First experience with a distraction apparatus prototype (SM-fix-phalanx distractor) for phalanges lengthening.

Since 1991 seven children aged between 5-17 years have been treated at the University Children's Hospital in Basel for 10 traumatically partially amputated phalanges with a newly developed external fixator and distractor. Through continual distraction of the osteotomy a phalanx lengthening of 3-10 mm has been achieved (on average 55% of the rest phalanx). The results of this method in distal phalanx amputation with resulting nail dystrophy (claw nail) has shown functional and cosmetic improvements. The average distraction and consolidation phases lasted 5 weeks. The after care lasted 2-12 months. As children have good distraction-histogenesis bone grafting is not necessary. A prerequisite would be, however, an intact or appropriately prepared integument. The advantage of this external fixator and distractor system is that it is suitable for the delicate anatomical structures of a child's hand. The distractor component is only necessary for a distraction step to be carried out. A further advantage of this system is the relatively light but stable construction.

A synthetic model for microsurgical training: a surgical contribution to reduce the number of animal experiments.

Microsurgery has grown to be an essential technique in pediatric surgery. Thus, there is an increasing need for basic training and skills maintenance, which require a continuous laboratory training. As an alternative to microsurgical exercises on living animals, a model including a simulation vein, artery and nerve is being introduced. It provides an opportunity to practice microsurgical technique with optimal availability at any time at fairly low cost. Its potentials and limits in the training of microsurgical dissection, anastomosis and quality control are being compared to experiments on anesthetized animals. Although a few exercises on living animals are mandatory to close the gap between the laboratory and the patient, a synthetic model is a valuable tool in microsurgical training and helps to reduce animal experiments.

Color Doppler sonography in the diagnosis of acute scrotum in boys.

Evaluation of acute painful scrotum is difficult and imaging studies have been reported to be unreliable in detecting testicular torsion. In order to assess the value of color Doppler sonography in acute scrotal disease, the authors reviewed 65 consecutive boys, ranging in age from 1 to 16 years. The study demonstrated absent or diminished flow signals in 11 patients. All of them had a surgical intervention, and in 8 of them, a testicular torsion was confirmed. 54 boys had a symmetrical or increased flow signal on the affected side. Just 5 boys among this group underwent surgical exploration. On follow up, none of the 54 patients with good flow signals proved to have a testicular torsion. Sonography and color Doppler sonography helped to differentiate epididymitis and torsion of a testicular appendage as a basis for further investigations and correct conservative therapy. In detecting a testicular torsion, color Doppler sonography yielded a positive predictive value of 73%, a sensitivity of 100% and a negative predictive value of 100%. We therefore conclude, that Doppler sonography can reliably rule out testicular torsion so that routine scrotal exploration in cases of acute scrotum is no longer necessary. By reducing the number of emergency operations and hospitalization days, color Doppler sonography can cut down the total cost of managing acute painful scrotum in boys.

Meconium periorchitis: case report and literature review.

Meconium periorchitis (MPO) is an uncommon entity associated with healed meconium peritonitis. The typical presentation is soft hydrocele at birth which becomes harder in weeks as the meconium calcifies. It mimics a scrotal mass, and, without knowledge of this rare disease, this may lead to unnecessary surgery. Both the masses and the calcifications have the tendency to resolve spontaneously without compromising the testicle. Sonographic features together with an abdominal plain film are diagnostic, and visualization of the normal testicle may be helpful in differentiating this tumor-like lesion from scrotal tumors. A case of a meconium periorchitis is reported on and the radiological and histological features are discussed with a literature review on the subject.

Congenital intracranial cysts: clinical findings, diagnosis, treatment and follow-up. A multicenter, retrospective long-term evaluation of 72 children.

A multicenter, retrospective evaluation of 72 children born between 1973 and 1987 with intracranial cysts was performed: 37 had an arachnoid cyst, 25 a Dandy-Walker malformation and 10 a porencephalic cyst. The following criteria were evaluated: history, clinical findings, diagnostic work-up (neuroradiology, CSF and intracystic pressures), surgical therapy and follow-up (outcome and cyst volumes).

[Rapidly growing tumor of the hand--is tuberculosis as differential diagnosis gaining increased importance?]. / Schnell wachsender Tumor an der Hand--Gewinnt die Tuberkulose als Differentialdiagnose an Aktualität?

A two-year-old healthy, Portuguese girl presented with a prominent, painless tumor over the first web space of the left hand. The tumor increased rapidly in size over a few weeks, but caused no functional problems. On X-ray films, a cystic structure of the first metacarpal bone with erosion of the corticalis was demonstrated. At operation, a "cold abscess" was found. Bacterial examination of the gastric juice showed acid-resistant bacilli. The spina ventosa (Latin: Spina-"a thorn"; ventosa-"full of wind, distended") is a typical extrapulmonary manifestation of tuberculosis in phalangeal, metacarpal, and metatarsal bones of children. The recognition of this diagnosis is very important and will become more so in the future as it has already been seen in HIV-positive children in the USA, as well as in immuno-suppressed children and in un-vaccinated and malnourished children from war zones in eastern Europe.

