Efficacy of early initiation of a gel containing extractum cepae, heparin, and allantoin for scar treatment: an observational, noninterventional study of daily practice.

BACKGROUND: Contractubex® (Merz Pharmaceuticals GmbH, Frankfurt, Germany) is a gel containing extractum cepae, heparin, and allantoin with proven efficacy in the prevention of excessive scarring and promotion of physiological scar formation. AIM: To investigate the efficacy of early initiation of Contractubex in the prevention of excessive scarring and promotion of physiological scar formation. METHODS: In total, 1,268 patients were included in this observational, noninterventional study. Patients were assessed at visit 1 (within 3 weeks of the injury), when treatment was initiated, with subsequent assessments after 2 to 3 months of treatment, and at the end of the study (after 4 to 5 months of treatment). Parameters measured included scar size, color, and pliability (consistency/hardness), as well as patients' and physicians' subjective assessments of treatment efficacy and tolerability. RESULTS: After 2 to 3 months of treatment, there were statistically significant improvements in color and pliability of the scar, sensation of pain, tension, and pruritus compared with visit 1 (P<.0001). By the end of the study, further statistically significant improvements compared with visit 1 were observed for all parameters. Only about 1% of scars were rated as markedly red or markedly hardened at the final visit. In addition, there was a reduction of 31.5% in mean scar width and of 47.8% in mean scar height at the end of the observation period. A high percentage of patients (85.8%) and physicians (86.6%) rated the treatment as good or very good with respect to prevention of excessive scarring and promotion of physiological scar development. Tolerability was described as good or very good by 92.0% of physicians and 91.5% of patients. CONCLUSIONS: The results of this study suggest that the scar gel is effective in preventing excessive scarring and promoting physiological scar formation when treatment is initiated early. In addition, the treatment was well tolerated.

Chest-deformities: a proposal for a classification.

BACKGROUND: In this article we assess the significance of classifying chest-deformities based on morphological findings in type-related treatment and its results. DATA SOURCES: Recent publications on chest-deformities in children and youth were retrieved from PubMed and Medline and from our clinical and intraoperative findings. RESULTS: Chest-deformities are diagnosed by thorax-measurements using a flexible meter projected on a graph-paper by MR/CT investigations and color coded videorasterstereography. In addition an ultrasound guided mediastinal analysis is performed on the heart, the great vessels and mediastinal organs. These investigations could determine meticulously the morphology of the sternum, the sterno-costal segments and the costal arch, enabling to find different chest wall deformities, i.e., 11 different types. The clinical and surgical significance of such a classification can be shown by comparing postoperative results of non-classified chest-deformities with those of classified. Preoperatively non-classified chest-deformities often have postoperative asymmetric shapes, partial local recurrences, costal arch eversions and a platythorax. Such a classification can be used to analyze and predict socalled "secondary associated alterations" of the vertebral column or mediastinal organs. CONCLUSIONS: Determining the specific type of a thorax deformity could be considered a type-related physiotherapy as conservative treatment or vacuum treatment and if surgery is indicated a type-related surgical correction can be performed. A type-related and adapted surgical correction can prevent subsequent mitral valve prolapse, recurrent infections, vertebral disturbances caused by kypho-scoliosis and increasing psychological irritation. Typing chest-deformities are an additional and essential help for the surgeon to perform specific surgical procedures: detorsion of the sternum, correction of the sterno-costal region, the costal arch bow and the kind of chest wall immobilization by metal struts. It can also compare the postoperative results more accurately in similar types of chest-deformities.

Infrared thermography: experience from a decade of pediatric imaging.

