[Therapeutic options for haemangiomas of infancy]. / Überblick der Therapiemöglichkeiten im Management von Säuglingshämangiomen.

The necessity of haemangioma treatment in infants has been controversially discussed for years. One reason is the favoured clinical observation of a potential spontaneous involution without any therapeutic approach or medical treatment, thus avoiding their specific risks. On the other hand, there are several reports on serious cases with -rapidly growing haemangiomas including severe consequences. There are potential complications such as loss of visus in cases of periorbital manifestation. A basic problem is the lack of a unique systematic classification, on the basis of which -diagnostic measures, therapeutic indications and modes could be compared. Such a classification would be much more competent including a sufficient comparison of treatment results. The basic aim in management is to achieve control of the haemangioma growth and induction of its sub-sequent involution back to only a cosmetic detraction. Each threatening functional loss can be classified as an urgent indication for treatment. There is a need to consider the treatment options and their values; in particular, cryotherapy or laser therapy in localised manifestations are mostly -favoured because of the convincing evidence from available data. In the case of a more disseminated haemangioma manifestation, the initiation of propranol medication is possible, a novel drug for this indication. However, there are no follow-up data on the mid-term or long-term outcome available at this time. Further studies on the subject are therefore required.

Bone formation using human demineralised bone matrix (Grafton) for the treatment of bone cysts in children.

Bone cysts, in particular solitary bone cysts, are the most frequent cause of pathological fractures in children. However, there is still a great variety of regimens used to treat these lesions. Since demineralised bone matrix (DBM) is commercially available, we aimed to use this material for the consolidation of bones diagnosed as fragile because of cyst formation. Each of the 7 bone cysts as well as one enchondroma filled with DBM showed a continuous decrease in bone transparency over a period of two years (mean 8 months). A significant decrease in bone transparency and simultaneous cortical remodelling was radiographically detected in these cases as the specific hallmark of an initiated graft incorporation after 3 to 4 months. It was demonstrated that it is possible to heal children within an acceptable period of time using DBM to fill the cystic lesion. DBM appears to be a reasonable and beneficial alternative for the treatment of bone cysts offering both osteoinduction and osteoconductive features.

[Diagnosis and therapy of the traumatic retrosternal dislocation of the sternoclavicular joint in childhood. A case report]. / Traumatische retrosternale Klavikulaluxation im Kindesalter. Diagnostik und Therapy..

Traumatic posterior dislocation of the sternoclavicular joint is a rare injury, most commonly occurring in childhood. Computed tomography should be performed on all patients with suspected or established injuries of the sternoclavicular joint to ensure differentiation between fracture and dislocation. Tridimensional computed tomography provides the best imaging for describing and classifying the lession. After closed repositioning, transarticular Kirschner wires were used for stabilisation.

Expression of MDR1/p-glycoprotein and multidrug resistance-associated protein in childhood solid tumours.

We evaluated the expression of MDR1/p-glycoprotein in paediatric tumours using reverse transcriptase polymerase chain reaction (RT-PCR), RNA dot blot analysis, and immunohistochemistry on formalin fixed paraffin-embedded material with JSB-1 and C-219 monoclonal antibodies, and compared these three techniques. The expression of multidrug resistance-associated protein (MRP) gene was examined by RT-PCR assay. We studied MDR1/p-glycoprotein and MRP expression in 13 samples from 10 neuroblastoma patients, 11 samples from 10 nephroblastoma patients, 2 rhabdomyosarcomas, 1 adrenocortical carcinoma and 10 benign tumours or tumour-like lesions. Eleven of 13 neuroblastomas, 7 of 11 nephroblastomas, 2 rhabdomyosarcomas, 1 adrenocortical carcinoma, and 7 of 10 benign tumours or tumour-like lesions showed MDR1 PCR products. By RNA dot blot analysis, MDR1 transcripts were detectable in 11 of 34 specimens. Immunohistochemically, we detected positive reaction products for JSB-1 in 26 of 36 samples. There was a significant correlation between the immunoreactivity for JSB-1 and the expression of MDR1 mRNA expression by RT-PCR (P = 0.0001). However, the presence of p-glycoprotein immunostaining does not correlate with the MDR1 expression shown by RT-PCR in every case. As for MRP mRNA expression, 9 of 13 neuroblastomas and 10 of 11 nephroblastomas revealed PCR products.

