Success and Failure for Children Born with Facial Clefts in Africa: A 15-Year Follow-up

Background: This study reviews the 15year program of our Department of Pediatric Surgery for the treatment and follow-up of children born with a cleft in Benin and Togo. Methods: We analyzed files of children born in Africa with a cleft. They were referred to us through a nongovernmental organization (NGO) between 1993 and 2008 and assessed in Africa by local pediatricians before and after surgery. Operations were performed by our team. Results: Two hundred files were reviewed: 60 cases of unilateral cleft lip, seven of bilateral cleft lip, 44 of unilateral cleft lip palate (UCLP), 29 of bilateral cleft lip palate (BCLP), 53 of cleft palate (CP), three of bilateral oro-ocular cleft, one of unilateral and two of median clefts (Binder), and one of commissural cleft. Sixty-nine (35%) of these cases were not operated in Africa: 25 (12.5%) had not shown up, 28 (15%) were considered unfit for surgery (Down's syndrome, HIV-positive, malnutrition, cardiac malformation), and 16 (7.5%) were transferred to Switzerland. Palatal fistula occurred in 20% of UCLP, 30% of BCLP, and 16% of CP. Evaluation of speech after palate surgery gave less than 50% of socially acceptable speech. Conclusions: Our partnership with a NGO and a local team makes it possible to treat and subsequently follow children born with a cleft in West Africa. Surgery is performed under good conditions. If aesthetic results are a success, functional results after palate surgery need further improvement to promote integration in school and social lif

Améliorer les pratiques de soins pour les personnes présentant une variation du développement du sexe en Suisse : l’Ecole de Lausanne (depuis 2005) = Improving Standards of Care for Persons with a Variation of Sex Development in Switzerland: The Lausanne School (since 2005)

Cet article présente un bref historique de l’Ecole de Lausanne, appelée parfois « modèle suisse » à l’étranger, qui a été créée dans le cadre d’un projet interdisciplinaire « SHS et genre en médecine » initié en 2005 pour améliorer les pratiques de soins pour les personnes présentant une variation du développement du sexe. Nous nous proposons de revenir ici de manière réflexive sur plus de dix ans de travail collaboratif en explicitant les conditions de possibilité, les raisons, les objectifs et les différentes modalités de développement d’une équipe enseignante et hospitalière multidisciplinaire connue pour différer toute chirurgie génitale précoce d’assignation du sexe, respectant en cela le droit des enfants concernés de participer à la décision d’être opéré ou non. L’expérience lausannoise témoigne de la possibilité non seulement de changer les pratiques cliniques au profit d’une prise en charge qui ne soit pas prioritairement chirurgicale, mais aussi de développer une éthique médicale « par le bas » pour pallier l’absence de recommandations éthiques comme c’était le cas jusqu’à récemment en Suisse. ENGLISH ABSTRACT: This article presents a short history of the Lausanne School or “Swiss model” (as it is sometimes called abroad) created in the context of an interdisciplinary “SHS and gender in medicine” project we launched in 2005 to improve medical care for persons with a variation of sex development (VSD). We reflect here on our collaborative work experience for more than 10 years now in order to highlight the conditions of possibility, the reasons, the goals and the various development modalities of a VSD teaching and hospital team committed to multidisciplinary care. Our team is also known for its commitment to differ early genital surgeries so as to respect children’s right to participate in medical treatment decisions. The Lausanne experience testifies to the possibility of changing clinical practices to implement “a less cutting, more talking” model of care and, at the same time, of developing a medical ethics “from below” to overcome the lack of ethical recommendations as it was the case until 2012 in Switzerland

Hematuria in a 12-year-old child, a rare case of urothelial papilloma of the urinary bladder

We describe a case of a 12-year-old boy with an isolated macroscopic hematuria. A urinary ultrasound revealed a bladder tumor next to the right ureteric orifice. A biopsy revealed a urothelial papilloma. He underwent a successful resection by cystostomy. This benign tumor is extremely rare in children and its management remains controversial

Diagnostic et prise en charge de la torsion testiculaire chez l'enfant

Testicular torsion is a true urologic emergency with a bimodal age presentation : the perinatal testicular torsion presenting with a hard, tender or non-tender scrotal mass usually with underlying dark discoloration of the skin and the peripubertal testicular torsion presenting with severe acute testicular pain, vomiting and frequently pain irradiation in the inguinal area, a high riding-horizontally positioned testis and absence of the cremasteric reflex. Obtaining a US Doppler must not add unnecessary delay to the urgent surgical treatment which entails detorsion and bilateral orchidopexy. We do not recommend manual detorsion as around 30 % of testis rotate externally. Up to 50 % of patients presenting with a testicular torsion suffered beforehand from intermittent testicular pain episodes

New combined serum creatinine and cystatin C quadratic formula for GFR assessment in children.

BACKGROUND AND OBJECTIVES: The estimated GFR (eGFR) is important in clinical practice. To find the best formula for eGFR, this study assessed the best model of correlation between sinistrin clearance (iGFR) and the solely or combined cystatin C (CysC)- and serum creatinine (SCreat)-derived models. It also evaluated the accuracy of the combined Schwartz formula across all GFR levels. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Two hundred thirty-eight iGFRs performed between January 2012 and April 2013 for 238 children were analyzed. Regression techniques were used to fit the different equations used for eGFR (i.e., logarithmic, inverse, linear, and quadratic). The performance of each model was evaluated using the Cohen κ correlation coefficient and the percentage reaching 30% accuracy was calculated. RESULTS: The best model of correlation between iGFRs and CysC is linear; however, it presents a low κ coefficient (0.24) and is far below the Kidney Disease Outcomes Quality Initiative targets to be validated, with only 84% of eGFRs reaching accuracy of 30%. SCreat and iGFRs showed the best correlation in a fitted quadratic model with a κ coefficient of 0.53 and 93% accuracy. Adding CysC significantly (P<0.001) increased the κ coefficient to 0.56 and the quadratic model accuracy to 97%. Therefore, a combined SCreat and CysC quadratic formula was derived and internally validated using the cross-validation technique. This quadratic formula significantly outperformed the combined Schwartz formula, which was biased for an iGFR≥91 ml/min per 1.73 m(2). CONCLUSIONS: This study allowed deriving a new combined SCreat and CysC quadratic formula that could replace the combined Schwartz formula, which is accurate only for children with moderate chronic kidney disease

Pédiatrie

Perinatal asphyxia. Perinatal asphyxia remains one of the most important causes for high mortality and morbidity in the neonatal population. Despite intensive animal and clinical research in this field, no pharmocological strategy has been shown neuroprotective in humans. Moderate hypothermia for severely and moderately asphyctic babies has been aknowledged since a few years as therapeutical approach to improve the outcome of these infants, specifically the long-term follow up (18 months). Neonatal hydronephrosis. Neonatal hydronephrosis is a pathology that requires regular and efficient follow up by a multidisciplinary team. One of the causes of neonatal hydronephrosis is obstructive pathologies which may endanger the kidney. We have developed a strategy that allows a rapid diagnosis of obstructive pathologies with minimal radiological exams. Moreover, this strategy assures the coordination between obstetricians, neonatologists, pediatric urologists, and pediatric nephrologists