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Biomedical subjects

Z Zachariou

Publications and source records attributed to Z Zachariou.

At least 19 recordsLinked to original sources
PubMed2002

IORT (intraoperative radiotherapy) in neuroblastoma: experience and first results.

Intraoperative radiotherapy (IORT) permits the application of a single large radiation dose to a malignant mass at the time of surgery sparing adjacent normal tissue from irradiation. Since 1996 we have used IORT to treat 13 children with neuroblastoma, stage 3 - 4. In all cases the tumour was not radically resectable at the first operation. Ultrasound, CT and MRI were performed and patients were treated with chemotherapy according to the NB90 protocol. The second-look operation was performed in the IORT operating room where the tumour was resected as completely as possible, while keeping the "no risk" principle in mind. Localised radiation of the residual tumour was 8 - 10 Gy. The child was monitored via 3 video cameras. No technical problems occurred during IORT application. The follow-up time was 6 - 69 months (May 2001). One patient died due to tumour progression, another in complete remission died after 9 months due to sepsis. The clinical course of 2 patients was complicated by a renal artery stenosis and a mesenteric artery occlusion. All other patients are in complete remission with regular follow-up examinations. Although the results are promising the number of patients is too small as yet for statistical analysis. However, IORT can be safely applied in patients with high-risk neuroblastomas, reducing the dose, side effects and resulting in remission.

Abdominal Neoplasms↗
PubMed2001

Accessory liver in an infant with congenital diaphragmatic hernia.

Incidence of congenital diaphragmatic hernia (CDH) ranges from 1 in 2,400 to one in 5,000 live births. Associated anomalies in CDH are approximately 30% to 35%. The authors report on an infant with CDH and an accessory supradiaphragmatic liver with separate vascularization from the thoracic aorta. The pathogenesis of this malformation is discussed. The postoperative course and the follow-up of the child over 5 years was completely uneventful.

Abnormalities, Multiple↗
PubMed2001

Paediatric surgical reality in Germany and visions for the future.

Over the past 2 centuries paediatric surgery has developed into a well-recognised, independent surgical speciality comparable to plastic surgery or thoracic and vascular surgery. About 550 members of the GAPS (German Association of Paediatric Surgery) annually treat about 2-3% of all 0-15-year-old children of the FRG and operate 32.5% of all children who need a surgical intervention in paediatric surgical centres. There are 83 paediatric surgical centres in the FRG. Most of them perform more than 2000 operations per year. Three newer developments are likely to influence the future of paediatric surgery in Germany: 1. demographic factors, particularly the massive reduction of the reproduction rate from factor 1 to 0.59; 2. the new German National Health Care System, called "Strukturreform 2000", which will introduce the Australian DRG system and a new administrative structure permitting only a restricted care of the patients under tight economic control; and 3. the European regulations of the UEMS/EBPS which the national Landesärztekammern will be required to adopt.

Delivery of Health Care↗
PubMed1999

Total and superior sternal clefts in newborns: a simple technique for surgical correction.

The authors discuss six cases of superior and total sternal clefts treated in their department in the last 34 years and discuss the problems of this congenital malformation. The inferior sternal clefts including Cantrell's pentalogy and the total ventral clefts were excluded because in these cases severe associated anomalies require another approach. In superior and total sternal clefts, cardiac, vascular anomalies in lungs and abdomen and craniofacial dysgenesias are rarely present. In these cases a primary repair during the first weeks of life should be performed. Furthermore, the authors describe their own surgical approach, consisting of the conversion of the partial cleft into a total one. Then the rims are trimmed, and a complete approximation of the two segments is possible.

Adult↗
PubMed1998

Impalement and anorectal injuries in childhood: a retrospective study of 12 cases.

BACKGROUND/PURPOSE: Because of the small numbers of impalement and anorectal injuries in childhood, a standardized therapeutic approach is necessary to avoid major complications. On the basis of a retrospective analysis of 12 children with such injuries treated from 1986 to 1996 in our department, the authors tried to establish guidelines for their treatment. METHODS: Additional therapeutic problems and main complications are elucidated after meticulous analysis of three selected cases. RESULTS: In two cases of anorectal impalement and a primary colostomy, no complications occurred. However, in three cases involving anorectal injury a primary fecal diversion was not performed, making a secondary colostomy necessary afterwound infection. CONCLUSIONS: The current standard principles in the treatment of severe anorectal injuries in children are fecal diversion, wound drainage, and broad spectrum antibiotics. A primary reconstruction in cases of impalement can be recommended only after exclusion of anorectal injury.

