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Biomedical subjects

B Höcht

Publications and source records attributed to B Höcht.

At least 19 recordsLinked to original sources
PubMed2006

[Perianal abscess and anal fistula in infancy and childhood. A congenital etiology?].

BACKGROUND: Perianal abscess and anal fistula in childhood are commonly treated in the same way as abscess and fistula in adults. We questioned whether they represent a cryptoglandular infection, as in adults, or two different diseases with the same symptoms. MATERIALS AND METHODS: We retrospectively analyzed all medical records of 80 children (seven male, 73 female) who underwent surgical treatment for primary perianal abscess or primary anal fistula during a 10-year period. The records were analyzed concerning age at appearance of lesion, sex, diagnosis (fistula and/or abscess), and anatomic localization of the lesion. RESULTS: Of all the children, 67.5% were treated during their 1st year of life and another 10% during their 2nd year (group 1: 77.5%, n=62). Only 22.5% were 3 or older (group 2, n=18). Group 1 contained significantly more male infants (m:f 30:1). However, much more balanced sex distribution was detected in group 2 (m:f 2.6:1), similarly to adults. Analyzing anatomic localization, a second important difference could be found: in contrast to group 2, almost two thirds of all anal fistulas/abscesses in group 1 were localized horizontally between 3:00 and 9:00 o'clock in crown-rump position. CONCLUSIONS: Divergences in preference of age, sex, and localization suggest a congenital etiology for anal fistulas and perianal abscesses in children.

Abscess↗
PubMed2006

Recurrent laryngeal nerve monitoring during thyroid surgery in childhood.

INTRODUCTION: Diseases of the thyroid gland are one of the most common endocrinopathies in childhood. Neither benign nor malignant thyroid diseases are often treated surgically. But if surgical treatment is carried out, intraoperative damage of the recurrent laryngeal nerve (RLN) is a common and severe complication. In adult surgery, therefore, intraoperative monitoring (IOM) of the RLN is a method which has been used since several years. The question is whether this method can be used in paediatric surgery for the identification and functional control of the integrity of the RLN. METHODS: Surgical treatment of benign (9 x) or malignant (1 x) thyroid diseases was performed in ten children (median age: 13 years) with 16 nerves at risk (NAR). The function of the vocal cord was controlled in all children before and after surgery. Intraoperative identification and functional control of the recurrent nerve was performed using the Neurosign 100, placing a needle electrode transligamentously into the vocal muscle. All results before and after resection were documented. RESULTS: A clear and reliable identification of the RLN was possible in all cases. All NAR showed a constant physiological nerve signal before and after surgical resection of the thyroid gland. However in one young patient the postoperative control of the vocal cord revealed a partial paralysis despite the constant intraoperative signal of the RLN. The control on this patient after a period of six months showed a normal function. CONCLUSION: IOM of the RLN as used in adult surgery could easily be used in paediatric surgery as well. A clear and positive identification of the RLN was possible in all these patients. Therefore, IOM of the RLN could develop into a helpful and easy method for the prevention of intraoperative damage of the recurrent laryngeal nerve during thyroid surgery in childhood.

Adolescent↗
PubMed2006

The advantages and disadvantages of nerve monitoring during thyroid surgery in childhood.

