P Günther

Universität Heidelberg, Heidelburg, Baden-Württemberg, Germany

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Publications (37)41.66 Total impact

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    ABSTRACT: Bei einem 16-jährigen Jungen wurden 3 bläuliche, teils schmerzhafte, subkutane Raumforderungen reseziert. Die Histologie ergab multiple, disseminierte Glomustumoren. Es handelt sich um seltene benigne Weichgewebstumoren, ausgehen von den Glomuskörperchen, welche die Thermoregulation v. a. an den Akren steuern. Glomustumoren treten meist solitär bei Frauen im Erwachsenenalter auf, nur in 10 % der Fälle wird ein multiples Vorkommen beobachtet, dann v. a. bei männlichen Jugendlichen. Die Therapie der Wahl ist die Exzision. Die Rezidivrate beträgt 12–50 %.
    Monatsschrift Kinderheilkunde 01/2014; 162(2). · 0.19 Impact Factor
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    ABSTRACT: Background Intracorporeal suturing and knot tying (ICKT) in minimal invasive surgery (MIS) represents a key skill for advanced procedures. Different methods exist for measuring knot quality and performance, but the heterogeneity of these methods makes direct comparisons difficult. The aim of this study is to compare the quality of a laparoscopic knot to one that is performed open. Methods To compare open and laparoscopic knot-tying methods we used a surgeon’s square knot. For laparoscopic knot tying we used a Pelvitrainer. The 32 participants were divided among 4 groups of different skill levels. Group 1 consisted of 6 senior physicians. Group 2 was made up of 10 first to fourth year interns. Groups 3 and 4 contained 16 medical students who had never performed either laparoscopic procedures or open sutures before. Group 3 participants received a 1-hour hands-on training in suturing, whereas group 4 participants received no prior training. Total time, knot quality, suture placement accuracy, and performance defined the parameters for assessment in this study. Results All participants, irrespective of education level were inferior in ICKT compared to open suturing. Only Group 1 showed no significant difference in knot quality and accuracy between the open and laparoscopic suture performance. Conclusion It is well documented that psychomotor skills need to be developed before more advanced skills can be put into practice. Training centres for minimally invasive surgery should be an integral part of surgical education. The variables in our study are meaningful and easy to implement. They can be used to measure personal progress and as objective parameters in the development of laparoscopic trainee education.
    Journal of Pediatric Surgery. 01/2013;
  • Patrick Günther
    Deutsches Ärzteblatt International 01/2013; 110(3):42. · 3.54 Impact Factor
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    Patrick Günther, Iris Rübben
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    ABSTRACT: The acute scrotum in childhood or adolescence is a medical emergency. Inadequate evaluation and delays in diagnosis and treatment can result in irreversible harm, up to and including loss of a testis. Various diseases can produce this clinical picture. The testis is ischemic in only about 20% of cases. This review is based on a selective literature search, the existing clinical guideline, and the authors' experience. The clinical approach to the acute scrotum must begin with a standardized, rapidly performed diagnostic evaluation. Dopper ultrasonography currently plays a central role. Its main use is to demonstrate the central arterial blood supply and venous drainage of the testis. The resistance index of the testicular vessels should also be determined. Physical examination and properly performed Doppler ultrasonography enable adequate evaluation of the acute scrotum in childhood and adolescence. In the rare cases of diagnostic uncertainty, immediate surgical exposure of the testis remains the treatment of choice.
    Deutsches Ärzteblatt International 06/2012; 109(25):449-57; quiz 458. · 3.54 Impact Factor
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    ABSTRACT: Traumatic dislocation of the elbow is rare in children with an incidence of 3-6% of all elbow injuries. In the literature the outcome after elbow dislocation in childhood is rarely discussed. In the present study 33 children treated in our clinic from 2001 to 2008 with an acute traumatic dislocation of the elbow were retrospectively included. All events were unilateral whereby 1 child (3%) showed a recurrence of elbow dislocation after 9 weeks, 30% had a pure dislocation, 70% had a concomitant fracture, 55% showed a fracture of the medial epicondyle, 6% a fracture of the lateral epicondyle and 9% a further fracture. Of the fractures 83% required open reduction with osteosynthesis. After an average of 4.5 years 20 children (61%) were clinically examined. There were no instabilities of the joint and only minor clinical limitations of the range of motion. The established Mayo elbow performance score showed good to excellent results for all children. Despite severe joint trauma with frequently accompanying fractures, post-traumatic functional deficits are rarely limiting, independent of the accompanying fracture. The frequency of recurrence is low and instabilities were not seen.
