[Subphrenic abscess due to ectopic appendicitis]. / Abcès sous-phrénique révélateur d'une appendicite ectopique.

BACKGROUND: Idiopathic subphrenic abscesses are uncommon in children. Standard chest X-rays may provide the suspicion of this diagnosis. Initial percutaneous drainage of the collection is usually performed. Surgery is required when the underlying cause remains unknown. CASE REPORT: A 12-year-old boy presented signs of pulmonary abscess. Chest X-rays, ultrasonography and computed tomography established the diagnosis of a right subphrenic abscess, which was percutaneously drained. Surgery disclosed an ectopic appendiceal perforation. CONCLUSION: In children, appendicitis is the main etiology of primary or postoperative subphrenic suppurations. Ectopic appendicitis is an important predisposing factor to this complication.

[Congenital cysts of the esophageal wall with a respiratory type mucosa]. / Kystes congénitaux de la paroi oesophagienne à revêtement muqueux de type respiratoire.

Eight patients with congenital esophageal cysts are described. They presented with respiratory or gastrointestinal symptoms or an abnormal mediastinal profile on a standard chest film. All cysts were contained in the middle or inferior portions of the thoracic esophagus. They were excised in a submucosal plane. Their coat was composed of a ciliated, respiratory type epithelium. In the embryo and after separation of the tracheal diverticulum, the esophagus is lined with ciliated cells which are able cover a "cystic duplication", which is surrounded by an esophageal muscular coat or can be "included" in a common mesenchyma, which explains the possible presence of bronchial elements in the wall of an esophageal cyst. In this eventuality the cyst may be defined as being "bronchogenic".

[Surgery of tetralogy of Fallot in the first year of life (author's transl)]. / Chirurgie de la tétralogie de Fallot pendant la première année de la vie.

Despite the very good results published by B. Barrat Boyes and A. castaneda with early correction of Tetralogy of Fallot in the first year of life, the authors prefer palliative surgery for this group. They have operated upon 47 infants less than one year of age, 15 of them being less than 2 weeks of age. The overall mortality is 4%, the only two deaths being in the neonate group, which is usually a very small group in the published series with early correction. Since all the children with S.P. Shunt performed for Tetralogy of Fallot can wait 2 to 4 years before complete correction, and since the mortality of corrective surgery at 4 years of age is almost nil, the authors think that the two stages approach give as good results than one stage surgery, despite the possibility of neurological complications which may occur between operations. They argue that with early correction, surgeons are obliged to put more transannular patches which result in more pulmonary insufficiency cases, and that the mortality in this age group is still very high in some publications. They have also compared the percentage of low cardiac output syndrome after correction and found that children with a previous S-P shunt have smoother post-operative course. Finally they think that it is possible to obtain a global mortality around 7% for the 2 stages approach and that this kind of surgery is technically easier than early correction and must be very useful for the majority of cardiac centers interested in congenital heart disease.