Imaging of intestinal involvement in endometriosis.

Deep gastrointestinal involvement in endometriosis is characterised by fibrous, retractile thickening of the intestinal wall. The most common location is the upper rectum, in contiguity with a lesion of the torus uterinus. As part of a preoperative assessment, it is essential to establish an accurate and exhaustive map of intestinal lesions so that the surgeon can plan his actions. Transvaginal sonography and MRI correctly analyse pelvic and rectal involvement. Given the frequency of multiple intestinal sites, particularly sigmoid and associated ileo-caecal lesions, water enema CT should be performed. The role of rectal endoscopic sonography is debated.

[Hepatic subcapsular hematoma: a case report and management update]. / Hématome sous-capsulaire du foie : cas clinique et mise au point actualisée sur la prise en charge.

Hepatic subcapsular hematoma (HSH) is a rare complication of pregnancy that keeps a materno-fetal high mortality rate. Given this severity, HSH management requires a prompt diagnosis and an appropriate care. Before focusing on the current management strategy of HSH, we illustrate this article with a clinical case presenting an original method of abdominal exploration, which has not been described to our knowledge. Thus, taking into account the presence of a moderate hemoperitoneum during a caesarean section procedure for HSH, introduction of laparoscopy through the same incision allowed a satisfactory evaluation of the abdominal cavity and hepatic area without performing an invasive midline laparotomy.

Laparoscopic surgery in a patient with ventriculoperitoneal shunt: monitoring of shunt function with transcranial Doppler.

We describe the use of transcranial Doppler (TCD) monitoring during laparoscopic resection of an ovarian cyst in a young woman who previously underwent ventriculoperitoneal shunting for hydrocephalus. Shunt function was not altered by pneumoperitoneum, except during transient episodes of high intra-abdominal pressure. The role of TCD monitoring during laparoscopic procedures in patients with cerebrospinal fluid shunt is discussed.

Copper and zinc blood levels among children with nonorganic failure to thrive.

BACKGROUND AND AIMS: Copper and zinc deficiency are commonly reported among children with organic failure to thrive. In contrast, reports on copper and zinc status in children with non-organic failure to thrive are scarce. The goal of this study was to evaluate copper and zinc blood levels and nutritional intake among children with non-organic failure to thrive. METHODS: A study group of 32 children with non-organic failure to thrive were investigated and compared with 32 healthy controls. Each child had copper and zinc blood level measurements. In addition, the study group underwent evaluation of thyroid function, immunoglobulins, endomesial antibodies and xylose test. A dietary questionnaire that included a diet history and a 24-h dietary recall was administered to parents by a dietician. Weight for height, height for age and mean daily intake of calories, protein, copper and zinc were calculated. RESULTS: There were no significant differences between the two groups in either socioeconomic status or caloric, copper or zinc intake. Protein intake was significantly lower in the study group (P<0.0001). Plasma copper levels were within the normal range in both groups (P=0.3). Zinc plasma levels were significantly higher in the study group as compared to controls (P=0.03); however, they remained within the normal range in both groups. CONCLUSIONS: Children with non-organic failure to thrive can maintain plasma copper and zinc levels within normal range and similar to normal controls.

Awareness of folic acid for neural tube defect prevention among Israeli women.

The failure of neural tube closure during early embryogenesis results in a range of neural tube defects (NTD), the most common of which is spina bifida. The role of folic acid in reducing the rate of NTD has been well-established. Three recent cases of infants with NTD inspired this investigative study into the level of awareness and knowledge of folic acid and its function in the prevention of NTD among Israeli women. Of 920 women interviewed, only 51 (5.5%) had heard of folic acid, and 27 (2.8%) were reported to have taken it. The source of information and the motivation for self-medication were also explored with regard to socioeconomic and health profile. Awareness of folic acid was significant among women aged 17-29 years (P = 0.005) and those aged 30-39 years (P = 0.009), and among semireligious and nonreligious women (P = 0.008 and 0.01, respectively). Among women who were aware of folic acid, only nonreligious women tended to take it. No correlation was found between folic acid intake and age, religiosity, nationality, number of pregnancies, and health status among women who were aware of folic acid intake. The poor level of awareness, evident in our study, demands that the medical community broadcast the benefit of folic acid. Furthermore, government health initiatives, such as the addition of folic acid to flour preparations, may effectively ensure its appropriate daily intake. These improved education and prevention programs may forcibly reduce the rate of NTD-affected pregnancies.

