[Show abstract][Hide abstract] ABSTRACT: Introduction
Metastasized pancreatic neuroendocrine tumors are extremely rare malignancies, especially in children. Therefore, therapeutic options are limited, and few standardized therapy regimens exist.
We report a case of a 14-year-old white girl. In 2011 she was diagnosed with a metastasized, well-differentiated pancreatic neuroendocrine tumor with expression of synaptophysin and chromogranin A. We describe her clinical course with special attention to her individual therapeutic regimens while bringing together several disciplines of medicine.
In patients such as ours, surgical intervention may be the only therapy that will lead to long-term survival.
Journal of Medical Case Reports 10/2015; 9(1). DOI:10.1186/s13256-015-0708-3
[Show abstract][Hide abstract] ABSTRACT: Aim of the study:
Insufficient data are available to determine the most suitable extent of intestinal resection required to induce short-bowel syndrome (SBS) in pigs. This study aimed to compare the three main SBS-models published.
A 75%, 90%, or 100% mid-intestinal resection was performed in groups of n = 5 pigs each. Clinical (body weight, stool consistency) and biochemical (serum eletrolytes, citrulline, albumin, prealbumin, and transferrin) parameters were determined daily, functional (D-xylose resorption) and histological (intestinal villus length) parameters were determined after 2 weeks. A t-test and ANOVA were used for statistical analysis.
Only in the 100% group, we observed a persistent weight loss (13.6 ± 3.8%) and diarrhea, as well as a decrease in prealbumin-levels (41%) and transferrin levels (33%). Serum electrolytes remained stable in all groups during the observation period. Citrulline stabilized at different levels (100% group 13.9 ± 1.0 μmol/L; 90% group 18.8 ± 1.0 μmol/L; 75% group 26.3 ± 1.4 μmol/L; all p < .05). D-xylose resorption was lowest in the 100%, followed by 90% and 75% group (100% group 32.8 ± 4.9 mg/L; 90% group 50.0 ± 19.6 mg/L; 75% group 57.8 ± 8.8 mg/L; p = .393). Intestinal villus length decreased in all groups (100% group 11.0%; 90% group 14.0%; 75% group 19.1%).
75% intestinal resection is less suitable as an SBS model, as animals tend to recover remarkably. The 90% model is suitable for longer-term studies, as animals might survive longer due to partial compensation. Due to severe nutritional, biochemical, and physiological derangements, the 100% model can only be used for acute experiments and those immediately followed by small bowel transplantation.
Journal of Investigative Surgery 09/2015; DOI:10.3109/08941939.2015.1057304 · 1.16 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background and aims Detection of intestinal ischemia is often delayed causing extensive complications. Serum citrulline is an important parameter for bowel integrity and functionality; however, no data is available on its response on postoperative intestinal impairment in children. The aim of this study was to evaluate the native effects of intestinal surgery on the postoperative citrulline course in children. Material and methods In two groups, of each five children under the age of 2, undergoing either intestinal surgery (IS) or non-intestinal surgery (NIS), we monitored unspecific intestinal impairment parameters (lactate, C-reactive protein (CRP), leukocytes) and citrulline prior to surgery and on the 3rd postoperative day. Results In both groups the postoperative course was uneventful, including unproblematic transition to a normal diet and regular stool. Postoperatively, CRP levels were slightly increased (IS p > 0.05; NIS p Conclusions This data suggests that IS does not affect perioperative citrulline levels in children under the age of 2 years with uneventful postoperative course. Changes in citrulline following surgery might be a sign of intestinal impairment and therefore further investigations are necessary on this field.
European Surgery 04/2015; 47(3). DOI:10.1007/s10353-015-0312-1 · 0.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction A targeted Hirschsprung disease (HD) diagnostic is necessary, as it determines a specific approach primarily based on surgical resection of the affected aganglionic colonic segment. The aim of this study was to evaluate the diagnostic accuracy of a contrast enema (CE) for HD diagnosis and to determine whether it should be performed before or after rectal biopsies (RBs). Methods A retrospective observational study of children undergoing RB for HD investigation was performed. In the performed CE, the occurrence and the level of a colonic caliber change (CCC) were recorded and its concordance with the histologically assessed level of aganglionosis by RB and the odds ratio were calculated. Results A total of 107 cases were included. Sensitivity and specificity for a CCC in CE were 74.1% and 94.6%. A CCC present in CE was associated with a 50-fold increased probability for a histologically proven HD. The overall concordance between a CCC and the histologically assessed level of aganglionosis was high (kappa 0.642, p = 0.003), being correct in 94.4% of cases when the CCC was located in the rectosigmoid, but only in 50% of cases when it was located in more proximal segments. By performing a CE only after HD diagnosis confirmation by RB would avoid 67.5% of CE with no loss of diagnostic accuracy. Conclusion We confirm that CE is a valuable tool for HD diagnosis; however, it should only be performed for subsequent diagnostic and surgical planning following histological confirmation of HD by RB. On the basis of this, an algorithm for an optimized investigation and management of HD is presented.
Georg Thieme Verlag KG Stuttgart · New York.
European Journal of Pediatric Surgery 03/2015; DOI:10.1055/s-0035-1546755 · 0.99 Impact Factor
[Show abstract][Hide abstract] 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 %.
[Show abstract][Hide abstract] 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.
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.
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.
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; 49(7). DOI:10.1016/j.jpedsurg.2013.12.018 · 1.39 Impact Factor
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] 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. · 0.65 Impact Factor
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] 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. DOI:10.1055/s-0031-1280824 · 0.99 Impact Factor
[Show abstract][Hide abstract] 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. DOI:10.1055/s-0029-1245903 · 1.40 Impact Factor
[Show abstract][Hide abstract] 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. DOI:10.1055/s-0030-1261938 · 0.99 Impact Factor
[Show abstract][Hide abstract] 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). DOI:10.1007/s00113-010-1858-9 · 0.65 Impact Factor
[Show abstract][Hide abstract] 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. DOI:10.1007/s00383-009-2534-4 · 1.00 Impact Factor