Philippe Petit

Severity scores in children with acute pancreatitis.

ABSTRACT Severity scores are used to predict the outcome of acute pancreatitis (AP). Several scores are used in adult patients, but none has been thoroughly validated for specific use in paediatric patients. We retrospectively collected data from 48 children with AP (13 severe and 35 mild). The main causes were trauma (23%), idiopathic (23%), lithiasis (12.5%), and virus (10.5%). We evaluated 3 clinical scores (Ranson, Glasgow modified, and DeBanto) and Balthazar computed tomography severity index. The clinical scores had a good specificity (approximately 85%) but a low sensitivity (approximately 55%) in predicting the severity of paediatric AP. The radiological score is better (sensitivity 80%, specificity 86%). The area under the receiver operator characteristic curve was 0.699 (95% CI 0.508%–0.891%, P = 0.054) for the DeBanto score, 0.846 (95% CI 0.69%–1%, P = 0.001) for the Ranson score, and 0.774 (95% CI 0.584%–0.964%, P = 0.008) for the Glasgow and 0.898 (95% CI 0.73%–1%, P = 0.011) for the Balthazar computed tomography severity index score. In our paediatric cohort, the severity of AP was best predicted by Balthazar computed tomography–based scoring scale. Our results confirm previously reported low sensitivity of adult-based clinical scoring scales.

Treatment of venous malformations: First experience with a new sclerosing agent – A multicenter study

PURPOSE To study the efficacy and safety of a new sclerosing gel of absolute ethanol in the percutaneous treatment of venous malformations (VM). MATERIALS AND METHODS In this prospective, non-randomized multicenter study patients with clinically and by magnetic resonance imaging diagnosed VM were treated. Efficacy and safety of the gel was evaluated. Therapeutic outcome was judged at day 56 after the last sclerosing therapy. Blood ethanol levels of ethanol were measured after each infusion. Local and systemic adverse events were recorded. RESULTS Seventy-five (75) patients (age 4-46 y, mean 26 y) were treated in 172 sessions. Compared to no treatment, ethanol gel showed a complete cure rate of about 15% per session (p<0.00001). At the end of the last session, therapeutic outcome was complete (score 2) and partial (score 1) in 28 (37%) and 42 patients (56%), respectively, whereas treatment failure (score 0) was observed in 5 patients (7%). The plasmatic ethanol levels were very low (mean±SEM 0.03±0.06 g L(-1)), with only one patient above the legal 0.5 g L(-1) intoxication limit (0.6 g L(-1)). Forty-six (46) product-related adverse events (all local, none systemic) were reported. They included temporary mild isolated pain (N=21), inflammatory reactions (N=4), and local complications (7 skin necroses, 7 compressive neuropathies, 4 product leakage/fistula, 2 intralesional fibrous or granulomatous tissue, 1 dense node; 12.2% of the infusions). All local complications resolved spontaneously, except for 2 skin necroses requesting surgical paring. CONCLUSION Ethanol gel is an embosclerosing substance that provides high efficiency and improves safety of ethanol in the treatment of VM lesions.

SFCP-041 – Chirurgie plastique – Prise en charge des malformations artério-veineuses chez l’enfant

Objectifs Les malformations arterio-veineuses sont rares chez l’enfant et posent des problemes de strategie therapeutique. Le but de ce travail est de tenter de preciser, en fonction de la classification de Schobinger, la prise en charge therapeutique de ces malformations vasculaires. Materiels Nous rapportons les cas de deux enfants âges de 5 ans et de 6 ans presentant respectivement une lesion perineale et une lesion temporo occipitale. Le bilan initial a repose sur la realisation d’un echo-doppler et d’une angio-IRM. Resultats Dans les deux cas la chirurgie a ete precedee d’une embolisation selective. Le recul est de un an sans recidive. Conclusion Nous pensons que l’embolisation la plus selective possible suivie dans un delai de quelques heures d’une chirurgie la plus complete reste la meilleure attitude. Le geste chirurgical doit permettre une eradication complete de la lesion afin d’esperer une guerison. La chirurgie doit etre reservee aux formes evolutives ou source de complications. Mais une exerese meme complete ne met pas a l’abri d’une recidive.

Prise en charge d’une malformation artérioveineuse périnéale chez un enfant de 5 ans

Arteriovenous malformations are seldom in children but raise important therapeutic problems. Apart from intracranial arteriovenous malformations, few observations have been described in the literature. We report the case of a superficial perineal arteriovenous malformation in a 5-year-old child. Tailored embolization followed shortly by thorough surgery is the best attitude. Surgery must totally eradicate the lesion to allow hope for a cure. Surgery should be reserved for forms that are extensive or a source of complications. Even total resection does not ensure non-recurrence.