Small bowel esophagoplasty without vascular microanastomosis: a preliminary report.

An intestinal segment through staged augmentation of its blood supply can be well suited to bridge a gap in the esophagus from the abdomen to the neck.

Penile agenesis: a report of six cases.

Agenesis of the penis is an extremely rare anomaly, occurring only once in 30 million births. This low incidence is responsible for the limited experience with this anomaly. There are only about 70 published cases, most reports being of one or two patients. This complex malformation requires urgent assessment at birth for several reasons: Female sex assignment is required early. Gonadectomy should be performed in the first few days of life to prevent male gender sex marking from the testosterone surge occurring between the tenth and the 60th day of life. Early gonadectomy and genital reconstruction helps the family to accept the child's altered gender and to reduce psychological problems.

Abnormal aorta and iliac arteries in children with urogenital abnormalities.

Retroiliac ureters have been found in association with a variety of urogenital abnormalities but the iliac artery usually retains a retroperitoneal position. We report 7 children with various urogenital abnormalities (cloacal malformation 4, bladder agenesis 1, urogenital sinus 1, neuropathic bladder 1) in whom the lower aorta and iliac arteries were so distorted as to pose a significant operative hazard. In all cases the distal aorta and/or iliac arteries lay within the peritoneal cavity, often anterior to the bladder. In 3 cases the aorta was fixed by a short ligament to the umbilicus, and in 3 patients one of the iliac arteries ran across the pelvis behind the pubic bones before entering the leg. In one patient an anomalous iliac artery was inadvertently divided during reconstruction of a cloaca; when recognized, the vessel was rejoined. Recognition of an association between urogenital or cloacal malformations and a major vascular anomaly is of great importance to reconstructive surgeons who, if not forewarned, could unintentionally compromise the arterial supply to one or both lower limbs.

Esophageal reconstruction with free jejunal grafts: an experimental study.

Replacement of a long segment of esophagus for esophageal atresia or severe stenosis remains a special problem in children. The following studies were designed to test the hypothesis that a section of small bowel without serosa could survive as a free autologous transplant to replace part of the mediastinal esophagus. Laparotomy was performed in 20 adult cats, a loop of small bowel was resected and an end-to-end jejunojejunostomy was completed. The serosa of the resected bowel was removed and the mucosa-muscularis graft was used to replace a segment of the middle esophagus that was resected via a right thoracotomy. The interposed graft was entirely wrapped with adjacent skeletal muscle flaps. Postoperative studies include barium swallow and cine esophagograms, histology and blood vessel casts. Results are presented which show anatomical and functional survival of 16 grafts without blood vessel anastomoses or intrinsic vascular pedicles.

[Complications following colon surgery]. / Komplikationen nach Operationen am Dickdarm

615 transperitoneal operations on the colon and rectum produced the following results. 377 abdominoperineal resections, anterior resections, partial and subtotal colectomies and proctocolectomies, 87 closures of colostomies and 151 operations with resection. 66% of the operations were required due to tumors. The death rate with 545 preopreratively prepared and scheduled operations was 8.1% whereas with the 70 emergency operations it was 25.7%. In 254 or 41.3% of the cases there were postoperative complications. Severe postoperative complications due to infection were the most frequent, followed by cardiopulmonary, haemorrhagic, urological and complications due to ileus. The quotient of insufficiency with the 356 anastomoses was 16%, the death rate 1.4%.

[Double kidney with ureterocele]. / Die Doppelniere mit Ureterozele.

Twenty-six children with ureteroceles--twenty-three with unilateral double collecting system and three with bilateral double kidney--are analyzed. The clinical and radiological features of these ureteroceles are presented. The different possibilities of surgical management and their results are discussed. In 14 of these children we performed resection of the ureterocele with en bloc reimplantation of both ureters. Eleven cases were treated by resection of the ureterocele and upper pole nephroureterectomy and four cases by nephroureterectomy. Vesicoureteral reflux in both renal pelvic moieties was found in five cases after ureteral reimplantation en bloc. Because of frequent bilateral disease (10%) and the common association of other urological malformation it is preferable to try to perform ureteric reimplantation rather than primary nephroureterectomy even when the possibility of postoperative reflux is considered.

Neourothelium in bladder augmentation. An experimental study in rats.

Experimental surgery in 7 rats was used to investigate the possibility of trigonal urothelium overgrowth into a segment of bowel which had its own mucosa removed. After subtotal cystectomy the intestinal mucosa from the cecum was completely stripped away, and the cecum was then anastomosed to the remainder of the bladder. Urothelial overgrowth of the bowel surface was evident one (3 animals) and two months (4 animals) after the initial procedure.

[Traumatic pseudocyst of the lung]. / Die traumatische Pseudozyste der Lungen.

A rare complication of closed chest injury is the traumatic pulmonary pseudocyst. A well documented case of a 15-year-old boy with this definite, acutely formed, primary structural manifestation within the lung is reported with a short review of nomenclature, pathogenesis, diagnosis and treatment.

[Staged functional closure of bladder extrophy (author's transl)]. / Der zeitlich gestaffelte, funktionelle Verschluss der Blasenekstrophie.

Two surgical alternatives exist in the treatment of classic bladder exstrophy: urinary diversion and functional closure. The staged ureterosigmoidostomy is the treatment of choice for patients not suitable for bladder and urethral reconstruction. The treatment of the patients selected for closure begins by closing the bladder during the neonatal period. Osteotomy appears to be necessary in children older than 2 days. Incontinence and vesico-ureteral reflux are treated by bladder neck-urethral reconstruction and reimplantation of the ureters at three years of age. Closure of the epispadias follows in the fifth year. It may be necessary to treat upper tract complications by secondary urinary diversion. Concerning incontinence, technical improvement in artificial sphincter may soon offer an alternative to urinary diversion. The results of 70 primary bladder closures selected from 94 patients presenting with bladder exstrophy are presented: 54 patients with long-term follow-up and completed staged repair were available for assessment: 31 (57.5%) proved to have a good result and 10 (18.5%) to have a fair results. 13 (24.0%) were completely incontinent or required diversion. Failures were thought to be the results of inadequate selection or failure to achieve continence.

Renal tumours other than Wilms' tumour in the paediatric age group.

The non-Wilms' renal tumours in the paediatric age group may be classified according to age of onset, clinical-biological behaviour and morphology. This distinction is of practical importance because treatment and prognosis are different from those of Wilms' tumours. We report on clinical features, histological patterns, treatment and outcome of 9 cases seen between 1959 and 1981: - renal cell carcinoma (3 patients) - congenital mesoblastic nephroma (2 patients) - bone metastasizing renal tumour (3 patients) - angioleiomyolipoma (1 patient) Our experience is compared with the few reports of the same conditions in the literature.

Granular cystitis in girls. Long-term follow-up.

Granular cystitis or 'papular cystitis' is a very common form of cystitis in young girls. In this paper we show the evolution of this affliction in women after puberty. In a series we were able to follow up leukoplakia or follicular cystitis patients to the age of 16 years.

[Spontaneous colon perforation in patients with chronic kidney failure]. / Die spontane Kolonperforation bei chronisch niereninsuffizienten Patienten.

Although spontaneous colonic perforation is a rare event, if has recently been observed with increasing frequency in patients with renal failure. Several of the drugs given to such patients may induce dehydration of faeces; the combination of very hard faecal masses and an abnormal fragility of the uraemic intestinal mucosa will then lead to the formation of a decubital ulcer. Prophylaxis or at least early diagnosis are imperative because after completed perforation the prognosis is very poor. The operative method of choice is the incontinuous resection of the entire segment of the colon affected by faecal impaction.