[Surgery of congenital malformations: ethics and economics].

The author summaries the severity of various congenital malformations based on his experience of 30 years of pediatric surgery. Emphasis is placed on the progress that has been made in the treatment of certain anomalies which, up until recently, were considered beyond surgical management. Most advances of diagnosis in utero and changing social attitudes of such malformations have dramatically modified their acceptance.

The cradle of pediatric surgery.

The nearly two hundred years history of the Hôpital des Enfants-Malades in Paris is described, with special emphasis on the development of pediatric surgery in this hospital. Described is also the work of the various surgeons-in-chief, who since 1899 were also appointed professors of pediatric surgery. Progress was slow during the first half of the nineteenth century, but after Guersant took over in 1844 the hospital became a center for this specialty.

[Cryptorchism and surgery].

Many different anatomical situations are observed by pediatric surgeons during the surgical procedure for cryptorchidism at any age. The authors propose an easy anatomical classification: type I seems to be a small trouble of the process of migration and to be more a disturbed fixation. Type III results from a big disturbed wolfian duct process.

Measuring the anorectal angle.

Lateral radiographs of the rectum and anus were taken in 90 children with chronic idiopathic constipation. A computer program was developed to obtain an objective quantitative assessment of the anorectal angle; it averaged 120 degrees at rest, decreased during forceful anal contraction and increased during defecation. It was noted that 24% of the children, when asked to defecate, decreased their anorectal angle as normally observed during forceful anal contraction and, that 21% when asked to contract the anus, increased the angle as if they were defecating.

Anorectal motility after surgery for spina bifida.

Anorectal motility was studied in 93 children (aged 15 days to 16 1/2 years) who had undergone surgery for myelocele or meningomyelocele, and 80 controls, matched for age and sex. Mean resting pressure in the anal canal of patients was markedly decreased, particularly in the presence of incontinence, and unstable. The recording of a rectoanal inhibitory reflex both in the upper anal canal and at the anal margin was associated with the presence of fecal incontinence and motor disorders of the lower extremities.

[Retroperitoneal hamartoma. Apropos of 6 cases].

Retroperitoneal hamartoma is an exceptional, benign, malformative tumor (1, 2% among retroperitoneal tumors in children). The authors report 6 cases which have been observed at the C.C.

[Abdominal complications of ventriculo-peritoneal shunts in children. 65 cases].

From 1971 to 1982, among 1 200 children with hydrocephalus cured by ventriculo-peritoneal shunt, 65 have presented an abdominal complication. Some of them are rare and easily explainable: 2 intra-operative viscus perforations, 1 intestinal obstruction, 3 extrusions of the catheter into an inguinal hernia. Also rare, C.

[Retrospective study of 56 congenital diaphragmatic hernias. Prognostic factors, therapeutic deductions].

Fifty-six neonates were treated for congenital diaphragmatic hernia (48 left and 8 right) in our intensive care unit from 1972 to 1980. Because of the high mortality, we studied the factors which could predict the outcome. Early onset of symptoms (before the 2nd hour of life) and low post-ductal shunt (PAO2/FiO2 less then 15) after the 3rd postoperative hour appear to be signs of poor prognosis.

Idiopathic disorders of fecal continence in children.

A group of 176 patients aged 2 to 15 years was investigated for idiopathic disorders of bowel function other than Hirschsprung's disease. Anorectal motility, as well as colorectal transit of radiopaque markers, were investigated. Before the end of the first month of life, 70 of the patients were constipated.

[Conservative treatment of injuries of the spleen in children].

Resolutely convinced of the necessity to preserve the spleen in all circumstances, the authors detail the indications and possibilities of non operative management and conservative surgery that allow the injured spleen to be salvaged. Of 55 cases observed from 1978 to 1982, only 22 required splenectomy because of our new experience; 13 of the remaining cases were treated non operatively and 20 had a conservative surgery. It is concluded that unless the child prognosis is directly and immediately involved, by the splenic injury (such cases require splenectomy or better still partial resection) every effort should be made to preserve a traumatized spleen.

[The place of surgery in the treatment of neuroblastoma].

From 1957 to 1980, 170 neuroblastoma were surgically approached: 3 cervical, 11 thoracic, 147 abdominal, 5 pelvic. The surgical data gathered from this large series leads us to assess that there are great differences between lateral and median neuroblastoma. Lateral ones can be surgically removed without major risk.

[EEG recordings in prolonged hypercapnia during surgery of a cervico-mediastinal tumor in a 3-year-old child].

An EEG has been recorded during surgery for a cervico-mediastinal desmoid fibroma in a 3-year-old child. Soon after anesthetic induction a bronchospasm occurred, followed by major respiratory difficulties. During more than 3 h, hypercapnia reaching 15-24 kpa was noted without hypoxia.

[Intestinal obstruction after child abdominal surgery (author's transl)].

From 1957 to 1978, 211 intestinal obstructions were treated at Hôpital des Enfants malades, Paris: 103 coming from our own surgery, 108 from other surgical centers. 24,6% cases are observed in children less than one year old, after neo-natal surgery. 41% are observed between 5 and 9 years of age, at the "appendicitis period".

Management of compulsive shoplifting through covert sensitization.

A client with a shoplifting of 4 years' duration was treated by convert sensitization. To control for improvement attributable to demand characteristics alone, thought-stopping was utilized prior to the treatment period. Results indicated that the application of thought-stopping produced an increase in all dimensions (frequency, duration and intensity) of shoplifting urges which were brought under control and virtually eliminated by instituting covert sensitization.

[Continued evaluation of results of surgical management of female congenital adrenal hyperplasia. Report on 48 cases (author's transl)].

In a continued surgical and medical evaluation of the surgical management of female congenital adrenal hyperplasia, 48 girls were studied. Clitoroplasty (relocation and recession) was considered satisfactory in 22 out of 26 children of pubertal age. Vaginoplasty results were rated as excellent in 8 cases, and fair in 19 cases.