Successful early surgical treatment in neonatal compartment syndrome: case report.

Neonatal compartment syndrome is rare, and the diagnosis is often missed or delayed because other ischemic diseases can mimic clinical signs observed on the skin. A premature newborn infant presented with skin lesions during the first hours of life that were recognized as the sentinel finding in compartment syndrome of the newborn. We restored normal function by emergency surgery. The authors highlight the importance of effective collaboration between pediatricians and surgeons to improve the management of this neonatal condition.

[Congenital mesoblastic nephroma: diagnosis and treatment of one case]. / Le néphrome mésoblastique congénital : diagnostic et prise en charge à partir d'un cas.

The congenital mesoblastic nephroma (CMN) described by Bolande et al. in 1967 is a renal tumor often discovered in neonatal period and early childhood. It's usually considered as a benign tumor with good prognostic for which nephrectomy is the reference treatment. But some cases of local recidives and metastatic sites had been described in the literature. For these reasons histologic analysis and quality of follow up are very important. In this observation we describe a neonatal kind of CMN and we discuss this pathology.

Transient pseudohypoaldosteronism: a potentially severe condition affecting infants with urinary tract malformation.

BACKGROUND: Secondary pseudohypoaldosteronism (S-PHA) is a life-threatening condition affecting young children with urinary tract malformation (UTM). OBJECTIVE: The aim of the study was to highlight the diagnosis of S-PHA in children with UTM and propose appropriate management. STUDY DESIGN: The authors retrospectively reviewed cases of S-PHA related to UTM observed at the institution and searched the PubMed® database to review the literature. RESULTS: A total of 116 cases of S-PHA associated with UTM, including the four cases from the institution, were reviewed. One hundred six cases (92.2%) were younger than 6 months, and 95 cases (81.9%) occurred in boys. Urinary tract infection was associated in 105 cases (90.5%). All types of UTM were observed. In the absence of urinary tract infection, S-PHA was related to bilateral UTM or solitary kidney. In 89 cases (76.5%), S-PHA resolved with medical treatment only. In cases of UTM requiring immediate surgery, electrolyte imbalance related to S-PHA also resolved after surgery. Children with associated urinary tract infection and bilateral UTM are at higher risk of developing S-PHA. DISCUSSION: The pathogenesis of S-PHA has not been fully elucidated. Renal tubular immaturity may be one of the factors involved, in view of the young age of the population being affected. A high rate of bilateral UTM (or UTM on solitary kidney) was observed (50.9%), suggesting an association with S-PHA. In the absence of urinary tract infection (UTI), S-PHA appeared to occur more frequently in the presence of bilateral UTM. Although the indication for early surgery remains unclear, it may have a role in the prevention of UTI and prevention of recurrence of S-PHA. Serum electrolytes should be checked in children with UTM before urological surgery, and/or presenting urinary tract infection, before the age of 6 months. The results of this study must be interpreted cautiously because of its retrospective nature and the fact that data were derived from various articles. Few articles on S-PHA related to UTM have been published in the literature. To the best of the authors' knowledge, the study constitutes the largest series published to date. CONCLUSIONS: S-PHA results in potentially severe electrolyte imbalance and affects children younger than 6 months with UTI and/or UTM. Electrolyte abnormalities related to S-PHA often resolve after administration of appropriate intravenous electrolyte solution and treatment of UTI and/or surgery.

Impact of colostomy on intestinal microflora and bacterial translocation in young rats fed with heat-killed Lactobacillus acidophilus strain LB.

A rat animal model of left colostomy was found to significantly impair the growth curve of rats. Assessment of the intestinal flora showed that colostomy mostly affects the cecal but not colonic microflora. Generally, the number of enterococci was increased in both ileum and cecum; cecal lactobacilli also rose, accounting for a promotion of lactic acid bacteria in colostomised rats. No significant differences between colostomised, laparotomised and control rats could be observed for the translocation of intestinal bacteria to internal organs of rats (i.e. spleen, kidneys, lungs or liver), whatever their diet. Heat-killed Lactobacillus acidophilus strain LB administration (dead probiotic bacteria) tended to exhibit a stimulatory effect on bifidobacteria, probably affecting the culture-medium fermentation substances included in the pharmaceutical product. This effect was abolished by laparotomy and colostomy. A trend towards a probiotic-like effect, not susceptible to colostomy, was also witnessed as counts of lactobacilli tended to increase in both cecum and colon of all animals fed with L. acidophilus LB.

