[The long Telegraph nail for humeral fractures]. / Le clou Telegraph long dans les fractures de l'humérus.

PURPOSE OF THE STUDY: We present an anterograde nailing system for humeral shaft fractures: the long Telegraph(R) nail. This nail enables static or dynamic anteroposterior distal locking and is easy to insert with the special aiming device. MATERIAL AND METHOD: This study concerned 148 patients who underwent surgery between September 1998 and February 2005, 86 women, men age 68 years and 62 men, mean age 53 years. After excluding patients lost to follow-up and pathological fractures, we analyzed 104 files to determine the rate of nonunion as a function of distal locking or not and dynamic versus static locking. We also reviewed 56 patients measuring the Constant score at mean 2.7 years follow-up. RESULTS: There were no cases of iatrogenic radial palsy and no cases of infection. There were four cases of nail fracture. The overall rate of nonunion was 7.7%. Nonunion was never observed with dynamic distal locking (p=0.03). Regarding the effect of the nail on shoulder function, the mean weighted Constant score was 105.4% with preservation of mean joint motion and a pain free shoulder in 36/56 patients. DISCUSSION: The long Telegraph(R) nail enables anterograde nailing of the humeral shaft with a simplified system for dynamic or static distal locking. In this series, dynamic distal locking appeared to provide the best rate of nonunion. If installed correctly, the system does not appear to affect shoulder function.

Home parenteral nutrition in children: bioavailability of vitamins in binary mixtures stored for 8 days.

Vitamin supply in children on long-term parenteral nutrition depends on the specific age-related needs and on the bioavailability of vitamins when introduced into nutritional bags. The present study aimed to investigate the vitamin status in children on home TPN receiving nutritional bags which had been stored during a prolonged period of 8 instead of 4 days and where the new vitamin preparation Cernevit has been introduced. 19 children aged from 5 months to 11 years receiving home parenteral nutrition, for 42 months on average, were studied. Daily vitamin supply for children above 2 years of age was: A 1050 ug, D 5.5 ug, E 10.2 mg plus 0.6 mg/g lipid (Intralipid), C 125 mg, B1 3.5 mg, B2 4.1 mg, B6 4.5 mg, biotine 69 mug; children who were younger than 2 years received half of these intakes. Water soluble vitamin status was only measured in children over 3 years old. Plasma levels remained stable and adequate for age, for most of the studied vitamins. Vitamin A concentration was inferior to 200 mug/l in 1 patient with hepatopathy. Plasma concentrations of vitamin E, which were initially below 6 mg/l in 4 patients, returned to normal during the study. Plasma levels of vitamin C were below 6.2 mg/l in several infants either temporarily (5 patients) or during the whole study period (2 patients). These results support a prolongation of the intervals between preparing batches of nutritional bags and also between deliveries. This results in a considerable reduction of costs, provided that plasma vitamin levels, specially vitamin C, are regularly monitored.

Aluminium loading in children receiving long-term parenteral nutrition.

Eight children on long-term, total parenteral nutrition (TPN) were found to have elevated aluminium (Al) levels in plasma (51 +/- 11 microg 1/1), urine (223 +/- 78 microg 24 h) and bone. The load of Al in TPN solution was 232 +/- 89 microg/day, and, among the different parenteral solution components high Al concentrations were found in amino-acids, calcium gluconate, potassium lactate, and trace elements, representing respectively 40%, 30%, 15%, and 10% of the total Al intakes. The authors conclude that children receiving long-term TPN have excessive Al intakes and are exposed to Al toxicity. The prevention of Al contamination requires careful control of the TPN components.

Ultrasonographic diagnosis of portal cavernoma in children: a study of twelve cases.

Portal vein and its two branches were evaluated by ultrasound in 12 children (14 months to eight years) with portal cavernomas; the cavernomas appeared idiopathic (five cases) or were secondary either to a catherization of umbilical vein in the neonatal period (six cases) or to trauma (one case). Angiographic confirmation of cavernoma was obtained in all patients. Twelve patients with intrahepatic portal hypertension were used as controls. The following abnormal patterns were observed: (1) absence of normal portal vein; (2) absence of normal portal division; (3) tortuous, small and irregular appearance and/or abnormal sagittal division of the venous system; (4) presence of small linear echoes dotting the portal vein; (5) presence of small linear echoes dotting the porta hepatis area. Ultrasonogram was normal in the 12 controls. Thus, ultrasound appears to be a procedure of choice in the evaluation of portal cavernomas, permitting postponement of invasive angiographic examination until surgical treatment is anticipated.

Emergency embolization in posttraumatic hemobilia in a child.

The authors report a case of hemobilia in a ten-year-old boy after abdominal trauma. An intrahepatic false aneurysm was successfully embolized during the diagnostic angiogram. This is, to their knowledge, the first pediatric case successfully embolized with posttraumatic hemobilia.

[Veinous return from the inferior vena cava into the left atrium after surgical correction of Fallot's tetralogy]. / Retour veineux cave inférieure dans l'oreillette gauche après correction d'une tétralogie de Fallot.

A child of 6 presented with a syndrome of gross respiratory distress together with persistant arterial desaturation, requiring ventilation for maintenance of life, occurring after the apparently straightforward correction of a Fallot's tetralogy. Postoperative investigation on the 15th day showed the reasons for the desaturation: there was a massive right-left shunt caused by flow from the inferior vena cava into the auricle of the left atrium through a low atrial septal defect which had not been recognised. Reoperation on the 15th day to close the atrial septal defect corrected the condition satisfactorily.

