Biomedical subjects
Publications and source records attributed to C Festen.
Closed reduction of a greenstick fracture of the forearm in a child of 9 years was complicated by interposition of the deep flexor tendon of the third, fourth, and fifth fingers in the fracture gap. Undelayed release of the tendon resulted in a complete functional recovery.
As a result of our experience and a review of the literature, early investigation by endoscopic retrograde cholangiopancreaticography (ERCP) and surgical intervention is recommended in chronic relapsing pancreatitis in childhood.
The midline cervical cleft is a rare congenital anomaly of the ventral neck. With reference to two patients with a midline cervical cleft, we discuss the clinical picture, the embryology, and the surgical treatment.
In a series of 183 patients with esophageal atresia in a period of 20 years, 25 had a "long-gap" esophageal atresia. In most of these cases we succeeded in saving the patients' own esophagus but at the cost of one to two years of intensive treatment. The overall survival was 80%. The result compares favorably with the results of esophageal replacement reported in the literature.
We report the successful treatment with extracorporeal membrane oxygenation of two Dutch neonates with severe respiratory insufficiency, due to meconium aspiration syndrome and persistent fetal circulation respectively. During this procedure part of the cardiac output is led outside the body via a venous cannula in the right atrium, oxygenated in a membrane oxygenator, rewarmed to the patient's body temperature in a heat exchanger and returned to the patient via a cannula in the carotid artery debouching into the aortic arch.
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A localized atypical mycobacterial infection of the major salivary gland is a rare disease. In this report the cases of three patients with this lesion are presented. The diagnosis was based on the clinical picture, skin testing with specific antigens, bacteriologic culture, and histopathologic findings. The patients were successfully treated by total parotidectomy with facial nerve preservation, which in our opinion is the therapy of choice in localized atypical mycobacterial infections.
Most perforations of the bowel during attempt at hydrostatic reduction of intussusception occur in an area of localised infarction in the normal transverse or left colon. An animal model of intussusception was used to find indications for the cause of this phenomenon. We submitted the intussuscipiens of 10 strangulated intussusceptions in 6 dogs to a histological examination. In 6 of 10 intussusceptions we found ischaemic changes in the mucosa of the intussuscipiens. In 3 cases these lesions were multiple. All lesions were found in locations where there was a close contact between the intussusceptum and the intussuscipiens. We did not find signs of impaired circulation of the whole intussuscipiens. We conclude that our findings give an indication that perforation of the intussuscipiens during attempt at hydrostatic reduction occurs through areas of localised ischaemic infarction on the basis of direct pressure by the intussusceptum.
To provide guidelines for the choice of treatment of intussusception, 10 factors that are known to be related to the outcome of treatment were studied in a series of 146 children with intussusception. The length of history, vomiting, rectal bleeding, small bowel obstruction, ileoileocolic intussusception, and the presence of a leading point were all significantly related to failure of hydrostatic reduction. Only 'rectal bleeding' and 'duration of symptoms of more than 48 hours' contributed significantly to the prediction of failure of hydrostatic reduction by logistic regression analysis. We believe that as well as the generally accepted contraindications--signs of peritonitis or bowel perforation--the presence of rectal bleeding when symptoms have lasted more than 48 hours is a contraindication to hydrostatic reduction.
Nine children presented with intussusception lasting for 14 days or more. Their mean age was 8.5 years. Diagnosis of intussusception was delayed considerably, probably due to an unusual presentation. Compared with acute intussusception, symptoms consist of infrequent attacks of abdominal pain, sporadic vomiting and no, or small, changes in defecation. Marked weight loss and an abdominal mass assume diagnostic significance, in contradiction to bloody stools. Ultrasonography can be of diagnostic value. An attempt at hydrostatic reduction is often unsuccessful. A high frequency of organic lesions precipitating intussusception warrants early surgical intervention.
We reviewed the problems during diagnosis and therapy of 11 patients with total colonic aganglionosis. Better knowledge of the clinical picture and greater alertness for the occurrence of this disease has led to an earlier diagnosis. Definitive operative therapy is still controversial. After ileostomy, a crucial point seems to be the allowance of sufficient time for the small bowel to adapt its absorptive ability. Little seems to be gained by performing a difficult procedure, such as Martin's operation, which involves the risk of serious complications. Our experience confirms that a standard Hirschsprung's operation is, in general, satisfactory. At present (mean follow-up 6.7 years), all our patients show normal growth and development, have no serious peri-anal problems, and are (with one exception) continent for faeces.
Late follow-up of 51 children operated on for the classical form of Hirschsprung's disease showed a great many unsatisfactory results. It is well known from the literature that achalasia of the anal sphincter is one of the most important causes. Twenty-five patients underwent redilatation of the anal sphincter. Complaints in the form of obstipation or diarrhoea remained in 40% of the cases after redilatation. Reinvestigation of the resected colon specimens using the conventional histological method showed the presence of ganglion cells in the proximal resection fragment in all patients. In the light of reports in the literature stating that despite normal histology, innervation disturbances can exist in the colon, we conducted a pilot study using polyclonal antibodies against S-100 protein. In three out of four patients with an adequate resection, in accordance with the conventional histological criteria, clear innervation abnormalities could be seen with the aid of polyclonal antibody staining.
Rectal prolapse in children is nowadays a rare anomaly. Potty training in young children is the common cause and the resulting prolapse can be treated conservatively. In children with refractory prolapse, sclerosing injections may be used. Operative treatment by posterior rectopexy is only indicated in the very few cases of long-standing prolapse.
In a retrospective study, 18 patients with neurovascular complications of supracondylar humeral fractures are presented. Adequate diagnosis, therapeutic procedures, and prognosis are discussed, together with a review of literature.
A long-term follow-up study of 38 fractures of the lateral humeral condyle was done to evaluate the special problems related to growth disturbances. Indications for operative treatment and clinical as well as radiographic results are discussed.
Two newborns are described, both with a hernia of the umbilical cord, which contained the gallbladder embedded in an accessory lobe of the liver.
Biliary obstruction due to cystic fibrosis is considered to be reversible and conservative management is recommended. We present two cases of cystic fibrosis with anatomic lesions of the extrahepatic bile ducts, necessitating operative correction. In the management of prolonged neonatal jaundice in cystic fibrosis, a conservative approach is frequently successful, but in some cases surgical intervention may be mandatory.
We describe seven children with subcutaneous rheumatoid nodules who had no clinical evidence of rheumatoid arthritis. Only one girl was seropositive for antinuclear factors and had a slightly raised erythrocyte sedimentation rate. Clinical aspects, risks for developing rheumatoid arthritis, and treatment of this entity are discussed.