Laparoscopic pyeloplasty for repair of pelvi-ureteric junction obstruction in children.

PURPOSE: To report our initial experience with laparoscopic pyeloplasty (LP) in children with pelvi-ureteric junction (PUJ) obstruction, and to describe the evolution and evaluate the results for these patients. MATERIALS AND METHODS: Between May 2005 and April 2008, we retrospectively reviewed the records of 28 consecutive infants and children (20 males, eight females; mean age 63 months, range 2-180 months) with unilateral PUJ obstruction, some with deterioration of renal function on isotope renography. They all underwent LP (18 on the right, 10 on the left). The patient was placed in a (3/4) lateral position with three ports. The PUJ was resected and the anastomosis made using absorbable sutures. A JJ stent was inserted by laparoscopy in the majority of patients. Follow-up included clinical and ultrasound assessment, and isotope renography at 6 months. RESULTS: LP was feasible in 26 of 28 patients (93%). The procedure could not be completed by laparoscopy in two patients, the main reason being difficulty in completing the anastomosis. Stent insertion was successful in 25 of the remaining 26 cases. In the one unsuccessful case, a perianastomotic drain was placed without complication in the postoperative period. An aberrant crossing vessel was found in four patients. In two we held up the aberrant crossing vessel and PUJ by 2-3 non-absorbable sutures without tension, and without the need for pyeloplasty. In the other two cases we performed an LP-enabled ureteric transposition. There were three postoperative complications: pyelonephritis in two patients and one patient required operative intervention for PUJ leakage, and underwent a nephrostomy with a further uneventful course. The mean operative time was 145 min (range 70-270 min), and mean hospital stay was 4 (1-8) days. In one patient the JJ time of removal by cystoscopy, and ureteroscopy was used to retrieve it. Mean follow-up was 18 months (range 4-64 months). The 26 patients who underwent LP were asymptomatic after removal of the double JJ stent, showing reduction of the degree of hydronephrosis in all patients, and had also improved PUJ drainage on isotope renography or sonography. CONCLUSIONS: LP is effective and safe in children with minimal morbidity and gives excellent short-term results. The feasibility is also excellent in patients younger than 1 year. The transabdominal approach revealed good exposition without disadvantage to the patient. However, the LP is more difficult and the operative time remains longer than open pyeloplasty.

[Management of chicken pox purpura fulminans: a pediatric case report]. / Prise en charge d'un purpura fulminans varicelleux: à propos d'un cas pédiatrique.

The authors report a case of a 4 years old girl who had presented a chicken-pox purpura fulminans. Lesions appeared 5 days after chicken-pox start and were quickly evoluted in cutaneous and sub-cutaneous necrosis on external side of thighs and behind side of right calf. A medical management was done with fresh plasma, blood, antithrombine 3, and fibrin. Specifics treatments were done: heparin and activated C protein. Surgical treatment was realised 5 weeks later. It consisted of clean necrosis areas and put a thin skin graft witch was took on the scalp. The evolution was fast good. The follow-up is 3 years without big esthetic and functional consequences. Some cases of this pathology were described in literature with serious lesions. The management should be multidisciplinary. Surgical treatment should be realised when lesions are stabilized. Scalp is a donor site for skin graft very interesting because of big quantity of skin and not esthetic consequence.

[Five cases of trichobezoars in children]. / Trichobézoard: à propos de 5 observations.

Trichobezoars are made up of concretions of ingested hair and food. A history of occlusive syndrome in a context of trichotillomania and psychological problems must lead to this diagnosis. Bezoars can be fortuitously recognised by palpation of an epigastric abdominal mass while investigating anemia or esophageal reflux. This deviance is particularly dangerous. The first case of this series illustrates the Rapunzel syndrome with many perforations and necrosis of the small bowel. The 4 others are strict intragastric bezoars, quickly identified by echography. Treatment is exclusively surgical, digestion by papain or endoscopic extraction being impossible. Psychological assistance is mandatory.

[Management of blunt abdominal trauma in children]. / Prise en charge des traumatismes fermés de l'abdomen chez l'enfant.

UNLABELLED: The aim of this study was to evaluate the radiological and therapeutic management of blunt abdominal trauma (BAT) in children, with retrospective data. POPULATION AND METHODS: During 6 years (Nov 1995-Oct 2001), 92 children were hospitalised for BAT (mean age 9.5 years; 61.9% boys). Falls (45.6%) and motor vehicle accidents (43.5%) were the most frequent causes. The initial management included abdominal plain film X-ray and ultrasonography, and sometimes computed tomography (CT). The non-operative treatment was used, unless the patient was hemodynamically unstable or had hollow visceral injury, diaphragmatic rupture or renal artery rupture. RESULTS: Among 92 BAT, 52 were minor traumas and 40 were associated with one or several abdominal injuries. The sensitivity of ultrasonography to find hemoperitoneum and/or abdominal injuries was 80.3%, but the initial diagnosis of such lesions was accurate in 21 cases (52.5%) and delayed in 19 cases (47.5%), ranging from 1 to 7 days. In the delayed cases, the diagnosis was possible in nine cases with ultrasonography, in five cases with CT, but also with transaminase, amylase or lipase assays in two cases, and surgery in three cases. Twenty-nine children had a non-operative treatment and stayed in hospital about 12 days on average. Three children had surgery in emergency (two bowel perforations and one splenic rupture) and eight with delay (four renal ruptures, one associated splenic nodes, one pancreatic pseudocyst and one duodenal perforation). Only seven children (17.5%) required blood transfusion and no death occurred. CONCLUSION: In a trauma centre, the management of abdominal injuries is possible with ultrasonography and its sensitivity is correct without increasing of morbidity and mortality. But, if in doubt, a CT must be performed because its sensitivity is better. Most of the time, the children can benefit from non-operative treatment.

Role of laparoscopy in vaginal malformation.

BACKGROUND: The aim of this study was to assess the role of laparoscopy in the management of vaginal malformations in children, a subject not often discussed in the literature. METHODS: Between 1980 and 2002, we treated 22 children for vaginal malformations. Two main patient populations were distinguished: younger children with asymptomatic hymenal imperforation and hydrocolpos, and adolescents with hematocolpos. A third of the malformations were identified on systematic clinic examination, a third on the basis of abdominal pain, and a third due to various other symptoms. Nine of the girls had associated malformations of the uterus, external genital organs, or urinary tract. Eight patients underwent laparoscopy, either to look for endometriosis in cases of hematocolpos, to make an accurate determination of malformations in cases where clinical and paraclinical methods failed, or to manage an abnormality. RESULTS: Eleven laparoscopic procedures were performed in eight patients. Three diagnostic laparoscopies enabled us to determine the exact nature of the malformations. One newborn underwent two laparoscopic procedures to treat peritoneal fibrous bands that had caused repeated episodes of obstruction. Six patients underwent exploratory laparoscopy to look for endometriosis, but none was found. CONCLUSION: Laparoscopy is not applied systematically in the management of any malformation, but it can be useful when complementary exams fail to make an accurate diagnosis of the anomaly or for the management of the rare complication of adhesions and bands. When used to search for endometriosis, MRI detects ~50% of lesions, but laparoscopy is certainly still appropriate for that purpose. However, the optimal timing of the procedure still needs to be established.

Modulation of InsP3 receptor properties by phosphorylation: targeting of PKA to InsP3 receptors shapes oscillatory calcium signals in pancreatic acinar cells

No abstract available.