[Right ventricular migration of a stent after endovascular treatment of a superior vena cava syndrome]. / Migration ventriculaire droite d'un stent après traitement endovasculaire d'un syndrome cave supérieur.

The authors report a case of migration of a Palmaz stent used for treatment of a patient with a malignant superior vena caval syndrome. Transoesophageal echocardiography showed the metallic device in the tricuspid subvalvular apparatus. Several attempts to recover the stent percutaneously failed. This case illustrates a rare but serious complication of endovascular stenting: migration of the material. Although it is often possible to reposition the stent by radiological interventional techniques, when the stent is located in the right ventricle, the procedure is more difficult and usually fails. Transoesophageal echocardiography enables accurate localisation of the material with respect to the surrounding cardiac structures, especially the tricuspid valve.

[Sensitivity and specificity of temporal Doppler in Horton's disease]. / Sensibilité et spécificité du Doppler temporal dans la maladie de Horton.

170 patients with suspected temporal arteritis underwent Doppler investigation before temporal artery biopsy. Doppler study included the large cervical trunks, the ophthalmic system and analysis of the terminal branches of the external carotid with recording of the temporal territory on 3 points. Biopsy confirmed the diagnosis of temporal arteritis in 48 cases; it was negative in 122 cases. Doppler study and histological examination agreed in 137 patients (80%). There was disagreement in 33 cases (20%). The Doppler signal was pathological in 43 of the 48 cases of temporal arteritis (90%). There were 5 false negatives (10%). In subjects free from temporal arteritis, the Doppler examination was normal in 94 cases (77%), and was pathological in 28 cases (23%). The sensitivity of Doppler examination in the diagnosis of temporal arteritis was 90%, its specificity was 77%. The predictive value of a positive Doppler vis-a-vis the condition was only 61%. On the other hand, the predictive value of a normal examination was very high (95%). The high level of false positives is explained by technical problems, but especially by a high incidence of sometimes very stenosing senile arteritis. Finally, 3 of the 28 false positives (11%) subsequently developed authentic inflammatory arteritis. The authors conclude that a positive Doppler examination does not allow reliable prediction of the presence of temporal arteritis. On the other hand, a normal examination almost always allows the diagnosis of temporal arteritis to be excluded with a risk of error of less than 5%.

[Remote control pacifier. A simple method for opacification of the digestive tract in children]. / La télététine. Un moyen simple d'opacification du tube digestif chez l'enfant.

The authors describe a remote control feeding pacifier for easy realisation of upper G.I. series in children.

[Ultrasound and portal hypertension in children. Demonstration of gastro-oesophageal collaterals. Preliminary report (author's transl)]. / L'échotomographie dans l'hypertension portale de l'enfant. Etude des dérivations gastro-oesophagiennes. Note préliminaire.

The authors studied the value of ultrasonography in demonstrating oesophageal collaterals in portal hypertension in childhood. 22 children with portal hypertension underwent successively an ultrasound examination and an endoscopy looking for submucosal oesophageal varices. Oesophageal collaterals were said to be present when ultrasound showed vascular structures in the gastro-hepatic ligament above the coeliac trunk origin. Among those 22 patient 18 had a satisfactory ultrasound examination. 12 true positive, 3 true negative, 3 false negative ultrasound examinations were obtained. 4 ultrasound studies were inconclusive. The value of ultrasound in the pre and post surgical check-up of portal hypertension in children is emphasized.

[Solitary hemangioma of the liver manifested by neonatal heart failure]. / Hemangiome solitaire du foie revele par une insuffisance cardiaque neonatale.

A new case of solitary angioma of the liver, complicated with heart failure, is reported in a newborn. The rarity of this anatomo-clinical form is emphasized, and the interest of venous catheterization, which permitted an angiogram of good quality, is underlined. Radiotherapy was so rapidly efficient that one is incited to promote this treatment before any other, especially in cases where surgery involves major risks.

Hepatic tumors in children: ultrasonic differentiation of malignant from benign lesions.

The authors studied 21 hepatic tumors in children using B-scan and real-time ultrasound as well as angiography. The final diagnosis was established surgically. Cystic tumors and hemangioendotheliomas were excluded. In all but one malignant tumor (15/16), ultrasound showed absence of one branch of the portal vein in the area of the tumor. Partial amputation of intrahepatic portal branches was confirmed angiographically in all cases. In all 6 benign tumors, ultrasound demonstrated a patent portal system despite compression by tumor. These findings were confirmed angiographically. No specific echo pattern allowing differentiation between benign and malignant tumors was found. The authors conclude that ultrasonic differentiation between malignant and benign hepatic tumors in children is possible, provided that special attention is given to the intrahepatic vessels.

Vascular occlusive agents.

The authors have reviewed the experimental literature about the different agents used for endovascular embolization: clots, tissues, duramater, Gelfoam, oxydized cellulose, Ivalon, beads, microspheres, cyanoacrylates, silicone, barium. Each occlusive agent was studied in regard to its physical properties, injection methods, characteristics of obstruction, vascular reaction, and toxicity. The level and quality of obstruction obtained depend on many factors which are discussed.

Successful electrocoagulation of an internal mammary artery in a child.

A case of successful electrocoagulation of an internal mammary artery with a bipolar electrode and alternating current is reported in a boy with cystic fibrosis of the lung and hemoptysis.