A new procedure for fractures of the medial epicondyle in children: Mitek(®) bone suture anchor.

We present a new bone suture anchor technique for fractures of the medial epicondyle. The hypothesis was that the results would be similar to those with the divergent K-wire fixation. This retrospective study included 40 patients who presented with displaced fractures of the medial epicondyle: one group was treated with a Mitek(®) non-resorbable bone suture anchor (group A: n=21), the other by K-wire fixation (group B: n=19). A medial approach was taken with an anchor placed above the olecranon fossa. The epicondyle was then repositioned by bone suture. After a mean follow-up of 18.6 months, union was obtained in all epicondyles. There was no difference in flexion-extension of the elbow. The rate of hypertrophy of the medial epicondyle was similar in both groups (57%). The bone suture anchor of the medial epicondyle is an effective technique that does not require hardware removal and is an alternative treatment option to divergent K-wire fixation.

[Unexpected respiratory complication after the surgical treatment of scoliosis in a teenager]. / Complication respiratoire inattendue après le traitement chirurgical d'une scoliose chez un adolescent.

We report the case of an unexpected respiratory complication after a surgical treatment of scoliosis during postoperative period in an adolescent patient. This complication results of a vascular compression of the left main bronchus between the aorta and the pulmonary artery, which induces severe atelectasis of left lower lobe. Prolonged non-invasive ventilation with high level of positive end-expiratory pressure prevents aorto-pulmonary compression, allows a pulmonary recruitment associated with a favorable prognostic for the adolescent.

[Neonatal infections of the bones and joints]. / Infections ostéoarticulaires du nouveau-né

Neonatal osteoarticular infections remain rare, with an estimated incidence of 1 to 3 cases per 1000 admissions to Neonatal Intensive Care Units. It usually results from bacteraemia and may thus be induced by IV catheters. More rarely it is due to direct inoculation secondary to cutaneous damage, or extension of soft tissue infection. The particularity of bone vascularization in the newborn explains the frequency of abscess formation in the periosteum or in soft tissues. The main pathogen involved is S. aureus (3/4 of cases), followed by group B streptococci and enterobacteriacae. Infection consists mainly of localised and slowly progressing abscesses. However, multifocal and severe infection is possible, in particular when caused by an IV catheter. Ultrasonography is the best initial investigation, possibly leading to surgical care. Medical treatment must include 2 synergistic antistaphyloccocal antibiotics, possibly associated with cefotaxime. The outcome is generally favorable, but orthopaedic consequences may emerge if the growth plate is involved. Rare specific causes, such as syphilis or tuberculosis, should also be evoked, but the clinical context is generally helpful for the diagnosis.

The carbon isotope composition of CO2 respired by trunks: comparison of four sampling methods.

The (13)C natural abundance of CO(2) respired by plants has been used in the laboratory to examine the discrimination processes that occur during respiration. Currently, field measurements are being expanded to interpret the respiration delta(13)C signature measured at ecosystem and global levels. In this context, forests are particularly important to consider as they represent 80% of the continental biomass. The objective of this investigation was to compare four methods of sampling the CO(2) respired by trunks for the determination of its carbon isotope composition: three in situ methods using chambers placed on the trunk, and one destructive method using cores of woody tissues. The in situ methods were based either on a Keeling plot approach applied at the tissue level or on an initial flush of the chamber with nitrogen or with CO(2)-free air. In parallel, we investigated the possibility of an apparent discrimination during tissue respiration by comparing the delta(13)C signature of the respired CO(2) and that of the organic matter. The study was performed on six tree species widely distributed in temperate and mediterranean areas. The four methods were not significantly different when overall means were considered. However, considering the individual data, the Keeling plot approach and the nitrogen flush methods gave fairly homogeneous results, whereas the CO(2)-free air method produced more variable results. The core method was not correlated with any of the chamber methods. Regardless of the methodology, the respired CO(2) generally was enriched in (13)C relative to the total organic matter. This apparent enrichment during respiration was variable, reaching as much as 3-5 per thousand. This study showed that, on the whole, the different sampling techniques gave similar results, but one should be aware of the variability associated with each method.

[Lumbar Chance fracture in an child associated with an intra-abdominal lesion]. / Fracture de Chance lombaire chez l'enfant associée a une lésion intra-abdominale.

We report the case of a teenager who was involved in a road traffic accident. She presented a flexion-distraction type of vertebral injury, (Chance fracture). This fracture was associated with an intra-abdominal injury. The child was a passenger in a rear seat using a shoulder seatbelt restraint.

Responses of trembling aspen and hazelnut to vapor pressure deficit in a boreal deciduous forest.

