[Tubulized gastric fundus in the treatment of esophageal atresia]. / Fundus gástrico tubulizado en el tratamiento de las atresias de esófago de segmento largo.

When is impossible to restore the oesophageal continuity in oesophageal atresia (EA), the stomach elevation (whether tubulized or complete) and colon interposition are the most accomplished techniques, usually from the age of six month, in different steps and with the result of a high mortality, prolonged hospitalizations and high familial and economical cost. From a total of 34 EA diagnosed in an eleven years period, we had treated three children, tubulizing the gastric fundus with mechanical sutures in continuity with the distal oesophageal end in neonatal period. The procedure is done with preservation of the distal esophageal end in continuity with the tubuliced gastric fundus with mecanichal staplers. All the patients had needed pneumatic dilatations of the anastomosis After eleven years, eight years and six months follow-up respectively, the clinical behaviour of those patients is suitable, without swallowing problems and with weight and height development in predictable limits. We think that this kind of neoesophagus is useful to treat the long segment EA in newborns as it sets an esophago-gastric tube orthotopically, with homogeneous diameter in a isoperistaltic continuity, in neonatal period and in one step, putting aside the gastrostomy performed at the firsts hours of life and obtaining an important decreasing of mobility and hospitalisation stay.

Fundus gástrico tubulizado en el tratamiento de las atresias de esófago de segmento largo / Tubulized gastric fundus in the treatment of esophageal atresia

Cuando resulta imposible restablecer la continuidad esofágica en las atresias de esófago (AE), el ascenso del estómago sólo y/otubulizado y la interposición de colon son las técnicas más realizadas, normalmente a partir de los 6 meses de edad, en varios tiempos y con alta morbilidad, larga estancia hospitalaria y alto coste social, familiar y económico. Hemos tratado a tres niños con AE, de un total de 34 AE diagnosticadas, en un período de 11 años, tubulizando el fundus gástrico, con suturas mecánicas, en continuidad con el cabo distal esofágico, en período neonatal. La técnica (basada en la técnica de Schärli) conlleva la tubulización desde la curvatura menor gástrica del fundus gástrico, mediante el uso de suturas mecánicas en continuidad con el cabo distal esofágico. De esta manera se efectúa una anastomosis esofago esofágica conservando el cardias y tubulizando el estómago en sentido isoperistáltico. Todos los pacientes han requerido dilataciones neumáticas de la anastomosis esofago esofágica. El control y seguimiento tras 11 años, 8 años y 8meses es satisfactorio en los tres pacientes, los cuales se encuentran bien, sin problemas de deglución y con un aceptable y adecuado desarrollo pondoestatural. Creemos que este tipo de intervención y realización de un neoesófago es útil para tratar las AE de segmento largo en neonatos, al emplazar un tubo esofagogástrico ortotópicamente de calibre homogéneo en continuidad isoperistáltica en período neonatal y en un solo tiempo, prescindiendo de la gastrostomía realizada a las pocas horas de vida, consiguiendo una importante reducción de la morbilidad y estancia hospitalaria (AU)

