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Biomedical subjects

U G Stauffer

Publications and source records attributed to U G Stauffer.

At least 37 records · Page 2Linked to original sources
PubMed1991

Characteristics and prognosis of extradural hematomas in children.

This is a report on 31 children with operated extradural hematoma. The aim of the study was to elucidate the characteristics of extradural hematoma in childhood and the different clinical pattern and outcome compared to adults. For that reason the charts of the patients seen at the Department of Surgery of the Children's University Hospital Zurich between 1972 and 1990 have been revised. Follow-up criteria were recorded according to the Glasgow Outcome Scale. Most hematomas have been provoked by minor injuries and almost all children presented with at least one typical clinical sign. Associated intracranial injuries have been found in four patients, while two were polytraumatised. 30 of the 31 patients survived. One patient died of malignant brain edema. The mean range of follow-up was seven years. 28 patients had a "good recovery", "moderate disability" and "severe disability" was found in a patient one each. Our results demonstrate that the long-term outcome in children with extradural hematoma is far better than in adults regarding survival as well as quality of life. The causes may be minor traumas with fewer associated lesions and presentation with typical clinical findings and therefore early diagnosis and treatment.

Adolescent↗
PubMed1991

Is intestinal lengthening effective in treating extreme short bowel syndrome?

Our report concerns a child with short bowel syndrome who had 20 cm of small intestine distal to the pylorus (duodenum and jejunum) which remained after subtotal intestinal resection; the resection was necessitated by intrauterine volvulus with intestinal necrosis as a result of gastroschisis. In addition, only 25 cm of the colon remained. Despite continuous enteral nutrition with a semi-elementary diet and conservative therapy, it was not possible to provide within six months at least occasionally half of the caloric intake required on an enteral basis. In such cases treatment is usually discontinued. As final alternative to a small intestine transplantation, we conducted an operation to lengthen the intestine (method according to Bianchi) when the patient was 8 months old. The massively dilatated jejunum section of the intestine was lengthened from 20 cm to 37 cm. Postoperatively enteral caloric intake could be increased from 11 kJ/kg/m to 20 kJ/kg/m. Unfortunately, at 14 months of age, the child died from hepatobiliary complications arising from aggravation of the cholestasis and acidosis. This case shows, nevertheless, that intestinal lengthening had a positive influence on intestinal resorption.

Colostomy↗
PubMed1991

[Reconstruction of external genitalia of the girl with adrenogenital syndrome].

Congenital adrenal hyperplasia (CAH) is the most common cause for female pseudohermaphroditism. In these patients uterus and Fallopian tubes are present and also in severe cases the clitoris cannot function as penis later in life. Therefore, a neonate with ambiguous genitalia due to CAH should be raised as female. To assess the degree of masculinization, a modification of Prader's classification was used. In 23 girls with ambiguous genitalia reduction clitoroplasty preserving the neurovascular bundle and creating a dorsal preputial skin flap and vaginoplasty with a perineal skin flap were performed. The phallic skin was used to create the labia minora and the anterior vaginal wall. The patients were reevaluated 1 to 14 years after the operation. The cosmetic and functional results have been excellent.

Adolescent↗
PubMed1991

[Resorbable implants in craniofacial surgery in childhood. A contribution to the development of poly(lactide) implants].

After research on minipigs we use since 2 1/2 years our polylactid and polydixanon implants for stabilisation after osteoplastic trepanation and in craniofacial reconstructions. The presented set with headless screws and nuts and woven bands are described in detail. Biodegradable osteosynthesis was done in 15 patients aged 11 months to 17 years and two months (m: 6 years four months). The results are at least as well as with conventional steel implants (plates, screws and wires). We did not see infections in any instant, and no patient had a second operation for explantation of fixation devices. After this encouraging prospective trial we are going to simplify the construction as well as the implantation procedure and to enlarge the spectrum of indications by using plates.

Adolescent↗
PubMed1990

The Shaw haemostatic scalpel in paediatric surgery: clinical report on 3000 operations.

