[Surgical management of acute abdominal pain in children]. / Prise en charge chirurgicale des douleurs abdominales aiguës de l'enfant.

Acute abdominal pain is one of the most frequent causes of admission to an emergency department of a children's hospital. It continues to be a clinical challenge and the diagnosis viewed with the most apprehension is acute appendicitis. The clinical examination must be meticulous and repeated in order to assess the evolution of the abdominal syndrome and to adapt the paraclinic examinations. All the abdominal pains are not surgical but justify an admission for observation in pediatric surgical department.

[Total rectal prolapse in children. Diagnostic and therapeutic trends. Statistics apropos of 52 cases]. / Prolapsus rectal total de l'enfant. Orientations diagnostiques et thérapeutiques. Statistique de 52 observations.

Rectal procidentia represents classically only 2% of rectal prolapse in children. This rarity is more apparent than real, because peritoneographies showing the excess of migration of the rectogenital pouch, allows to diagnose more often this pathology. The normal trend of this anomaly of the infant and the young child even if it could be serious with strangulation is usually a spontaneous healing. Accordingly therapeutic indications should be cautious. Surgery is only indicated in confirmed or complicated forms. After analysis of the statistic of 52 observations, the modified Lockhart-Mummery is our prefered procedure. It needs a short and simple surgery and the results appear satisfactory.

Polypoid formations at the anal margin in infants less than two years old.

Polypoid formations in the anal canal and at the anal margin are sometimes observed in the newborn and in infants less than 2 years old. Unlike hamartomatous polyps, which are commonly reported in infantile proctology, these growths are rare in early childhood. Only by performing a pathological anatomy examination is it possible to determine the nature of the numerous affections encountered to assess prognosis and to decide on suitable therapeutic management.

[Duplication of the digestive tract in children. Apropos of 12 cases]. / Les duplications du tube digestif chez l'enfant. A propos de 12 observations.

Duplications of the gastro intestinal tract are characterised (Ladd and Gross) by the following histological features two muscular layers with myenteric cells inside. Cystic or tubular, they are always situated on the mesenteric border of the gastro intestinal tract with a common blood supply. The pathogenesis of duplication affects early fetal development via various mechanisms. Located anywhere along the alimentary tract as in our review of 12 cases, clinical manifestations vary according to the site. Abdominal cystic mass, mediastinal compression or intestinal obstruction bleeding or perforation are possible symptoms, but the presentation is very variable. The age of presentation is usually within the first year of life. The diagnosis can be made preoperatively by several investigations but the malformation is frequently discovered during surgery. Surgery is the only treatment for these duplications, but smaller cystic lesions are easily treated. However surgery of extensive duplications remains difficult.

[Gastric tumor in children. Apropos of 3 cases]. / La pathologie tumorale gastrique chez l'enfant. A propos de 3 observations.

Gastric tumours are exceptional in children and are usually discovered due to digestive tract bleeding or after palpation of a mass in the abdomen. Appropriate exploratory techniques are need to correctly localize the lesions in the stomach. Nevertheless, the absence of any particular signs can mask the polymorphic nature of the lesions that can only be determined by pathologic examinations. The extent of the surgical exeresis and prognosis depend on the nature of the pathological process.

Anatomic basis of pathology of the urachus.

The urachus, derived partly from the allantoic canal, tethers the apex of the bladder to the umbilical ring. This vestigial structure, though constant in man, is formed by a whole series of embryologic mechanisms which are still controversial. Total or partial persistence of the lumen of the urachal canal, when sufficiently extensive, becomes manifested by characteristic clinical features. Moreover, it is frequently associated with malformational urogenital involvement, which must be routinely sought. The sole form of treatment consists of total surgical excision of the urachus.

[Abdominal cystic lymphangiomas in children. Apropos of 6 cases]. / Lymphangiomes kystiques abdominaux chez l'enfant. A propos de six observations.

