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Pean N.,University Paris - Sud | Pean N.,University Paris Diderot | Doignon I.,University Paris - Sud | Garcin I.,University Paris - Sud | And 12 more authors.
Hepatology | Year: 2013

Many regulatory pathways are involved in liver regeneration after partial hepatectomy (PH) to initiate growth, protect liver cells, and sustain functions of the remnant liver. Bile acids (BAs), whose levels rise in the blood early after PH, stimulate both hepatocyte proliferation and protection, in part through their binding to the nuclear farnesoid X receptor (FXR). However, the effect of the BA receptor, TGR5 (G-protein-coupled BA receptor 1) after PH remains to be studied. Liver histology, hepatocyte proliferation, BA concentrations (plasma, bile, liver, urine, and feces), bile flow and composition, and cytokine production were studied in wild-type (WT) and TGR5 KO (knockout) mice before and after PH. BA composition (plasma, bile, liver, urine, and feces) was more hydrophobic in TGR5 KO than in WT mice. After PH, severe hepatocyte necrosis, prolonged cholestasis, exacerbated inflammatory response, and delayed regeneration were observed in TGR5 KO mice. Although hepatocyte adaptive response to post-PH BA overload was similar in WT and TGR5 KO mice, kidney and biliary adaptive responses were strongly impaired in TGR5 KO mice. Cholestyramine treatment, as well as Kupffer cell depletion, significantly improved the post-PH TGR5 KO mice phenotype. After bile duct ligation or upon a cholic acid-enriched diet, TGR5 KO mice exhibited more severe liver injury than WT as well as impaired BA elimination in urine. Conclusion: TGR5 is crucial for liver protection against BA overload after PH, primarily through the control of bile hydrophobicity and cytokine secretion. In the absence of TGR5, intrahepatic stasis of abnormally hydrophobic bile and excessive inflammation, in association with impaired bile flow adaptation and deficient urinary BA efflux, lead to BA overload-induced liver injury and delayed regeneration. © 2013 by the American Association for the Study of Liver Diseases.


Gicquel-Schlemmer B.,Service dorthopedie traumatologie | Beller J.-P.,Service danesthesie | Mchalwat A.,Service danesthesie | Gicquel P.,Service de chirurgie pediatrique
Orthopaedics and Traumatology: Surgery and Research | Year: 2015

The authors report a case of a shoulder arthroscopy in which epinephrine saline irrigation was held responsible for acute hypertension followed by fatal Takotsubo cardiomyopathy. © 2015 Elsevier Masson SAS.


Haie-Meder C.,Institute Of Cancerologie Gustave Roussy | Mazeron R.,Institute Of Cancerologie Gustave Roussy | Martelli H.,Service de chirurgie pediatrique | Oberlin O.,Institute Of Cancerologie Gustave Roussy
Cancer/Radiotherapie | Year: 2013

Brachytherapy in paediatric malignancies is rarely used, limited to expert institutions. The most frequent tumour sites treated with brachytherapy are gynaecological rhabdomyosarcomas, and prostate/bladder rhabdomyosarcomas. Ballistic advantages make brachytherapy technique the treatment of choice, with a high and selective protection of organs at risk. Techniques, brachytherapy modalities (low dose-rate, high dose-rate, pulsed dose-rate), doses and indications vary according to centres. Brachytherapy advantages are in relation with ballistic properties, allowing a very high dose to the target with normal tissue sparing. This review analyzes brachytherapy techniques, indications and results according to the two most frequent tumour sites: gynaecological and bladder/prostate tumours. This technique requires a muldisciplinary approach. © 2013.


Lardellier-Reynaud F.,Service de chirurgie pediatrique | Varlet F.,Service de chirurgie pediatrique | Francois M.,Service de chirurgie urologique et viscerale pediatrique | Mouriquand P.,Service de chirurgie urologique et viscerale pediatrique
Progres en Urologie | Year: 2011

Purpose: Congenital buried penis in children is an uncommon and poorly known entity. The aims of this study were to report an original technique for correction of buried penis and to evaluate its results. Patients and methods: It is a retrospective study of buried penis operated between November 1998 and May 2009. The acquired concealed penis and hypospadias were excluded from this study. The procedure includes several stages: degloving of the penis through a ventral anchor-like incision; division of the adherent layers surrounding the corpora cavernosa; anchorage of the Buck's fascia to the corporeal albuginea at the base of the penis; and ventral cutaneous coverage. The long-term results were evaluated by the parents and the surgeon according to anatomical, functional and aesthetic criterion. Results: Twenty-five boys were evaluated. The mean age at surgery was 27 months (seven days-120 months). Two children required an additional plasty. Results were satisfactory in 24 cases (96%). One child required a redo procedure for unsatisfactory outcome. Of seven children with redundant skin (28%), three underwent a complementary cutaneous excision. Conclusion: Congenital buried penis remains a controversial issue. Our technique was simple and easily reproducible. Voiding difficulties, urinary tract infection or strong parental request were the main indications of this surgery in our experience. © 2011 Elsevier Masson SAS.


Dobremez E.,Service de chirurgie pediatrique | Harper L.,Service de chirurgie pediatrique
Andrologie | Year: 2010

Most of cryptorchidisms are due to failure in testicular descent during fetal life, but secondary forms of cryptorchidism exist. They are represented by cryptorchidism associated to general disease, ascended testis, retractile testis and iatrogenic forms. It is important to know and diagnose these forms, because histological lesions are present in any testis which stayed out of scrotum for a prolonged period. © 2010 Springer.


