption rates of 84-89%. Growth parameters revealed at transplantation a mean height Z-score of -1.17. After Tx, two-thirds of children had normal growth, whereas in one-third, Z-scores remained lower than -2, concomitant to a delayed puberty. Adult height was normal in 5/6. Endoscopy and histology analyses were normal in asymptomatic patients. Chronic rejection occurred only in non-compliant patients. Five intestinal grafts were removed 2.5-8 years post-Tx for acute or chronic rejection. CONCLUSIONS: This series indicates that long-term intestinal autonomy for up to 18 years is possible in the majority of patients after SBTx. Subnormal energy absorption and moderate steatorrhoea were often compensated for by hyperphagia, allowing normal growth and attainment of adult height. Long-term compliance is an important pre-requisite for long-term graft function.


Assuntos
Digestão , Crescimento , Enteropatias/cirurgia , Intestinos/transplante , Adolescente , Biomarcadores/sangue , Biópsia , Criança , Pré-Escolar , Nutrição Enteral/métodos , Feminino , Seguimentos , Rejeição de Enxerto/patologia , Humanos , Íleo/patologia , Enteropatias/patologia , Enteropatias/fisiopatologia , Mucosa Intestinal/patologia , Masculino , Estado Nutricional , Nutrição Parenteral/métodos , Estudos Retrospectivos , Síndrome do Intestino Curto/cirurgia , Resultado do Tratamento
16.
Transplant Proc ; 38(6): 1689-91, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16908249

RESUMO

We evaluated 131 patients (6 months-14 years) who experienced 21 deaths before listing, 11 continuing on the waiting list, 38 well on home parenteral nutrition, 6 off parenteral nutrition and 59 transplanted (20 girls) aged 2.5 to 15 years, (18 >7 years). They received cadaveric isolated intestine (ITx, n = 31) or liver-small bowel (LITx, n = 32), including right colon (n = 43; 23 LITx) for short bowel (n = 19), enteropathy (n = 20), Hirschsprung (n = 14), or pseudo-obstruction (n = 6). Treatment included tacrolimus, steroids, azathioprine, or interleukin-2 blockers. After 6 months to 10.5 years, the patient and graft survivals were 75% and 54%. Sixteen patients (10 LITx) died within 3 months from surgery (n = 3), bacterial (n = 5) or fungal (n = 6) sepsis, or posttransplant lymphoproliferative disorder (n = 2). Rejection occurred in 27 patients, including 10 steroid-resistant episodes requiring antilymphoglobulins. The grafts were removed due to uncontrolled rejection in seven ITx recipients. Surgical complications were observed in 38 recipients (25 LSBTx) within 2 months, including bacterial (n = 22) or fungal (n = 11) sepsis, cytomegalovirus disease (n=12), adenovirus (n = 11), or posttransplant lymphoproliferative disorder (n = 12). Forty-two children (19 LSBTx) are alive. Weaning from parenteral nutrition was achieved after 42 days (median). Factors related to death or graft loss were pre-Tx surgery (P < .01), pseudo-obstruction (P < .01), age over 7 years (P < .03), fungal sepsis (P < .03), steroid resistant rejection (P < .05), hospitalized versus home patient (P < .01), and retransplantation (P < .05). Colon transplant did not affect the outcome. Interleukin-2 blockers improved isolated ITx (P < .05). Early referral and close monitoring of intestinal failure and related disorders are mandatory to achieve successful ITx.


Assuntos
Intestino Delgado/transplante , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Enteropatias/classificação , Enteropatias/cirurgia , Estudos Retrospectivos , Análise de Sobrevida , Transplante Homólogo/mortalidade , Transplante Homólogo/fisiologia , Falha de Tratamento , Resultado do Tratamento
17.
Eur J Pediatr Surg ; 15(2): 95-101, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15877257

RESUMO

UNLABELLED: This retrospective study aims to analyze the outcome, the prognosis factors and the long-term growth of children after extensive small bowel (SB) resection in the neonatal period. PATIENTS AND METHODS: 87 children, born between 1975 and 1991 who had undergone extensive neonatal small bowel resection, were followed up over a mean period of 15 years. Anatomical data influencing PN dependency and duration were analyzed. Data on height and weight were collected and compared using growth standards. Final heights were studied for patients who achieved their puberty and compared to predicted height based on Tanner's formula. Patients were analyzed according to PN weaning and growth: children still receiving PN (group A), patients weaned from initial PN but requiring PN once again or enteral feeding (group B), and children with permanent intestinal autonomy (group C). RESULTS: The overall survival is 89.7 %, depending on the date of birth. The duration of PN-dependency varies according to the intestinal length and the presence of the ileocaecal valve (ICV). All patients who remain PN dependent had less than 40 cm of small bowel and/or the absence of ICV. Patients in group B had a mean small bowel length of 35 +/- 19 cm, resection of the ICV in 50 % of cases, and a PN duration of 47.4 +/- 23.8 months. There was a significant decrease in height and weight gain within the 4 years after cessation of PN, requiring enteral or parenteral feeding. Patients in group C had a mean small bowel length of 57 +/- 19 cm, presence of ICV in 81 % of cases and a PN duration of 16.1 +/- 11.4 months. After PN weaning, they grow up normally with normal puberty and final height as predicted from genetic target height. CONCLUSION: PN duration is influenced by the length of residual SB and the absence of ICV. With good anatomic prognosis factors and short duration of initial PN, normal long-term growth may be predicted. Conversely, poor anatomical factors and protracted initial PN require careful monitoring of growth and may sometimes require nutritional support to be restarted. The last group, permanently dependent on PN, might be candidates for intestinal transplantation.