Cystic lymphangiomas are rarely observed in the abdomen, even in a paediatric surgery ward. From 1977 to 1991, we diagnosed and treated six such lesions in our paediatric surgery department in Clermont-Ferrand. Most of the lymphangiomas were seen in boys. Mesenteric localizations were seen in 4 out of 6 cases with the characteristic chylous contents in 3 cases. There were very many different presenting signs, although two acute episodes of intestinal vuvulus occurred. The clinical features and the usefulness of exploratory techniques are discussed. The frequency of abdominal cystic lymphangiomas is probable underestimated although the number of cases diagnosed will undoubtedly rise with routine echography, especially in the ante-natal period. Surgical exeresis is the standard therapy but other alternative or complementary methods such as sclerosis techniques could be of interest.

Malignant pleural tumor in a child mimicking a mesothelioma.

Malignant tumors of pleural origin are rare in childhood and difficult to diagnose. We report a case in a white 11 1/2-year-old girl who presented with a bulky tumour in the basal left lung field. There was an area of osteolysis at the ventral extremity of the 9th left rib allowing excision of the tumor by lateral thoracotomy. Macroscopically the operation was satisfactory. Despite two complementary excisions, chemotherapy with Vin-Caepi and consolidation chemotherapy followed by bone-marrow autograft, left pleural metastases appeared two years later. A second operation, a new course of chemotherapy with stage IV SIOP MMT, followed by a second bone-marrow graft and mediastinal radio-therapy, resulted in remission. At the time of this report, after three and a half years of evolution, the child's condition is satisfactory and she leads a normal life without treatment. A probable diagnosis of pleural mesothelioma was arrived at by elimination. This kind of tumour, without specific markers, is difficult to distinguish from small-round-cell tumors. Evolution is unpredictable and often rapidly fatal. Although these tumors generally have a weak response to chemo- and radiotherapy, we think that close follow-up and active therapy, rapidly initiated at the slightest sign, can improve the quality of life of the patients and increase their survival.

Relations between Meckel's cartilage and the morphogenesis of the mandible in the human embryo.

Based on a series of human embryos classified in stages, the authors studied the evolution of Meckel's cartilage in its ventral portion and its relations to the morphogenesis of the mandible. Three stages appeared particularly important: stage 16, appearance of Meckel's cartilage; stage 20, beginning of membranous ossification; and stage 23, end of the embryonic period (8th week). The primitive bony nodule which develops from the embryonic mesenchyme appears as a double bony layer forming a groove containing the neurovascular bundle, into which the dental lamina is also invaginated.

The relationship between Meckel's cartilage and the development of the human fetal mandible.

This work studied the development of the ventral part of Meckel's cartilage and its relationship to the morphogenesis of the mandible in a series of human fetuses. The development of the cartilage was followed up to the end of the embryonic period (stage 23, 8th week) when the primary ossification centre, which was formed from a condensation of embryonic mesenchyme, had become two bony plates forming a trough in which lay the neurovascular bundle. From this trough invagination of the bony plate formed the dental crypt. The primary ossification centre disappeared around the sixth month of fetal life.

Severe farm machinery injuries to children--a report on 15 cases.

Fifteen children with 24 farm injuries were admitted to our institution during a 12 years period. Ten accidents occurred in boys and five in girls. They ranged in age from 1 to 15. The cause of fatal and non-fatal injury was farm machinery and especially tractor in 9/15. Fractures, lacerations and amputations were the most common injuries requiring multiple reconstructive surgical procedures. The magnitude of the problem requires emergency management in rural areas. However, educational programs with an emphasis on prevention by physicians, family members, educators and legislators is necessary to reduce the incidence of farm accidents.

[Testicular ectopy. Current concepts]. / L'ectopie testiculaire. Notions actuelles.

Testicular descent is a complex mechanism influenced by hormonal and anatomical factors. Whatever the age of the patient or the descent technique used for either one or both testes, there is a risk of degeneration and sterility counts. Anatomical studies and the results of sperm are important, hence the importance of establishing a precise anatomical and therapeutic classification.

[Functional aspects of lymphatic drainage of the human ovary in vivo explored with isotopic lymphography]. / Aspects fonctionnels du drainage lymphatique de l'ovaire humain in vivo explore par lymphographie isotopique.

Pelvic lymphoscintigraphy with 99 m Tc colloid injected directly in mesovarium during coelioscopy is able to schon that: drainage of ovaries' lymph is taken up by pelvic, paraortic or both lymph nodes, during genital activity ovarian lymph often diffuse in the other side of the pelvis with a true regional circulation.

