Postoperative intussusception in childhood.

Over a period of 10 years, five children developed postoperative intussusception after intra-abdominal procedures at the Department of Pediatric Surgery of the Johannes Gutenberg University Mainz. Two appendectomies, one ileal resection for a Meckel's diverticulum, one operative procedure for Hirschsprung's disease plus intestinal neuronal dysplasia type B, and one hiatoplasty with jejunostomy preceded the intussusception. Three of the five children were older than 2 years. The clinical symptoms consisted primarily of abdominal distension, diffuse abdominal pain, bilious vomiting, and rectal bleeding in one case. Preoperative diagnosis was achieved in four cases by abdominal ultrasound. Plain abdominal radiographs demonstrated dilated loops of small intestine with air-fluid levels in four of the five cases. In the case without radiographic findings, the jejunojejunal intussusception was missed even by a bowel follow-through. The intussusceptions were ileocolic (3), ileoileal (1), and jejunojejunal (1). A hydrostatic procedure to reduce an ileocolic intussusception was not successful. Operative treatment of the intussusception was performed in three cases within 5 days, once at 32 days, and once 3 months after the primary operation, in all cases by laparatomy and simple manual reduction without intestinal resection. In contrast to idiopathic intussusception, noninvasive hydrostatic procedures are not indicated in postoperative intussusception, since protection of intestinal anastomoses from hydrostatic pressure and exclusion of other causes of postoperative ileus are mandatory.

[Diagnosis and surgical therapy of thyroid gland diseases in childhood]. / Diagnostik und operative Therapie von Schilddrüsenerkrankungen im Kindesalter.

Among children, thyroid disease rarely points to a particular surgical therapy and therefore requires a very specific surgical approach as well as close interdisciplinary cooperation between pediatricians, pediatric surgeons, and nuclear medicine practitioners, in particular regarding the follow-up. As a consequence, excellent functional and long-terms results can be achieved. The extent of the radical surgery pertaining to the small, encapsulated papillary carcinoma is still being discussed and investigated.

On the haemodynamics of arteriovenous fistulas in the rat.

Direct and indirect arteriovenous fistulas were applied to the cervical vessels of 19 rats in order to study the haemodynamic parameters of angioma-like, rapid blood flow in small vessels. Flow was measured electromagnetically and intraoperatively using the Doppler sonography, and both methods were compared. Resultant alterations in vessel walls were examined under the electron microscope. Following fistula application, the flow rates increased by a factor of ten. At the same time, the flow pattern profile and stream resistance also changed. At present, the Doppler sonography device employed here is the only one commercially available, yet it could not detect rapid flow rates (greater than 85 cm/sec). The abnormal haemodynamic strain on the venous walls led to morphologically and angiographically detectable alterations.