The mobile order solubility equation applied to polyfunctional molecules: The non-hydroxysteroids in aqueous and non aqueous solvents.

The solubility equation for real solutions derived from the thermodynamics of mobile order in liquids is used to predict the solubility of non-hydroxysteroids in water and in common polar and nonpolar organic solvents. Strictly obtained on a thermodynamic basis, the model allows not only correct predictions of the solubilities from the knowledge of a limited number of characteristics of solutes and solvents, but also enables a better understanding of the solution process and of the factors that determine solubility. Some practical rules are derived which might help to orient the choice of a solvent for liquid pharmaceutical forms.

Cryptorchidism: a morphological study of 670 biopsies.

Among a series of 512 boys with an empty scrotum, 495 (96.7%) were found to have cryptorchidism, 4 had ectopia and 13 unilateral anorchia. Cryptorchidism was bilateral in 106 boys (21.4%). The only anomaly consistently associated with cryptorchidism was a detached epididymis, present in 31 patients. A total of 670 biopsies were studied, 441 of which came from cryptorchid and 229 from scrotal testes. Spermatogonial counts, performed according to Mancini's method, showed the germ cell population to be diminished in nearly all cryptorchid testes. The seven boys who still had a well preserved germ cell population were found in a group of 51 patients operated before age three; four of the seven boys with normal counts were below age one. No difference in the mean spermatogonial counts was found between uni- und bilateral cryptorchidism and ectopia, with the exception of bilaterally intraabdominal testes whose spermatogonial cell loss was particularly severe. Mean counts remained constant during childhood, no gradual increase with age having been observed. The scrotal testes in unilateral cryptorchidism showed cell loss in 30.1% of the cases, the germ cell depletion being severe in one out of every six cases. In the remaining scrotal testes, the counts were in the low normal range with a significantly lower mean than that found in scrotal testes associated with anorchia. Control biopsies were performed several months or years after orchidopexy in 18 boys with unilateral and in 24 boys with bilateral cryptorchidism. Orchidopexy does not improve the number of germ cells in either originally cryptorchid or in scrotal testes, the only postoperative change being an increase in tubular diameter. A search for malignant tumours which could have developed in this series has remained negative. According to our data, no optimal time for orchidopexy can be proposed. The damage to germ cells, once established, seems to remain unchanged during childhood at least after age three, and does not warrant special timing for operative correction of cryptorchidism.

[Laparostomy in children]. / Die Laparostomie im Kindesalter.

Laparotomy means leaving the abdomen open after a laparotomy. This enables the surgeon to revise the abdominal cavity regularly and to check the efficacy of the drainage without repeated damages to the abdominal wall. In adults, this method is used in cases of abdominal pathology with necrotic or infectious pathogenesis. We describe the method of laparotomy in 3 cases of paediatric surgery. It was used in cases of postoperative peritonitis and we think that laparotomy may be used in these situations, especially because there are almost no sequelae.

Frequency of testicular atrophy following incarcerated hernia.

From 1977 to 1981, 40 infants and children were operated for incarcerated inguinal hernia, 35 boys and 5 girls. During this time, 903 hernias were cured. Follow-up examination has been possible with 32 boys, from 6 months to 5 years after surgery. Three have an irreversible lesion of the testis (2 atrophies, 1 orchiectomy), 4 a decrease of testicular volume, 1 has a bilateral retentio testis, 1 has a cryptorchidism on the non-operated contralateral side and 23 are normal. Risk factors of testicular lesions were studied with regard to age, duration of symptoms, reducIbility of hernia and to other clinical findings, and the follow-ups are evaluated with regard to macroscopic operative appearance of testicles. The group of infants less than 1 month of age with symptoms for more than 24 hours and with ileus is the highest risk group for testicular infarction at the time of incarceration of hernia.

An unusual association of small bowel atresia and biliary atresia: a case report.

The embryological development of the hepatobiliary bud presupposes that biliary and duodenal malformations are often associated. On the other hand, the association of biliary atresia with more distal small bowel malformations, possibly due to a vascular accident, seems to be fortuitous. We herewith report such a case and, on reviewing the literature, have found only two previous similar observations.

Follicle-stimulating hormone. IV. Study of the histology of pubertal cryptorchid and scrotal testes in relation to the secretion of gonadotropins.