[Isolated gallbladder agenesis mimicking biliary colic: A difficult preoperative diagnosis]. / Coliques hépatiques révélant une agénésie de la vésicule biliaire : un diagnostic préopératoire difficile.

Isolated gallbladder agenesis is a very rare and unrecognized congenital anomaly. Patients are usually asymptomatic, but 23% present with symptoms suggestive of biliary colic. Ultrasound investigation often fails to diagnose this malformation, misinterpreted as scleroatrophic gallbladder, leading to unnecessary and potentially dangerous surgery. We report on a case of a 9-year-old child who complained of biliary colic. Ultrasound showed a possible scleroatrophic gallbladder. This diagnosis was in doubt, however, because the patient had no previous history of cholecystitis. Finally, magnetic resonance cholangiopancreatography failed to show any gallbladder. The absence of the visualization of the gallbladder in a context of right upper quadrant pain should suggest gallbladder agenesis. Pain can be explained by the so-called postcholecystectomy syndrome.

[Giant mesocolic cystic lymphangioma: A treacherous prenatal presentation. Case report]. / Lymphangiome kystique géant du mésocôlon : un diagnostic anténatal difficile. À propos d'un cas.

Cystic lymphangiomas are usually located in the neck region. Less frequently, they can be found in the abdomen. In those cases, pre- and neonatal diagnosis is extremely difficult. We report on the case of a giant mesocolic cystic lymphangioma, diagnosed at birth, in a child who had been monitored during the prenatal period for what was believed to be a digestive dilatation. The progression was marked by excellent tolerance despite a complete lack of regression in the first 10 months of life. The authors discuss the prenatal signs that should suggest this diagnosis and an MRI, as well as management during the 1st year of life.

[Congenital mesenteric band simulating a small-bowel volvulus in a mesenteric rotation anomaly]. / Bride mésentérique congénitale simulant un volvulus de l'intestin grêle sur anomalie de rotation mésentérique.

A congenital mesenteric band is a rare cause of intestinal obstruction. We describe a case of upper gastrointestinal obstruction on a jejunal congenital band in a 2-year-old child. The challenge is to make the diagnosis in a patient with no history of previous surgery.

[Complete resolution of inflammatory myofibroblastic tumor of the bladder after antibiotic therapy]. / Régression complète d'une tumeur myofibroblastique inflammatoire de vessie après antibiothérapie.

Inflammatory myofibroblastic tumors (IMT) are rare benign tumors, most commonly arising in the lungs and urinary bladder. Many etiologic factors are suspected in their development, but none have been formally demonstrated. Conventional treatment for bladder IMT is complete surgical resection by partial cystectomy or transurethral resection. We report the case of an 8-year-old girl with documented bladder IMT that resolved completely after antibiotic therapy.

[Laparoscopic surgery in children]. / Chirurgie coelioscopique chez l'enfant.

In the last two decades, laparoscopy surgery has been progressively adopted to children. Cardiorespiratory changes induced have been understood and controlled. Abdominal and urological surgery have widely benefited from this technique. Immediate postoperative period is simpler. The risk of small bowel obstruction by bands and adhesions is limited. Nevertheless, laparoscopy is not indicated for all pathologies. In neonatal surgery, more studies are necessary. Maybe the future is robotic surgery.

[Urodynamic investigations in children]. / Place des investigations urodynamiques chez l'enfant.

Performing urodynamic investigations in children presents some difficulty due to the lack of any normogram, and due to the results that vary with age. Such investigation is therefore carried out only when clinical examination and radiological assessment fail to explain a voiding dysfunction. The procedure should be performed in a urodynamic unit that has paediatric expertise. A specific paediatric procedure is to be respected when performing uroflowmetry and cystometry in children. Assessing the urethral pressure profile is very difficult since moving a catheter along the urethra causes a reflex activity of the pelvic floor muscles. Main indications are: neuropathic bladders, voiding dysfunctions, urinary infections, anorectal malformations and pelvic tumours. As in adults, urodynamic investigations are useful when selecting a therapeutic strategy.

[A bulky lateral cervical mass]. / Une volumineuse tuméfaction cervicale latérale.

Branchial cysts are rare, benign cervical lesions that can mimic thyroid goiters, in particular in areas where goiters are endemic. This case describes an Ivorian patient who presented with what appeared to be a voluminous thyroid goiter. At surgery, it proved to be a cyst of the second pharyngeal arch.

[Chronic intestinal pseudo-obstruction complicated by an eating disorder]. / Pseudo-obstruction intestinale chronique compliquée d'un trouble des conduites alimentaires chez une adolescente.

