Biomedical subjects

F Schier

Publications and source records attributed to F Schier.

At least 19 recordsLinked to original sources

PubMed2006

Laparoscopic transabdominal pyeloplasty in children is feasible irrespective of age.

PURPOSE: We assessed the feasibility of laparoscopic transabdominal dismembered pyeloplasty in 46 infants and children with regard to patient age. MATERIALS AND METHODS: A total of 46 consecutive infants and children (31 male and 15 female) underwent laparoscopic transabdominal dismembered pyeloplasty using a 3 to 4-trocar technique. All patients had confirmed unilateral deterioration of renal function on isotope renography. The 46 patients were divided into 3 age groups--1 to 12 months (group 1, 14 patients), 1 to 7 years (group 2, 15 patients) and 7 to 18 years (group 3, 17 patients). Followup included clinical and ultrasound assessment, and isotope renography at 3 months. RESULTS: Laparoscopic pyeloplasty was feasible in 44 of 46 patients (96%). Mean operative time was 175 minutes (range 120 to 270). The operation was converted due to impracticality of stenting the PUJ in 1 patient, and due to bleeding in 1. Mean operative time in 44 successful laparoscopic procedures was not significantly different among the 3 age groups (171 minutes in group 1, 169 minutes in group 2 and 173 minutes in group 3). Two patients required operative intervention for PUJ leakage, and 1 underwent percutaneous nephrostomy with a further uneventful course. Mean followup was 29 months (range 3 to 86). A total of 44 patients (96%) were asymptomatic and had improved PUJ drainage on isotope renography. Two patients underwent redo pyeloplasty due to recurrent hydronephrosis at 1 month and 2 years. CONCLUSIONS: Laparoscopic transabdominal dismembered pyeloplasty is effective and safe in infants and children. The feasibility is also excellent in patients younger than 1 year. The transabdominal approach revealed good exposition without a disadvantage for the patient.

Abdomen↗

PubMed2005

Laparoscopic resection of congenital choledochal cyst, choledochojejunostomy, and extraabdominal Roux-en-Y anastomosis.

BACKGROUND: The feasibility of laparoscopic resection of choledochal cyst and hepaticojejunostomy in children is still unclear. This report presents the author's experience with a first series of patients. METHODS: Data from 11 consecutive children (median age 17.5 months, SD 22, range 2 to 70) with choledochal cyst scheduled for laparoscopy were collected prospectively. There were nine type I and 2 type V cysts according to Todani's classification. All except one patient had intermittent jaundice or recurrent pancreatitis. The laparoscopic technique included excision of the cyst. A Roux-en-Y anastomosis was constructed after exteriorization of the small bowel via the infraumbilical trocar incision. After repositioning of the bowel an end-to-side hepaticojejunostomy was carried out laparoscopically. RESULTS: The procedures were carried out in nine children without intraoperative events and a median duration of 289 min (SD 62). In two patients, the operation was converted after 60 and 90 min due to a lack of overview at the dorsal margin with problems in separation of the portal vein. Oral food intake was started within 2 days and tolerated well in all except one patient, in whom biliar fluid from the drain led to laparoscopic reevaluation on day 1. A small leak was resutured and the patient was discharged on day 5. In one patient, recurrent cholangitis and a dilated Roux-en-Y loop led to correction of some kinking of the loop via laparotomy after 3 months. All other patients are well with bile-stained stools after a mean follow-up of 13 months. CONCLUSIONS: Laparoscopic resection of congenital choledochal cyst and choledochojejunostomy in children is feasible. We feel that there is a considerable learning curve with the technique. Future studies will have to prove the feasibility of laparoscopic Roux-en-Y bowel anastomosis without the need for bowel exteriorization.

Anastomosis, Roux-en-Y↗

PubMed2004

Rare inguinal hernia forms in children.

Rare inguinal hernia forms are encountered more frequently in the laparoscopic technique than in the open approach. The reasons are subject to speculation. The incidence of unusual inguinal hernia forms was studied in a series of inguinal hernias corrected laparoscopically in 452 children (334 boys and 118 girls aged 4 days--14 years, median age 1.6 years). The videos were retrospectively evaluated. Direct hernias were found in 10 children (2.2%), femoral hernias in five (1.1%), hernias en pantalon in three (0.7%), and a combination of indirect and femoral hernia and a combination of indirect, direct, and femoral hernia in one child each (0.2%). Routine videorecording during laparoscopy provides for the first time an objective and absolute picture of the true incidence of these unusual hernia forms.

