Quantitative and qualitative study in keratinocytes from foreskin in children: Perspective application in paediatric burns.

BACKGROUND: We performed a quantitative and qualitative evaluation of keratinocytes from foreskin in children. MATERIALS AND METHODS: We harvested 18 foreskins after circumcision. The mean average age of the operated children was 4 years. The keratinocytes were isolated after double-enzymatic digestion. After filtration and centrifugation we put the keratinocytes in culture. Then, the keratinocytes were cultivated on collagen lattices. The keratinocytes were cultured in submerged condition for 2 days and then in an air-liquid interface condition for further differentiation. After cultures, the cells were counted and a histological examination was done. An immunohistologic analysis enabled us to highlight the markers characteristic of neo-epidermis differentiation. RESULTS: After enzymatic digestion, we obtained 11.4 million cells per foreskin. After 10 days of culture and from 2 million cells, we obtained 24 million cells. In contact with the collagen lattices, we obtained a neo-epidermis and we described the markers of keratinocytes differentiation as well as the markers of the dermo-epidermal junction. CONCLUSION: Keratinocytes from foreskin have a high capacity for division. These cells can divide for long periods before differentiation. These observations allow us to propose foreskin keratinocytes as a potential source of cells to provide coverage in burns.

[Cultured keratinocyte cells from foreskin and future application for burns in children]. / Modèles de cultures cellulaires kératinocytaires de prépuce. Possibilité d'application chez les enfants brûlés.

PURPOSE OF THE STUDY: We tested in vitro the keratinocytes capacity for division and differentiation. The donor site was the human foreskin. PATIENTS AND METHODS: For 12 months, we harvested 18 foreskins after circumcision. The middle age of the operated children was four years. The keratinocytes were isolated after double enzymatic digestion (thermolysin and trypsin, respectively). After filtration and centrifugation we put the keratinocytes in culture. In parallel, the keratinocytes were cultivated on the surface of collagen lattices. The keratinocytes were cultured in submerged condition for two days and then in an air-liquid interface condition for further differentiation. After nine days of culture, a histological examination and immunostain were used. An immunohistologic analysis made it possible to highlight the markers characteristic of epidermal skin differentiation. RESULTS: We obtained an average of 8.8 10(6) cells per foreskin. After seven days of culture, we obtained on average 23.7 10(6) cells by culture. In contact with the collagen lattices, we obtained an epidermal skin and we highlighted the markers of keratinocytes differentiation as well as the markers of the dermoepidermic junction. CONCLUSION: The keratinocytes resulting from foreskin have a high capacity of division. These cells can divide a long time before differentiation. The observations enable us to propose with our patients the keratinocytes from foreskin for wound healing especially for burns in children.

[Cleft lip and palate: indications for radiological postnatal explorations]. / Fentes labiopalatines isolées: place des examens radiologiques postnataux.

AIM: We evaluated the utility of systematic neonatal radiological explorations in 20 instances of isolated cleft lip and palate in 20 cases. METHODS: This study included 13 infants with prenatal ultrasound diagnosis. The type of cleft and possible associated anomalies were noted. A systematic chromosomal test was done. In 7 cases, the cleft lip was noted at birth. Postnatal outcome was obtained and a clinical examination and radiological explorations were carried out. RESULTS: For the cases with prenatal diagnosis, the chromosomal test was normal in 11 cases and we noted associated anomalies in three cases. For the cases with neonatal diagnosis, the chromosomal test was normal in 6 cases and 1 infant had associated anomalies. CONCLUSIONS: The biological and radiological explorations can be numerous. In our study, the systematic neonatal radiological explorations did not find more elements compared with neonatal clinical examinations. The high risk of having a chromosomal anomaly in children with cleft lip requires systematic prenatal chromosomal exploration.

[Nonoperative management of splenic trauma in children]. / Traitement conservateur des traumatismes spléniques de l'enfant: savoir persévérer!

In haemodynamically stable children with splenic trauma, conservative treatment is recommended to preserve the spleen and prevent potentially lethal post-splenectomy infectious complications. We report on the case of a 11-year-old child who suffered a fistula of a huge subcapsular splenic hematoma into the colon, 16 days after the traumatism. Decision to sustain the non-operative treatment allowed the preservation of the spleen without complications.

