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ABSTRACT: Thrombocytopenia caused by platelet consumption in thrombi is a major manifestation of hemolytic uremic syndrome (HUS) associated with Shiga toxin (Stx) producing Escherichia coli. Platelets have glycosphingolipid receptors capable of binding Stx, but a direct interaction between the toxin and platelets, leading to platelet activation, has not been reported. In this study, it is shown that Stx1 and its B (binding) subunit (Stx1B), at 10 pg/mL to 10 ng/mL, bound to platelets. Toxin was internalized in platelets within 2 hours. This led to increased platelet aggregation, as demonstrated by confocal microscopy. Preincubation of Stx1B with anti-Stx1 antibody inhibited this reaction. Stx1 induced morphologic changes in platelets seen on scanning electron microscopy. In the presence of platelets and tumor necrosis factor-pretreated human umbilical vein endothelial cells (HUVEC), Stx1 and Stx1B induced the binding of platelets to the endothelial cell membrane and were present at this binding site. Incubation of Stx1 and Stx1B with whole blood increased fibrinogen binding to platelets detected by flow cytometry. Fibrinogen binding was partially inhibited by preincubation with anti-Stx1. Stx1 increased platelet retention measured in a glass bead assay. In addition, plasma from 17 patients with HUS, taken during the acute phase of the disease, increased the retention of normal platelets and normalized after recovery. Taken together, the results of this investigation show that Stx1, Stx1B, and a factor or factors in the plasma of patients with HUS activate platelets. The presence of Stx1 at the binding site of platelets to HUVEC suggests that Stx may be directly involved in the prothrombotic state seen in HUS.
Blood 06/2001; 97(10):3100-8. · 9.90 Impact Factor
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ABSTRACT: There are still no accepted criteria for the selection of patients with nonpalpable testes for laparoscopy versus a primary surgical exploration. We here report our experience using routine laparoscopy in such patients. The aim was to determine whether laparoscopy should be the first operative intervention or follow an inguinal exploration. Included in the study were 61 boys with 69 nonpalpable testes. Thirty-three testes were found in the abdomen, and 36 testes were extra-abdominal or nonexistent. If an exploration of the inguinal region had been the initial surgical intervention, six testes would have been found, making laparoscopy unnecessary. On the other hand, in the search for 63 missing testes, laparoscopy saved the patients from laparotomy or an extensive inguinal exploration. We conclude that an accurate knowledge of testis, vas, and vessel location gained by laparoscopy facilitates the selection of an appropriate surgical strategy, saving at least 51% of patients from laparotomy or an extensive inguinal exploration.
Journal of Laparoendoscopic & Advanced Surgical Techniques 07/1999; 9(3):239-41. · 1.40 Impact Factor
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ABSTRACT: A gastrostomy button complication, not previously reported, is described. The button, with an inflatable balloon, was used for nutrition. The patient had had a gastrostomy for 4.5 y, with the same type of gastrostomy button for the previous 2 y and the same device for 1 y. The tip of the button caused a perforation of the posterior stomach wall, leading to death.
Acta Paediatrica 12/1998; 87(11):1203-4. · 2.07 Impact Factor
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ABSTRACT: An original one-puncture technique of performing laparoscopic gastrostomy is described. The implications are analysed. The results of five operations are presented and the advantages and limitations are discussed in the light of current available methods.
Pediatric Surgery International 12/1998; 14(1-2):43-4. · 1.25 Impact Factor
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ABSTRACT: The experience of our 16 patients treated for membranous duodenal stenosis is reported. Their treatment and course was analysed in a retrospective study. Eight patients were operated on within the first 16 days of life and in the remaining group surgery was performed at 1 month to 4 y of age. The presenting symptom leading to diagnosis was, in all but one case, non-bile-stained vomiting. Associated malformations were found in all but four patients, mostly morbus Down. The operative procedure performed was a partial excision of the duodenal membrane and a duodenoplasty in 10 patients, a duodenojejunostomy in 5 patients, and a duodenoplasty only in 1 patient. The postoperative course was without lethal complications. One late stricture in an anastomosis occurred. We conclude that in its presentation, duodenal stenosis differs from duodenal atresia, and can often be misinterpreted, resulting in a late diagnosis, and should be reported as a separate entity.
Acta Paediatrica 10/1997; 86(9):953-5. · 2.07 Impact Factor
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ABSTRACT: The aim of this report is to describe a method for laparoscopy aided button gastrostomy in children.
The method includes the use of two ports, one umbilical and one subcostal on the left side. The stomach is exteriorized using a grasping forceps in the subcostal port. Under direct vision the gastrostomy button, MIC-KEY, is inserted into the stomach at the lesser curvature and secured by purse string sutures. The stomach is attached to the anterior abdominal wall.
The results show that this method has been successfully used in 33 children without operative complications.
We conclude that by inserting the gastrostomy button under direct vision, damage to other abdominal organs is avoided and a correct placement at the lesser curvature obtained. The combination of laparoscopic and open procedures makes the method easy and safe.
Annales chirurgiae et gynaecologiae 02/1997; 86(1):19-22.
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ABSTRACT: A case of bilateral nonpalpable testes is described. Ultrasonography showed no testis. Laparoscopy revealed no intraabdominal testis, vas or vessels. Human chorionic gonadotrophine test suggested the presence of testicular tissue. Computed tomography showed a testis present in each inguinal canal. Inguinal exploration confirmed the finding. This case stresses the importance of careful interpretation of the laparoscopic findings together with other diagnostic methods in localizing testicular tissue in patients with nonpalpable testes.
