New aspects in a murine model for extrahepatic biliary atresia.

The cause of extrahepatic biliary atresia (EHBA) remains unknown, and even an animal model is still lacking. Observations in a murine infectious model (newborn Balb/c mice infected with rhesus rotavirus group A [RRV]) reported extrahepatic biliary obstruction similar to findings in children who have EHBA. In the present study, this animal experiment was repeated, and the clinical and histomorphologic changes were observed over 3 weeks. Eighty-nine newborn mice were infected with RRV, and 67% showed signs of cholestasis and delayed growth. Eight of these animals recovered spontaneously whereas the others remained icteric. Fourty-six pups were prepared for microscopic examination following a 2-day interval. From the fifth day, the whole biliary tract showed edematous swelling with cellular infiltration. Ten days later, in the extrahepatic bile duct, a transformation took place in which concentric infiltration led to complete obstruction, sometimes with prestenotic dilatation. The intrahepatic changes showed reactive necrosis and proliferation of the small bile ducts. In one 19-day-old mouse, a ballooning dilatation was observed, similar to a developing choledochal cyst. Infection with RRV induces in newborn Balb/c mice a cholestatic clinical picture with different courses of the disease leading mostly to complete biliary obstruction and secondary hepatic changes similar to EHBA in children. This is the first animal model for EHBA with complete obstruction of the extrahepatic bile duct induced by infection. These findings present a new basis for further studies.

Experience with repair of 120 hypospadias using Mathieu's procedure.

Between 1985 and 1993 120 boys with distal hypospadias (from distal penile shaft to glandular position) were treated using Mathieu's procedure at the department of pediatric surgery, Hannover Medical School, Germany. The outcome of these cases has been analysed. Fistula-rate was 12.5%. Results are compared with published reports, recent developments and changes in treatment are discussed.

[Treatment outcome after complex pelvic trauma in children]. / Behandlungsergebnisse nach komplexem Beckentrauma bei Kindern.

Between 1972 and 1994 21 children up to 14 years old sustained complex pelvic trauma treated at the Trauma Department of the Hannover Medical School. Sixteen of the 17 survivors were followed at an average of 8.9 years. In 8 patients operative treatment of the disrupted pelvic ring (external or internal fixation) was performed; in 8 patients the treatment was conservative. At follow-up 9 patients (56%) were pain-free; 4 reported slight, 2 moderate and one patient severe pain (at rest). There were no neurological deficits. Four patients had disturbed micturia, and 1 had bowel incontinence. Radiological evaluation showed anatomic reconstruction of the pelvic ring in 9 cases (56%). Residual maximum displacement of 12 mm was detected in 2 patients. In 3 cases osteoarthritis or ancylosis of the SI joint was present. In 3 cases a clinically not disturbing heterotopic ossification was found. Another 2 cases had ossifications of the pubic symphyses. A post-traumatic acetabular dysplasia was detected in 2 cases; a hypoplasia of the hemipelvis was seen in 3 patients. In a retrospective analysis of the primary radiographs, 13 pelvic lesions were not detected during the primary clinical course (sacral fractures, lesions of the triradiate cartilage). Despite this finding the pelvic outcome was rated good and excellent in 10 patients (63%), moderate in 1 patient (hypoplasia of the hemipelvis, and poor in 5 patients (31%) with severe pain or urogenital disturbances. The maximum ratings in social reintegration was given to 9 patients, a medium rating to 7 patients. All patients were socially integrated.