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Biomedical subjects

W C Hecker

Publications and source records attributed to W C Hecker.

At least 55 records · Page 3Linked to original sources
PubMed1987

[Sacral teratomas in childhood. An analysis of long-term results in 87 children].

52 patients were followed up out of a total of 87 children with sacrococcygeal teratomas, within a period of 25 years, from three paediatric surgery hospitals and out of altogether 73 survivors. The results in 35 children where the operation had been performed more than three years ago, were classified as "late results". From this group, 18 children were followed up by clinical examination only, without detecting any dysfunctions. By the additional use of electromanometry of urinary bladder and rectum, however, bladder and rectum dysfunctions were seen in about 40% of 17 further children. These dysfunctions were partly myogenic and partly neurogenic in nature and were directly related to the size, tumour status and intrapelvic extension of the sacrococcygeal teratoma.

Child↗
PubMed1986

Long-gap esophageal atresia: experience with Kato's instrumental anastomosis, with cervicothoracic procedure and primary anastomosis, and with retrosternal colonic interposition.

Twenty-four patients with long-gap esophageal atresia have been treated since 1960. Instrumental anastomosis according to Kato was applied in seven cases, cervicothoracic procedure with primary anastomosis followed extended mobilization of the upper and lower pouches in four cases, and retrosternal colonic interposition was performed in 13. Currently, treatment of long-gap esophageal atresia, Vogt-type II, should include first a gastrostomy and, 4-6 weeks later, if the baby is thriving, extended cervicothoracic mobilization of the upper pouch up to the larynx and of the lower pouch down to the cardia, followed by primary anastomosis. If primary anastomosis cannot be performed, both pouches should be adapted, by necrosing sutures according to Santulli, and perforated with a thin mandrin. Thus, esophageal replacement is necessary only in exceptional cases, for which retrosternal colonic interposition is recommended.

Colon↗
PubMed1986

The significance of tracheal stenosis in esophageal atresia.

The significance of tracheal stenosis in children operated upon for esophageal atresia is described. Stenosis is caused mainly by tracheal compression by the innominate artery leading to tracheal malacia. Following esophageal repair tracheal compression is increased causing life-threatening asphyctic attacks during feeding. After establishment of diagnosis urgent surgery by means of truncopexy is indicated. The incidence of this complication is about 1 in 20 according to our figures and 1 in 40 according to Filler (Filler et al. 1976).

Esophageal Atresia↗
PubMed1986

The history of pediatric surgery in Germany.

Pediatric surgery as defined today is a very young specialty, and it was not until the middle of our century that pediatric units were established at surgical clinics in Germany. Pediatric surgery in Germany developed first in children's hospitals. The author distinguishes four stages: Stage 1: The pediatrician as operating surgeon; Stage 2: The surgeon as consultant; Stage 3: Pediatric surgical hospitals at children's hospitals; Stage 4: Pediatric surgery as an independent discipline in its own right. This chapter then relates the history of the German Society of Pediatric Surgery and the coming of age of pediatric surgery as a completely independent discipline, in which there are now 55 pediatric surgical units in the Federal Republic of Germany. The publications, textbooks, and journals listed at the end of this chapter show the advance of this discipline.

General Surgery↗
PubMed1986

[Surgical treatment of bile duct cysts in childhood].

Nine cases of cystic and cylindric bile duct dilatation are discussed. They were treated at the Children's Surgical Hospital of the University of Munich from 1970 to 1984. The patients' mean age was 4.2 years. Upper abdominal sonography in combination with hepatobiliary functional scintigraphy or computer tomography has been proven the best diagnostic procedure. The operating procedure of choice is a total cyst excision followed by an end-to-end anastomosis or a hepatojejunostomy according to the Roux-Y-technique. There were no immediate postoperative complications such as cholangitis. In one case we found a stenosis of the anastomosis after primary hepatocholedochostomy.

Child↗
PubMed1985

Retroesophageal hiatal plasty and gastropexy in the treatment of gastroesophageal reflux with or without hiatus hernia in childhood.

