[Reconstruction of proximal nasal defect after deep carcinological resection. Interest to combine titane mesh with fat grafting]. / Reconstruction de la racine du nez après exérèse carcinologique profonde. Intérêt de combiner implants de titane et greffe de tissu graisseux.

INTRODUCTION: The mucosal cylindroma or adenoid cystic carcinoma is the second sinonasal non-epithelial malignant tumor frequency argument. Due to the achievement of the nasal mucosa and a late diagnosis reconstructions are often complex. We report the case of a mucous cylindroma recurrence of nasal septum requiring a wide and deep excision of the root of the nose with nasal reconstruction. CASE REPORT: A patient aged 66 years whose history resection two years ago with a mucous adenoid cystic carcinoma of the right side of the nasal septum, had a local recurrence T2NOM0 imposing a wide excision with amputation nasal septum own bones of nose, the anterior portion of the triangular cartilages. The reconstruction was carried out in three areas: a musculocutaneous forehead flap to the mucosal level, a titanium plate to the bone plane, nasal native skin to skin level. Histological examination confirmed the existence of a recurrence cylindroma infiltrating the bone. The surgical margins were however in sano. Adjuvant radiotherapy to 60Gy dose of the surgical area was indicated after surgery. The consequences of surgery and radiotherapy were simple. However local changes to show a progressive refinement of the nasal skin due to irradiation leading to a small titanium plate exposure revision surgery with coverage by a glabellar flap associated with a time of lipomodeling unexposed areas have improved and trophism of soft tissue. Two further lipomodeling sessions have yielded a good quality and stable skin. From an oncological point of view, no recurrence was detected with a decline of 10 years. Aesthetic and functional point of view the results were highly satisfactory. DISCUSSION: Oncologic resections subtotal nasal pyramid are complex, we will see the benefits and disadvantages of the different techniques used in the different stages. CONCLUSION: This case report illustrates the difficulties of reconstruction after wide excision of mucosal lesions root of the nose carrying the mucous plan and nasal bones. It stresses the importance of bone reconstruction titanium plate and innovative element, the efficiency of fat transfer to restore the quality and trophicity soft tissue. Fat transfer in addition to reconstructions by titanium plates and splints may thus expand the indications of these types of techniques in complex facial and cranial reconstructions.

Day-care unit for rigid panendoscopy of the upper aerodigestive tract: A study of 436 procedures.

OBJECTIVES: To assess the role of day-care management of upper aerodigestive tract (UADT) panendoscopy and to study criteria for conventional hospital admission and reasons for conversion. PATIENTS AND METHODS: Retrospective study, from January 2011 to May 2013. Inclusion criteria UADT panendoscopy for carcinoma assessment. Study variables, age, gender, tumor location, reason for panendoscopy, TNM stage, previous external radiotherapy, home-to-hospital distance and Apfel, Detsky and ASA scores. A day-care and a conventional admission group were compared using Fisher's test for ASA score, student's test for age and Pearson's chi2 test for the other variables. RESULTS: Four hundred and thirty-six panendoscopies were performed: 252 in day-care, including 4 cases of conversion and 184 with conventional admission. There were no significant differences between groups for age, gender, tumor location, TNM stage, reason for panendoscopy, previous external radiotherapy, home-to-hospital distance or Apfel score. A significant difference was observed for ASA score (P<0.0001) and Detsky score (P=0.03). In 39% of cases, the reason for hospital admission without criteria defined by the French Society of Anesthesia and Intensive Care Medicine (SFAR) and French Health Authority (HAS) was the patient's refusal of day care. In 10% of conventional admissions, day-care was not implemented because of psychosocial factors. CONCLUSION: Day-care management is appropriate for UADT panendoscopy in selected patients. The reasons for the high rate of patient refusal should be studied.

[The double system of child protection: a French original]. / Le double système de protection de l'enfance: une originalité française.

France has a double system of child welfare as decreed by the law of July 1989. Social welfare is under the responsibility of the Regional Council (social services, early childhood health services, and child protection services). These type of services require the family's collaboration with respect to the proposals concerning child protection: financial aid, family counseling, and placement. In case of severe danger, or if it is impossible to obtain the family's collaboration, the child's judge can order family counseling or placement. None of these measures modifies parental authority. A child in danger and the child's best interest are the two fundamental concepts which ought to guide social welfare and children's court workers in choosing the best possible protection measure.

[Early discharge from maternity: problems, exigencies and recommendations]. / Sorties précoces de maternité: problèmes posés, exigences, recommandations.

Early discharge 72 hours after delivery remains the mother choice, although the final decision is taken by the midwife as well as the paediatrician of the unit, and never before the third day. A follow-up at home is systematically proposed during at least two days. Specially trained midwives of the maternity are in charge of this follow up. A one year evaluation of this practice shows that early discharge, after good clinical evaluation, with regular follow up as long as necessary, is not responsible for infants rehospitalisations as a result of undiagnosed pathology or maternal incompetence.

[Abused children]. / Les enfants maltraités.

After a description of child abuse and neglect among young children in the literature, the authors focus on the recognition of the problem by professionals. They describe the clinical symptoms which are found among battered and neglected children. When faced with this non specific and polymorphic symptomatology, they provide means to reach the diagnosis. They conclude with a brief description of the behaviour one should adopt when dealing with the children as well as with the legal protection system.

[Medical violence toward young children]. / La violence médicale envers les jeunes enfants.

The author describes the many circumstances during which infants and young children are submitted to violence by doctors or medical assistants when given medical care. This violence starts at birth in the newborn ward. Later it is found in all forms of care dispensed to young children in ambulatory as well as hospital practice. The author shows that most of this violence can be avoided provided that doctors act in full consciousness of its consequences.

[A case of child abuse. An impediment in diagnosis]. / Une observation d'enfant maltraité. L'entrave au diagnostic.

Child abuse is reported in a 30 month old boy. This observation shows the difficulties of this diagnosis when parents have a normal psychosocial appearance.

[The pediatric team in the presence of physical cruelty to and severe affective deprivation of children]. / L'équipe pédiatrique devant le sévice corporel et la carence affective grave chez l'enfant.

From a study of 50 cases the authors suggest a more suitable approach for paediatricians to the problems of battered babies and children with severe emotional deprivation. A multidisciplinary team is recommended in which everyone is involved and not just specialised personel. The study shows the frequency of emotional deprivation of children in care and the possibility offered by adoption. Local psychiatric support is often needed for parents who do not ask for help. The need to make long term arrangements during hospital admission requires an interdisciplinary team with close links between the paediatric team and other child welfare services.

The Rapunzel syndrome: case report and review of the literature.

We report a case of a gastric trichobezoar (TB) extending throughout the small bowel in a child. The possibility of a TB causing an epigastric mass should be borne in mind, and ultrasonography could be used to support such a diagnosis. These bezoars should be considered to possibly have extensions for which there may be no preoperative or endoscopic evidence. Their complete operative removal is required. A psychiatric consultation and long-term follow-up are necessary, as recurrence of trichophagia and eventually the TB could occur.