Breast-feeding and inguinal hernia.

A case-control study was conducted to study the association between breast-feeding and inguinal hernia. The case group was significantly less often breast fed than control subjects (odds ratio, 0.49; 95% confidence interval, 0.29 to 0.83) and exclusive breast-feeding was associated with a significant dose-response risk reduction. The association was not confounded by birth weight, maternal education, type of birth, number of other children in the family, or gender. Breast-feeding may represent a protective factor against inguinal hernia.

Intrauterine intussusception as a cause of ileal atresia occurring late during pregnancy.

A case of intrauterine intussusception causing ileal atresia is reported. The sonographic diagnosis of intestinal obstruction at the 30th week of gestation suggests that intrauterine intussusception is a cause of ileal atresia occurs late in the course of pregnancy.

Infant feeding and idiopathic intussusception.

A case-control study showed that, compared with infants who had never been fed human milk, breast-fed infants had a relative risk of intussusception of 6.0 (95% confidence interval, 1.8 to 20.4) when breast-feeding at admission was exclusive and of 2.3 (95% confidence interval, 0.8 to 6.6) when it was partial. Exclusive breast-feeding may be a risk factor for intussusception in infancy.

Pulmonary barotrauma in congenital diaphragmatic hernia: experimental study in lambs.

A left diaphragmatic hernia was created surgically in 20 fetal lambs between 93 and 110 days of gestation. Ten animals were alive with defects at cesarean section near term (135 to 140 days). These animals and two controls were submitted to various transpulmonary pressure gradients (inspiratory pressure minus pleural pressure). Hemodynamic and ventilatory studies were performed after the correction of the hernia. Morphometric analysis of the lung was carried out in all cases. The results showed a highly significant linear correlation between the transpulmonary pressure gradient employed and the pulmonary interstitial emphysema found at morphometry. Our data suggest that using low ventilatory pressures and not draining the pleural cavity results in less trauma to both lungs and may prevent one of the components of the pulmonary hypertension so often seen in newborns with congenital diaphragmatic hernia.

Xanthogranulomatous pyelonephritis in childhood: report on an unusual case.

A case of localised xanthogranulomatous pyelonephritis (XPN) in a 4-year-old female with an unusual radiological picture is reported. The young girl was suspected to have a liver tumour because of a hypervascularised area found by arteriography in the hepato-diaphragmatic region. Laparotomy disclosed a large mass in the upper pole of the right kidney which was adherent to the liver and to the diaphragm. Excision of the large mass including upper pole of the kidney was carried out. Recovery was uneventful. Pathological examination revealed the XPN disease pattern.

Laparoscopy in the diagnosis and treatment of an unusual complication of ventriculo-peritoneal shunt.

A significant number of abdominal complications of ventriculoperitoneal shunts have been reported. Laparoscopy has proved to be extremely useful in the diagnosis and treatment of a number of these cases. A rare case of abdominal wall perforation is described. At laparoscopy the route taken by the catheter was detected, and the latter freed from adhesions and repositioned in the peritoneal cavity, with optimal functional results.

[Congenital cystic adenomatoid malformation of the lung]. / La malformation adénomateuse kystique congénitale du poumon.

Congenital cystic adenomatoid malformation of the lung (CCAM) has been reported with increasing frequency since it was first described in 1949. In a review of the literature by Halloran and co-workers in 1972, 61 cases were reported. After ten years, we collected from the literature 279 cases. The malformation is characterized by a multicystic mass of lung tissue with bronchiolar proliferation and alveolar impairment. The clinical picture of this pulmonary malformation varies with the age at presentation. In the neonatal period the respiratory distress syndrome is often very serious and may require an urgent treatment. In the older infant, the unrecognized disease has more often a chronic course characterized by recurrent respiratory infections and failure to thrive. Sometime, the malformation may be completely silent and be disclosed during a routine examination of the thorax for others reasons. Both types of presentations of the cystic adenomatoid malformation require a surgical therapy and the lobectomy is the treatment of choice. The prognosis following resection in the older patients is generally good, while in the neonatal period the remaining hypoplastic pulmonary tissue may represent a problem in the postoperative ventilatory management. Two cases of congenital cystic adenomatoid malformation observed in a 5 months old and in a 10 months old infants are reported. The clinical, pathologic and radiologic features of this pulmonary malformation are discussed. The hypothesis of a future "in utero" correction of the most severe cases, in order to prevent the pulmonary hypoplasia of the healthy parenchyma, is also suggested.