[Pheochromocytoma associated with pregnancy. Report of 2 cases and review of the literature]. / Association phéochromocytome et grossesse. A propos de 2 cas et revue de la littérature.

Pheochromocytoma is rarely observed during pregnancy and not easily diagnosed, especially since the clinical manifestations may mimic common gravid hypertension. The maternal and fetal prognosis depends on early diagnosis and multidisciplinary management preparing for tumor resection. Appropriate laboratory tests easily provide the positive diagnosis, if they are ordered. The tumor is localized by ultrasonography or magnetic resonance imaging (MRI). By prescribing an alpha-blocker, it is possible to prepare the resection as a function of term, before or after delivery. This strategy allows a reduction in maternal and fetal mortality which is high if the pheochromocytoma goes undiagnosed.

[Vesico-uterine fistula occurring after a normal labor in a patient with a scarred uterus]. / Fistule vésico-utérine survenant après un accouchement normal chez une patiente porteuse d'un utérus cicatriciel.

We report a vesico-uterine fistula occurring after vaginal delivery in a woman with previous cesarean section. Diagnosis of this rare complication, only 2 cases reported in the literature, is based on clinical findings and retrograde cystography. Medical treatment should be attempted first, but laparotomy is often required for resection of the fistula and simple suture of the bladder and the uterus.

Dumping syndrome following Nissen fundoplication, diagnosis, and treatment.

We evaluated the prevalence, diagnosis, and treatment of dumping syndrome (DS) following Nissen fundoplication in 50 consecutive infants and children who underwent the operation for gastroesophageal reflux. Examination included a preoperative dietary assessment with emphasis on specific postprandial clinical symptoms and technetium scintigraphy to evaluate gastric emptying. In the immediate postoperative period, postprandial glucose levels were examined in all patients with symptoms clinically suggestive of DS. In the late postoperative period (6 months to 5.5 years), all patients with more than one specific clinical symptom of DS were further evaluated by glucose tolerance test (GTT), HbA1C levels, and gastric technetium scintigraphy. DS was diagnosed in 15 patients (30%). Five patients had immediate severe DS (SDS), and 10 in the late postoperative course had latent postoperative DS (LDS). In all patients with DS, preoperative and postoperative gastric emptying scan T1/2 did not show any statistical significance. High levels of HbA1C ranging from 7.9 to 9% (mean, 8.25 +/- 0.5) were found in only three patients. Treatment included parenteral nutrition in one patient. All the others were successfully managed with nutritional manipulation alone, using a combination of lactose-free formula and fat emulsion. In patients whose postprandial symptoms persisted, pectin 5-15 g/day divided into six doses was added to the diet. Following 6 months of dietary treatment, the postprandial normoglycomic response was restored. Eleven patients experienced complete resolution of symptoms (78.5%), and three patients (21.4%) showed significant clinical improvement. This study indicates that DS is a common complication following Nissen fundoplication. The GTT is the most reliable examination for establishing the diagnosis. Treatment is simple and effective. The technetium gastric emptying scan and HbA1C level do not play a significant role in the diagnosis.

[Primary retroperitoneal mucinous cystadenoma: a case treated by celioscopic surgery]. / Cystadénome mucineux rétropéritonéal primitif: un cas opéré par coelioscopie.

We used laparoscopy to treat a case of primary retroperitoneal mucinous cystadenoma. This tumours is rarely encountered and has been reported in 22 cases in the literature. The histogenesis is uncertain. Diagnosis is never made preoperatively since primary retroperitoneal mucinous cystadenomas are usually mistaken for cystic lymphangiomas of the retroperitoneum. Surgery is the only treatment. Laparoscopic surgery can be used only if the cystadenocarcinomatous nature of the tumour is ruled out.

[Prenatal diagnosis of spontaneous thrombosis of the umbilical artery during the third trimester of pregnancy. Two cases with surviving infants]. / Diagnostic anténatal d'une thrombose spontanée d'une artère du cordon ombilical au troisième trimestre de la grossesse. A propos de 2 observations avec enfants vivants.

