[Unusual aspects of the late manifestations of diaphragmatic hernia]. / Aspect inhabituel d'une hernie diaphragmatique à révélation tardive.

A 5-year-old boy investigated for abnormality in right cardiophrenic angle was found on radiologic and perioperative exploration to have a large diaphragmatic hernia allowing right intrathoracic passage of stomach and colon. The diaphragmatic defect included a wide left middle diaphragmatic Bochdalek cleft adherent to hiatal orifice due to agenesis of pillars.

[The lungs in congenital diaphragmatic hernias (author's transl)]. / Les poumons dans les hernies congénitales des coupoles diaphragmatiques.

In congenital diaphragmatic hernias, the presence of abdominal viscera in the thoracic cavity will arrest the development of the ipsilateral lung, and occasionally of the controlateral lung also. The lung may thus be either compressed or hypoplastic in varying degrees. Its state of development conditions the prognosis of this disease. In severe forms, known as "High Risk" forms, presenting in the 3 first days of life with respiratory distress, the lung is very often hypoplastic, the number of bronchial, bronichiolar and vascular generations is diminished. The airways pulmonary function in medium and long term has been studied in 10 children over a period of 3 to 15 years. The clinical radiological, scannery and fonctional lung study results present not unfrequently signs of overdistention, of obstructive disease, and pulmonary bronchectasis on the side of the hernia. The evolution could be explained by the normal post natal multiplication of airways as well as by an increase of their size in such a manner as to occupy the whole thoracic cavity.

[Cricopharyngeal achalasia, exceptional cause of dysphagia in newborn (author's transl)]. / L'achalasie du cricopharyngien cause exceptionnelle de dysphagie du nouveau-né.

Dysphagia of the newborn and the infant presents with many varied causes, neurological, malformative, turmoral or functional. Among the latter, cricopharyngeal achalasia is an exceptional entity open to discussion. Suspected as early as the first month, presenting with difficulty in swallowing with choking episodes and coughing up of food without any obvious etiology. Profile roetgengraphic studies will allow the diagnosis to be made. The characteristic sign is a round and regular posterior narrowing on the posterior wall of the esophagus (C4 - C5 level) with enlargement of the hypopharynx. This narrowing is a constant finding. This pathological entity, an absence of relaxation of the cricopharyngeus muscle during the third period of swallowing, well-known in the adult patient, has only exceptionally been described among newborn children. In the following case study, cure has only been obtained by an extra mucosal myotomy of the esophagus at the age of seven months. The discussion, considering the five cases reported in pediatric journals, covers the diagnostic elements, the physiopathology of the disease, the risks presented during evolution without treatment. Therapy must be precocious and surgical.

[Closed thorax esophagectomy in caustic stenosis of the esophagus]. / L'oesophagectomie à thorax fermé pour sténose caustique de l'oesophage.

The technique of oesophagectomy without thoracotomy using a stripper for oesophageal eversion has been applied to 6 cases of caustic stenosis of oesophagus in infants. This technic has been realized 6 to 18 months after the initial lesion in 5 cases, 13 years in a case. There is neither morbidity nor mortality. This procedure seems well adapted to pediatric indications of oesophagectomy.

[Congenital sternal cleft. Closed with a periosteal graft]. / Fissure sternale congénitale. Fermeture par greffon périosté.

Three cases of sternal cleft are treated. In two cases direct approximation of the two sternal halves have been possible in neonatal period. The third case was seen later at 11 months: the cleft was 5 cm wide, we used autogenous periostal graft in two layers, the first in depth, the second above the sternal halves. This technique have given a good clinical and radiological result for two years. She must be reserved for the wide and "old" sternal cleft.

[Traumatic dislocations of the hip in children under 6. Apropos of 10 cases]. / Luxations traumatiques de la hanche de l'enfant de moins de 6 ans: A propos de 10 observations.

In a group of 11 traumatic dislocations of the hip, treated between 1962 and 1979, the authors find and study 10 cases of pure dislocation in often mild traumatism, about children between 4 and 5 and half yeard old. They remembre the classic tests: the most frequent hit by the boy, frequency of the posterior dislocation, the relative geod pronostic of the hurt in the growth, at this age. In front of theses particular facts of happening, they look for predisposing bone-factors by anamnestic investigations, a coxometric study of the hip, and for 5 children, a tomodensitometric investigation. They cannot have a definitive conclusion, but the results seem to show an association of predisposing articular defects which they go to the dislocation. That would be explain the great frequency of pure dislocations and the rarety of the cephalic necrosis.

[Acute acalculous gallbladder disease in children: acute cholecystitis or acute gallbladder distension (author's transl)]. / Pathologie vésiculaire aiguë non lithiasique de l'enfant: cholécystite aiguë ou distension vésiculaire aiguë (à propos de 2 cas).

Acute acalculous gallbladder disease is rarely encountered in children. Two observations permit a review of its clinical, diagnostic, and therapeutic aspects. Acute acalculous cholecystitis and acute gallbladder distension present clinically in a similar fashion, although, in the latter the fever is usually absent and there is a history of episodic pain. The pathogenesis of these affections remains uncertain but generalized infection and anomalies of the cystic duct seem to be favoring circumstances. The diagnosis, rarely initially made, could be confirmed by oral cholecystography showing an non visualized gallbladder. Surgery is necessary in order to confirme or refute the diagnosis. The therapeutic approach can be either the simple drainage of the gallbladder or a cholecystectomy. Due to the risk of allowing a cervicocystic obstacle persist, it seems that a cholecystectomy, which is well tolerated by the child, would be preferable.

[Renovascular hypertension in infancy treated by aortorenal by-pass (author's transl)]. / Hypertension rénovasculaire du nourrisson traitée par pontage aorto-rénal.

The writers record a severe case of renovascular hypertension resulting from fibromuscular dysplasia which appeared in the only main left renal artery. The first clinical symptoms were noticed at five months. The failure of medical treatment led to exploratory surgery at seven months with renal revascularisation by an aortorenal by-pass using a hypogastric arterial autograft. The writers stress the scarcity of hypertension symptoms among infants of less than one year and conclude the impossibility of prognosis in spite of an apparent cure after six months.