Chronic duodenal ulcer in children and response to highly selective vagotomy.

The effectiveness of highly selective vagotomy (HSV) in adult duodenal ulcer surgery is confirmed by absence of peroperative mortality or postoperative morbidity and by ulcer healing in the majority of cases. Whether it could be used in children with the same result was the subject of our study in 13 successive cases of complicated duodenal ulcer treated between 1974 and 1987. There was complete ulcer healing in 4 cases. Pain relapsed in 5 cases and there was recurrence of hemorrhage in 2 cases. Although immediate good results lasted for at least 3 years, 2 patients were lost to follow-up. Still, we consider HSV as a safe procedure available for children as it does not "queer the pitch" for a subsequent treatment if it fails.

[Evaluation of the transfer of Algerian children with cancer to the Léon-Bérard center (1984-1987)]. / Evaluation des transferts d'enfants algériens en oncologie pédiatrique au centre Léon-Bérard (1984-1987).

From 1984 to 1987, 80 pediatric oncology patients were transferred from Algeria to the centre Léon-Bérard (Lyon, France). Diagnoses were mainly lymphomas neuroblastomas and bone tumours (75% of the total number of cases). Survival (39% at 46 months), number of hospitalization days (12,655) and cost (29,324,254 FF) were calculated. These costs were compared with the mean annual public health allocation per capita in Algeria and with the French limitations on accepting transfer of spending money for children from abroad. New directions are suggested to improve the efficiency of these transfers to optimize the use of limited resources in both countries and to increase survival of individual patients.

Xanthogranulomatous pyelonephritis in children. Report of 7 cases and one associated with nephroblastoma.

8 cases of XGP in children are reported. The presence of urolithiasis together with xanthogranulomatous lesion in 7 cases and of nephroblastoma in one may be of help in understanding the aetiopathogenesis. In all the cases the involved kidney did not function thus necessitating subcapsular nephrectomy via retroperitoneal approach.

Abdominal Burkitt-type lymphomas in Algeria.

In a previous retrospective analysis from the principal paediatric centres of Algeria, Burkitt-type lymphomas (BL) were shown to account for around 46.5% of the total childhood non-Hodgkin's malignant lymphomas in that country. In the present study, a series of 49 abdominal BL from the Paediatric Clinic of Surgery, Mustapha Hospital, Algiers, has been studied. The age distribution shows a peak between 4 and 5 years of age, and the sex ratio is (M:F) 2.26:1. The disease is characterized by a rapid evolution in the absence of therapy. The major problem is an explosive form of the disease, which at present seems difficult to control in this country. Fifteen of the 49 patients (30.6%) died before completion of the first course of chemotherapy; however, complete remission (CR) was obtained for 30 patients (61%). Overall survival was 42.85% (21/49), whereas survival of patients who reached CR is 70% (21/30). When CR was obtained, deaths were related to cerebrospinal fluid involvement, local recurrence, secondary bone marrow involvement or therapeutic accidents. All patients alive with no evidence of disease (NED) 8-months after CR can be considered definitively cured. Epstein-Barr virus (EBV) serology performed on 31 BL patients and on a control group of 25 children with other malignant tumours showed that most Algerian BL have elevated EBV titres. A search for viral markers within malignant cells in 17 patients indicated that 88% (15/17) of the BL cases were EBV-associated. Analysis of the immunological and cytogenetic data showed that, as in the rest of the world, these BL cases involve proliferation of B-cell-type lymphocytes, with characteristic cytogenetic translocations involving chromosome 8. This report represents the most detailed description so far of BL from an area in non-equatorial Africa and the first report of a large series from North Africa.

[Urethral injuries caused by hair strangulation]. / Plaies de l'urètre par cheveu étrangleur.

Fifteen urethral injuries by hair strangulation gave to the authors the opportunity to search the meaning of such a practice. The observed damages of urethra are not the result of some overzealous ritualistic circumcision as the child or his family say. A patient tedious investigation establishes that this strange practice finds its assessment probably in a mythic belief or in an unrevealed erotic purpose. The authors emphasize the best results of a two stage repair procedure.

[Segmental dilatation of the ileum associated with an omphalocele and a common mesentery. Discussion around 2 cases : chance or morphogenically "related"? (author's transl)]. / Dilatations segmentaires iléales associées à une omphalocèle et à un mésentère commun réflexions à propos de 2 cas : hasard ou "instantané" de morphogénèse pathologique?

Segmental dilatation of the ileum is the subject of this report which concerns two cases. Both cases were associated with omphalocele and intestinal malrotation, an observation already noticed by some authors. Is it still a hazardous coincidence or rather a real opportunity which throws light over the explanation of this malformation?

[Future of the remaining rectum after treatment of familial polyposis (author's transl)]. / Devenir du rectum restant dans la polypose recto colique familliale.

In the treatment of familial polyposis the conservation of the rectum is essential to assure a convenient control and rhythm of defecation. Meanwhile the future of resting polyps deserves the attention of the surgeon. Certain authors are optimistic and claim that spontaneous regression of the polyps is possible. Our experience illustrates that the rectal mucosa tends to fabricate new crops of polyps. The prolonged post operative observation of more than 4 years of polyposis in one family has permitted us to follow the evolution of the rectal mucosa and to deduce that gravity of the lesion is quite variable. The polypotique character of the rectal mucosa must influence the choice of certain surgical technic specially that nine of them achieve entire satisfaction yet.