Approximately 1% of the fetuses present some dilatation of their urinary tract in utero. More than 50% of these antenatally detected hydronephrosis will disappear spontaneously after birth. The other 50% comprises ureteropelvic junction obstruction, vesico-ureteral reflux and primary megaureters. Postnatal radiological evaluation (renal ultrasonography and VCUG) is performed in every infant with a significantly dilated renal pelvis (> 8 mm between 20 and 30 weeks or > 10 mm after 30 weeks in utero). Renal nuclear scan should be done in every child with significant/worsening post-natal hydronephrosis. Antibioprophylaxis will be started from birth to prevent urinary tract infection. Medical or surgical approach will be chosen in the light of the uroradiological exam results and the clinical progress.

Approximately 1% of the fetuses present some dilatation of their urinary tract in utero. More than 50% of these antenatally detected hydronephrosis will disappear spontaneously after birth. The other 50% comprises ureteropelvic junction obstruction, vesico-ureteral reflux and primary megaureters. Postnatal radiological evaluation (renal ultrasonography and VCUG) is performed in every infant with a significantly dilated renal pelvis (> 8 mm between 20 and 30 weeks or > 10 mm after 30 weeks in utero). Renal nuclear scan should be done in every child with significant/worsening post-natal hydronephrosis. Antibioprophylaxis will be started from birth to prevent urinary tract infection. Medical or surgical approach will be chosen in the light of the uroradiological exam results and the clinical progress.

A 9-month-old girl presented with life-threatening acute respiratory failure 1 week after the surgical correction of a double aortic arch, which was due to a severe bulging of the pars membranacea into the lumen of the trachea that produced a complete obstruction of the lower trachea. Under cardiopulmonary bypass, a Y-shaped posterior biodegradable splint was placed behind the trachea and sutured to the posterior trachea, and a simultaneous right aortic arch aortopexy was performed. Thereafter, the child recovered normal respiratory function. Follow-up bronchoscopy showed a posterior dip at the splint level and an asymptomatic persistent posterior compression of the right main bronchus.