Thrombosis of the umbilical artery was diagnosed in utero in two cases at the echography examination performed during the third trimester of gestation. The infants were born live and in good health. This is the first report of such antenatal diagnosis. The lack of prospective studies hinder the evaluation of fetal morbidity and mortality. Nevertheless, umbilical artery thrombosis is a high risk obstetrical situation since the potential risk of another thrombus in the second umbilical artery would lead to fetal death in utero. Careful monitoring is required with extraction of the fetus as soon as term allows or whenever the elements compromise fetal development.

[Prenatal diagnosis of homozygous pyruvate kinase deficiency]. / Déficit homozygote en pyruvate kinase à révélation anténatale.

Two consecutive cases of severe neonatal anaemia due to severe deficiency in pyruvate kinase were observed in the same sibhood. The first child died one hour after birth and the second required major transfusion support. Pyruvate kinase deficiency is a rare cause of congenital anaemia with recessive autosomic inheritance. Clinically, this deficiency has a very variable expression, and neonatal forms are not always very severe. Several variant molecules in pyruvate kinase deficiency have been described. Recent progress in our understanding of the gene would suggest the possibility of new diagnostic and prognostic approaches.

[Nissen fundoplication for gastroesophageal reflux in children].

During a 5-year period 50 children, aged 2 months to 15 years, underwent Nissen fundoplication for the management of severe gastroesophageal reflux and were then followed for from 3 months to 5 years. There were no immediate postoperative deaths. 8 patients (16%) died of serious underlying medical conditions during follow-up. The operation was successful in 86.3% in relation to indications for surgery. Postoperative complications specific for fundoplication occurred in 27 (54%) and other complications in 11 (22%). Of those with complications, 71% were treated successfully. The rest developed dumping syndrome which was diagnosed 1 month to 4 years after operation. They were treated with carbohydrate restriction and a special diet, the results of which will be evaluated later. Although Nissen fundoplication is very successful in resolving the indications for surgery, the high rate of postoperative complications demands re-evaluation of the indications for the operation in children.

[Pheochromocytoma of the broad ligament]. / Phéochromocytome du ligament large.

The authors report a rare case where a pheochromocytoma which was not in the adrenal gland occurred in the broad ligament. A review of the literature resulted in only three published cases being found. When the symptomatology suggests that there may be a pheochromocytoma in the body one has to research where it is sited and one has to think of such a possibility if a tumour in the broad ligament is found during an operation, so that the risks of operating on these tumours can be lessened.

[Metastasis of breast cancer to a uterine leiomyoma]. / Métastase d'un cancer du sein dans un léiomyome utérin.

The authors report a case of metastasis of cancer from the breast in a uterine leiomyoma. The metastases into the body of the uterus from extragenital cancers are rare. If they occur they are usually in the myometrium where they are asymptomatic and where the diagnosis is difficult, or in the endometrium where the diagnosis can be made by biopsy after curettage. A few rare cases of metastases in uterine leiomyoma have been reported in the literature. They can be the cause of very sudden increase in size of fibroids with compression of the pelvic organs.

Radiographic, haematological, and biochemical findings in a fetus with Caffey disease.

An early case of prenatal Caffey disease is reported. Ultrasound examination performed at 20 weeks showed major angulations of long bones, but both ultrasound scan and X-rays failed to make the differential diagnosis between Caffey disease and lethal osteogenesis imperfecta. A cordocentesis allowed us to find important biological abnormalities. The pregnancy was terminated after the rapid development of hydrops fetalis. The definitive diagnosis of Caffey disease was obtained by special X-ray and pathological study.

[The difficulty of diagnosing Caffey's disease in utero. Apropos of a case simulating lethal osteogenesis imperfecta]. / La difficulté du diagnostic de la maladie de Caffey in utero. A propos d'un cas simulant l'ostéogenèse imparfaite létale.

A very early case of infantile cortical hyperplasia (Caffey disease) is reported. The ultrasound examination performed at 22 weeks gestational age evidenced angulations of the long bones, leading to the diagnosis of lethal osteogenesis imperfecta. Hydrops fetalis developed and the pregnancy was terminated. The roentgenographic study of the fetus and results of pathological studies led to the correct diagnosis of Caffey disease. The difficulty of the diagnosis of these early forms of infantile cortical hyperostosis should be pointed out.