Intralesional bleomycin injection (IBI) treatment for haemangiomas and congenital vascular malformations.

Successful treatment of vascular anomalies has eluded the physician until now, despite various treatments utilised. Bleomycin has been successfully used in intralesional injection treatment of cystic hygromas and haemangiomas, based specifically on a high sclerosing effect on vascular endothelium. In a prospective study of 95 patients, the effectiveness of intralesional bleomycin injection (IBI) treatment in haemangiomas and vascular malformations was evaluated and documented. Complete resolution or significant improvement occurred in 80% of all patients treated. Complete resolution occurred in 49% of haemangiomas, 32% of venous malformations, and 80% of cystic hygromas. Significant improvement occurred in 38% of haemangiomas, 52% of venous malformations, 13% of cystic hygromas and 50% of lymphatic malformations. Of the six patients who presented with a painful lesion, four experienced complete resolution and two had significant improvement to treatment. Local complications encountered were superficial ulceration occurring in 2 patients, and cellulitis in 1 of the 95 patients. Systemic complications were flu-like symptoms in three patients and partial, transient hair loss in two patients. None of the patients presented with haematological toxic effects or signs of pulmonary involvement (fibrosis, hypertension). IBI is an effective treatment in haemangiomas and vascular malformation lesions, obviating the need for invasive primary surgery or systemic treatment regimens in 80% of cases, and allowing for limited need of secondary surgical or adjunctive procedures in cases with a moderate result.

[Splenic artery embolization in hematologic diseases in children]. / L'embolisation artérielle splénique dans les affections hématologiques chez l'enfant.

In the past four years or so splenectomy used in children with hematological defects, who showed hypersplenism has been replaced with partial arterial splenic embolization (Pase), in general, 2/3 of the lower spleen were embolized. Pase was performed after the selective catheterization of the splenic artery up to the hilum with local anesthesia. As an embolizing agent, with the first 2 patients a suspension of Gelaspon microparticles and absolute alcohol (90 degrees) was used, and with the others (7 patients with 9 embolizations) only absolute alcohol. The Pase indication was: congenital hemolytic anemia in 5 cases; thrombocytopenia in 3 cases (5 pase); portal hypertension by extra-hepatic blockage with secondary hypersplenism in one case where the endoscopic sclerosis of the esophageal varices had been done first, followed by Pase after weeks. The evolution after Pase was simple in 6 patients: fever, pain in the left hypochondrium, and moderate ileus for 2-3 days. In 3 cases the evolution was both complicated and difficult excessive Pase in the first 2 patients, that practically resulted in total splenectomy, and, in the other one, the growth of a big subcapsular hematoma with effusion that had to be eliminated through transparietal drainage, under echographic control and operated secondary for peritonitis. Hematologically, in all cases but one (1 failure) hypersplenism remission was obtained and the results are the same 1-3 years after Pase. Partial arterial splenic embolization can very well replace splenectomy in hematological defects manifested as hypersplenism. The use of absolute alcohol (90 degrees) as an excellent embolization agent has not been reported so far in children.

[A new technic of gastric tube esophagoplasty in children]. / Une nouvelle technique d'oesophagoplastie par tube gastrique chez l'enfant.

In cases of caustic oesophageal strictures that need oesophagoplasty, the removal of the injured oesophagus is always necessary--a fact that demands a new transthoracic operation. The authors describe a technique which combines, in a one stage operation, the blunt total transmediastinal oesophagectomy and reverse gastric tube oesophagoplasty, this being placed in the posterior mediastinum in the bed of the oesophagus removed by eversion stripping. The authors carried out thirteen oesophagoplasties of this type with no mortality and no severe complications.

[Non-operative/conservative treatment of hemoperitoneum in children]. / Le traitement non-opératoire/conservatoire de l'hémopéritoine chez l'enfant.

The authors present 34 cases of the traumatic hemoperitoneum with nonoperative/conservative treatment followed up in the past five years. The cases of hemoperitoneum are divided into three categories: hemorrhagic shock; stable clinic status; unstable clinic status. The first category included the cases of operational emergency, the other two categories were treated in the intensive care unit; the most of them needed no operation. The punction and punction-lavage of the peritoneum was systematically carried out and it was a therapeutic step of draining out the blood and appreciating the importance of hemoperitoneum. If laparotomy was requested initially or later on, a conservative surgery was used: spleen-hepatorrhaphy, partial splenectomy, selective arterial ligations, splenic replantation.

[Modelling longitudinal ureteroplasty in children]. / Ureteroplastia longitudinala modelanta la copil.

On the basis of their personal experience acquired in the total of 29 modelling interventions in the ureters of 16 children, the authors discuss the value, the technique and the indications of modelling longitudinal ureteroplasties--or the Hendren operation. This intervention was performed in 8 patients for secondary megaureter, and in another 8 patients it was performed for primary megaureters. When it was necessary modelling was performed simultaneously on both sides. In patients without previous derivations systematic use was made of ureter splintering after modelling--when it was re-implanted. Some technical details are discussed. The authors stress the necessity to know exactly before the intervention, the true functional value of the kidney the ureter of which will undergo modelling. Otherwise inutile modelling interventions will be performed (one case). In 3 of the patients, at 4--6 months after surgery, modelling of the upper segment of the ureter was necessary, together with pyeloplastia. The series analysed confirmed the value of this technique aimed at direct correction of the large dilatations of the ureters.

[Reversed gastric tube oesophagoplasty in children (author's transl)]. / L'oesophagoplastie par tube gastrique chez l'enfant.

Over the last two years the authors performed 6 oesophagoplasties with reversed gastric tube, no splenectomy, retrosternal placement of the gastric tube and cervical termino-terminal anstomosis within a single operating interval. Only one death occurred, independent of the oesophagoplasy technique, as well as two minor complications favourably solved spontaneuosly (cervical anastomosis fistule). The operation was perfectly gone through, post-operation consequences were surprisingly simple and the distant result, in all five cases of survival,--clinically excellent, both oesophagoscopically and radiologically; the children went back to an absolutely normal feeding programme. Though short, this series joins the other papers published of late and indicates oesophagoplasty with reversed gastric tube as a valuable method in reconstruction children's oesophagi.