[Refractory pain in children with cancer: role of peridural analgesia]. / Douleurs réfractaires de l'enfant cancéreux: place de l'analgésie péridurale.

BACKGROUND: Adequate treatment of pain in children with cancer is a critical issue, and is of equal importance as discussions concerning chemotherapy, surgery and radiotherapy. OBJECTIVE: To evaluate the treatment of refractory pain by peridural analgesia. METHODS: Seven children (1-15 years) with solid tumors were treated with long term epidural analgesia for refractory pain. Catheters were inserted in epidural space (L1-L2) and infused with sufentanil, bupivacaine and clonidine. RESULTS: Three out of five children with good response to peridural therapy could be discharged. A 12-month-old infant had a poor response. Treatment was discontinued in a teenager boy because of patient refusal. The side effects were: early catheter displacement in two patients and a bacterial contamination in one. Serious adverse effects related to high doses of opiates were not observed. However, toxicity of bupivacaine was observed in three patients leading to treatment discontinuation in one. CONCLUSION: Long-term epidural analgesia looks promising in selected children with refractory pain.

[A comparative study of standard and total orthotopic cardiac transplantation]. / Etude comparative de la transplantation cardiaque orthotopique standard et totale.

The classical orthotopic heart transplant modifies size and geometry of the atria, may affect mitral and tricuspid function, and ventricular filling. A technical modification with subtotal excision of the recipient's heart, with anastomosis of a cuff of left atrium and of venae cavae has been used and compared with 2 consecutive series of transplantations : 70 classical (group I) 1986-1991, and 50 modified (group II) 1992-1994. The patients were similar for age, pretransplant characteristics, postoperative treatment. The aortic cross-clamping in the recipient (duration of cardiac excision and graft implantation) has been longer in group II (87 +/- 19 mm vs 65 +/- 15: p < 0.001). No surgical complication due to the technique was observed. Mortality was similar in the 2 groups (14% group I, 18% group II; NS). Five patients of group I has a systemic embolism (1 month to 5 years after transplant), none in group II. Two comparable groups of 30 patients were studied at least 6 months after transplantation with: surface EKG, Holter, transthoracic and esophageal echodoppler. A larger number of EKG anomalies, a significant increase in the size of atria, a significantly larger number of mitral and tricuspid insufficiencies, an increase in the variability of E/A ratio (left ventricular filling parameter) were noted after classical transplantation. Spontaneous contrast echo and thrombus in the left atrium were also noted after classical transplant. We conclude that these technical modifications result in a geometry and anatomy closer to normal. Less anomalies of the cardiac function were found. Due to the absence of left atrial thrombus and of systemic embolism we think that there is a definite advantage in this technically rather simple approach.

[CO2 laser in pediatric laryngology]. / Le laser CO2 en laryngologie infantile.

Carbon dioxide Laser is a recently developed instrument which has became essential in laryngology, especially in its pediatric applications. Authors report 86 cases of children with a laryngeal pathology treated by CO2 Laser at the Childrens Hospital of La Timone in Marseille. Four groups emerge from this study. They are composed of laryngomalacia (n = 34), subglottic angiomas (n = 12), laryngeal papillomatosis (n = 12) and laryngeal stenosis (n = 14). Other patients (n = 14) made up a miscellaneous population (granulomas, laryngeal paralysis, benign tumors). Post-operative data are analyzed and compared with those of literature. The result is that this therapeutic method, used within the limits of precise indications and, if necessary, with divided sequences, can offer rapid curative care with few complications.