Chronic idiopathic intestinal pseudo-obstruction is a rare and serious chronic disease starting in childhood, which can affect the entire digestive tract. It is caused by a peristalsis intestinal disorder that leads to occlusions without any obvious obstruction. Few studies have been carried out regarding the prognosis of this illness. This disease is often diagnosed by a process of elimination, but some histological anomalies have been present in the digestive wall of certain patients. This clinical case concerns a 17-year-old girl affected by CIPO and eating disorders. It seems difficult to discriminate between digestive disorders and eating disorders. What psychological effects can this severe pathology have? Are eating disorders induced by CIPO? These questions are raised in this article through the example of this patient's somatopsychic complexity and the ensuing difficulties in her overall care.

[Does prenatal diagnosis modify neonatal management and early outcome of children with esophageal atresia type III?]. / Le diagnostic anténatal modifie-t-il la prise en charge néonatale et le devenir à 1 an des enfants suivis pour atrésie de l'œsophage de type III ?

OBJECTIVE: Evaluate neonatal management and outcome of neonates with either a prenatal or a post-natal diagnosis of EA type III. STUDY DESIGN: Population-based study using data from the French National Register for EA from 2008 to 2010. We compared children with prenatal versus post-natal diagnosis in regards to prenatal, maternal and neonatal characteristics. We define a composite variable of morbidity (anastomotic esophageal leaks, recurrent fistula, stenosis) and mortality at 1 year. RESULTS: Four hundred and eight live births with EA type III were recorded with a prenatal diagnosis rate of 18.1%. Transfer after birth was lower in prenatal subset (32.4% versus 81.5%, P<0.001). Delay between birth and first intervention was not significantly different. Defect size (2cm vs 1.4cm, P<0.001), gastrostomy (21.6% versus 8.7%, P<0.001) and length in neonatal unit care were higher in prenatal subset (47.9 days versus 33.6 days, P<0.001). The composite variables were higher in prenatal diagnosis subset (38.7% vs 26.1%, P=0.044). CONCLUSION: Despite the excellent survival rate of EA, cases with antenatal detection have a higher morbidity related to the EA type (longer gap). Even if it does not modify neonatal management and 1-year outcome, prenatal diagnosis allows antenatal parental counseling and avoids post-natal transfer.

Superior vena caval thrombosis and recurrent pericarditis caused by a bronchogenic cyst.

A 49-year-old man with a past history of multiple episodes of acute pericarditis was admitted with a recurrence of symptoms combined with the superior vena caval syndrome. A bronchogenic cyst, located beneath the carina, was discovered. At operation, the cyst was partially resected, and superior vena caval flow was restored by a Gore-Tex prosthesis. Ten months later the superior vena caval syndrome reappeared. Angiography demonstrated subtotal stenosis of the graft, which was considered to be thrombotic due to the discontinuance of oral anticoagulants. Reoperation, however, showed no thrombosis, but kinking of the graft. The folded portion of the prosthesis was resected, since when the patient has done well.

[Diverticulum of the right atrium. A case report and review of the literature]. / Diverticule de l'oreillette droite: description d'un cas et revue de la littérature.

Congenital atrial diverticula are rare, especially those involving the right atrium. This condition was observed in a 52 year old man who presented with palpitations. The diagnosis was made by two-dimensional echocardiography and confirmed by CT scan, magnetic resonance imaging and angiography. In the absence of significant invalidity, no treatment was recommended. Only three other cases of this condition have been previously reported, all of which were referred for surgery for thrombotic complications, arrhythmias and cardiac failure. Anatomo-pathological analysis showed different appearances: fibrous tissue and lipomatous degeneration. In the absence of associated heart disease, these aneurysms are probably congenital.

[Change in management of ureteropelvic junction obstruction]. / Evolution de la prise en charge du syndrome de la jonction pyélo-urétérale.

PURPOSE: The aim of this study was to evaluate the change in ureteropelvic junction management, from surgical correction to observation of the hydronephrosis. We checked wether or not it was deleterious for kidney. MATERIALS AND METHODS: We retrospectively reviewed 96 charts between 1988 and 1998. Initial ultrasonography, and voiding cystourethrogram were available for all cases. Intravenous urography and diuretic renography were studied when available. Minimal follow-up of patients was one year. Patients were divided into three groups: surgery right away, surgery after observation, and observation only. RESULTS: Later was the diagnosis, more significant were the hydronephrosis and impairment of renal function (p < 0.01). In group operated on right away (69 cases), drainage improved, hydronephrosis decreased, but renal function did not improve significantly (p = 0.37). Sixteen patients were operated on after observation without deleterious effect for kidney. Eleven patients were only observed: hydronephrosis progressively decreased. Initial radiological results were not different between the last two groups (p > 0.05), and were not predictive of their course. CONCLUSION: Initial non operative management of hydronephrosis was not dangerous for renal function. It is advisable to detect at the earliest all signs of obstruction, because surgery improves renal drainage but not renal function.

