[Treatment of Wilms' tumor (author's transl)]. / Therapie des Wilms-Tumors.

Uniform treatment based on the therapeutic approach of the 1st and 2nd US National Wilms' Tumor Study was decided on in March 1976 by paediatricians, surgeons, urologists and radiotherapists in Austria. Wilms' tumour was diagnosed in 34 children between 1 january 1976 an 29 february 1980 (stage I: n = 11, stage II: n = 8, stage III: n = 8, stage IV: n = 7). Parents of two children refused treatments; both children have since died of metastases. Of the remaining 32 children 29 (90.6%) are alive, 10 for more than 4, 15 for more than 3 and 19 for more than 2 years after diagnosis. 21 children are without need of treatment. Three children have died, one due to postoperative complications, one due to haemorrhagic chickenpox, but free of tumour, and one after insufficient treatment. Two of the five children with a recurrence between 2 1/4 to 15 months after diagnosis had been treated inadequately in the initial phase. The tumour free survival rate in 74.2%. Two children with early occurring or recurrent lung metastases have survived for 53 1/2 and 54 months up to now.

[Illness due to enterolith in children (author's transl)]. / Krankheitsbilder im Kindesalter, die durch Kotsteine verursacht werden können.

The aim of this paper is to emphasize the extreme importance of the rectal examination and exact palpation of the abdomen in cases of obscure abdominal pain, especially as it is purely a question of a simple and inexpensive diagnostical procedure. The rectal examination should always be carried out prior to any large scale diagnostical procedures as it does, in the care of positive findings, spare the child the considerable burden of X-rays. If, after an appendectomy, the same pains that led to the operation continue, one must conclude that their cause has not been removed by the operation. An exact clinical classification should be undertaken to avoid the later occurrence of a critical illness (ileus). As with any diagnosis, it is necessary in the event of enterolith too, to regard it as a possibility. The anamnestic registration of a daily bowel movement should not be a reason for not carrying out the rectal examinations as large quantities of stool can collect.

[How dangerous is splenectomy in Hodgkin's disease? (author's transl)]. / Wie gefährlich ist die Splenektomie bei Morbus Hodgkin?

Serious complications aetiologically connected with the operation were found in 8 out of 51 patients (19 females, 32 males) who had undergone splenectomy for Hodgkin's disease. Weighing potential complications against the expected beneficial effects, clear indications for splenectomy are only found in stages I and IIa. In all more progressed clinical stages splenectomy should only be performed when 1) platelet deficiency existed prior to treatment, 2) additional irradiation of the splenic area is to be avoided, 3) oophoropexy is to be performed at the same time. When discussing the indication for splenectomy one should remember that a delay of treatment by approximately three weeks will result.

[Cholelithiasis in children and adolescents (authors transl)]. / Cholelithiasis bei Kindern und Jugendlichen.

Cholelithiasis is a rare, but important condition to be considered in the differential diagnosis of abdominal symptoms in childhood and adolescence. A survey over a 20-year period revealed 10 cases between the ages of 11 and 20 years, with a clinical history of cholelithiasis of between 5 days and 6 years. The most consistent finding was epigastric or right upper quadrant pain. Serum chemistry did not contribute conclusively towards the diagnosis. Hereditary spherocytosis was demonstrated in 3 cases, 2 had familial gall bladder disease, whilst in the rest no cause could be found. Two patients are described in some detail: one girl with spherocytosis and a bilirubin of 78 mg/100 ml, presenting with choledochal obstruction and pancreatitis, and another girl with a history of recurrent abdominal pain, negative radiologial and chemical pathological findings and a tentative diagnosis of neurosis. Oral cholecystograms lead to the diagnosis in most cases; however i. v. cholangiograms should be considered whenever the diagnosis appears in doubt. All cases were treated by cholecystectomy and recovery was uneventful in 9 patients. Cholecystectomy should be performed in all patients with gall stones, even in the absence of symptoms.

[Polycythaemia as sole symptom of renal adenoma (author's transl)]. / Polyzythämie als einziges Symptom eines Nierenadenoms bei 2 Kindern.

In two children, a 9 year-old boy and a 10 1/2 year-old girl, who presented with polycythaemia as the only symptom, the expected renal tumour was only found after exclusion of all other causes of polycythaemia. The delay in diagnosis was caused by technically inadequate intravenous urograms, which were erroneously passed as normal. In one child low kv X-ray exposition of the kidneys led to the diagnosis of a renal tumour. In the other child high-dose urography and tomography gave the indication for selective angiography. Normalization of the red blood count postoperatively verifies the connection between preoperative erythrocytosis and the renal tumour. Histologically both cases proved to be renal adenomas, which are extremely rare in childhood.

[Congenital hepatic fibrosis and polycystic disease of the kidneys in two siblings (author's transl)]. / Congenitale Leberfibrose und Zystennieren bei zwei Geschwistern.

Report of 2 siblings, aged 12 1/2 and 9 years, with congenital hepatic fibrosis and polycystic disease of the kidneys. Hepatosplenomegaly had been noted in both children at birth. The younger child had suffered from oliguria aged 2 1/2 years. At diagnosis both children had low platelet counts, one also had leucopenia. The cystic disease of the kidneys was verified by angiography. Coeliacography and splenopartography were diagnostically irrelevant. The diagnosis only became apparent from liver biopsy which was performed during splenectomy. After splenectomy there was an increase of platelets, white blood cells and the clotting factors II, V and X. The three years follow-up showed a constancy of renal impairment and of the minor oesophageal varices observed in the one patient who did not have a spontaneous spleno-renal anastomosis. So far no bleeding has been observed. Porto caval anastomosis was omitted in both children. Pros and cons are being discussed.