BACKGROUND: Intraoperative damage of the recurrent laryngeal nerve (RLN) and the external branch of the superior laryngeal nerve (EBSLN) are common and cause complications in thyroid surgery. The method of intraoperative electrophysiological neuromonitoring (IONM) of the RLN and the EBSLN has been used in adults for several years. The question is whether IONM can be used in paediatric surgery for the identification and functional control of the RLN and the EBSLN, and what the advantages and disadvantages of using it are. METHODS: Surgical treatment of benign (n = 9) and malign (n = 2) thyroid diseases was carried out in eleven children (median age: 13 years) with a total of 18 nerves at risk (NAR). The function of the vocal cord was monitored in all children before and after surgery. Intraoperative identification and functional control of RLN and EBSLN was performed using the Neurosign 100. All results before and after resection of the thyroid gland were documented. RESULTS: A clear and reliable identification of the RLN and the EBSLN was possible in all cases. All NAR showed a constant physiological nerve signal before and after surgical resection of the thyroid gland. However, in one young patient the postoperative examination of the vocal cord revealed a partial paralysis on the left side after thyroidectomy, despite the constant intraoperative signal of the RLN. After a period of six months, normal functioning had resumed. CONCLUSION: The IONM of both RLN and EBSLN in adult surgery could be used successfully in paediatric surgery. In this study a clear and positive identification of both nerves was possible in all patients. Therefore the IONM of the RLN and EBSLN could develop into a successful and easy method for the prevention of intraoperative nerve damage during thyroid surgery in childhood and young adolescence. Assuming that a constant IONM signal represents a normal vocal cord, our evaluation showed that there is a small percentage of false negative and positive results.

Adolescent↗
PubMed2004

[Long term results of orchidopexy: transscrotal fixation versus Dartos-pouch].

UNLABELLED: The aim in treating the undescended testis is to move the testis, without tension, permanently and deeply into the scrotum. Depending on the treatment, literature reveals a quote of relapses up to > 10 %. It was the aim of our investigations to judge in how far the quote of relapses after operative treatment of undescended testes can be related to the technique of operation. METHODS: Two groups with maldescensus testis treated by two different techniques of orchidopexy were compared retrospectively. 692 boys (mean age: 4.7 years; median age: 4.0 years) with 867 undescended testes underwent operative orchidopexy by the Gross technique (group 1). In comparison, the Petrivalsky/Schoemaker technique was performed on 493 boys (mean age: 5.0 years; median age: 4.0 years) with 609 undescended testes (group 2). Three months to eight years after operative treatment, the localisation and size of the testis was recorded. RESULTS: (1) In group 1 there were 39.3 % right-sided, 35.4 % left-sided and 25.3 % bilateral undescended testes. Primary operations were performed on 612 of 692 boys (88.4 %), whereas 469 patients (76.6 %) had a follow-up examination: the operation by using the Gross technique was successful in 90.6 % of the cases; there was an atrophy of the testis in 0.2 % and relapses were found in 9.2 %. (2) In group 2 there were 41.2 % right-sided, 35.3 % left-sided and 23.5 % bilateral undescended testes. Primary operations were performed on 446 of 493 boys (90.5 %), whereas 353 patients (79.1 %) had a follow-up examination: the operation using the Petrivalsky/Schoemaker technique was successful in 95.5 % of the cases; there was an atrophy of the testis in 0.3 % and relapses were found only in 4.2 %. (3) Under the same outer conditions the amount of relapses after orchidopexy was significantly (p < 0.025) smaller in group 2 (Petrivalsky/Schoemaker technique) than in group 1 (Gross technique). CONCLUSION: Our observations show that the Petrivalsky/Schoemaker technique for the operative treatment of undescended testis results in a significantly lower rate of relapses. However, the consequences of both techniques concerning fertility must be discussed after further investigations.

Adolescent↗
PubMed2003

[Historical development of the surgical treatment of the undescended testicle].

An undescended testicle can be found in about 3-4% of all newborns and in 21-23% of all premature infants. In most of the young patients, the testicle will descend spontaneously during the first year of life. Thus, at the end of the second year of life, an undescended position of the testis will remain in 1-2% of all children. Since the first successful surgical treatment of the undescended testicle by Max Schüller 120 years ago in Munich, many various surgical procedures have been described. This paper gives an overview starting with the historical development of the operative treatment of the undescended testicle and leading up to the modern techniques used today.

Age Factors↗
PubMed1992

[The value of Ender nailing in hip para-articular femoral fractures in gerontologic traumatology. Ender nailing--hip para-articular femoral fractures--gerontologic traumatology].