Lucas G.,Service de chirurgie pediatrique | Accadbled F.,Service de chirurgie pediatrique | Violas P.,Service de chirurgie pediatrique | Sales de Gauzy J.,Service de chirurgie pediatrique | Knorr J.,Service de chirurgie pediatrique
Orthopaedics and Traumatology: Surgery and Research | Year: 2015

Background: The management of isolated meniscal tears in paediatric patients is poorly standardised, and few published data are available. Nevertheless, there is widespread agreement that meniscectomy, even when partial, produces poor outcomes including the premature development of osteoarthritis. Hypothesis: Arthroscopic repair of isolated meniscal tears in paediatric patients yields good outcomes and should be attempted routinely. Materials and methods: We retrospectively assessed 19 arthroscopic repair procedures performed between 2006 and 2010 by a single surgeon in 17 patients with a mean age of 14 years. In every case, the knee was stable and the meniscus normal before the meniscal tear, which was the only injury. Mean follow-up was 22 months. In all 19 cases, the evaluation included a physical examination, pre-operative magnetic resonance imaging (MRI), and determination of the Tegner and Lysholm scores. Post-operative MRI was performed in 10 cases. Results: The outcome was good in 12/17 (70%) patients with significant improvements in the mean Tegner score, from 3.9 to 7.1, and mean Lysholm score, from 55.9 to 85.4, between the pre-operative and post-operative assessments. The clinical outcomes were not significantly associated with time to arthroscopic repair, gender, lesion site, or lesion type. Neither was any correlation demonstrated between clinical outcomes and meniscal healing as assessed by MRI. Discussion: The known poor outcomes after meniscectomy in paediatric patients, the results of our study, and previously published data support routine arthroscopic repair of isolated meniscal tears in this age group, regardless of the site and type of injury. In addition, in asymptomatic patients, clinical follow-up is sufficient and post-operative MRI unnecessary. Level of evidence: Level IV. Retrospective study. © 2015 Elsevier Masson SAS.


Children presenting with acute abdominal pains at emergency rooms are frequent, but few of them require a pediatric surgeon. However it can be dangerous for the patient (and for the physician = major cause of prosecutions) to misdiagnose those cases. Children with «classic» gastroenteritis may prove to have a perforated appendicitis, while those with tender abdomens may suffer pneumonia or streptococcal pharyngitis, and a comatous child may have an intussusception and not a metabolic disease. We review the diagnostic and management of some common causes of surgical abominal pains in children to help the physicians to avoid some pitfalls, and to involve the pediatric surgeons at an early stage.


AIM: Evaluate the care of burn sequel of the hand in the services of orthopaedic trauma and paediatric in the teaching hospital Gabriel Touré. METHOdS: It was about a longitudinal and prospective study lasting from Jun 2006 to January 2008 in all the children aged from 0 to 14 years with burn sequel of the hand admitted and treated in the services of orthopaedic- trauma and paediatric surgery of Gabriel Touré. Patients with an incomplete file or lost during the study were not included. RESULTS: In 20 months we brought together 40 cases of burn sequel of hand. The mean age of the patients was 8.5 years. There were 18 boys and 22 girls. The sex-ratio was 1.22 for girls. The causal agent was more frequently thermal (85%) by hot liquid. Burn was caused by domestic accident in 95%. 14 of our patients were seen by a doctor after 24 months of burn and another 14 were after 36 months. A functional deficit was noted to the physical examination in all our patients. The treatment was surgical in 26 patients. Results were judged well in 16 cases, little good in 8 and bad 2 case. A good initial treatment done in a fear condition permit to reduce the number of sequel of the hand and to stay less severe.


Pecquery R.,Service de chirurgie pediatrique | Laville J.-M.,Service de chirurgie pediatrique | Salmeron F.,Service de chirurgie pediatrique
Orthopaedics and Traumatology: Surgery and Research | Year: 2010

Introduction: Classical surgical treatments for Legg-Calvé-Perthes (LCP) disease are pelvic or femoral osteotomies, which are not without complications and inconvenience for the patient. An effective, relatively undamaging surgical alternative would improve this disease treatment. Hypothesis: Augmentation acetabuloplasty using shelf acetabuloplasty is a recognized treatment for LCP disease, but its results have never been assessed in view of Herring's lateral pillar classification, the current reference in determining the prognosis of this disease. Assessment of its efficacy based on this system is therefore needed. Material and methods: Over 15 years, 21 patients underwent shelf acetabuloplasty. Included in the study were children with a progressively subluxating femoral head and classified minimum grade B in the lateral pillar classification. The last follow-up had to be at least 12 months after surgery and include a clinical examination as well as an AP pelvic X-ray. Results: The mean follow-up was 4 years and 3 months. Only two complications occurred, one of which required surgical revision. Shelf acetabuloplasty was considered effective (contained and Stulberg 1 or 2) in 13 cases and ineffective (lysed or Stulberg 3, 4, or 5) in eight cases. Discussion: The lateral pillar classification demonstrated its high value in LCP disease in correlation with symptom onset. This series shows that at the medium term, shelf acetabuloplasty is as effective as pelvic or femoral osteotomies for children of any age and any level of disease severity, with fewer complications and less inconvenience for the patient. Level of evidence: : Level IV. Therapeutic retrospective study. © 2010.


Oesophageal atresia is an extreme surgical emergency of the first week of birth. Authors report 10 cases treated in 5 years in two hospitals of Yaounde in Cameroon. This study high line: Difficulties of oesophageal atresia management in less medicalised countries. Possible solutions in this context.

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