[Distinctive features of appendicitis in childhood]. / Besonderheiten der Appendizitis im Kindesalter.

INTRODUCTION: This article describes the specific features of the diagnostics and therapy for acute appendicitis in childhood. As a result of the rapid progression of appendicitis in children, in spite of extensive diagnostic possibilities, we still see significant rates of perforation or vice versa of the so-called negative appendectomies. PATIENTS AND METHODS: Our own results (1,247 appendectomies) of 20 years (1987-2006) were retrospectively analysed. The patients had an average age of 10.3 years (range: 3 months-18 years). RESULTS: The perforation rate was approximately 8.5%, the non-positive appendectomy rate 15.5%. The laparoscopic approach amounted constantly to 20% in the last 5 years. The median length of hospitalisation was reduced from 9.1 (1987-1991) to nearly 5 days (2002-2006). The relevance of active observation by experienced surgeons in addition to ultrasonographic examinations of the abdomen is stressed. CONCLUSION: The appendectomy in children can be performed either by an open or a laparoscopic approach. The expected advantage of the endoscopic procedure (due to the smaller trauma of access) could not be proven in our own patients, as well as in various prospective studies. The early diagnosis and therapy are still today a challenge for the attending doctors.

Climate-driven ecosystem succession in the Sahara: the past 6000 years.

Desiccation of the Sahara since the middle Holocene has eradicated all but a few natural archives recording its transition from a "green Sahara" to the present hyperarid desert. Our continuous 6000-year paleoenvironmental reconstruction from northern Chad shows progressive drying of the regional terrestrial ecosystem in response to weakening insolation forcing of the African monsoon and abrupt hydrological change in the local aquatic ecosystem controlled by site-specific thresholds. Strong reductions in tropical trees and then Sahelian grassland cover allowed large-scale dust mobilization from 4300 calendar years before the present (cal yr B.P.). Today's desert ecosystem and regional wind regime were established around 2700 cal yr B.P. This gradual rather than abrupt termination of the African Humid Period in the eastern Sahara suggests a relatively weak biogeophysical feedback on climate.

[Urodynamics of urethral valve resection]. / Zur Urodynamik der Urethralklappenresektion.

Basing on the cases of 8 children with urethral valves who were diagnosed and treated during the first year of life we report on the urodynamic results. It is concluded that after valve resection enhanced pressure levels may still exist during micturition for some time even if the flow of urine has become normal. A morphologically and functionally satisfactory treatment result (separate lasix clearance on both sides) can be expected only after the pressure has dropped, a phenomenon that often occurs spontaneously.

[Incidence of primary heart tumors]. / Zur Häufigkeit primärer Herztumoren.

Report on 9 primary tumours of the heart as well as of pericardium (3 sarcomas, 3 myxomas, 1 rhabdomyoma as well as 1 mesothelioma and 1 lipoma). Discussion of histology, complications, diagnostics and therapy of these neoplasias on the basis of own material as well as of literature.

Ectopic cervical thymus in a 12-year-old boy: a case report.

The case of a 12-year-old boy with ectopic cervical thymus is reported. This is a rare differential diagnosis in cervical tumors in childhood. The clinical symptoms might present as complications; in rare cases malignant transformations have been reported. The diagnosis ectopic cervical thymus can be achieved only histologically. Due to possible malignant transformation, it is mandatory to excise this thymus tumor totally.