[The course of mortality in juvenile ileus cases: analysis and conclusions for therapy].
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Biomedical subjects
Publications and source records attributed to I Joppich.
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Peripheral primitive neuroectodermal tumor (PPNET) is a malignant neoplasm of the peripheral nervous system and soft tissues. Representing the fourth case published we herein report a PPNET arising in the pancreas of a six year old girl. She presented with severe anemia due to ulcerative tumor growth and hemorrhage into the duodenum. From the first biopsy pancreatoblastoma was considered as histological diagnosis. Therefore pancreato-duodenectomy was successfully performed. Immunohistochemically, the tumor cells were positive for cytokeratines and several neuronal markers. Due to focal membranous staining for MIC-2 gene product and rosettes in one lymph node metastasis the diagnosis had to be altered into PPNET. This was confirmed by cytogenetic analysis. We conclude that the interpretation of histologic sample excisions from pediatric pancreatic neoplasms may be difficult and that PPNET should be included in the differential diagnosis.
Circumcision is one of the most frequent operative procedures done in males. About 120 circumcisions are performed every 5 minutes over the world [14]. Three different reasons lead to circumcision: 1) Medical reasons in present of a pathologic phimosis. 2) Circumcisions done due to religious, social or cultural rea-reasons. 3) Finally in many countries circumcision is performed as "routine-circumcision" in the newborn period. While in the United States the number of routine-circumcisions decreases (about 60% of all male newborns) South-Korea has a rate near to 100%. Even with no religious or cultural background in Germany circumcision often is performed without scrutinizing medical indication. Circumcision is regarded as an procedure with no complications and no disadvantage for the patient. In general circumcision has no medical benefit neither in decreasing the incidence of urinary tract infections nor of sexual transmitted diseases nor of neoplasias. Medical indication for circumcision is given in present of pathologic phimosis in 4% of all males. Postoperative complications range up to 2% and "circumcision is the amputation of the prepuce from the rest of the penis, resulting in permanent alteration of the anatomy, histology and function of the penis...". There are many reports about having discomfort and disadvantages after circumcision as well to the males as to the sexual partners. This challenge the legality of neonatal involuntary circumcision because legality is based on saving the children's best interests.
Complications after ineffective medical management are indications for surgical treatment in Crohn's disease and ulcerative colitis. Immediate intervention is necessary in perforation, bleeding and intestinal obstruction, but abscess, fistulation, chronic bowel obstruction and an inflammatory tumor need also surgery without longer delay. Acute ileitis terminalis imitating acute appendicitis is an exceptional case of Crohn's disease. Local recurrence, severe abdominal pain, diarrhoea, retardation of growth and development, and risk of malignant change may be reasons for elective surgery. As development of recurrence after operation is frequent and the results of colectomy and proctocolectomy with ileostomy are not always satisfactory some caution to surgery in ulcerative colitis and Crohn's disease in childhood is advisable.
OBJECTIVE: Infants with gastroschisis (GS) still face severe morbidity. Prenatal closure may prevent gastrointestinal organ damage, but intrauterine GS repair (GSR) has not been established yet. METHODS: In New Zealand White rabbits we developed and compared GS versus GSR: creation of GS was achieved by hysterotomy, right-sided laparotomy of the fetus and pressure on the abdominal wall to provoke evisceration. GSR was accomplished by careful reposition of eviscerated organs and a running suture of the fetal abdominal wall. For study purposes, 18 animals were divided equally into 3 groups: GS, GS with GSR after 2 h, and unmanipulated controls (C). Vitality was assessed by echocardiography. After 5 h all animals were sacrificed. RESULTS: GSR inflicted no increased mortality, because all fetuses survived GS or GS with GSR. All fetuses with GS demonstrated significant evisceration of abdominal organs. In contrast, the abdominal wall of the fetuses from GSR was intact. CONCLUSION: The present animal model demonstrated the technical feasibility and success of an intrauterine repair of GS for the first time. However, further long-term studies (leaving GS and GSR in utero for several days) will be necessary to compare survival rates and intestinal injury, motility or absorption. The clinical application of GSR in utero remains a vision so far.
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