[Pathogenesis and size development of infected saccular aneurysms--an animal experiment study]. / Pathogenese und Grössenentwicklung infizierter sacciformer Aneurysmen--eine tierexperimentelle Studie.

Both femoral arteries of 56 Wistar rats were intersected and re-anastomosed by microsurgical technique. 24 anastomoses were performed under aseptic conditions and 88 were contaminated with a standard suspension of staphylococcus aureus. All the contaminated anastomoses which had remained patent developed true saccular aneurysms that reached their maximum volume during the acute period of infection between the 10th and 50th postoperative day. None of the anastomoses performed under aseptic conditions developed an aneurysm. This experiment represents an animal model for the reproduction of true saccular aneurysms of the arterial wall. It may help to investigate the etiology of arterial aneurysm formation.

[Intraoperative morphologic functional evaluation of the arterial outflow tract--its importance for indications for vascular reconstruction of the femoro-crural vascular segment]. / Die intraoperative morphologisch-funktionelle Beurteilung der arteriellen Ausflussbahn--ihre Bedeutung für die Indikation zur Gefässrekonstruktion im femoro-kruralen Gefässabschnitt.

Radioresistometry, a combination of intra-operative angiography with measurement of peripheral resistance permits a simultaneous morphological and functional judgement of the terminal flow passages. The authors describe a self constructed apparatus making possible to introduce the method into the clinical program of surgical treatment of chronic peripheral arterial occlusions. In a prospective, clinical-experimental study of 106 femoro-popliteal reconstructions they prove: 1. The method completes the preoperative angiogram, enables a more exact indication for vascular reconstruction and allows the detection of surgical technical faults. 2. In extreme values of peripheral resistance (greater than 2,5 PRU) there is no indication for arterial reconstruction in the proximal segments.

[The prognosis of Wilm's tumor in childhood]. / Zur Prognose der Wilmstumoren im Kindesalter.

From January 1974 to June 1990 33 children suffering from Wilms' tumor were treated at the Department of Pediatrics of the Magdeburg Medical Academy. The cumulative five year survival rate was 0.87. The treatment regimen depended on age of patient, stage and histological subclassification of tumor. In spite of an impressive reduction of therapy during the observation period the survival rate of patients remained high. Since 1989 the Nephroblastoma study No 9 of the European International Society of Pediatric Oncology has been applied to improve furthermore the treatment by a preoperative chemotherapy in all patients.

[Experiences with percutaneous drainage of abscesses and pseudocysts]. / Erfahrungen mit der perkutanen Drainage von Abszessen und Pseudozysten.

Percutaneous catheterised drainage of abscesses and pseudocysts as well as of circumscribed suppurations in soft-part tissue is considered an established therapeutic approach. Therapeutic puncture or drainage was successfully performed in 19 cases, following CT-targeted fine-needle puncture and subsequent cytological and bacteriological diagnosis. Inflammatory alterations were tackled by antibiotic therapy according to an antibiogram. Complications did not occur.

[Treatment of acute cholecystitis]. / Die Behandlung der akuten Cholezystitis.

A retrospective investigation was conducted to give an account in this paper of clinical diagnoses, intra-operative findings, and therapeutic results obtained from 453 patients who had received surgical treatment for acute cholecystitis, between 1975 and 1986. The benefits of the approach may be seen from the overall lethality which had been as low as 4.2 per cent. Conservative treatment was found to be indicated only for high-risk cases.

[Paget-von Schroetter syndrome. Therapeutic possibilities, early and late results]. / Das Paget-von-Schroetter-Syndrom. Therapeutische Möglichkeiten, Früh- und Spätergebnisse.

33 patients were treated for Paget-von Schroetter syndrome at the Surgical Department of the Medical Academy of Magdeburg, between 1975 and 1985. The therapeutic concepts were based on streptokinase, thrombectomy, heparin treatment or combinations of these. Phlebography and clinical follow-up checks were used to compare early results with late results (between one and nine years from therapy). The functional results were generally good, but they did not correlate in all cases with findings of patency of the lower veins in the upper extremity. Streptokinase, as compared to thrombosis of the lower extremity, should be therapeutically used with some caution.

