[Surgery of achalasia in childhood. The thoracic or abdominal approach?]. / Operace achalázie v detském veku. Hrudní nebo brisní prístup?

The authors present their experience with surgical treatment of achalasia of the oesophagus in child age. During a nine-year period (1984-1992) they operated 11 children with achalasia. The group comprised 6 boys and 5 girls. The mean age at the time of operation was 9.5 years. The youngest patient was operated at the age of 14 months and the oldest one at the age of 15 years. The main clinical symptoms at the time of establishment of the diagnosis were: vomiting in 91%, dysphagia in 64%, the children did not thrive and lost weight in 36%; they suffered from relapsing bronchopneumonia in 27%, chronic bronchitis in 9%, bronchial asthma in 9% and one female patient was treated and followed up on account of anorexia nervosa. In six patients a modification of Heller's operation was performed with left-sided thoracotomy which in three patients was supplemented by anti-reflux Belsey Mark IV plastic operation. During the last three years five patients were operated from an abdominal approach and myotomy was supplemented by Nissen fundoplication. At present the authors prefer and abdominal approach and supplement myotomy of the distal oesophagus by Nissen fundoplication.

[Surgical treatment of pectus excavatum and pectus carinatum]. / Chirurgické lécení pectus excavatum a pectus carinatum.

The authors present their experience with surgery of deformities of the chest wall in childhood. In the course of 1986 to 1992 they operated 93 children with the diagnosis of pectus excavatum. This number comprised 66 boys and 27 girls. The mean age of the operated children was 10.5 years. During the same period 17 patients (12 boys and 5 girls) were operated on account of pectus carinatum. The mean age of the latter group of patients was 13.5 years. 23% of the patients with a pectus excavatum had before operation mild scoliosis, two patients suffered from severe scoliosis. 76 patients after operation of pectus excavatum were followed up for more than one year after operation. In 44 patients the result was excellent (58%), in 31 patients the result was good. One patient developed a relapse. Fifteen patients after operation for pectus carinatum were followed up for more than one year. In 12 patients (80%) the result of the operation is excellent, in three patients (20%) the result is good. From the group as a whole seven patients had dehiscence of the wound after surgery, four patients developed a seroma in the surgical wound, three patients developed pneumothorax after operation and in one instance an abscess developed in the surgical wound. In the course of 1987 the authors changed the surgical technique in pectus excavatum from Jensen's to Holcomb jun. operation.

[Gastroesophageal reflux as the basis of recurrent and chronic respiratory diseases]. / Gastroezofageální reflux jako podklad recidivujících a chronických respiracních onemocnení.

Among many causes of relapsing and chronic respiratory diseases in children the authors revealed gastrooesophageal reflux (GER) in 53 of 106 examined children, i.e. in 50%. Therefore examination of GER was included in routine examinations of all children admitted on account of the following diseases: laryngitis rec., bronchitis rec., bronchitis obstructiva rec., pneumonia rec., bronchiectasy, bronchitis deformans, asthma bronchiale. GER was detected in 208 children aged 6 months to 15 years. All children were subjected to an X-ray examination by contrast substance and to sonography of the cardia. In clinically serious cases manometric and pH metric examinations were made. When GER was detected the authors recommended conservative treatment: postural position, restricted fluid intake before going to bed, elimination of cocoa and chocolate, antacids. A favourable effect of conservative treatment in the course of 1-2 years was recorded in 60 of 76 children, who attended check-up examinations, i. e. in 79%. In children where serious complaints persisted, in particular rec. pneumonia, the development of deforming bronchitis and bronchiectasy or dyspnoic attacks, the authors indicated after completion of examinations and agreement with surgeons, a surgical approach. Fundoplication was performed in 22 children, i. e. in 10% of the patients where GER was revealed.

[24-hour esophageal pH measurement in 52 children with gastroesophageal reflux]. / 24-hodinová jícnová pH-metrie u 52 detí s gastroezofageálním refluxem.

The authors give an account of their experience with 24-hour pH metry of the oesophagus in children. They made 56 examinations in 52 patients with different clinical complications of gastrooesophageal reflux (GER). The pathological finding during oesophageal pH-metry was in the great majority consistent with the pathological finding during oesophageal manometry. Of 52 children 18 patients were indicated for surgery on account of GER. The authors emphasize the advantages of 24-hour oesophageal pH-metry in particular as an auxiliary method in indications for surgery of gastrooesophageal reflux.

[Surgical treatment in primary tumors of the liver in children (in a group of 37 children)]. / Moznosti chirurgické terapie primárních nádoru jater u detí (soubor 37 detí).

The authors present an account of 37 children with primary hepatic tumours at the age of 1 to 16 years. The mortality in the group was 50%. Right-sided lobectomy on account of a hepatoblastoma was performed in 13 children, probatory excision on account of an advanced process in 9, left-sided lobectomy only in five children. The most frequent tumour was a hepatoblastoma in infants, followed by haemangioma and a hepatocellular carcinoma. The authors draw attention to the importance of careful examination of the abdomen by palpation as the first possible diagnostic guide. They emphasize the importance of sonography and arteriography of the hepatic vein in the preoperative examinations.

[Therapy of esophageal strictures in childhood using balloon dilatation catheters]. / Terapie striktur jícnu v detském veku dilatacními balónkovými katétry.

The authors used in 1987-1988 Grüntzing's balloon catheter for the treatment of oesophageal strictures in nine children. They were successful in eight, in one patient after burning of the oesophagus with sulphuric acid the dilatation by means of the balloon failed. These injuries must be treated by surgery. The method is safe, easy and effective, in particular in the treatment of tight, long and irregular oesophageal strictures which cannot be dilated by the standard technique, using dilatation bougies. Dilatation by means of balloon catheters is a perspective method for severe oesophageal strictures.

[Gastroesophageal reflux in childhood asthma]. / Gastroezofageální reflux u detských astmatiku.

Gastrooesophageal reflux (GER) may participate in the development and persistence of asthmatic complaints. For its detection various examination methods may be used such as oesophagography, oesophageal manometry and pH-metry, ultrasonography, isotope scintigraphy, oesophagoscopy. By means of these methods we detected GER in 27 children, i. e. 41% of a total number of 65 asthmatic children with a medium severe and severe form of the disease. Because of failure of conservative treatment of reflux and hitherto used anti-asthmatic therapy, in 1984 to 1986 in 11 children surgical treatment of reflux by Nissen's fundoplication was indicated. The group comprised 9 boys and 2 girls aged 2 to 14 years. The effect of the operation was evaluated after an interval of 1.5 to 3.5 years following operation. Surgical treatment was successful in four patients (36%) and partly successful in 5 patients (45%). Despite these encouraging results the indication surgery in GER in asthmatic patients still is strictly individual.

[Diagnosis of isolated tracheo-esophageal fistula by manometry of the esophagus]. / Diagnostik der isolierten Tracheoösophagealfistel durch Manometrie der Speiseröhre.

A method for diagnosis of isolated tracheo-oesophageal fistula by oesophageal manometry is described. It consists of pull-through registration of intraluminal pressures. An abrupt pressure rise in the area of the fistula during inspiration is pathological. In principle, this method consists of the graphical tracing of the original Koops test which we have slightly modified. The investigation is non-invasive and accurate in comparison with roentgenological and/or endoscopical methods.