[Blunt injuries of the pancreas in children. Diagnostic and therapeutic approach apropos of 8 cases]. / Traumatismes fermés du pancréas de l'enfant. Approche diagnostique et thérapeutique à propos de 8 cas.

From 1970 to 1985, eight severe blunt pancreatic traumas were admitted. There is significant difference in morbidity between early pancreatectomy with or without splenectomy (a mean hospital stay of 23 days, low loss of weight) and initial simple external pancreatic drainage with delayed partial pancreatectomy or pancreato-cystojejunostomy Roux-en-Y (mean hospital stay of 45 days, 24% loss of weight, one death two years later). Thus it seems essential to diagnose the pancreatic injury and particularly rupture of the pancreatic duct. Aiming to evaluate these lesions, biology, ultrasonography or computerized axial tomography proved insufficient. As a result, in the last two patients, an endoscopic retrograde pancreatography was performed confirming total transection of the pancreatic duct, one case with fistula, the other with a contrast fluid stop. The surgical approach was guided by these X-ray findings and a distal pancreatectomy performed preserving spleen. The authors propose the following protocol: endoscopic pancreatography if an evident improvement in recent pancreatic injury is not obtained in 48 hours, or in the case of former complicated pancreatic trauma; in the event of total rupture of pancreatic duct, operation should be carried out: abdominal exploration guided by the X-rays findings, distal pancreatectomy or, rarely, repair of the pancreatic duct; when no pancreatic duct lesion is found, but ultrasonographic blunt trauma patent, the surgical decision depends on the amount of peripancreatic reaction: medical treatment or external drainage; when lesion of the head of pancreas is detected, conservative treatment is to be preferred to pancreatoduodenectomy.

[Use of the Pavlik harness before the age of 3 months in congenital hip dislocation]. / Utilisation du harnais de Pavlik avant l'âge de 3 mois dans la luxation congénitale de hanche.

The authors report 128 cases of reduction of congenital dislocation of the hip by the Pavlik harness with more than one year of follow-up. They studied 60 patients who had less than 3 months of age at the beginning of the treatment. They obtain 59 reductions (98%) without necrosis of femoral heads. The only case of unsuccess, treated after by continuous extension, has doubtful femoral heads at 15 months of age. The femoral heads appear in normal delay and walk was normal between 10 and 18 months. Only a strict watchfulness, as strict as a continuous extension, can obtain good results with progressive flexion. Bath is not authorized and harness is not removed before stable reduction. Parents are taught how to hold their infant without bringing his knees together. The most important thing is the X-ray control on D8, D21, and D60, the prevent the trap of too much flexion, too nice penetration or persistent eccentration. Under these conditions, the authors think that the treatment of congenital dislocation of the hip by the Pavlik harness is the safest method especially before 3 months of age.

[3 case reports of lumbosacral agenesis; role of the lumbo-iliac bone graft]. / A propos de 3 observations d'agénésie lombosacrée, place de la greffe lombo-iliaque.

From 3 cases (8,2 and 16 years) the two first patients have been followed since birth, and in reviewing the 124 cases published in the literature, the authors analyze: the possible causes with in first the mother's diabetes, the possibility of antenatal diagnosis with ultrasound, the clinical symptoms: paraplegia with stiff joints and deformities of lower limbs, finally the therapeutic possibilities to correct the deformities of lower limbs and find the compromise between straighten the patient to authorize the possible standing and keep mobility between trunk and pelvis to allow sitting. In this case, the lumbo-iliac bone graft can be used if necessary and if the mobility of the hips make that possible. This bone graft was realized once in January 1979 (follow up 5 1/2 years). All the references are in Dr Barnetche's thesis (Bordeaux 1984, n degrees 135).

[Prepuce plastic surgery, known as the Lille operation, in distal hypospadias. Apropos of 138 cases]. / La plastie du prépuce, dite lilloise, dans les hypospades distaux. A propos de 138 cas.

Distal hypospadias with meatus situated on the glans, in the balano-penile furrow, even on the distal part of the shaft, are the most frequent hypospadias. Without chordee, it's only a cosmetic handicap. The aim of surgery is to produce the esthetic appearance of a normal penis. In France, circumcision is not usual and most people prefer a child with prepuce. The best technique in this case is to keep the meatus in its hypospadial situation and get the prepuce circular with a ventral suture. It's an easy technique. The hospital stay is short, 2 or 3 days, without any diversion of the urine. This operation is made when the child is about 3 years. Saint-Aubert described this procedure in 1967. The authors present their technique and results. Since 1971, 138 boys underwent this operation with few complications: 2% of fistulas and 2% of phimosis on the last hundred of cases.

[Urethral duplications in a young girl. Apropos of a case]. / Les duplications urétrales chez la fille. A propos d'un cas.

One unusual case of urethral duplication in a girl is presented. A case report is given of a female aged 2,5 years presenting with a discharge from a small opening in front of the pubis. Urination was normal and physical examination revealed no abnormalities but this opening. An intravenous pyelogram showed a right pyeloureteral duplication and a cystogram no reflux. Dye injected into the opening revealed a small duct that passed under the pubis and ended on the anterior wall of the bladder. No contrast medium entered the bladder. Through a double approach, all the duct was removed; there was no communication with the bladder. The histologic examination showed an urinary epithelium and concluded in favour of urethral duplication.

[Pseudo-surgical aspects of hemolytic-uremic syndrome in childhood (author's transl)]. / Aspects pseudo-chirurgicaux des syndromes hémolytiques et urémiques de l'enfant.

The hemolytic-uremic syndrome consists of hemolytic anemia, acute renal failure and thrombocytopenia. In childhood, some hemolytic-uremic syndrome can take the mask of a pseudo-surgical crisis mimicking intussusception or ulcerative colitis. Two cases are reported in children with abdominal pain, rectal bleeding, anomalies on the barium enema and in one case histologic features of ulcerative colitis. In the two cases, the biological disturbance of the hemolytic-uremic syndrome appeared with delay after the onset of the abdominal syndrome making the diagnosis difficult. Typical findings on the barium enema must evoke the hemolytic-uremic syndrome before renal failure: narrowing of the lumen of the colon, "thumbprinting", spasms and ulceration. But sometimes the diagnosis is more complicated because of the possibility of true surgical complications of hemolytic-uremic syndrome.

[Preoperative intravenous cholangiography and residual common bile duct calculi. 600 cases reviewed 2 to 15 years after operation]. / Cholangiographie intraveineuse pré-opératoire et calcul résiduel du cholédoque. 600 cas revus 2 à 15 ans après opération.

The authors have carried out as a routine since 1960 before operation a good intravenous cholangiography, i.e. showing up satisfactorily the bile ducts from the bifurcation of the common bile duct to the duodenum and have abandoned routine per-operative radiography. Satisfactory cholangiography was obtained in 96% of cases of simple cholecystitis and in 80% of complicated cases. 600 cases were questionned 2 to 15 years after operation (average 7 years). The 567 controllable cases were all questionned or seen again. The reliability of pre-operative cholangiography is excellent: no common bile duct declared normal on X-ray was found to contain a gall stone either during or after operation and the negative choledocotomies were only 0.17%. The operative simplification permitted us to reduce the operative mortality of simple cholecystectomy to 0.4%. The number of controlled residual calculi was 5.8%. With routine per-operative radiomanometry, the average level without control at the Lille Colloquium in 1968 was 7%. But with late control according to the estimation of the authors it should be about 10%.