[Surgical complications of intestinal ascariasis]. / Les complications chirurgicales de l'ascaridiose intestinale.

Ascaridiosis is a usually benign disease caused by the parasite Ascaris lumbricoides. Medical treatment is usually sufficient. Prevalence in tropical zones is high, sometimes leading to severe surgical complications requiring treatment and having a high morbidity and mortality. Codified treatments are needed to reduce the incidence of ascaridiosis. Large scale prevention is needed, especially in endemic zones.

[Neonatal treatment of congenital hip dislocation using an abduction pillow]. / Traitement néo-natal de la luxation congénitale de hanche par coussin d'abduction.

Numerous and various devices are being used in the treatment of congenital dislocation of the hip before the age of 1 year. We prefer the abduction pillow of Becker, owing to the simple design and use; there is also an economical factor: everybody can afford it. The abduction pillow can in no way be used for prevention. Only pathological hips with clinical signs confirmed by X-ray or sonography justify this treatment. Because of the good tolerance and efficacity of the pillow, it is the first choice treatment for unstable and luxated hips before the age of 4 months. If hips are not centered, other procedures should be used, in particular the Pavlik harness.

[Treatment of the dislocated hip in older children]. / Traitement de la hanche luxée chez le grand enfant.

Between 1976 and 1987, 85 cases of CDH occurring after walking age were followed in the department. Eighteen children aged 5 years or older were reviewed. In 11 children the dislocation was unilateral and in 7 bilateral; out of these 25 hips, 20 were high luxations and 5 occurred at a lower level. Two children, 6 and 13 years old, had a bilateral dislocation. Except for 2 children of 5 years of age who were treated conservatively, surgical treatment was indicated in the other 18 cases usually after tenotomy and derotation. In 13 hips, a surgical repositioning was performed, associated with femoral osteotomies, either shortening osteotomies (7) or derotation osteotomies (3). Pelvic osteotomies were indicated either immediately or later in 15 hips. A triple osteotomy was usually performed (11); a Salter (2) or a Chiari (2) has been rarely used. After a follow-up of 5 years, evaluation according to clinical and radiological criteria showed 14 good and 7 bad results. The latter 7 cases had either a dislocation or an eccentration. Reviewing these series, the authors describe the problems in the treatment of the dislocated hip in the older child: the indications, the therapeutic strategy for those dislocations and the decision for treatment of the bilateral high dislocation in the older child.

[Caustic esophageal stenosis in children: report and prevention]. / Sténoses caustiques de l'oesophage de l'enfant. Bilan et prévention.

From 1976 to 1988, 22 caustic burns of the esophagus in children were treated by retrograde dilatations (21 cases), by surgical resection and end-to-end anastomosis (2 cases) and by myotomy of the residual stricture after 12 to 18 months retrograde dilatations (4 cases). 3 deaths are recorded which might have been avoided; the treatment was successful in 11 cases and failed in 4 cases which led to the replacement of the esophagus; dilatations are being continued in 4 cases. In view of these results, the choice of the treatment should not be restricted either to conservative treatment continued in spite of poor results or systematic surgical replacement of the esophagus at an early stage. Furthermore, the use of an intraluminal splint has proved efficient in preventing esophageal stricture in 4 cases of caustic burns at stage III.

[Rectal prolapse in children. Review of 260 cases]. / Le prolapsus rectal de l'enfant. Revue de 260 cas.

Rectal prolapse is mostly seen in constipated children after prolonged straining at stool. In Morocco, it will occur in children suffering from digestive parasitosis or hypotrophic children following episodes of acute diarrhea. In order to evaluate the respective role of these factors and consequently adapt the management of this condition, a prospective study of 260 cases was conducted between 1979 and 1986 bearing on etiologic factors on the one hand and with a view to assessing the efficacy of medical treatment and of sclerosing injections on the other hand. As regards etiology, diarrhea in connection with digestive parasitosis appears as a predominating factor (62%). A deficient condition was also noted in 67 out of 160 children (42%). Medical treatment was successful only in 28% of cases, whereas 98% of our patients were cured by sclerosing injections without need for surgical treatment.

[The treatment of Pott's disease in children. Apropos of 100 cases]. / Le traitement du mal de pott de l'enfant. A propos de 100 cas.

