Endoscopic appendectomy in childhood--technical aspects.

Since March 1992 we initially performed 87 laparoscopic appendectomies applying two cat-gut loops for ligation of the stump. Since we postoperatively found abscess formation twice, we modified the technique in the following aspects: After the introduction of the scope at the umbilicus, 2 working trocars with a diameter of a 5 mm are placed in the left lower quadrant of the abdomen, so that the surgeon can skeletonize the appendix bimanually until it can be dissected with an Endo-GIA. This procedure we carried out in 41 cases and did not see any postoperative complications yet. Thus we consider it an appropriate alternative to conventional surgery.

Transplantation of fetal adrenal glands in syngeneic rat strains.

In a syngeneic rat model we investigated the feasibility of fetal adrenal gland transplantation into adult recipient animals. We determined the optimal site of graft implantation by morphological criteria. Transplantation into the omentum majus proved superior to transplantation underneath the fascia of the rectus abdominis muscle possibly due to superior access to vascular supply. We assessed transplant function by sequential determinations of serum corticosterone, aldosterone, sodium and body weight. We compared rats which received syngeneic fetal adrenal transplants and underwent excision of their own adrenal glands four weeks thereafter to control animals without adrenalectomy or transplantation and to adrenalectomized animals without prior transplantation. The total study period was 16 weeks. Whereas all adrenalectomized rats without prior transplantation died within 2 weeks, all the animals which had received fetal adrenal grafts survived. Their serum sodium remained within normal limits. Weight gain and serum corticosterone levels were decreased when compared to control animals. Aldosterone levels dropped intermittently but had normalized by 16 weeks. We conclude that fetal adrenal grafts may be able to substitute for the animals' own adrenal glands in the syngeneic model.

New morphological findings in so-called negative appendectomies.

Appendices of children operated on because of clinical signs of acute appendicitis and presenting normal histological findings were revised by means of special assays. These findings were then compared with appendectomies during abdominal surgery, catarrhal and early phlegmonous appendicitis. We found pathological changes of the epithelium and the lymphatic tissue in more than two thirds of the specimens originally classified as normal. Therefore the term of "negative appendectomy" has to be redefined.

Fetal intestinal transplantation: a new therapeutic approach in short-bowel syndrome.

Intraperitoneally transplanted fetal rat intestine can be anastomosed to the intestine of the host after 4 weeks of maturation. In syngeneic transplant combinations morphological findings as well as functional parameters suggest that the intestinal transplant might provide a substitute for normal intestinal tissue. Four weeks after fetal intestinal transplantation in adult Lewis rats we resected the total small bowel of the host and interposed the matured transplant. Resection of total small bowel without transplant interposition led to a decline of body weight in control animals but was prevented in the transplanted group. After total small bowel resection and cecectomy (a lethal resection in the control group) we found a 40% (4/10) survival in the group in which the transplant had been anastomosed to the remaining bowel.

[Persistent subarachnoid-pleural cerebrospinal fluid fistula following excision of a thoracic ganglioneuroma. Case report]. / Persistierende subarachnoidal-pleurale Liquorfistel nach Exstirpation eines thorakalen Ganglioneuroms. Kasuistik.

During extirpation of a thoracic ganglioneuroma, haemostasis of venous haemorrhage by application of bone wax close to the costovertebral junction at Th 4/5 resulted in plegia of the lower extremities on the fourth postoperative day. Compression of the myelon due to the applied bone wax was relieved directly after CT scan diagnosis. In the postoperative course, a persisting subarachnoidal pleural fistula was closed by means of muscle flap plasty and fibrin adhesive.

The influence of extracorporeal circulation and hemoseparation on red cell deformability and membrane proteins in coronary artery disease.

Extracorporeal circulation and hemoseparation may lead to coupled mechanical and chemical blood trauma and thus influence red cell deformability. Ten patients with coronary artery disease underwent coronary bypass. Patients' blood samples were drawn preoperatively, after extracorporeal circulation, and after hemoseparation. Ten healthy adults served as control subjects. Red blood cell deformability was determined by direct microscopic observation of red blood cells subjected to shear stresses of 1.2 to 13.3 Pa with a counter-rotating rheoscope. Red cell membrane proteins were separated by one-dimensional polyacrylamide gel electrophoresis in the presence of sodium dodecyl sulfate. At 1.2 Pa, preoperative red cell deformability was significantly greater in patients with coronary artery disease than in control subjects. Neither extracorporeal circulation nor hemoseparation changed red cell deformability significantly. Electrophoretic separation of membrane proteins failed to show any quantitative or qualitative differences between patients and control subjects. Moreover RBC membrane proteins of red blood cells in the patients were not altered as a result of extracorporeal circulation or hemoseparation. The preoperatively increased red cell deformability in the patients may be drug-induced. Our data suggest that the extracorporeal circulation and hemoseparation techniques used in this study do not lead to red blood cell damage.

[About the question of indication for surgery of retractile testis]. / Zur Frage einer Operationsindikation bei Pendelhoden.

Histometric studies in 34 boys with retractile testes and 21 controls with normal descent showed no significant statistic differences with regard to tubulus diameter and spermatogonia count. Operative treatment of retractile testes, therefore, is not indicated.

[Appendicitis in enteritis]. / Appendizitis bei Enteritis.

We are confronted with the fact that in a considerable number of cases appendicitis occurring during enteritis is diagnosed late and is often only operated on in the state of perforation. Among our own cases of 519 appendectomies in the last five-years-period this applied to 13 children (2.4%). The problems of these cases and methods to a correct and immediate diagnosis are shown.

[Differential "adrenal gland tumor-adrenal gland hemorrhage" diagnosis. A sonographic follow-up]. / Zur Differential-diagnose "Nebennierentumor-Nebennierenblutung". Eine sonograpische Verlaufsbeobachtung.

A case report with typical sonographic follow-up findings of adrenal hemorrhage in neonates is presented. The most important follow-up criteria to differentiate adrenal malignoma from hemorrhage sonographically are significant reduction of size, loss of echogenity as well as formation of a capsula within the first 10 days of life. Otherwise - even with insignificant laboratory findings - malignoma, especially congenital neuroblastoma, has to be suspected.