Assuntos
Desenvolvimento Infantil/fisiologia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Intestino Delgado/cirurgia , Apoio Nutricional , Síndrome do Intestino Curto/terapia , Tamanho Corporal/fisiologia , Nutrição Enteral , Feminino , Seguimentos , Humanos , Recém-Nascido , Masculino , Nutrição Parenteral , Prognóstico , Estudos Retrospectivos , Síndrome do Intestino Curto/etiologia , Análise de Sobrevida , Resultado do Tratamento
18.
Arch Pediatr ; 12(3): 258-63, 2005 Mar.
Artigo em Francês | MEDLINE | ID: mdl-15734120

RESUMO

Congenital hyperinsulinism of infancy is a severe disease that leads to important brain damage. Two different forms of the disease have been identified by pathologists: a diffuse and a focal form. A specific genetic anomaly identified in focal forms has never been described in diffuse ones. However, for most of authors, failure of medical treatment results in near-total pancreatectomy in all cases, which ends in diabetus. The aim of this retrospective study was to assess the results of elective partial pancreatectomy performed in 60 cases of focal form of hyperinsulinism over the last 18 years. Fifty-eight patients were cured with euglycemia at both fasting and hyperglycaemic tests without insulin-dependent diabetes mellitus. One patient is still in hypoglycaemia from unrecognized lesion; insulin-dependent diabetes mellitus occurred in one case nine years after surgery (a near-total pancreatectomy has been performed because of unknown focal form, in 1985).


Assuntos
Hiperinsulinismo Congênito/cirurgia , Pancreatectomia , Biópsia , Criança , Pré-Escolar , Hiperinsulinismo Congênito/classificação , Hiperinsulinismo Congênito/diagnóstico , Hiperinsulinismo Congênito/genética , Hiperinsulinismo Congênito/patologia , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Mutação , Pâncreas/patologia , Complicações Pós-Operatórias , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
19.
Arch Pediatr ; 9(12): 1226-9, 2002 Dec.
Artigo em Francês | MEDLINE | ID: mdl-12536102

RESUMO

UNLABELLED: Classically, testicular torsion occurs in neonates or during puberty. Between these two ages, is it really an exception? METHOD AND PATIENTS: In order to answer the question, we reviewed the charts of the patients referred to the department of pediatric surgery of Bicêtre hospital between 1992 and 2001. We studied the preoperative examinations, the operative data and the long term evolution. Cases of torsion occurring during neonatal or pubertal periods were excluded. RESULTS: During nine years, 86 patients with "acute scrotum symptoms" underwent surgery. The ages of patients ranged from one month to 11 years (average age: five years) in 26 patients, among which 12 had true testicular torsion. Consultation at the emergency room occurred after one to 72 hours (average of 17). The localization of the pain was on the left in eight cases and on ectopic testicle in two. The testicular volume was increased in 11 cases. Cremasteric reflex was absent in four cases. The doppler flow was normal in four cases and absent in four. During surgery, the testis appearance was considered as normal in six testicles, as necrotized in three (and an orchidectomy was performed) and as ischemic in three. In seven cases, a peroperative contralateral testicle fixation was performed and later one in two. The postoperative course was simple, without infection and with a normal testicular volume in eight cases, increased in one ischemic testis. Testicular atrophy was noted in an ischemic testis, after several months. CONCLUSION: Whatever the age, testicular torsion remains a surgical emergency even with a normal doppler flow.


Assuntos
Torção do Cordão Espermático/cirurgia , Fatores Etários , Criança , Pré-Escolar , Gráficos por Computador , Ecocardiografia Doppler , Humanos , Lactente , Masculino , Estudos Retrospectivos , Torção do Cordão Espermático/diagnóstico , Torção do Cordão Espermático/epidemiologia , Resultado do Tratamento
20.
Ann Chir ; 125(1): 62-5, 2000 Jan.
Artigo em Francês | MEDLINE | ID: mdl-10921187

RESUMO

Abbreviated laparotomy and planned reoperation(s) is a new concept in severely injured patients with multivisceral failure by hemorrhagic shock, coagulopathy and hypothermia. The aim of an abbreviated laparotomy is to control hemorrhage, prevent digestive contamination and close the abdominal wall without tension. After a delay for reanimation during 24 to 96 hours, discovery of unknown lesions and anatomic reconstruction will be possible through planned reoperation in better conditions. Emergency reoperation for hemorrhage and abdominal hyperpression severely worsens prognosis.


Assuntos
Traumatismos Abdominais/cirurgia , Hemorragia Gastrointestinal/cirurgia , Laparotomia/métodos , Traumatismos Abdominais/patologia , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Hipotermia , Pressão Negativa da Região Corporal Inferior , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos , Prognóstico , Reoperação , Choque Hemorrágico , Fatores de Tempo
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