[Gartner's cyst communicating with the bladder and vagina with associated complete vaginal diaphragm]. / Kyste de Gartner communiquant avec la vessie et le vagin, associé à un diaphragme vaginal complet.

Gartner's duct cyst is a relatively common benign cystic lesion and represents embryologic remnants of Wolffian ducts. These cysts are usually small and asymptomatic and have been reported to occur in as many as 1% of all women. We report a case of a 30 month old baby presenting with recurrent urinary tract infection and Gartner's duct cyst communicating with the vagina and bladder with associated complete vaginal diaphragm. The diagnosis of Gartner's duct cyst was suggested by pelvic ultrasonography and MR imaging. Vaginal diaphragm and communication between the Gartner's cyst, the bladder and vagina were established during cystoscopy and vaginoscopy.

[First-line vesico-psoas hitch ureteroneocystostomy for primary obstructive megaureter]. / Méga-uretère primitif obstructif: réimplantation sur vessie psoïque de première intention.

Between 1989 and 1997, 23 children with primary obstructive megaureter underwent surgical repair, routinely using a vesico-psoas hitch ureteroneocystostomy. Ten of them had a antenatal diagnosis. Mean postoperative follow-up was 3 years. No postoperative obstruction and no vesicoureteric reflux occurred. Assessment of renal function on the operated side showed improvement in 7 cases and stabilization in all other cases. No bladder dysfunction was observed. Vesicopsoas hitch is an advantageous procedure in this indication. It is almost always unnecessary to perform ureteral tailoring and its specific complications can be avoided. Psoas hitch is easily performed in infants and young children and this technique is particularly appropriate in the subgroup of patients with antenatal diagnosis.

Pancreaticoduodenectomy in childhood for rare pancreatic ductal anomalies--case reports.

In the past 9 years, 3 children suffering rare pancreatic disorders have undergone cephalic pancreaticoduodenectomy (Whipple procedure) required after the failure of initial conservative treatments. Ductal anomalies such as pancreas divisum or predominant Santorini duct can be managed conservatively (especially by papillotomy of the minor papilla), unless the extent of the fibrotic lesions of the pancreas jeopardizes the final evolution of the pancreatic disease. Intrapancreatic gastric duplications remain extremely rare. Even to-day, diagnosis was made only on pathologic specimens after radical surgery. Better knowledge of this rare pathology, with emphasis on its radiological features, may help better assessment. Hemoductal pancreatitis is evocative of the coexistence of gastric duplication and pancreatic aberrant duct. However, when fibrotic and necrotic changes in the duodenopancreatic region are considerable, assessment of this anomaly becomes difficult. Radical though it is, pancreaticoduodenectomy may be necessary to treat cephalic pancreatic lesions in childhood after the failure of reasonable attempts of conservative treatment.

Postobstructive enteropathy in infants with transient enterostomy: its consequences on the upper small intestinal functions.

Repeated or prolonged organic obstruction of the small intestine in the neonatal period can lead to severe refeeding problems, despite a transient ostomy. These problems are thought to result from a postobstructive enteropathy (POE) of the apparently normal small intestine segment above the obstruction. Ten infants with a POE, characterized by limited oral caloric and carbohydrate intakes and increased ostomy effluent, were compared with 8 controls with an enterostomy and a normal postoperative refeeding pattern. There was no statistical difference in the histomorphometric appearance of the mucosa or its digestive or absorptive capacity (brush-border hydrolases, glucose transport) between the two groups. The effluent and duodenal floras of the two groups were similar. However, all POE patients showed significant abnormal peristalsis characterized by barium and carmin transit times. This suggests that repeated or prolonged obstruction in the neonatal period could lead to a POE, caused by chronic motricity abnormalities of the small intestine above the obstruction. Although this POE is more frequent after small bowel atresia, it may also occur with other conditions causing prenatal and postnatal intestinal obstruction.

[Valves of the posterior urethra in the small infant. The surgeon's role and point of view]. / Valves de l'urèthre postérieur chez le tout petit Rôle et point de vue du chirurgien.

The treatment of urinary obstruction by urethral valves is now performed in the newborn since the anomaly is recognized early on by ultrasonography. Its seems that the final result concerning recovery of renal function and urodynamic condition can be obtained by the primary destruction of valves better than by multiple operations following high urinary diversion. An unresolved problem is the persistence of urinary leakage following the treatment of such severe urinary obstructions.

