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Biomedical subjects

F Schier

Publications and source records attributed to F Schier.

At least 55 records · Page 3Linked to original sources
PubMed1996

Laparoscopic removal of Meckel's diverticula in children.

We report on 4 children where Meckel's diverticula (MD) were excised laparoscopically. In two of the children the finding of an MD was incidental and in two it was suspected preoperatively. In three of the patients the MD was ligated by means of an "endoloop" and could be removed in a similar manner to an appendix. In one patient the MD was resected by means of a stapler. No complications occurred. Subsequent histology confirmed the complete excision of the MD. Allowing for the size and shape of an MD, we prefer to excise it by means of an endoloop. An endoloop has the advantage that it can be used through a 5 mm trocar while a stapler has the disadvantage that it requires a larger 12 mm trocar and it leaves a foreign body, i.e. metal clips behind.

Adolescent↗
PubMed1996

[Minimal invasive surgery in childhood].

An overview is provided of the procedures performed to date in children. The procedures are listed according to their estimated frequency and a prognosis is attempted on their presumed future role in pediatric surgery. A good prognosis is indicated for diagnostic laparoscopy such as for ill-defined abdominal pain, cryptorchidism, and diagnostics of the inner genitalia. Amongst the diagnostic and therapeutic procedures, the lysis of adhesions and ligature of varicoceles will become part of pediatric surgical practice, as will appendectomy. Procedures such as fundoplication, pyloromyotomy, cholecystectomy, sigmoid resection, splenectomy and nephrectomy may only continue to carried out in specialized centers. Technical details of the various procedures are given.

Adolescent↗
PubMed1994

Laparoscopy in children with ill-defined abdominal pain.

The experience gained with 225 laparoscopies in newborns and older children is reported. Most laparoscopies started as diagnostic procedures and, once a diagnosis was established, were carried on as surgical interventions. The procedures were appendectomies, lyses of adhesions, cyst resections, interventions on the internal genitalia, resections of Meckel's diverticula, and herniotomies. The children ranged from newborns weighing 1,850 g to 15-year-olds, the average age being 8 years. The majority of children were girls (60%) with recurrent ill-defined lower abdominal pain. Laparoscopy provides excellent exposure. Though the complication rate does exceed that of similar conventional procedures, with practice a comparable operating time may be achieved. The cosmetic result is better. The expenses for installation and manpower are high, but in-hospital time is decreased.

Abdominal Pain↗
PubMed1994

Late results in the management of choledochal cysts.

From 1971 to 1990, 18 children were surgically managed for choledochal cysts at two Berlin pediatric surgical units. Eight patients underwent an internal drainage procedure, eight a Roux-en-Y hepaticojejunostomy and one a choledochoplasty. The children were followed-up 2 to 20 years later (median: 8.4 years). Three children died in the early postoperative period, but the immediate postoperative course was uneventful in all other cases. Later, five patients suffered from recurrent gastrointestinal disease, cholangitis and pancreatitis and, in two cases, from progressive liver fibrosis. Four of the five patients with symptoms had undergone internal drainage procedures; one developed cholangitis after a hepaticojejunostomy. In one case of internal drainage, the anastomosis was transformed into a hepaticojejunostomy. No patient had cancer.

Adolescent↗
PubMed1994

Laparoscopic fundoplication in a child.

A case of laparoscopic fundoplication is described in a child weighing 25 kg. The patient had severe skeletal deformities. Five trocars were used. The view was excellent. A complete posterior wrap was achieved without transsecting the short gastric vessels. Operating time and expenses were greater than with the conventional technique. No complications occurred. The cosmetic result was good.

Child↗
PubMed1993

Biliary atresia--bile acids and prostaglandin E2 in cell cultures of bile duct epithelia.

In a cell culture model of bile duct epithelial cells, the effect of prostaglandin E2, lithocholic acid and deoxycholic acid was studied. Bile acids and prostaglandin are administered postoperatively in biliary atresia empirically as choleretics. Prostaglandin E2 and the bile acids all had inhibitory effects on bile duct epithelial cells in culture. There is no clinical study proving the efficacy of either bile acids or prostaglandin E2 in biliary atresia. The negative results with these substances in cell cultures warrants reserve in their routine clinical use in biliary atresia.

Adult↗
PubMed1993

The use of the laser in the treatment of arterio-venous malformations and vascular tumours of the liver.

Vascular tumours of the liver present variously in the paediatric age group. Their clinical course depends on tumour size, its growth characteristics, localization and complications. The most feared complications are cardiac failure and the Kasabach-Merritt syndrome which may occur in up to 50% of affected children. In haemangioendotheliomata and capillary haemangiomata spontaneous regression can be expected. Regression may be stimulated by x-ray radiation therapy, corticosteroids, Endoxane or alpha Interferon. Emergency percutaneous catheter embolization or operation must be carried out in the event of such complications. The Nd:YAG laser is particularly well suited for these cases. In all events, careful interdisciplinary cooperation among paediatricians, radiologists, cardiologists, oncologists and paediatric surgeons is required owing to threatening complications which mostly occur in neonates and infants.

Adolescent↗
PubMed1992

Endoscopic laser resection of a duodenal membrane.

This report documents the first resection of a duodenal membrane by laser. Subsequently, however, a laparotomy was required because of an annular pancreas. Nevertheless, it demonstrates that the laser endoscopical resection of a duodenal membrane is technically feasible.

Duodenum↗
PubMed1991

Microlymphography of spontaneous lymph vessel anastomosis in small bowel transplantation in the rat.

