[A 6-week-old infant with failure to thrive: insidious presentation of group B streptococcal ventriculitis]. / Stagnation pondérale chez un nourrisson de six semaines : présentation insidieuse d'une ventriculite à streptocoque du groupe B.

Failure to thrive is frequently seen in breastfed infants. The most common diagnosis is insufficiency of breast milk in an otherwise healthy child. However, several differential diagnoses need to be considered. Progressive feeding difficulties and failure to thrive can be the first manifestation of group B streptococcal ventriculitis. This rare disease does not present with acute symptoms of sepsis or meningitis but evolves insidiously with no fever. Diagnosis is therefore often delayed and made only when intracranial hypertension develops. Cerebrospinal fluid (CSF) culture confirming the group B streptococcal infection and cerebral imaging are the necessary investigations for diagnosis. To our knowledge, only 10 cases have been previously reported.

Hysteroscopic resection of submucous myomas.

Within just a few years, operative hysteroscopy has largely replaced laparotomy in the treatment of submucous myomas. Due to the rapid expansion of hysteroscopic surgery techniques, guidelines must be defined to standardize the procedure and at the same time provide the basis for highly individualized treatment of each patient. The choice of an appropriate therapeutic approach in this context is an issue of logistics, rather than surgery. Factors contributing to the individualized decision regarding the therapeutic approach include indications, individual anatomical conditions encountered, necessity of medical pretreatment, available equipment and adequate premises at the surgical center, and intraoperative procedure of choice. Taking into consideration all these issues, the present article aims at presenting to the surgeon not only a summary of the state-of-the-art techniques, but also a guideline for sophisticated strategy planning for and performance of the hysteroscopic technique of myoma resection.

[Hepatitis B vaccination: knowledge and acceptance by Swiss physicians]. / Hepatitis-B-Impfung: Kenntnisse und Akzeptanz bei Schweizer Arzten.

Difficulties with the acceptance of immunization recommendations by physicians have been documented. A recommendation for universal hepatitis B vaccination was published in 1998 for Switzerland. We conducted a qualitative study of pediatricians and family physicians in the fall of 1996 with eight focus groups stratified by region of the country and medical specialty. Sixty-two physicians participated. Most participants felt that universal hepatitis B immunization would be useful. Pediatricians in the French-speaking part of the country were more willing to implement such a recommendation, while family physicians in the German-speaking regions were least willing. Before supporting universal hepatitis B immunization, physicians stated that they need more information about the epidemiology of the infection, the effectiveness and safety of the vaccine, and the perceived high cost of an immunization program. Participants felt that two injections per visit was the maximum tolerable for infants and young children. Many preferred to immunize older children or adolescents against hepatitis B, both because fewer injections are currently recommended at that age and because adolescence is a developmentally appropriate age to address sexuality and drug abuse. Physicians expected the population to be reluctant to accept universal hepatitis B vaccination, partly because of a lack of understanding of the disease and partly because of a feeling that children already receive more than enough immunizations. While the general sentiment for a universal hepatitis B immunization recommendation in Switzerland seems to be positive among physicians, concerns regarding its implementation linger. It remains to be seen how hepatitis B will be perceived in the population, and how willing parents and adolescents will be to get their children and themselves vaccinated. Helping physicians to understand the importance of this measure, in addition to convincing them to immunize their patients, will be an important first step towards achieving sufficient hepatitis B immunization coverage.

True epineural neurolysis in Morton's neuroma: a 5-year follow up.

Morton's neuroma is a frequent cause of metatarsalgia. Neuroma resection was the usual recommended surgical treatment. Failure rate of neurectomy can be as high as 14% to 21%, and treatment of recurrences is difficult. The authors have treated Morton's neuroma by neurolysis since 1985. They present their results in a group of 40 patients with 5 years follow up. Thirty-seven of 40 patients had an excellent result after neurolysis and 35 patients had normal toe sensitivity at the date of examination. Thirty-nine patients stated they would undergo the operation again if necessary.

[Sciatic nerve block in the popliteal fossa]. / Bloc du nerf sciatique dans le creux poplité.

A technique of sciatic nerve block in the popliteal fossa, for operations on the foot and the ankle is described. It is obtained in the patient in prone position with a 12 cm long and insulated 22 G needle, connected to a nerve stimulator. The latter increases the rate of success and acceptance by the patient. This technique was used in 1000 patients between 16 and 88 years of age without any significant complication.

Basal osteotomy of the fifth metatarsal for the bunionette.

A proximal basal chevron osteotomy was carried out on 20 patients (22 feet) with a Tailor's bunion deformity. The follow-up was of a minimum of 3 years for all patients. Direct surgery on the fifth metatarsophalangeal joint for bunionette treatment has often been unsuccessful and there have been recurrences due to metatarsophalangeal instability. Basal osteotomy is therefore preferred. The patients were satisfied. The intermetatarsal 4-5 angle was noticeably reduced. There were no postoperative complications and no recurrences. The fifth metatarsophalangeal joint was corrected despite the absence of direct surgery and remains stable. This operation is recommended for acute bunionettes with intractable plantar keratosis.