Editor: The use of expandable Gianturco Z stents for the treatment of tracheobronchial benign or malignant obstruction has gained popularity during the past decade. However, stent disruption and migration have been described, provoking life-threatening hemoptysis or even death. Gathering experience on the long-term tolerance of Gianturco Z stents is of the utmost importance for therapeutic decision-making when planning the implantation of an expandable stent in an airway. We therefore report on an 11-year prospective analysis of the tolerance and damage observed with two Gianturco Z stents placed in the trachea and left main bronchus in a 6-month-old child. A 6-month-old child was treated for a transposition of the great vessels by a switch operation and a Lecompte maneuver. Severe compression of the lower trachea and left main bronchus by the nearby vessels led to a progressive respiratory insufficiency and numerous life-threatening episodes secondary to hypercarbia. All medical and surgical attempts to relieve the tracheal and bronchial vascular compressions failed. Two Gianturco Z stents 15 mm wide and 25 mm long (William Cook Europe, Bjaeverskov, Denmark) were placed in the airways as a last resort, one in the lower trachea and the other in the left main bronchus, with immediate relief of the respiratory symptoms (1Bugmann P Rouge JC Berner M Friedli B Le Coultre C Use of Gianturco Z stents in the treatment of vascular compression of the tracheobronchial tree in childhood: a feasible solution when surgery fails.Chest. 1994; 106: 1580-1582Crossref PubMed Scopus (23) Google Scholar). We prospectively studied the behavior of the two prostheses with chest radiography. After a progressive increase in stent diameter during the first 3 years, the stents were not fully expanded. However, the diameter of the lumen at the level of the tracheal stent was clearly larger than the airway diameter above the stent, indicating some overexpansion produced by the stent radial forces. The first strut's rupture occurred in the posterior aspect of the tracheal stent during the 4th year after implantation (Figure, part b). This rupture was found incidentally on the planned control chest radiograph. There was no dyspnea nor dysphagia. Computed tomography showed that the posterior free wire tip of the “opened” stent had migrated through the pars membranacea, passed near the esophagus, and reached the anterior part of the second thoracic vertebra. The second rupture occurred 1 year later, two struts away from the initial rupture, within the tracheal wall (Fig, part c). This event was also clinically undetectable. At 6 years, the Gianturco Z stent at the left main bronchus broke at its distal inferior part. However, the stent did not widen dramatically, nor did it migrate outside the bronchus (Fig, part g). In the last strut's rupture, which occurred on the tracheal stent at 10-year follow-up, the posterior part that was stuck in the vertebra broke in two, leaving a single free strut posterior to the trachea (Fig, part d). All ruptures took place at the bent extremities of the struts. We also noticed the progressive appearance of steel fragments near the anchoring welding of the barbs on the left main bronchus stent at 4 years (Fig, part f). After 10 years, the four barbs of the bronchial stent were pulled out of their bases, leaving a path of small steel fragments near the anchoring sites of the barbs (Fig, part h). The child has never experienced hemoptysis. He is now symptom-free and without any physical restriction. We suspect that cyclical radial constraints ultimately lead to fatigue and strut fracture. Hramiec et al (2Hramiec JE Haasler GB Tracheal wire stent complications in malacia: implications of position and design.Ann Thorac Surg. 1997; 63: 209-212Abstract Full Text Full Text PDF PubMed Scopus (80) Google Scholar) reported the rupture of all three tracheal Gianturco stents in their series within 6 months after implantation, requiring removal of the stents. The first rupture in our case occurred much later, suggesting that the constraints during childhood might be smaller than those encountered in adults. The bronchial stent also broke, but after twice the time necessary to produce the first tracheal stent fracture. Therefore, the bronchial radial forces might indeed be less than those at the tracheal level (2Hramiec JE Haasler GB Tracheal wire stent complications in malacia: implications of position and design.Ann Thorac Surg. 1997; 63: 209-212Abstract Full Text Full Text PDF PubMed Scopus (80) Google Scholar). Interestingly, the bronchial stent did not migrate outside the bronchus, possibly because the struts were contained by the bronchial cartilage rings. Regarding the secondary ruptures seen on the tracheal stent, we hypothesize that the portion of the stent that migrated posterior through the tracheal wall after the first fracture was still subjected to bending stresses because the tip of the strut was stuck in the vertebral bone. The fact that the third rupture occurred in an isolated portion of the stent located between the trachea and spine indicates that relative movements exist between the trachea and spine. It is also noteworthy that all the fractures occurred very near or at the hairpin curve of the stent, confirming the observations made by Hramiec et al (2Hramiec JE Haasler GB Tracheal wire stent complications in malacia: implications of position and design.Ann Thorac Surg. 1997; 63: 209-212Abstract Full Text Full Text PDF PubMed Scopus (80) Google Scholar). The progressive disruption of the anchoring bases of the stent's barbs, especially on the bronchial stent, was unexpected. It must be assumed that the barb bases undergo considerable forces or that the welding of the barbs is insufficient. The rupture of all barbs of the bronchial stent has allowed a slight longitudinal displacement of the stent with time and growth of the child, demonstrated by the gap between the broken barbs' bases and their respective points of fixation on the stent. The implantation of two Gianturco Z stents saved the life of this child. The stents allowed full restitution of airway patency with normal mucociliary transport, offering an excellent clinical result at 11-year follow-up. However, the complications encountered over time raise considerable concern, mainly because of the potential life-threatening dangers associated with strut rupture. We recommend cautious use of this type of prosthesis, particularly in the tracheal location.

Owing to the frequent occurrence of minor head injuries in their daily practice, pediatricians and primary care physicians have a constant concern about their management. Evaluation of a neurotraumatised children must take account of the epidemiological, anatomical, pathophysiological and clinical specificity of each age class. Recent publications of the American Academy of Pediatric, with evidence based medicine review of the literature and experts consensus have permitted to define precise guidelines for the management of children over and below 2 years of age. Taking account in the initial evaluation of the indirect signs of severity and pediatric mechanisms criteria allows to better define the principles of triage.

The authors report the case of a child who had severe bronchial synechia of the left main bronchus after removal of a pistachio shell embedded in granulation tissue. Histology finding of the removed granulation tissue at initial bronchoscopy showed an Actinomyces bacterial invasion. It was decided not to treat this local contamination and to perform a control bronchoscopy to verify the disappearance of local bacterial invasion. The control bonchoscopy performed 4 weeks after the foreign body (FB) removal disclosed a large central left main bronchus synechia producing a 70% reduction of the lumen, although the child had become asymptomatic except for a slight residual cough. The resection of the synechia restored a normal bronchial lumen. The performance of a systematic control bronchoscopy after removal of long standing FB is discussed and recommended.

