[Utilization of a pedicled labial flap, single or double face, for the management of post-obstetric urethral damage]. / Utilisation du lambeau labial pédiculé retourné simple ou double face pour le traitement des destructions urétrales post-obstétricales. A propos de 56 cas.

Reported here is our experience with a single or double-face new procedure using a pedicled labial flap for urethral reconstruction in patients treated for extensive urethral damage after obstetrical injury. Between January 1992 to July 1997, 56 cases of urethral damage on African female patients, with an average age of 18 years old, were treated by pedicled labial urethroplasty. This procedure was done by using a single or double-face pedicled flap obtained from the major or minor labia. The flap was then introduced as in a tunnel beneath the vaginal epithelium reaching the damaged urethra. A variety of techniques were proposed: patch for sufficient lengthening (27 cases), tubularized flap allowing complete reconstruction of the urethra (18 cases) and the double-face urethroplasty (11 cases). Good quality urine continence was obtained by using the sub urethral Martius'sling procedure. In 11 cases, we combined the treatment with a colposuspension procedure. The average follow-up was 23 months (ranging from 5 to 47 months). The global success was 82% (52 patients treated). Recovery of normal miction and absence of urinary leak was obtained in 36 cases (69%). While 7 moderate failures occurred (13%), 9 cases were considered complete failures (17%). In view of the high success rate, we consider that the one-stage procedure by the use of a single or double face pedicled labial flap is a choice treatment and highly suitable for the management of extensive urethral cervical damage after obstetrical injury.

[Pediculated labial ureteroplasty: an original treatment procedure for ureteral lesions of obstetric origin]. / Urétroplastie labiale pédiculée: un procédé original de traitement des lésions urétrales étendues d'origine obstétricale.

Destruction of the urethra is the most severe complication of pregnancy-related vesicovaginal fistula. Although uncommon in Europe, pregnancy-related urethral destruction is still observed in Africa. In this study we describe our experience with a new reconstruction technique using a pedunculated skin flap raised from the labia majora. Between January 1992 and June 1996 we treated 35 patients in the Urology Department of Niamey Hospital in Niger. All patients were black. Mean age was 18 years and mean follow-up was 19 months. Two plasty techniques were used, i.e. extension (16 cases) and tubulisation (19 cases). Urinary incontinence was treated using a suburethral loop system created using a fatty flap taken from the labia majora (Martius method). Urethrocervico-suspension of the vagina was necessary in 6 cases. Normal micturition with no leakage was obtained in 24 patients (68.6%) and functional improvement in 6 cases (17.1%) Treatment failed in 5 cases (4.2%). In comparison with previously reported techniques, urethral reconstruction using a pedunculated labial flap and suburethral looping system allows successful treatment of pregnancy-related urethral destruction in 70% of cases. This technique is particularly well suited for use in developing countries where occurrence of this complication is most frequent. However even with the greatest skill, creation of a physiologically perfect closure system is currently impossible.

[Plasma determination of lidocaine and bupivacaine after caudal anesthesia in children]. / Dosages plasmatiques de lidocaïne et de bupivacaïne après anesthésie caudale chez l'enfant.

Serum concentrations of lidocaine and plasma concentrations of bupivacaine were measured so as to assess the risk of systemic toxicity following their administration by the caudal route in children, and study their pharmacokinetic profiles according to age. The serum concentrations of lidocaine were measured by immuno-enzymology in 37 children (23 +/- 13 kg) during the first hour after administration of 7 mg . kg-1. The plasma concentrations of bupivacaine were measured by high performance liquid chromatography in 40 children (18.03 +/- 8.90 kg) during the first hour after administration of 2.5 mg . kg-1. The greatest concentrations observed between 15 and 30 min after the injection were of 2.40 +/- 0.86 micrograms . ml for lidocaine and 0.93 +/- 0.44 microgram . ml-1 for bupivacaine. Higher values were observed in infants weighing less than 12 kg where they reached 2.89 +/- 0.72 and 1.52 +/- 0.68 micrograms . ml-1 respectively. These results showed that caudal anaesthesia with lidocaine (7 ml . kg-1) and bupivacaine (2.5 ml . kg-1) was a safe technique for children, giving average plasma concentrations inferior to toxic values. However, it seemed prudent not to give more than the prescribed doses in the small infant.

[Surgery of tetralogy of Fallot in the first year of life (author's transl)]. / Chirurgie de la tétralogie de Fallot pendant la première année de la vie.

Despite the very good results published by B. Barrat Boyes and A. castaneda with early correction of Tetralogy of Fallot in the first year of life, the authors prefer palliative surgery for this group. They have operated upon 47 infants less than one year of age, 15 of them being less than 2 weeks of age. The overall mortality is 4%, the only two deaths being in the neonate group, which is usually a very small group in the published series with early correction. Since all the children with S.P. Shunt performed for Tetralogy of Fallot can wait 2 to 4 years before complete correction, and since the mortality of corrective surgery at 4 years of age is almost nil, the authors think that the two stages approach give as good results than one stage surgery, despite the possibility of neurological complications which may occur between operations. They argue that with early correction, surgeons are obliged to put more transannular patches which result in more pulmonary insufficiency cases, and that the mortality in this age group is still very high in some publications. They have also compared the percentage of low cardiac output syndrome after correction and found that children with a previous S-P shunt have smoother post-operative course. Finally they think that it is possible to obtain a global mortality around 7% for the 2 stages approach and that this kind of surgery is technically easier than early correction and must be very useful for the majority of cardiac centers interested in congenital heart disease.

[Long lasting anaesthesia. Study among the children (author's transl)]. / Les anesthésies de très longue durée. Etude chez l'enfant.

In five years 14 children aged 1 to 15 underwent long lasting anesthesia (9,6 +/- 1,7 hours), excluding cardiac and neuro-surgery. These anesthesias, which are seldom performed are essentially used for the correction of congenital malformations of the cephalic pole (9 patients). Two types of anesthesia were used: neuroleptanalgesia (11 patients), enflurane and narcotic (3 patients). In addition to the usual monitoring in pediatric anesthesiology the insertion of a catheter in the radial artery proved essential. Temperature never went below 35 degrees C. In 8 cases blood loss was higher than the patient blood volume. The average preoperative perfusion was 9,4 +/- 5,4 ml/kg/heure.

[Trials of propanidid in anesthesia for bronchial endoscopy in infants and children]. / Essai du propanidide en anesthésie pour endoscopie bronchique chez l'enfant et le nourrisson.

This study reports a series of 48 bronchial endoscopies performed in children aged between 3 months and 16 years using Propanidide as sole anaesthetic agent. Individual variations were large. Repeated examinations showed that this type of anaesthetic had only moderate effects upon haemodynamic parameters. Disturbances in pH and PCO2 in arterial blood measured five, fifteen, twenty five and thirty five minutes after induction were less than with anaesthesia by inhalation of halothane. The quality of recovery of such that examinations could be performed on an ambulatory basis. Intravenous administration has the advantage of separating the anaesthetic from the endobronchial examination.