[Neonatal curettage of giant congenital nevi]. / Curetage néonatal des naevus congénitaux géants.

OBJECTIVE: All agree upon the need for early treatment of giant congenital nevi, basically because of the risk of melanoma degeneration, estimated at about 5 p. 100. Another reason is the cosmetic, psychological and social impact of such nevi. The aim of this study was to assess neonatal curettage of giant congenital nevi as an alternative to classical surgery. PATIENTS AND METHODS: Between 1996 and 1999, the curettage technique was used in 14 newborns with giant congenital nevi. Three nevi were located on the scalp, 4 on lower limbs and 7 on the trunk with a jacket configuration in 1 case and a cape configuration in 4. RESULTS: Curettage achieved 70-95 p. 100 clearing of the giant nevi in 10 of the 14 children. Four of the children developed hypertrophic scar tissue which resolved with time. Secondary hair growth was observed in 5 cases. Outcome was better when the curettage was performed very early (before 2 weeks of life). DISCUSSION: Curettage is a surface technique proposed when surgical excision cannot be performed because the surface is too large or the localization is incompatible with surgery. Curettage is a simple low-cost technique which provides particularly satisfactory cosmetic results for very extensive giant congenital nevi. The risk of malignant transformation is greatly reduced although not totally. Regular clinical surveillance under conditions greatly improved by the clearing should help reduce the risk.

Laparoscopic versus open appendectomy in children--comparative study of 403 cases.

Laparoscopic appendectomy (LA) has not achieved widespread acceptance among surgeons, open appendectomy (OA) being a simple and secure technique. We compared retrospectively 200 LAs and 203 OAs in children and adolescents (mean age = 10 years) from January 1, 1989, to March 31, 1993. The introduction of LA did not modify our operative indications. Laparoscopic investigations found 22 right lower quadrant peritoneal adhesion diseases (11%), those lesions were totally unknown with OA. Operative complications are more frequent with LA (5% versus 1%--p < 0.02): bleeding of the appendiculary artery or of an epigastric vessel, intestinal perforation and burn of the ileum are the most serious complications that we had. On the other hand, the postoperative complications mostly occur after OAs (10.8% versus 1.5%--p < 0.001): 11 wound abscesses, 8 intraperitoneal infections and 4 obstructions after OA and only 1 wound abscess and 2 intra peritoneal abscesses after LA. The general anesthesia was significantly longer for LA (72 minutes vs 55 minutes--p < 0.001). Mean hospital stay was 4 days after LA and 6.4 days after OA. The postoperative complications involved 27 additional hospital days after LA and 162 days for OA. As a conclusion, OA is quicker and has few operative complications. But LA has many advantages: less traumatic, easy treatment of ectopic appendix, efficient lavage of the peritoneum, less frequent postoperative complications and better postoperative comfort. All this encourages us to go on with LA, all the more as the operative complications fall off with the training of the operator.

[Post-anesthetic hepatitis. The role of halothane and antimitotic combinations]. / Hépatite postanesthésique. Responsabilité de l'association halothane-antimitotiques.

A 12 year old boy with Burkitt's lymphoma developed severe hepatitis with hepatomegaly, subclinical jaundice, and a small rise in body temperature, associated with an important rise in SGPT and fall in prothrombin titres, 6 days after anticancer chemotherapy and 24 hours after halothane anaesthesia. Hepatitis A and B serology remained negative. This hepatic failure explained perhaps the unusually severe vincristine toxicity which gave rise to a polyneuritis with important sequelae. The association of halothane hepatitis with antimitotic drugs appeared particularly dangerous, and halothane should probably be avoided in all patients been given or about to be given anticancer chemotherapy.

[Apropos of complications following the use of methylmethacrylate. Possible prevention by betamethasone]. / A propos des accidents après utilisation de métacrylate de méthyle. Prévention éventuelle par la bétaméthasone.

The aim of this study was to determine whether the prior injection of betamethasone was capable of preventing blood pressure changes and the fall in arterial pO2 when following the fixation of total hip protheses with methyl metacrylate. It involved 54 patients in whom systolic, diastolic and mean blood pressure (BP), arterial pO2, pCO2 and heart rate were noted at different times: T1, 15 minutes after the beginning of the operation; T2 and T3, one minute and five minutes after application of the cement; T4, at the end of the operation. There was no significant difference between the various measurements at times T1, T2, and T3 as far as blood pressure and heart rate were concerned. By contrast, there was a fall in pO2 at times T2 and T2 in relation to times T1 and T4. This fall was significant (p is less than 0.01) but never theless remained moderate. The possible influence of betamethasone is discussed.

[Neuroleptanalgesia as the anesthesia in pediatric surgery]. / Neuroleptanalgésie pour l'anesthésie en chirurgie pédiatrique

In work carried out over a period of two years in the department of anesthetics and intensive care of the Saint-Etienne University Hospital, the authors report their experience of neuroleptanalgesia using droperidol-dextromoramide in children in 104 cases. The observations may be divided up into 2 groups: - 1 group of children below the age of 2 years; - 1 group of children from 2 to 10 years. This study showed the side-effects and complications common to both groups, in particular, the extrapyramidal syndrome. Furthermore, the authors present their technique of administration.