The results of 214 children operated upon for cardial insufficiency with or without hiatus hernia are reported. For follow-up, 160 patients were reexamined: 83% were without symptoms, and 15% showed mild symptoms without pathological radiological findings. Recurrences occurred in 1.8%, all following thoracic operations performed during the early years of this series. A retroesophageal hiatopexy and gastropexy through an abdominal approach was performed on 146 patients. There was no recurrence in this group. Five patients died (2.3%). However, the mortality rate has been zero for the last 12 years. General aspects, diagnosis, and indication for operation are considered. The operative technique is described in detail.

Child↗
PubMed1985

[Separation of an asymmetric xipho-omphalo-ischiopagus tripus].

A case of asymmetrical thoraco-omphalo-ischiopagus tripus will be reported. Anal atresia, ruptured omphalocele with lesion of the small intestine made an artificial anus necessary. Recurrent adhesion ileus made three further operations necessary. After precise preliminary examinations we separated these twins at the age of 21/2 years. After 7 and 9 months both children had to be reoperated because of fistula of the small intestine. Twin R. died at the age of 3 years and 8 months in consequence of a candida sepsis. Twin P. now lives with his parents.

Abdomen↗
PubMed1985

[Omphalocele and laparoschisis--a clinical analysis].

As yet, it has not been sufficiently investigated whether the pathogenesis of omphalocele and gastroschisis can be attributed to the same cause or to different processes. Therapeutical principles, however, are the same in omphalocele and gastroschisis: the very soon closure of the abdominal wall defect. Our own procedure strives for primary fascial closure. If this is not possible, we prefer skin closure above the silastic cylinder according to Schuster, 72 patients with omphalocele and 62 patients with gastroschisis were Schuster, 72 patients with omphalocele and 62 patients with gastroschisis were analysed. Lethality was 32% in omphalocele and 22% in gastroschisis during the last 6 years. The predominant cause of death was postoperative infection. It is therefore necessary to improve infection therapy in order to reduce lethality.

Abdominal Muscles↗
PubMed1985

Follow-up studies in 50 totally colectomised children.

We report on 50 totally colectomised children, most of whom suffered from Hirschsprung's disease. Of the 50, one child died postoperatively of enteritis. On an average, the children were re-examined 5 1/2 years after the colectomy. The findings were as follows: With the exception of four, the size and weight of the patients were within the norm; 20 passed frequent stools of pulpy consistency; 16 suffered from disturbances of continence; 14 developed severe, partially recurrent enteritis. We did not find any advantage of a single method of operation, e.g. Martin's operation.

Adolescent↗
PubMed1985

[Preoperative risk assessment in pediatric surgery].

The further development of the risk score presented by us in 1976 combined with Peter's score now permits a satisfactory preoperative risk estimation in pediatric surgery for all age groups. The score includes 18 lines for all significant preoperative parameters and the procedure planned. Each parameter is judged by a number of points according to its significance (1-4 points). An increasing number of points indicates an increasing operation risk. The evaluation of 533 cases using this core proved it to be a reliable preoperative risk estimation.

General Surgery↗
PubMed1985

[Postoperative pneumothorax following interventions for diaphragmatic hernias and defects].

Basing on the fact that postoperative pneumothorax occurred in a third of 47 patients with diaphragmatic hernias and defects, the mechanisms of progressive respiratory insufficiency and the occurrence of postoperative pneumothorax are debated as well as therapeutical measures for prevention. It is suggested as an important therapeutical principle in order to prevent any negative pressure on the operated thoracic side and to keep by all means the mediastinum in the middle. By the aid of these therapeutical principles, an improvement of the still high lethality of 40% - which postoperative pneumothorax is decisive for - can be achieved.

Diaphragm↗
PubMed1984

[Surgical separation of symmetrical conjoined ischiopagus twins].

This is a case report on symmetrical ischiopagus tetrapus. We made exact preoperative examinations of the topographic anatomical relationships before performing the separation at the age of ten months. Both twins survived the operation without complication. A second procedure to correct the misformed pelvices of both children was successfully performed. The twins have been released from the hospital. One child, who can walk, lives with his parents. The second child has a perinatal brain defect, and as such is cared for in a nursing home.

