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  • 1
    Electronic Resource
    Electronic Resource
    Appendicitis in preschool children (1995)
    Springer
    Pediatric surgery international 10 (1995), S. 68-70 
    Details
    ISSN: 1437-9813
    Keywords: Appendicitis ; Preschool child
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Appendicitis in preschool children, although uncommon, is associated with a high perforation rate and increased morbidity. Of 132 preschool children treated for appendicitis over a 5-year period, 63 (47.7%) had perforations and 29 (22.0%) had an appendiceal mass. Although classic symptoms were present in the majority of the patients, atypical symptoms were found in many children and included diarrhoea (35), cough/sore throat (15), dysuria (4), headache (2), and earache (2). A diagnosis other than appendicitis was suspected by attending medical practitioners in 53 (40%) patients, leading to delay in management. Mean duration of symptoms before admission was as follows: acute appendicitis 38.9 h, perforation 52.6 h, and appendix mass 81.7 h. Ten (7.6%) patients developed postoperative complications that included wound infection in 5, intra-abdominal abscess in 4, and adhesive intestinal obstruction in 1. A high index of suspicion of appendicitis is necessary in preschool children in view of the atypical presentation and high incidence of advanced appendicitis and morbidity.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00171156
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  • 2
    Electronic Resource
    Electronic Resource
    Appendicitis diagnosed following active observation does not increase morbidity in children (1995)
    Springer
    Pediatric surgery international 10 (1995), S. 76-78 
    Details
    ISSN: 1437-9813
    Keywords: Appendicitis ; Active observation ; Child
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract An audit was undertaken to assess the outcome of patients aged less than 16 years who underwent appendicectomy after active obsevation. A comparison was made of the incidence of perforation, complications, and hospital stay of patients who underwent emergency appendicectomy (group A) and those who were operated upon after active observation (group B). A total of 1,672 patients were admitted with acute abdominal pain. Emergency appendicectomy following the diagnosis of acute appendicitis on admission was performed in 744 patients (group A); an appendicectomy was performed in 123 patients following active observation (group B). In group A, 140 patients (18.8%) were found to have macroscopic or microscopic perforations; a normal appendix was removed in 75 (10.1%) cases and 31 (4.2%) patients developed postoperative complications. In group B, perforations occurred in 19 (15.1%) patients, normal appendix was encountered in 25 (19.8%), and postoperative complications occured in 7 (5.5%). The overall normal appendicectomy rate was 11.5%. Mean duration of hospital stay was 3.5 days in group A and 4.7 days in group B. The remaining patients who were actively observed and did not require surgery were discharged when their symptoms and signs had resolved. The study illustrates that appendicectomy after a period of active observation in hospital fro acute abdominal pain carries no increase in morbidity compared with urgent appendicectomy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00171158
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  • 3
    Electronic Resource
    Electronic Resource
    Persistence of enterocolitis following diversion of faecal stream in Hirschsprung's disease (1988)
    Springer
    Pediatric surgery international 3 (1988), S. 141-146 
    Details
    ISSN: 1437-9813
    Keywords: Hirschsprung's disease ; Enterocolitis ; Immunocytochemistry ; Mucins
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Mucosal defence mechanisms of the excluded bowel were studied in 12 patients with Hirschsprung's disease. The entire resected segment of colon obtained following Swenson's operation was cut at 0.5-cm intervals and serially examined by routine haematoxylin and eosin staining, immunocytochemistry, and mucin histochemistry. Seven patients who had clinical evidence of enterocolitis prior to defunctioning colostomy showed histological and immunological evidence of enterocolitis (crypt abscesses, ulceration, leucocyte aggregation, Paneth cell metaplasia, and marked immunocyte responses) in the excluded bowel even several months after diversion of the faecal stream. Mucin histochemistry showed marked depletion of neutral mucins and sulphomucins in the excluded bowel with inflammatory changes and reversal of the sialo- to sulphomucin ratio. These results indicate that patients with enterocolitis complicating Hirschsprung's disease have persistent inflammatory changes in the excluded large bowel after diversion of the faecal stream by colostomy. Environmental factors such as bacterial stimulation and proliferation probably cause inhibition of cell renewal, resulting in abnormalities of mucin fractions. Changes in mucin composition, which is an important mechanical and chemical factor of the mucosal defence mechanism, may lead to altered susceptibility to bacterial degradation and hence may be important in the pathogenesis of enterocolitis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00182770
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  • 4
    Electronic Resource
    Electronic Resource
    Inguinal hernia in the newborn A 15-year review (1988)
    Springer
    Pediatric surgery international 3 (1988), S. 156-157 
    Details
    ISSN: 1437-9813
    Keywords: Inguinal hernia in the newborn