[Neonatal cleft lip repair: psychological impact on mothers]. / Réparation chirurgicale néonatale des fentes labiales: impact psychologique chez les mères.

AIM: To investigate the psychological impact on mothers of an early neonatal cleft lip repair. METHODS: Between January and December 2004 mothers of 24 infants born with a cleft lip completed psychological interviews and questionnaires 1 month after neonatal repair. We evaluated the psychological impact on mothers of antenatal and postnatal diagnosis. We noted the parental preferences for the timing of cleft repair and their satisfaction after neonatal repair. RESULTS: Stress, incomprehension and anxiety were often noted. Most mothers preferred their infant to receive neonatal repair. We noted a great satisfaction after neonatal cleft lip repair. DISCUSSION: We are currently encouraging early repair in the full-term baby as the optimum, reliable and safe method of management of newborns with cleft lip. Mothers expressed a preference for and greater satisfaction with neonatal repair. Parental preferences should routinely be considered in deciding the timing of this procedure.

[Torsion of the spleen in children]. / Volvulus splénique chez l'enfant.

The wandering spleen is caused by congenital absence of fixating ligaments or abnormally long ligaments. It is an uncommon clinical entity, which rarely affects children. The clinical presentation of wandering spleen is variable, but the most dangerous complication is splenic torsion. A 7 year-old boy presented with abdominal pain and vomiting. The abdominal ultrasound scan discovered spleen ischemia. Volvulus of the spleen was evoked. Laparotomy was carried out and the patient underwent splenectomy. In this case the anatomical means of spleen fixity were absent. Because wandering spleen is uncommon in the paediatric population, a heightened awareness of the condition is required for accurate diagnosis and appropriate management. The treatment of choice is splenopexy, while if splenic necrosis is present, splenectomy is required.

[Endoscopic management for hepatic duct injury in children]. / Drainage perendoscopique d'une plaie traumatique des voies biliaires chez l'enfant.

Non-operative management of hepatic injury in children with abdominal trauma represents a standard of care. A major duct injury with persistent bile leakage may result from trauma to the liver. This injury is of concern in patients treated non operatively because it generally requires major hepatic surgery. We report on a case of a 13-year-old boy with an hepatic duct injury from trauma in which healing occurred without surgical repair or resection.

[Macrocephaly and multiple hamartoma: a very variable entity]. / Macrocéphalie et hamartomes multiples : une entité d'expression très variable.

UNLABELLED: The Bannayan-Zonana is a dominant autosomal polymalformation syndrome. CASE REPORT: We report a case of Bannayan-Zonana syndrome in a 3-year-old girl, who presented with macrocephaly and a cervical lipoma. The patient's mother had neurofibromatosis I. No mutation in the PTEN gene was found. The slowly progressive lipoma increased with age and the surgical reduction was necessary. COMMENTARIES: Macrocephaly is constant in different syndromes characterized with multiple hamartomas. The multiple hamartomas syndrome represents an entity with a high variability of expression.

[Intrauterine intussusception causing intestinal atresia during pregnancy]. / Invagination intestinale aiguë anténatale et atrésie du grêle.

CASE REPORT: A case of intrauterine intussusception causing ileal atresia is reported. The neonate presented at the age of one day with bilious vomiting, failure to pass meconium and progressive abdominal distension. A clinical diagnosis of intestinal obstruction was made, and was confirmed by plain abdominal radiographs. At laparotomy, atresia of the terminal ileum was found. The lumen of the resected distal segment contained an intussusceptum. The blind ends were resected and an anastomosis was performed. Recovery was uneventful. COMMENTS: Intrauterine bowel intussusception is a rare clinical entity. When intussusception occurs in the foetus and the time elapsed is enough to allow for gangrene and resorption of the intussuscepted portions of the bowel, intestinal atresia may result. CONCLUSIONS: The careful examination of the distal blind end of the ileum aids to obtain a correct classification and etiologic diagnosis of the atresia.

[Johanson-Blizzard syndrome: a case report]. / Syndrome de Johanson-Blizzard: à propos d'un cas.

UNLABELLED: The Johanson-Blizzard syndrome is a rare autosomal recessive syndrome. This syndrome includes congenital aplasia of the cutis, aplasia of the alae nasi, bilateral hearing loss, dental malformations and pancreatic insufficiency. CASE REPORT: We report a sporadic case male infant from nonconsanguineous parents. He presented aplasia of the cutis and high anorectal malformation, associated with exocrine pancreatic insufficiency. A colostomy was performed at birth and anorectal atresia was corrected surgically at two months. Exocrine pancreatic insufficiency required immediate enzyme supplementation.