    Der Unfallchirurg 02/2012; 115(2):125-33. · 0.64 Impact Factor
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    ABSTRACT: Neuroblastoma (NB) is one of the most common malignant tumors in infancy. The commonly used International Neuroblastoma Staging System is not suitable for determining the surgical risks. To address this, we aimed to evaluate the correlation between so-called image-defined risk factors (IDRFs) and the surgical risks in abdominal neuroblastoma. We evaluated 60 cases who underwent surgical intervention and examined the pre-surgical radiological imaging to look for IDRFs and surgical complications in children with abdominal neuroblastoma. The MRI- and CT-scans showed a total of 122 IDRFs in 39 cases. Complete resection was carried out in 50%, partial excision in 32%, and biopsy in 18% of cases. Total resection was possible in 100% of cases with no IDRF. Where IDRFs were present, total resection was only possible in 26% of cases (p<0.0001). We found a highly significant, negative correlation between the number of IDRFs and the possibility of performing complete resection of NB (p<0.0001). 7 (11.6%) complications were detected, all in patients who showed at least one IDRF previously. Our findings indicate that IDRFs are useful indicators for predicting surgical risk and surgical outcome and thus should be taken into account when planning surgery.
    European Journal of Pediatric Surgery 07/2011; 21(5):314-7. · 0.84 Impact Factor
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    ABSTRACT: Neuroblastoma is an embryonic tumor of the sympathetic nervous system which represents one of the most common malignancies in early childhood. Its clinical and biological behavior show a remarkable heterogeneity, ranging from spontaneous regression to inexorable progression with a fatal outcome. This review summarizes the clinical risk stratification and treatment options. An extensive overview of the role of imaging during the course of the disease and typical imaging findings in all imaging modalities are demonstrated.
    RöFo - Fortschritte auf dem Gebiet der R 03/2011; 183(3):217-25. · 2.76 Impact Factor
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    ABSTRACT: Propranolol has recently been reported to be a highly effective treatment for infantile hemangioma (IH) and is emerging as a first-line therapy. This study reports the observations after completed propranolol therapy in 55 patients. Propranolol was administered in a dosage of 2 mg/kg per day with initial monitoring of vital signs. Therapy duration was planned for 4 to 6 months; if there was significant relapse, the period of treatment was extended. The mean age of 55 patients at the beginning of the treatment was 6 months (52.7% <4 mos, 30.9% 4-9 mos, 16.3% >9 mos). Thirteen patients (21.7%) showed a reaction possibly due to the medication, but we did not observe any life-threatening adverse effects. The therapy was interrupted due to temporary aggravation of preexisting bronchial asthma in one child. The initially administered dosage was adjusted to the increase of weight in 21 patients (38.2%), but most did not require a dosage adjustment despite somatic growth. Mean duration of treatment was 6 months; younger patients needed longer treatment periods. Response to treatment was favorable; eight (14.5%) showed total regression and 46 (83.4%) partial regression, and one (1.8%) had no response. Propranolol is an efficacious therapy for severe IH. Risks and complications appear moderate. If indicated, therapy should be initiated early to minimize the extent of residual changes. Young patients show quick and extended benefit. Prospective controlled trails are necessary to observe the effects on a long-term basis.