[Upper jejunal atresia: treatment using jejunal resection, duodenal modeling and duodeno-jejunal or ileal anastomosis. Results in 13 newborn infants]. / Atrésies jéjunales hautes: traitement par résection jéjunale, modelage duodénal et anastomose duodéno-jéjunale ou iléale. Résultats chez 13 nouveau-nés.

13 high jejunal atresias, including 6 type IIIb apple peel small bowel deformities, have been treated by a one stage surgical procedure, including proximal jejunal resection, tapering duodenoplasty and end-to-end duodeno-jejunal or duodeno-ileal anastomosis. All 13 infants survived. There were no anastomotic leak or malfunction. 7 jejunal atresias with normal distal small bowel were fed a mean of 9 days post-operatively (range 4 to 12 days). Intra-venous fluids were discontinued at a mean of 18 days post-operatively (range 13 to 24 days). Patients, all premature babies, were discharged on the mean 30th post-operative day (range 24 to 40). 5 jejunal atresias with apple peel deformity were fed with an average post-operative delay of 21 days (range 12 to 24). All intra-venous fluids were discontinued at a mean of 48 days post-operatively (range 35 to 90). Average hospital stay was 78 days (45 to 120). In one case, an ileal diaphragm, unnoticed during the first operation was subsequently resected at age 45 days and an iterative tapering duodenoplasty was performed at the age of 8 months. Recovery was then uncomplicated and the child was discharged on a normal oral feeding at the age of 10 months. Functional obstruction of the intestine at the site of anastomosis often occurs in high jejunal atresias. 70% of mortality resulted from operative complications in atresias with apple peel deformity. Intestinal distension is the cause of anastomotic malfunction. After jejunal resection, the duodenum remains dilated and anastomosis cannot function properly.(ABSTRACT TRUNCATED AT 250 WORDS)

[Rupturing of valves of the posterior urethra in the newborn using a balloon catheter. Results of the technic apropos of a series of 10 children]. / Rupture des valves de l'urètre postérieur du nouveau-né par sonde à ballonnet. Résultats de la technique à propos d'une série de 10 enfants.

Prenatal ultrasonographic diagnosis of urethral valves is now common. Treatment of the urethral obstruction has sometimes to be done in low weight newborn babies. In these babies, the stripping of valves using a Fogarty catheter provides an helpful way of treatment, easier than endoscopy. The technique is presented here. The results of this procedure in 10 neonates with a follow up of 3 to 22 months are reported. The urethral obstruction is easily cured in most patients without using a previous diversion. This procedure is indicated in premature or hypotrophic newborns when the urethral size is too small to allow a safe endoscopic section of the valves. We did not observe secondary stricture. Follow up is too short to allow a correct investigation of the continence.

[Nodules of renal regeneration in children. Presentation of 2 cases and review of the literature]. / Nodule de régénération rénale chez l'enfant. Présentation de deux cas et revue de la littérature.

Although rarely encountered in childhood, renal regenerated nodules present definite characteristics, individualizing this pseudorenal tumor. They appear on kidneys previously affected by infectious or degenerative process. On IVP they do not enlarge the kidney's size, but roll-up the calyces, without amputation. They are homogeneous on ultrasonic investigation, isofixing on radio-isotopic scan., normally vascularized on computerized angiography, if a doubt upon nephroblastoma imposes this investigation. The percutaneous puncture biopsy, aided by sonography, shows normal glomeruli and tubules two or three times wider than usual, without scars of the original disease. Some authors consider them as a peculiar pattern of hypertrophic compensation, starting from remaining healty renal parenchyma. Reasons of their i frequency, and functional value are still unknown.

Long-term outcome of children with malformative uropathies.

125 cases of severe malformative uropathies, 42 urethral valves (V), 52 degree III vesicoureteral refluxes (VUR), 18 ureterovesical junction stenoses (UVJ), 13 pyeloureteral junction stenoses (PUJ), were studied for a period of 12 years. Based on the hypothesis that prognosis depends on the number of residual nephrons, we used the glomerular filtration rate (GFR) as our basic reference. 62% of our cases had an initial GFR below 50 ml/min/1.73 m2 and 30% had GFR's below 25. Early diagnosis and intervention are important for improvement of GFR. Of the 32% who improved, most were diagnosed in the first year of life, and the exceptional few after 2 years. The extent of initial renal damage is also a limiting factor. Improvement was rarely seen when the initial GFR was below 30 ml/min/1.73 m2. There was a correlation between the initial and final GFR levels. Renal degradation (28% of cases) is most influenced by follow up time. The average age of end stage renal failure (ESRF) onset was 11 years 4 months, but is earlier for V than for VUR. Onset is even earlier when initial damage is more severe. As normal GFR does not exclude later degradation of renal function, another indicator of the risk of this type of evolution should be adopted.

