Biomedical subjects
H Mau
Publications and source records attributed to H Mau.
[Differential diagnosis of benign bone tumors. Clinical aspects and imaging procedures].
In the assessment of bone tumors and tumor-like lesions the first aim is to clarify potential malignancy and aggressiveness. To rely exclusively on clinical assessment is not sufficient. Imaging techniques are invaluable, the most important still being plain roentgenograms. Radiological assessment according to the Lodwick grading system is useful. MRI has now been established to be superior to further investigations. Ultrasonography has proved to be helpful as a noninvasive and cost-saving screening method, particularly in the presence of non pathologic X-ray findings and persistent complaints. Only non-ossifying fibroma and osteochondroma can be diagnosed reliably with X-ray. For solitary bone cysts, chondromas of small tubular bones and fibrous dysplasia, X-ray diagnosis can be doubtful. Most of the lesions to be considered have to be verified histologically. Specialized experience is necessary for the best selection and timing of diagnostic measurements in individual cases in order to prevent fatal errors.
Cystic dilatation of the common bile duct: surgical treatment and long-term results.
Twelve patients (11 female) with an extrahepatic biliary cyst (six type I, three type II and three type III according to the classification of Todani) are reviewed with emphasis on aetiology, clinical features and long-term results at follow-up of 3-10 years. The clinical manifestations were abdominal pain, cholestasis with jaundice, fever and episodes of pancreatitis. The diagnosis was established before surgery in all cases by ultrasonography, endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography and computed tomography. An abnormally long common channel was found in four patients. Three patients had had cysts drained internally in the 1970s. Of these three patients, one developed carcinoma of the cyst 23 years later. Radical excision of the dilated bile duct and reconstruction by Roux-en-Y hepaticojejunostomy was performed in nine cases. Two patients, each with a small choledochocele, were treated successfully by endoscopic sphincterotomy and stone extraction. There were no serious postoperative complications. All nine patients operated on remained in good health for 3-10 years. These results support radical excision of the cystically dilated bile duct with reconstruction by end-to-side Roux-en-Y hepaticojejunostomy for types I and II cyst. Endoscopic treatment of type III choledochocele should be limited to the management of smaller lesions.
[Characteristics of chondromyxoid fibroma: are malignant courses possible? Presentation of personal cases and review of the literature].
The chondromyxoid fibroma as a benign bone tumour is described. The difficult but extremely important differential diagnosis from chondrosarcoma is discussed, and the question of the existence of malignant chondromyxoid fibroma is examined. Cases of malignant chondromyxoid fibroma that have been reported in the literature are described and critically analysed. Experience with seven chondromyxoid fibromas and two tumours misdiagnosed as malignant chondromyxoid fibromas are described. In view of the clear definition of chondromyxoid fibroma and chondrosarcoma the term malignant chondromyxoid fibroma is not justified and should no longer be used.
Immune restoration in children after partial splenectomy.
Splenectomy (SE) is recognized to be a therapeutical approach in treating children with severe autoimmune diseases (chronic idiopathic thrombocytopenia; hemolytic anemia) or hypersplenism because of portal hypertension. Nevertheless, removal of a main immune organ results in elevated infection risk for these patients. Partial splenectomy (PSE) was developed as a therapeutical compromise to retain immunologically active spleen tissue. Here, we document the analysis of immune parameters obtained from children after both partial and total splenectomy, which have been followed up for a period of more than 6 years: (i) Lymphocytes from both groups of patients failed to produce IgG in response to pokeweed mitogen in vitro. This was observed in 11/20 splenectomized patients even 10 years after operation, whereas in PSE patients a restoration of this parameter after 1-2 years was seen. (ii) In patients after PSE, but not in splenectomized persons, an elevated number of HLA-class II positive cells had been detected suggesting a different situation of immune regulation following this operation. However, in parallel with an improvement of B cell in vitro activity this parameter was found to achieve normal values. Our findings indicate that partial splenectomy may be a therapeutical alternative, if the therapeutic goal can be achieved by this procedure.
[Post-traumatic hemobilia in childhood].
We observed three patients with a hemobilia after surgically or conservatively treated liver lacerations. The diagnosis was suspected on clinical grounds and verified by ultrasonography, computed tomography or angiography or a combination thereof. Depending on the findings therapy was planned reaching from conservative treatment to liver resection. Because this complication is rare it should be cared for in a specialized institution.
[Caroli syndrome in childhood. Review and report of a patient with an unbalanced karyotype].
This paper describes the clinical symptomatology, the pathogenesis, diagnosis and therapy of the Caroli'Syndrome with a special reference to differences to other congenital hepatic diseases with similar manifestations. We report on a male infant with a Caroli'Syndrome, which is associated with a chromosomal imbalance and other malformations and discuss the genetical background.
[Changes in esophageal function caused by sclerotherapy of esophageal varices in children and adolescents with portal hypertension--a manometric study].
Morphological changes of the oesophageal wall, induced by injection sclerotherapy of oesophageal varices, may produce functional disturbances which are difficult to evaluate especially in children. Therefore manometric studies in 33 consecutive patients with portal hypertension (age: 2-18 years) were performed and functional parameters as of the oesophagus and oesophageal sphincter were recorded in different stages of treatment. The results were compared to findings in healthy children. From our studies we could conclude that functional disturbances seen in sclerolised patients must be set in relation to functional changes which we could see in patients without treatment of oesophageal varices. Endosclerosis affects essential parameters of oesophageal function; however, a large reversibility after termination of the treatment could be documented. The clinical relevance of the recorded findings and the diagnostic value of oesophageal manometry are discussed.
