Publications by authors named "Jean-Luc Michel"

26 Publications

  • Page 1 of 1

Risk Factors of Early Mortality and Morbidity in Esophageal Atresia with Distal Tracheoesophageal Fistula: A Population-Based Cohort Study.

J Pediatr 2021 Mar 2. Epub 2021 Mar 2.

University Hospital of Clermont Ferrand, France.

Objective: To identify the risk factors for early mortality and morbidity in a population with distal esophageal atresia (EA)-tracheoesophageal fistula.

Study Design: Cohort study from a national register. Main outcomes and measures included early mortality, hospital length of stay (LoS), need for nutritional support at 1 year of age as a proxy measure of morbidity, and complications during the first year of life.

Results: In total, 1008 patients with a lower esophageal fistula were included from January 1, 2008, to December 31, 2014. The survival rate at 3 months was 94.9%. The cumulative hospital LoS was 31.0 (17.0-64.0) days. Multivariate analysis showed that intrahospital mortality at 3 months was associated with low birth weight (OR 0.52, 95% CI [0.38-0.72], P < .001), associated cardiac abnormalities (OR 6.09 [1.96-18.89], P = .002), and prenatal diagnosis (OR 2.96 [1.08-8.08], P = .034). LoS was associated with low birth weight (-0.225 ± 0.035, P < .001), associated malformations (0.082 ± 0.118, P < .001), surgical difficulties (0.270 ± 0.107, P < .001), and complications (0.535 ± 0.099, P < .001) during the first year of life. Predictive factors for dependency on nutrition support at 1 year of age were complications before 1 year (OR 3.28 [1.23-8.76], P < .02) and initial hospital LoS (OR 1.96 [1.15-3.33], P < .01).

Conclusions: EA has a low rate of early mortality, but morbidity is high during the first year of life. Identifying factors associated with morbidity may help to improve neonatal care of this population.
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March 2021

Is laterality of congenital diaphragmatic hernia a reliable prognostic factor? French national cohort study.

Prenat Diagn 2020 07 8;40(8):949-957. Epub 2020 May 8.

Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Bordeaux, Bordeaux, France.

Objectives: The objective of this study was to assess whether the laterality of congenital diaphragmatic hernia (CDH) was a prognostic factor for neonatal survival.

Methods: This was a cohort study using the French national database of the Reference Center for Diaphragmatic Hernias. The principal endpoint was survival after hospitalization in intensive care. We made a comparative study between right CDH and left CDH by univariate and multivariate analysis. Terminations and stillbirths were excluded from analyses of neonatal outcomes.

Results: A total of 506 CDH were included with 67 (13%) right CDH and 439 left CDH (87%). Rate of survival was 49% for right CDH and 74% for left CDH (P < .01). Multivariate analysis showed two factors significantly associated with mortality: thoracic herniation of liver (OR 2.27; IC 95% [1.07-4.76]; P = .03) and lung-to-head-ratio over under expected (OR 2.99; IC 95% [1.41-6.36]; P < .01). Side of CDH was not significantly associated with mortality (OR 1.87; IC 95% [0.61-5.51], P = .26).

Conclusion: Rate of right CDH mortality is more important than left CDH. Nevertheless after adjusting for lung-to-head-ratio and thoracic herniation of liver, right CDH does not have a higher risk of mortality than left CDH.
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July 2020

Predictors of the Performance of Early Antireflux Surgery in Esophageal Atresia.

J Pediatr 2019 08 6;211:120-125.e1. Epub 2019 May 6.

Saint Etienne University Hospital, Saint-Priest-en-Jarez, France.

Objective: To identify predictors of and factors associated with the performance of antireflux surgery during the first year of life in children born with esophageal atresia.

Study Design: All patients were included in a French registry for esophageal atresia. All 38 multidisciplinary French centers completed questionnaires about perinatal characteristics and one-year outcome for children born with esophageal atresia.

