C. Le Coultre

A silicone-coated nylon dressing reduces healing time in burned paediatric patients in comparison with standard sulfadiazine treatment: a prospective randomized trial

Mepitel is a new grid like silicone coated nylon dressing containing no additional biological compounds. We describe a prospective randomized pilot study comparing Mepitel to the standard silver sulfadiazine cream (Flamazine) dressing for the topical treatment of paediatric burns. Seventy-six children presenting within 24 h of injury with a non previously treated burn were randomly assigned to Mepitel treatment (group M) or Flamazine treatment (group F). Age, sex, surface area of burn and causal agent were noted at admission. The depth of the burn, cumulative number of dressings, presence or absence of a complete epithelial cover, infection, bleeding and allergy were noted at each dressing change. There were 41 children in group M and 35 children in group F. Five children were subsequently withdrawn from each group because they required skin grafting. Analysis of the above mentioned criteria showed no statistical difference between the two groups except for the healing time (group M: 7.58+/-3.12, group F: 11.26+/-6.02, p < 0.01) and the number of dressings (group M: 3.64+/-1.5, group F: 5.13+/-2.9, p < 0.05). Mepitel has proved to be an easy-to-remove dressing, adhering only to intact skin. The faster healing time found in the Mepitel group may be related to a direct effect of silicone on epithelial growth or to a decrease in surface-cell damage compared to the silver sulfadiazine group. This attractive product will be further assessed on a larger scale trial to confirm our observations.

Reliability of color Doppler and power Doppler sonography in the evaluation of intussuscepted bowel viability.

Abstract In two similar cases of irreducible intussusception with wall necrosis and perforation, symptoms had begun 24 h before admission and the plain radiographs showed signs of small-bowel obstruction. The sonographic (US) appearances, however, were different: color Doppler (CD) US showed vascular flow in the intussuscepted bowel in one case and no flow in the other. After radio-clinical assessment, both children underwent surgery and an intestinal resection had to be performed, manual reduction being impossible. The reliability of the US findings and the prognostic value of CD and power Doppler US in determining the viability of the intussuscepted bowel are discussed with a review of the literature.

Thoracoscopic sympathectomy using ultrasonic coagulating shears: a technical improvement in the treatment of palmar hyperhidrosis

Abstract.Thoracoscopic sympathectomy has emerged in recent years as the treatment of choice for primary palmar hyperhidrosis when medical treatment fails. Postoperative complications have been reported in large series, however, including neurologic problems such as temporary or definitive Horner syndrome and peripheral nerve injuries. The authors report the use of ultrasonic coagulating scissors instead of electrocautery for the dissection and removal of a segment of sympathetic chain in an 11-year-old girl. A bilateral procedure was performed sequentially through three 5-mm axillary trocars on each side. The use of ultrasonic shears eliminates the risk of distal nerve injury induced by the spread of electric current and could possibly reduce the incidence of the above-mentioned complications.

An unusual association of small bowel atresia and biliary atresia: A case report

The embryological development of the hepatobiliary bud presupposes that biliary and duodenal malformations are often associated. On the other hand, the association of biliary atresia with more distal small bowel malformations, possibly due to a vascular accident, seems to be fortuitous. We herewith report such a case and, on reviewing the literature, have found only two previous similar observations.

Biliary Atresia and Orthotopic Liver Transplantation - 11 Years of Experience in Geneva

Biliary atresia (BA) is a congenital malformation or an evolutive inflammatory process which, without treatment, leads to cirrhosis, hepatic failure and death within two years of birth. The literature gives a survival rate of 60% at five years and 25% to adulthood after an initial operation performed for BA. 30% of children do not survive beyond two years of age. BA has become the most frequent indication for liver transplantation (LT) in children. With LT, survival expectancy is 90%. Results of the operation designed for BA remain unsatisfactory, and seem to depend on the age of the infants, as well as on other factors such as liver histology, and centre experience. Since 1989, onset of the paediatric hepatic transplantation program in Geneva, to July 2000, 20 children have been referred for initial treatment of BA, and 26 for possible hepatic transplantation after initial treatment done in another centre. The aim of the current study is to analyse our own results of the initial operation and to present the results of liver transplantation in this particular group of patients. All the patients with a BA are included in this study. The initial operation for BA yielded 43% favourable outcome at five years and the survival in this group following LT reached 91.3% survival. The importance of the age of the patient at time of initial operation is underlined.

Multiloculated epidermoid cyst of the liver.

Epidermoid cysts of the liver are extremely rare and have been described in both children and adults. Their etiology remains an enigma, and several theories have been suggested as to their origin. Due to their possible malignant potential, early detection and resection are mandatory whether the cysts are unilocular or multilocular.