Progress in pediatric surgery最新文献

Between 1980 and 1986, 224 patients underwent one-stage hypospadias repair, of whom 100 were operated on using a modification of the Asopa technique. This technique, in which a vascularised preputial pedicle flap is rotated ventrally in order to reconstruct a neo-urethra as well as to cover the ventral skin defect, is described. The post-operative results are discussed. Fistula formation was the most common complication, but was easily correctable.

A computer system was designed and applied to anorectal manometry that allows pressure data to be analysed in various ways. Two kinds of applications were presented. Image analysis enabled anorectal movements to be visualized as a three-dimensional image. This technique was shown to be useful in studying the pathophysiology of chronic constipation in children. Radial variation analysis demonstrated that there was no significant radial difference in the anal-canal pressure.

Preoperative electromyographic examination is very useful in locating the external sphincter muscles and determining their degree of development. Electromyographic examinations showed the relatively abundant distribution of the external sphincter muscles in the perineum even in high-type anomalies. The results obtained by these examinations lead to the conclusion that preserving both the puborectal and external sphincter muscles should be the main consideration in surgery for anorectal malformations.

A total of 82 patients were assessed by rectal manometry after operation for Hirschsprung's disease according to the Soave-Denda technique. A positive rectoanal reflex was obtained in 32 cases (39%), whereas the remaining 50 cases (61%) did not exhibit a rectoanal reflex. Among the children examined, 72% showed normal rhythmic activity of the anorectum. Anorectal function tended to increase over the years, 90% having good continence 10 years or more after operation. Patients who encountered postoperative complications had poor continence since such complications may have damaged the levator and sphincter muscles.

Anorectal manometry, defecography, and ultrasonographic study were performed in 36 children with complete rectal prolapse and 45 age- and sex-matched controls. Anorectal manometry disclosed that there was no significant difference in Pr, Pac, or length of HPZ between patients and controls. The rate of BRC of the smooth muscle of the anal canal and RC were significantly lower in patients. Rectoanal reflex was present in all patients and controls. Defecography and ultrasonographic examination confirmed the hypothesis that rectal prolapse starts initially as an intussusception of the rectum, then fully develops. In 29 cases patients were cured by conservative treatment, but seven patients required surgical treatment. Results of modified Sudeck's operation were, in general, satisfactory.

Altered motility of the intestine after laparotomy, adynamic bowel segments, blind bowel loops following bypass operations, or diverticula may cause pathological growth of intestinal microflora and thus lead to contaminated small bowel syndrome (CSBS). As a result of malabsorption in the jejunum and ileum, loss of weight, growth arrest, diarrhea, steatorrhea, megaloblastic anemia, and hypoproteinemia may occur. In addition to these, the acute symptoms of small bowel contamination, intestinal obstruction and secretory diarrhea, are less well known. A stenosis in the terminal ileum was experimentally created in Göttingen minipigs and the bacterial flora of the small bowel assessed by quantitative cultures. After 3 months the number of aerobic and anaerobic bacteria in the pre- and poststenotic region had increased by a factor of 10(2)-10(5). The acute form of CSBS was diagnosed by microbiological examination of gastric samples in 14 children. After the children were treated with orally and intravenously administered antibiotics, the symptoms disappeared within 12-36 h. Reoperations for small bowel obstruction can be avoided by conservative treatment of CSBS with antibiotics.

We report 185 children with clinical manifestations of various conditions classically described as giant hamartoma, angiodysplasia, congenital hypertrophy, congenital trophoedema, localised gigantism (e.g. macrodactyly), etc. It is proposed to group all these conditions into a single entity: congenital soft-tissue dysplasia (CSTD). According to recent advances in fundamental embryology and cell biology, CSTD appears to be a consequence of embryonal or fetal cell biosynthetic dysregulation. The concept of the CSTD entity leads to a common protocol for clinical investigation and a common therapeutic plan, with special reference to the stability and the benign nature of the condition. Treatment should be confined to improving function rather than attempting to correct cosmetic deficits.

This preliminary analysis of surgical data is based on the evaluation of 323 patients operated on for soft-tissue sarcoma of varying histology. Data were collected for the Cooperative Soft-Tissue Sarcoma Study of the Gesellschaft für Pädiatrische Onkologie (Society of Paediatric Oncology). The following preliminary results are presented: 1. The number of mutilating operations, formerly undertaken with great frequency, can be reduced by chemotherapy, except where very aggressive tumours necessitate radical tumours excision. 2. According to the protocol in use, second look operations were performed in 117 patients, usually following the second course of chemotherapy. It is concluded that second look operations should be performed between the 16th and 19th post-operative week. Patients with scars in the former tumour bed must be assessed particularly critically, since residual tumour nodes may be masked by the scars.

With the decrease in infant mortality, together with an increase in survival rates of many conditions of later childhood, the death of a child became a relatively rare event. The concept of death developing in a child from its 3rd year of life on renders sensitive care necessary. Caring for dying children is not the sole preserve of the professional counsellor, social worker or psychologist. Children will chose whom they communicate with. It is important that the person who is chosen is able to seek support for him- or herself and can be part of a team offering help.