Nailing according to Ender is one of several competing methods of osteosynthesis for treating per- and subtrochanteric fractures of the femur in geronto-traumatology. Within 5 years we have treated 62 geriatric patients by this procedure. The average-age of our patients was about 76 years. Only 20 of them were able to be examined after a time of ca. 37 months post operationem. Intraoperative complications were backing out of the femur corticalis at the entry hole, followed by perforations of the head or neck of the femur. In one case we saw a supracondylar fracture. In the postoperative period we mostly found dislocations of the nails to cranial or caudal. Moreover there were one wound infect and one pseudarthrosis. The mortality rate came to 6.5% and was never caused by the method. When leaving the hospital the majority of the elderly patients was mobilized and able to walk. In spite of reduction of function of hip and knee and external rotation deformity and shortened legs the patients declared to be content with the result of the operation. Important geronto-traumatological aspects of the Endernailing-method could be seen in the simple procedure, the short operating time, a minimal surgical trauma and a diminishing of the risk of the mostly multi-morbid patients. Regarding the great number of specific complications competing methods are going on to be preferred. Meanwhile the application of Endernails is an exception in geronto-traumatology.

Aged↗
PubMed1991

[Polytrauma in automobile drivers--on the coincidence of adolescents and the elderly].

In traffic severe accidents accompanied by polytraumata reach more and more importance to traumatology. We explored our own patients with regard to the coincidence of such accidents with juvenile and senior age and found out a very high risk in the age groups between 16 and 25 years. The causes could be little experience, readiness for risks and overrating their own talent. Elder persons driving motor vehicles are also very often involved in traffic accidents. In this group polytraumata however are not so frequent compared to many accidents without severe consequences. Polytraumatisized patients are very important as to the costs in the health and social system. In any case they cause a considerable economical loss.

Accidents, Traffic↗
PubMed1991

Indications, surgical treatment and after-care in juvenile hyperthyroidism.

Between 1974 and 1985, 12 children and adolescents aged 10-18 years were operated on for immunogenic hyperthyroidism resistant to medical treatment. Bilateral, subtotal strumectomies were carried out, leaving a remnant of 2-3 g of thyroid tissue in place. There were no immediate postoperative complications. Hyperthyroidism recurred in two instances. During the same time, 26 children and adolescents up to 18 years of age underwent surgery for autonomous adenoma. Enucleation is the method of choice in adenoma, but is not always possible.

Adolescent↗
PubMed1989

[Improving anal continence performance by intensive continence training].

Ten children of six to sixteen years with anal incontinence following anal atresia were treated with a conservative intensive continence training programme for a period of 6 to 18 months. The continence efficiency distinctly improved by an optic and acoustic biofeedback conditioning, transcutaneous electrostimulation of the pelvic muscles, by physical examinations and a sensibility training, as well as by contraction exercises. Not only the partial continence ability with low atresia but also the incontinence with high anal atresia could be improved to a level of continence, especially short-time continence. The essential success is based on an improvement of the strength and duration of the muscle contraction, of the sensible perception and of the nerval coordination of the pelvic muscles. After two weeks of therapy, 90% of the possible maximum increase had already been achieved. Thus, an evaluation of the training success was possible. This continence training programme proved an ideal supplement to surgical therapy. Even if other methods of therapy are exhausted, continence training is indicated for the improvement of anal sphincter function.

Adolescent↗
PubMed1989

[Magnetic resonance tomography of children with surgically treated anal and rectal atresia].

MRI of the pelvis was performed in 17 children following surgical correction of anal and rectal atresias and in five children without ano-rectal malformations. A muscle score was used to characterize the muscles of the pelvic floor and their relationship to the rectum. There was close agreement between the MRI muscle score and clinical continence. MRI provided additional information that should improve continence following conservative and surgical treatment.