    Pediatric Dermatology 01/2011; 28(6):640-4. · 1.04 Impact Factor
  • Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology 01/2011; 50(1):1-3. · 3.12 Impact Factor
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    ABSTRACT: Hemangiomas are the most common tumors of infancy. Multiple cutaneous hemangiomas may be associated with the presence of hemangiomas in inner organs. However, there is little data on the risk factors for organ involvement and the outcome of a large sample of patients. patients with 3 or more cutaneous hemangiomas were evaluated with regard to patient characteristics, distribution of hemangiomas, results of radiological abdominal/cerebral imaging, clinical course, and therapeutic approach. We analyzed the risk factors for organ involvement and complications/outcome. The average gestational week at birth was 32.8; radiological imaging showed liver hemangiomas in 13.5% and mesenteric lesions in 1 (1.9%) but no cerebral lesions. Preterm infants (p=0.02) and patients with high numbers of cutaneous hemangiomas (p=0.02) were at higher risk of organ involvement. A life-threatening event occurred in 1 patient (1.9%). None of the patients died. Organ manifestation is relatively common in patients with multiple hemangiomas, complications are rare, but potentially life-threatening. We recommend abdominal imaging for patients with 3 or more hemangiomas, especially in preterm infants.
    European Journal of Pediatric Surgery 11/2010; 20(6):379-81. · 0.84 Impact Factor
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    ABSTRACT: Eine traumatische Ellenbogenluxation ist im Kindesalter ein relativ seltenes Ereignis mit einer Inzidenz von 3–6% aller Ellenbogenverletzungen. In der Literatur wird selten das Outcome nach einer Ellenbogenluxation im Kindesalter beschrieben. Die vorliegende Studie schließt retrospektiv 33 Kinder mit einer Ellenbogenluxation ein, die in den Jahren 2001 bis 2008 in unserer Klinik behandelt worden sind. Alle Ereignisse waren einseitig, ein Kind (3%) erlitt ein ipsilaterales Rezidiv 9 Wochen nach dem Erstereignis. Von den Patienten wiesen 70% eine Begleitfraktur auf: 55% hatten eine Epicondylus-ulnaris-Abrissfraktur, 6% eine Fraktur des Epicondylus radialis und 9% eine weitere Fraktur. Eine offene Reposition mit Osteosynthese erforderten 83% aller Frakturen. Nach durchschnittlich 4,5 Jahren wurden 20 Kinder (61%) klinisch nachuntersucht. Sie zeigten kein Gelenkinstabilitäten und nur geringe klinische Einschränkungen des Bewegungsumfangs. Der etablierte Mayo-Ellenbogen-Score zeigte gute bis exzellente Ergebnisse bei allen Kindern. Trotz eines starken Gelenktraumas mit häufigen Begleitfrakturen sind posttraumatische Funktionsdefizite nach Ellenbogenluxationen im Kindesalter selten einschränkend, unabhängig von der Begleitfraktur. Die Rezidivhäufigkeit ist gering und Instabilitäten wurden nicht beobachtet.
    Der Unfallchirurg 02/2010; 115(2). · 0.64 Impact Factor
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    ABSTRACT: Testicular torsion in children is found both in neonates [perinatal testicular torsion (PTT), <30th day of life] and in older children [testicular torsion (TT)]. Prediction of testicular viability is essential for deciding whether to perform emergency exploration surgery. The aim of the present study, therefore, was to investigate the sonomorphological parameters as predictors for testicular viability. All our cases of sonographically diagnosed and surgically confirmed testicular torsion (n = 25) in a 7.5-year period were reviewed. We evaluated the overall group and two subgroups, PTT (n = 9) and TT (n = 16), and assessed the following sonomorphological parameters: normal echogenicity (homogeneous), diffuse hyper-/hypoechogenicity (homogeneous) and focal hyper-/hypoechogenicity (heterogeneous). These findings were correlated with the testicular recovery rate. In both groups, we found the highest recovery rates in testes with normal, homogeneous echogenicity and a zero recovery rate in testes with heterogeneous echogenicity (p = 0.0117). By using the sonomorpohological criteria presented here, testicular viability can be appraised in all age groups to help determine the prognosis for testicular outcome. In PTT, a nonperfused, homogeneously appearing testis represents the initial phase of torsion. Only for this type is there hope for salvage. In addition to the intraoperative appearance, a testis that is preoperatively heterogeneous in appearance can support the decision for orchiectomy.
