Renal transplantation in children: critical analysis of age related surgical complications.

To determine age-related risk factors of urological and vascular complications. We performed a retrospective analysis of the data of 202 renal transplantations in 193 children between 1989 and 2007 at a single institution. Out of 193 grafts (combined renal and liver grafts were excluded), we observed urological complications in 42 cases (21.7%) leading to graft loss in one case and vascular complications in 27 cases (13.9%) leading to graft loss in seven. The urological complications were VUR (n=25, 12.4%), ureteral stricture (n=10, 5%), anastomotic leak (n=4, 2%), ureteral necrosis (n=2, 1%), and incrustative pyelitis (n=1, 0.5%). Vascular complications were arterial stricture (n=14, 7.2%), arterial thrombosis (n=4, 2%), venous thrombosis (n=2, 1%), and others (n=7). Donors aged less than six yr were a risk factor of vascular complications leading to graft loss (p=0.0001), whereas patients with PUV had more urological complications (p=0.001). Overall patient and graft survival is 93.1% and 84% at five yr, respectively. Surgical complications remain a major cause of graft loss (12%) and morbidity in children's kidney transplantation (38.9%). Young age of donors is the major risk factor of early graft loss as a result of vascular complication. However, donor selection based on age is limited by the shortage of organs.

[Postoperative imaging of the cardia and stomach]. / Imagerie post-opératoire du cardia et de l'estomac.

In addition to treatment of complications from peptic ulcer disease, gastroesophageal reflux and gastric cancer, bariatric surgical procedures have increased over the recent years. Complications after gastric surgery are imaged with upper gastrointestinal contrast studies and CT. This imaging is not always easy and it is important for radiologists to know the different types of surgical techniques and to be familiar with normal postoperative anatomical and pathological findings.

Colorectal surgery in cirrhotic patients: assessment of operative morbidity and mortality.

PURPOSE: The morbidity from colorectal surgery can be high and increases for patients with cirrhosis of the liver. This study was designed to assess morbidity, mortality, and prognostic factors for patients with cirrhosis undergoing colorectal surgery. METHODS: From 1993 to 2006, 41 cirrhotic patients underwent 43 colorectal procedures and were included. Both univariate and multivariate analyses were performed to identify variables influencing morbidity and mortality. RESULTS: Postoperative morbidity was 77 percent (33/43). Postoperative mortality was 26 percent (11/43) among whom six patients (54 percent) underwent emergency surgery. Four factors influenced mortality on univariate analysis: presence of peritonitis (P < 0.05), postoperative complications (P < 0.04), postoperative infections (P < 0.01), and total colectomy procedures (P < 0.02). On multivariate analysis, the only factor influencing mortality was postoperative infection (P < 0.04). The only factor influencing morbidity was the existence of preoperative ascites (P < 0.04). CONCLUSIONS: Colorectal surgery for cirrhotic patients has a high risk of morbidity and mortality. This risk is associated with the presence of infection, ascitic decompensation, and the urgent or extensive nature of the procedure. The optimization of patients through selection and preparation reduces operative risk.

[Imaging of child osteoarticular infections]. / Imagerie des infections ostéoarticulaires de l'enfant.

The diagnostic strategy in imaging osteoarticular infections is currently quite well codified. X-rays, always available in the emergency situation, are systematically taken. They can be usefully completed with sonography in accessible superficial locations, when looking for a puncturable abscess. MRI is not systematic but is widely used: In place of bone scintigraphy, when osteomyelitis is suspected with a normal x-ray and a clinical warning sign; In the acute period of certain deep topographies when looking for an abscess (pelvis, spinal cord); When growth cartilage is involved to evaluate the risk of epiphysiodesis; When there is resistance to treatment; In the chronic forms of osteomyelitis, for diagnosis and evaluating the extent of infection. The CT scanner has few indications: it is performed when looking for bone sequestrum in chronic forms and when MRI access is impossible in difficult anatomical sectors (spinal cord, pelvis, scapula). Scintigraphy is currently only performed when x-rays are normal and there are no clinical warning signs.

Primary diffuse large B-cell non-Hodgkin lymphoma of the paranasal sinuses: a report of 14 cases.

Sinonasal lymphoma (SL) is a rare form of extranodal lymphoma. Of 33 SL cases, 14 consecutive diffuse large B-cell lymphomas were treated with CHOP (adriamycin, cyclophosphamide, vincristine and prednisone) or CHOP-like chemotherapy regimen. Ten achieved complete remission (CR) and three achieved a partial remission. With a median follow-up period of 80 months, seven patients relapsed or progressed [one case including central nervous system (CNS) progression]. Four of the relapses involved the CNS. Eight patients were alive, including seven in CR and six patients had died of their lymphoma. This observation strongly suggests that CNS prophylaxis should be used in SL.

[Carcinoid tumor of the small bowel: value of hydro-MR imaging for diagnosis]. / Tumeur carcinoïde de l'intestin grêle: apport d'une technique d'hydro-IRM dans le diagnostic.

Hydro-MR imaging is a technique based on the use of a strongly T2-weighted single-shot fast spin-echo (SSFSE) sequence, similar to that used for MR-cholangiography. We report herein one case of carcinoid tumor of the small bowel diagnosed by hydro-MR imaging. This non invasive MR technique showed suggestive features such as radial convergence and segmental dilatation of a small bowel loop, similar to those seen on conventional follow-through studies. This case illustrates the major role that may be played in the future by hydro-MR imaging for the non invasive diagnosis of carcinoid tumor of the small bowel without the use of ionizing radiation.

[Late diagnosis of a bronchial fracture after thoracic injury]. / Diagnostic tardif d'une fracture bronchique après traumatisme thoracique.

We report a case of bronchial fracture diagnosed in a child who had sustained a chest injury two and a half months earlier. Immediately after the injury, clinical and roentgenographic findings usually suggest the diagnosis, which is then confirmed by fiberoptic endoscopy. Because latent forms are frequent (10%), fiberoptic bronchoscopy should be widely used in patients having sustained a motor vehicle accident responsible for a significant chest injury. A follow-up visit two months after the injury ensures prompt detection of secondary complications.