The branch bag method was used to monitor photosynthesis and transpiration of trembling aspen (Populus tremuloides Michx.) and hazelnut (Corylus cornuta Marsh.) over a 42-day midsummer period in 1996, as part of the Boreal Ecosystem-Atmosphere Study (BOREAS). During the same period, daytime measurements of stomatal conductance (g(s)) and leaf water potential (Psi(leaf)) were made on these species, and sap flow was monitored in aspen stems by the heat pulse method. Weather conditions during the study period were similar to the long-term average. Despite moist soils, both species showed an inverse relationship between daytime g(s) and vapor pressure deficit (D) when D was > 0.5 kPa. Daytime Psi(leaf) was below -2 MPa in aspen and near -1.5 MPa in hazelnut, except on rainy days. These results are consistent with the hypothesis that stomatal responses are constrained by hydraulic resistance from root to leaf, and by the need to maintain Psi(leaf) above a minimum threshold value. Reductions in g(s) on sunny afternoons with elevated ambient D (maximum 2.3 kPa) were associated with a significant decrease in photosynthetic rates. However, day-to-day variation in mean carbon assimilation rate was small in both species, and appeared to be governed more by solar radiation than D. These results may be generally applicable to healthy aspen stands under normal midsummer conditions in the southern boreal forest. However, strong reductions in carbon uptake may be expected at the more extreme values of D (> 4 kPa) that occur during periods of regional drought, even if soil water is not locally limiting.

Transpiration of a boreal pine forest measured by branch bag, sap flow and micrometeorological methods.

Three independent methods were used to evaluate transpiration of a boreal forest: the branch bag, sap flow and eddy covariance methods. The branch bag method encloses several thousand needles and gives a continuous record of branch transpiration. The sap flow method provides a continuous record of sap velocity and an estimate of tree transpiration. The eddy covariance method typically measures evaporation rates between a forest and the atmosphere. We deployed an extra eddy covariance system below the forest to estimate canopy transpiration by difference. The three systems detected small water vapor fluxes despite a plentiful supply of energy to drive evaporation. We also observed that transpiration rates were low even when the soil was well supplied with water. Low rates of transpiration were attributed to the canopy's low leaf area index and the marked reduction in stomatal conductance as vapor pressure deficits increased. Water vapor fluxes, derived from the sap flow method, lagged behind those derived by the branch bag method by 1 to 2 h. The sap flow method also suffered from sampling errors caused by the non-uniformity of flow across the sapwood and the spatial variability of sapwood cross section throughout the forest. Despite technical difficulties associated with hourly measurements, daily totals of transpiration agreed well with values derived from micrometeorological systems.

[Accessory thymus in cervical ectopy: apropos of a case]. / Thymus accessoire en ectopie cervicale: à propos d'un cas.

Cervical tumors of thymic origin are considered to be uncommon lesions in the differential diagnosis of neck masses. They can be either cystic or solid. The authors present one case of solid cervical thymic tumor in a 2 month-old baby. The embryogenesis of the thymus explains the cervical location of these tumors. Theories of physiopathology are presented. The clinical presentation is variable and their nature is often recognized only upon surgery and preoperative pathologic examination. Some cases of thymoma and respiratory complications resulting from ectopic thymus have been described in the literature, so that total excision of the mass must be performed. This lesion may be more common than suggested in the literature.

[Sacrococcygeal teratomas in antenatal diagnosis]. / Tératomes sacro-coccygiens de diagnostic anténatal.

The authors report eight cases of antenatal diagnosis of sacro-coccygeal teratoma (SCT) in five girls and three boys in whom the diagnosis was made between the 19th and 34th week of amenorrhea (mean = 27 weeks). The ultrasound pictures taken antenatally of the SCT assist in the discovery of a mass that is usually heterogenous, attached to the distal end of the sacrum, and the discovery is usually made fortuitously or because the height of the uterus is too great. A different series of antenatal diagnoses for SCT have made it possible to work out certain criteria of seriousness to be able to predict intra-uterine death: the presence of anasarca or of hydramnios, the discovery of the lesion before the 30th week of amenorrhoea, the relative weight of the teratoma as against the weight of the fetus being above 50%. We think from our experience that it is important to add the scale of the antenatal growth of the teratoma. A rapid growth of the SCT will lead to a tumour mass which is great as compared to the size of the fetus. Similarly in certain cases the vascular bed will increase in size, and intratumour haemorrhages can occur and give rise to fetal heart failure and also to fetal anaemia, hypoproteinaemia and the appearance of anasarca or of hydramnios. The child dies in utero or immediately after birth because of prematurity from the haemorrhagic state or from cardiac insufficiency. Furthermore accelerated growth of the tumour is nearly always in the immature tumour cells and that means that the child, if it is born alive, should be followed up for a long time because there is a risk of it becoming locally malignant. In practice the monitoring of SCT and the antenatal discovery of the condition should be carried out very seriously in order, in some cases, if it is viable to produce a living child in conditions where the rapid growth of tumour would make it likely that the child would die in utero.

