J. Guitard

Fetal ovarian cysts management and ovarian prognosis: a report of 82 cases.

BACKGROUND/PURPOSEnFetal ovarian cysts are frequently complicated by intracystic hemorrhage without associated clinical signs, which is often secondary to ovarian torsion leading to loss of the ovary. The aim of this study was to evaluate ovarian outcome and the place of prenatal management and surgery in the first few days of life in order to save the ovary.nnnMETHODSnBetween January 1987 and June 2006, 82 fetal ovarian cysts in 79 patients were managed and clinically and ultrasonographically followed up for several months (median, 11 months; range, 6 months to 10 years) in all of the cases where the ovary was not removed. The ultrasonographic results regarding the ovarian parenchyma were broken down into 3 categories: follicular ovary, homogeneous ovary, and undetected ovary.nnnRESULTSnTwenty-seven cysts remained simple throughout their evolution, and 55 were complicated by intracystic hemorrhage usually several weeks before birth. Overall, after disappearance of the cyst, a follicular ovary was detected in only 39% of the cases (32/82) and more often when the cyst was simple than when it presented an intracystic hemorrhage (85% vs 16.4%, chi(2), P < .0001).nnnCONCLUSIONSnA review of our series confirms the poor ovarian outcome linked to ultrasonographic signs of intracystic hemorrhage. Preventive action by puncture of simple cysts is still being studied. The presence of a bilateral cyst can, if pulmonary maturity has been reached, be an argument for inducement of premature birth with a view to performing conservative surgery. After birth, surgery in the first few days of life is only justified if the signs of intracystic hemorrhage appeared in the period very close to birth.

Contribution to the study of the tributaries and the termination of the external jugular vein

SummaryThe dissection of 100 external jugular veins in 50 cadavers was the object of this anatomic study. A certain number of notions concerning the afferent veins, the mode of termination and the valvular system of this vessel were defined. 1)Afferent veins. Along its pathway toward the deep venous system, the external jugular vein successively received: the transverse cervical vein in 88 cases (88%), usually opposite the intersection of the external jugular vein with the dorsal border of the sterno- cleidomastoid muscle; the suprascapular vein in 47 cases (47%); the anterior jugular vein in 46 cases (46%); the cervical vein or anastomosis with the latter in 13 cases (13%). 2)Mode of termination. Forty-three subjects presented a symmetric mechanism. 100 anastomoses can be classed into three types: in 60 cases (60%), the external jugular vein flowed into the jugulo-subclavian venous confluence; in 36 cases (36%), in to the subclavian vein at a distance from its junction with the internal jugular vein; in 4 cases (4%) in to the trunk of the internal jugular vein. 3)Study of the valves. There were studied in 25 subjects (50 external jugular veins). The valves were found in the ostial and paraostial position in 49 out of 50 veins.RésuméCette étude anatomique repose sur la dissection de 100 vv. jugulaires externes chez 50 cadavres. Elle a permis de préciser un certain nombre de notions concernant les veines afférentes, le mode de terminaison et le système valvulaire de ce vaisseau. 1)Veines afférentes. Le long de son trajet vers le sytème veineux profond, la v. jugulaire externe reçoit successivement: la v. cervicale transverse dans 88 cas (88 %), habituellement en regard du croisement de la v. jugulaire externe avec le bord dorsal du m. sterno-cléido-mastoïdien ; la v. supra-scapulaire dans 47 cas (47 %); la v. jugulaire antérieure dans 46 cas (46 %) ; la v. céphalique ou une anastomose avec celle-ci dans 13 cas (13 %). 2)Mode de terminaison. Quarante trois sujets présentent un dispositif symétrique. Les 100 abouchements peuvent être classés en trois types : dans 60 cas (60 %) la v. jugulaire externe se déverse dans le confluent veineux jugulo-subclavier ; dans 36 cas (36 %), dans la v. subclavière à distance de sa réunion avec la v. jugulaire interne ; dans 4 cas (4 %) dans le tronc de la v. jugulaire interne. 3)Etude des valvules. Recherchées chez 25 sujets (50 vv. jugulaires externes), les valvules ont été retrouvées dans 49 cas sur 50 en position ostiale ou paraostiale.