Between 1976 and 1984, 100 children aged 13 months to 15 years were treated for tuberculosis of the spine. 29 patients seen at an early stage and presenting limited lesions healed completely with mild or moderate residual kyphosis after orthopaedic treatment associating antibiotherapy and strict immobilization in plaster shells. 71 patients having extensive vertebral destruction or after failure of the orthopaedic treatment underwent surgery for excision and anterior spine fusion. A supplementary posterior spine fusion was performed in 48 patients. This procedure, in conjunction with preoperative traction, obtained stabilization of the spine and healing of vertebral lesions in most cases with excellent correction of recent kyphosis. In view of these results, it seems possible to determine which treatment is best adapted according to: the extent, severity and level of the lesions, the degree and age of kyphosis, the existence or not of paraplegia. The possibility to reduce fixed severe kyphosis (6 cases) and the indication for a supplementary posterior fusion are evaluated.

[Prevention of caustic stenoses of the esophagus with an intraesophageal mold]. / La prévention des sténoses caustiques de l'oesophage par moule endo-oesophagien.

The various methods for the management of full-thickness caustic burns of the esophagus, whether by early bougienage or by corticosteroïd treatment and/or use of an intraluminal catheter, have proved unsuccessful to this date. The use of an intraluminal splint kept in place during 3 weeks, as advocated by Reyes, slows down the growth of exuberant granulation tissue and prevents the formation of synechia and stricture during the healing process. Reyes's method was modified as follows: after a delay of 4 or 5 days, an esophagoscopy is performed along with a histologic study in order to ascertain the extent of the burn. Then, a Blackmore catheter is introduced in the esophagus to serve as a splint. No corticosteroids are used. The authors report 3 cases of deep caustic burns of the esophagus as attested by endoscopic and histologic studies, which have been successfully treated.

[Atlanto-axial dislocations in children]. / Les dislocations atloïdo-axoïdiennes chez l'enfant.

A series of 9 cases of atlanto-axial dislocation observed between 1976 and 1982 illustrates the wide range of etiologic factors as well as their possible implication. The findings were as follows: 3 congenital anomalies of the odontoid process, 2 luxations resulting from trauma, 1 spine infection, 2 Grisel syndromes, 1 psoriatic rheumatism. Among them 3 children had incomplete tetraplegia. Six patients were treated by posterior spine fusion either directly or after failure of conservative management. The authors emphasize the difficulty in relating the disorder to its real cause and discuss the various methods of treatment according to the etiology, whether reduction and stabilization are possible and according to the neural involvement and the date of onset of the disorders.

[Esophagus ligation on murphy button in the management of bleeding esophageal varices in children (author's transl)]. / Place de la ligaturae de l'oesophage sur bouton dans les varices oesophagiennes de l'enfant.

Bleeding esophageal varices in 9 children (among whom 5 with extra-hepatic and 4 with intra-hepatic obstruction) were treated by ligation of the esophagus on an anastomotic button. Two patients died, one presenting mesenteric infarction following splenectomy, the other due to mismanagement of postoperative esophagus stenosis. In the patients with extra-hepatic obstruction, no recurrent bleeding was noted and the varices have completely disappeared on X-Ray and endoscopy with nearly 5 years follow-up, which proves the efficiency of the method. In cases of intra-hepatic obstruction, this procedure remains useful for the management of advanced cirrhosis or as a temporary treatment to help a young infant over a dangerous period.

[Treatment of hematologic disorders in children by splenic artery ligation (author's transl)]. / La ligature de l'artère splénique d'indication hématologique chez l'enfant.

Because of the risk of overwhelming sepsis following splenectomy, and since it is possible to reduce the splenic function while preserving the spleen, the treatment of various hematologic disorders by splenic artery ligation has been attempted in 11 children, among whom 3 under 5 years of age. 3 patients had thalassemia, 4 had hereditary spherocytosis and 4 others suffered from secondary hypersplenism. One patient died of overlooked splenic necrosis. The other patients are well, with an average follow-up of 19 mo. The aim of this study is to find out whether the desarterization produces the expected results and is well tolerated and whether the desarterialized spleen still preserves its ability to protect the host against infection. The satisfactory treatment of hereditary spherocytosis and secondary hypersplenism would indicate that splenic artery ligation offers an alternative to splenectomy, especially in children under 5 year old.

[New approach to the management of caustic esophageal stricture in children (author's transl)]. / Une nouvelle thérapeutique des sténoses caustiques de l'oesophage chez l'enfant.

