Biomedical subjects
Publications and source records attributed to R Daum.
A detailed report is given on a modified surgical technique of the resection of the spleen. A successive division is performed within the area of the demarcation line after careful study of the vessels. The wound surface is sealed by fibrin and collagen fleece soaked with fibrin and therefore flexible.
61 cases of neuronal intestinal dysplasia are compared in a follow-up study. Two clinically and bioptically different types of intestinal dysplasia can be distinguished. One type with involvement of the sympathetic nerves and the clinical signs of intestinal spasticity, ulcerative colitis with haemorrhagic stools. Histotopochemically, this disease pattern shows aplasia or hypoplasia of the sympathetic nerves with enhanced parasympathetic activity (elevated acetylcholinesterase activity in the lamina propria mucosae and orbicular musculature). One type with involvement of the plexus submucosus clinically accompanied by adynamia of the colon with megacolon formation. This type becomes manifest usually around the 6th month of life. Bioptically there are large groups of ganglion cells and Schwann's cells, but there is also acetylcholinesterase activity as in the other type. This 2nd form is seen more frequently. A third form is a combination of both diseases. The incidence rate of neuronal intestinal dysplasia is equal to that of Hirschsprung's disease.
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%.
Although diaphragmatic rupture in children due to blunt trauma is a rare condition we have observed an increasing number of these cases during the last years. Four cases will be reported and compared to the literature. The majority of diaphragmatic ruptures occurred on the left side. One third of all patients, however, had a rupture of the right diaphragm. In contrast to adults rupture of the diaphragm in children is rarely associated with rib fractures. Frequently liver and spleen become injured and two thirds of the patients presented with prolapse of abdominal organs into the pleural cavity. The prognosis of isolated diaphragmatic rupture is good, usually, however, prognosis is limited by the severe injuries sustained by the initial trauma. Only in half of the cases diaphragmatic rupture was diagnosed initially.
A 15-year review of 34 children with suprarenal tumours is presented. With the exception of one adrenal carcinoma and 4 neuroblastoma, all 12 cortical and 22 medullary tumours (neuroblastomas predominated in the latter group with 19 cases) showed hormonal hyperactivity. The symptomatology, the fundamental steps in diagnosis and therapy and the operative results are discussed.
477 patients with soft tissue sarcomas, including 87 children (18.2%) were treated at the Surgical Center of the University of Heidelberg between 1950 and 1980. 22.8% of the patients with solid tumors (excluding brain tumors) in childhood were soft tissue sarcomas. In the pediatric age group there were 30% rhabdomyosarcoma and 20% angioblastic sarcoma. Since introduction of combined tumor therapy (surgery, radiation, and chemotherapy) the survival rate increased impressively from (29% to 58%).
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5 cases of intramural haematomas are discussed. The haematomas were of different origin, were localized at different sites and treated differently. In one case an obstructive duodenal haematoma developed after a liver and spleen rupture. This hematoma was treated by gastro-enterostomy. In the second case the cause could not be determined. The third haematoma was induced by an intestinal clamp. In the last two cases there was a tendency to haemorrhages (Morbus Schönlein-Henoch and haemophilia A).
In recent years a multidisciplinary therapy contribution has brought about a remarkable change from a purely morphological to a markedly functional type of surgery in corrective operations of intersexual genitals. Methods of surgery generally in use today are described groupwise according to functional aspects. Their development is subject to cultural influences just as it depends on general medical progress and recent psychological knowledge.
The authors report on a consecutive series of 123 children (46 males, 54 females) with congenital duodenal obstruction who were operated on between 1962 and 1980 at the Department of Paediatric Surgery, University of Heidelberg, Surgical Centre. 78 patients (64%) had an extrinsic obstruction; in 36% of the children a membraneous stenosis or complete atresia was observed. 74 children (60%) were mature at birth and had no additional malformations. Out of the remaining 49 children, 25 were mature but had additional malformations. 13 prematurely born children without and 11 prematurely born children with additional malformations were seen. 17 (14%) out of 123 children died. In 74 cases with uncomplicated duodenal obstruction only 5 children (5%) died, as compared to 13 children (27%) out of 49 cases with complicated obstruction. A division of our patients into two time spans (1962 to 1971, 1972 to 1980) shows a total lethality of 25% for the first series, which included 39% cases with complications. In a consecutive series of 54 children operated between 1972 and 1980 no child died.
