0000000000870656
AUTHOR
Steffen Berger
Repeated pull-through surgery for complicated Hirschsprung's disease--principles derived from clinical experience.
Abstract Background In some patients, an initial pull-through procedure for Hirschsprung's disease fails, and obstructive symptoms persist or recur. Then a repeated pull-through operation may be necessary. Methods Seventeen patients with Hirschsprung's disease aged 2 to 9 years (median, 4.6 years) have undergone a repeated pull-through procedure because of unresponsive symptoms after an initial operation. The initial procedure was Soave in 3 patients, Rehbein in 13 patients, and Duhamel in 1 patient. Surgical revision was indicated by incomplete resection of the transition zone in 16 patients, anastomotic strictures in 9 patients, and fistulas in 2 patients. All 17 patients have undergone R…
Hypertonic saline solution and decompressive craniectomy for treatment of intracranial hypertension in pediatric severe traumatic brain injury.
Experimental data 8 –11 and first clinical results in adults 12,13 suggest that hypertonic saline ( 1.0) may be highly effective in lowering ICP even when mannitol has lost its therapeutic potential after prolonged and repeated use. In children, only limited experience exists with the use of hypertonic saline solutions: a randomized prospective study in children with severe head injury compared the effects on ICP (increased to 15–20 mm Hg) of isotonic (0.9% NaCl) and hypertonic (3% NaCl) saline injections, demonstrating a beneficial effect of the hypertonic solution. 14 Another prospective randomized trial compared the effects of continuous infusion of either lactated Ringer’s solution (277…
Hypertone Kochsalzlösung und Entlastungskraniotomie beim schweren Schädelhirntrauma im Kindesalter
Hypertone Kochsalzlosungen werden als ‚small volume resuscitation’ in der Therapie des Volumenmangelschocks eingesetzt. Tierexperimentelle Untersuchungen konnten auch eine Hirndrucksenkung durch hypertones NaCl nach Schadelhirntrauma (SHT) zeigen. Erste klinische Erfahrungen beim Erwachsenen mit SHT haben eine Wirksamkeit von hypertonem NaCl auf den erhohten intrakraniellen Druck (ICP) gezeigt, die auch dann noch besteht, wenn Mannitol nach mehrfachem Einsatz keine Wirksamkeit mehr besitzt. Stark hypertone NaCl-Losungen (> 3%) wurden beim kindlichen SHT bisher nicht eingesetzt. Material und Methoden: Bei zwei Jungen (11 J, 12 J) mit isoliertem SHT (jeweils unilateraler temporoparietaler Kon…
Small omphalocele with umbilical evagination of the bladder: a distinct entity?
A neonatal case of umbilical evagination of the bladder combined with a small omphalocele is presented. This rare congenital malformation has previously been described in only three cases. Umbilical evagination can be understood as a disturbance of development of both the vitelline and allantoic ducts, resulting in a non-descended but otherwise normal bladder opening to the inferior margin of a small omphalocele. Diagnosis is made by clinical inspection and ultrasound. Since other malformations are not present, this entity may be regarded as a minor form of a lower midline defect with excellent prognosis.