Complex long-segment intestinal dysganglionosis.

A case is reported with aganglionosis of the rectum, sigma, and descending colon; dysganglionosis with heterotopic ganglionic cells in the muscularis propria of the hypoganglionic transverse colon; and extreme hypoganglionosis (without detection of ganglionic cells) of the ascending colon and distal ileum. The ileum showed a transition zone with hypoganglionosis and intestinal neuronal dysplasia (IND) type B. As to the etiology of such complex intestinal innervation defects, pre- and perinatal perfusion deficits must be considered because their localization seems to be linked to the vascular anatomy of the colon. Early diagnosis may be difficult, causing a delay in operative treatment and multiple operations. Different manifestations of dysganglionosis may be found in the same patient. The classical continuum of distal aganglionosis followed by proximal hypo- or dysganglionosis and then normally innervated bowel may not always be present. Therefore, in children with recurrent (sub-)ileus after resection of an aganglionic bowel segment, additional dysganglionosis such as IND or hypoganglionosis or even complex intestinal dysganglionosis should be excluded by full-thickness colon and small bowel biopsies.

[Traumatic hip dislocation in childhood]. / Die traumatische Hüftluxation im Kindesalter.

The article reports on eight cases of traumatic dislocation of the hip in children. Six of these were genuine dislocations and two dislocation fractures. The children were between 5 and 13 years of age at the time of injury. Seven of these 8 children could be followed up one to 21 years after the accident. All 7 children were free from complaints at the time of follow-up examination; in one case only we found a moderate loss of function in the injured hip joint. In this patient the x-ray film showed deformation of the head of the femur after partial necrosis of the femoral head, as well as initial signs of coxarthrosis. Prognosis of this rare injury in children is favourable if repositioning is performed in time and if relief of the hip is effected for the proper period of time, depending on the individual case.

Endotracheal and endobronchial tumours in childhood.

Following a review of the literature on the most common types of endobronchial tumours (carcinoid cylindromas and mucoepidermoid tumours), four cases of such bronchial tumours in children are reported. Two of them underwent isolated bronchial resection, whereas one of the others had to undergo bilobectomy in addition and the other, pneumonectomy. The patients remained free of recurrences after a follow-up of 5-20 years. The advantage of circumferential resection and some technical aspects are discussed.

[Post-traumatic radio-ulnar synostoses in childhood]. / Posttraumatische radioulnare Synostosen im Kindesalter.

This article reports on five children treated surgically during 1973-1975 for posttraumatic radioulnar synostosis. The synostoses had developed as a complication after a proximal radial fracture. Lesion of the proximal ulna plays an important part in creating such an osseous union. Another factor of equal importance is the traumatization of the tissues during surgical treatment of the fracture, especially if debris of the periosteum and fine bone fragments additionally enter into the space between radius and ulna. Formation of excess callus, and hence synostosis, is also promoted if repositioning or re-repositioning of a proximal radial fracture is effected too late. The article presents the technique of surgical treatment of proximal radioulnar synostosis with Lyodura sheathing. Follow-up examination of the five children during an observation period of five years showed good results in two children, a moderate result in one, and poor results of surgery in two cases. Improved results may be expected from further improvement of the surgical method, such as resection of the bicipital tuberosity (tuberositas radii) or from additional partial sheathing of the ulna at the side facing the radius.

Pulmonary arteriovenous fistula in childhood.

We report two cases of children with pulmonary arteriovenous fistula treated at the University Clinic of Mainz. This angiodysplasia is relatively more diffuse and the clinical signs are more marked in childhood. The non-invasive techniques should be preferred for diagnosis. Complications occur frequently even in asymptomatic children so it is recommended to operate them. The local excision without extirpation of lung tissue should be preferred to segmentectomy or lobectomy for peripheral lesions. Therapeutic embolisation should be tried in inoperable cases.

[Indication of appendectomy in chronic appendicitis in children. (author's transl)]. / Die Indikationsstellung zur Appendektomie bei der chronischen Appendizitis im Kindesalter.

The results of the study presented in this paper are based on a comparison of two equally large groups of 33 children each with chronic appendicitis on whom appendectomy had been performed, as well as 33 children with inguinal hernia and relevant surgery. The preoperative and postoperative signs and symptoms were compared in both groups. It was found that reduction of symptoms was significantly greater following appendectomy than after herniotomy. Hence, the question whether after diagnosis based on a more liberal interpretation of the indication for appendectomy in chronic appendicitis in children, the overall well-being of the children can be improve significantly, should be given an affirmative answer.