Neonatal repair of cleft lip: a decision-making protocol

PURPOSEnTreatment of clefts lip during the neonatal period remains a controversial subject. Those who are in favor of delayed closure argue a higher-risk general anesthesia when it was performed in neonatal period. The purpose of this study was to evaluate the complications and the feasibility of this surgery during the neonatal period.nnnMETHODSnThis was a retrospective study of 61 children with labial, labioalveolar, labio-alveolo-palatine, and labiopalatine clefts between May 2000 and November 2006. Each patients medical file and particularly his or her anesthesia file was used to record the principal demographic data, the results of the malformation workup, and preoperative complications.nnnRESULTSnSixty-one newborns, 20 girls and 41 boys, aged 7.5 +/- 6.7 days were operated on. The mean weight on the day of surgery was 3190 +/- 454 g. Fifty-four children had a malformation workup (abdominal ultrasonography, spinal bone workup, transfontanelle ultrasonography, and cardiac ultrasonography). Thirteen associated malformations (21%) were thereby detected. There were no surgical complications. The anesthesiologists did not have any real intubation problems. In 4 cases, however, intubation was only possible after several laryngoscopies and changing the type of intubation shaft. There were no major complications. However, one child did present a preoperative complication. It was an episode of desaturation with bradycardia that was quickly resolved without further consequences in a child with a ventricular septal defect and an auricular septal defect.nnnCONCLUSIONSnWe think that neonatal lip closure should continue to be performed. It is essential for the psychological status of the parents. We have not found any studies in the literature that reported an anesthesia risk that was greater in the neonatal period than at 3 months in patients without risk of complications.

The vascular system of the upper eyelid. Anatomical study and clinical interest

Thorough knowledge of the vascular supply is indispensable for repair and oncologic surgery of the eyelids, and has a significant impact on the management of complex defects of this region. This anatomic study was performed with five fresh cadavers after arterial injection of coloured neoprene latex. The distribution of the vascular system of the upper eyelid was examined after dissection and photographic study. It is made up of three arcades: the preseptal arcade, the supratarsal arcade, and the marginal arcade, under the orbicularis oculi muscle. These arcades are supplied by branches of the ophthalmic artery (supraorbital artery, supratrochlear artery and medial palpebral artery) and branches of the facial artery and temporal artery. Small vertical branches arising out of these arcades provide an anastomotic network. This anatomical study aimed to describe the vascular system of the upper eyelid in order to search for constant features and to map the blood supply of the principal upper lid flaps.

CL070 - Traumatismes hépatiques sévères de l’enfant : quelle présentation, quelle prise en charge ?

Objectif Analyser la presentation, la prise en charge et l’evolution des traumatismes hepatiques fermes de haut grade. Materiel et Methode Les donnees retrospectives unicentriques de 11 patients admis de janvier 1999 a decembre 2009 pour traumatisme hepatique ferme de grade III a V selon Schweitzer sont reprises. Resultats L’âge moyen etait de 8,8 ans. Le mecanisme etait un accident de la voie publique ( n = 5), un accident de sport ( n = 4), ou une defenestration ( n = 2). Le traumatisme relevait d’un stade III dans 3 cas, IV dans 5 cas, V dans 3 cas. Une laparotomie d’hemostase a ete realisee chez 6 patients pour packing et/ou suture vasculaire. On deplore 3 deces post-operatoires precoces sur decompensation hemorragique. Dans 5 cas une complication biliaire a necessite un drainage peritoneal et une derivation par cholecystostomie. Les complications vasculaires associaient 2 pseudo-anevrysmes arteriels, traites par embolisation selective, une thrombose sus-hepatico-cave, traitee par anti coagulation, une thrombose portale gauche segmentaire respectee. La duree d’hospitalisation moyenne des patients etait de 56 jours (17- 104). Conclusion Les rares traumatismes fermes severes de l’enfant demeurent une urgence vitale dont la prise en charge doit repondre aux multiples complications evolutives.

Artère pulmonaire gauche rétro trachéale: mise au point embryologique et anatomique à propos d’un cas

But de l’étude.— Décrire les anomalies de développement des arcs vasculaires et illustrer les différentes malformations qui en résultent par l’imagerie en coupes. Matériel et méthodes.— Travail rétrospectif à partir de sept cas pédiatriques pour lesquels l’exploration tridimensionnelle des anomalies vasculaires par scanner multi détecteurs a permis d’établir un diagnostic anatomique. Résultat.— La radiographie thoracique et le transit œso-gastro-duodénal permettent de suspecter une anomalie vasculaire compressive chez un enfant présentant une symptomatologie respiratoire persistante ou un stridor congénital. L’imagerie en coupes fait le diagnostic anatomique de la malformation, objective la compression des organes de voisinage et guide le traitement chirurgical. Après avoir rappelé l’embryogenèse des arcs vasculaires, nous nous attacherons à corréler les anomalies de développement aux aspects tomodensitométriques grâce aux reconstructions mutiplanaires et volumiques. Ainsi nous présenterons les aspects tomodensitmétriques, non seulement des principales anomalies du 4e arc, y compris les anomalies de longueur et de continuité de la crosse, mais aussi celles plus rares du 6e arc, que sont l’artère pulmonaire gauche rétro trachéale et l’aplasie d’une artère pulmonaire. Conclusion.— Grâce à sa résolution spatiale inframillimétrique, le scanner multi détecteurs tend à supplanter l’angiographie dans le bilan des malformations des gros vaisseaux. Elle permet aux radiologues et aux chirurgiens d’avoir accès, de manière non invasive, à une imagerie tridimensionnelle.