Peutz-Jeghers colonic tumour in a newborn.

The authors refer a case report of the Peutz-Jeghers tumour localised in transverse colon found during a systematic clinical examination of the 4-day-old newborn, without any signs of intestinal occlusion. The end-to-end colic resection was made. Post-operative course was without any complications. The observation is rarely due to the tumour's atypical localisation as well as its presence in the newborn.

[Role of laparoscopic surgery in the treatment of abdominal pain in children]. / Miesto laparoskopickej chirurgie v liecbe bolestí brucha u detí.

Principal indications of the coelioscopy in pediatric surgery is the laparoscopic appendectomy. In compare with classic techniques it has several advantages but as well as some limitations. During decision about eventual laparoscopic intervention in children is important to take into the consideration personal and material facilities of the unit or hospital for pediatric coelioscopic interventions, their accessibility as well as longer operating time and higher price of the operation. It is amoral to use the laparoscopic appendectomy as a method of teaching surgeon and team to the technique. The authors consider the laparoscopic exploration of the peritoneal cavity with subsequent appendectomy to be a very suitable technique for examination and treatment of pre-pubertal and pubertal girls or young women with chronic or repeated abdominal pain of the uncertain origin, however, its indication in indubitable acute appendicitis of a boy is questionable.

Flexible stable intramedullary pinning technique in the treatment of pediatric fractures.

We report our 12 years' experience with the treatment of 308 fractures of the long bones in children using the flexible stable intramedullary pinning technique (FSIMP). This technique is a simple, rapid, and reliable procedure with minimal complications. It assures correct reposition and sufficient stable fixation of fragments, needs only small incisions, and most of all, allowed early mobilization of a child, thus avoiding long hospitalization and permitting his rapid normal activity and return to the school. The results are very encouraging for children up to age 5 years. The age limit is caused by the volume of the intramedullary space.

[Embryological study of the mechanism of antenatal lower urinary tract obstruction]. / Obstruction anténatale du bas appareil urinaire: étude embryologique de son mécanisme.

Closure of the embryonic bladder based on the results of the study of 25 human embryos (Crown-Rump length: 5mm-60mm) and 8 Born's reconstructions, is presented. It is a complex but well regulated stage of organogenesis. Division of the cloaca depends on caudal regression, development of the genital tubercle and growth of the urorectal fold which joins the cloacal membrane. The didermal cloacal membrane (composed of the ecto and endodermal layers) opens on its caudal part. On the cranial part, there is a cloacal plug, composed of packed cells, which strengthens the inferior part of the genital tubercle. After progressive vacuolation, this plug is colonized by mesodermal tissue derived from the urorectal fold, which assumes the development of the anterior perineum. This stage depends on cranial growth of the genital tubercle. On a human embryo (31 mm Crown-Rump length, 52 days, 10 Weeks of amenorrhea), the bladder is closed, urachus obturated and urethra patent. The vesico-ureteral junction, and prostatic utricle are present and the colliculus seminalis is well developed. A temporary obstruction (caused by asynchronism between urachus closure and urethral opening) can induce antenatal vesicoureteral reflux which could regress after birth. However if urethral obstruction is definitive (posterior urethral valves or atresia), reflux persists. Antenatal sonographic bladder identification is possible after 10 weeks of amenorrhea with visualisation of the two umbilical arteries by color duplex ultrasound. If the urachus remains patent, it can be visualized inside the arterial umbilical triangle, on a transverse view.

Principal modifications of the Duhamel procedure in the treatment of Hirschsprung's disease. Analysis based on results of an international retrospective study of 2,430 patients.

In the literature, many articles refer to the DUHAMEL technique or some of its modifications in the treatment of Hirschsprung's disease, however, no complete review of all of them has been published to date. The authors present an analysis of the principal modifications of this technique based on the results of an international retrospective survey that evaluated a series of 2,430 patients as well as data from the literature. The important role of the internal anal sphincter in the physiology of continence is emphasized; understanding its function is an imperative prerequisite for a successful Duhamel procedure. The original technique, which used two crushing Kocher clamps as proposed by Duhamel in 1956, as well as a majority of the modifications with various spur-crushing instruments are no longer in use. At present, surgeons generally use staplers for the colorectal anastomosis.

