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This case-control study was designed to evaluate the potential advantages and disadvantages of video-assisted thoracoscopic surgery for right middle lobectomy in children. Ten children (6.1 +/- 3.0 yr, mean +/- SD) who underwent right middle lobectomy under videoscopy were compared with 10 controls matched for age (6.8 +/- 3.5 yr) and operated by thoracotomy (muscle-sparing technique) during the same period by the same surgeon. Operating time was significantly longer in the videoscopy group than in the thoracotomy group (146 +/- 28 mn vs 100 +/- 27 mn, P < 0.001). Minimum oxygen saturation values were significantly higher in the videoscopy group whereas oxygen requirements did not differ between groups. Incidence of postoperative respiratory complications (mainly atelectasis) was similar in the two groups. No difference in postoperative analgesic requirements in the postoperative period was demonstrated. No real benefit or disadvantage of videoscopy over standard thoracotomy could be observed in this retrospective case-control study.

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Despite increasingly rigorous preventive measures which have limited the number of cases in France, the number of children undergoing surgery for tuberculosis has remained unchanged. Over the last ten years we operated on 40 children in our pediatric unit. In 10 cases, surgery was indicated for diagnosis, in 19 cases surgery was required in an emergency situation during treatment and in 11 the operation was performed at the stage of sequellae. The type of surgery depended on the clinical situation. Thoracoscopy was used for surgical diagnosis and to empty caseous nodes in the lateral tracheal chain but was generally impossible at the sequellae stage.

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Right pneumonectomy can lead to severe respiratory impairment due to stenosis of the left main bronchus. This syndrome is usually treated by inserting a fixed-volume prosthesis but, in children, expandable prostheses have the advantage of being adaptable to growth and permit progressive recentering of the mediastinum. We report 3 such cases, with the results of pulmonary function tests. The patients were aged 11, 17, and 22 years at the time of implantation and had undergone pneumonectomy during childhood for either bronchiectasis or complete pulmonary sequestration. All 3 patients are doing well, with a follow-up of 1 to 3 1/2 years. Pulmonary function tests have shown a substantial improvement in the obstructive syndrome in 2 patients whereas, in the third patient, in whom the contralateral lung was not perfectly healthy, the functional improvement was only moderate.

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The authors report the case of an intralobar pulmonary sequestration in a newborn presenting congestive heart failure. The clinical symptoms mimicked a persistent ductus arteriosus. Clinical, radiographic and echographic data suggested the diagnosis which was confirmed by the angiography. A surgical treatment was realised at seven weeks consisting in the ligation of the abnormal artery and a right lower lobectomy. This is the 9th case found in the literature. A congestive heart failure in a neonate with normal intracardiac anatomy may suggest a pulmonary sequestration.

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The authors report the case of 5 1/2 year-old boy with insulin-dependent diabetes mellitus revealed during the induction therapy of an acute leukemia of the mixed type, and who presented with an unusual type of pulmonary fungal infection: mucormycosis. It had a favourable outcome with surgical excision preceded and followed by amphotericin B treatment.

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Intraoperative hemorrhage during hepatic veins approach or during liver parenchyma transsection is the major risk of liver resection for children. We report a technique for hepatic resection based upon facility of safe ligation or clamping of vessels and ductules on a bloodless cut surface during transsection. This technique limits risk of extensive hemorrhage or damage to residual parenchyma, without heavy procedures of anatomical resections. Particularities of liver tissues and capsula of children are used. Perfect hemostasis of the cut edge is obtained by mattress sutures on Silastic * straps performed after clamping with specially designed liver clamps. The 3 main interests of this clamping are detailed. 21 liver resections were performed on children ranging in age from 9 months to 11 years. There was one intra-operative death and one within 30 days. Total blood loss during procedure was about 1/3 blood mass.

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21 cases of bronchogenic cysts and 8 cases of oesophageal duplications obstructing trachea and main bronchus are described. These mediastinal obstructing cysts should be recognized very early to avoid complications: respiratory distress and destroyed lung particularly. Surgery is not difficult and the results are good. 28 children are alive with no symptom and one death only occurred.

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Digestive duplication affecting the oesophagus is rare, and forms causing compression of the airways are even more so. We prefer to distinguish these lesions from bronchogenic cysts and have collected 8 cases: 6 of Jaubert at Beaujon and 2 personal. The group includes 6 boys and 2 girls.

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Three children presenting with vascular abnormalities of the right lungs are reported. Clinical symptoms were not specific. Total lack of perfusion associated with normal ventilation at pulmonary scintiscanning was highly suggestive. Diagnosis was confirmed by pulmonary catheterism and angiography. The congenital or acquired nature of these abnormalities is not established. Development of pulmonary arterial hypertension during follow-up may need pneumonectomy.

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The authors report the cases of 2 children, 12 and 4 years old respectively, presenting with a lipoma of the postero-superior mediastinum, that were investigated within a 6 year-period. Costal erosions were present in both cases with intraspinal extension in one child. Standard X-ray films should have led to the diagnosis, because of the relative low density of the mass considering its volume. In one case, CT scan confirmed the homogeneous fatty nature of the mass.

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The authors report 5 cases of bronchial cysts of the carina tracheae in girls. Symptomatic cysts were located on the left. Diagnostic delay was often very long: about 2 years between the first signs and surgery. When the cyst was on the left side, it was not directly visible on standard x-ray films or tomographies of the chest. Barium swallow shows a typical compression on the anterior part of the esophagus. In children with relapsing atelectasis or over distension, localized on the left, CT scan might allow for earlier diagnosis, as the density of bronchial cysts in high: about 50 Hounsfield units.

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The short term prognosis of the esophageal atresia has been improved by the progress of diagnosis and surgical techniques. The long term prognosis still depends upon the occurrence of bronchopulmonary complications. Having investigated fourteen cases and a review of the literature, the authors studied the cause of these respiratory complication. Two factors seem to play an important role: the gastroesophageal reflux and the tracheomalacia. This has important therapeutical implications: treatment of the gastro-esophageal reflux and long term respiratory kinesitherapy. The authors suggest for these patients a management plan over several years.

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