Basing on exemplary case histories - trauma, benign tumour and staging of lymphogranulomatosis - the possibility of maintaining the function of splenic tissue by means of partial splenic resection is discussed. Indication, surgical approach including fibrin glueing and postoperative follow-up are described, taking recent literature into account, and are discussed as an alternative to splenectomy and autotransplantation.
The method of partial splenectomy by applying fibrin glueing has become a safe surgical procedure thus opening new aspects of pediatric surgery of the spleen. Indications for partial splenectomy are discussed with special regard to Hodgkin's disease. The autotransplantation of splenic tissue--a localized form of iatrogenically induced splenosis--is considered as secondary to partial splenectomy since the arterial perfusion and the filter function of the spleen are not maintained. In cases, where partial splenectomy cannot be performed, splenic tissue should be placed in a retroperitoneal pouch of the splenic bed. The vulnerable infant omentum is rejected as a possible site of implantation since there is danger of spreading splenic tissue into the whole abdominal cavity inducing further complications by infections or neoplasma with splenic participation.
Hepatoblastoma was diagnosed in a 12 month old boy presenting with hepatomegaly and isosexual precocious puberty. Preoperative levels of both alpha-1-fetoprotein (AFP) and human chorionic gonadotropin (HCG) were highly elevated. The tumor was removed by hepatic trisegmentectomy. Tumor tissue contained high concentrations of AFP and HCG. On combination chemotherapy with cyclophosphamide (CYC), vincristine (VCR), adriamycin (ADR) and 5-fluorouracil (5-FU) HCG dropped over a period of 9 months to normal values. In contrast, AFP was undetectable following surgery. One year after initiation of therapy there is no clinical or radiological evidence of recurrence of the malignancy but the observation period is too short to draw any conclusions on the effect of therapy and the final outcome.
Operative treatment of femur fractures in 20 polytraumatized children had worse after-results than conservative treatment in 14 comparable fractures except for the CCD angle. The indication for operative treatment should be made very cautiously, also in polytraumatized children. The indications are listed. The most frequency indication for operative treatment after polytrauma was long-lasting severe motor agitation due to cerebral contusion.
86 patients with Wilms' tumor were treated in Heidelberg between 1951 and 1980. Using the histopathologic grading according to Hardwick and Stowens the sarcomatous tumor type has an unfavorable prognosis. All the patients in stage III to V developed metastases. In contrast to other types of Wilms' tumor these sarcomatous tumors do metastasize to bones, not primarily to the lung. Boys up to 5 years are mostly affected by the tumor. These were "cold" lesions in bone scan using different radionuclides on skeletal osteolytic metastases, which is limiting the application of scans to detect bone metastases in Wilms' tumor. A more aggressive chemotherapy should be given to improve prognosis of the sarcomatous type of Wilms' tumor.
Over the past 10 years 18 patients have been operated upon (sometimes repeatedly) because of pulmonary metastases. The primary tumour with pulmonary secondaries was usually an osteosarcoma or a Wilm's tumour. The indication for surgery and the result of treatment are discussed. The pre-operative diagnosis is helped considerably by ventilatory and perfusion isotope studies.
The use of ultrasound investigation in children with portal hypertension is discussed and a 14 year old patient is presented. With this non-invasive investigation, the course, diameter and patency of the splenic vein can be demonstrated, repeated post-operative investigations showed a reduction in the size of the splenic vein of at least 2 mm. following patent spleno-renal anastomosis. The ultrasound technique is demonstrated.
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