The risk of wound infection after inguinal incision in pediatric outpatient surgery.

To study the risk of wound infection in pediatric outpatients, two series of children operated on with an inguinal incision during a 5.2 year period in the same department, either in day-surgery or in standard hospitalization, are compared. It appears that the frequency of inguinal wound infection is lower for outpatients (1%; 18/1816) than for inpatients (4%; 17/427). This difference is due, on the one hand, to the way day-surgery hospitalization functions and, on the other hand, to the difference of population produced by the criteria for selection for admission in the Day-Surgery Unit.

[Fatal hyperparathyroidism]. / Les hyperparathyroïdies mortelles

Hyperparathyroidism is able to determine suddenly after a very poor clinical history a deep coma : in such a condition, the diagnosis with the paraneoplastic hypercalcemia may be a difficult one : cervicotomy can be the heroïc way to lead to diagnosis and in the same time to perform treatment. To avoid such a dramatic situation, the authors propose cervicotomy for every patient suspected of P.T.H. adenoma, when calcemia is higher than 115 mg c/l, even if the symptoms are very slight or nil.

[Gaseous encephalography under ketamine hydrochloride general anesthesia in the child (author's transl)]. / L'encéphalographie gazeuse sous anesthésie générale au chlorhydrate de kétamine chez l'enfant

The aim of this technical note is to show that ketamine hydrochloride anesthesia, owing to the preservation of muscle tone, enables one to safely and comfortably carry out gaseous encephalography on a simple radiological table in the toddler or child. However the authors very strictly select the indications for this investigation. Whenever the child's clinical condition leads one to suspect intracranial hypertension and/or a cerebral tumor, they think it more prudent, owing to the vasopressor effect of ketamine hydrochloride and a possible elevation in the cerebrospinal fluid pressure, to transfer the child to a specialized neuroradiological center, where the investigations would be carried out under the best technical conditions, and close to a neurosurgical unit which is capable of intervening rapidly in case of complications. The authors voluntarily limit their indications to children suffering from psychomotor retardation, epilepsy or neurological disorders which make one suspect a congenital malformation.

[Early treatment of labiopalatine clefts. Their management and anesthetic problems]. / Traitement précoce des fentes labio-palatines. Gestion et problèmes anesthésiques.

The authors review a new therapeutic chronology for cleft lip and palate developed by R. Malek and J. Psaume. This involves very early treatment requiring orthopaedic or surgical procedures in small infants aged one to three months. These have been made possible by progress in techniques and equipment from both a surgical and orthopaedic standpoint as well as in anaesthesia. They describe the organisation of anaesthesia and analyse their results, showing that this is a simple anaesthetic, free of risk. The postoperative course is simple. The child is fed normally and is discharged on the 2nd or 3rd postoperative day.

[Hepatectomy in children using the trans-parenchymatous compressing suture as a hemostatic procedure]. / Hépatectomie chez l'enfant en utilisant comme procédé d'hémostase la suture appuyée trans-parenchymateuse.

Intraoperative hemorrhage during hepatic veins approach or during liver parenchyma transsection is the major risk of liver resection for children. We report a technique for hepatic resection based upon facility of safe ligation or clamping of vessels and ductules on a bloodless cut surface during transsection. This technique limits risk of extensive hemorrhage or damage to residual parenchyma, without heavy procedures of anatomical resections. Particularities of liver tissues and capsula of children are used. Perfect hemostasis of the cut edge is obtained by mattress sutures on Silastic * straps performed after clamping with specially designed liver clamps. The 3 main interests of this clamping are detailed. 21 liver resections were performed on children ranging in age from 9 months to 11 years. There was one intra-operative death and one within 30 days. Total blood loss during procedure was about 1/3 blood mass.

[External fistulas of the small intestines in the newborn infant and child. Medical aspects and digestive resuscitation (19 cases)]. / Fistules externes du grêle chez le nourrisson et l'enfant. Aspects médicaux et de réanimation digestive (19 cas)

The prognosis in fistulae of the small intestine in the infant and child is totally different according to whether they develop following a simple operation involving the healthy small intestine or multiple or complicated operations on pathological bowel. Under these latter conditions, constant medico-surgical cooperation, modern techniques of renutrition (total parenteral renutrition or constant flow enteral nutrition), together with restoration of water/electrolyte balance and the treatment of infections give increasingly satisfactory results. In a series of 19 children, with 26 enterocutaneous fistulas, deaths were reduced to 4. Independently of recourse to surgery determined by local abdominal conditions (peritonitis, obstruction) or persistence of the fistula, the choice between total parenteral renutrition and constant flow enteral nutrition (C.F.E.N.) depend essentially upon the site of the fistula. When the latter is proximal the digestive tract may not be used, while C.F.E.N. may be employed when it is distal, sometimes resulting in cure without further surgery.

[Broncho-pulmonary complications in survivors of esophageal atresia. (author's transl)]. / Les complications broncho-pulmonaires des atrésies de l'desophage. A propos de quatorze observations.

The short term prognosis of the esophageal atresia has been improved by the progress of diagnosis and surgical techniques. The long term prognosis still depends upon the occurrence of bronchopulmonary complications. Having investigated fourteen cases and a review of the literature, the authors studied the cause of these respiratory complication. Two factors seem to play an important role: the gastroesophageal reflux and the tracheomalacia. This has important therapeutical implications: treatment of the gastro-esophageal reflux and long term respiratory kinesitherapy. The authors suggest for these patients a management plan over several years.

Urinoma and arterial hypertension complicating neonatal renal candidiasis.

During antibiotic treatment for E. coli urinary tract infection and meningitis, a male new born developed a Candida albicans urinary tract infection with a mycotic kidney abscess and pelvicalyceal fungus balls diagnosed by US investigations and confirmed by radiology. Three weeks later a perirenal urinoma with arterial hypertension developed. After surgical treatment of the urinoma the arterial pressure returned to normal.