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I Joppich

Publications and source records attributed to I Joppich.

At least 19 recordsLinked to original sources
PubMed2000

A computerised vector manometry study of the so-called ectopic anus.

There are several totally different definitions of the so-called ectopic anus. To determine whether computerized eight-channel manometry helps to define the entity of the ectopic anus, ten patients (nine females) were operated upon for an ectopic anus by the anal transposition technique (perineal pull-through procedure). Besides the software-supported manometric data, the qualitative imaging analysis was of interest. We calculated the factor by which the pressure of the three ventrally-located segments was lower than the mean segmental pressure at this part of the anal canal. The results were compared to standard age-related values established in a former study in 100 children. Besides pre- and postoperative manometry, barium roentgenograms were obtained. The anal-canal length at rest in the ectopic anus was significantly (P < 0.0001) longer. The segmental asymmetry index in the lower anal canal (LAC) was increased, but not significantly. The pressure in the ventral segments of the LAC was significantly (P < 0.0001) decreased and was less than one-half of the mean segmental pressure in this zone. We found a significant correlation between the degree of anterior displacement and the factor by which the ventrally-located pressure values were decreased. Postoperatively, this factor increased significantly. From a functional point of view, the definition of the ectopic anus includes a deficient high-pressure zone ventrally in the LAC. The LAC seems to run out or nearly out of the ventral sphincteric issue to end ectopically on the perineal surface.

Age Factors↗
PubMed2000

Organ-specific distribution of major histocompatibility antigens in rats.

The present study systematically investigated the expression and distribution of the major histocompatibility complex (MHC) classes I and II in the rat. About 150 native tissue probes from eight adult Lewis rats were taken, representative for most organs, tissues, and the vascular system. MHC expression was analyzed by two monoclonal antibodies (mAb) generated against the non-polymorphic determinants of rat MHC class I (Ox-18) and class II (Ox-6). Immunoreactivities were compared to those of different endothelial (HIS52, TLD-3A12, Ox-43, REHA-1 antigen), histiocytic (ED1, ED2), B-cell (RLN-9D3), and T-cell (MRC Ox-52) markers. A nonspecific mAb (MR12/53) served as a negative control. Pretested concentrations on various tissues and the alkaline phosphatase-anti-alkaline phosphatase technique allowed semiquantitative evaluation of serial cryostat tissue sections. MHC class I expression was detected on most immunocompetent cells. Endothelial cells were stained heterogeneously along the vascular system and the organ-specific microcirculation. Furthermore, some organs showed staining of parenchymal cells. MHC class II was found on all immunocompetent cells positive for the B-cell marker and about 15% of cells positive for the histiocytic markers. Besides the well-known expression of MHC class II in the outer zone of the renal proximal tubule, further organ-specific cell forms were found positive. In conclusion, the present study outlines tissue-specific distribution of MHC I/ II and implies that each organ carries a variable immunologic burden that needs to be considered for any transplantation model.

Adrenal Cortex↗
PubMed2000

Proliferation, zonal maturation, and steroid production of fetal adrenal transplants in adrenalectomized rats.

The present study investigated the histologic maturation, proliferative capacity, and steroid production of fetal adrenal transplants (Tx) in adrenalectomized rats. A pair of fetal adrenal glands (18-20 days of gestation) was transplanted into the omentum of syngeneic Lewis rats (n = 45). Four weeks later, in 5 animals the grafts were excised for morphologic evaluation. Proliferation was investigated by immunohistochemical staining for KI-67 protein and quantified by the proliferation index (PI = positive cells/100 counts). All other hosts (Tx; n = 40) underwent bilateral adrenalectomy (AE) to induce Addisonian crisis. Postoperatively, survival and concentrations of potassium, sodium, aldosterone, and corticosterone were recorded for 6 months. These data were compared to controls (C=only AE; n = 30) and a sham group (S; n = 10). At the end of the study period all surviving hosts were killed for histologic examination of grafts. At 4 weeks post-Tx the adrenal grafts demonstrated a distinct zona glomerulosa and frequent proliferation with a PI of 0.084, comparable to normal control (0.092). Following AE survival was significantly prolonged in Tx (86% vs 12% of C, P < 0.05). Control animals developed severe hyponatremia and hyperkalemia, whereas in Tx only transient signs of Addisonian crisis were recorded. Levels of aldosterone dropped within 7 days in the Tx and C groups, but returned to normal for Tx within 8 weeks. Corticosterone levels of Tx animals fell to 25% within week, but steadily increased to 70% by the end of the study. At 6 months, grafts revealed a mature adrenocortical structure with little proliferative activity, which was comparable to controls. In a syngeneic rat model fetal adrenal transplants thus mature and proliferate to provide sufficient steroid production for adrenalectomized hosts.

Adrenal Glands↗
PubMed1998

Fetal adrenal transplants respond to ACTH and prevent addisonian crisis in adrenalectomized rats.

