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Biomedical subjects

F Schier

Publications and source records attributed to F Schier.

At least 37 records · Page 2Linked to original sources
PubMed2000

A Meckel's diverticulum containing pancreatic tissue and nesidioblastosis in a patient with Beckwith-Wiedemann syndrome.

A 30-month-old twin with Beckwith-Wiedemann syndrome underwent exstirpation of a nephroblastoma from the right kidney. A Meckel's diverticulum (MD), an incidental finding intraoperatively, was resected because it was indurated and enlarged. Histologically, the MD contained ectopic gastric and pancreatic mucosa. Nesidioblastosis was identified within the pancreatic tissue. This is probably the first description of ectopic nesidioblastosis within a MD.

Beckwith-Wiedemann Syndrome↗
PubMed2000

Appendico-ileal fistula in cystic fibrosis.

This report describes a young woman with cystic fibrosis presenting with small bowel obstruction. Intraoperatively, an appendix with a wide lumen was found with a fistula to the distal ileum.

Adult↗
PubMed2000

Smith-Lemli-Opitz syndrome: case report and literature review.

The authors report the case of a 6-week-old boy with the Smith-Lemli-Opitz-syndrome (SLOS) and review the literature on the subject. Intersexuality was suspected and a laparoscopy performed. Abnormalities of the gastrointestinal tract, the lower extremities, and the face prompted DNA analysis, which found a defect of cholesterol biosynthesis in the form of the Smith-Lemli-Opitz-syndrome, a rare congenital defect. The clinical course of this case is compared with similar cases in the literature.

Humans↗
PubMed2000

Laparoscopic surgery of inguinal hernias in children--initial experience.

PURPOSE: The aim of this study was to document the authors' experience with laparoscopy in the treatment of inguinal hernia in girls and boys. METHODS: The internal inguinal ring was closed with 1 or 2 stitches of 4-0 monofilamentous material. Two 2-mm needle holders were inserted through the inferolateral abdominal wall. The laparoscope was advanced through the umbilicus. A total of 129 children underwent surgery. RESULTS: Once the technique of intracorporeal suturing is mastered, the procedure is straightforward, requiring 22 minutes for bilateral and 16 minutes for unilateral hernias. Age and size are not factors because of the magnifying effect of the laparoscope. In almost half our patients, the preoperative diagnosis could not be matched unequivocally with the intraoperative findings. There was 1 recurrence of hernia in a boy. No serious complications and no hydroceles occurred. Five direct hernias were found in this group (5%). CONCLUSIONS: The technique is easy for experienced laparoscopists. Bilaterality is of no concern. Cosmesis is superb. For recurrences, the technique is preferable to the open technique.

Adolescent↗
PubMed2000

Transoesophageal echocardiographic assessment of haemodynamic changes during laparoscopic herniorrhaphy in small children.

Laparoscopic techniques for surgery are gradually becoming established in paediatric surgery. Technical aspects, such as the maximum safe gas insufflation pressure, are still open to discussion. We used transoesophageal echocardiography to study the haemodynamic changes in eight small children undergoing laparoscopic herniorrhaphy, with two different levels of intra-abdominal pressure (IAP), 6 and 12 mm Hg. End-tidal carbon dioxide tension was maintained constant at 4.3-4.7 kPa. After baseline measurements, an IAP of 12 mm Hg was applied for 10 min. Next, IAP was decreased to 6 mm Hg, followed by a second period of 12 mm Hg. Haemodynamic measurements were obtained at each stage. A further measurement was obtained 10 min after abdominal deflation at the end of surgery while anaesthesia was unchanged. Cardiac index (CI) decreased significantly only after the first 12 mm Hg level of IAP. The subsequent decrease in IAP to 6 mm Hg caused return of CI to baseline levels. The second increase in IAP did not cause any reduction in CI. The initial reduction in CI, although statistically significant, did not appear to be clinically important. We conclude that an IAP of up to 12 mm Hg appeared to be safe in healthy small children undergoing laparoscopic herniorrhaphy.