The aim of this study was to evaluate the feasibility of clinical application of infrared thermography (IRT) in the pediatric population and to identify pathological states that can be diagnosed as well as followed up using this non-invasive technique. In real time computer-assisted IRT, 483 examinations were performed over a period of 10 years from 1990-2000 on 285 patients in the pediatric age group (range 1 week-16 years) presenting with a wide range of pathologies. The temperature was measured in centigrade ( degrees C), and color images obtained were computer analyzed and stored on floppy discs. IRT was found to be an excellent noninvasive tool in the follow-up of hemangiomas, vascular malformations and digit amputations related to reimplantation, burns as well as skin and vascular growth after biomaterial implants in newborns with gastroschisis and giant omphaloceles. In the emergency room, it was a valuable tool for rapid diagnosis of extremity thrombosis, varicoceles, inflammation, abscesses, gangrene and wound infections. In conclusion, IRT can be performed in the pediatric age group, is non-invasive, without any biological side effects, requires no sedation or anesthesia and can be repeated as desired for follow-ups, with objective results that can demonstrated as colored images. Periodic thermographic studies to follow progression of lesions seem to be a useful and reproducible method for repeated and long-term examination.

Valuable lessons from two decades of pectus repair with the Willital-Hegemann procedure.

OBJECTIVE: Pectus deformities are the most common congenital hereditary chest wall deformity. The aim of this study was to evaluate the efficacy of thoracic wall reconstruction using a uniform technique of internal stabilization with stainless-steel struts. METHODS: Hospital charts of patients with chest wall deformities managed with the Willital-Hegemann procedure between January 1984 and January 2004 were reviewed. RESULTS: Surgical corrections were performed in 1262 patients with pectus deformities (968 male and 294 female patients). The corrections were completed with successful repair in 1244 (98.6%) patients, along with a low complication rate of 5.7%. The median age of the patients was 14.9 years (range, 2-53 years). The follow-up period ranged from 2 to 12 years (mean, 5.4 years). Major recurrences were observed in 18 (1.4%) patients, and mild recurrences were observed in 46 (3.6%) patients. There was 1 death in this series. The struts were removed after a period of 24 to 36 months and were associated with a complication rate of 2.6% at the time of removal. CONCLUSION: Custom-tailored molding of the chest wall can be achieved by using this method, which is not possible with minimal-access techniques. Open repair is effective for all variations of chest wall deformities and in patients of all ages, causes only mild pain, and produces good physiologic and cosmetic results. Improvement of subjective complaints, satisfactory long-term results, and improvement in psychological problems indicate the need to offer this procedure among other surgical correction options for low-risk children.

Look twice before you clamp: decapitation of an omphaloenteric duct. A case report.

OBJECTIVE: To report a case of accidental decapitation of a persistent omphaloenteric duct (POD) in congenital hernia of the umbilical cord in a newborn male. CASE PRESENTATION AND INTERVENTION: The newborn was transferred to an intensive care unit, where under closer inspection the diagnosis of an omphalocele was presumed. Surgical exploration at our Pediatric Surgical University Clinic revealed a clamped and decapitated POD in the umbilical cord. The decapitation had gone unnoticed due to severe asphyxia resulting from meconium aspiration encountered at the time of delivery. Using general anesthesia, the clamp was removed under sterile conditions. The decapitation of the POD in the herniated umbilical cord was confirmed at this time. The severed intestine was sutured and closed using 5-0 Vicryl sutures. The further course was uneventful. CONCLUSION: Herniation of the umbilical cord at the time of birth by intestinal loops or POD is rare, but caution should be taken by midwives before clamping in order to avoid the type of injury seen in this case.

Experience with management of anterior abdominal wall defects using bovine pericard.

During 5 years from 1999 until 2003, our experience with 29 (100%) neonates managed for anterior abdominal wall defects is presented. Twenty-one (72%) neonates presented with gastroschisis and 8 (28%) neonates with giant omphaloceles. The male:female ratio was almost equal in gastroschisis (1:1) while a male predominance was observed in omphaloceles (6:1). A primary closure of the defect was possible in 5 (17%) cases and a single patch along with skin closure was achieved in a further 9 (31%) cases. In 15 (52%) neonates the defect was large and two patches were employed to sufficiently cover the defect. All patients (97%), except one (mortality due to extreme prematurity), were managed successfully. Depending upon the size of the defect and the metabolic condition of the neonate, the defect closure was completed after a mean of 85.7 days. Special protocols were created to manage the bovine pericard patches, which behaved differently to lyophilized dura patches previously used at our center. Integration of the patches was successful in 28 (97%) neonates; however, one neonate with gastroschisis presented significant challenges in the management. Bovine pericard patches are optimal biomaterials for the closure of anterior abdominal wall defects in gastroschisis and omphaloceles.

