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ABSTRACT: According to recent studies, the percentage of neonates suffering a combination of very low birth weight (VLBW) and intestinal malformation or diseases that require surgery has increased. As opposed to mature newborn, split stoma is the therapy of choice in VLBW infants. These neonates and patients with other causes for a congenital or acquired short-bowel syndrome usually require parenteral nutrition and have a high risk of a cholestasis. Until 1993, stoma patients were treated with a special diet in our department, but depending of the stoma site often required parenteral nutrition, while the non-used distal bowel was irrigated with an isotonic electrolyte solution. With this regime, up to 38.5% of the treated patients (10126) were found to have a hyperbilirubinemia (> 3 mg/dl) after the 21st day of life. 1994, we started to use a device that continuously transfers the intestinal chylus from the proximal into the aboral bowel via a pump like a continuous extracorporeal stool transport (CEST). In this study, we evaluated the risk of cholestasis by comparison of the prospectively investigated group (CEST-group 1994-1998) of 33 infants with the results of the retrospectively studied group of 26 patients operated on between 1987 and 1993. We found a significantly lower risk of cholestasis in the CEST-Group (12.9% versus 38.5%; p<0.04). Only 3% of our patients with CEST (one patient) required permanent parenteral nutrition, compared to 50% of the conventionally treated patients.
European Journal of Pediatric Surgery 08/2000; 10(4):224-7. · 0.81 Impact Factor
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ABSTRACT: Prematures and neonates with stomas have a high risk of developing sepsis by bacterial translocation, particularly when combined with parenteral nutrition. We studied a group of 35 newborns where split ileo- or jejunostomas were implanted in their first week of life. To prevent the development of a non-used distal bowel and a short bowel syndrome, the proximal bower content was transferred into the aboral stoma via the new continuous extracorporal stool transport (CEST) technique a few days after surgery. By using CEST the sepsis rate was reduced from 9 (without CEST) to only 0.8 cases of sepsis in 1000 days.
Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress 02/1998; 115:1172-4.
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ABSTRACT: Between May 1994 and June 1995, nine newborns underwent surgery due to mechanical ileus or intrauterine perforation of the small bowel. Three were very-low-birth-weight infants weighing between 520 and 1,200 g. Surgery was performed in the first 2 days of life and split ileo- or jejunostomas were implanted. Early oral nutrition was initiated. To avoid non-use of the distal bowel and short-bowel syndrome, the aboral stoma was irrigated a few days later with the proximal feces. A new technique was applied to transport the chyle continuously from the oral to the aboral stoma: the stool was collected in an especially constructed stoma bag and transported distally by a roller pump. No major complications were seen. The general outcome was excellent in all cases, and reanastomosis under optimal bowel conditions was achieved in all patients without further problems.
Pediatric Surgery International 02/1997; 12(1):73-5. · 1.25 Impact Factor
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ABSTRACT: Since 1994, 25 children have been treated for abscesses of the soft issue. After the incision, a complete debridement was done, followed by implantation of a collagen sponge containing gentamicin and primary wound closure. Only two relapse were seen, which had to be re-opened.
Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress 01/1997; 114:1350-2.
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ABSTRACT: Between 1988 and 1995 we treated ten patients aged 7-18 years for familial MTC or MEN II syndrome with a total of 17 operations. Using these surgical procedures, 6/9 patients remained free of tumor after 0-8 years (mean 4.5 years). In conclusion, we recommend thyroidectomy [1] in children younger than 5 years of age and a family history of MEN IIa; [2] in children younger than 3 years of age, presenting the characteristic phenotype of MEN IIb, both with a positive test for mutation of the RET protooncogene [4].
Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress 02/1996; 113:202-4.
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ABSTRACT: Between 1972 and 1990 44 patients with ovarian tumors were treated at the Department of Pediatric Surgery of the University of Heidelberg. 27 patients (61%) suffered from tumor-like lesions: neonatal, pubertal (functional) cysts, and cysts in case of syndromes. 17 genuine tumors were found (39%): 8 germ-cell tumors, 7 cystomas respectively cystadenomas and 2 tumors of the gonadal stroma. Malignancy has been observed only in two cases: 1 malignant teratoma and 1 malignant granulosa-theca-cell tumor. 2 tumor-like lesions were caused by syndromes: Albright-McCune-Sternberg- and Stein-Leventhal syndrome: Treatment of uncommon tumors depends on their size, hormonal activity, on the syndromes with which they are associated, and on the tumor status.
European Journal of Pediatric Surgery 09/1991; 1(4):210-5. · 0.81 Impact Factor
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ABSTRACT: We here present a review of ten pediatric patients with rib tumors that were treated in our hospital since 1970: a juvenile bone cyst, an aneurysmal bone cyst, an eosinophilic granuloma, a Ewing sarcoma, a metastasis of a neuroblastoma, an osteochondroma, a hemangiopericytoma, and a callous tumor at the site of a previous single rib fracture. The relative frequency of rib tumors is similar to that of bone tumors in other locations. A biopsy of the affected bone should be the first step of the operative intervention. As demonstrated in a case of eosinophilic granuloma, the indication for subperiosteal rib resection can be defined generously. A completed regrowth of the rib defect can be expected. Even the loss of a complete rib is generally well tolerated, as shown in an infant with an aneurysmal bone cyst, a rare disease in this age group. Malignant tumors of the chest wall, however, require special experience in thoracic surgery and necessitate close interdisciplinary cooperation. Complete primary resection of a malignant rib tumor and its plastic reconstruction is demonstrated in a case of a Ewing sarcoma in childhood. In children and adolescents a vicryl net should generally be used to reconstruct extended chest wall defects reliably and functionally stable.
Chirurgie pédiatrique 02/1990; 31(3):152-6.
