[Cryoanesthesia by freon spray for venepuncture in children]. / Cryoanesthésie par pulvérisation de fréon pour ponction veineuse chez l'enfant.

This prospective study was designed to assess the quality of skin analgesia provided by cryoanesthesia induced by a spray of freon (dichloro-tetrafluoro-ethane) for venous cannulation (22 or 24 Gauge cannulas). Eighty children between the ages of 5 and 15 years were allocated to two groups: 40 children had a conventional venepuncture, 40 others had a venepuncture under cryoanesthesia. The spray of freon was applied for ten seconds on the area of skin to be anaesthetised. The venous cannulation was carried out by an anaesthetist of the paediatric surgical unit. The intensity of pain at venepuncture was quantified with a visual analogic scale (range 0 to 100). The median values of the pain scores were 11.5 (0 to 50) in the cryoanesthesia group and 48 (11 to 75) in the control group respectively. It is concluded that freon spray provides a convenient analgesia for venepuncture in children aged 5-15 years.

[Giant sacrococcygeal teratoma. A method of perineal reconstruction]. / Tératome sacro-coccygien volumineux. Une méthode de reconstruction périnéale.

A method to reconstruct the perineum, after excision of a giant sacrococcygeal teratoma, using one anterior V and multiple posterior V incisions, is described. A baby weighing 2,400 g with a 1,000 g sacrococcygeal teratoma was operated using this technique.

[Laparoschisis. Indications for a teflon patch in wall repair]. / Laparoschisis. Indication du patch en téflon dans la réparation pariétale.

In 14 newborns with gastroschisis, fascial closure was effected by muscular suture associated with teflon mesh prosthesis interposition. This was realized either in urgency during neonatal period (9), either secondly (5). Neonatal cases were treated between 0 h 30 and 5 h of age. Pulmonary hyper-pressure risk was very important when primary suture was early employed (card freq: 150 b. min-1. PA syst: 60 cm Hg; pulm pres: 20 cm Hg). When we used a teflon mesh prosthesis, we had 8 good results and only one initial death. 5 complications were represented by cutaneous ischemia which spontaneously disappeared (1), ischemia with infection and partial necrosis (2), important necrosis with teflon mesh prosthesis exteriorization (2). It has been definitely possible to achieve complete fascial in 7 newborns. Only one of them had a little ventral hernia. 5 newborns were early treated by simple skin coverage (Gross) as primary management. They have had teflon mesh prosthesis between 5 and 14 M of age and have undergone excision of the teflon mesh prosthesis and fascial repair without difficulty (5 good results). With teflon mesh prosthesis for treating congenital abdominal defects, abdominal hyper-pressure and pulmonary complications are exceptional. Local complications are very limited because of good vascular conditions. We did not have any adherences because of teflon mesh prosthesis good biological and histological tolerance. Digestive complications (statis, septicemia...) have been few and mild because physiological intra abdominal pressure has been early obtained.

[Sacrococcygeal teratoma. Apropos of 15 cases]. / Les tératomes sacro-coccygiens. A propos de 15 observations.

Fifteen cases of sacrococcygeals teratomas were treated at our hospital over the last ten years. There is no correlation between prematuration and tumor weight, as between tumor weight and low babys' weight. High tumoral weight didn't influence the prognosis. The treatment is always surgical. Chemotherapy was used only for recurrence in one case (the patient is dead). For all the cases, we performed a perineal procedure without abdominal procedure. No patient had an abdominal extension of the teratoma.

[Role of acquired protein C deficiency in a case of pulmonary arterial and multiple venous thromboses]. / Rôle du déficit acquis en protéine C dans une observation de thromboses artérielle pulmonaire et veineuses multiples.

After surgical repair at birth of an omphalocele, a one-year old child died with pulmonary hypertension; multiple venous thromboses were associated with pulmonary arterial thrombosis and acquired protein C deficiency. The features of pulmonary embolism in children are reviewed and the role of protein C deficiency is discussed.

[Laparoschisis: therapeutic problems. Apropos of 48 cases]. / Le laparoschisis: problèmes thérapeutiques. A propos de 48 observations.

A non-selective series of 48 neo-nates was treated during a period of 8 years (1978-1985), with follow-up more than four months for recent observations. Surgical treatment comported Gross-technique in 32 cases; immediate total-closure in 7 cases and progressive reintegration (Schuster) in 10 cases. Long-term parenteral nutrition was performed in 38 neo-nates. The etiology of different deaths (toxic++-infection, mechanical obstruction) is discussed. The percentage of survivors was progressively raised: 70% since 3 years, and better in the last 11 cases, all with good result.

[Blood histamine level and anaphylactic reaction under alphadione]. / Histaminémie et réactions anaphylactoïdes sous alfadione.

Histamine release is generally thought to play a major role in anaesthetic-induced anaphylactoid reactions. In 12 patients who were developing such a reaction at the start of a slow rate intra-venous infusion of alphadione, serum histamine was measured using the enzyme-isotopic assay from a blood sample drawn within the first 5 minutes following the onset of clinical signs. Histaminemia above normal value was noted in 3 patients only without clear clinical correlation. These results would suggest that histamine release is unlikely to be principally involved in this kind of adverse reaction.

Hypersensitivity reactions to Althesin infusion: measurement of complement involvement.

Two cases of hypersensitivity reactions in the course of slow infusion of Althesin are reported. Serial examination of their complement system showed a marked activation of the alternate pathway which returned almost to normal within 24 hours.