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Biomedical subjects

W C Hecker

Publications and source records attributed to W C Hecker.

At least 37 records · Page 2Linked to original sources
PubMed1990

Deviated trachea in hypoplasia and aplasia of the right lung: airway obstruction and its release by aortopexy.

Three cases of male infants with hypoplasia and aplasia of the right lung and dextrocardia are reported. The infants developed increasing obstructive respiratory distress in the first 4 months of life. In all three cases, there was an opaque right hemithorax with overinflation of the left lung, a posterior deviation of the trachea with pulsatile stenosis, and a posteriorly located aortic arch. Hypoplasia (two cases) or aplasia (one case) of the right pulmonary artery and an absence or a remnant of the right main bronchus were also observed. Associated malformations were esophageal atresia with an abnormal high pouch of the proximal esophagus in case 1, and hypertelorismus syndrome in case 2. Because of severe respiratory distress in all three patients, an aortopexy was performed at the ages of 5 months (one infant) and 10 months (two infants). The obstructive respiratory signs disappeared postoperatively in the following weeks. It has been observed that tracheal stenosis in aplasia or hypoplasia of the right lung may be caused by the dislocated aortic arch. An aortopexy can release the airway compression in such cases. Because of associated malformations, a careful evaluation of the airway and vessels is recommended.

Airway Obstruction↗
PubMed1990

[Tracheal compression by the brachiocephalic trunk in infants--surgical treatment of 30 cases].

This is a report on 30 cases of innominate artery compression of the trachea and its operative correction by an aorto-truncopexy. Tracheoscopy is the most important examination for arriving at the diagnosis. Magnetic resonance imaging (MRI), which offers representative pictures of many moments of expiration and inspiration, shows the anatomic relationship between the innominate artery, the aortic arch and the trachea, also demonstrating the extent of the tracheal compression. Surgical treatment is indicated if narrowing of the lumen of the trachea is greater than 70%. By fixing the aortic arch and the proximal innominate artery at the back of the sternum the trachea is relieved of its compression. In 30 children there was no unsuccessful operation, and none of them died.

Aorta, Thoracic↗
PubMed1989

[Quality of life after surgical interventions in pediatrics].

Quality of life is a complex entity without "normal finding" and can be judged by objective and subjective criteria. Quality of life of a child results out of the main factors which are connected to each other and represent the actual specific profile of a personality. The disease or dysplasia itself, personality of the patient, personality of the attending physician as well as of the parents. Quality of life of a child consists of five interwoven spheres: bodily function of the child; psychological well-being; social interactions; physical state; and parents.

Activities of Daily Living↗
PubMed1989

[Appendicitis in enteritis].

We are confronted with the fact that in a considerable number of cases appendicitis occurring during enteritis is diagnosed late and is often only operated on in the state of perforation. Among our own cases of 519 appendectomies in the last five-years-period this applied to 13 children (2.4%). The problems of these cases and methods to a correct and immediate diagnosis are shown.

Adolescent↗
PubMed1988

[Primary liver tumors in childhood: an analysis of 19 cases].

Nineteen patients were operated on for primary liver tumors at our hospital from 1970 to March 1987. Among malignancies, hepatoblastomas and hepatocellular carcinomas were equally often seen (7 cases each), among benign tumors, there were 3 hemangioendotheliomas and 2 hemangiomas. In 6 of the 14 children with malignant tumors, only a biopsy could be performed due to primary inoperability, tumor excision was possible in 8 cases. Following chemo-embolisation, tumor excision could be carried out in a second-look operation in one case. Six patients with hepatoblastoma died within 6 months following diagnosis, 2 of them, however, succumbed to therapeutical side effects. Four of the seven patients with hepatocellular carcinoma were alive after a mean follow-up of 6.4 years (2-15 years).

Adolescent↗
PubMed1988

[Clinical aspects and problems of pigeon breast and funnel chest].

Chest wall protrusion and depression deformities, also known as funnel chest and pigeon chest, are nosologically a uniform entity. Our own histopathological studies revealed secondary changes, found likewise in arthroses, scolioses, aseptic osteonecroses and inflammatory processes, as well as changes found in so-called primary collagenous diseases of unknown aetiology. Investigation of the collagen metabolism did not disclose differences from the normal II-type collagen either qualitatively or quantitatively. The aetiology of funnel chest and pigeon chest can be defined as follows: A hereditary disturbance of metabolism results in weakening of the wall of the parasternal cartilage, effecting a deformation secondary to mechanical strain by respiration and growth. Psychocosmetic reasons are recognised as indication for operation. In our opinion, the optimal age for operation is the second to the sixth year of life. During 20 years, 765 patients were operated on at our hospital without lethality. Postoperative complications were pneumothorax (4%), pneumonia (2%), after bleeding (2%) and disturbed wound healing (7%). Late results 5 years following surgery were excellent in 57%, good in 27%, satisfactory in 10% and unsatisfactory in 6% of the cases, thus adding up to 84% good results.

Cartilage↗
PubMed1988

[Correction of subtotal esophageal aplasias and extensive artificial esophageal defects by gastric transposition].

The successful treatment of subtotal oesphageal defects by means of gastric transposition in three children is reported. Two children had a subtotal oesophageal aplasia, one a complete destruction of more than half of the thoracic oesophagus. In two cases the stomach was transposed into the physiological oesophageal bed, in the third the stomach was pulled retrosternally to the cervical region via the anterior mediastinum. All three children developed normally following gastric transposition. Normal oesphageal passage was confirmed radiologically.