When is impossible to restore the oesophageal continuity in oesophageal atresia (EA), the stomach elevation (whether tubulized or complete) and colon interposition are the most accomplished techniques, usually from the age of six month, in different steps and with the result of a high mortality, prolonged hospitalizations and high familial and economical cost. From a total of 34 EA diagnosed in an eleven years period, we had treated three children, tubulizing the gastric fundus with mechanical sutures in continuity with the distal oesophageal end in neonatal period. The procedure is done with preservation of the distal esophageal end in continuity with the tubuliced gastric fundus with mecanichal staplers. All the patients had needed pneumatic dilatations of the anastomosis After eleven years, eight years and six months follow-up respectively, the clinical behaviour of those patients is suitable, without swallowing problems and with weight and height development in predictable limits. We think that this kind of neoesophagus is useful to treat the long segment EA in newborns as it sets an esophago-gastric tube orthotopically, with homogeneous diameter in a isoperistaltic continuity, in neonatal period and in one step, putting aside the gastrostomy performed at the firsts hours of life and obtaining an important decreasing of mobility and hospitalisation stay When is impossible to restore the oesophageal continuity in oesophageal atresia (EA), the stomach elevation (whether tubulizedor complete) and colon interposition are the most accomplished techniques, usually from the age of six month, in different steps and with the result of a high mortality, prolonged hospitalizations and high familial and economical cost. From a total of 34 EA diagnosed in an eleven years period, we had treated three children, tubulizing the gastric fundus with mechanical sutures in continuity with the distal oesophageal end in neonatal period. The procedure is done with preservation of the distal esophageal end in continuity with the tubuliced gastric fundus with mecanichal staplers. All the patients had needed pneumatic dilatations of the anastomosis After eleven years, eight years and six months follow-up respectively, the clinical behaviour of those patients is suitable, without swallowing problems and with weight and height development in predictable limits. We think that this kind of neoesophagus is useful to treat the long segment EA in newborns as it sets an esophago-gastric tube orthotopically, with homogeneous diameter in a isoperistaltic continuity, in neonatal period and in one step, putting aside the gastrostomy performed at the firsts hours of life and obtaining an important decreasing of mobility and hospitalisation stay (AU)

[Intralobar pulmonary sequestration with multiple arterial blood supply]. / Secuestro pulmonar intralobar con irrigación arterial múltiple.

We report the case of a 4 years old boy, who presented at our institution with reiterative neumonia affecting left basal lobe. Anomalous vascular appearance was detected in the chest x-ray. With the suspicion of pulmonary sequestration we carried on Digital Intravenous Angiography by Substraction (DIVAS) and aortogram. The anomalous systemic arterial supply was formed by 6 vessels coming from the thoracic aorta and going into the left lower lobe basal segment. Lobectomy was performed and previous diagnosis was confirmed pathologically.

[Paravesical hemangiopericytoma. Apropos of a case]. / Hémangiopéricytome paravésical. A propos d'une observation.

Paravesical hemangiopericytoma is a vascular tumour that develops at the expense of the pericyts surrounding the blood capillaries. Its dim prognosis relates to its high potential of malignancy. With respect to the first case examined at the Dakar C.H.U. (the 10th case world wide), a literature review has been done. The diagnosis is based on histology while arteriography provides guiding elements. This particular case strikes especially the young individual, with no preference for a given sex. Therapy-wise, radiotherapy seems efficient. But, surgery remains, at the moment, the choice treatment of paravesical hamangiopericytoma. It consists of a large exeresis associated with radiotherapy. Chemotherapy still hold a limited place within the therapeutic arsenal against paravesical hemangiopericytoma.

[Bloodless emergent laparotomy for acute abdominal syndrome]. / Laparotomies blanches en urgence pour syndrome abdominal aigu.

Bloodless laparotomy (BL) is defined as an opened exploration of the abdominal cavity that yields negative results, i.e., "provides no information as to the cause of the clinical and paraclinical symptoms responsible for prompting the surgical investigation". The authors report a retrospective study spanning January 1975 to December 1989, on the incidence of and mortality associated with emergent BL in patients with acute abdominal syndrome, with the intent of reducing its frequency. Over this period, 24 BL occurred in 3480 emergent laparotomies, i.e., 0.63%. These involved 7 men, 5 women, 5 boys and 7 girls, aged 4 to 52 years (mean age = 19.5 years). Indications for surgery were based on clinical signs, as well as on laboratory findings such as chest X-ray and plain radiography and needle-puncture of the abdomen. Surgical data indicated:liver cirrhosis--3 cases; mesenteric adenopathy--3 cases; intestinal parasitosis--1 case; bilateral adnescitis--1 case; polycystic ovaries--1 case; wall abscess--1 case; unexplained pain--14 cases. The mortality rate was 2/24. Use of other paraclinical investigations, namely ultrasonography, laparoscopy and peritoneal lavage, and of computer science methods after a prior clinical examination initiated by history-taking, might help reduce the rate of BLs, which are non-devoid of mortality.