Acute respiratory insufficiency in an infant caused by a tracheogenic cyst.

The unusual case of acute respiratory insufficiency in an infant of 5 months caused by a large cyst of true tracheal origin is presented.

Cholelithiasis with common bile duct obstruction in a 20-week-old infant.

Formation of bile calculi in the common bile duct is a rare event in early infancy. The following article describes the case of a 20-week-old infant with anal atresia and a deep rectovaginal fistula who presented with recurrent jaundice due to a single calculus in the common bile duct that led to intermittent obstruction of the papilla Vateri. Diagnosis was proven by endoscopically performed retrograde cholangiography and the concretion was successfully removed after transduodenal papillotomy using a Dormia basket.

[Cystic space occupying lesion of the upper pole of the kidney in a newborn infant. Case report and differential diagnosis]. / Zystische Raumforderung am oberen Nierenpol eines Neugeborenen. Fallbericht und Differentialdiagnose.

In a newborn female infant a cystic lesion in the upper pole of the right kidney was detected by sonography 4 weeks before an uneventful delivery. In the postnatal period the sonographic examination, IVP, CT, and the biochemical data as well were not able to classify definitely this lesion as a benign cyst, adrenal hemorrhage or cystic malignoma. Therefore a laparatomy was performed, which revealed a cystic neuroblastoma.

Total pancreatectomy in a case of nesidioblastosis due to persisting hyperinsulinism following subtotal pancreatectomy.

Hypoglycemia with hyperinsulinism persisted in a newborn weighing 6410 g despite treatment with high doses of diazoxide and glucagon, as well as infusions of glucose and somatostatin. A subtotal pancreatectomy was performed after nesidioblastosis had been diagnosed on the basis of the laboratory findings. Due to the persistence of therapy-resistant hypoglycemia, a total pancreatectomy preserving the duodenum and the bile duct was done 6 weeks later. With insulin and pancreatic enzyme substitution the now 6-year, 9-month-old child has shown normal, age, appropriate development.

Treatment of achalasia by the endoscopic-pneumatic dilatation method.

There is no definite cure for the loss of oesophageal peristalsis and incomplete relaxation of the lower oesophageal sphincter associated with achalasia. Pneumatic dilatation is a simple and safe method of achieving symptomatic improvement of the oesophageal passage. By this means five young patients became free of complaints within an average observation period of 6 3/4 years.

Small bowel transplantation: report of a clinical case.

Extensive small bowel resection may become necessary for several reasons in children and adults. The only causal therapy of short bowel syndrome is small bowel transplantation. So far severe immunological problems have caused deleterious results despite technically successful transplantation. A clinical case of small bowel transplantation in a child is reported. The 3-year-old boy had been operated on for volvulus which had led to nearly total gangrene of the whole small bowel. Finally, only 4 cm of jejunum could be saved. Total parenteral nutrition (TPN) therefore became necessary. Small bowel transplantation was carried out with the mother as donor; transplantation technique is described in detail. Postoperative immunosuppression was performed by administration of cyclosporin A and prednisolone. Because of graft rejection, the graft had to be removed on the 12th postoperative day. At present, the child is well and on TPN again. This case shows that small bowel transplantation by living related organ donation is technically possible without impairment of the donor's quality of life. Further experimental and clinical work should be encouraged.

Deep anterior resection with circular stapled anastomosis of congenital megacolon: clinical results.

This report deals with instrumental suture in the deep anterior rectum resection when treating Hirschsprung's disease. The concept includes: ensuring diagnosis, cleaning the intestines, antibiotic prophylaxis, intraoperative testing of the anastomosis and postoperative X-ray by a standardized technique. Our first experience in the use of the stapler was gained with ten patients. One case of anastomosis insufficiency occurred. With the stapler apparatus, safe anastomosis was possible. The stapler facilitates anastomoses in deep resections. Therefore, a deep resection of the pathological segment in Hirschsprung's disease is possible. The practicality of the stapler and the favourable clinical experience justify the continued application of the instrumental suture technique in children's surgery.

[Psychological and cosmetic indications for the surgery of funnel chest]. / Untersuchungen zur psychisch-kosmetischen indikation zur Trichterbrust.