[Diagnostic and therapeutic procedures in liver injuries in children].
Despite of severity of posttraumatic liver lesions after blunt abdominal trauma the availability of modern imaging diagnostic methods has changed the therapeutic concept. Nonoperative treatment attained an alternative place to operative procedures. For this kind of treatment personal and technical premises are mandatory. With ultrasound and computed tomography are non-invasive methods for diagnosis available. Paracentesis has lost of importance. This report of 7 children with liver laceration within 6 years discuss diagnostic and therapeutic practice. Decision for operative or nonoperative treatment depends on critical evaluation.
[The use of homologous spongiosa chips in the treatment of juvenile bone cysts].
Juvenile bone cysts are characterized by trials of hypothetic interpretations in case of aetiology and general disagreement in relation to indicated therapy. The therapeutic spectrum is ranging from primary conservative treatment till subtotal e.g. total cyst resections. Because in juveniles a quantitative limitation for gathering of autogenous material exists the use of allogenous cancellous bone chips has a definitive place in treatment strategy.
[Surgically relevant problems of chronic hemodialysis in childhood].
It is reported about 100 children undergo chronic hemodialysis. The most frequent operation is to get a sufficient vascular access. The Cimino-fistula is the best access. There is no more any regularly indication creating a Scribner-Shunt. The nephrectomy as also a frequent operation is complicated by bleeding. To cure the renal osteopathy total parathyroidectomy with autotransplantation is used. Gastritis, pancreatitis and disturbance of bowel movement are seen. The enhancement of renal transplantation will help to diminish mortality of patients undergoing hemodialysis.
[Therapy success in the treatment of severe renal osteopathy as the result of effective interdisciplinary team work. Case report].
Report about therapy of a severe renal osteopathy, a case of tertiary hyperparathyroidism. It will be shown the good team work between paediatrics, surgery and orthopaedics. Only on this way the patient get the ability for a later dialysis or kidney transplantation.
[Surgical treatment of renovascular hypertension in children].
The main reason for renovascular hypertension in children is ideopathic fibrous and fibromuscular displasia. The pathogenetic classification of the disease was worked out in 1971 by Harrison and McCormac. Of all cases of hypertension in children between 5 and 20% are of renovascular origin. The illness demands an absolute necessity for treatment. The concept of management of renovascular hypertension includes the conservative treatment as well as angioplasty and especially the surgical reconstruction of the arteries. Nephrectomy should be considered as the treatment of last resort. For the surgical reconstruction of arteries a variety of techniques are available. Aortorenal bypasses using autologous arterial or venous grafts are expecially suitable in surgical treatment of renovascular hypertension in children. Results given in literature of the management of 334 children with renovascular hypertension and 8 own cases were evaluated by us according to the criteria of the National Heart, Lung and Blood Institute. In the majority of surgical treated children a substantial improvement in the state of health, or cure, could be achieved.
[The exact prenatal diagnosis of abnormalities of the kidneys and efferent urinary system--a possibility for further decreasing perinatal morbidity and mortality].
Early detection of fetal malformations has become possible owing to the availability of highly advanced ultrasound systems. Majority of malformations, 30 per cent, has been recordable from urinary system. This system is early of access for the examiner, so that even sophisticated diagnosis of malformation is possible. High accuracy diagnosis has been increasingly helpful in forecasting pregnancy prognosis. Hence, with adequate perinatological management, it will be possible to influence on perinatal morbidity and mortality positively. 70 fetuses with malformations of kidneys and to urinary system have been observed in the context of this study. An assessment was made of diagnostic efficiency, postpartum development and long-range prognosis. Recommendations are derived from the above mentioned findings for perinatological approach in cases of diagnosed malformations of kidneys and the other urinary system.
[Management of children with fatal liver diseases with reference to eventual liver transplantation].
Children suffering from alpha 1-antitrypsin deficiency hepatopathies, autoimmune hepatitis and from extrahepatic biliary atresia are cared for with the aim of rendering possible a liver transplant in case of liver insufficiency. Among the laboratory parameters signalling hepatic insufficiency the increase in the indirect bilirubin as well as the decrease of cholinesterase activity and the Quick are of great importance. So far it has not been possible to generalize from the data obtained from the longitudinal examination of patients in order to predict the prognosis of severe hepatopathies.
Partial splenectomy for treatment of chronic idiopathic thrombocytopenia in childhood.
The aim of this paper was to demonstrate the efficiency of partial splenic resection in treatment of chronic idiopathic thrombocytepenie purpura (Werlhof-Disease). In all but one case remissions of thrombocyte counts over 100 Gpt/l could be achieved. Immunological studies demonstrate the existence of a suppressor-state after this operation, which could be responsible for success of this procedure. In contrast to general considerations the partial-splenectomized child must be considered as an immunological deficient organism for about 6 to 12 months. Restoration of immunological-means whole splenic functions-parameters is to expect always after this time.
[Experiences with the use of cerium nitrate silver sulfadiazine in the local treatment of thermal injuries in childhood].
Ointment containing cerium nitrate and silver sulphadiazine (Flammacerium) was applied to 47 children with second-degree to third-degree thermal injuries, with something between five and 60 per cent of the body surface being affected, as had been reported in a one-year prospective study. This ointment proved to be superior to several alternative approaches with regard to local properties, antimicrobial effectiveness, and applicability to several degree of burns. The process of treatment can be optimised due to unproblematic applicability in open and closed variants under both hospitalised and outpatient conditions. This assessment has been underlined by good to very good therapeutic results.