Child, Preschool↗
PubMed1988

[Rare complications in surgically treated rectal and anal atresia with submucous pull-through of the rectal mucosa].

Two rare complications after Rehbein's pull-through operation are reported. The first case is a four-year-old child producing at two times a urethral-rectal-muscle cuff fistula, the rectal muscle cuff being filled with urine. The second case deals with a now fourteen-year-old boy in whom a mucosa-regenerated rectal muscle cuff led to an enterogenous cyst of double fist size.

Anus, Imperforate↗
PubMed1987

Resection of an intrathoracic tracheal stenosis in a child.

A 6-year-old boy sustained a severe head injury during a traffic accident. He was first treated at another hospital. Despite a short intubation period of only 3 days, within 4 weeks he developed severe tracheal stenosis, with a residual lumen 3 mm in diameter and a total length of 2.3 cm, ending 3 cm above the carina. After initial bougienage enlarging the lumen to 6 mm in diameter, surgery was performed at our hospital 6 weeks after the accident. The stenosis was resected in toto, and tracheal continuity was restored by interrupted sutures using the Grillo technique. The postoperative course was uneventful. Follow-up tracheoscopy 3 months later showed a residual stenosis of 20% within the anastomotic region, and the patient was free of symptoms.

Child↗
PubMed1987

[Results of follow-up of operations in pediatric patients with indirect inguinal hernia].

This paper present the results of follow-up examinations of 2801 operated inguinal hernias. In comparison with the high excision of the hernial sac plus "crude suture", the standard Bassini technique produces poorer results as regards recurrence, testicular atrophy and secondary maldescent. The mortality of elective herniotomy was 0.016% in this series.

Atrophy↗
PubMed1987

[Therapy of postoperative complications following abdominoperineal or abdominosacroperineal pull-through surgery in anal atresia].

In 144 pull-through-operations performed for anorectal-atresia, following complications were observed: pneumonia 11%, sepsis 8.3%, peritonitis 5%, bowel obstruction 5%, osteomyelitis 1%, retraction of the pulled-through colon 4%, anal stenosis 16%, secondary megacolon 9%, fistula relapse 8%, mucosal prolapse 4%. Recto-urethral, recto-vesical- and recto-vaginal fistula relapses are managed by interposition of the gracile muscle. Anal stenoses and secondary megacolon are prevented by a sufficiently long postoperative bougienage.

Anus, Imperforate↗
PubMed1987

[Urinary incontinence in epispadias and bladder exstrophy with special reference to free autologous muscle transplantation].

This is a report on 16 patients with epispadias of grades II to IV and on 35 patients with exstrophy of the bladder, grades III and IV. The following surgical treatment was carried out: in children with epispadias, simple closure of the urethra in one case, neck of the bladder plasty according to Young-Dees in two cases, the method after Thiersch-Duplay in three cases, whereas four patients were treated after Williams, five after Johnston and one patient after Ombrédanne in reverse. Seven additional operations were done mainly for prepuce correction and closure of fistula after urethroplasty. Three of the 16 patients were continent already before the operation. 4 children were partially continent. Two of these showed improved continence, thus achieving prolonged periods of dryness. 9 children remained incontinent. Hence, free muscle transplantation to the bladder was performed in four patients. A total of 45 operations were performed on children with exstrophy of the bladder. Of these, 12 concerned primary closure of bladder; in 13 cases, an ileum bladder was constructed, whereas cystosigmoideostomy was done in 5 times, uretersigmoideostomy 5 times, cutaneous ureterostomy once, rectum bladder once, and a colon conduit once. The postoperative continence performance of the 12 patients with primary bladder closure was unsatisfactory. Three children only attained periods of dryness up to two hours; 5 remained completely incontinent, whereas in 4 it was subsequently necessary to construct a urinary passage into the intestine by means of an ileum bladder in 2 cases, a colon conduit in one case, and ureterosigmoideostomy in one case. Free muscle transplantation to the bladder was performed in two patients. Free muscle transplants were also performed on 2 children, in one case after traumatic tearoff of the urethra and in one case after iatrogenic lesion of the musculus sphincter vesicae externus in adrenogenital syndrome (AGS) according to Prader III and IV. This means that a total of eight free muscle transplants were performed. All children were primarily incontinent. Postoperatively, complete continence could be achieved in four cases, once an improvement with dry periods up to 2 hours. The two patients with bladder exstrophy remain incontinent, in one patient with epispadias the postoperative interval has been too short so far to arrive at a final judgement. It follows from the examinations that free muscle transplantation is a good method for treating urinary incontinence, the suspension effect playing an important part. However, in patients with bladder exstrophy the indication should be considered with caution.

Adolescent↗
PubMed1987

[Causes of postoperative death in pediatric surgery--a comparative analysis of 3 decades].

Causes of postoperative deaths at our clinic from 1949 to 1982 were analysed. The most important results were: the overall lethality of the patients operated on was 1.5%; in 1985, however, it was only 0.19%. Infection was with 27.7% the predominant cause of postoperative death in all patients, followed by pneumonia with 20.3% and death from the underlying disease with 18.8%. Combining the groups infection and pneumonia, it turns out that nearly one-half (48%) of the children succumbed to infectious diseases. Classification of the causes of postoperative deaths in 5 different age groups revealed that more than a half of the deaths occurred in the neonatal period and 20% still in infancy. Furthermore, particularly newborn and infants died from postoperative infection. From 1976-1982 no child beyond the 4th year of life succumbed to an infection or pneumonia. The analysis presented is based on post-mortem protocols. From 1970 on-ward post-mortem examination was performed in 80% of the children who had died.

Adolescent↗