Multicentric evaluation of the adherence to Peristeen® transanal irrigation system in children.

BACKGROUND: Since 2009 in France, the Peristeen® transanal irrigation (TAI) device has represented an alternative treatment of faecal incontinence (FI). OBJECTIVE: The primary objective of this study was to assess the mid-term adherence to TAI in paediatric patients. The secondary objective was to identify factors determining TAI continuation. METHODS: This observational study conducted in 5 French paediatric centres prospectively reviewed from March to May 2012 all children educated in TAI for at least 9months. RESULTS: We included 149 children (mean [SD] age 10.6 [4.1] years) educated in TAI. Children mainly had neurogenic disorders (52.3%) or congenital malformations (30.9%). The main symptoms motivating TAI initiation were recurring faecaloma (59.7%) and daily FI (65.1%). At last follow-up (mean 14 [7.4] months), 129 (86.6%) children continued the TAI procedure, independent of pathology or age. The main motivation was resolution of FI and/or constipation (77.3%). In total, 107 (82.9%) children fulfilled the initial therapeutic contract established with their healthcare professional before TAI initiation was met. Twenty children had stopped the TAI when they answered the questionnaire, at a mean duration of 16 (8.4) months. The reasons were mainly "lack of motivation" (45%), "poor tolerance" (35%), "difficulties" performing the procedure (35%) and "inefficacy" (30%). Factors related to continuation were performing at least one TAI procedure under a nurse's supervision during the initial training and prescribing TAI at a daily frequency (P=0.014 and P=0.04). Continuing constipation treatment after the training session was a factor in discontinuation (P=0.024). CONCLUSION: This study reports a very high mid-term adherence to TAI in a paediatric cohort, provided that the training is pragmatic, personalized and repeated.

Antenatal diagnosis of Multicystic Renal Dysplasia.

Multicystic Renal Dysplasia (MRD) was discovered during antenatal ultrasound examination in 138 fetuses between 1980 and 1995. Associated malformations were present in 66 % (42 % urological) and 22 % of the fetuses did not survive the pregnancy or the peri-natal period.Anatomical analysis showed a wider variety of MRD than in classical descriptions. Obstruction of the urinary tract was almost invariable. Like the hypothesis published by Beck in 1971, our view is that, with a very early obstruction of the urinary tract (during the first trimester), there is a dysplastic evolution of renal tissue, while later in pregnancy the same obstruction can induce a hydronephrosis with corticomedullary dysplasia.We advise complete neonatal urological investigation, and surgical removal of multicystic kidneys, to avoid multiple and inadequate evaluations of those children with a single functioning renal unit.

Precipitating and aggravating factors of migraine versus tension-type headache.

OBJECTIVE: We conducted the present study to determine whether there are headache precipitating and aggravating factors that differentiate migraine from tension-type headache and headache precipitating and aggravating factors that differentiate tension-type headache from migraine. METHODS: We interviewed 38 patients with migraine and 17 patients with tension-type headache (diagnosed using International Headache Society criteria) by telephone, using a questionnaire. The questionnaire inquired about the following precipitating and aggravating headache factors: (1) physical activity, (2) straining, (3) bending over, (4) stress/tension, (5) coughing/sneezing, (6) fatigue, (7) reading, (8) driving, (9) lack of sleep, (10) specific foods/drinks, (11) alcohol, (12) not eating on time, (13) smoke, (14) smell, (15) light, (16) noise, (17) menstruation, and (18) weather. RESULTS: The most common precipitating factors acknowledged by both groups of patients were stress/tension, not eating on time, fatigue, and lack of sleep. Weather, smell, smoke, and light were the precipitating factors that differentiated migraine from tension-type headache. Excluding those factors that are part of the International Headache Society migraine diagnosis, the aggravating factors were straining, bending over, and smell. We found no precipitating or aggravating factors differentiating tension-type headache from migraine. CONCLUSION: Apparently there are precipitating and aggravating factors differentiating migraine from tension-type headache but not vice versa. It is interesting that three of the migraine-specific precipitating factors (ie, weather, smell, and smoke) involve the nose/sinus system, suggesting a greater significance of this system in headache than is generally considered.

Chronic daily headache: a time perspective.

OBJECTIVE: To determine the development and outcome of chronic daily headache in 258 headache practice patients, consisting of 50 men and 208 women. Chronic daily headache was defined as headaches occurring on at least 5 days per week for at least 1 year. METHODS: Two hundred fifty-eight patients with headache were interviewed and evaluated. Ninety-one patients were contacted by telephone for follow-up. RESULTS: Twenty-two percent of the patients had daily headaches from the onset, and 78% initially experienced intermittent headaches. Of the patients with initially intermittent headaches, 19% experienced an abrupt transition into daily headaches and 81%, a gradual one. In the patients with gradual transition, the transition of the initial, intermittent headaches into daily headaches took an average of 10.7 years. The initial headaches were mild in 33% of the patients and severe in 67%. The severe headaches were associated with nausea and vomiting significantly more often than the mild ones. However, the daily headaches that these patients ultimately developed were the same, regardless of whether the initial headaches were mild or severe. The patients who gradually developed daily headaches from initially intermittent headaches were contacted to determine the outcome of their headaches. Of these patients, 33% continued to have daily headaches and 67% again experienced intermittent headaches. Of the latter group, 88% of the patients who now had migraine also had migraine initially.

Collagen-coated Vicryl mesh: a new bioprosthesis in pediatric surgical practice.

Collagen-coated Vicryl mesh (C.C.V.M.) was used in 28 children who needed repair of thoracic and abdominal wall defects. Herein the authors report the clinical experience, surgical technique, and outcome in these cases.

[Surgery for lung metastases in children]. / Chirurgie des métastases pulmonaires de l'enfant.

The authors report a series of 76 children with lung metastases followed from 1974 to 1989. Forty-four children were operated on with 64 thoracotomies (50 wedge resections, 5 segmentectomies, 2 pneumonectomies, 6 biopsies, 1 excision of an inflammatory granuloma): 23 of these children are alive, and 17 of them without any adjuvant radiotherapy. Thirty-two were not operated on; of the 13 that are alive, 7 had no adjuvant radiotherapy. The indications for surgery were: to treat a complication of the metastasis, to verify persistent images on CT-scan, but essentially to avoid more aggressive treatment (chemotherapy, radiotherapy) with its risk of sequelae in children.

[Treatment of traumatic rupture of the urethra. Apropos of 30 patients]. / Traitement des ruptures traumatiques de l'urètre. A propos de trente patients.

Thirty patients with traumatic rupture of the urethra were treated in the Urology Department of Cochin Hospital between 1975 and 1985: 11 as an emergency procedure, 7 for an early complication and 12 for a late complication. In the patients treated early, urethrorrhaphy or one-stage urethroplasty gave the best results. Two stage urethroplasty constituted best treatment for patients with a complication of earlier treatment. In patients with late complications, endoscopic urethrotomy is rarely sufficient on its own and two-stage urethroplasty is generally indicated.