Percutaneous angioplasty of carotid artery stenoses.

Percutaneous angioplasty is a well-established method of treating arterial stenoses and occlusions in various regions. In the carotid area this technique is still under discussion. The successful application of angioplasty in eight patients with carotid artery stenoses is reported.

[Hemorrhagic complications following vascular reconstructions in arterial occlusive disease of the lower extremity]. / Die Blutungskomplikation nach Gefässrekonstruktionen wegen arterieller Verschlusskrankheit der unteren Extremitäten.

In comparison with the results of international literature the authors present their experiences gained from 515 arterial reconstructions for chronic arterial vascular occlusion of lower limb with respect to early and late hemorrhage. In this connection hemorrhage following infections of angioplasty using artificial material is of special significance. Despite of its rare occurrence the aorto-enteric fistula should also be known.

[Vascular injury problems in childhood and adolescence]. / Zur Problematik von Gefässverletzungen im Kindes- und Jugendalter.

Because of the marked elasticity of healthy blood vessels in children and adolescents, vascular trauma is very rare. In penetrating injuries, arteriography is not usually necessary but this procedure is essential in cases of blunt trauma to the blood vessels. The type of reconstructive procedure depends on the injury and its extent and can be performed by direct vascular anastomosis, by the insertion of a vein patch or by the transplantation of an autogenic venous segment. General anaesthesia is usually essential. Interrupted one-layer end-to-end anastomosis is advocated. The surgical technique of vascular repair must be meticulous. 12 children and adolescents (most of them had severe multiple injuries including vascular injuries) were followed up clinically and via arteriography. In 11 patients, the reconstructed vessels were found to be functioning normally.

[Histochemical-morphometric studies of skeletal muscles in advanced arterial circulation disorders of the extremities]. / Histochemisch-morphometrische Untersuchungen der Skelettmuskulatur bei fortgeschrittenen arteriellen Durchblutungsstörungen der Extremitäten.

Biopsies of M. gastrocnemius and Nervus suralis of 12 patients with advanced disturbances of circulation were examined by means of morphometrical and histochemical methods. The histological picture of a neurogenic atrophy of the muscle fibres with partially strong hypertrophy of the slow-twitch fibres was found. The main reaction patterns and the pathogenetic mechanisms are discussed. Alterations in the ratio of type I and type II fibres are described. Fiber type disproportions, i.e. more than 75% type I fibres, may suggest that in hypoxia the type II fibres are more intensely damaged than type I fibres. There are correlations between pathological fibre distribution and the success of vasosurgical treatment.

[Electrophoretic behavior of peripheral blood lymphocytes in thermally injured patients]. / Untersuchungen zum elektrophoretischen Verhalten peripherer Blutlymphozyten bei thermisch geschädigten Patienten.

The division of peripheral blood lymphocytes in two populations succeeds by means of the electrophoresis equipment PARMOQUANT 2. These two fractions correspond to the B and the T cells according to Sabolovic. Continuous controls of the course in 9 patients with severe burn injuries showed an increase of the slowly migratory lymphocytes on the second to third day after the trauma. There occurs a slow normalisation towards the initial values in the end of the second week after the burn. This did not happen in case of the death of the patient because of his burn injury.

[Histochemical studies on striated muscle of ischemic and angiosurgically reperfused lower extremities]. / Histochemische Untersuchungen der quergestreiften Muskulatur an der ischämischen und angiochirurgisch reperfundierten unteren Extremität.

There have been reports on an increased oxidative capacity in muscle tissue from the diseased legs of patients with intermittent claudication. In biopsy from specimens the gastrocnemius muscle of 25 patients the effect of arterial reconstructive surgery were studied, using fresh frozen cryostate sections and histochemical reactions for some oxidoreductases. The present study describes additional histochemical changes in the leg muscles in patients suffering from arterial insufficiency. The changes observed are correlated to the clinical severity of the disease.