Results: Of 835 infants with esophageal atresia born in France from 2010 to 2014, 682 patients, excluding those with long-gap esophageal atresia, were included. Three patients had type I, 669 had type III, and 10 had type IV esophageal atresia. Fifty-three children (7.8%) received fundoplication during the first year of life. The median age at the time of the end-to-end esophageal anastomosis was 1.1 day (range 0-15). Multivariate analysis identified three perioperative factors that predicted the need for early antireflux surgery: anastomotic tension (P = .004), associated malformations (P = .019), and low birth weight (P = .018). Six other factors, measured during the first year of life, were associated with the need for antireflux surgery: gastroesophageal reflux (P < .001), anastomotic stricture (P < .001), gastrostomy (P < .001), acute life-threatening event (P = .002), respiratory complications (P = .045), and poor nutritional status (P < .001).

Conclusions: Gastroesophageal reflux disease, low birth weight, poor nutrition, and surgical anastomosis difficulties predicted the performance of antireflux surgery in the first year of life in infants with esophageal atresia.
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August 2019

Acute pyelonephritis revealing an intraprostatic obstructive megaureter in an adult: A rare finding.

Int J Surg Case Rep 2018 13;51:78-81. Epub 2018 Aug 13.

Department of Urology, CHU Saint Pierre, Avenue du Président Mitterrand, 97448, Saint Pierre, La Réunion, France. Electronic address:

Introduction: Duplicated renal collecting system is one of the most common congenital upper urinary tract abnormalities. Duplex system with ectopic obstructive megaureter in the prostatic urethra is rare and exceptionally revealed in adulthood.

Presentation Of Case: We present a rare case of a 72-year-old man without any previous history of urinary symptoms, admitted through the emergency department for altered general condition associated with fever for several days. Investigations have identified left complete duplex system and intraprostatic obstructive megaureter manifesting as acute pyelonephritis. The evolution of acute pyelonephritis was favorable under urine drainage by percutaneous nephrostomy tube and antibiotherapy. Given the multiple comorbidities of the patient, radical surgical treatment by left upper pole nephrectomy was ruled out and we opted for an iterative change of percutaneous nephrostomy tube.

Discussion: We briefly review the pathophysiology, diagnosis and therapeutic aspects.

Conclusion: Early diagnosis and treatment of complicated duplex system is important. Urologists should keep this anomaly in mind.
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August 2018

ZORRO: Z Omphaloplasty Repair for Omphalocele.

J Pediatr Surg 2018 Jul 6;53(7):1424-1427. Epub 2018 Apr 6.

Department of Neonatology, CHU Félix Guyon, Saint Denis, La Réunion, France.

Purpose: To suggest a novel technique for omphalocele closure which uses the circular base of the umbilical cord, thus allowing for a more physiological healing process and natural-looking scar.

Methods: Among 16 neonates operated for omphalocele between 2011 and 2016, 12 were closed with a one-stage procedure using a Z omphaloplasty (ZORRO). Median gestational age was 36.5 weeks; median birth weight was 3210 g. The umbilical arteries were divided and ligated outside the peritoneal cavity above the parietal musculocutaneous plane. The upper part of the defect was closed vertically in the midline, while the lower part was closed in a circular fashion by imbricating 2 lateral cutaneous Z flaps thus forming a new cordonal base.

Results: The postoperative course was uneventful in all cases. The reconstructed cordonal bases healed as would a normal umbilical cord, with central umbilication surrounded by healthy skin. With a median follow-up period of 11 months, the umbilicus was in the normal position, with a 0.6 xyphoumbilical/xyphopubic ratio.

Conclusions: This technique mimics the natural necrosis mechanism and physiological healing of the umbilicus thus allowing for an esthetic and "natural looking" umbilicus.
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July 2018

Thoracic skeletal anomalies following surgical treatment of esophageal atresia. Lessons from a national cohort.

J Pediatr Surg 2018 Apr 21;53(4):605-609. Epub 2017 Jul 21.

University Hospital, 2 Avenue Martin Luther King, 87000 Limoges, France. Electronic address:

Introduction: Thoracotomy as surgical approach for esophageal atresia treatment entails the risk of deformation of the rib cage and consequently secondary thoracogenic scoliosis. The aim of our study was to assess these thoracic wall anomalies on a large national cohort and search for factors influencing this morbidity.

Materials And Methods: Pediatric surgery departments from our national network were asked to send recent thoracic X-ray and operative reports for patients born between 2008 and 2010 with esophageal atresia. The X-rays were read in a double-blind manner to detect costal and vertebral anomalies.

