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Biomedical subjects

W B Kiesewetter

Publications and source records attributed to W B Kiesewetter.

At least 19 recordsLinked to original sources
PubMed1981

The rationale and results in two-stage orchidopexies.

The two-stage orchidopexies for cryptorchidism done over a period of 20 yr were reviewed. It was found that of 60 staged orchidopexies attempted, 56 were successfully completed. Based on follow-up of 40 testes, the 82% anatomical results would seem to support the assertion that staged orchidopexy is the procedure of choice for the "difficult" undescended tests with a primarily short blood supply. The results in a small group of bilateral two-stage procedure did not justify as great an optimism in regard to fertility.

Adolescent↗
PubMed1981

Secondary anorectal surgery for the missed puborectalis muscle.

A detailed analysis and personal follow-up of 25 patients who underwent secondary anorectal surgery for incontinence suggests the following: (1) The puborectalis muscle is missed in pull-through surgery with greater frequency than is generally appreciated. (2) Direct visualization of the muscle at primary surgery can markedly reduce bowel misplacement. (3) Continence after secondary surgery improves with age, especially with the passage through puberty. (4) Secondary surgery improves sensation and thereby benefits continence. (5) No long term urinary problems appeared after reoperation. (6) Secondary surgery can restore a socially acceptable degree of continence in 3 out of 4 patients.

Adolescent↗
PubMed1980

Unilateral inguinal hernias in children: What about the opposite side?

The decision for or against bilateral exploration in unilateral hernias in infants is necessitated by the high incidence of obscure anatomic hernias on the opposite side. On the basis of studies done in 400 pediatric patients (mostly under 2 years of age), we believe that unilateral repair of a known hernia without ascertaining the presence of a contralateral hernia is unjustified. Because of an appreciable risk to the gonads and/or vas deferens, we do not believe routine bilateral herniorrhaphies in all infants are indicated. The attempts at an intraoperative, transperitoneal insertion of a Bakes dilator into a contralateral sac were unreliable in our hands. Herniography is a reliable, safe way to reduce the incidence of unnecessary contralateral exploration. It should be liberally used where the necessary radiologic expertise is available.

Hernia, Inguinal↗
PubMed1979

Stapled cystograstrotomy. A method of treatment for pediatric pancreatic pseudocyst.

An uncommon complication of pancreatic inflammatory disease or pancreatic trauma in children is the development of a pseudocyst. The English literature records less than 100 cases in children and emphasizes that surgical intervention is the indicated form of treatment. The authors have had experience with nine pediatric patients suffering from pseudocysts in a seven year period. All except one were successfully treated by internal drainage; the other spontaneously resolved. Four had cystogastrostomy using a stapler. This method is discussed as far as indications, technique, advantages and complications.

Child↗
PubMed1979

Imperforate anus: an analysis of mortalities during a 25-year period.

A careful analysis of 53 deaths in a series of 284 patients suggests the following points are important in reducing risk: 1. Imperforate anus is a complicated lesion which should only be done by experienced surgeons in a large-volume pediatric surgical center in order to avoid the wrong choice of procedure. 2. A careful colostomy technique is essential to avoid herniation, prolapse, evisceration or obstruction. 3. Hyperchloremic acidosis from a large rectourinary fistula into the distal blind pouch of a colostomized high type lesion must be watched for. 4. The mucocutaneous junction (natural or surgical) must be kept free from stenosis to avoid fecalomas or enterocolitis-sepsis sequelae. 5. Neonatal pullthrough should be avoided as they carry an increased risk, make handling of fistulas difficult, and may lead to the placement of the bowel outside of the continence muscles.

Abnormalities, Multiple↗
PubMed1978

Alimentary tract duplications in children.