[Surgical treatment of wilms' tumour and neuroblastoma with particular reference to staging (author's transl)]. / Chirugie der Wilms--Tumoren und Neuroblastome unter besonderer Berücksichtigung der Stadieneinteilung

Combined surgical, irradiation and cytostatic therapy has considerably improved the outlook in cases of Wilms' tumour over the past years. Unfortunately the therapeautic results in neuroblastoma have not shown improvement to the same extent. Staging of the tumour is an essential basis for thee establishment of optimum therapeutic management and prognosis. Further improvement in results could be achieved with enhanced early diagnosis of these tumours and centralized treatment in centres with requisite specialist teams.

[Cystic changes in the lungs in childhood (author's transl)]. / Zystische Lungenveränderungen im Kindesalter

Two boys with presumably congenital cystic changes in the lungs are described. In one child multiple cystic deformations led to acute symptoms of severe respiratory distress necessitating urgent resection of the right middle and upper lobes. The other boy had a large thick-walled cyst in the left upper lobe causing no distress whatsoever. This patient was observed for more than 6 years before operation. Multiple vascular anomalies and anastomoses were revealed during surgery. Both cases are presented in detail and the completely different clinical course is outlined. Only when careful supervision of intrapulmonary cystic changes is guaranteed can operation be postponed for longer than 6 months. Pulmonary cysts may lead to emergency procedures. They are always a potential source of serious complications such as rupture or infection. When no tendency for regression can be discovered surgical removal is indicated. Conservative treatment will not influence the course. Differential diagnosis is discussed briefly.

A morphologically different type of smooth muscle cell in the inner media of the splenic artery.

A morphologically different cell type to the typically smooth muscle cell has been found in the inner medial layers of the splenic artery. Besides the morphological differences, typical criteria for a smooth muscle cell are demonstrated, giving an account of their identity. Morphological details are described. The importance of these cells as regards lesions of the vessel wall is briefly discussed.

[Clinical aspect and therapy of BCG-lymphadenitis (author's transl)]. / Die BCG-Lymphadenitis und ihre Behandlung

BCG-Lymphadenitis is a local complication of BCG-vaccination. The rate of complication depends on the kind of vaccine used, the dose and the used technique. In the last 9,5 years 32 infants with BCG-Lymphadenitis complicated with suppuration or perforation have been treated surgically. For 6 patients the treatment included a pre- and postoperative tuberculostatic therapy, for 11 patients included antibiotics. In 15 cases only surgical treatment was performed. In all 3 groups satisfactory results have been achieved, therefore tuberculostatic therapy seems not to be necessary and an antibiotic therapy ought to be reserved for cases with secondary miscellaneous infection. There is no doubt that it is possible to shorten the duration of this disease through early extirpation and to achieve a favourable cosmetic result too.

[Angiography, scintigraphy and ultra sound in the diagnosis of splenic or hepatic disease in Hodgkin's disease (author's transl)]. / Angiographie, Szintigraphie und Ultraschall zum Nachweis von Milz- oder Leberbefall bei Morbus Hodgkin

The combined use of selective angiography, scintigraphy and ultra-sound is not reliable enough for the certain exclusion of visceral involvement in Hodgkin's disease. Since this is of importance in the planning of treatment, it confirms the recommendation made by Wagenknechts, Glatsteins and others that a diagnostic splenectomy be carried out in order to determine the presence of visceral involvement.

[Clinical picture and therapy of gastroschisis (author's transl)]. / Zur Klinik und Therapie der Gastroschisis

The results of operative treatment of gastroschisis have been improving in recent years. The survival rate is now between 50 and 60 p.c. It is very important to perform primary repair as soon as possible after birth. According to our own experiences resection of the bowel should be avoided as it gives a poor prognosis. Combined malformations of gastroschisis are very rare and their treatment should be tired since there is no other alternative. An own successfully treated case of combined malformations of gastroschisis with atresia of the small bowel is presented. Stenosis of the duodenum and tubular duplication are described

[Morphology of transplanted liver. an experimental study (author's transl)]. / Zur Morphologie der transplantierten Leber. Eine experimentelle Studie

Experimental orthotopic livertransplantation is a very difficult procedure (Largiadér). This is due to the difficult specific anatomy of the liver, the high sensibility of the liver against anoxia and the distrubance of blood coagulation during transplantation. This investigation demonstrates that ischemia does not only damage the livercells, but also the bile ducts. We could show that these changes on the bile ducts are responsible for a certain number of unsuccessfull results of livertransplantations. In basic experiments we could demonstrate that ischemia is the cause of bile duct changes. There is always a critical situation for the common bile duct, when we tie the hepatic artery and dissect simultaneously the common bile duct. To keep this changes to a minimum we pay attention to the following points: 1. Correct perfusion and cooling of the livertransplant. 2. Fast recirculation of the hepatic artery before performing portal anastomosis. 3. The dissection of the common bile duct near the duodenum to preserve collaterale vessels from the proprial hepatic artery considering the specific anatomy.