Results: Among 322 inclusions from 32 centers, 110 (34.2%) X-rays were normal and 25 (7.7%) displayed thoracic malformations, including 14 hemivertebrae. We found 187 (58.1%) sequelae of surgery, including 85 costal hypoplasia, 47 other types of costal anomalies, 46 intercostal space anomalies, 21 costal fusions and 12 scoliosis, with some patients suffering from several lesions. The rate of patients with these sequelae was not influenced by age at intervention, weight at birth, type of atresia, number of thoracotomy or size of the center. The rate of sequelae was higher following a classical thoracotomy (59.1%), whatever the way that thoracotomy was performed, compared to nonconverted thoracoscopy (22.2%; p=0.04).

Conclusion: About 60 % of the patients suffered from a thoracic wall morbidity caused by the thoracotomy performed as part of surgical treatment of esophageal atresia. Minimally invasive techniques reduced thoracic wall morbidity. Further studies should be carried out to assess the potential benefit of minimally invasive approaches to patient pulmonary functions and on the occurrence of thoracogenic scoliosis in adulthood.

Levels Of Evidence: Level III retrospective comparative treatment study.
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April 2018

Preliminary experience using a tunica vaginalis flap as the dorsal component of Bracka's urethroplasty.

BJU Int 2017 03 17;119(3):470-473. Epub 2016 Aug 17.

Department of Pediatric Surgery, CHU F Guyon, Bellepierre, Saint-Denis de La Réunion, Réunion Island, France.

Objective: To evaluate clinical use of a tunica vaginalis flap as the dorsal component of a two-stage urethroplasty in boys with cripple hypospadias.

Patients And Methods: We performed the first stage of a Bracka two-stage urethroplasty, using a tunica vaginalis flap as the dorsal component in six boys with cripple hypospadias. We analysed their clinical characteristics and the results of this technique.

Results: The mean (range) age of the boys was 57 (34-120) months. The mean (range) number of previous procedures the boys had undergone was 4 (3-5). At the 6-month follow-up, all the boys presented significant fibrosis of the dorsal graft rendering it unusable for tubularisation.

Conclusions: Exposure to the external environment seems to induce retraction and fibrosis of the tunica vaginalis. We believe one should be very cautious about using tunica vaginalis as the dorsal component of a two-stage urethroplasty, as significant fibrosis might well render the flap unusable.
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March 2017

A novel approach to evaluating the benefit of post-urinary tract infection renal ultrasonography, using decision curve analysis.

Pediatr Nephrol 2016 10 14;31(10):1631-6. Epub 2016 May 14.

Unité de Soutien Méthodologique, CHU de La Réunion, Saint-Denis, Réunion, France.

Background: The benefit of post-urinary tract infection (UTI) sonography to detect clinically significant renal abnormalities remains a subject open to debate. Decision curve analysis (DCA) is a novel method for evaluating the clinical usefulness of diagnostic tests. Our objective was to determine, using DCA, the benefit of post-UTI sonography and of post-UTI sonography with biological markers of inflammation to predict the risk of recurrence of febrile UTI in children aged 2 to 24 months without known uropathy.

Methods: We retrospectively analyzed all children aged 2 to 24 months, without known uropathy, who presented with a first episode of febrile UTI between 2009 and 2012 and followed them for 30 months. We then used DCA to estimate the benefit of post-UTI sonography or post-UTI sonography + biological markers of inflammation for detecting the risk of recurrence.

Results: A total of 318 children [144 boys (45.3 %) and 174 girls (54.7 %)], with a mean age of 6.9 ± 5.6 months, were identified. Of these, 210 children presented with a significant inflammation [66.2 %; 95 % confidence interval (CI) 61.0-71.4], and 30 (9.4 %; 95 % CI 6.2-12.6) presented with abnormal post-UTI sonographic findings. Eighteen (5.7 %; 95 % CI 3.1-8.2) children presented with recurrent UTI at 30 months.