Duhamel operation 40 years after: a multicentric study.

The authors present the results of an international retrospective study evaluating the present situation in using Duhamel's technique or its modifications in the treatment of Hirschsprung's disease on the basis a series of 2430 patients. After evaluation of all important criteria and discussion with data from the literature it is concluded that the techniques is simple, fast, less shocking, logical, reliable, respecting the rectal anatomy and physiology, ingenious in its principle, without serious complications. The rectum is preserved in place with all its vascular drainage and innervation. This technique can be performed by every sufficiently experienced surgeon.

Incarcerated umbilical hernia in children.

Over a period of 5 years, four cases of incarcerated (one strangulated) umbilical hernia (UH) in children were observed and treated in Saint-Denis, France. In a review of the literature, only 45 descriptions of complicated UHs in children were found worldwide. Incarceration of UHs is considered to be very rare in children, however, it appears to occur more frequently than it is generally believed. Therefore, a more active therapeutic approach is recommended even in smaller hernias, from more than an aesthetic point of view.

[Replacement continent bladder in dogs by opening an antro-pyloric graft onto the abdominal wall (seven cases between 1980 and 1983)]. / Etude d'une vessie continente de remplacement chez le chien par ouverture à la paroi abdominale d'un greffon antro-pylorique (sept cas réalisés de 1980 à 1983).

To determine the usefulness of antral bladder controlled by the pyloric sphincter denervated for urological applications, bladder replacement was performed in 17 dogs using the antral segment with its own sphincter, initially with the pylorus supplied by the left gastro-epiploic artery, and later by the right gastro-epiploic artery. The smooth pyloric muscle was denervated to obtain permanent spasm and pulled through the striated anterior abdominal muscle. Both ureters were anastomosed by a Cohen's procedure. The best results were obtained with a gastric pouch supplied by the right gastro-epiploic artery; dissection and reimplantation of the ureters in the gastric wall are difficult. IVP and cystography indicated good function of the antral pouch, with no reflux. The antral bladder controlled by the denervated pyloric sphincter could be a possible alternative in the surgical management of neurogenic or exstrophic bladder.

Immunological consequences of burn injury in children.

The authors investigated immunological changes after burn injury in children. Relevant findings were observed in the following immunological factors: phagocytose activity, T-lymphocytes, active T-lymphocytes, test of blastic transformation of lymphocytes and immunoglobulins. The findings confirm from an immunological point of view the requirement of early necrectomy (at the latest on day 4 or 5 after injury). Later necrectomy cannot prevent immunosuppression after burn injury but itself causes deterioration of the immunological status of patient. Adequate therapy can improve the immunological status of burned patients.

[Ileus after appendicitis in children]. / Ileus po apendicitíde u detí.

A relatively frequent and alarming complication of appendicitis in children is ileus. The authors submit an analysis of 41 cases of ileus with a time interval of 3 days to 8 years after appendectomy. In eight patients conservative treatment was successful, and 33 children were operated with the finding of intraabdominal adhesions (23 times), bands (3 times), abscesses and adhesions (7 times). Two children were re-operated on account a relapsing ileus. None of the children died. Prophylaxis of ileus after appendectomy is ineffective and uncertain, therefore the authors emphasize early diagnosis and early operation of the appendicitis but warn against inadequately considered appendectomy.

[Unusual burns in older boys]. / K niektorým zvlástnym popáleninám u starsích chlapcov.

The authors give an account a less frequent mechanism of burns in older boys during the domestic manufacture of smoke-boxes from a mixture of sodium dithionite (decolourizer) and urea peroxyhydrate (solid hydrogen peroxide). The chemical reaction explains the development of exogenous heat and the depth of burns. The authors analyze their own material of 16 patients and emphasize early necrectomy and prevention.