Following small bowel transplantation, new lymph vessel anastomoses form spontaneously. Surgical anastomoses of the lymphatic vessels are unnecessary. The formation occurs in three stages. To the second postoperative day, lymph stays within the lymphatic vessels of the transplant. Following the fourth postoperative day, lymph flows within preexistent adventitial lymphatic vessels along the transplanted mesenteric artery to the arterial anastomosis at the aorta and stops there. From the sixth postoperative day on, lymph crosses the arterial anastomosis for the first time and flows along the recipient's aorta. To the eighth postoperative day a new lymph anastomosis is formed between the adventitia of the aorta and the neighbouring major lymphatic vessels. In the experiments presented here, these are represented by the vasa lymphatica testicularia sinistra of the recipient. Thus, the new anastomosis between lymphatic vessels is complete on the eight postoperative day. These new vessels gradually dilate with time.

Animals↗
PubMed1991

Surgical correction of abdominal testes after Fowler-Stephens using the neodymium: YAG laser for preliminary vessel dissection.

Two boys with high undescended testes were submitted to laparoscopic laser transsection of the internal spermatic vessels. Subsequently strong collaterals developed. Definitive scrotal transfer was performed six weeks later through an inguinal incision. Two and a half years later, the testes had recovered very well. Their volume had increased markedly, and further development was normal.

Arteries↗
PubMed1991

Laparoscopic surgery in neonates and infants.

Between 1978 and 1991 a total of 136 operations with the laparoscope have been performed. 79 additional laparoscopies were carried out for diagnostic purposes. The most frequent indications for operative laparoscopy were: adhesions, abdominal cysts, tumors, gonadectomy, appendectomy and cholecystectomy. Diagnostic laparoscopies were performed for the differential diagnosis of cholestasis, chronic abdominal pain, intersex and cryptorchidism. The only complication was a scar hernia in a 1,400 gram preterm baby. We recommend laparoscopy because of its smaller trauma and the reduced postoperative complication rate. Furthermore, an advantage is the magnification by the lupes and video, the excellent illumination and exposure.

Abdomen↗
PubMed1991

Dura covered with fibrin glue reduces adhesions in abdominal wall defects.

Dura can greatly facilitate the closure of abdominal wall defects. However, a main disadvantage of its use are the adhesions which develop between omentum, bowel and dura and may lead to bowel obstructions. In this study various groups of rats had either the anterior wall replaced by untreated dura or by dura covered with fibrin glue prior to implantation. Adhesions were found in 75% of sham operated rats, 100% after untreated dura implantation and 50% after the implantation of fibrin glue treated dura.

Abdominal Muscles↗
PubMed1991

[Technique of open and endoscopic laser treatment in pediatric urology].

The neodymium:YAG laser is now the most common type of laser applied in pediatric surgery. The bare fibres with diameter of 400 microns and 600 microns can be introduced through the side channel of #8 cystoscope thus the cystoscopic laser can be used even in newborns.--Generally accepted power settings are not yet available for laser therapy in pediatric urology. After 5 years of systemic laser application in children standard parameters have been established. They follow the principle of reaching the desired therapeutic goal using the least energy at the shortest exposure time possible. In the non-contact method 15-25 watts, 0.1-0.3 sec pulses and 0.3 sec intervals are recommended for coagulation, and 100 watts in continuous waves for cutting. The same pulses and intervals are advisable for the contact method using the bare fibre, but 10-12 watts are sufficient for coagulation and 20-25 for vaporization. With these settings all endoscopic procedures in pediatric urology such as the resection of urethral valves and structures, the ablation of ureteroceles and the treatment of hemangiomas can be performed.

Cystoscopes↗
PubMed1990

Experience with laparoscopy for the evaluation of cholestasis in newborns.

In many children with cholestasis, ultrasonography can rule out the possibility of biliary atresia. In the few cases when a diagnosis cannot be established by ultrasonography, laparoscopy is still justified as an initial procedure, as the amount of trauma involved is still minimal. Of the 36 children with cholestasis on which a laparoscopy was performed, one-third eventually underwent laparotomy because of biliary atresia. The question was whether the primary laparoscopy was really advantageous. In comparison to laparotomy no advantages were found with regard to anesthesia time; morbidity, or complications. The diagnostic accuracy was comparable to that of laparotomy. The only complication was a small scar hernia in a premature baby.

Biliary Atresia↗
PubMed1990

[Surgical therapy of malrotations in childhood].

From a total of 174 children treated with malrotations from 1971 to 1988, 148 could be evaluated for long-term results of surgical treatment. The various modalities of treatment were: no correction, dissection of Ladd's bands only, caecoascendopexy, Ladd's procedure and the so-called total correction. Comparing the late results in children with and without correction it was found that those without correction, i.e. without pexy, had to be reoperated in 17% of the cases, whereas the totally corrected children required reoperation in 8% of the cases only. Corrected cases needed to be admitted but not operated later because of pain, constipation, vomiting or poor weight gain in 23%, the uncorrected ones in 6%. Likewise, corrected malrotations resulted in complaints in 27% in contrast to the noncorrected ones in 9%. The conclusion is that total correction results in fewer reoperations but in more symptoms not requiring surgery.

Cecum↗
PubMed1990

[Diagnosis and therapy of lung abnormalities: current status].

Malformations of the lung must be detected early before the onset of complications. Therefore invasive diagnostic techniques are increasingly being replaced by less complicated methods such as sonography, colour-coded Doppler sonography, DSA and CT. In certain cases, angiography and thoracoscopy should not be renounced. The use of these methods is preferred in combination with nonoperative techniques: embolisation in av-aneurysms, endoluminal endoscopic resection of congenital bronchial stenoses, stabilization of the bronchial wall in valve mechanisms or thoracoscopical resection of a cyst using fibrin glue to seal the area of resection. These endoscopical procedures are simplified by the application of laser. The smaller the child the more obvious it's advantages.

Abnormalities, Multiple↗