Conclusions: There were significantly more recurrences in those children who presented with abnormal sonographic findings than in those who did not (relative risk 7.68; 95 % CI 3.03-19.46). However, taking into account the effect of false-positives and false negatives, the DCA revealed that for threshold probabilities of >30 %, at which patients/doctors are concerned about unnecessary interventions (whether tests or treatments), neither post-UTI sonography nor post-UTI sonography + biological markers of inflammation have sufficient value to improve care.
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October 2016

Prevalence of Barrett Esophagus in Adolescents and Young Adults With Esophageal Atresia.

Ann Surg 2016 Dec;264(6):1004-1008

*Reference Center for Congenital and Malformative Esophageal Disorders, Hôpital Jeanne de Flandre, Lille†Department of Pediatric Surgery, CHU, Strasbourg, France‡Department of Pediatric Gastroenterology, Hôpital Robert Debré, Paris, France§Department of Pediatric Gastroenterology, HFME, Lyon, France¶Department of Pediatric Gastroenterology, CHU, Rennes, France||Department of Pediatric Surgery, CH Départemental Félix Guyon, Saint Denis-La Réunion, France**Department of Pediatric Gastroenterology, Hôpital Mère-Enfants Ste Justine, Montréal, Canada††Pediatric Surgical Service, Centre Hospitalier de Luxembourg, Luxembourg, Grand-Duché du Luxembourg‡‡Department of Pediatric Gastroenterology, AZ VUB, Bruxelles, Belgium§§Department of Pediatric Gastroenterology, CHU, Caen, France¶¶Department of Pediatric Gastroenterology, Hôpital des Enfants, Toulouse, France||||Department of Pediatric Surgery, CHU, Poitiers, France***Department of Pediatric Gastroenterology, Hôpital des Enfants, Bordeaux, France†††Department of Pediatric Gastroenterology, HUDERF, Bruxelles, Belgium‡‡‡Department of Pediatric Surgery, CHU, Angers, France§§§Department of Pediatric Gastroenterology, Hôpital Trousseau, Paris, France¶¶¶Department of Pediatrics, CH, Le Havre, France||||||Department of Pediatric Gastroenterology, HME CHU, Nantes, France****Department of Gastroenterology CHC, Liège, Belgium††††Department of Pediatric Gastroenterology and Hepatology, UCL, Cliniques Universitaires St Luc, Bruxelles, Belgium‡‡‡‡Public Health, Methods in Clinical Research Team, CHU, Strasbourg, France§§§§Centre Biologie Pathologie, Lille, France.

Objective: To study the prevalence of Barrett esophagus (BE) (gastric and/or intestinal metaplasia) in adolescents treated for esophageal atresia (EA).

Summary Of Background Data: EA patients are at high risk of BE.

Methods: This multicenter prospective study included EA patients aged 15 to 19 years. All eligible patients were proposed an upper endoscopy with multistaged esophageal biopsies under general anesthesia. Histological suspicion of metaplasia was confirmed centrally.

Results: One hundred twenty patients [mean age, 16.5 years (±1.4)] were included; 70% had been treated for gastroesophageal reflux disease (GERD) during infancy. At evaluation, 8% were undernourished, 41% had received antireflux surgery, and 41% presented with GERD symptoms, although only 28% were receiving medical treatment. Esophagitis was found at endoscopy in 34% and confirmed at histology in 67%. BE was suspected after endoscopy in 37% and was confirmed by histology for 43% of patients (50 gastric and 1 intestinal metaplasia). No endoscopic or histological anomalies were found at the anastomosis site. BE was not significantly related to clinical symptoms. In multivariate analysis, BE was associated with EA without fistula (P = 0.03), previous multiple antireflux surgery (P = 0.04), esophageal dilation (P = 0.04), suspicion of BE at endoscopy (P < 0.001), and histological esophagitis (P = 0.02).

Conclusions: Patients with EA are at high risk of persistent GERD and BE. The development of BE is related to GERD history. Long-term systematic follow-up of the esophageal mucosa including multistaged biopsies is required, even in asymptomatic patients. (NCT02495051).
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December 2016

Primordial Influence of Post-operative Compliance on Weight Loss After Adolescent Laparoscopic Adjustable Gastric Banding.

Obes Surg 2016 Jan;26(1):98-104

AP-HP, Hôpital Necker-Enfants Malades, Service de Chirurgie Pédiatrique Viscérale, 149 rue de Sevres, 75015, Paris, France.