[Outcome at 2 years of very premature infants cared at the hospital of Cayenne in 1998]. / Devenir médicosocial à l'âge de 2 ans des grands prématurés pris en charge au centre hospitalier de Cayenne en 1998.

UNLABELLED: Perinatal mortality in French Guyana is twice as high as the national rates. Within a global project rallying all the people working around the birth, a catching up program benefited the neonatal unit of the Cayenne hospital in order to make up for the important lack of modern structures and means. OBJECTIVES: To establish some quality care for the less than 33 weeks preterm infants born in 1998, and to estimate the medical and familial future for these infants after they have reached 2 years of age. METHODS: All less than 33 weeks old infants born alive and admitted at the neonatology unit of the CHC were included in the study. The obstetrical and neonatal data were recorded from the medical files. A survey was conducted through a questionnaire including the familial and medical outcome and was led from december 1999 to july 2001. Results were analysed with Epi-info 6.0 software (CDC, Atlanta, USA). RESULTS: Eighty-eight infants issue from 78 pregnancies were included. Among them, 29 were transferred in utero and 12 were transferred after birth. The mothers' situations were mainly characterized by precariousness, a poor follow-up of the pregnancy (27% non-declared), a higher morbidity of their newborns. Neonatal results did not differ from national results from Epipage cohort in terms of gestational age (29.9 weeks), weight at birth (1411 g), mortality (90.9 alive when released from the hospital), morbidity, growth at 2. However, 26% were hypotrophic (15% in Epipage cohort) in relation with the 29% pregnancies complicated with hypertension. Four infants were suffering from acquisition retardation due to motor handicaps; 2 infants had severe socio-educative difficulties. The postnatal follow-up was mainly performed by the Mother and Children Health Centers. A third of medical exams were not recorded in the health book, sensory screening exams were not performed. The opening of a medicosocial actions center in 2001, will allow a prospective follow-up of this population. CONCLUSION: Early neonatal mortality decreased from 10.3 for 1000 births to 4.4 in 1998. This reflects the improvement of the new-born caring possibilities. However, an improvement of mortality rates will not be possible without a better pregnancy follow-up.

[Treatment of subcutaneous ruptures of the Achilles tendon by percutaneous tenorraphy]. / Traitement des ruptures sous-cutanées du tendon d'Achille par ténorraphie percutanée.

Since 1982, the authors have progressively settled a technique to repair the calcaneal tendon, the result of which is a percutaneous tenorraphy exclusively used for more than 2 years. Their study includes 28 cases between 1989 and 1992, with an average post operative time of 15.6 months. The technique is fully described, its aim was to restore a normal length of the ruptured tendon in placing together the 2 tendinous ends during the required time to obtain natural regeneration of the Achilles tendon. It reduces the theoric immobilization time, makes rehabilitation easier as well as the return to sportive and professional activities. The suture was percutaneously made with a special material: A Dacron yarn with a 5 mm wide hook set on a 12 long flexible needle. The results were globally good and only very few complications were observed.

[Sinus infection and diving (a case of cerebral empyema)]. / Infection sinusienne et plongée (à propos d'un empyème cérébral).

Intracranial complications following swimming or diving accidents are exceptional. A recent observation of a cerebral empyema in a 15-year old boy, with neurological sequellae was an opportunity the clarify the issue. Apart from the rapidity of the neurological signs, two points drew our attention: bacteriology, with a predominance of anaerobic germs; and the problem of therapy, both for the timing of neurosurgery and for the role of anticoagulants in venous thrombosis.

[The styloid bone and carpal protuberance]. / Os styloïdeum et carpe bossu.

Dorsal carpal protuberance of the wrist is frequently caused by the presence of a styloideum bone. We report a case illustrating this pathophysiological hypothesis. This pathology is often confused with synovial cyst emphasizing the importance of a lateral view of the hand in 30 degrees supination. Computed tomography sections are also helpful showing the exact nature of the protuberance. A cuneiform resections of the joint line can leave to complete symptom relief.