This report reviews the experience with 78 alimentary tract duplications found in 64 patients over a 40 year period at the Children's Hospital of Pittsburgh. Ten patients had the duplication discovered at autopsy. Multiple duplications were found in 15% of patients. The symptoms and physical findings of a duplication varied with location, size and mucosal pattern. About one-fifth of the duplications contained ectopic mucosa, usually gastric. Two-thirds of the patients were diagnosed prior to one year of age. Vertebral anomalies, as a clue to the presence of the lesion, were present in 15% of the patients. The most common indications for surgery included a mediastinal or abdominal mass, intestinal obstruction, and gastrointestinal bleeding. The results of surgery were favorable, with a mortality of 20%. Surgical complications accounted for six deaths, while four children died of severe associated anomalies. Three others died without surgical treatment, but with symptoms from the duplication.

Digestive System Abnormalities↗
PubMed1977

Mediastinal masses in infants and children.

In a group of 93 pediatric patients with mediastinal masses, three quarters of them were diagnosed because they were symptomatic. Approximately one half of the masses were malignant, and of neurogenic or lymphomatous origin. Neurogenic tumors predominated before the age of 4 years, while lymphomas were most common beyond age 4. Two thirds of the malignancies were potentially curable by surgery, irradiation, and chemotherapy; 54% of the patients were salvaged. Enteric duplications, ganglioneuromas, bronchogenic cysts, hemangiolymphangiomas, thymic cyst, and teratomas were the most frequently occurring benign masses. Simple excision was uniformly effective in these lesions.

Adolescent↗
PubMed1977

Recognizing and referring neonatal surgical emergencies.

Ultimate survival of the neonate with a surgical emergency depends upon early recognition by the family physician, who may refer the infant to a pediatric surgical center. The family physician must prevent infectious and metabolic insults to the critically ill neonate while preparing him for safe and rapid transport to a specialty institution. In many cases, the final outcome is as often determined by the initial care received at the referring hospital and during transport as it is by the surgical procedures and postoperative management.

Abdominal Muscles↗
PubMed1977

Imperforate Anus: a five to thirty year follow-up perspective.

A twenty-five year experience with 284 patients with imperforate anus has been reviewed, with a 5 to 30 year assessment after surgical intervention. The following conclusions seem to be suggested by the study: 1. There was a 20% mortality overall, with the greatest number of these occurring in the Type III high lesions. Eighty per cent of the deaths were unrelated to imperforate anus and resulted from associated anomalies. 2. Eighty-eight per cent of the overall series achieved socially acceptable continence. Four out of five poor results occurred in the Type III high lesions. 3. Functional results achieved in imperforate anus surgery seem more closely related to the anatomy presented to the surgeon than by his choice of operative procedure. 4. Continence is more slowly achieved in an imperforate anus patient than in a normal child. It is an evolutionary process which seems to improve with age, being especially influenced by the social motivation that comes with puberty. 5. An appreciable number of patients with poor musculature for continence remain clean by promptly heeding the defection signals, by avoiding laxative foods, and by enforced constipation. 6. Secondary surgery when the levator sling muscles have been missed or partially bypassed seems to improve continence in a high percentage of patients.

Adolescent↗
PubMed1976

Imperforate anus.

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Age Factors↗
PubMed1976

Imperforate anus.

Sucessful treatment of the child with imperforate anus yields an individual with satisfactory continence and a healthy urinary tract. These goals are achieved by accurate evaluation of the newborn, optimal technical results, and conscientious follow-up. The infant born with one of these malformations frequently has a serious associated anomaly which also requires early specific diagnosis and management. When the bowel has passed through the puborectalis in utero, the deformity can often be definitively treated in the neonate by dilations or anoplasty. However, if a urinary or high vaginal fistula is present, or if the anomaly is of the supralevator type, definitive surgery is best postponed some months and the neonate given a colostomy. We have found the sacroabdominoperitoneal approach to be the most satisfactory pullthrough procedure for the supralevator lesion. The children with high, supralevator anomalies have higher mortality rates and, in one out of four cases, have suboptimal fecal continence. They require the utmost in technical skill and continuing care if they are to lives free of social stigma. The mortality rate in all other types is low and the functional continence uniformly acceptable.

Abnormalities, Multiple↗