Cardiac Output↗
PubMed1999

Hyaluronate, tetrachlorodecaoxide, and galactolipid prevent adhesions after implantation of Gore-Tex and dura mater into the abdominal wall in rats.

Gore-Tex (GT) and dura mater (DM) are used as prosthetic materials for the closure of the abdominal wall defects, however, they create intra-abdominal adhesions. This study addresses the question of which substances can reduce these adhesions. In rats, Gore-Tex and DM were placed on the inner abdominal wall. Two weeks later the animals were killed; the anterior abdominal wall was excised and photographed. The photographs were digitized and the surface area covered by adhesion was measured by computer analysis. In animals where DM or GT was implanted without the addition of an anti-adhesive substance, 45% of the DM and 34% of the GT surface was covered by adhesions. When hyaluronate (HA), tetrachlorodecaoxide, or galactolipid was applied to the bowel intra-operatively, adhesions were found on only 14%, 11% or 8% of the GT surface. For DM, only HA was effective, and reduced adhesions to 9% and 10%, respectively. Plasmin, taurolidine, and streptokinase-streptodomase were ineffective in preventing adhesions in both DM and GT.

Abdominal Muscles↗
PubMed1999

Laparoscopic bilateral adrenalectomy in a child.

Laparoscopic adrenalectomy is an established technique--in adults. This report describes a bilateral laparoscopic adrenalectomy in a child. As in adults, it indicates that the technique is superior in anatomic exposure and postoperative recovery, and is well suited for children.

Adolescent↗
PubMed1998

Qualitative and quantitative analysis of synapses in Hirschsprung's disease.

In Hirschsprung's disease (HD), certain intestinal nervous plexuses are absent. Sprouting nerve endings contain different amounts of synaptophysin (SY), a protein and main constituent of acetylcholinesterase (AChE) storage compartments. Due to the lack of specific markers for synapses, a qualitative analysis of nerve endings of intestinal segments affected by HD has not yet been undertaken. For this study, resected colorectal specimens from patients with HD (n = 8, mean age 2.1 years) were investigated in parallel for AChE, SY, and content of small synaptic vesicles by biochemical, immunohistochemical, and electronmicroscopic means. In the microdissected muscular layer, reduced SY (1.4 microgram/mg total protein, normal 24 +/- 0.3) was observed. Immunohistochemistry showed in affected tissues reduced numbers of SY-positive nerve fibers and nerve endings, which in turn were thickened and distorted, in both the muscle proper and the muscularis mucosae. Combining both morphologic and biochemical findings, in HD the number of cholinergic vesicles in the remaining nerve endings seems to be increased as measured by SY, a marker molecule specific for synaptic vesicles. Our data also suggest that nerve endings in HD may contain high concentrations of cholinergic vesicles, paralleling the known high amounts of acetylcholine and AChE found in intestinal segments of patients with HD.

Acetylcholinesterase↗
PubMed1998

Laparoscopic Anderson-Hynes pyeloplasty in children.

In two children (ages 14 and 7 years) a laparoscopic Anderson-Hynes pyeloplasty was performed. In the 14-year-old boy a para-anastomotic drain was placed; a urinoma developed postoperatively, which was treated by a pyelostoma placed transcutaneously. In the 7-year-old boy a transanastomotic pyelostoma splint was placed intraoperatively. The splint was removed 10 days later; the postoperative course was uneventful. Operative time was 6.5 h in the first and 2.5 h in the second case. On ultrasonographic controls 3 months postoperatively, in both children residual dilatation of the renal pelvis was noted. On scintigraphy the first child had only slightly improved, from 46% to 48% function in the involved kidney; the second child improved from 34% preoperatively to 44%.

Adolescent↗
PubMed1998

Laparoscopy for Crohn's disease in children.

