Diagnostic and therapeutic management of esophageal and gastric caustic burns in childhood.

Early esophago-gastroscopy is the most effective investigation for the classification of caustic burns. Evaluation includes graduation of the pathological lesion. Assessment of extension of spread and of control of motility of esophagus and stomach. The aim of all therapeutic procedures is to preserve the patients' own esophagus. All endoscopies were done under general anesthesia. From September 1988 to April 1992, 102 endoscopies were carried out on 39 patients. Gastric lesions with clinical relevance were found in 10 patients (26%). First degree of corrosion was found in 21 patients (54%): they were discharged without any therapy within 48 hours. Maximal second degree was seen in 14 patients (36%), who were successfully treated with diet, antacids and H2-blockers: they were discharged after control-endoscopy after one week. Four patients (10%) suffered from third-grade lesions: a gastrostomy was performed as well as treatment with cortisone, antibiotics and H2-blockers. Bouginage was started between the 5th and 7th day after ingestion and was necessary for 8, 11 and 16 weeks in three patients and more than 2 years in one patient. Even in this last case we could preserve the esophagus, although a gastric or colon interposition was discussed.

[The chronically altered appendix in children. Cooperative work of the Austrian Society for Pediatric Surgery]. / Die "chronisch veränderte" appendix beim kind. Gemeinschaftsarbeit der Osterreichischen Gesellschaft für Kinderchirurgie.

In this multicentric study the anamnestic data and parents questionaires of 2-29 children were evaluated, whose appendix vermiformis at the time of operation showed no signs of inflammation. 31,1% macroscopically showed cicatrisation or fasciation, in 13,7% other enteral or gynaecological (1%) findings were present. In 1194 of the cases of patho-histological examination of the appendix had been made of which 36.4% were negative, 37.7% showed cicatrisation, 15,0% oxyuriasis and 10,4% coproliths. In the discussion of the significance of the chronically altered non-inflamed appendix we compared patients with and without macroscopical or microscopical alterations. We came to the conclusion that the probability-index as to sex, duration of symptoms, complexity of symptoms, incidence of postoperative well-being, proved the chronically altered appendix not to be an illness per se, but the result of spontaneously arrested inflammation. Since the rate of children admitted with a perforated appendix is high (15-20%) in comparison with the rate of complications after removal of non-inflamed appendices (2,9%), we believe that according to the diagnostical problems the principle can be maintained: in dubio pro operatione.

[Duplications of the gastrointestinal tract]. / Doppelbildungen des Verdauungstraktes.

The pathology and clinical presentation of intestinal duplications are discussed. 8 assorted cases are presented. Spherical lesions of the small intestine were resected together with the stenosed segment of bowel while the cysts of the ileo-caecal region were dissected out. The rare tubular duplication of the rectum was managed with an anastomosis at the most distal end of the duplication to the original bowel.

[Chronic abdominal pain in childhood]. / Der chronische Bauchschmerz im Kindesalter.

Recurrent abdominal pain in childhood can be caused structurally, functionally, metabolically or psychosomatically. In the neonatal period there occur malformations, in infancy chronic inflammations of bowel as well as obstructions due to adhesions following laparotomies or chronic intussusceptions or volvulus. In pre-school and school-age symptoms of appendicitis, lymphadenitis, Crohn's disease or Colitis ulcerosa occur. But every 8th to 9th child of school-age suffers from functional abdominal pain without structural origin, probably caused by an "irritable colon".

[Familial megacolon (author's transl)]. / Familiäres Megakolon.

The genetic aspects of Hirschsprung's disease are discussed and there is a family incidence of 1 to 6%. Boys are more frequently affected. The mode of genetic transmission is not known. Three families with Hirschsprung's disease are reported with special reference to the transmission of Hirschsprung's disease.