[Extrahepatic biliary tract atresia and a common biliopancreatic canal. Review of the literature apropos of a case]. / Atrésie des voies biliaires extra-hépatiques et canal biliopancréatique commun. Revue de la littérature à propos d'une observation.

The authors report the case of an 3 months old caucasian boy which had an extrahepatic biliary atresia associate with a congenital biliary cyst and an anomalous pancreaticobiliary junction. The patency between gallbladder and duodenum permits the operative opacification of this long common pancreaticobiliary channel. The congenital biliary cyst was located on the upper part of the common bile duct and was obstructed by biliary concretions. Unfortunately, no patency between intrahepatic bile ducts and this cyst was found. Because this long common pancreaticobiliary channel may cause biliary dilatation or biliary cancer, we performed an hepatic portoenterostomy rather an hepatic portocholecystostomy. A few weeks later, the bile flow was restored and the jaundice decreased. With a follow up of 18 months, this boy is currently anicteric, despite the hepatic fibrosis found on the operative biopsy. The association extrahepatic biliary atresia-long common pancreaticobiliary channel is uncommon and only 20 cases were reported. In our case, the pancreatic juice reflux into the biliary tract might have caused the dilatation of the common bile duct and the biliary atresia by chronic obstructive cholangiopathy.

[Primary volvulus of the small intestine without malrotation. Apropos of 7 cases]. / Volvulus primitif du grêle sans malrotation. A propos de sept observations.

We report seven cases of complete volvulus of the small bowel without malrotation seen from 1973 through 1986. The clinical setting is always the same in this condition: the infant exhibits no clinical anomalies during the symptom-free interval between birth and the volvulus (4 h to 35 d, m = 7 d in our series). Onset is extremely sudden, with a complete, proximal obstruction, early and abundant passage of blood per rectum, and above all a severe shock that fails to respond to resuscitation. Roentgenograms contribute little to the diagnosis and surgery should never be delayed to perform complementary investigations of any kind. Indeed, the only effective treatment is unwinding the volvulus within the first six hours following onset, for beyond that time irreversible necrosis of the entire small bowel and occasionally colon occurs. Five infants died because they were seen too late and operated on 36 hours on average after the onset of symptoms. The two survivors had an early operation that prevented total necrosis of the small bowel. However, this pattern seems to vary according to the degree of cecum anchorage: a fixed cecum results in a very tight volvulus with complete, early ischemia and usually irreversible necrosis of the small bowel beyond the sixth hour (9/9 published cases); an even slightly mobile cecum results in a looser volvulus, with less severe ischemia, more delayed necrosis, and a possibility of complete recovery (5/6 published cases).(ABSTRACT TRUNCATED AT 250 WORDS)

[Blunt injuries of the pancreas in children. Diagnostic and therapeutic approach apropos of 8 cases]. / Traumatismes fermés du pancréas de l'enfant. Approche diagnostique et thérapeutique à propos de 8 cas.

From 1970 to 1985, eight severe blunt pancreatic traumas were admitted. There is significant difference in morbidity between early pancreatectomy with or without splenectomy (a mean hospital stay of 23 days, low loss of weight) and initial simple external pancreatic drainage with delayed partial pancreatectomy or pancreato-cystojejunostomy Roux-en-Y (mean hospital stay of 45 days, 24% loss of weight, one death two years later). Thus it seems essential to diagnose the pancreatic injury and particularly rupture of the pancreatic duct. Aiming to evaluate these lesions, biology, ultrasonography or computerized axial tomography proved insufficient. As a result, in the last two patients, an endoscopic retrograde pancreatography was performed confirming total transection of the pancreatic duct, one case with fistula, the other with a contrast fluid stop. The surgical approach was guided by these X-ray findings and a distal pancreatectomy performed preserving spleen. The authors propose the following protocol: endoscopic pancreatography if an evident improvement in recent pancreatic injury is not obtained in 48 hours, or in the case of former complicated pancreatic trauma; in the event of total rupture of pancreatic duct, operation should be carried out: abdominal exploration guided by the X-rays findings, distal pancreatectomy or, rarely, repair of the pancreatic duct; when no pancreatic duct lesion is found, but ultrasonographic blunt trauma patent, the surgical decision depends on the amount of peripancreatic reaction: medical treatment or external drainage; when lesion of the head of pancreas is detected, conservative treatment is to be preferred to pancreatoduodenectomy.