[Multiple bilateral pyelogenic renal cysts (author's transl)]. / Bilaterale multiple pyelogene Nierencysten.

In general, pyelogenic cysts are solitary and unilateral. Multicystic renal dysplasia is as a rule unilateral, and the cysts do not communicate. Here the rare case of multiple bilateral renal cysts communication with the pyelon is presented.

Mortality after operation for hiatus hernia.

When we started this investigation we were convinced that we would not be able to collect enough fatal cases to enable us to analyse the various causes of death following operation for hiatus hernia. To our surprise, inquiries made at 53 paediatric surgical centres produced a total of 67 fatalities. Most of these deaths could have been prevented if the following rules would have been followed: 1. The diagnosis must be made early and therapy must be commenced as soon as possible before there is a deterioration of the patient's general state of health increasing the risk of operation. 2. It is important to be familiar with the various operative techniques and the possible complications which they can produce. 3. Follow-up examinations are essential as certain complications will be detected by the patient himself only too late! Mortality and morbidity of hiatus hernia should be very small if the correct treatment has been carried out. Nissen's fundoplication, Rehbein's hiatal plasty and gastropexy, Lortat-Jacob/Grob's oesophagogastropexy and their modifications, all carry a low mortality and are followed by good results stopping the gastro-oesophageal reflux.

[Reflux esophagitis: operative procedures in children: fundoplication (author's transl)]. / Refluxoesophagitis. Operationstaktik beim Kind: Fundoplicatio.

Hiatus hernia and peptic esophagitis in children lead in 20% of the cases to peptic stenosis, thus rendering a reflux-preventing operation mandatory in many patients. We consider fundoplication as the operation of choice and have used it for 17 years. The early and late mortality varies between 1.2% and 1.4% and can be lowered even further through improvement of treatment. Functional complications such as "gas bloat syndrome," dysphagia, diarrhea, disappear spontaneously in the first 2-3 months after surgery. The only severe late complication is the development of a paraesophageal hernia months after surgery: This complication can be avoided through better technique. Out of 61 patients who were examined 10 or more years after operation, 58 are totally free of symptoms.

Fundoplication in hiatal hernia--results after 10 years.

Of the 194 fundoplications for hiatus hernia published by the authors at an earlier date, 66 were done before 1965 and 61 were available for an evaluation of the results after 10 years. Clinical results are good, 58 patients being free of symptoms. Only 3 complained of diarrhea or slight dysphagia. The radiological check up was ideal in 59 cases. 2 patients showed an "en bloc" herniation, but the fundoplication worked still very well as a reflux-preventive mechanism. 40 patients were no'longer able to vomit, a fact that has been suspected by other authors. Only 14 of them resented this as an inconvenience.

[Changes of kappa/lambda ratio of human serum immunoglobulins in the course of development]. / Veränderungen des kappa/lambda-Verhältnisses der menschlichen Serumimmunglobuline im Verlaufe der Entwicklung

In sera of normal individuals of different age groups the kappa- and lambda-type immunoglobulins were measured and the kappa/lambda ratio was calculated. The relative concentration of lambda-immunoglobulins in sera of newborns and young children was found to be significantly higher than in the adult sera. The well-known asynchronous maturation of immunoglobulin classes and IgG subclasses in the early childhood is evidently accompagnied by a asynchronous maturation of immunoglobulin types.

Prophylactic long-term anticoagulant treatment of hydrocephalic patients with ventriculo-atrial shunts.

Thrombosis of the superior vena cava is a frequent cause of death among patients with ventriculo-atrial shunts. In this study, one group of spina-bifida children with such shunts was treated with prophylactic anticoagulant therapy and a second group was not. While there was no significant difference between the two groups in the number of shunt revisions required over a six-year period, distal catheter complications were twice as frequent in the group not receiving anticoagulant therapy. There was little difference between the groups in the rate of proximal catheter revisions. It is suggested that the benefit of anticoagulant therapy is in transferring shunt problems from the distal to the proximal catheter, obstruction of which is less dangerous and more easily treated.