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Seventy consecutive neonates presented with inguinal hernia during a 15-year period. There were 69 males and 1 female. Fifty-one infants were born at full-term and 19 were premature. Sixty-one (87%) neonates presented as an emergency with incarverated inguinal hernia. Only 3 babies with incarceration required emergency operation and in the remaining 58 (95%) patients it was possible to reduce the incarcerated hernia manually and do an elective herniotomy. At follow-up, 3 (5%) of the boys who presented with incarceration were noted to have testicular atrophy. Contralateral inguinal exploration revealed a hernial sac or a patent processus vaginalis in 70% of babies. Two of the 6 boys who had an orchidopexy performed for cryptorchism at the time of herniotomy required a subsequent revision orchidopexy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00182772
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  • 5
    Electronic Resource
    Electronic Resource
    Abnormalities of elastin and elastic fibers in infantile hypertrophic pyloric stenosis (1999)
    Springer
    Pediatric surgery international 15 (1999), S. 540-542 
    Details
    ISSN: 1437-9813
    Keywords: Key words Infantile hypertrophic pyloric stenosis (IHPS) ; Elastic fibers ; Elastin ; Connective tissue ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Infantile hypertrophic pyloric stenosis (IHPS) is characterized by hypertrophy of the pyloric muscle, causing pyloric-channel narrowing and elongation. The rigidity of the muscle is increased, which is characterized as an “olive.” Elastin is an insoluble protein that forms the major structural component of the elastic fibers and maintains the tensile strength of the tissues. To understand the possible histologic and molecular basis of the elasticity of the hypertrophic muscle in IHPS, we determined the distribution of the elastic fibers and elastin expression using Victoria blue van Gieson (VVG) staining and immunohistochemistry. In IHPS, the number of elastic fibers in the connective tissue was significantly increased in the thickened connective-tissue septa (CTS) compared with normal control specimens. In normal pyloric muscle, weak to moderate elastin immunoreactivity was observed in the CTS while no immunoreactivity was observed among the muscle fibers. In IHPS, strong immunoreactivity of elastin was observed in the CTS and moderate immunoreactivity among the hypertrophic smooth-muscle fibers. Our findings suggest that the increase on elastic fibers and elastin expression in the pyloric muscle in IHPS may play an important role in the development of pyloric-muscle rigidity, causing pyloric-canal obstruction.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830050665
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  • 6
    Electronic Resource
    Electronic Resource
    Management of appendiceal mass in children (1989)
    Springer
    Pediatric surgery international 4 (1989), S. 306-308 
    Details
    ISSN: 1437-9813
    Keywords: Appendiceal mass ; Appendicitis ; Conservative treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract During a 5-year period 1072 children were treated for appendicitis. Of these, 112 (10.5%) had an appendiceal mass at presentation that was discovered in 32 cases on clinical examination, in 3 on ultrasound, and in 77 (69%) on examination under anaesthesia. All patients were treated conservatively initially; 98 (87.5%) had uneventful resolution of the appendiceal mass and were discharged after a mean hospital stay of 10.5 days. Fourteen (12.5%) failed to respond to conservative management: 10 showed worsening of symptoms during hospitalisation and required drainage of an appendiceal abscess and 4 were readmitted with recurrence of symptoms 2, 4, 4, and 11 days respectively following discharge. These were managed by appendicectomy. Interval appendicectomy was performed after a mean 6.8 weeks following discharge with a complication rate of 3%. Microscopic examination of appendices removed at interval appendicectomy revealed that over one third of specimens showed evidence of acute or subacute inflammation. There were no deaths in this series. Our results show that conservative management of appendiceal masses is a safe and effective method of treatment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00183394
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  • 7
    Electronic Resource
    Electronic Resource
    Ultrastructural demonstration of abnormal multiaxonal Schwann-cell units in Hirschsprung's disease (1989)
    Springer
    Pediatric surgery international 4 (1989), S. 326-331 
    Details
    ISSN: 1437-9813
    Keywords: Hirschsprung's disease ; Electron-microscopy ; Schwann cells ; Monoclonal antibodies
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The pathophysiology of Hirschsprung's disease is not fully understood. Using light microscopy we have previously demonstrated the absence of a unique Schwann-cell antigen in the circular muscle of aganglionic colon identified by D7 monoclonal antibody. In an attempt to characterise the morphological changes in neuronal cells at subcellular level, we studied innervation patterns in normal and aganglionic colon by electron microscopy. The most striking observation on ultrastructural serial examination of the entire resected specimen of colon from patients with Hirschsprung's disease was the presence of grossly swollen monoaxonal or oligoaxonal Schwann cell units with loss of cellular contents in the circular muscle of aganglionic colon. The extent of subcellular changes in Schwann cells and axons corresponded with a diminution of immunoreactivity with a panel of neuronal cell antibodies. These ultrastructural findings suggest that degenerative changes in Schwann cells and axons within the circular muscle coat of aganglionic segment may be a significant factor in the pathogenesis of Hirschsprung's disease.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00183400