This report presents the experience in a prospective series of 100 operative procedures in all fields of paediatric surgery with the Shaw haemostatic scalpel, which we have subsequently used in more than 3000 further operations. The Shaw scalpel proved to be advantageous in about 80% of major cases. The scalpel cuts tissue with a sharp steel edge, like a cold scalpel, and simultaneously seals blood vessels by heat thermally conducted to the tissue from heated blade which is electrically insulated from the patient. The heat seals most small blood vessels (under 2 mm) as they are cut. Since no electric current passes through the patient, a grounding pad is not needed and the risk of accidental electrical current burns at grounding sites is eliminated. Muscle stimulation associated with the use of a normal cautery is avoided, improving surgical precision of cutting. The Shaw haemostatic scalpel minimizes damage to the tissue as compared with other thermocoagulating instruments. Since it seals small vessels as it cuts tissue, it largely eliminates the flow of blood into the incised area and allows better visibility of the surgical field. The use of the scalpel requires a different cutting technique which is however easy to learn. The Shaw haemostatic scalpel reduces blood loss and overall operating time in major cases. It is relatively inexpensive and can be recommended for use in paediatric surgery.

Adolescent↗
PubMed1990

The Herbst triad: report of two cases.

We report two patients with hypoproteinemia and finger clubbing in whom the underlying gastroesophageal reflux was only detected after symptoms of esophageal stenosis became apparent. Ignorance of gastroesophageal reflux as a possible cause of these impressive symptoms led to complications and delayed surgery.

Child, Preschool↗
PubMed1990

[Biodegradable osteosynthesis applied to craniofacial surgery].

Since skin problems as decubitus and infections are well known risks in osteoplastic trepanations in congenital malformations in children, we searched for a reduction in size of the implants and the possibility to use biodegradable materials. After design of special constructions regarding dimension and stability purposes for children below one year, we performed osteoplastic trepanations in 27 minipigs. In 78% the healing was uneventful and the osteoplasty remained in place whereas in 22% (= 6 animals) we observed a local infection which lead to loss of implants as well as cranioplasty in 3 animals. Based on this research, we used our biodegradable implants in osteoplastic trepanations of congenital craniostenosis in children. The postoperative follow-up is now from 3 to 6 months in 4 children and the results are perfect in all. We did not observe any local infection, neither cutaneous problems, even not in bilateral frontal advancement and floating forehead procedures. The implants are presented as well as the results in animal research and the first follow-up in 4 children.

Acrocephalosyndactylia↗
PubMed1989

[Prenatally diagnosed intestinal obstruction--contribution of pediatric surgery].

The diagnosis of a small intestinal obstruction was made prenatally between the 31st and 36th week of pregnancy in 7 patients with neonatal ileus. Five newborns showed a meconium-peritonitis, a meconium-ileus and the last a ileal atresia. These were compared with newborns with small intestinal obstruction, which had not been diagnosed prenatally. The analysis of our hospital information indicates, that primarily serious forms of ileus and intestinal perforations are diagnosed prenatally, whilst isolated small intestinal obstruction often avoids diagnosis. For this reason, diagnostic punctation of the foetal abdomen contribute little to the establishment of the etiology of the obstruction and should be avoided. On the other hand, punctation of a foetal ascites can, through pressure reduction of the abdomen, lengthen the duration of pregnancy and permit a spontaneous birth.

Adult↗
PubMed1989

[Treatment of femoral and lower leg shaft fractures in adolescents].

In adolescents dynamic-compression-plate osteosynthesis is an excellent modality for treating femoral shaft fractures. It provides anatomical stabilisation as well as short hospitalisation and rehabilitation. In contrast, fractures of the tibial shaft are usually treated with casts or by extension. Primary operation is rarely necessary, for example in cases of an impaired neurovascular system. In third degree open fractures we usually recommend external fixation. In our department clinical and radiological late-term controls are performed over a period of at least two years for tibial and four years for femoral shaft fractures.

Adolescent↗
PubMed1989

[Bone healing after oblique osteotomy of the metacarpus in 6-week-old calves after conservative treatment or osteosynthesis].

Bone healing in infants treated by a rigid osteosynthesis of AO type showed mostly a marked periosteal and endosteal callus formation. In adults a callus formation is seldom seen and primary bone healing is mainly based on direct conduction of Havarian channels. Periosteal callus formation is even judged as a sign of instability in adults. We did à 2:1 osteotomy of the right metacarpal bone in 48 calves of 6 weeks of age. The treatment consisted in reposition and a plaster (6) in osteosynthesis with a metal screw of AO type (6) or a biodegradable screw of polylactid (36). The animals were sacrified 1-6 weeks postoperatively and a histological study was done in a comparative way based on the most common criteria in the literature of osteology and traumatology. In calves bones healing takes about 4-6 weeks even if the treatment is conservative or if there is a progressive dislocation in the first two postoperative weeks. A periosteal and endosteal callus formation is seen in every instance, even after interfragmentary compression by metal or biodegradable screws. All the results of biodegradable screws are at least as good as with metallic screws, at least in the growing skeleton. The force applied for interfragmentary compression does not lead to primary bone healing in the growing skeleton of young calvess.