Background: Accumulating evidence suggests that the benefits seen in adult bariatric surgery can be reproduced in adolescents. In contrast with North America, bariatric surgery in adolescents is still not well accepted in Europe and indications and protocols have still to be formulated.

Methods: This prospective study tested the gastric banding procedure in 49 patients operated in a single French institution since 2008. The mean age at surgery was 16.2 ± 0.9 years with a weight of 118.8 ± 22.3 kg and body mass index of 42.5 ± 5.9 kg/m(2).

Results: At 6, 12 and 24 months after surgery, weight was 103.7 ± 20.8 kg, 98.7 ± 21 kg and 93.6 ± 19.3 kg, respectively (p < 0.001), corresponding to excess weight loss (EWL) of 31.6 ± 17.2 %, 41.8 ± 21.4 % and 59.1 ± 24.9 % (p < 0.001), respectively. Multivariate analysis showed that the number of consultations per year was the only variable significantly associated to weight loss. Metabolic disorders were corrected, with a decreased prevalence of insulin resistance from 100 to 17 % and normalisation of homeostasis model assessment-insulin resistance (HOMA-IR) at 24 months (2.09 ± 0.95). Band-related complications were five slippages, one psychological intolerance and two ports repositioning. Six patients (12 %) had the device explanted. The death of a patient was an exceptionally severe adverse event.

Conclusion: Given frequent follow-up support by a multidisciplinary team, laparoscopic adjustable gastric banding (LAGB) surgery in adolescent results in sustained weight loss. However, even exceptional, potentially serious complications are possible and long-term follow-up is needed to evaluate the risk/benefit ratio at 5 or 10 years after LAGB surgery.
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January 2016

Results from the French National Esophageal Atresia register: one-year outcome.

Orphanet J Rare Dis 2014 Dec 11;9:206. Epub 2014 Dec 11.

Reference Center for Congenital Esophageal Anomalies, University Hospital Lille, Avenue Eugène Avinée, Lille, 59037, France.

Background: The aim of the present national prospective population-based study was to assess the early morbidity of esophageal atresia (EA).

Methods: All 38 multidisciplinary French centers that care for patients with EA returned a specific questionnaire about the 1-year outcome for each patient. This information was centralized, checked, and entered into a database.

Results: From the total population of 307 EA patients born in 2008 and 2009, data about the 1-year outcome were obtained from 301 (98%) patients, of whom 4% were lost to follow-up and 5% died. Medical complications occurred in 34% of the patients: anastomotic leaks (8%), recurrent tracheoesophageal fistula (4%), and anastomotic stenosis (22%); all of the latter group needed dilation (median, 2 dilations/patient). A new hospitalization was required for 59% of patients (2.5 hospitalizations/patient) for digestive (52%) or respiratory (48%) reasons. Twelve percent of patients required antireflux surgery at a median age of 164 days (range, 33-398 days), and 1% underwent an aortopexy for severe tracheomalacia. The weight/age Z-score was -0.8 (range, -5.5 to 3.7 months) at 12 months. Fifteen percent of patients were undernourished at 12 months of age, whereas 37% presented with respiratory symptoms and 15% had dysphagia at the last follow-up. Significant independent factors associated with medical complications were anastomotic esophageal tension (p = .0009) and presence of a gastrostomy (p = .0002); exclusive oral feeding at discharge was associated with a decreased risk of complications (p = .007).

Conclusions: Digestive and respiratory morbidities remain frequent during the first year of life and are associated with difficult anastomosis and lack of full oral feeding.
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December 2014

Comparison of the ultra-low-dose Veo algorithm with the gold standard filtered back projection for detecting pulmonary asbestos-related conditions: a clinical observational study.

BMJ Open 2014 May 30;4(5):e004980. Epub 2014 May 30.

Department of Radiology, University Hospital CHU G. Montpied, Clermont-Ferrand, France.

Objectives: Radiation delivered during CT is a major concern, especially for individuals undergoing repeated screening. We aimed to compare a new ultra-low-dose algorithm called Veo with the gold standard filtered back projection (FBP) for detecting pulmonary asbestos-related conditions.

