[Cleft lip and palate: retrospective study of 35 years of management]. / Rétrospective: 35 ans d'expérience de traitement chirurgical des fentes labio-maxillo-palatines.

The author having treated more than 2,000 C.L. (P) cases, and recognized his errors, delivers his main conclusions: 1--The Cupid-s bow always complete on the healthy side is to be strictly respected; 2--The nasal floor muscles should be identified and set in due place, especially the oblique part of the orbicularis oris, responsible for the nasal equilibrium; 3--The long muscular loop (orbicularis, buccinator, superior pharyngii constrictor) should be closed within the neo-natal period; 4--The velum should be closed and set back before the ninth month; in order to minimize scarring, only mucosal flaps should be taken from the palatal shelves; 5--If the velum deserves lengthening, tissue transfer by superiorly based pharyngeal flap, to be cut six months later; 6--Leave alone the bone until 7 or 8 years of age, close the gap with a Campbell flap; 7--Consider that no forceful orthopaedics can overwhelm the strength of scars developed over and between the palatal shelves. So, be light and late on the bone; 8--No addiction to any skin design provided some sort of Z-plasty is used; 9--Think muscle. Spare the bone.

Lipomatous polyposis of the colon with multiple lipomas of peritoneal folds and giant diverticulosis: report of a case.

A case of multiple lipomatosis exclusively located in the colon is reported in a young male (33 years). It is characterized by a great number of lipomas with polyposis growth appearance, multiple lipomas of peritoneal folds, and giant diverticulosis probably caused by weakened areas of colonic wall induced by the lipomas.

Coloanal anastomosis for benign lesions: long term functional results in 11 patients.

OBJECTIVE: To assess the indications, morbidity, and long-term functional results of rectal resection and coloanal anastomosis for benign rectal lesions. DESIGN: Retrospective study. SETTING: Teaching hospital, France. SUBJECTS AND INTERVENTIONS: Eleven patients were operated on for villous adenoma (n = 5), radiation proctitis (n = 2), solitary rectal ulcer (n = 2), rectal stenosis (n = 1) and rectovaginal fistula (n = 1). MAIN OUTCOMES MEASURES: Morbidity, mortality, and long-term results. RESULTS: There were no postoperative deaths. 2 patients (18%) developed major postoperative complications: one pelvic abscess was treated conservatively and one anastomotic fistula required a diverting colostomy. The mean (SD) follow-up period was 89 (35) months. Functional results were judged as perfect (n = 4), good (n = 1), or acceptable (n = 2) (mean stool frequency: 1.4), including the five with villous adenoma, one with radiation proctitis, and the one with a rectovaginal fistula. By the end of the follow-up period, 4 patients (36%) had permanent colostomies (including the two patients with solitary rectal ulcers). Two of them were required soon after operation, and two following failure 5 and 2 years later, respectively, after initially good functional results. CONCLUSION: Rectal resection with coloanal anastomosis can safely be proposed for selected patients with benign rectal lesions including diffuse villous adenoma, rectovaginal fistula, and radiation proctitis without deterioration of the anal sphincter. The poor results in the 2 cases of solitary rectal ulcer suggest that for this condition coloanal anastomosis should be done only after the failure of previous surgical treatment.

Ileal pouch/anal anastomosis for Crohn's disease.

BACKGROUND: Patients with Crohn's disease (CD) are not commonly considered as candidates for ileal pouch/anal anastomosis (IPAA). This approach has been avoided because of the poor results observed, retrospectively, in patients with an initial diagnosis of ulcerative colitis who were found to have CD on examination of the resected specimen. However, in 1985, we decided to investigate an alternative to coloproctectomy with definitive end-ileostomy by a prospective study of IPAA for selected patients with CD. METHODS: Between 1985 and 1992, 31 patients with CD, but with no evidence of anoperineal or small-bowel disease, were recruited to our study. They comprised 15 men and 16 women whose mean age was 36 years (SD 14; range 16-72). All CD patients underwent IPAA. The short-term and long-term functional results of this procedure were compared with those of 71 ulcerative colitis patients who also underwent IPAA during the same period in our unit. Mean follow-up was 59 (SD 25) months. FINDINGS: No significant differences were observed between patients with CD and ulcerative colitis in the postoperative complication rate. Of the 31 CD patients, six (19%) experienced specific complications 9 months to 6 years after surgery: three had pouch-perineal fistulas, which required pouch excision in two cases; one had a pouch-vaginal fistula that was treated by gracilis muscle interposition; and one had an extrasphincteric abscess, which was treated surgically. Two patients (6%), one of whom was treated for an extrasphincteric abscess, experienced CD recurrence on the reservoir, and were treated successfully with azathioprine. At 5-year follow-up, there were no significant differences between patients with CD and ulcerative colitis in stool frequency (5.0 [2.0] vs 4.7 [1.4] per day; p=0.68), continence, gas/stool discrimination, leak or need for protective pads, and sexual activity. INTERPRETATION: Our results show that in selected cases of CD without anoperineal or small-bowel manifestations, IPPA can be recommended as an alternative to coloprotectomy with definitive end-ileostomy, when rectal resection is essential.

[Cleft lip and palate. The semantic conception for informatics. The Cleftor program]. / Fentes labio-palatines. Conception sémantique pour l'informatique. Logiciel Cleftor.

The authors present the creation of a computed programme (Cleftor) which examines the terminology used in the pathology of cleft palates. The malformed anatomy is simplified and superimposed with embryological data. A classification which includes all possible malformation is used. Surgical treatment had also advanced, gestures practised in the past are reviewed and defined to give authors a common basis for discussion when it is time to appreciate results concerning such or such methods or techniques. Thanks to a strict control of facts; the programme gives another idea of the treatment and above all, of the results from that can be called chronic pathology. The Cleftor programme is also a means of communication creating perhaps a supplementary chance of success for a treatment that everyone admits to and considers as always difficult.

[Fronto-nasal dysplasia (apropos of 4 cases)]. / La dysplasie fronto-nasale (à propos de quatre observations).

Four cases of frontonasal dysplasia are reported in two boys and two girls. Clinical diagnosis was made at 16 months in one case and sooner in 3 cases (1 month-3 1/2 months) in presence of following features: severe hypertelorism (4/4), paramedian lip and palate cleft (3/4), nose root broadering (4/4), bifid or cleft nose tip (3/4), window's peak (3/4) mediofrontal swelling (4/4), cranium bifidum occultum (2/4). Many abnormalities were associated: conduction deafness (1/4), goldenhar syndrome (1/4), GH deficiency (1/4), etc... In three cases when cerebral investigation was possible, it was pointed out: corpus callosum agenesis (3/3), hydrocephalus (3/3), Dandy-Walker cyst (2/3). Caryotype is normal in whole cases which are sporadic. Two children are dead. The two alive remaining have severe mental impairment.