[Established caustic stenosis of the esophagus in children. Closed-thorax esophagectomy with in situ colonic esophagoplasty]. / Sténose caustique organisée chez l'enfant. Oesophagectomie à thorax fermé avec oesophagoplastie colique in situ.

Replacement of the oesophagus with a colonic graft brought up to a retrosternal or intrathoracic position is usually performed in children with undilatable oesophageal stenosis resulting from caustic burns. However, incidents associated with the oesophagus remaining in situ regularly raise the problem of concomitant or delayed oesophagectomy and therefore thoracotomy. A one-stage surgical technique is described, which includes closed-thorax oesophagectomy and colonic oesophagoplasty in situ in the oesophageal bed. The 3 patients operated upon by this method made an uneventful recovery.

[Posterior urethral valves in the very young infant: rupture by balloon catheter]. / Valves de l'urètre postérieur du tout petit: rupture par sonde à ballonnet.

A simple treatment of valves obstructing the posterior urethra in male neonates consists of breaking them by pulling a balloon catheter. This technique is preferable to instrumental manoeuvres, always delicate in such small urethras. In the case reported here a 28-months follow-up showed satisfactory results with regard to both renal function and urinary continence.

[Immediate and secondary results of duodeno-duodenostomies with tapering in the treatment of total congenital duodenal obstructions in newborn infants]. / Résultats immédiats et secondaires des duodéno-duodénostomies avec modelage dans le traitement des obstructions duodénales congénitales complètes du nouveau-né.

For the last 5 years, duodeno-duodenostomy with tapering of the dilated duodenal pouch has been the usual method of surgical treatment of complete neo-natal duodenal occlusions. The results of this technic in 25 operated newborns have been compared with those obtained in a previous group of 24 cases operated by technics preserving the duodenal pouch. By restoring the peristaltic efficiency of the upper part of the duodenum, this technic allows early oral feeding (average delay: 7 days), thus avoiding a classical inconvenience of the usual methods of duodeno-duodenostomy or duodeno-jejunostomy. The aetiology of a non-patent anastomosis after the 10th post-operative day is clarified, a persistent duodenal obstruction indicates an organic complication that must lead to re-operation.

[Enlargement colocystoplasty with temporary skin opening. Modification of the trans-appendicular continent cystostomy technic]. / Colocystoplastie d'agrandissement à abouchement cutané temporaire. Modification de la technique de cystostomie continente trans-appendiculaire.

The results of trans-appendix continent vesicostomy, described in 1980 by P. Mitrofanoff, depends on the capacity of the neurogenic bladder. A cystoplasty using the sigmoïd colon is able to resolve the problem of small and hypertonic bladders. The colon conduit is placed between the bladder and the antero-lateral wall of the abdomen, where a temporary urinary stoma is performed. Results of this technic are reported in 3 cases: no specific complication related to the colocystoplasty has been observed. In all cases, the colon conduit permits a large capacity. It reduces the intravesical pressure and the risk of urinary fistula and urethral repermeation. If any accident occurs, it is easy to re-open the sigmoïdal stoma and to obtain an efficient decompression of the urinary tract. With this technic, it is possible to perform a continent vesicostomy in most children with neurogenic bladder.

[Pseudo-Hirschsprung's disease (author's transl)]. / Démembrement du cadre "pseudo-Hirschsprung". A propos de 8 observations pédiatriques.

Eight children with pseudo-Hirschsprung's disease are reported. They can be divided into three groups: alimentary ganglioneuromatosis, schwann cell hyperplasia and those with normal appearance by stantard histology. In view of the heterogeneity, histology cannot predict the extent or the prognosis of the disease. Several biopsies at various levels of the alimentary tract and the use of advanced techniques are necessary to assess fully the extent and the type of the lesion and whether it is congenital or acquired. The majority of pseudo-Hirschsprung's disease tend to affect most of alimentary tract, which may lead to the formation of stagnant loops with all their risks. Treatment includes ileostomy, continuous hypoallergenic oral feeding, and manual expression several times a day.