The present study investigates whether fetal adrenal transplants into the omentum of adrenalectomized rats will be integrated into the recipient's endocrine system to provide competent adrenocortical function. The results demonstrate that fetal adrenals graft with a rich vascular supply, mature histologically, and produce increasing levels of corticosterone. When bilateral adrenalectomy is performed in the recipient, survival is prolonged and addisonian crisis can be prevented. Moreover, adrenocorticotrophic hormone levels decrease with increasing levels of corticosterone, indicating that the fetal grafts are integrated into the physiological pituitary-adrenocortical feedback system.

Adrenal Glands↗
PubMed1998

Cryopreservation and transplantation of fetal adrenal glands in adrenalectomized rats.

In a syngeneic rat model, the present study investigated the cryobiology of fetal adrenal glands and compared the endocrinological function of cryopreserved versus fresh fetal adrenal transplants in the adrenalectomized hosts. Ultrastructural studies showed no significant tissue damage by the cryopreserving technique: cellular membranes were intact, the mitochondria showed discrete swelling and vacuoles were found in the endoplasmatic reticulum. Following transplantation, maturation and bilateral adrenalectomy in the host, assessment of endocrinological parameters demonstrated that survival was prolonged and Addison crisis could be prevented in both transplant groups with no significant difference between fresh versus cryopreserved grafts. To our knowledge this study presents the first morphological and endocrinological data about the successful transplantation of cryopreserved fetal adrenal glands in rats. In conclusion, cryopreservation is tolerated well by the tissue and long-term banking may therefore contribute to the feasibility and benefit of fetal adrenal transplantation. However, further investigations will be necessary to evaluate fetal adrenal transplantation in an allogeneic and xenogeneic setting.

Adrenal Glands↗
PubMed1997

Fetal adrenal transplantation: success of a laparoscopic technique in rats.

BACKGROUND/PURPOSE: The present study investigates a new laparoscopic technique for fetal adrenal transplantation in rats. RESULTS: The procedure was successful in 9 of 10 cases (one hole in the omentum) with no postoperative complications. On examination 4 weeks postoperatively, all but one graft showed macroscopic integrity, vascular supply, and histological maturation to normal zonal differentiation. When bilateral adrenalectomy was performed in the recipient to assess endocrine competence of the fetal adrenal grafts, survival was prolonged and Addison crisis was prevented in the animals that underwent transplantation. Levels of aldosterone dropped within the first week after adrenalectomy, but recovered steadily. Analysis of corticosterone demonstrated that levels fell to 25% of sham operated rats in the first week, but then steadily climbed to 70%. CONCLUSIONS: To the authors' knowledge this report presents the first study for laparoscopic transplantation of fetal tissues. Laparoscopic transplantation of fetal adrenal glands seemed feasible and successful in rats. The fetal adrenal transplants matured and served for a prolonged survival.

Addison Disease↗
PubMed1997

Atypical hemihepatectomy during primary CDH-repair in a neonate on ECMO.

We report the case of a newborn with a large left-sided congenital diaphragmatic hernia (CDH) who required extra corporeal membrane oxygenation (ECMO) for severe respiratory insufficiency. CDH repair had to be performed on bypass circulation. Intraoperatively, an atypical hemihepatectomy of the herniated lobe was conducted, because reposition of the liver led to a kinking of the vena cava and to a torsion of the right lobe, resulting in ischemia and compromised venous flow. The extraordinary anatomical indication and the potential danger of uncontrollable bleeding are discussed.

Extracorporeal Membrane Oxygenation↗
PubMed1997

[Guidelines in pediatric surgery].

Guidelines are intended to give more structure and transparency to medical procedures and to reduce unnecessary medical costs. The aims of guidelines and the claims made upon them are defined and their usefulness is discussed, with a short review of special problems in pediatric surgery.

Child↗
PubMed1996

Patient controlled analgesia (PCA) in paediatric surgery: a prospective study following laparoscopic and open appendicectomy.

Patient controlled analgesia (PCA) has not yet gained universal acceptance for the management of postoperative pain in paediatric surgery. In a prospective study we evaluated feasibility and complications of PCA following 90 cases of laparoscopic or open appendicectomy. PCA proved to be a safe and feasible method with few complications (2% of medical complications, no abort of application, 17 technical checks in a total running time of 4125 h). Acceptance by patients was high and children of all age groups worked the system properly. Assessment of application protocols showed, that the consumption of analgesics was significantly reduced following laparoscopic appendicectomy (P < 0.05). PCA is a safe and feasible method for the management of postoperative pain in children and PCA recording provides an excellent insight into the consumptional behaviour of patients, enabling staff to evaluate postoperative pain for various procedures.

Analgesia, Patient-Controlled↗
PubMed1996

[Surgery of atresia of the gastrointestinal tract].

The most common sites of atresia in the gastrointestinal tract are the oesophagus, the duodenum and the anorectum. Surgical intervention is always necessary. Because of the rapid progress in surgical techniques and peri- and postoperative intensive care management, lethality has been minimized, even when treating very small premature infants. In the meantime, the surgical intervention itself is no longer the great risk it was; associated congenital malformations such as complex cardial defects are now much greater risks.