Accidents↗
PubMed1998

Autogenic allotopic small-bowel mucosa transplantation in beagles. A new perspective for treatment of small-bowel syndrome?

There is no standard treatment for the short-bowel syndrome. The aims of surgical therapy are based on: slowing the intestinal transit, increasing the absorbing intestinal area and small-bowel transplantation. Searching for a new surgical treatment we developed an alternative for increasing the absorbing small-bowel area by means of autogenic allotopic small-bowel mucosa transplantation in beagle dogs. In young animals we isolated the transverse colon leaving the blood supply intact. Colonic continuity was reestablished and two abdominal stomata were performed at the ends of the isolated transverse colon. A week thereafter the colonic mucosa of the isolated transverse colon was surgically removed and autologous small-bowel mucosa was transplanted in the demucosed colon. The animals were then sacrificed 2, 4 and 6 weeks after transplantation and the colon-coat-ileal-mucosa complex (CIC) was histologically examined. The ileal mucosa could be transplanted in the demucosed colon showing histological characteristics of ileal mucosa. The circular muscle of the colon coat developed a hypertrophy which was present even 6 weeks after transplantation. In this study we could show that autogenic allotopic small-bowel mucosa transplantation is feasible in beagle dogs and may prove a novel method of small bowel expansion in cases of small-bowel syndrome.

Animals↗
PubMed1997

Continuous extracorporeal stool-transport system: a new and economical procedure for transitory short-bowel syndrome in prematures and newborns.

Between May 1994 and June 1995, nine newborns underwent surgery due to mechanical ileus or intrauterine perforation of the small bowel. Three were very-low-birth-weight infants weighing between 520 and 1,200 g. Surgery was performed in the first 2 days of life and split ileo- or jejunostomas were implanted. Early oral nutrition was initiated. To avoid non-use of the distal bowel and short-bowel syndrome, the aboral stoma was irrigated a few days later with the proximal feces. A new technique was applied to transport the chyle continuously from the oral to the aboral stoma: the stool was collected in an especially constructed stoma bag and transported distally by a roller pump. No major complications were seen. The general outcome was excellent in all cases, and reanastomosis under optimal bowel conditions was achieved in all patients without further problems.

Feces↗
PubMed1997

Amniotic membranes as prosthetic material: experimental utilization data of a rat model.

BACKGROUND/PURPOSE: Prosthetic materials are applied for closing big tissue defects, the repair of traumatized organs, or hernias. Because nonabsorbable synthetic materials are rigid, possess a defined and unchangeable size, and foreign body reaction (FBR) may occur, biological materials may be an alternative. METHODS: In experimental studies in rats the authors implanted the fetal parts of the human amniotic membranes and examined the utilization and FBR induced in a standardized model. In addition amnion (AM) was combined with vicryl-net (VN) for higher implant stability. Fifteen, 30 and 90 days after implantation, macroscopic appearance was examined, and light microscopy and immunohistology testing of the specimens were performed. RESULTS: Adhesions to parenchymal organs and omentum were present irrespective of the side facing the abdominal cavity. AM induced a rapid FBR, which diminished with time. Chorion (CH) and parts of the AM were resorbed within the examined period after infiltration with recipient cells and neovascularisation. The combined implant, AM, and VN showed best results because disadvantages of one material could be compensated for by the advantages of the other. CONCLUSION: The studies show that AM, in its anatomic definition, combined with VN proves to be a safe and reliable prosthetic material for the use in tissue defects.

Amnion↗
PubMed1996

A rare case of an antenatally diagnosed tumor of the neck--a hamartoma of the thyroid gland.

A case of connatal hamartoma of the left thyroid lobe is reported. During routine prenatal ultrasonographic examination, a tumor of the neck was diagnosed. The baby was born at 30 weeks' gestation, and the tumor (measuring 7.0 x 5.5 x 4.2 cm) was extirpated. Histologically, the tumor was a hamartoma of the thyroid gland. Follow-up evaluation (3 and 6 months after resection) showed that the child was doing well and had no signs of hypothyroidism or hypoparathyroidism. The case is discussed with respect to antenatal diagnosis, postpartum diagnostic measures, management, and surgical therapy.