Although benign, hepatic haemangioendotheliomas (HHE) are rare vascular tumours of the infant which have a high mortality rate secondary to high output congestive heart failure. The management of these tumours is still controversial and none of the different medical or surgical options has been unanimously accepted. We report the case of a neonate with congestive heart failure (CHF) due to a localized HHE, treated successfully by selective ligation of the left hepatic artery branch irrigating the tumour, under perioperative ultrasound Doppler control. A review of the literature showed 35 cases of HHE treated by hepatic artery ligation (HAL) with a survival rate of 80%.

Owing to the frequent occurrence of minor head injuries in their daily practice, pediatricians and primary care physicians have a constant concern about their management. Evaluation of a neurotraumatised children must take account of the epidemiological, anatomical, pathophysiological and clinical specificity of each age class. Recent publications of the American Academy of Pediatric, with evidence based medicine review of the literature and experts consensus have permitted to define precise guidelines for the management of children over and below 2 years of age. Taking account in the initial evaluation of the indirect signs of severity and pediatric mechanisms criteria allows to better define the principles of triage.

We present a case of volvulus without malrotation in a twin fetus where serial antenatal US assisted in the diagnosis and ensured prompt postnatal surgical treatment. When a fetal subumbilical intestinal mass is seen, changing its echogenicity from complex to cystic, and associated with progressive proximal small-bowel obstruction and/or bowel perforation, small-bowel volvulus should be included in the differential diagnosis.

Objective: To create an endocervical canal in a patient with a complete cervical agenesis.Design: Case report.Setting: University hospital.Patient(s): A 12-year-old girl presented with lower abdominal pain. On examination, complete vaginal agenesis was noted, with a 2-cm vaginal dimple. A pelvic magnetic resonance imaging scan disclosed an hematometra and absence of the cervix and vagina.Intervention(s): Initial surgical therapy consisted of a vaginoplasty with a sigmoid bowel segment and opening of the uterus by puncture and stenting. The cervical permeation failed, with immediate complete stenosis. A new attempt was made through a low sagittal hysterotomy by removing a central muscular cylinder and lining the channel with a free tubularized bladder mucosa graft. A stent was left in place.Main Outcome Measure(s): Hysteroscopy, hysterography, and clinical follow-up evaluation.Result(s): The cervical stent was removed after 5 months. A hysterography and hysteroscopy confirmed the permeability of the cervix, which was lined by a well-vascularized longitudinally folded mucosa. Regular menses had been noted for more than 3 years as of this report.Conclusion(s): Cervicoplasty with mucosal lining permits the creation of a patent cervical canal, even in the reputedly unfavorable forms of congenital cervical agenesis. (C) 2002 by American Society for Reproductive Medicine.

We present a 7-month-old boy with a giant abdominoscrotal hydrocoele associated with right leg oedema. US revealed an abdominoscrotal fluid-filled mass with a normal testis in the scrotum. MRI allowed precise delineation of the mass while MRA sequences showed extrinsic compression of the right iliac vein and its patency. Hydrocoelectomy and laparotomy were performed and confirmed the diagnosis. US followed by MRI are often necessary to diagnose and delineate giant hydrocoeles. MRA is a non-invasive elegant tool for the detection of vascular complications.

Apres transplantation hepatique chez l'enfant on peut actuellement esperer une survie de 90%. Les indications a la transplantation sont l'atresie des voies biliaires, les maladies metaboliques, l'hepatite fulminante et d'autres pathologies plus rares. Les besoins de transplantation hepatique chez l'enfant en Suisse sont de cinq a huit par an. Pour pallier le manque d'organes, les equipes chirurgicales ont du utiliser des techniques comme la reduction du foie, la bipartition ou le recours aux donneurs vivants apparentes. Geneve a un programme combine adultes-enfants et est le seul centre de reference en Suisse pour les enfants. De juillet 1989 a juillet 2001, quarante-huit transplantations ont ete realisees chez quarante-quatre enfants (quatre retransplantations). Les complications techniques (thromboses vasculaires, problemes biliaires et ascite) ont ete pratiquement eliminees par des ameliorations et des Innovations techniques, comme le monitoring vasculaire en cours d'Intervention et les techniques microchirurgicales. La survie actuarielle de notre serie est de 91%. Le programme a permis plusieurs projets de recherche, comme l'etude de la fonction glomerulaire et tubulaire, de la nutrition et la croissance, le monitoring de l'osteoporose.

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.