Setting: University Hospital CHU G. Montpied, Clermont-Ferrand, France

Participants: Asbestos-exposed workers were recruited following referral to screening for asbestos-related conditions. Two acquisitions were performed on a 64-slice CT: the gold standard FBP followed by Veo reconstruction.

Outcome Measures: Two radiologists independently assessed asbestos-related abnormalities, pulmonary nodules, radiation doses and image quality (noise).

Results: We included 27 asbestos-exposed workers (63.3±6.5 years with 11.9±9.7 years of asbestos exposure). We observed 297 pleural plaques in 20 participants (74%). All patients (100%) had pulmonary nodules, totalling 167 nodules. Detection rates did not differ for pleural plaques (Veo 87% vs FBP 97%, NS), pleural thickening (100% for both) and pulmonary nodules (80% for both). Interstitial abnormalities were depicted less frequently with Veo than FBP. False negative and false positive did not exceed 2.7%. Compared with FBP, Veo decreased the radiation dose up to 87% (Veo 0.23±0.07 vs FBP 1.83±0.88 mSv, p<0.001). The objective image noise also decreased with Veo as much as 23% and signal-to-noise ratio increased up to 33%.

Conclusions: A low-dose CT with Veo reconstruction substantially reduced radiation. Veo compared favourably with FBP in detecting pleural plaques, pleural thickening and pulmonary nodules. These results should be confirmed on a larger sample size before the use of Veo in clinical routine practice in asbestos-related conditions, especially regarding the low prevalence of interstitial abnormalities in this study.

Trial Registration Number: NCT01955018.
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May 2014

Esophageal atresia: data from a national cohort.

J Pediatr Surg 2013 Aug;48(8):1664-9

Reference Center for Congenital Oesophageal Anomalies, University Hospital Lille, France.

Purpose: A prospective national register was established in 2008 to record all new cases of live-birth newborns with esophageal atresia (EA). This epidemiological survey was recommended as part of a national rare diseases plan.

Methods: All 38 national centers treating EA participated by completing for each patient at first discharge a questionnaire validated by a national committee of experts. Data were centralized by the national reference center for esophageal anomalies. Quantitative and qualitative analyses were performed, with P-values of less than 0.05 considered statistically significant. Results of the 2008-2009 data collection are presented in this report.

Results: Three hundred seven new living cases of EA were recorded between January 1, 2008, and December 31, 2009. The male/female sex ratio was 1.3, and the live-birth prevalence of EA was 1.8 per 10,000 births. Major characteristics were comparable to those reported in the literature. Survival was 95%, and no correlation with caseload was noted.

Conclusions: Epidemiologic surveys of congenital anomalies such as EA, which is a rare disease, provide valuable data for public health authorities and fulfill one important mission of reference centers. When compared with previous epidemiological data, this national population-based registry suggests that the incidence of EA remains stable.
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August 2013

Necrotizing enterocolitis in full term neonates: is there always an underlying cause?

J Neonatal Surg 2013 Jul-Sep;2(3):29. Epub 2013 Jul 1.

CHU Reunion, Saint Denis, Reunion.

Objective: To review our experience with full-term neonates with necrotizing enterocolitis (NEC) and to compare its characteristics to those published in the literature.

Design: Retrospective review of all neonates born after 35 weeks of gestation managed in Reunion Island for NEC from 2000 to 2012.

Results: Among the 217 diagnosed NEC, 27 patients (12.4%) were full term neonates, who were born at a mean gestational age of 36.8 ±1.7 weeks. The mean onset of the disease was 12.1±11.2 days after birth. Twenty patients had underlying causes (15 organic pathologies of the child, 3 isolated maternal disease, and 2 infections); 7 had idiopathic NEC. Surgery was required in 12 patients (37.5%) at 23.2±20 days after birth. NEC affected most of the time the colon (n=6) and the rectum (n=3). Overall survival rate was 88.8% (24/27). Two patients required partial non-enteral nutrition for1.3 and 2.1 years.

Conclusions: NEC in full term neonates is a rare pathology. The onset of the disease in our experience was slightly later than described in the literature, but remains earlier than in the premature population. In some cases, no obvious cause can be found, suggesting a different pathogenesis. Further investigations are required in order to better understand this pathology. The goal will be to find measures to reduce global mortality.
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May 2015

Primary extraosseous Ewing sarcoma of the lung in children.