Traditionally, the diagnosis of Crohn's disease is established by colonoileoscopy and radiology. With these techniques the main area of interest, the distal ileum, is not easily reached. Also, the outer aspect of the bowel is ignored and there is no appreciation of the involvement of other intra-abdominal organs. Laparoscopy provides additional information. This may establish a more precise diagnosis, better standardization in comparative studies, and more specific therapy.

Adolescent↗
PubMed1998

Laparoscopic appendectomy with 1.7-mm instruments.

A modified technique for laparoscopic appendectomy is described. The telescope features two channels, one for the optical system and the second for forceps, scissors, and endoloops. The operation is performed through the working channel. The coaxial instrument is inserted through the umbilicus. One or two additional 1.7-mm instruments stabilize the appendix during the procedure. This technique leaves practically no scars.

Appendectomy↗
PubMed1998

Laparoscopic herniorrhaphy in girls.

BACKGROUND/PURPOSE: Laparoscopy has been used to evaluate the contralateral side in inguinal hernias. Once a hernia was identified in such procedures, laparoscopy was terminated and a conventional groin exploration was undertaken. This study presents a purely laparoscopic approach using miniature instruments without the use of a groin incision. METHODS: The technique was applied in 14 girls (median age, 6.5 years). The laparoscope was inserted via the umbilicus. Two 1.7- or 2-mm instruments were advanced (without a trocar) trough the abdominal wall for intraabdominal suturing of the open inguinal rings by the placement of two to three Z-sutures. RESULTS: With this procedure the diagnosis is easy, although the placing of miniature suturing needs practice. When there is doubt about an inguinal ring during laparoscopy, an open processus vaginalis also can be sutured using the same approach. There were no recurrences or complications. The longest follow-up period is 1 year. CONCLUSIONS: A purely laparoscopic approach using miniature instruments combines diagnosis and immediate treatment without the need for conversion to another technique. There is rapid recovery and excellent cosmetic results.

Child↗
PubMed1998

[Laparoscopy in suspected Crohn disease in childhood].

The traditional diagnostic tools for the diagnosis of Crohn's disease barely reach the terminal ileum. For coloileoscopy in children, anesthesia is required. We have used it for an additional and simultaneous laparoscopy, including biopsies from lymph nodes or the liver. In 11 children (mean age 11.8 years) laparoscopies were performed in order to establish the diagnosis Crohn's disease. In 9 children laparoscopy was performed simultaneously with coloileoscopy. A 5-mm laparoscope was advanced through the umbilicus and a 1.7-mm forceps through the left lower anterior abdominal wall. There were no complications. Laparoscopy provides a novel, direct image of the early stages of Crohn's disease and may initiate a more adequate medical treatment.

Adolescent↗
PubMed1997

Experience with laparoscopy in the treatment of intussusception.

Instead of proceeding directly to open surgery after failed hydrostatic reduction, the author has performed laparoscopy and found that laparoscopic reduction is successful in approximately half of cases. The remainder are treated by conventional surgery.

Cecal Diseases↗
PubMed1996

Thoracoscopy in children.

Pediatric surgical experience with video-assisted thoracoscopy is limited. The authors report their experience with 27 thoracoscopies in 22 children. The median age was 6.1 years (range, 1 day to 16 years). The two primary indications for thoracoscopy were management of pneumothorax and mediastinal cysts. Fifteen thoracoscopies accomplished their purpose without complications. Intraoperative complications required conversion to an open operation in three patients. One bronchogenic cyst and four pneumothoraces recurred. The main complications were poor visualization, bleeding from an intercostal artery, and difficulty with suturing. Compared with open thoracotomy, anesthesia time did not differ significantly, and less pain medication was required postoperatively.

Adolescent↗
PubMed1996

Laparoscopic Swenson's procedure in children.

The technique is described, and the experience gained with 7 laparoscopic sigmoid resections is reported. The approach resembles Swenson's technique with only the preparatory part performed laparoscopically. With the most recent procedures, the anaesthesia time of the laparoscopic procedure did not exceed that of the open technique. There were no serious complications or blood losses.

Adolescent↗