Biliary atresia and orthotopic liver transplantation. 11 years of experience in Geneva.

Biliary atresia (BA) is a congenital malformation or an evolutive inflammatory process which, without treatment, leads to cirrhosis, hepatic failure and death within two years of birth. The literature gives a survival rate of 60% at five years and 25% to adulthood after an initial operation performed for BA. 30% of children do not survive beyond two years of age. BA has become the most frequent indication for liver transplantation (LT) in children. With LT, survival expectancy is 90%. Results of the operation designed for BA remain unsatisfactory, and seem to depend on the age of the infants, as well as on other factors such as liver histology, and centre experience. Since 1989, onset of the paediatric hepatic transplantation program in Geneva, to July 2000, 20 children have been referred for initial treatment of BA, and 26 for possible hepatic transplantation after initial treatment done in another centre. The aim of the current study is to analyse our own results of the initial operation and to present the results of liver transplantation in this particular group of patients. All the patients with a BA are included in this study. The initial operation for BA yielded 43% favourable outcome at five years and the survival in this group following LT reached 91.3% survival. The importance of the age of the patient at time of initial operation is underlined.

[Scooter injuries or a chronicle of a new epidemic. Apropos of a prospective study of Geneva cases]. / Traumatismes à trottinette ou la chronique d'une épidémie annoncée. A propos d'une étude prospective de cas à Genève.

AIM: Confronted with an increasing number of an unpowered scooter-related injury and an absence of available data in the literature, we undertook a prospective and exploratory study, in order to assess the circumstances and trauma consequences of this kind of injury. METHOD: Between the 15th of August 2000 and the 15th of November 2000, each child consulting our emergency room for a scooter-related injury was questioned about the circumstances of the accident and his general scooter experience. Data about all injuries and there treatment were collected. RESULTS: 32 children (16 B/16 G) with a the mean age of 10.1 +/- 2.3 years have consulted. Eight children (25%) required hospitalization. In almost half of the cases, the injury was caused by direct or indirect material facts. No child was wearing protection at the time of the accident. Fracture was the most frequent injury (55%) and the upper limb was concerned by almost half of the lesions. Four fractures required osteosynthesis (12.5%) and six treatments a general anesthesia (19%). The severity of injury and the treatment were more substantial when the unpowered scooters were used for transport rather than for playing. CONCLUSION: Our short study gives a first estimation of the potential danger of the unpowered scooter and its confrontation with the traffic, without prevention given by the law or the producer. However this product can lead to important injuries.