[Tissue expansion in management of giant omphalocele parietal sequelae]. / Place de l'expansion cutanée dans le traitement des séquelles pariétales des omphalocèles géantes.

OBJECTIVE: According to major difficulty for the giant omphalocele management in the visceral reintegration and the parietal closure, many teams use currently conservative treatment by topical application. These techniques are suppliers of a covered eventration and a scar sequela requiring a complementary treatment. We report the place of the tissue expansion as complementary treatment. PATIENTS AND METHODS: Two patients with a giant omphalocele benefited from a protocol of cutaneous expansion for the correction of their abdominal scar±of their residual eventration. RESULTS: An eventration closure was possible thanks to this protocol. The skin expansion allowed the complete excision of the abdominal scar and the defect cover. An additional skin graft was necessary in the first case. CONCLUSION: The cutaneous expansion in the parietal sequela management of the giant omphaloceles seems to be an interesting alternative. This technique should be realized remotely and except any septic context.

[Factors influencing the duration of breast feeding. A study of 150 women]. / Facteurs influençant la durée de l'allaitement maternel chez 150 femmes.

BACKGROUND: The duration of breast feeding has not yet been thoroughly described in France. A prospective survey has been performed on 150 breast feeding mothers to determine its duration. The objective of this study was to analyse predicting factors of this duration. METHODS: A questionnaire including sociological, psychological and medical variables was completed by the mothers and fathers. After discharge, the mothers were contacted every month by a physician until the completion of weaning. RESULTS: The median duration was 10 weeks. By univariate analysis, several variables were associated with a longer duration: decision to breast feed before pregnancy (12 weeks vs 9 weeks; P < 0.01), multiparity (17 weeks vs 12 weeks, P < 0.05), high paternal social level (14 weeks vs 9 weeks, P < 0.001), high maternal education level (12 weeks vs 9 weeks; P < 0.05), mother's idea of "bad" milk (9 weeks vs 30 weeks; P < 10(-6), satisfied mothers (11 weeks vs 2 weeks; P < 0.001), motivation to breast feed (P < 0.05), baby and mother in the same room during the night (13 weeks vs 10 weeks; P < 0.05), and formula supplementation (6 weeks vs 13 weeks; P < 0.01). The mother's return to work was related to a decline in the breast feeding rate at 12 weeks, yet working women generally breast fed the most frequently before returning to work, and many women breast fed and worked concomitantly. A Cox multivariate analysis took into account six significant variables: "bad" milk (lower duration), mother who had been fed, mother satisfied with breast feeding, multiparity, high maternal education, closer proximity of baby to mother (longer duration). DISCUSSION: The duration in our study is longer than in other studies in France. Predictive factors are sociological, linked to maternal education, and psychological, with antecedent of mother breast feeding and decision before pregnancy. The role of the mother's occupation was not very important because working women are generally at a higher social level. The role of the father was analysed, as well as the role of professional workers, family and breast feeding women's associations. CONCLUSION: Factors of breast feeding duration can be somewhat modified, but it is necessary to respect the plans of both the mother and the father. However, early assistance in the hospital and after discharge can help parents realize their plans for prolonged breast feeding and helps obviating the cessation of 20% of mothers during the 1st month.

[Precocious puberty revealing Bourneville tuberous sclerosis]. / Puberté précoce centrale révélatrice d'une sclérose tubéreuse de Bourneville.

BACKGROUND: Benign tumors are seen in tuberous sclerosis. They are found in many organs, and the precocious puberty due to hypothalamic hamartoma and tuberous sclerosis has been reported. However, precocious puberty exceptionally reveals the tuberous sclerosis. CASE REPORT: A 2 month-old boy was admitted because of the fortuitous discovery of polycystic renal disease. Precocious puberty developed at 13 months with enlargement of the penis and testes, appearance of pubic hair, acne and deepening of the voice. Linear growth was recently accelerated and the bone maturation was advanced. Plasma testosterone was elevated (460 ng/100 ml) and LH-RH injection induced rapid rises in plasma LH (2.6 to 28 mUl/ml) and FSH (2 to 8 mUl/ml). Brain imaging techniques (CT scan and NMR) showed a hypothalamic hamartoma and periventricular calcified lesions. Examination with the Wood lamp identified two white leaf macules in the dorsal area. Administration of an analogue of LH-RH effectively reduced the manifestations of precocious puberty. CONCLUSION: Tuberous sclerosis is exceptionally revealed by precocious puberty. The association of polycystic disease and precocious puberty has never before been reported in tuberous sclerosis.

[Vertebral involvement and fetal alcohol syndrome]. / Atteintes vertébrales et syndrome d'alcoolisme foetal.

Vertebral abnormalities observed in 8 children with fetal alcohol syndrome are described and discussed. They include scoliosis (4 cases), neural tube defects (4 cases) and complex malformations of the cervical spine (2 cases). The latter probably constitute a different entity from that of the Klippel-Feil syndrome. It is probable that alcohol plays a direct role in the genesis of these abnormalities.