Biomedical subjects
Publications and source records attributed to I Joppich.
Empyema is a rare parapneumonic complication in children. The use of antibiotics and closed-tube thoracostomy drainage has superseded operative procedures like decortication even in anaerobic infections. Only a few authors still recommend early decortication. However empyemas based on malformations such as lobar emphysema or cystic lung should be treated surgically.
Neither chemotherapy nor surgery alone provided satisfactory treatment of bone sarcomas in children. However, their combination improved the 3-year-survival rate by up to 80% in the last decade. For better life quality, limb-sparing techniques like en-bloc-resection, rotation plasty or endoprosthesis should be preferred instead of amputation, if they are possible within the demands of radical oncological surgery. The significantly higher incidence of pulmonary metastasis of en-bloc-resection compared to that of ablative surgery as shown in the COSS-80-study points out that limb-sparing surgery is still problematic and needs further technical improvement in the future.
According to the difficulties in communication with babies and very young children there often are problems in the early diagnosis of abdominal pain or symptoms. This is demonstrated in the example of appendicitis in children and meconium peritonitis in the newborns. The possibilities of pain measuring in newborn or preterm babies are shortly discussed.
Explore the source record for details and available documents.
About 50% of children with thyroid carcinoma present with regional lymph node metastases as the leading symptom. The "cold nodule" is the typical scintigraphic finding in thyroid cancer in infants. Papillary carcinoma is the predominating histologic type (80%) and has a good prognosis. Radical removal of the thyroid lobe with the primary lesion and subtotal resection of the opposite lobe, combined with selective neck dissection if necessary, seems to improve the results. Postoperative scintigraphic examinations detect remnants of malignant tissue requiring 131-iodine treatment and, finally, TSH-suppressive hormone is administered. In our own cases, the survival rate in 25 children was over 90%.
Gluing of oesophageal anastomoses in atresia effected by means of three or four sutures will definitely produce better results than suturing alone. The results of endoscopic closure of tracheo-oesophageal fistulas by gluing with fibrin are excellent. Furthermore, it is possible with fibrin gluing alone to treat iatrogenic perforations of the oesophagus in the newborn, following a false passage of nasogastric tubes from the hypopharynx into the mediastinum or pleural cavity.
Segmental intestinal dilatation is rare and has so far been described for 26 patients only. The article presents three own observations. The clinical symptoms correspond to those of intestinal obstruction and are in most cases manifest in infancy and early childhood. The affected section of the intestine is dilated regionally to 3 to 4 times the normal value and can be situated both in the small intestine and in the colon. The intestinal wall is thickened or thinned; all intestinal wall layers are preserved and the ganglionic cells are regular. A characteristic feature is the histological finding of heterotopic tissue such as gastric mucosa and tissue of pancreas, lung or cartilage. The mesenterial veins are markedly congested. In 50% of all patients association with other malformations is seen.
When using fibrin glue we must distinguish, on the basis of the clinical results obtained, between an obsolute and a relative indication for glueing. Glueing of the oesophageal anastomosis in atresia effected by means of three of four fibres only definitely produces better results than suturing alone. Likewise, fixation of skin grafts and treatment of ruptured spleen are an exclusive indication for fibrin glueing. Endoscopic glueing of oesophagotracheal fistulas and treatment of rupture of the kidneys, liver and pancreas are essential indications for glueing, alone or together with suturing. Intestinal anastomoses which are in danger of becoming detached can be secured by means of fibrin, thus improving the results. This applies equally to all fields of plastic surgery. In bone surgery, small detached parts of cartilage or of bone can be fixed atraumatically by glueing. Finally, improved and accelerated reconstruction e.g. of removed bone cysts can be expected by inserting fibrin-spongiosa fillings.
Explore the source record for details and available documents.
During the last few years the coordination of ultrasound, radiology and urologic surgery led to the diagnosis and treatment of numerous diseases of the kidney. From 1976 till the beginning of 1979 we were able to diagnose 50 expanding retroperitoneal processes. These were hydronephroses, malignant tumors and enlargement of the kidney due to inflammatory affections ensuing nephrolithiasis as well as urosepsis and shock. The fact that sonography is a harmless, non invasive, simple and often repeatable examination is the most important advantage. Provided that ultrasound diagnosing is performed by an experienced person, there is a good correlation to the common x-ray methods and specially recommended for postoperative controls.
In more than 5,500 patients operated upon for Hirschsprung's disease which were obtained from the literature, the late complications following the 4 principal operative procedures of Swenson, Duhamel, Rehbein and Soave were compared. After Duhamel's operation, there was a lower incidence of postoperative constipation: 6.7%, compared with an average rate of 9.3%. Rehbein's resection showed the best results in relation to incontinence with a complication rate of 2.1% while the average was 9.8%, also in enterocolitis and diarrhoea (2.4%, average 7.8%) and enuresis (5.1% compared with 9.7%). We found the lowest incidence of late ileus (2.2% to 4.4%) and mortality with the Rehbein method. Judging by the frequency of late complications, the technique of Rehbein's anterior resection seems to be the most commendable.
Explore the source record for details and available documents.
Surgical problems of congenital malformations of the female genital tract, especially in combination with anorectal or urological anomalies, the correction of clitoral hypertrophy due to endocrinological disorders (AGS) and inflammatory and tumorous alterations of the ovary in childhood are discussed.
As abdominal tumor in childhood show a high rate of malignancy, a quick and exact diagnostic management is necessary. Different diagnostic procedures are described and their value in finding the diagnosis is discussed.
In about 50% the thyroid carcinoma in childhood presents regional lymphnode metastases as leading symptom. The "cold nodule" is the typical scintigrafic equivalent of thyroid cancer in infants. Papillary carcinoma is the predominating histologic type (80%) with a good prognosis. Radical removal of the thyroid lobe with the primary lesion and subtotal resection of the opposite lobe, combined with selective neck dissection if necessary seems to improve the results. Scintigrafic control postoperatively detects malignant remnant tissue for 131-iodine-treatment, finally TSH-suppressive hormone administration is followed. In our own cases the survical rate in 25 children was at least more than 90%.
Explore the source record for details and available documents.
Infectious complications such a peritonitis, septicaemia and pneumonia are the most important factors causing postoperative death in surgery of intestinal obstruction in children. In a series of 237 patients with intestinal obstruction with 21 fatalities, the percentage of deaths due to infection was 85.7%. In 1967 to 1976, 259.301 children died in Germany, among them 1541 suffering from intestinal obstruction (0.6%); that means 3.1% of the 49.540 patients who died of intestinal obstruction were children. The mortality of intestinal obstruction in infancy and childhood had fallen to one third of the original during this period, but the mortality in newborn infants fell only by 50%. This correlates with the decreasing birth rate, so that the lower death rate due to intestinal obstruction seems to be explained by a lower number of neonates. The literature shows that relative mortality (20%) from intestinal obstruction in the newborn has, however, remained constant during the last 20 years.
The congenital choledochus cyst is an extremely rare disease pattern. The author presents two own cases of boys aged 4 1/2 years in whom the disease was manifested as a fusiform dilatation of the cholodochus and of the other bile ducts on the one hand, and by a cyst in the second case. Both cases were characterised by an additional annular stenosis of the cholodochus immediately before the junction of the pancreatic duct. The article discusses the most essential criteria in respect of clinic, diagnosis and therapy, as well as the etiological aspects.