Biomedical subjects
Publications and source records attributed to C Festen.
Little has been written about the follow-up after temporary exteriorization of the small bowel for intraabdominal catastrophies in neonates and small infants. This report summarizes our results in 27 patients who had as a rule intestinal continuity restored electively within 4 weeks. There was a leakage rate of 10% and no mortality.
Between January 1970 and December 1984, 65 patients with a congenital anterior abdominal wall defect were admitted to the Pediatric Surgical Center of the St. Radbound Hospital, Nijmegen, The Netherlands. There were 39 cases of omphalocele. Ten had giant omphalocele, defined as omphalocele that could not be closed primarily. In these cases, a conservative method of treatment was used. The results are reported of these 10 cases of giant omphalocele with special emphasis on mortality, complications, and length of hospital stay. Mean hospital stay was 95 days. Local infection did not present serious problems. Sepsis occurred in half the patients but was managed with antibiotics. There was one case of late volvulus of the stomach. All local applications, if used regularly, gave rise to complications. Two cases of hypothyroidism caused by the application of povidon-iodine and one case of alcohol intoxication were observed. In early years, one child was lost due to mercury poisoning. There was one early and one late death unrelated to the procedure.
The results of treatment of oesophageal atresia show that attentiveness and knowledge of the referring paediatrician concerning diagnostics, preoperative care and transport, together with concentration of high-standard care and specific experience in centres for paediatric surgery, can lead to a substantial decrease in morbidity and mortality. Between 1955 and 1968 a total of 193 children have been operated for oesophageal atresia. Mortality has declined from 51% in the period 1955-1969 to 10% in the timespan 1980-1986. Mortality is almost solely determined by additional congenital malformations, in which congenital heartdefects form the major cause. Management of oesophageal atresia seems to have evolved to a routine-procedure. New trends in paediatric surgery pose new sorts of specific problems, that require attention.
Gastro-oesophageal reflux (GER) in children, causes sometimes aspecific symptoms in children. Not only in the case of regurgitation but also in respiratory problems or even in the 'near missed' - Sudden Infant Death Syndrome GER is to be considered. The most important method of investigation is pH-monitoring during 24 hours preceded by a barium meal and followed by endoscopy, in most cases. Operative treatment is necessary for a hiatal hernia, or after failure of conservative treatment of an oesophagitis. In mentally retarded children, who continue to vomit, a fundoplication can be necessary to improve general care.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
In the Pediatric Surgical Department of The St Radboud Hospital, Nijmegen, The Netherlands, between January 1970 and December 1980, 1476 laparotomies were performed on neonates, infants, and children. In 33 of these patient the abdominal surgery was complicated by a postoperative small bowel obstruction (SBO), for which a second laparotomy had to be performed. In 80% of patients this SBO developed within three months of the prior operation. The risk of developing an adhesive SBO was greater when there was more than one prior peritoneal procedure, and when, during this prior procedure, there was already a peritonitis. There was no obvious relation with the nature of the original operation. In more than 70% of patients a single adhesion caused the obstruction, while in many of these cases there were already circulatory disturbances, even by early reintervention. The mortality was 6%.
Between January 1980 and December 1981 13 babies were admitted to the Pediatric Surgical Department of Nijmegen, The Netherlands because of necrotizing enterocolitis or its complications. Two patients underwent surgical exploration, but had no bowel necrosis. One of them recovered and the other had to be operated later on because of ileal stenosis. Two patients had resection of necrotic bowel and a primary anastomosis. One survived and one died. Five patients with perforation of the gut underwent resection and ileostomy. Two of them developed a colonic stricture later on that had to be resected. In all five the ileostomy was closed after recovery. Four patients, who were treated conservatively elsewhere, developed bowel stricture. In three of them after resection a primary anastomosis was done. One had a colostomy after resection, that was closed later on.
Paraesophageal hernia was a major complication in a number of patients who were treated surgically for gastroesophageal reflux by fundoplication. This major complication seems to be predominant in the pediatric age group. The best surgical treatment for gastroesophageal reflux, whether a hiatus hernia is involved or not, is still uncertain. As with many other surgical problems where we must find a compromise, several surgical techniques are adopted. The choice of the surgical approach may depend upon the indications. As the indications for surgery are precise, the results must be reached with the utmost certainty, particularly hen complications already exist (esophagitis, stricture). The results of operative treatment of gastroesophageal reflux are in part, at least, influenced by the considerable tendency to spontaneous improvement, particularly in infants. In most cases, nonoperative treatment is initially undertaken if there are no prior complications. The number of children who are surgically treated depends to a great extent upon the accuracy of this conservative treatment.
Wandering spleen is a rare condition, commonly treated with splenectomy. Authors report a case of wandering spleen, preoperatively diagnosed, and successfully treated with splenopexy.
In the last 10 years 92 children were treated for oesophageal atresia at the Pediatric Surgical Department of the St. Radboud Hospital, Nijmegen, The Netherlands. In 10 cases it proved impossible to establish a primary anastomosis between both ends of the oesophagus. Personal experience is presented with the methods of reconstruction in these cases of a "long gap".
Explore the source record for details and available documents.
The unexplained bleeding tendency in Noonan's syndrome is mentioned on behalf of personal experience in four patients. This problem is important for the pediatric surgeon because in boys the syndrome is frequently accompanied with uni- or bilateral undescended testes. After orchidopexy there is a great tendency for post-operative hemorrhage.
Explore the source record for details and available documents.
Explore the source record for details and available documents.