Surgical excision of cerebral arteriovenous malformations: late results.

A follow-up study of 153 consecutive patients who underwent complete excision of an angiographically visualized intracerebral arteriovenous malformation was conducted. The follow-up period ranged from 0.5 to 10.6 years, with a mean of 3.8 years. The presenting clinical event was hemorrhage in about one-half of the patients and seizure in about one-third. There was a marked tendency for postoperative neurological deficits to improve with time, so that whereas the immediate postoperative rate of serious morbidity was 24.2%, only 7.8% of the patients were found to have serious morbidity at follow-up. An additional 3 patients had died, one of an unrelated carcinoma, making the mortality related to arteriovenous malformation 1.3%. The classification of Spetzler and Martin (43) was used retrospectively; the percentages of Grade I (easiest) through Grade V (most difficult) lesions were 7.8%, 22.9%, 28.8%, 26.8%, and 13.8%, respectively. The early result was well correlated to grade, with good or excellent results in 100%, 94.3%, 88.6%, 61%, and 28.6% of the patients in Grades I through V, respectively. At follow-up, 98.7% of the patients with arteriovenous malformations of Grades I, II, and III were in good or excellent condition. The late morbidity and mortality rates for the patients in Grades IV and V were 12.2% and 38.4%, respectively. Of the patients who did not have seizures before surgery, 8.2% had only one or two seizures during the immediate postoperative period, and 7.1% had late seizures that were well controlled with medication in all. Of the patients who had seizures before surgery, over half were either cured or greatly improved with respect to the seizures.(ABSTRACT TRUNCATED AT 250 WORDS)

[True neurolysis in the treatment of Morton's neuroma]. / La neurolyse vraie dans le traitement du névrome de Morton.

The authors consider Morton's neuroma as a tunnel syndrome, the most likely etiology being the compression of the nerve by the intermetatarsal ligament. Therefore, they have treated Morton's disease by decompression of the intermetatarsal nerve via a dorsal approach. They operated 45 patients, 82% of whom were women. In 85% of the cases, a large neuroma was found and they did not find the theoretical predominance of the 3rd intermetatarsal space; 9 times in 10, the treatment consisted in epineural dissection of the nerve and its collaterals at the bifurcation. In 84% out of the cases, the result was satisfactory; associated pathology was treated at the same time. The authors discuss the results and emphasize that, in case of failure, a simple neurectomy may be used.

Basal osteotomy of the fifth metatarsal with intermetatarsal pinning: a new approach to tailor's bunion.

The direct approach to the fifth metatarsophalangeal joint for the treatment of metatarsus quintus valgus often has been unsuccessful, mainly because of technical difficulties in the osteotomy of the narrow fifth metatarsal neck and the fixation of the unstable head fragment. Complications such as delayed union, nonunion, or recurrence have been reported. This paper describes a surgical technique for optimal correction of this deformity. The technique has a biomechanically sound fixation and a shortened bone healing time with minimum complications. Results of 12 patients presenting severe deformities are reported, with 1-year average follow-up.

Periventricular leucomalacia and neurodevelopmental outcome in preterm infants.

During an 18 month period, 120 preterm infants of 34 weeks' gestation or less were prospectively examined for periventricular leucomalacia (PVL) by cerebral ultrasound. Neurological and developmental assessment was carried out at 18 months of age corrected for prematurity in 82 surviving neonates. The developmental outcome (Griffiths development quotient) was above 80 and similar in infants with normal scans (n = 41), isolated periventricular-intraventricular haemorrhage (n = 13), and post-haemorrhagic hydrocephalus (n = 4), and no major handicap was diagnosed in these groups. By contrast, the prognosis was variable and poorer in infants with PVL (n = 24) and depended on the extent and site of the lesion. Infants with frontal PVL (n = 13) developed normally. Major sequelae (n = 8) were closely related to frontal-parietal PVL and frontal-parietal-occipital PVL and could be ascribed to the presence of cysts as well as to a persistent hyperechogenic ultrasonographic PVL appearance. A relation between size and site of the lesion and type and severity of the handicap was established.

Initial chemoimmunotherapy in inflammatory carcinoma of the breast.

Fifteen patients with clinical primary inflammatory carcinoma of the breast were treated with initial chemoimmunotherapy between September 1974 and May 1977. The protocol was a combination of Adriamycin, vincristine, 5-fluorouracil, and methotrexate given by I.V. push, and melphalan per os. Thermographic cooling was taken as the criterion of operability. Initial chemotherapy was resumed after surgery up to a total of ten courses and followed by maintenance chemotherapy for a minimum of one year. Immunotherapy using I-BCG-F. Pasteur was routinely associated with the antimitotic agents. The median survival for our 15 patients has not been reached and exceeds 56 months. These results correspond to an obvious therapeutic benefit compared with recent attempts in which similar chemoimmunotherapy protocols were used; this benefit seems to be the consequence of the adaptation of the length of initial chemotherapy to the data given by plate-thermography.