From 1980-1983 the funnel chest of 29 patients (age range 6-40 years) was surgically corrected using Ravitch's method. In 25 patients clinical and cosmetic follow-up investigations were possible. The psychological investigation consisted of standardised interviews with special questions concerning the problems that patients with funnel chest have to deal with. In 16 cases the result of the operation was good, in 7 cases satisfying, 2 patients had a poor result. The presence of a funnel chest did have a psychological impact on most of the patients, who were inhibited in their psychosocial activities. Surgical correction changed these restrictions in most of the patients in a positive way. We conclude that the psychosocial indication for surgical correction of the funnel chest is justified, since our results strongly support this indication.

[Comparative studies on the bioavailability of paracetamol from suppositories]. / Vergleichende Untersuchungen zur Bioverfügbarkeit von Paracetamol aus Suppositorien.

In a comparative study with 10 healthy male volunteers three paracetamol preparations (two commercial products and one preparation with micronized paracetamol) are tested. No differences in absorption and elimination rate as well as in bioavailability are determined. Reported variations in absorption rate and bioavailability can be explained by different vehicle volumes which were applicated. The vehicle volume, that means the dimension of the rectal absorption area is main factor for interpretation of pharmacokinetic data. The micronization of the drug leads to a sustained release. This result is in correlation with in vitro studies.

[Congenital nesidioblastosis. Successful treatment with total pancreatectomy]. / Kongenitale Nesidioblastose. Erfolgreiche Behandlung mit totaler Pankreatektomie.

A 6,410 g newborn baby suffered from severe hypoglycemia despite therapy with high doses of diazoxide and glucagon as well as intravenous application of glucose. There was no persistent response of blood glucose to continuous infusion of somatostatin. A 85% pancreatectomy was performed at the age of 6 weeks, after biochemical findings had indicated hyperinsulinism. As the hypoglycemia reappeared postoperatively, the child underwent total pancreatectomy. Now, at the age of 9 months, the baby's growth and development is normal under substitution therapy with Pankreon and depot-insulin 0.2 U/kg/day.

Leydig cell tumours in childhood.

Two cases of Leydig cell tumours in childhood are presented. In one case, delayed diagnosis and operation led to pubertas praecox vera whereas in the other case normal growth and development occurred after early diagnosis and operation.

Histopathology of the cryptorchid testis.

Morphologic studies of cryptorchid testes do not show any pathologic changes other than one of malpositioning within the first year of life. Beginning with the third year of life histologic alterations become apparent in all structures. There is a marked increase in the number of mitochondria, which later degenerate and develop vacuoles. The endoplasmic reticulum loses its ribosomes almost completely. An enlargement of the perinuclear space develops between the lamellae of the nuclear membrane in the Sertoli cells and the spermatogonia. Light microscopy reveals a decrease in the number of spermatogonia and lack of development of the seminiferous tubules. The tunica propria is widened by a growing number of collagenous fibers, which become arranged in bundles.

Predicting school failure from information available at birth.

Information available from birth certificates was used to predict the psychological and educational status of approximately 1,000 randomly sampled first-grade children. The purpose of the research was to explore the feasibility of using birth certificate information as a cost-effective mechanism to identify children who were likely to need special educational services at public school entry. Multiple-regression and discriminant-function analyses revealed the following factors to be important in predicting psychoeducational status: birth order, race, educational status of the mother, month prenatal care began, survivorship of older siblings, and the child's legitimacy.

Cryptorchism.

Our results from 121 patients as well as data from the literature prove that fertility rates after treatment of uni- or bilateral cryptorchism remain unsatisfactory. There is no statistically significant difference in fertility between a group of patients treated with human-chorionic-gonadotrophin and another group treated by orchidopexy after unsuccessful hormonal therapy. On the other hand, late results in unilateral cryptorchism are to a statistically significant extent better than in bilateral cryptorchism (46/29%). According to our histological findings in maldescended testicles, early treatment (before the age of 3 years) is advocated.

[Morphologic changes in cryptorchism (author's transl)]. / 65. Die feingeweblichen Veränderungen bei der Retentio testis

Histologic changes caused by malposition occur in the undescended testicle after the second year of life. Histologic changes like those seen in the human are found in experimental cryptorchism in dogs. The same pathologic changes also occur in the unilaterally descended testicle. The results of preliminary experiments in dogs allow the statement that in unilateral cryptorchism the damage to the contralateral, descended, testicle is produced by an autoimmunologic mechanism.