    Pediatric Surgery International 11/2009; 26(3):281-6. · 1.22 Impact Factor
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    ABSTRACT: Surgical complications after tumor operations are frequent in children, with rates of up to 30% cited in the literature. Various approaches to reduce these complication rates have been attempted, with preoperative chemotherapy holding pride of place. One approach to minimize surgical complications is better preoperative preparation. In a retrospective analysis, we evaluated the complications associated with tumor surgery. We retrospectively analyzed patient data from 1991 to 2007. The distribution of the various tumors, the type of surgery, and complications were evaluated. For neuroblastomas a differentiated analysis of complications was performed, which included staging and radiologically defined surgical risk factors (SRFs). Patients were divided into two groups: A and B. Intensified surgical planning with 3D visualization was used in patients of group B. A total of 145 operations for abdominal tumors were performed in 123 patients. The three most common diseases were neuroblastoma (36%), nephroblastoma (26%), and ovarian tumor (19%). In 68% of patients complete resection and in 19% of cases partial resection of the tumor was carried out; open biopsy was performed in 13%. A total of 15 (10.3%) complications developed: the incidence of complications for group A was 11.8% and 7.7% for group B (p=0.5). For nephroblastoma these figures were 27.9% and 21.2% (p=1.0). In the group of patients with neuroblastoma, six complications developed in patients from group A (21.4%) and one in a group B patient (4.2%) (p=0.107). 54% of neuroblastomas were completely and 33% partially resected; these figures and the distribution of SRFs were similar in the two groups. A significant increase in the risk of complications could be seen with an increase in SRFs (p=0.0267) and with disease stages 2 and 3 (p=0.016). Tumor reduction surgery was also associated with an increase in complications (p=0.086). In summary, tumor surgery is associated with considerable risks in children. Therefore it is very important to look for new approaches that could potentially minimize these risks. As the causes of surgical complications are multifactorial, we are of the opinion that intensified surgical planning can contribute to reducing risks. Particularly neuroblastoma surgery could profit from an increased use of 3D visualization and improved preoperative planning.
    European Journal of Pediatric Surgery 06/2009; 19(5):297-303. · 0.84 Impact Factor
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    ABSTRACT: A 9-month-old girl presented with massive bilateral diffuse nephroblastomatosis. After response to actinomycin D and vincristine over a period of 1 year, the nephroblastomatosis continuously progressed under this treatment. As retinoic acid signaling is critical for normal renal development and nephroblastomatosis seems histologically as undifferentiated embryonal tissue, we added 13-cis retinoic acid to the chemotherapy regimen. Three months thereafter, kidney volumes declined significantly over a period of 1 year. Interestingly, nephroblastomatosis-associated acquired von Willebrand disease also resolved. Retinoic acid maybe a novel nontoxic treatment option for nephroblastomatosis requiring further systematic evaluation.
    Journal of Pediatric Hematology/Oncology 05/2009; 31(4):296-9. · 0.97 Impact Factor
  • S Holland-Cunz, P Günther
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    ABSTRACT: Fast track protocols are justified for several pediatric surgical procedures. Particular operations on neonates and babies require specialized postoperative care. In these very young patients, no benefit can be expected from rigid fast track concepts. Many workflows in pediatric surgery have already been optimized with a view toward very short hospital stay. The published experiences with fast track protocols in pediatric surgery show that the method is feasible and safe. Complication and readmission rates are very low. Perioperative adjustments, shorter fasting periods, and the use of new analgetics are desirable in pediatric fast track protocols. Particularly for children, customizing protocols to the individual patients' requirements must be guaranteed.