[Epidermolysis bullosa hereditaria dystrophica mutilans Hallopeau-Siemens--a complex problem]. / Epidermolysis bullosa hereditaria dystrophica mutilans Hallopeau-Siemens--eine komplexe Problematik.

Epidermolysis bullosa hereditaria dystrophica mutilans Hallopeau-Siemens is an autosomal recessive, chronically mutilating disease. Causal therapy is not known. In a five-year-old boy suffering from this disease and having the right hand completely clumped to a fist, syndactyly and contraction release was performed. The wounds healed under the care of the silicone-coated polyamide net dressing Mepitel. Under intensive postoperative physio- and ergotherapeutic care, a major part of his previous hand function could be restored. Complete epithelialization occurred within four weeks. Twelve months after the procedure, the area of the previous lesions was marked by an unexpected mechanical stability. It was very impressive to see the improvement in his psychological well-being and his sense of self-esteem during this period of partial recovery of his hand function.

[A new method for treating the Kirner deformity with the SM-Fix phalangeal distractor]. / Eine neue Behandlungsmethode der Kirner-Deformität mit dem SM-Fix-Phalangendistraktor.

The Kirner deformity belongs to the rare bony deformities of the small finger. The present treatments range from hemiepiphysiodesis to osteotomy with bone-grafting. We present a ten-year-old girl with a unilateral Kirner deformity treated in a new fashion. Through a distal phalanx osteotomy and the use of a SM-Fix-phalangeal distractor, bridging the distal interphalangeal joint, the axis was corrected. After four to five weeks the defect was filled by callus distraction. The advantage of this method is not only the minimal traumatisation of the juvenile distal phalanx but also the functional and cosmetic results.

[Finger tip amputations in children]. / Fingerkuppen-Amputationen beim Kind.

Among the various alternative forms of treatment of digital tip amputations, replantation of the amputated tip as composite graft or conservative treatment (healing by secondary intention) are of special interest for the management of fingertip injuries in children. From 1986 until 1987, the authors treated thirteen fingertip amputations in children between one and eight years of age (mean 3.5 years). In twelve cases, the amputated tip was reattached as composite graft, one injury healed by secondary intention. Twelve children were reexamined according to a prospective protocol after a mean follow-up time of 3.4 years. In three cases, primary healing of the replanted tip could be observed, in eight cases partial necrosis and superficial mummification preceded complete healing. At follow-up, seven cases presented with an anatomical tip, four with a slight asymmetry. Distal phalangeal length was identical to the opposite side, but in two cases a maximal loss of length of 2 mm was observed. Fingernails showed no significant deformities, although nail bed injuries had occurred in 90% of the cases. Sensitivity was normal in all cases. Child and parents considered the final result excellent in 75% and good in 25%. Reattachment as composite graft or conservative treatment for management of fingertip amputations in children (Zone I to III according to Rosenthal) is recommended and discussed.

Experimental approaches towards testicular autotransplantation.

An experimental approach was designed to analyse the outcome of testicular autotransplantation after microsurgery of arteries with 0.3-0.6 mm diameter in two different animal species. In particular, the patency of the anastomosis of the vessels, as well as testicular histology and fertility, was studied. In rats as well in rabbits, we could not observe contralateral damage after testicular autotransplantation. With the rabbit model, we can achieve a fertility rate of 37.5%; but only when we have a good patent anastomosis. Whereas, the rat model is good for surgical training of microvascular anastomosis; the quality of the microanastomosis shows no correlation to the testicular histology of the transplanted testis.

[Congenital hydrocephalus--an analysis of the course of pregnancy, prenatal studies and labor]. / Der konnatale Hydrozephalus--Analyse des Schwangerschaftsverlaufs, der pränatalen Untersuchungen und des Geburtsvorganges.

An analysis of the pool of our patients revealed few disturbances during pregnancy. In two cases the malformations were possibly due to drugs. Prenatal sonographic diagnostics were performed in one-third of the cases or documented: in 60% of the investigated cases a hydrocephalus was found, this being only 20% of the whole pool. The major part of the births were performed by Caesarean section, mainly because of a prolongation of the birth directly or indirectly due to the large circumference of the head. The hereditary trait of associated malformations and malformations of the central nervous system was frequent. Therefore, we advocate a better prenatal work-up and a birth by planned Caesarean section.

The role of the processus vaginalis in cryptorchidism. Does a patent processus vaginalis have a prognostic importance for predicting subsequent fertility?

A cryptorchid testis within an open processus vaginalis is a frequent operative finding. An almost obligate additional epididymal dissociation (90%) and a ST-Index (Spermatogonia per tubulus) of 0-0.2 in over 50% of the patients are an indication of a complex and severe form of cryptorchidism. Postoperative treatment with a LHRH-analogon (Buserelin) is recommended.

[Cervical thymic cyst in childhood]. / Zervikale Thymuszyste im Kindesalter.

In three children (2, 4 and 10 years of age) a cervical thymic cyst was removed. We found multilocular cysts with xanthochromic luminal fluid covered with a fibrous capsule. Histological features are lymphatic follicles, partly atrophic, as well as regular thymic tissue with cortex, marrow and Hassall's corpuscles.