The morphologic characteristics of 85 cryptorchid and 63 contralateral (scrotal) testes showing histologic changes of puberty were studied. Spermatogenesis was not only delayed on the cryptorchid side but also hypocellular in all cases. The scrotal testes appeared hypocellular in 82.5% of the cases. Repetitive biopsies, performed in 12 patients, showed no improvement of cellularity after orchidopexy but progress in pubertal maturation. In the 22 boys submitted to luteinizing hormone-releasing hormone (LH-RH) stimulation, luteinizing hormone (LH) baseline values did not change significantly whereas follicle-stimulating hormone (FSH) baseline levels increased with advancing age and histologic stage of maturation. LH responses increased with the stage of maturation (without statistical significance); however, LH responses were significantly higher in the group without germ cells. FSH responses to LH-RH stimulation were consistently and significantly higher with advancing stages of maturation and in the group without cells.

[Prophylaxis of recurrent urinary infections in children. Long-term use of a weak dose of trimethoprim-sulfamethoxazole]. / Prophylaxie des infections urinaires récidivantes de l'enfant. Emploi à long terme d'une faible dose de Trimethoprim-Sulfamethoxazole.

The efficacy of a long-term prophylaxis with Co-trimoxazole was studied in 18 girls with recurrent urinary tract infections. SEven patients had neither anatomical nor functional anomalies of the urinary tract. Eight patients had a vesico-ureteral reflux, and three patients a complex urinary problem. The following therapeutic plan was applied: administration of a low dose of Co-trimoxazole (TMP: 0,6-1 mg/kg) given as a single evening dose during 3 months followed by a 3-month period without treatment. The children were followed in this way during 2 years. Seven children had no reinfection from the start of the prophylaxis during the 2 years of observation. Nine children had a significant decrease of the number of reinfections during the Co-trimoxazole treatment periods. Two children without anatomical anomaly had early reinfections with Co-trimoxazole resistant germs. No side effects related to Co-trimoxazole have been observed, and the tolerance of treatment was excellent. Co-trimoxazole administered as a single evening low dose efficiently prevented the recurrence of urinary tract infections.

Primary closure of laparoschisis.

Five consecutive cases of laparoschisis repaired with primary closure were successfully treated between 1977 and 1980. All five remained intubated after surgery and with assisted ventilation for 24 hours to 10 days. Parenteral alimentation was systematically instituted and continued from 10 to 30 days, until recovery of bowel function. In this small series, primary closure seems to have been an important factor in the good prognosis of the laparoschisis, despite the necessity of assisted ventilation. The authors discuss the advantages of primary closure compared to the other surgical procedures.

[Nephrotomy using in situ hypothermic perfusion. Apropos of a case]. / Néphrotomie sous perfusion hypothermique "in situ". A propos d'un cas.

The case of a 14 year old boy, suffering from severe bilateral nephrolithiasis, secondary to cystinuria, is presented. The progressive increase of the lithiasis, the dilatation of the excretory system of the right kidney and the painful passage of stones justified surgical removal of the staghorn stones on the right. The nephrolithotomy was performed under hypothermic perfusion of the kidney in situ, with section of the renal artery. This allowed an exsanguineous nephrotomy and the complete removal of all the stones. Anatomical repair of the calyces was possible, renal artery was re-anastomosed and the opening of the renal vein sutured without difficulty. No complication was encountered in the postoperative period, renal function remaining good. The intravenous pyelogram at the 15th postoperative day showed a marked improvement of the hydronephrosis. The authors review the literature describing the different methods of ischemic nephrotomy and compare the advantages of the procedure chosen in their case with the others : these advantages are the good preservation of the kidney, a bloodless nephrotomy, the long time allowed for the procedure and the removal of all the stones, and the possibility to continue the operation ex vivo when necessary, even using microsurgery.

Surgical correction of caudal duplication.

The authors report the rare case of a dipygus monster. The infant had an omphalocele, a secondary pelvis with two limbs, an accessory pelvic kidney, and two bladders. At operation, the secondary pelvis and extremities were removed, and the omphalocele was repaired. The postoperative course was complicated by wound infection, urinary infections, proteinuria, cardiomegaly, and hypertension of renovascular origin. The infant died after right nephrectomy, 5 mo after the first operation.

Intramural diverticulosis of the esophagus in an eight-year-old boy.

A third pediatric case of intramural diverticulosis of the esophagus is reported in an 8-year-old boy. A hiatal hernia, chronic nonspecific esophagitis and defective esophageal motility was also documented in his 10-year-old brother.