Giant pedunculated lipofibroma of the elbow.

Lipofibromas are rare hamartomatous lesions almost exclusively involving the medial nerve and have been reported to date only in the adult population. The case of a giant pedunculated lipofibroma involving the radial nerve in the elbow of a 1-year-old child is presented.

Laparoscopic suture rectopexy for rectal prolapse in a 22-month-old child.

We present the case of a 22-month-old female child who presented with severe recurrent rectum prolapse. The patient was successfully managed using the laparoscopic simple suture rectopexy approach with 5-mm instruments employing two 3-0 nonabsorbable sutures on either side of the rectum to secure it to the presacral fascia. There was no blood loss, and the procedure was completed without complication. The child was followed up for a period of 24 months with good results.

Neonatal hemoperitoneum caused by a congenital liver angioma.

Severe intraabdominal bleeding in neonates within 24 hours after birth are an extremely seldom event. In our neonate, the intraabdominal bleeding was diagnosed by the clinical picture and by abdominal ultrasound examination. The etiology for this bleeding was primarily a blunt abdominal trauma as described in most cases of the liver; however, histology showed a congenital cavernous angioma of the liver resulting in a different tensile strength of this part of the liver in comparison with the rest of the liver tissue. Therefore, a relatively blunt abdominal trauma caused a rupture of the liver in a histologically altered part, which histologically was found to be a relatively soft and fragile tumor of the liver.

Unusual case of needle embodiment in talar neck.

An unusual case of a needle head injury, with deep embodiment of the needle head in the neck of the left talus bone is presented. The needle head was removed at our centre after two previous unsuccessful surgical attempts at other hospitals. The mechanism of trauma and the surgical procedure has been described.

Gastroschisis: a 15-year, single-center experience.

70 cases of gastroschisis (GS) were surgically treated at the Pediatric Surgical University Clinic, Münster, from 1984 through 1998. The defect occurred more frequently in males (44) than females (26). The average birth weight was 2,383 g and mean gestational age 36.8 weeks. 9 infants (12.9%) were delivered vaginally and the rest (87.1%) by cesarean section; 34 of the 61 (55.7%) cesarean sections were done solely for prenatal ultrasonic identification of the abdominal-wall defect. 10 infants (14.3%) underwent primary closure; in 19 (27.1%) primary closure of the skin was possible, however, a single solvent-dried dura (SDD) graft was required for fascial enlargement. The remaining 41 infants (58.6%) had extensive defects and required two grafts for optimal closure. 22 patients (31.4%) had associated anomalies, the most common being bowel atresias and undescended testis. 14 (20%) required secondary laparotomies because of bowel-associated complications and 1 (1.4%) for a urinary-bladder perforation. 11 patients (15.7%) had non-bowel-associated complications. The average postoperative tracheal intubation time was 3.9 days and the average hospital stay was 75.6 days. The overall mortality was 2.8%. No major complications associated with SDD implants were encountered; only 4 patients (5.7%) had minor complications such as local inflamation and infection and were managed conservatively. The present data support the employment of SDD implants as acceptable biomaterial for the repair of large GS defects.

Angiomyolipoma with hypertension mimicking a malignant renal tumor.

A 13-month-old girl with a unilateral renal angiomyolipoma causing severe hypertension is reported. The differential diagnosis of renal masses, a review of the literature, and the diagnostic algorithm for renal masses used at our center are presented.