The management of long segment esophageal stenosis following chemical burns in children remains a difficult problem although various kinds of treatment have been proposed. The surgical treatment, consisting in replacing the injured segment, is mutilating and always performed at some risks. On the other hand dilatations must be carried on over several years in order to produce results and are not compatible with normal life. Furthermore, they are often followed by complications. The authors have been led to develop a method which would both allow the conservation of the esophagus and avoid long term dilations. This procedure mainly consists in a lengthwise myotomy of the residual structure after 12 or 18 months retrograde dilatations so as to peel off the wall fibrosis. The technique is presented and discussed about 2 successfully treated cases with a 9 to 12 months follow up.

[Treatment of esophageal varices using Murphy device (author's transl)]. / Traitement des varices oesophagiennes de l'enfant par ligature de l'oesophage sur bouton de Murphy.

Bleeding esophageal varices in 7 children (5 with extra-hepatic obstruction and 2 with intra-hepatic obstruction) were treated by ligation of the esophagus on a Murphy button. Two patients died, one presenting mesenteric infarction following splenectomy, the other due to mismanagement of post-operative esophagus stenosis. Among the 5 surviving patients, the fact that no recurrent bleeding was noted and the complete disappearance of varices on X ray and endoscopy with a 2-6/12 year follow up demonstrate the efficiency of this treatment. The authors stress upon the precautions enabling to reduce the morbidity of this procedure (esophageal stenosis) giving otherwise good result in the management of bleeding esophageal varices in children.

[Livaditis procedure used for repair of esophageal atresia type I (author's transl)]. / Un cas d'atrésie de l'oesophage du type I traitée par le procédé de Livaditis.

The livaditis procedure and the prognosis of post-operative leakage being now improved, it is tempting to perform an early repair of esophageal atresia type I. The authors report the successful treatment of esophageal atresia performed at the age of 7 weeks, despite a gap of 5 vertebrae between both segments and an anastomotic leak.

Intestinal calcium-binding protein 3 months after massive small bowel resection in the piglet.

Changes in intestinal calcium-binding protein and calcium binding activity were studied at resection and 3 months after 90% small bowel resection in piglets and one adult pig. A calcium-binding protein (MW congruent to 11.000) with calcium-dependent eletrophoretic mobility was partially purified from mucosal extract of proximal jejunum, mid-gut, and ileum. The concentration of calcium-binding protein and the calcium-binding activity of the intact animals were found highest in the proximal jejunal segment, lowest in the ileal segment. After resection in the four surviving animals out of nine, a significant increase in calcium-binding activity was observed in the proximal jejunum and in the distal ileal segment. The change in calcium-binding activity was much more marked in the ileum than the jejunum. These data demonstrate that pig intestinal mucosa possesses an adaptive capacity to increase the synthesis of calcium-binding protein after massive small bowel resection.

[Vascular and infectious enteropathy in newborn infants. Reflections on pathogeny; clinical and therapeutic deductions. Apropos of 45 cases]. / Entéropathie vasculaire et infectieuse du nouveau-né réflexions pathogéniques; déductions cliniques et thérapeutiques. A propos de 45 observations

Necrotizing enterocolitis of the new-born has an anatomical definition: lesions discovered during surgery or on post-mortem examination. Progress in neanatal shock reveals facts already known in the adult and in experimental medicine: concept of preferential and circulatory by-pass. A considerable decrease in blood flow is seen in the latter during shock; this shock is sometimes not important. Mesenteric circulation is the best example. This syndrome should therefore be included in the major vascular changes of neonatal period. Vascular and infectious enteropathy is a broader term which seems more appropriate because of aetiological and therapeutic implications. The aetiology should be considered as a sum of several factors varying from one patient to another (multifactorial disease). The circulatory component remains very important. Its severity depends on whether or not it is treated. Four notions should be defined: -- Census of population of subjects with "high risk" of vascular and infectious enteropathy (score trial); -- Isolation of clinical pictures corresponding to a medical or surgical stage; Grouping of elements for immediate and long term prognosis; -- Grouping of elements for immediate and long term prognosis; -- Proposal of preventive treatment to the "high risk" patients (surgery; continuons parenteral and enteral feeding are intientionally left out in this paper). The interest of this concept of the disease is to eradicate severe forms as in the neonatal idiopathic respiratory distress syndrome where a similar concept was adopted.