Anastomosis, Surgical↗
PubMed1995

Pulmonary sling: morphological findings. Pre- and postoperative course.

Pulmonary sling (PS) is a congenital condition in which the left pulmonary artery (LPA) arises from the right pulmonary artery (RPA), forming a sling around the trachea causing tracheal compression. The incidence is not so rare as initially thought. Symptoms of severe airway obstruction often begin in the newborn or young infant. Echo-colour-Doppler may reveal the PS but emphysema can mask the typical findings. Deviation of fluid-filled lungs may be detected prenatally. Chest radiographs show unusual air distribution, deviation of heart and mediastinum and altered tracheobronchial angles. Bronchography and bronchoscopy demonstrate the high incidence of associated tracheal anomalies such as cartilagenous rings and long tracheal stenosis. Anterior oesophageal indentation is not always seen in the oesophogram. Magnetic resonance imaging (MRI) and computed tomography (CT) reveal the PS, but cautious interpretation is necessary because of different levels of the anomalous LPA. PS and associated cardiovascular malformations can be clearly detected by angiography. Associated extrathoracic anomalies are common. Early diagnosis and therapy of PS is mandatory and consists of reimplantation of the LPA into the pulmonary trunk and division of the ligamentum arteriosum. The postoperative course may be cumbersome necessitating bronchological interventions. Tracheal resection may be necessary but restenosis is frequent. A one-stage repair has been proposed in such cases and was successfully done in a few reported cases. Relief of respiratory obstruction is often complete when there are no associated tracheobronchial anomalies. Late postoperative course is favourable but respiratory obstructive attacks may occur with decreasing incidence over time and tracheal growth.

Abnormalities, Multiple↗
PubMed1994

Thyroid carcinoma in childhood: management and follow up of 11 cases.

Eleven patients under 16 years of age, 5 males and 6 females were diagnosed with thyroid carcinoma in our hospital between 1974 and 1992. Median age at diagnosis was 9.5 years (range: 5.2-15.7 years). The presenting sign was a single thyroid nodule in 5, multiple thyroid nodules in 1, cervical adenopathy in 3, and thyroid nodules in conjunction with cervical adenopathy in 2 patients. Histological diagnosis was papillary carcinoma in 5 cases, follicular carcinoma in 2, mixed papillary-follicular carcinoma in 3, and anaplastic carcinoma in one. Only 4 patients had no extrathyroidal metastases at diagnosis. All but one subjects underwent total thyroidectomy, either one-stage or two-staged. If metastases were present, ablative radio-iodine therapy followed. Two patients died within a few months, one from complications of lung metastases, another from diffuse spread of anaplastic carcinoma. Two patients were lost to follow up; 7 patients have been followed for 9.0-18.0 years. Of these, one patient with initial lung metastases has had six recurrences which were successfully treated each time with radio-iodine although thyroglobulin levels remained elevated; another patient who had an initial subtotal thyroidectomy incurred a relapse 12 years later during pregnancy but is doing well now after more intensive surgery. We propose that children with differentiated thyroid carcinoma should undergo total thyroidectomy and selective lymph node extirpation by a skilled surgeon followed by whole body radio-iodine scan and ablative radio-iodine treatment if necessary. Plasma thyroglobulin can then be used as a tumour marker and suppressive levothyroxine does should be given.

Adenocarcinoma, Follicular↗
PubMed1994

[Torticollis].

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Facial Asymmetry↗
PubMed1993

[Surgically treatable chronic constipative defecation disorders. Indications, diagnosis and therapy].

Paediatric surgeons are engaged in different causes of chronic constipation. Aganglionosis usually needs surgical therapy, but in dysganglionosis a distinct differentiation is necessary between patients sufficiently treated by conservative methods and others requiring surgery. Sometimes the operation seems to be an "ultima ratio" in these patients. Otherwise surgery can be necessary early in enterocolitis, ileus or toxic megacolon. In the spectrum of anal malformations constipation may be a primary symptom (anal ectopia, anal stenosis, low anal atresia with anocutaneous fistula) or appears as a post-operative complication (intermediate or high anal atresia). In secondary megacolon, surgery is performed to remove the result of therapeutic negation over many years. The operation may be the supposition to follow up with conservative treatment. In the management of constipated patients an exact diagnostic clarification has a central position. This especially includes anorectal manometry, x-ray examination with contrast medium application and defaecography and as last rectal biopsy.

Anal Canal↗
PubMed1993

[Surgical complications caused by tracheobronchial foreign body in childhood].

Four cases of tracheobronchial foreign body aspirations are described that necessitated surgical interventions. Bronchial rupture occurred in three cases and in one case the foreign body had to be removed via thoracotomy after endoscopic extraction had failed. The possible complications in case of a chronic tracheobronchial foreign body due to delayed diagnosis are pointed out. The purpose of this contribution is to provide the general practitioner with guidelines to suspect the presence of a foreign body well in time and to refer the patient quickly to a competent hospital for immediate treatment.

Bronchi↗