Ecancermedicalscience 2013 30;7:312. Epub 2013 Apr 30.

Department of Thoracic, Vascular, and Cardiac Surgery, University Hospital Felix Guyon, Reunion, France.

We report a case of primary extraosseous Ewing sarcoma (EES) of the lung in a four-year-old child. In the literature, there are only a few case reports of EES located in the thorax.
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May 2013

Commentary to 'Native nephrectomy in pediatric transplantation--less is more!'.

J Pediatr Urol 2013 Feb 2;9(1):90-1; discussion 91. Epub 2012 Jul 2.

Pediatric Surgery and Pediatric Nephrology, CHU F Guyon, Saint-Denis de La Reunion, Reunion Island, France.

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February 2013

Choosing a technique for severe hypospadias.

Afr J Paediatr Surg 2011 Sep-Dec;8(3):286-90

Department of Paediatrics Surgery, CHR F Guyon, Bellepierre, Saint-Denis de La Réunion, Reunion Island, Madagascar.

Introduction: We participate in humanitarian missions in Madagascar during which we treat severe hypospadias. We report our experience and results with these patients, in these conditions, and discuss our choice of technique in this particular setting.

Materials And Methods: We retrospectively reviewed the data of 27 patients operated for severe hypospadias during our humanitarian missions in Madagascar between November 2006 and September 2009. Twenty one patients underwent a modified Koyanagi procedure, three underwent a Duckett urethroplasty, two an onlay island flap, one an augmented Duckett and one a tubularised plate urethroplasty. Two patients who underwent a modified Koyanagi repair also had a Nesbitt dorsal plication.

Results: Patient age at the time of surgery ranged from 22 to 198 months with a median age of 54.1 months. Mean follow-up was 16 months. Of the 21 patients who underwent a modified Koyanagi procedure, 16 presented at least one complication (76%): A fistula developed in 12 patients (57%), meatal regression developed in 7 (33%) and 2 showed complete wound dehiscence (9.5%). None developed stenosis or urethrocoele.

Conclusion: In this particular setting, the postoperative complication rate is high. Nevertheless, the Koyanagi technique is appropriate, because its complications are easy to treat and there is always sufficient ventral tissue for the secondary operation, if necessary.
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May 2012

Successful management of congenital bronchial stenosis using an expandable stent.

J Pediatr Surg 2012 Jan;47(1):e1-4

Department of Pediatric Surgery, CHR Felix Guyon, 97405 St Denis, Reunion Island.

Congenital bronchial stenosis is a very rare cause of neonatal dyspnea. Surgical management remains challenging in small children. We report successful implantation of a bronchial stent in a 3-month-old female infant presenting with congenital right bronchial stenosis and 18 months of follow-up. Use of stents in children remains controversial because of the problem of size mismatch as the child grows. Nevertheless, expandable stent implantation could be an interesting alternative to complex surgery for localized bronchial stenosis in neonates.
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January 2012

Rapidly growing mature retroperitoneal teratomas.

J Pediatr Hematol Oncol 2009 Sep;31(9):705-6

Department of Paediatric Surgery, Felix Guyon Hospital, CHR La Réunion, Saint-Denis, Reunion Island.

Retroperitoneal mature teratomas are rare benign tumors, most commonly found in neonates and young adults. We report 2 cases of fast-growing retroperitoneal mature teratomas. Both patients were girls operated on before the age of 6 months. In both cases, during the delay between diagnosis and surgery, the tumors practically doubled in size every 10 days. We believe the possibility of rapid growth of these tumors implies that treatment should be conducted as soon as possible.
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September 2009

Spontaneous pneumothorax in Wegener granulomatosis.

Chest 2005 Oct;128(4):3074-5

Department of Internal Medicine, CHU Clermont-Ferrand, Hôpital G Montpied, 58 rue Montalembert, 63003 Clermont-Ferrand, France.

Spontaneous pneumothorax in Wegener granulomatosis (WG) is uncommon. Three cases of pneumothorax that occurred early in the course of this vasculitis are reported. In the first patient, the disorder was disclosed by a pyopneumothorax. In the second patient, a rupture of the subpleural cavitary nodule into the pleural space was observed. In the third patient, the pneumothorax was discovered at the same time as a pulmonary hemorrhage. The three patients improved with immunosuppressive therapy. In WG, the pulmonary nodules are predominantly in the subpleural location, which entails the risk of pneumothorax and therefore require particular attention.
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October 2005

Inflammatory pseudotumor of the ureter.