Humans↗
PubMed1984

Smooth muscle reverse plasty. A new method to treat anorectal incontinence in infants with high anal and rectal atresia. Results after gracilis plasty and free muscle transplantation.

Forty-one patients with Pickrell's gracilis transposition, 6 patients with free muscle transplantations using the Hakelius/Grotte's method, and 2 children with a smooth muscle transplantation after the method described by Schmidt are reported. The results are compared with those reported in the literature. A new operative method is described that can be carried out during infancy at the same time as the abdominal perineal pull-through operation. It involves the fashioning of a smooth muscle cuff formed from a segment of pulled-through colon that is denuded from its mucosa. This cuff is folded back over the distal end of the pulled-through colon. The radiological and manometric results in 2 infants operated upon by this method are described.

Adolescent↗
PubMed1984

Operative correction of intersexual genitals in children.

In intersex the external genitalia should be corrected operatively before the 2nd year of life. In patients with the adrenogenital syndrome with a low opening of the vagina into the urogenital sinus, a plastic operation on the vagina and displacement of the clitoris can be carried out in one operation. The operative technique is described. In cases where the vagina opens high in the urogenital sinus, the operative technique of Hendren and Crawford (1969), with transplantation of the vaginal introitus into the perineum in combination with displacement of the clitoris, is advised. In 7 patients, partial vaginal aplasia was observed. The abdominoperineal operative technique for the correction of this malformation is described. In intersex patients where male external genitalia are desired, the phallus is straightened at the first operation and a hypospadias operation using the technique described by Denis Browne is performed at a second sitting. More than 130 patients with intersex have been operatively corrected.

Adrenal Hyperplasia, Congenital↗
PubMed1984

[Time of death in diseases with lethal outcomes in a pediatric surgery department and a pediatric hospital].

Thirteen hundred twenty five deaths in children were investigated at the Dept. of Pediatric Surgery of the University Children's Hospital Munich and the University-Children's Hospital Giessen in order to evaluate a possible correlation between time of death and time during the day. Subdividing according to age groups and pediatric-surgical and pediatric cases, there was no accumulation of deaths between 2 and 6 o'clock a. m. as could have been expected according to Aschoff. On the other hand, between 12 und 3 o'clock p. m. there was an increase of deaths which was partly statistically significant and in accordance with Aschoff's findings. One can deduce that during the early afternoon hours technical and nursing potentialities for compensation were not fully used, whereas this seemed to be the case during early morning hours. Therefore it should be attempted to optimize personal and technical expenditures particularly during the early afternoon hours.

Child↗
PubMed1984

[Preoperative risk evaluation in juvenile ileus].

Preoperative risk calculation in children with bowel obstruction allows early therapeutic measures to improve prognosis. In a retrospective study the preoperative status was evaluated in 310 newborns and 127 children beyond the newborn period who had to be operated for bowel obstruction. Preoperative parameters were: age, birth weight (newborns), weight, body temperature, red and white blood count, electrolytes, urea-nitrogen, total serum protein, pH, PO2, PCO2 and base excess. These parameters were compared in surviving children and children who died postoperatively. In newborns a statistically significant difference between both groups was found for birth weight, rectal temperature, pH and total serum protein, whereas in children beyond the newborn age the same was true for age, weight and total serum protein. Besides well balanced electrolytes and good management of artificial respiration, total serum protein and in newborns additionally blood-pH and rectal temperature must be normalized preoperatively to reduce the risk in children with bowel obstruction.

Acid-Base Equilibrium↗
PubMed1984

[Treatment results following the pull-through operation and continence-improving operations in high anal and rectum atresia].

Of 174 patients with anorectal malformations, among them 71 children with high atresia, 59 patients could be followed-up. 57% were entirely incontinent according to electromanometrical findings. These patients necessarily needed sphincter-replacement operations to improve the function of the sphincter-apparatus. Eighty-one sphincter-replacement operations were performed in 68 patients, among them 56 gracilis transplantations, 12 palmaris-longus transplantations, and 4 stalked smooth muscle transplantations. All sphincter replacement operations improved continence considerably.

Adolescent↗