Avascular transplantation of small bowel in newborn piglets.

Segments of small bowel of newborn piglets were isolated and wrapped in omentum as free autotransplants. After initial necrosis, they regenerate either completely, or at least their muscular layer is restored. As there is a lot of inflammatory reaction in most of the grafts, the conclusion is drawn that either preexisting infection, or autoaggressive reactions are responsible for this. Homografts behave like autografts in the beginning, their structures being restored, but are all rejected by the sixth week. Immaturity of the immunologic system in the newborn may be the reason for this late rejection.

A proposal to preserve the ileocecal valve and right colon in total colonic aganglionosis.

We report two cases of total colonic aganglionosis in which the ileocecal valve and right colon were preserved. The aganglionic ileal segment is removed leaving behind only a very short prececal remnant, which is anastomosed end-to-back to the remaining ileum. An ileal loop (of approximately 20 cm in length) is isolated and interposed between the right colon and rectum. The operation can be performed as a staged procedure. The advantage of preserving the ileocecal valve with respect to physiology is discussed.

[Value of cholescintigraphy in the differential diagnosis of direct hyperbilirubinemia in infancy]. / Wertigkeit der Choleszintigraphie in der Differentialdiagnose der direkten Hyperbilirubinämie des Säuglingsalters.

Cholescintigraphy using 99mTc-diethyl-, 99mTc-diisopropyl-, 99mTc-iodo-diethyl- and 99mTc-bro-motrimethyl-IDA was performed in 22 newborns and infants with direct hyperbilirubinaemia. Retrospective evaluation of 99mTc-diethyl- and 99mTc-diisopropyl-IDA (n = 18) showed an efficiency of 66% in the differentiation between extrahepatic biliary atresia and neonatal intrahepatic diseases if the hepatocyte-clearance index and transit time were taken into consideration; the sensitivity of detecting extrahepatic biliary atresia was 100%. Cholestyramine treatment (n = 9) did not increase the efficiency of the test. Efficiency was markedly reduced when the serum direct bilirubin level was above 5.5 mg/dl (94 mumol/l). The gall bladder was not visualized in 13 out of 18 examinations. The prospective and retrospective analysis of 99mTc-iodo-diethyl- and 99mTc-bromo-trimethyl-IDA revealed intrahepatic disease in all 6 infants with serum values up to 12.6 mg/dl (216 mumol/l) direct bilirubin; the gall bladder was not visualized in 4 out of 7 examinations.

[Bacterial aortic aneurysm due to pseudomonas aeruginosa after pneumonectomy (author's transl)]. / Bakterielles Aortenaneurysma durch Pseudomonas aeruginosa nach Lungenresektion

After transpericardial extrapleural pneumonectomy because of bronchial carcinoma in a 56-year old woman an infection of the thoracic cavity develops, caused by pseudomonas aeruginosa. The patient dies from this infection. At autopsy an aneurysm of the thoracic aorta is discovered close to the previous site of operation. In the wall of the aneurysm pseudomonas aeruginosa is found. Pathogenetic problems concerning the development of bacterial aortic aneurysms are discussed, and in the case presented an infection of the aortic wall from outside via the lymphatics of the adventitia and vasa vasorum is regarded as the most probably way of infection.

Partial nephrectomy in well-responding stage I Wilms' tumors: report of three cases.

We report on 3 of 21 stage I Wilms' tumor patients with tumor volumes of 190, 890, and 1300 mL, respectively, who responded dramatically to preoperative chemotherapy according to the Austrian/Hungarian Wilms' Tumor Study 89 by tumor volume reductions to 20%, 23%, and 13%, respectively. Radical resection of the tumors with renal preservation was achieved in all patients. Postoperative studies did not show any functional deficit in the preserved kidney. The patients have been in complete remission for 26, 33, and 60 months, respectively. Our preliminary results indicate that tumor resection should be feasible in patients with good responding stage I Wilms' tumors.

[Primary and secondary inoperable teratoid hepatoblastoma--multidisciplinary management]. / Primär und sekundär inoperables teratoides Hepatoblastom--multidisziplinäres Management.

Hepatoblastomas are the most frequent malignant liver tumors of childhood. Prognosis mostly depends on their resectability. Unresectable tumors are almost invariably fatal, unless their size can be decreased by chemotherapy and/or irradiation to permit surgical removal. In the present case report we discuss the clinical course of a 15 months old boy, who was admitted with primary inoperable teratoid hepatoblastoma. After alternating intravenous and intraarterial chemotherapy as well as radiation therapy, the tumor could be successfully resected. Specific problems of histological diagnosis and of the therapeutic management are discussed, and an overview of the recent literature in behalf of the histological basis, therapeutic possibilities and prognostic factors of hepatoblastomas is given.