J Pediatr Surg 2005 Mar;40(3):597-9

Department of Pediatric Surgery, Felix Guyon Hospital, Saint-Denis, Reunion Island, 97400, France.

Inflammatory myofibroblastic pseudotumors are rare solid tumors found in most soft tissue locations although mainly in the lung. Their etiology is uncertain, and they are generally considered benign although some have a potential for recurrence and dissemination. Recent studies have suggested, however, that some of these tumors are in fact neoplastic processes that harbor chromosomal aberrations similar to those seen in certain lymphomas. The authors report a case of inflammatory pseudotumor of the ureter in a child and discuss recent reports.
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March 2005

Insufficiency fracture. A survey of 60 cases and review of the literature.

Joint Bone Spine 2003 Jun;70(3):209-18

Rheumatology department, CHU Gabriel Montpied, BP 69, 63003 cedex 1, Clermont-Ferrand, France.

Unlabelled: We report findings on the site, risk factors and imaging of insufficiency fractures (IF) in 60 patients admitted to our department between 1989 and 1997.

Results: Fifty-five women (mean age 72.5 years) and five men (mean age 59 years) had 91 fractures, accounting for 0.32% of admissions. Fractures occurred most commonly in the pelvic girdle (30.7%, 28/91) and in the sacrum (29.6%, 27/91). In eight patients fractures of the sacrum were associated with fractures of the pelvic girdle. The next most common sites of occurrence were the tibia (16.5%, 15/91: 11 transverse, four longitudinal) and the femoral neck (9.9%, 9/91). There were three subchondral fractures of the femoral head, three fractures of the femoral diaphysis (two longitudinal, one transversal), two of the astragalus, and one each of the ilium, perone, calcaneum and sternum. Thirty patients had osteoporosis: six had received fluoride treatment and five had corticosteroids. Other risk factors were rheumatoid arthritis (4), osteomalacia (4), corticosteroid treatment (4), and hyperparathyroidism (1). Radiography showed a fracture line or osteocondensation in 65% (39/60) of cases. Scintigraphy was positive in 87.5% of cases (21/24), showing a fracture line (15) or a callus (6). Bone computed tomography (CT) scan was positive in 98.1% (54/55) of cases. IF occurs in elderly women with osteoporosis and most commonly in the pelvis.

Conclusions: Since radiologic signs are inconstant, scintigraphy is the choice procedure.
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June 2003

Management of asymptomatic neonatal cystic adenomatoid malformations.

J Pediatr Surg 2003 Apr;38(4):548-52

Department of Pediatric Surgery, Hospital Necker-Enfants Malades, Paris Cedex, France.

Background/purpose: Although much is known about the prenatal course of cystic adenomatoid malformations (CCAM), the postnatal course of asymptomatic lesion is less well documented. The authors studied the pre- and postnatal course and treatment of asymptomatic CCAM.

Methods: The authors reviewed the files of all patients referred to Necker-Enfants Malades hospital with an antenatal diagnosis of CCAM and asymptomatic at birth.

Results: Files of 29 patients were studied. The first x-ray film was considered normal in 12 cases (41.3%). Computed tomography was normal in 4 cases and showed cystic lung malformations in the other patients. Postnatally, clinical manifestations occurred in 3 patients (10.3%). CCAM vanished in 6 cases. Surgical resection of CCAM was performed in 17 cases (58.6%). All the patients currently are asymptomatic.

Conclusions: CCAM can shrink or vanish during pregnancy and antenatal ultrasound findings are not predictive of the postnatal course. Thus, all infants with prenatal diagnosis of CCAM require postnatal evaluation. Normal radiographic findings at birth do not rule out CCAM persistence on CT. The treatment of asymptomatic CCAM is controversial. Surgery may be advocated because of the low morbidity and the prevention of late complications, above all, cancer. The surgical indications of small (<3 cm) and asymptomatic lesions should be discussed on a case-by-case basis with the parents.
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April 2003