ABSTRACT
A method of back closure with the use of latissimus dorsi myocutaneous flap in cases of myelomeningocele is reported. A three-layer cover consisting of the skin, subcutaneous fat, and the muscle with proper innervation and blood supply of the flap permits successful closure of large defects. Well-vascularized coverage prevents common complications such as partial necrosis of the flap or wound breakdown and consequent infection of the central nervous system. This report is based on 30 cases of newborns with large thoracolumbar myelomeningocele.
Subject(s)
Meningomyelocele/surgery , Muscles/transplantation , Back , Humans , Infant , Surgical FlapsSubject(s)
Cleft Palate/surgery , Palatal Obturators/methods , Age Factors , Child , Child, Preschool , Humans , InfantABSTRACT
The intravesical transurethal electrostimulation was introduced by F. Katona in order to create consciously controlled micturition in patients with neurogenic bladder lesions. The principle of therapy is based on the activation of the intramural receptors and vegetative pathways from the bladder with special exponential electric impulses. The electric stimulation should evoke the bladder sensation and finally the conscious urge to void might develop. Simultaneously the detrusor tonus should be normalised and evoked contractions become stronger and organised, to be able to empty bladder in stream. During the period from May 1977 to October 1980, 24 children with neurogenic urinary incontinence (aged 2-18 years), were treated in the Surgical Department of the Institute of Mother and Child. Most of them have been operated on for meningomyelocoele , 1--for spinal ependymoma, 1--suffered from extensive haemangioma of pelvic brim and spine, 1 child had no obvious signs of dysraphism. The therapeutic programme consisted of 2 series of 40 stimulations in each serie , applied every day. Each session lasted 90 minutes. The current parameters were: intensity of exponential waves, steadily increasing from 0,4 to 6 m A, frequency 70 Hz, impulse duration 5 msek . Before treatment the clinical, neurological and radiological evaluation were done. The extension of neurologic deficite and state of urinary tract were assessed. Every child had IVP and micturition cystourethrography. Since 1978 the urodynamic investigations were introduced. Cystometry was performed before and after each serie of stimulation. Since 1979 the measuring of urethral pressure profile was included, for more exact evaluation of the type of bladder lesion.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Electric Stimulation Therapy/methods , Urinary Bladder, Neurogenic/therapy , Urinary Incontinence/therapy , Adolescent , Child , Child, Preschool , Follow-Up Studies , Humans , Reflex, Abnormal/therapy , Urinary Bladder/innervation , Urinary Bladder, Neurogenic/complications , Urinary Incontinence/etiologyABSTRACT
The authors discuss two cases in which following abdominal operations in consequence of septic shock, infection and hypoxia, necrosis of the gastric wall developed requiring further operations, subtotal resection of the stomach included. Attention is paid to the factors responsible for full recovery.