Adolescent↗
PubMed1989

[Effect of magnetic resonance tomography on therapy planning in incontinence after anal atresia].

Five healthy children and 16 children, ages 6-17 years, who had been operated on for anorectal atresia underwent magnetic resonance (MR) imaging of the pelvis. The development of sphincter muscles and the location of the pulled-through intestine in relation to the sphincter muscles were evaluated by a muscle score. There was good correlation between MR muscle score and clinical continence score. MR imaging provides additional information for therapeutic management and surgical procedures to improve continence.

Adolescent↗
PubMed1989

[Biofeedback training and functional electrostimulation for improving incontinence in children with anal atresia].

Eleven children with anal incontinence following a pull-through operation for anorectal agenesis (4 low, 7 high anomalies) were treated with a conservative continence training program (optic/acoustic biofeedback, transcutaneous electrical stimulation, physical therapy, contraction exercises and sensibility training). All patients with one exception showed subjective and objective improvement of continence. Sphincter contraction increased by 80% in high and by 40% in low anomalies. For a short time electrostimulation provided an improvement of up to 20% in sphincter pressure. One additional success was improved coordination. Beside surgical therapy and other methods continence training is always indicated.

Adolescent↗
PubMed1987

LH-RH treatment for cryptorchidism. Randomized study and 10-year follow-up results.

A randomized study (LH-RH treatment or surgery) of 60 cryptorchid children between 2 and 9 years of age was performed. Testicular biopsy obtained in all patients undergoing orchiopexy showed histological changes compatible with cryptorchidism. Only maldescended and non-retractile testes were treated. LH-RH treatment was successful in 59% of the patients. Ten years later, 52% of testes remained descended. Thus LH-RH treatment is effective in achieving descent of true cryptorchid testes.

Child↗
PubMed1987

Screening for cryptorchid boys risking sterility and results of long-term buserelin treatment after successful orchiopexy.

This long-term prospective follow-up study showed that in cryptorchid patients a significant correlation exists between the number of germ cells at the time of orchiopexy (prepuberty) and the spermiogram, and thus a biopsy has a prognostic value. Fifty percent of our patients had a germ cell count of less than 0.1 per tubule and belong to the risk group for sterility. Successful surgery could not induce a significant increase of germ cells in the risk group, although it does prevent secondary testicular damage. Patients with cryptorchidism developed after birth have significantly better chances of fertility than those with primary cryptorchidism. The priming effect of testosterone in the first months of life is important for male fertility. In patients belonging to the risk group treated with buserelin, a significant age-dependent increase in germ cell count occurred.

Adult↗
PubMed1984

[Late results following compression treatment of deep 2d and 3d degree burns].

Pressure therapy following burns is necessary for at least 9 months, normally 12 to 15 months. Results are dependent on the age of the patient, anatomical localization and type of reepithelization. Side effects such as pruritus and swelling of maturing scars are minimized. The initially vulnerable epithelium is protected.

Adolescent↗
PubMed1983

[Therapy of prepubertal cryptorchism. Clinical experiences with LH-RH treatment].

The etiology of cryptorchidism is not uniform. Insufficiency of the hypothalamo-pituitary-gonadal axis is one of the main etiologic factors. For treatment of this disorder both HCG and LH-RH could be used. The rate of success of both hormonal treatments is comparable. Hormonal investigations show no significant changes for LH after cessation of treatment but significant decrease in FSH after 4 weeks of nasal spray treatment. This is more pronounced if the treatment was successful. There was no significant difference in the number of the germ cells before and after treatment. This indicates that hormonal treatment has no anti-fertility effect on cryptorchid gonads. With LH-RH a physiological stimulation of the pituitary is achievable. LH-RH stimulates by this way the Leydig cells to develop. The mode of administration is gentle and suitable for children. Side effects due to increased plasma testosterone as after HCG were not observed.

Administration, Intranasal↗