Diagnostische Möglichkeiten und Behandlungsstrategien für die Fraktur der Eminentia intercondylica im Wachstumsalter

Between 1970 and 1993 29 fractures of the intercondylar eminence were seen in children with almost the same number of cases showing no or minor displacement as those requiring open reduction for major dislocation. Combined knee injury must be suspected the higher the patient's age and the more pronounced the displacement of the fragment. Magnetic resonance imaging (MRI) has gained diagnostic predominance. Arthroscopy remains important for surgical management, especially of associated meniscus and cartilage damage. Early puncture of hemarthrosis is essential. Closed management is the therapy for nondisplaced fragments or those with bone contact or only tuberculum fractures--while displaced f…

Results of the smooth-muscle fold-over double-plasty (SMFD)

Since 1980, when we developed substitute for the internal anal sphicter, the smooth-muscle fold-over double-plasty (SMFD-plasty), we have operated on seven children using this method, usually in combination with the pull-through procedure, and on five children after one or more previous operations. Since 1983, 11 cases with previous operations have undergone the modified “door-wing” SMFD-plasty. The results are excellent if the operation is used in primary combination with the pull-through procedure or if the “door-wing” modification is combined with reconstruction of the pelvic floor. It is also necessary that all cases undergo a biofeedback conditioning program.

Congenital malformations and perinatal morbidity associated with intestinal neuronal dysplasia.

A close relation between different forms of dysganglionosis such as intestinal neuronal dysplasia (IND) type B and aganglionosis has been established. No systematic analysis of other malformations and diseases accompanying IND has been made as yet. Congenital malformations and perinatal morbidity were analyzed in 109 patients with IND seen at the Department of Pediatric Surgery in Mainz from 1977 to 1996. IND was associated with Hirschsprung's disease in 47 cases; 22 children with IND had other abdominal malformations, including anal atresia, rectal stenosis, sigmoidal stenosis, ileal atresia, pyloric stenosis, and esophageal atresia. A cystic bowel duplication, a choledochal cyst, and a pe…

Neuronal intestinal dysplasia

Findings in 23 children with neuronal intestinal dysplasia (NID) are presented. Twelve children had Hirschsprung's disease that masked the existence of proximal NID. In all cases the diagnosis was established by histological-histochemical examination. Amelioration of symptoms by conservative treatment alone was achieved in 4 children; in 13 cases colostomy was necessary. In 6 patients colon resection was performed: 2 suffered from both colitis and obstruction; the other 4 were treated for obstruction, multiple perforations, persistant adynamia of the left colon, and fistulation. In 9 patients the colostomy was closed. Four of 6 children who did not have sonographic confirmation of motility …

Acute Multilocular Osteomyelitis in Infancy and Childhood

38 cases of acute multilocular osteomyelitis out of a total of 165 osteomyelitis patients were treated between 1974 and 1986 at the Department of Paediatric Surgery and Paediatric Diseases at the University of Mainz. Osteomyelitis in infants was separated from juvenile osteomyelitis because of the different problems inherent to this disease depending upon the age; likewise, multilocular remote involvement was separated from regional multiple involvement. It was found that distant involvement is of special importance in infancy. 6 of the 8 cases in this group presented with symmetrical involvement. This interesting phenomenon is described in this article for the first time in acute multilocu…

Gegenwärtiger Stand der Trichterbrustbehandlung

Chirurgische Strategien bei Schilddrüsenerkrankungen im Kindes- und Jugendalter

In the Department of Paediatric Surgery of the University Hospital of Mainz and the Department of Paediatric Surgery of the University Hospital of Frankfurt/M 90 children with thyroid gland lesions were operated on between 1970 and 1988. 78 patients had benign findings and 12 had malignant tumours. The most frequent operative indication for benign lesions was the euthyroid goitre (57 patients). We found nodular goitre in 45 patients, cystic goitre in 11 patients, and diffuse goitre in only 1 patient. 20 children were suffering from hyperthyroidism (11 with Basedow's disease, 9 with autonomy) and 1 from Hashimoto's thyroiditis. Among the malignant tumours, papillary carcinomas were the most …

Pressure-Induced Growth (PIG) of Atretic Esophagus: A Contigent Management for High-Risk Esophageal Atresia

The management of uncomplicated esophageal atresia is a straightforward procedure consisting of thoracotomy with anastomosis of the atretic segments and ligature of any tracheoesophageal fistula present. However, besides the rareness of isolated esophageal atresia, our observations in the past few years show increasing incidence of the anomaly in association with premature births and other malformations which are usually incompatible with life. Aspiration pneumonia resulting from reflux of gastric content through a lower tracheoesophageal fistula, rather than the overflow of saliva from an upper atretic pouch, also threatens the life of an otherwise healthy neonate with esophageal atresia.

Der Stellenwert der chirurgischen Behandlung des Neuroblastoms

Results of surgical treatment of 29 neuroblastoma patients between 1968 and 1980 are presented. 13 of these children have remained free from relapses and complaints for more than 2 years. Despite the progress in (immuno)chemotherapy and (immuno)radiotherapy the prognosis depends on the kind of surgery performed, also and especially in stages III and IV (after Evans). Among the author's own patients it became evident that both the survival rate and the survival period were increased in the prognostically unfavourable cases by subtotal resection. No representative collective statistics are known and it will probably take quite some time before these can be compiled, since it is extremely diff…