Female↗
PubMed1996

Proteus syndrome associated with a sacrococcygeal teratoma; a rare combination.

We report on an 5-year-old boy with a Proteus syndrome known since his second year of life. Hidden in a lipomatous tumor we excised a sacrococcygeal teratoma which must have been present since birth. This is the first case, out of about 50 published Proteus cases, of a patient with Proteus syndrome and sacrococcygeal teratoma.

Bone Neoplasms↗
PubMed1995

Preoperative diagnostics and surgical management of tertiary hyperparathyroidism after chronic renal failure in a child.

Although hyperparathyroidism if a rare condition in young children, the pediatric surgeon is asked occasionally to participate in the management of a child with parathyroid disease. In this paper we report on a girl with global glomerulosclerosis, an unsuccessful renal transplantation and a long-term peritoneal dialysis, who developed an autonomous hyperparathyroidism. Emphasis is placed on the preoperative diagnosis and surgical management in children.

Child, Preschool↗
PubMed1995

[Not Available].

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Christianity↗
PubMed1994

Ileitis hyperplastica follicularis Golden: surgical or conservative treatment?

The authors report on four cases of Golden's syndrome, a rare disease with unknown etiology and controversial therapy. The first two 7-year-old boys had gastrointestinal bleeding; their hemoglobin levels were 7.0 g% and 7.3 g%, respectively. A blood transfusion was required. Both patients underwent gastroscopy and rectoscopy, and no source of bleeding was found. Biopsies were taken during laparotomy, after terminal ileotomy in case one and coecotomy in the other. Bowel resection was not necessary in either case. The third and fourth boys (5 and 6 years old, respectively) were treated conservatively with parenteral nutrition; blood transfusion was not necessary. All four patients recovered within several days. Control colonoscopies 6 months later showed normal mucosa. The authors discuss their diagnostic and therapeutical regime, stressing that in their experience, this rare disease does not require surgical intervention.

Child↗
PubMed1994

Tumor infiltration of the vena cava in nephroblastoma.

Although operative treatment of Wilms' tumors has become more straightforward as a result of advances in preoperative treatment and precise diagnosis, vascular involvement by the tumor can cause serious problems at operation. These problems can be more easily managed if they have been identified pre-operatively and the level of the intravascular tumor thrombus has been defined. In this study we propose a classification of intravascular involvement of Wilms' tumors suggesting the clinical consequences and operative strategy. In our series of 84 patients we treated 7 (8.3%) with preoperatively diagnosed intracaval tumor thrombus using ultrasound as the most sensitive non-invasive diagnostic technique. The surgical therapy depends on the stage; stage III and stage IV should be operated in cooperation with the cardiovascular surgeon in deep hypothermic circular arrest.

Child↗
PubMed1992

Ovarian cysts in the fetus and neonate--changes in sonographic pattern in the follow-up and their management.

In a multicenter trial we retrospectively evaluated the clinical and sonographic data of 49 neonatal ovarian cysts, 44 of which were detected prenatally and 5 on the first day after delivery. Of the 44 prenatally detected cysts 39 were purely cystic, 5 echogenic or had a mixed pattern. In 20 patients the cystic appearance changed during delivery from purely cystic to a mixed pattern being independent on the size of the cyst. 26 of the 44 cysts were treated surgically. Salpingotorsion was found in 8 and was independent on the size of the cyst. In 15 a salpingo-oophorectomy or oophorectomy was performed, in 11 the ovary was saved. 23 patients were followed sonographically: 15 cysts showed complete resolution within 14 months without correlation to the sonographic pattern. The volume of these cysts varied between 5 and 71 ml. Neonatal ovarian cysts disappear spontaneously frequently and rarely cause severe symptoms. The authors recommend follow-up by ultrasound as the primary modality. Surgical intervention is recommended only if the cyst is space-occupying and percutaneous puncture can not be performed or in the case of emergency.

Female↗
PubMed1992

Does lateral bending lead to bowing fracture in an infantile lower arm?

In a postmortem study on 50 lower arms of fetuses of the 25th week of gestation and newborn we performed three-point bending experiments to find out the stability of the lower arm after bending to the resulting fracture. Lower arms with intact soft tissue show an elastic behavior when bent from the side until fracture occurs. Applying the loading deflection diagrams we could classify the fractures into three types which differ significantly by means of bending moment, maximal deflection per unit length, and force required.

Biomechanical Phenomena↗