[Azygo-portal disconnection using the thoracic approach in children]. / Déconnexion azygo-portale par voie thoracique chez l'enfant.

Porto-azygos disconnection is one of the therapeutic choice of portal hypertension. This technique have been used in a 13 year old boy with bleeding oesophageal varices during the evolution of a cirrhosis caused by active hepatitis. Disconnection was done in emergency using a total ligature of the oesophagus by left thoracotomy upon a clip introduced by oral way. By this technique, the abdomen and the digestive tract keep untouched. One year after the operation no oesophageal varices can be seen at endoscopy and a slight oesophageal stenosis have been easily treated by dilatations.

[Sigmoid volvulus in children. About 6 cases (author's transl)]. / Volvulus du sigmoïde chez l'enfant. A propos de 6 observations.

About six of sigmoid volvulus m children, the authors underline the rarity of this etiology in large bowel obstruction. Two cases happened during neonate and four cases are associated with other pathologic diseases (2 neurologic ans 2 Hirschsprung diseases). Diagnosis is based on baryum enema and the best surgical management in emergency is resection and derivation with secondary anastomosis.

Rectoanal pressures and rectal sensitivity studies in chronic childhood constipation.

Rectoanal pressures and rectal sensitivity studies were performed in 32 control children and 144 chronically constipated children. The rectoanal inhibitory reflex threshold, the maximal anal resting closure pressure, and the conscious rectal sensitivity threshold were studied in these children. The rectoanal inhibitory reflex threshold was increased in 6.2% of the constipated patients. Anal hypertony (increased maximal anal resting pressure) was found in 46% of the constipated children. Decreased rectal sensitivity (increased conscious sensitivity threshold) was found in 68% of the constipated children. The three parameters were found to be normal in only 13% of the constipated subjects. Thus, it appears that children with chronic constipation who do not have Hirschsprung's disease do have abnormalities at manometry in most cases.

Surgical treatment of high imperforate anus with definition of the puborectalis sling by an anterior perineal approach.

An operative technique in which the sling of the puborectalis muscle is seen through an anterior perineal approach in the treatment of high imperforate anus is described. The operation has been performed, on children with previous colostomies, and on older children with unsuccessful previous abdomino-perineal pull-through procedures. While our series of patients is still small, 24 children, operated upon sufficiently long ago for follow-up purposes, have generally shown good to excellent functional results.

[The lungs in congenital diaphragmatic hernias (author's transl)]. / Les poumons dans les hernies congénitales des coupoles diaphragmatiques.

In congenital diaphragmatic hernias, the presence of abdominal viscera in the thoracic cavity will arrest the development of the ipsilateral lung, and occasionally of the controlateral lung also. The lung may thus be either compressed or hypoplastic in varying degrees. Its state of development conditions the prognosis of this disease. In severe forms, known as "High Risk" forms, presenting in the 3 first days of life with respiratory distress, the lung is very often hypoplastic, the number of bronchial, bronichiolar and vascular generations is diminished. The airways pulmonary function in medium and long term has been studied in 10 children over a period of 3 to 15 years. The clinical radiological, scannery and fonctional lung study results present not unfrequently signs of overdistention, of obstructive disease, and pulmonary bronchectasis on the side of the hernia. The evolution could be explained by the normal post natal multiplication of airways as well as by an increase of their size in such a manner as to occupy the whole thoracic cavity.