[Interstitial laser hyperthermia of gastrinoma liver metastases in a child]. / Interstitielle Laserhyperthermie von Gastrinomlebermetastasen beim Kind.

Ultrasound-guided, laser-induced thermocoagulation with Nd:YAG laser (1064 nm) was performed in a child with metastatic gastrinoma disease. The emitted laser energy to coagulate a radius of 15-20 mm of metastatic liver tissue was 4 W with a duration time of 300 s. Marked reduction of gastrin was observed after interstitial laser hyperthermia.

Late results in the management of choledochal cysts.

From 1971 to 1990, 18 children were surgically managed for choledochal cysts at two Berlin pediatric surgical units. Eight patients underwent an internal drainage procedure, eight a Roux-en-Y hepaticojejunostomy and one a choledochoplasty. The children were followed-up 2 to 20 years later (median: 8.4 years). Three children died in the early postoperative period, but the immediate postoperative course was uneventful in all other cases. Later, five patients suffered from recurrent gastrointestinal disease, cholangitis and pancreatitis and, in two cases, from progressive liver fibrosis. Four of the five patients with symptoms had undergone internal drainage procedures; one developed cholangitis after a hepaticojejunostomy. In one case of internal drainage, the anastomosis was transformed into a hepaticojejunostomy. No patient had cancer.

The transthoracic hiatoplasty for cases of non-operable gastroesophageal reflux.

After surgery in the upper abdomen is performed, conditions may develop prohibiting transabdominal repair of gastroesophageal reflux. The transthoracal hiatoplasty after L. Braun does not in all cases eliminate the reflux; it cures, however, the ulcers as well as the esophagitis.

[Urethral replacement with free urinary bladder mucosal transplant]. / Harnröhrenersatz durch freies Harnblasenschleimhauttransplantat.

An electro-resection was carried out in a subvesical blind-hole stenosis in a 5 month old male baby. Afterwards a 3 cm long urethral defect resulted in the penoscrotal junction. This was bridged with a free mucosal graft from the urinary bladder by the technique of Memmelaar and Hendren.

[Bladder exstrophy. Treatment results over 27 years]. / Die Blasenekstrophie. Behandlungsergebnisse von 27 Jahren.

Between 1960 and 1988 47 patients with bladder exstrophy were attended. 7 various operative procedures were applied. 3 patients died postoperatively, 37 of the 42 patients would be examined after 1 11/12 to 27 years. All patients with ureterosigmoidostomy exhibited electrolyte disturbance and metabolic acidosis. Patients with sigmoid conduit, rectal bladder and bladder reconstruction had unremarkable findings. The uretero-enterostomy anastomotic region was endoscopically essentially unremarkable. The control of continence was from satisfactory to good, and there was not absolute incontinence. X-ray investigation revealed both distinct and indistinct changes. The psychic and social stress was more serious in childhood than in adulthood.

Experimental studies on caustic burns of the stomach by aggressive chemicals.

The treatment of caustic burns of the stomach in childhood by acids, alkalis and especially soldering fluids has remained without any clear concept so far. Surgical treatment consists of therapy of acute complications or late sequelae. Early endoscopy enables one to decide between conservative treatment and early laparotomy. Animal experiments were performed in albino rats for the development of a therapeutic concept. Because of its amphoteric and aggressive nature, soldering fluid zinc dissolved in 33-50 M saline) was used as the caustic substance. Clear demarcation and tissue changes can be recognized after 6-8 h, at the earliest. Laparotomy aiming at protective plication or atypical gastric resection should be performed at that time, if endoscopy reveals a third-degree caustic burn of the stomach.

[A rare cause of rectal hemorrhage]. / Seltene Ursache einer Rektalblutung.

Report of a patient who discharged water and doughy stools since birth. At the age of 2 yrs. 10 mo. he had terry stools, a perforation of the sigmoid was caused by an ulcer, the perforation was oversewn. Further discharge of liquid stools. Rectoscopy, endoradiography, rectal biopsy with identification of gastric mucosa. 99mTc-pertechnetate was accumulated in the rectal mucosa. At the age of 4 years, demucosation and pull-through was done. A cleft vertebral body and a finger-shaped diverticulum were found and interpreted as sigmoid duplication. This is the only such case observed by us in 32 years.

Outcome following surgery for solitary kidney in children.

We reviewed 8700 urological patients treated as inpatients over a period of 30 years, among them 386 children with primary or secondary solitary kidneys. Forty-one of these children had to undergo surgery for secondary pathological conditions of their solitary kidney. Diagnosis, treatment and results are analysed and tabulated for 20 primary and 21 secondary solitary kidneys. Generally, the prognosis of a primary solitary kidney is poorer than that of a secondary solitary kidney. Patients who have to undergo dialysis belong to the group with primary solitary kidneys. The worst prognosis is that for the combination of subvesical stenosis and associated uropathy.

Experience in surgical treatment of pulmonary and bronchial tumours in childhood.

From the patient material of three paediatric surgical centres and the patient material of the paediatric surgical hospitals of Zurich, Switzerland and Leipzig, GDR, 24 cases of lung and bronchial tumours are reported. The aim of this review is to show a spectrum of the cases observed in our region. The most frequent of these very rare tumours was pulmonary blastoma, followed by endobronchial adenoma in its different variants. Since only the latter can be endoscopically diagnosed, endoscopy should be carried out as early as possible when the diagnosis is not clear. Cystic lung disease seems to be particularly frequently associated with pulmonary blastomas. Uncertainties in diagnosis and therapy owing to the rareness of these diseases cause further problems.

Clinical symptoms and therapy of lung separation.

This paper refers to the different terminology used in so-called lung separation/sequestration and to the standpoint of the pathologist. Theories of development are discussed. Clinical symptoms, diagnosis, indications for operation and operative technique are described, and nine cases of lung separation (six with extralobar and three with intralobar forms) tabulated analysed. Among them there is a 5-month-old female infant with extralobar lung separation in the right hemithorax resulting in recurrent pleural effusions with severe respiratory insufficiency. There was evidence of aeration in the pathohistological preparation. Pleural effusion and the origin of the aeration in the separated lung are discussed.

[Perforated appendicitis in childhood--an apparently ever-present problem]. / Appendicitis perforata im Kindesalter--ein scheinbar bleibendes Problem.

An analysis was made of the authors' surgical patients in childhood with perforated appendicitis for two periods of time, 1957 to 1967 and 1971 to 1985. The rate of perforation remained to be high, with no change to the good being discernible. Hints are given on its possible reduction.

Immunologic status of children after splenectomy.

Fifty-six splenectomized children were reexamined to verify their immune status and were compared with a control group. Except for Werlhof's disease, there was a significantly increased serum IgG level in splenectomized children, as compared with the control group, and diminished IgA and IgM levels. Susceptibility to postoperative infections is dependent on age and underlying disease. Generally, susceptibility cannot be predicted following splenectomy in the individual case.