Animals↗
PubMed1989

[Preliminary results of biodegradable osteosynthesis in craniofacial surgery in the child].

After an experimental study on biodegradable implants for fixation purpose in skull plasties of the minipig we began a clinical trial. Six children aged 1-18 years and suffering from trigonocephaly, Morbus Apert and Morbus Crouzon as well as plagiocephaly underwent a reconstructive procedure of the skull and midface, mostly frontal advancement. The different part of skull have been fixed by biodegradable implants made of polylactate acid. Another two infants, one with a skull defect after removal of an encephalocele and the other for reconstruction of the skull after open cerebral injury and consecutive osteoclastic trepanation, have been treated with skull splitting. The two halves of the skull have been fixed by biodegradable material too. The follow-up of these 8 children now is from 2-20 months (medium 10 1/2 months). From the aesthetic point of view as well as from radiological and clinical signs we judge the result as good as with conventional materials, for example wire loops. No material had to be removed and CT scans show a fully resorption of the implants. The present paper shows the preoperative, intraoperative and postoperative evolution.

Acrocephalosyndactylia↗
PubMed1988

[Surgery of the female gonads].

37 girls, 2 to 16 years of age, with 38 ovarian tumours or ovarian cysts were treated between 1971 and 1986. 14 patients had teratomas, 8 cystadenomas, 11 follicular cysts and 5 cysts of parovarian origin. 2 of the teratomas were malignant. Abdominal pain was the leading symptom in 32 patients, an abdominal mass was found by palpation in 18 patients. Most of the teratomas were found in prepubertal girls. With one exception all children with follicular cysts and cystadenomas were between 11 and 16 years of age. The patients with teratomas and cystadenomas were treated by ovariectomy, in the 2 patients with malignant teratomas followed by chemotherapy. The girls with ovarian or parovarian cysts were treated by cystectomy. All patients are doing well 1 to 15 years after operation.

Adenocarcinoma↗
PubMed1987

[Denis-Browne corrective surgery of hypospadias: long-term results].

From 1971 through 1975, 59 children with hypospadias were operated upon at the Department of Paediatric Surgery of the University Children's Hospital Zürich. The external meatus was penile in 52 and scrotal or perineal in 7 cases. Average patient age at the time of definitive repair was 5 1/2 years. Fistulas or wound dehiscence developed in 22 patients (37.3%) requiring 28 reoperations. 27 patients were seen at a prearranged outpatient clinic 10 to 15 years after the last operation. All patients were satisfied with the result of the operation. None had persistent chordae or fistulas. In all patients the meatus was situated distal to the sulcus coronarius. The penis length was just below the normal range. Encouraged by the good functional and cosmetic results, we believe that the Denis Browne procedure has still its place among the other techniques for hypospadias repair.

Adolescent↗
PubMed1987

[Knee injury in childhood: a retrospective analysis of patients of the Zurich Pediatric Surgery University Clinic].

During the past 10 years (1976-1985) we treated more than 1000 knee injuries at our department. More than 90% were minor traumas and could be treated on an outpatient basis. In 78 children x-ray or clinical examination revealed a haemarthros which was confirmed by aspiration. This group represents 7.6% of patients. In 38 patients a major knee injury led to surgical treatment. Conservative treatment was successful in 40 children. In 26 cases we could not find the origin of haemarthrosis by clinical or radiological examination. 14 children showed major lesions, mostly undislocated fractures of the patella or avulsion of the cruciate ligaments. In all 78 patients haemarthrosis was evacuated by aspiration or during operation and the injured knee joint was immobilised for 4-6 weeks. 56 of the 78 patients (72%) were radiologically and clinically re-evaluated after 5 1/2 years (1-11 years). The aim of this presentation is to judge, based on our own patients, if arthroscopy in paediatric knee injuries is mandatory in every case as demanded by different authors. We were most interested to find out whether diagnostic errors lead to false, positive or negative indication for operation. In very few cases only our diagnosis was based on arthroscopic evaluation.

Adolescent↗