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  • 8
    Electronic Resource
    Electronic Resource
    Natural history of congenital diaphragmatic hernia: implications for management (1987)
    Springer
    Pediatric surgery international 2 (1987), S. 327-330 
    Details
    ISSN: 1437-9813
    Keywords: Congenital diaphragmatic hernia ; Incidence ; Mortality ; Associated anomalies ; Prenatal correction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Advances in ultrasonography have made it possible to accurately diagnose congenital diaphragmatic hernia (CDH) prenatally, and recently interest has been expressed in in-utero correction of CDH as a solution to the problem of high mortality. In an attempt to elucidate the natural history of CDH, we analysed the incidence and mortality of this disorder in a large maternity hospital with an autopsy rate of 100% for all stillbirths and neonatal deaths. Between 1973 and 1985, there were 47 cases of CDH among 99,062 births, an incidence of 1 in 2,107 birhts. There were 15 (32%) stillbirths and 32 (68%) live births. All 15 stillborns had lethal associated non-pulmonary anomalies. Of the 32 liveborn patients, 17 died prior to transfer to the referral centre and 11 of these had major associated anomalies. Prematurity was a feature in 65% of patients who died prior to transfer to the referral centre. Nine of the 15 patients who arrived at the referral centre survived. Our date suggest that the only patient who may benefit from prenatal correction of CDH is a fetus who has serious persistent pulmonary hypertension. However, in the absence of reliable criteria for the in-utero prediction of persistent pulmonary hypertension in association with CDH, surgical correction of CDH prenatally is not practicable at present even for this group of patients. Newer therapeutic approaches in the management of persistent pulmonary hypertension should be addressed as the most promising approach in the management of a CDH patient who develops respiratory failure in the first few hours of life.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00175643
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  • 9
    Electronic Resource
    Electronic Resource
    Differential susceptibility of neonatal lymphocytes to the immunosuppressive effects of anesthesia and surgery (1992)
    Springer
    Pediatric surgery international 7 (1992), S. 47-50 
    Details
    ISSN: 1437-9813
    Keywords: Mitogen ; Lymphocyte function ; Anaesthesia ; Surgery ; Newborn
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The effect of anaesthesia and surgery on the lymphocyte dose-dependent response to four mitogens was measured in 15 neonates for up to 4 days following surgery. The mitogen response to phytohaemagglutinin (PHA), concanavalin A (Con A), pokeweed mitogen (PWM), and staphylococcal protein A (SPA) following anaesthesia and surgery showed varying degrees of immunosuppression depending on the mitogen used. No significant difference was found in the response to PHA throughout the period of study. Lymphocyte responses to Con A were significantly depressed immediately after surgery (P 〈0.005). All patients showed an increase in PWM and SPA responsiveness after induction of anaesthesia, followed by significant depression immediately after surger (P 〈0.01) and 24 and 48 h postoperatively. The variability in responsiveness of neonatal lymphocytes to a range of mitogens during and following surgery suggests subtle differential immunosuppressive effects on individual lymphocyte sub-population, particulary T-cell-dependent B-cell responses. The results are further evidence of the particularly complex nature of the immune response of the newborn.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00181002
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  • 10
    Electronic Resource
    Electronic Resource
    Endoscopic correction of primary vesicoureteric reflux by subureteric Teflon injection (STING): follow-up study in 123 patients (1991)
    Springer
    Pediatric surgery international 6 (1991), S. 269-272 
    Details
    ISSN: 1437-9813
    Keywords: Vesicoureteric reflux ; Children ; Endoscopic treatment ; Polytetrafluoroethylene
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract During a 4-year period 123 children (191 ureters) with primary vesicoureteric reflux (VUR) were treated endoscopically by subureteric Teflon injection (STING). They have now been followed up for periods ranging from 2 to 6 years. Sixty per cent of the ureters had grade III VUR and 36% had either grade IV or grade V. Reflux was corrected in 149 (78%) ureters after a single injection of polytef paste; 11 (6%) ureters showed improvement to grade I or II reflux after one injection and no further treatment was given; 24 (12%) ureters required two injections and 7 (4%) needed three to four subureteric injections for the correction of VUR. Of the 123 patients, 116 were discharged from the hospital on the day of the procedure. Of the 149 ureters corrected with one subureteric injection, 83% required less than 0.3 ml paste per ureter to stop reflux. At follow-up micturating cystography 91% of the ureters continue to show absence of reflux 2 to 6 years after endoscopic correction; 9% had recurrence of reflux, but more than one-half of the recurrences were only of grade I or grade II severity and required no further treatment. Seven ureters had recurrent grade III or IV reflux and were reinjected without any difficulty. There was no evidence of delayed appearance of vesicoureteric obstruction. Treatment of primary VUR by endoscopic subureteric injection of polytef paste was found simple, safe, and effective in correcting all grades of VUR.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00178635
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