[Radiographic study of the lumbar spine bearing weight in weight lifters]. / Etude radiographique du rachis lombaire en charge chez l'haltérophile.

Radiographies of lumbar spine at rest in standing position and upon a force of 100kg were undertaken in 19 young sportsmen. If comparison between two pictures demonstrated important modification in few subjects, statistical study shown only little variations. Clinical studies in weight lifters demonstrated effectively few lesions with a good training, it's possible to modifiate pelvic orientation and this pelvic support permits a optimal posture for the lumbar spine.

[Anatomic basis of the Lockhart-Mummery procedure in the treatment of total rectal prolapse in children]. / Bases anatomiques du procédé de Lockhart-Mummery dans le traitement du prolapsus rectal total de l'enfant.

From four pelvic cavities of adults (2 males and 2 females) and one of neonate the authors studies structures between rectum ventrally and sacrum dorsally. Always they found an avascular space behind the perirectal fascia in which were embedded arteries of rectum and above the presacral fascia with inside median sacral artery and sympathic trunks. This avascular space permit to made there surgically procedures such Lockart-Mummery to attach rectum to sacrum.

[Various mechanic characteristics of bony structures of the temporo-mandibular joint in several classes of mammals studied by measurement of hardness and resistance to penetration]. / Etude de quelques caractéristiques mécaniques des éléments osseux de l'articulation temporo-mandibulaire dans certaines classes de mammifères par duromètrie et pénétrométrie.

Applying the principles of mechanics, the authors have studied and compared the bony structures of the temporo-mandibular joint. Using the means of investigation usually implemented in the metallurgical sector, they have tried to establish a link between the morphology and mechanical strength of the various components of this joint in some subjects belonging to the mammals classification and with various feeding modes. The results obtained by hardness micrometry tend to show that during masticatory movements, the temporo-mandibular joint works in a hanging rather than in a compressed mode.

[Mechanics of the characteristic geometry of the human spine undergoing vertical pressure]. / Justification mécanique approchée de la géométrie particulaière du rachis humain soumis à contrainte verticale.

Since MAGENDIE in 1816, it has been a common assertion in books of Anatomie that curves of the spine increase its strength. This increase in strength has been estimated by a formula attributed to EULER: R = nc2 + 1 in which R is the strength and nc2 stands for the square of the number of curves. Applying the actual law of Euler on the strength of beams submitted to a vertical effort, the authors conclude that strength is increased by about 30% and not multiplied by 10, 16 or even 17 as is often falsely written.

Ultrastructural and immunohistochemical evidence of in situ differentiation of mononuclear phagocyte system cells in the interstitium of human fetal testis.

Ultrastructural and immunohistochemical studies were made of the testicular interstitial tissue from eight human fetuses of 15 to 27 weeks gestation. Three cell types developed in mesenchymal cells: Leydig cells and peritubular cells, as already reported, and cells of the mononuclear phagocyte system (MPS), which are located in the intermediate area of the interstitial tissue. Located at the periphery of Leydig cells, these gradually differentiate between 16 and 20 weeks and later acquire the ultrastructural characteristic of histiocytes during the involution phase of the fetal testis. Immunohistochemical studies using monoclonal antibodies (Mo Ab) to antigens of human myelomonocytic cells isolated a cell subpopulation in the interstitial tissue that is distinct from the peritubular (fibroblastic) and the Leydig cells. This subpopulation expressed all or some of these antigens according to their stage of differentiation; all cells are labelled by MY7 Mo Ab which is directed against myelomonocytic cells, including stem cell. Using monoclonal antibodies directed against more mature cells (MY4, MO1 and MO2), the number of labelled cells decreased in this mesenchymal population. MY4 Mo Ab, which detect myelomonocytic cells excluding stem cell, label fewer than MY7 Mo Ab. MO1 MO Ab and MO2 Mo Ab, respectively, directed against antigens of more mature or mature monocytic cells, label less number of mesenchymal cells, which are histiocytes after 20 weeks. These ultrastructural and immunohistochemical findings suggest that cells of the MPS differentiate within the interstitium.