[Early repair for infants with cleft lip. Retrospective study of 263 cleft lip repairs]. / Réparation chirurgicale précoce des fentes labiales. Revue de 218 enfants (263 fentes labiales) opérés.

This study attempts to define the effect of early repair on the surgical procedure and immediate outcome of cleft lip surgery. The first part deals with 263 consecutive cleft lip repairs (218 infants) categorized retrospectively by age at operation. 123 patients (150 cleft lips) were operated on during the first 4 weeks of life; a subgroup of 40 infants was operated on at a week or less of age; 95 patients (113 cleft lips) were operated at an older age (1 to 12 months). There were no significant difference in immediate surgical result between the groups and there was no apparent difference in the operative results as defined by whether or not the child needed subsequent revision. We are currently encouraging early repair in the full-term baby as the optimum method of management of newborns with cleft lip.

[Cowden's disease in an adolescent]. / Maladie de Cowden chez un adolescent.

Cowden's disease is an autosomal dominantly inherited syndrome characterized by mucocutaneous lesions and multiple hamartomas. We report here a 12 years-old boy case with craniomegally, intestinal polyps, epilepsy and multiadenomatous goiter. All the lesions were beginnings. The predisposing genetic defect has been assignated to chromosomal 10 (PTEN-gene mutation). A long term follow-up is necessary because of the risk of malignancies.

Phagocytic reaction in contact with macroplastic: application in pediatric surgery.

BACKGROUND/PURPOSE: With regard to the problems of using polytetrafluoroethylene (PTFE) in the treatment of vesicoureteric reflux in children, the authors have tested polydimethylsiloxane (PDMS), which is conveyed by polyvinylpyrrolidone (PVP), a hydrogel. METHODS: The phagocytic reaction was tested with both PDMS and PVP. The phagocytic reaction of PDMS and PVP was tested in vitro, then the outcome of PVP was tested in vivo in the mouse. RESULTS: In vitro PVP was phagocytosed by mouse peritoneal macrophages. However, PDMS particles were not phagocytosed because of their large size. In vivo, PVP migrated to other organs but did not induce clear histologic lesions. CONCLUSIONS: Silicone (PDMS) has been used in the treatment of vesicoureteric reflux in children. It is now necessary to do tests on heavier animals with a long incubation period to know whether these particles migrate and what the histologic and clinical consequences might be.

[Cleft lip and palate. Epidemiologic analysis: report of 60 cases]. / Fentes labiopalatines. Analyse épidémiologique: à propos de 60 cas.

The authors reviewed 60 cases of cleft lip and palate between November 1996 and May 1998. Any family history of cleft lip and palate and associated syndromes was noted, to detect a possible mode of transmission. A family history of cleft lip and palate was reported in 14 cases (23%). Possible autosomal dominant transmission was observed in this series. A syndromic form was observed in eight cases (13%), with one case of Van der Woude's Syndrome (VWS), and another of velo-cardiofacial Syndrome (VCFS). Molecular and chromosomal studies are indicated in both cases. A Pierre Robin sequence (PRS) was found in six cases.

Treatment of facial dog bite injuries in children: a retrospective study.

PURPOSE: The authors assess their approach to immediate surgical repair with general anesthesia of facial dog bites in children over a 10-year period in their pediatric department. METHODS: The authors reviewed a series of 100 children (59 boys, 41 girls) who required immediate surgical intervention during the first hours after admission between 1985 and 1995. Strict disinfection was always used to preclude the risk of rabies, and parenteral antibiotherapy was used to avoid aero-anaerobic infections. RESULTS: A total of 68% of children were below 5 years of age. The most frequent injury was to the midface. Associated injuries or death were not observed. One case of postoperative wound infection was noted. Four surgical revisions were performed because of unsightly scars, but in most children the scar had attenuated 1 year after injury. CONCLUSIONS: The aim of immediate surgical repair is to obtain a satisfactory cosmetic result and to avoid infections. Better cosmetic results (4 cases of scar revisions) with a minimal risk of wound infections (1 cheek wound infection) are obtained.