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Clermont-Ferrand, France

Scalabre A.,Service de Chirurgie Pediatrique | Gorincour G.,Service de Radiologie Pediatrique | Hery G.,Service de Chirurgie Pediatrique | Gamerre M.,Hopital de la Conception | And 2 more authors.
Journal of Pediatric Surgery | Year: 2012

Objective: The objective of this study is to describe the evolution of 8 cases of congenital malformations of the umbilical-portal-hepatic venous system diagnosed before the first month of life. Materials and methods: All cases of congenital malformation of the portal and hepatic venous system diagnosed prenatally or during the first month of life in our institution were systematically reviewed since November 2000. Clinical features, imaging, and anatomical findings were reviewed, focusing primarily on clinical and radiologic evolution. Results: Eight cases of congenital malformation of the umbilical-portal-hepatic venous system were studied. Fifty percent of these malformations were diagnosed prenatally. We report 4 portosystemic shunts. Three involuted spontaneously, and the fourth one required surgical treatment. We report a variation of the usual anatomy of portal and hepatic veins that remained asymptomatic, an aneurysmal dilatation of a vitelline vein causing portal vein thrombosis that needed prompt surgical treatment with good result, a complex portal and hepatic venous malformation treated operatively, and a persistent right umbilical vein that remained asymptomatic. Conclusion: Prenatal diagnosis of malformations of the umbilical-portal-hepatic venous network is uncommon. Little is known about the postnatal prognosis. Clinical, biologic, and radiologic follow-up by ultrasonography is essential to distinguish pathologic situations from normal anatomical variants. © 2012 Elsevier Inc. All rights reserved.


Fuchsmann C.,Service dOtorhinolaryngologie Pediatrique | Fuchsmann C.,University Claude Bernard Lyon 1 | Quintal M.-C.,University of Montreal | Giguere C.,University of Montreal | And 7 more authors.
Archives of Otolaryngology - Head and Neck Surgery | Year: 2011

Objectives: To report the efficacy of propranolol as first-line treatment of head and neck hemangiomas in children and to present an optimized protocol for treating hemangiomas. Design: Multi-institutional retrospective study. Setting: Two tertiary care referral pediatric centers. Patients: Thirty-nine children with head and neck infantile hemangiomas were treated. Main Outcome Measures: Review of clinical records. Results: Propranolol was the sole treatment in 60% of patients and was started at a mean age of 4.1 months (age range, 1-11 months) for early interventions among 33 of 39 patients. Propranolol therapy resulted in lightening and reduction of hemangiomas at 37 of 39 locations within 2 days to 2 weeks. One subglottic hemangioma and 1 nasal tip hemangioma did not respond or showed only a partial response; in these patients, propranolol therapy was delayed and followed other treatment failures. After successful therapeutic regression, 6 recurrences occurred; when reintroduced, propranolol was again effective. Recurrences were avoided by prolonged treatment. Twenty-six hemangiomas occurring at locations for which corticosteroid treatment previously would not have been initiated (nose, lips, and parotid area) unless a complication had occurred were treated with propranolol and were rapidly controlled. The mean duration of propranolol therapy was 8.5 months. No instances of β-blocker discontinuation because of complications occurred, but propranolol was substituted by acebutolol in 5 patients because of trouble sleeping. Conclusions: Propranolol is an effective treatment of head and neck infantile hemangiomas, especially when started early within the rapid growth phase, and is first-line treatment of orbit and larynx hemangiomas. The efficacy and tolerability of propranolol led us to treat some hemangiomas in patientswhomwe previously would have observed rather than subject to corticosteroid therapy. Relapse was avoided if treatment was prolonged after theoretical involution (age 12 months). Questions remain about optimal dosing and age at treatment cessation. ©2011 American Medical Association. All rights reserved.


Auregan C.,Service des urgences pediatriques | Berteloot L.,Service de Radiologie Pediatrique | Pierrepont S.,Service de Nephrologie Pediatrique | Cheron G.,Service des urgences pediatriques | Cheron G.,University of Paris Descartes
Archives de Pediatrie | Year: 2015

Xanthogranulomatous pyelonephritis is a rare form of chronic pyelonephritis observed in only a few cases in children. Symptoms are mild, which explains the delay in diagnosis. Diagnosis is based on histology but can be suspected on CT. The treatment is medical and often surgical, with an uncertain renal prognosis. It is therefore imperative to diagnose early. We report the case of a 4-year-old child who presented with xanthogranulomatous pyelonephritis caused by Pseudomonas aeruginosa, which evolved into pyonephrosis, due to inadequate antibiotic therapy. This highlights the importance of understanding this disease and not treating urinary tract infections blindly. © 2014 Elsevier Masson SAS.


Fabre A.,Service de pediatrie multidisciplinaire | Petit P.,Service de Radiologie Pediatrique | Gaudart J.,Aix - Marseille University | Mas E.,Unite de Gastroenterologie | And 3 more authors.
Journal of Pediatric Gastroenterology and Nutrition | Year: 2012

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. © 2012 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.


Veyrac C.,Service de Radiologie Pediatrique | Blondiaux E.,Service de Radiologie Pediatrique | Hadjigeorgi C.,Childrens Hospital Aghia Sophia
Pediatric Radiology | Year: 2011

Introduction: Abdominal injuries in abused children are less common than musculoskeletal and craniocerebral injuries; however they carry high mortality and morbidity rates. In every case of trauma, regardless of aetiology, radiologists are responsible for the documentation and evaluation of injuries. Injuries: Any abdominal injury pattern maybe observed following physical abuse and none is specific for abuse. However, a high index of suspicion should be maintained for every case of pancreatic, hollow viscous and other solid organ injuries, especially when there is delay in seeking help, a history of trauma to the child or siblings, young age, undernourishment, ecchymosis in non-ambulatory children or a non-plausible explanation for the injuries based on the provided history and the psychomotor condition of the child. Imaging modalities: CT with intravenous contrast material is the imaging modality of choice in every suspected inflicted abdominal injury. US could be the first imaging test for abused children with a low probability of abdominal injury and for follow-up. Upper gastrointestinal series could reveal acute or resolving mural haematomas in children with equivocal CT or US findings. Conclusion: Child abuse should be considered in the differential diagnosis of acute abdominal symptoms in young children. © 2010 Springer-Verlag.

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