European Journal of Pediatric Surgery 03/1996; 6(1):7-9. · 0.81 Impact Factor
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ABSTRACT: The objective of this report is to describe a new method of nonsuture end-to-end microvascular anastomosis. The vessels to be anastomosed are prepared separately before division by inserting a cylinder-shaped intravascular stent into each vessel. The anastomosis is completed after dividing the vessels. The vessels containing the stents are approximated. The anastomosis is then performed by sliding the stents into each other and is kept together by the force of friction. The method was used for anastomosing the aorta, end to end, in seven rats. The rats survived for one to 25 days with a radiological patient aorta and a fibrous healing of the vessels. This method has a potential use for microvascular anastomosis.
Annales chirurgiae et gynaecologiae 02/1996; 85(1):36-9.
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Lakartidningen 10/1995; 92(36):3237-8.
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ABSTRACT: Vascular occlusion is a common clinical problem in children dependent on prolonged vascular access. As an alternative to conventional central venous catheter placement we report our experience of four children receiving translumbar inferior vena cava catheter on 12 different occasions. All catheter placements were successful. No procedure-related complications occurred. The median catheter patency was 4.8 months (range 1-10 months). The translumbar route for central venous access is safe and reliable and should be considered when prolonged use is anticipated in infants and small children.
Pediatric Radiology 02/1995; 25(1):28-30. · 1.67 Impact Factor
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ABSTRACT: Computerised tomography and magnetic resonance tomography were performed in nine faecally incontinent patients more than eight years after rectoplasty for high imperforate anus. No statistically significant correlation was found between function, i.e. degree of faecal incontinence, and anatomical findings. Thus, in spite of a detailed demonstration of the post-operative anatomy, the information does not seem to be directly applicable in indicating a way to reoperate for faecal incontinence in this group of patients.
Zeitschrift für Kinderchirurgie: organ der Deutschen, der Schweizerischen und der Osterreichischen Gesellschaft für Kinderchirurgie = Surgery in infancy and childhood 07/1990; 45(3):178-81.
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ABSTRACT: The role of physiotherapy for the achievement of faecal continence after Stephens' rectoplasty for high imperforate anus was studied. Clinical assessment and ano-rectal manometry were performed more than 7 years after surgery, both before and after one year of physiotherapy training of the perianal musculature. After the training period the faecal control improved. This effect was verified by the ano-rectal manometry findings. Faecal continence can be achieved by Stephens' rectoplasty. Furthermore, with any persisting incontinence, postoperative physiotherapy with training of the voluntary muscles in the perianal region can be valuable for the achievement of faecal continence.
Zeitschrift für Kinderchirurgie: organ der Deutschen, der Schweizerischen und der Osterreichischen Gesellschaft für Kinderchirurgie = Surgery in infancy and childhood 05/1986; 41(2):101-3.
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ABSTRACT: Three children with malrotation 4.5, 5 and 9 years old at operation are presented. Their preliminary diagnoses were gastrointestinal (GI) allergy, GI allergy with colon irritable and psychosomatic abdominal pain. They were treated on an outpatient basis under these diagnoses for more than two years before their malrotations were discovered. In two children radiology did not demonstrate any signs of intestinal obstruction and in one of these children repeated radiological examinations were necessary for the diagnosis of malrotation. Operative findings were chronic volvulus with compromised blood flow and obstructive duodenal bands. The third child suffered acute strangulation ileus with gangrene of the intestines before diagnosis was made. We conclude that special consideration must be given to the possibility of malrotation when treating and radiologically investigating children with GI disturbances.
Acta paediatrica 04/1985; 74(2):296-9. · 1.77 Impact Factor
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The Lancet 01/1985; 2(8414):1279. · 38.28 Impact Factor
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ABSTRACT: The clinical usefulness of the preoperative determination of C-Reactive protein (CRP) in patients with suspected acute appendicitis was studied in 156 consecutive patients undergoing acute appendicectomy. The CRP values were found to increase with an advancing stage of the appendiceal inflammation found at operation and the length of the preoperative phase of illness. Eight out of 66 patients with a phlegmonous appendix found at operation showed no signs of bacterial infection, as revealed by an increased C-Reactive protein level. These results suggest that a preoperative quantitative determination of the C-Reactive protein in patients with suspected acute appendicitis might add a valuable parameter to the laboratory profile in this condition and can be used for the selection of those patients who would benefit from a preoperatively administered antibiotic prophylaxis. Furthermore, these results might support the theory that an obstruction of the appendix lumen is the most important factor in the genesis of acute appendicitis.
Annales chirurgiae et gynaecologiae 02/1984; 73(5):281-4.
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ABSTRACT: A follow-up study of 12 patients who had undergone Stephens rectoplasty for high imperforate anus is presented. Clinical assessment and anal electromyography were performed more than 7 years after surgery, both before and after a year's physiotherapeutic training of the perianal musculature. Electromyography showed correlation between faecal continence and tonus of the anal sphincter, the anocutaneous reflex and maximal voluntary activity in the perianal muscles. After the physiotherapeutic training there was significant improvement of faecal continence. This effect was electromyographically corroborated. The results confirmed clinical observations that postoperative physiotherapy and training of the voluntary muscles in the perianal region is of value for the achievement of faecal continence.
Acta chirurgica Scandinavica 154(7-8):467-70.
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ABSTRACT: Computed tomography (CT) was performed in 9 patients with faecal incontinence more than 8 years after rectoplasty for high imperforate anus. The radiologic findings were correlated with the clinical evaluation of faecal incontinence. No statistically significant correlation was found between function and anatomic findings as demonstrated by CT. Thus, although CT demonstrates the post-operative anatomy in a detailed way, the information does not seem to be directly applicable when selecting the type of reoperation for faecal incontinence.
Acta Radiologica 30(1):25-8. · 1.37 Impact Factor
