[Recurrent tracheoesophageal fistula in type III esophageal atresia. Diagnosis and treatment are not easy]. / Reperméation de fistule œso-trachéale dans l'atrésie de l'œsophage de type III : un diagnostic et une prise en charge difficile.

Recurrent tracheoesophageal fistula (TEF) is possible after repair of congenital esophageal atresia. The frequency of recurrent TEF is observed in about 10% of the cases. Within a cohort of 67 children with type III esophageal atresia repaired between 1998 and 2009, we aimed to identify the number of children with recurrent TEF, the risk factors for this condition, and the treatment proposed. The sex ratio was 1.7. Surgery was performed between 4 and 36 hours of life. Five children (7.5%) had a recurrent TEF, usually during the first 3 months, revealed by respiratory symptoms related to feeding in some cases. We noted that recurrent TEF was more frequent with anastomotic leakage (P=0.09) or postsurgical pneumothorax (P<0.01). The diagnosis was made in four cases out of five by a methylene blue test performed during a tracheobronchial endoscopy. Surgical treatment was noted in four children, with three postsurgical secondary effects. One child was treated by endoscopy and an esophageal clip. With a median follow-up of 52 months, no recurrence was noted. The recurrence of TEF may be linked to postsurgical events. Diagnosis is not easy and treatment is not clearly codified. Endoscopic treatment may be an advantageous option to surgery, likely with less morbidity.

[Medium-term outcome, follow-up, and quality of life in children treated for type III esophageal atresia]. / État de santé, suivi et qualité de vie à moyen terme d'enfants opérés d'une atrésie de l'œsophage de type III.

The aim of this study was to evaluate the medium-term outcome (health status, medical and surgical French National Health Authority-recommended follow-up, and quality of life) of children born with type III esophageal atresia (EA). Previous events (during the perinatal period, associated abnormalities, respiratory and digestive complications) of children treated for type III EA at the Marseille university hospitals between 1999 and 2009 were noted. Parents completed a standardized questionnaire concerning the health of their children during the previous year, and a quality-of-life questionnaire (PedsQL 4.0) was also completed by children aged more than 8 years. Among the 68 children treated, 44 responded to our solicitation (mean age, 7.6 years; range, 3-12.8 years). Previous important events were : pneumonia(s) (65%), asthma before the age of 3 years (66%), hospitalization for a respiratory event (45%), fundoplication (20%), and esophageal dilatation (45%). We noted current chronic cough (16%), asthma (30%), dysphagia (39%), and symptomatic gastroesophageal reflux (9%). National guidelines were not respected, except for the surgical indications in children aged less than 6 years. The quality-of-life scores (n=43 children) were similar to healthy controls but were negatively influenced by a gastrostomy procedure (P=0.020), pneumonia (P=0.013), and hospitalization due to a respiratory event (P=0.006) or a digestive event (P=0.010), and also by current asthma (P=0.004). In conclusion, despite recurrent respiratory or digestive symptoms and inadequate recommended follow-up, the quality of life of children treated for type III of EA is good.

Characterization of the surface organization of nanostructured hybrid organic-inorganic materials by time-of-flight secondary ion mass spectrometry

Time-of-flight secondary ion mass spectrometry (TOF-SIMS) has been used to analyse the surface composition of organic-inorganic hybrid solids obtained by a sol-gel process. Gels of type O(1.5)Si-R-SiO(1. 5), obtained from bis-silylated precursors (R'O)(3)-R-Si(OR')(3) (R' = Me, Et and R = (-CH(2))(n)-, n = 1, 2, 6, 10, 12;--CH=CH-; (-CH(2))(3)NH(CH(2))(3)-; 1, 1'-ferrocenyl; (CH(2))(n)-Ph-(CH(2))(n)- with Ph = 1,4-phenylene and n = 0, 1, 2; Ph = 1,3,5-phenyl and n = 0) were analysed. The results were highly dependent on the nature of the organic group. When the organic group was small or 'rigid', the main peaks detected corresponded to SiOH and SiOR' residual groups. Fragment ions from the organic group were poorly detected in this case. When the organic group was larger and more 'flexible', characteristic mass fragment ions were detected at higher relative intensities, indicative of a different organization of the organic units in the solid. TOF-SIMS clearly showed the differences between the xerogels derived from mono- and bis-silylated organic precursors : the organic group is present at the surface of mono-silylated xerogels, whereas for bis-silylated ones, the organization is dependent on the length and the flexibility of the organic units. These TOF-SIMS results are in agreement with other features already reported. Copyright 1999 John Wiley & Sons, Ltd.