    Der Chirurg 04/2009; 80(8):719-23. · 0.52 Impact Factor
  • Klinische Pädiatrie 02/2009; 221(02). · 1.90 Impact Factor
  • S. Holland-Cunz, P. Günther
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    ABSTRACT: Fast-Track-Protokolle in der Kinderchirurgie sind für einzelne Prozeduren gerechtfertigt. Bei größeren Operationen im Neonaten- und Säuglingsalter ist eine aufwendige postoperative Betreuung notwendig, die starre Fast-Track-Protokolle nicht sinnvoll erscheinen lassen. Bei sehr vielen Eingriffen im Kindesalter sind die Abläufe bereits so gestrafft, dass Fast-Track-Protokolle keine weitere wesentliche Verkürzung des stationären Aufenthaltes mit sich bringen würden. Die veröffentlichten Fast-Track-Erfahrungen für das Kindesalter zeigen, dass die Methode für einzelne Indikationen durchführbar und sicher ist. Die Komplikationsquoten und Wiederaufnahmeraten sind gering. Die perioperativen Abläufe können anästhesiologisch durch kürzere Nüchternzeiten, die Umgehung des Aufwachraumes und den Einsatz suffizienter, nebenwirkungsarmer Analgetika im Sinne von Fast Track angepasst werden. Gerade für das Kindesalter muss jedoch die individuelle Anpassung an die Bedürfnisse des einzelnen Patienten gewährleistet sein.
    Der Chirurg 01/2009; 80(8). · 0.52 Impact Factor
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    ABSTRACT: The authors present two case histories of children with synovial soft tissue tumor of the ankle. Synovial soft tissue tumors of the ankle in childhood are rare. The symptoms are unspecific so that the clinical diagnosis is difficult. In both cases the children came primarily to the clinic with painful swelling at the ankle after trauma, which further complicated the diagnosis. It should be taken into consideration that the rare differential diagnosis of pain at the ankle could be synovial soft tissue tumor especially when the clinical course is protracted.
    Der Unfallchirurg 08/2008; 111(7):559-62. · 0.64 Impact Factor
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    ABSTRACT: Magnetic resonance imaging (MRI) presents the main diagnostic tool for differentiation and staging of renal tumors in childhood. Nephroblastoma is the most common malignant tumor in children. Radiological findings play an important role in therapy study trials of SIOP (International Society of Pediatric Oncology), especially for indicating preoperative chemotherapy. In the past few years MRI has gained great importance in imaging of nephroblastoma and has replaced computed tomography (CT). The aim of this review is to present the diagnostic possibilities of MRI in relation to the requirements of therapy studies. For nephroblastoma, MRI provides important information about tumor extent and distant metastasis. A special focus of MRI in distant staging is venous extent of the tumor into the inferior vena cava. In addition, MRI has an important role in monitoring chemotherapy and in preoperative planning by volume rendering and three-dimensional postprocessing.
    European Radiology 05/2008; 18(4):683-91. · 4.34 Impact Factor
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    ABSTRACT: 3D imaging and surgical planning for the treatment of embryonal tumors using different techniques (CT versus MRI) are presently under discussion. Up to now, the main focus has been on visualizing the anatomy. Contrast medium dynamics have not been taken into consideration. The aim of the present study was to establish the technical means of integrating the 3D images from functional MRI data into the anatomical images and to determine clinical applications for this approach. In 11 patients (mean age: 2.4 years) with solid tumors, 26 diagnostic MRI examinations were performed for primary diagnosis, treatment monitoring, or as part of the surgical planning. Seven children presented with neuroblastomas, three with Wilms' tumor, and one with advanced bilateral nephroblastomatosis. The MRI data were acquired using a 1.5-T system. For post-processing, we used volume rendering software, including an evaluation of perfusion. By using color-coded parametric images and integrating functional information, perfusion could be visualized and used for interactive surgical planning. Macroscopic and microscopic sections served as the gold standard for assessing tissue viability. We were able to integrate the dynamic data into the anatomical images for all patients. A good agreement was found between the results of surgical planning, including perfusion mapping, with the surgical site, subsequently produced macroscopic sections and the results of random microscopic examinations. Perfusion mapping using color-coded parametric images of pediatric abdominal tumors extends the diagnostic techniques currently available. We provide first proof of the possibility of integrating functional information into 3D MR images in children. Monitoring the treatment of nephroblastoma and surgical planning for pediatric embryonal tumors represent potential applications of this technique.
    European Journal of Pediatric Surgery 03/2008; 18(1):7-12. · 0.84 Impact Factor