Adolescent↗

PubMed2004

Occult, life-threatening, cardial tumor in syndactylism in Gorlin Goltz syndrome.

Pediatric, orthopedic, plastic, and hand surgeons perform the surgical correction of syndactylism. It is sometimes forgotten, however, that syndactylism can be part of a syndrome. The components of such a syndrome can each be life threatening. A 7-month-old boy was hospitalized for correction of cutaneous syndactylism. The mother claimed that, with the exception of the syndactylism, her son was healthy. However, review of the admission documents found that the family physician suspected Gorlin Goltz syndrome. A preoperative echocardiography showed 3.9-cm intramural tumor in the wall of the left ventricle. Electrocardiography documented ventricular tachycardia. Because of the danger of life-threatening malignant ventricular tachycardia, the tumor was resected. Before the resection, cardiac transplantation was considered because of the size of the tumor. Histologic examination found a fibroma. When observing syndactylism, one must always be aware of the possibility of a syndromic disease. It is particularly important that screening investigations, including electrocardiography and echocardiography, are performed before surgical treatment.

Basal Cell Nevus Syndrome↗

PubMed2003

Pansclerotic morphea in childhood: a case report.

Scleroderma can be differentiated into progressive systemic and circumscript forms. The extensive form with lethal outcome is known from case reports of children and adolescents. The present case report concerns a boy who died at 16 years of age. In the 5th year of life, he experienced weight loss and developed multiple, firm, partially atrophic plaques in the skin of the extremities. These plaques gradually became confluent and extended over the whole torso and head. Plaque ulceration resulted in massive mutilations to the body. Later the patient's cachexia worsened and he developed keratose, moderately differentiated squamous cell carcinoma of the right leg. The prognosis of pansclerotic morphea for children is worse than for adults. No successful therapy is known.

Adolescent↗

PubMed2003

Laparoscopic herniorrhaphy in children.

BACKGROUND: We report our clinical experience with 403 inguinal hernias in 279 children. They were treated via a purely laparoscopic approach using 2-mm instruments, obviating the need for a groin incision. METHODS: Laparoscopic herniorrhaphy was performed in children ages 4 days to 15 years. A 5-mm laparoscope was inserted through the umbilicus, and two 2-mm needle holders were inserted through the inferolateral abdominal wall. The open inner inguinal rings were closed by placing Z-sutures of monofilamentous nonabsorbable material. RESULTS: The mean operating time was 14 min for unilateral hernias and 21 min for bilateral hernias. We found 3.9% direct hernias. Hydroceles occurred in 1.7% of patients, testicular atrophy was noted in one patient, and no hernia was found in 2.3%. In girls with inguinal hernias, a contralateral asymptomatic patent processus vaginalis (PPV) was found in 45.2%, regardless of whether the hernia was on the right or the left side. In boys with inguinal hernias, contralateral PPVs were found on the right side in 21.9% and on the left in 8%. There were no major complications. One conversion to an open procedure was necessary because of a dilated bowel. The mean follow-up period was 23 months. There were 2.7% hernia recurrences; this rate was slightly higher than that seen with the open technique. The incidence of direct inguinal hernias was higher than has been previously reported. CONCLUSIONS: Laparoscopic herniorrhaphy allows the surgeon to identify the type of defect and proceed with immediate treatment. This technique is safe, reproducible, and technically easy for experienced laparoscopists. Bilaterality is of no concern. The cosmetic results are excellent; and in patients with recurrence of a hernia, this procedure is preferable to the open technique.

Adolescent↗

PubMed2003

Left ventricular regional wall motion abnormalities during pneumoperitoneum in children.

BACKGROUND: In adult patients, certain levels of PEEP (16 and 20 cm H(2)O) have been associated with left ventricular (LV) regional wall motion abnormalities. Since any increase in intra-abdominal pressure (IAP) exerted by a pneumoperitoneum is transmitted to the intrathoracic cavity, similar effects on LV regional wall motion cannot be ruled out. METHODS: To investigate the effects of pneumoperitoneum on LV regional wall motion, we performed a post hoc analysis of a transoesophageal echocardiography study in eight small children (mean age 3 yr, range 15-63 months) undergoing laparoscopic herniorrhaphy under anaesthesia with sevoflurane in nitrous oxide/oxygen and a PEEP of 5 cm H(2)O. During carbon dioxide insufflation, end-tidal carbon dioxide concentration ()was kept constant by increasing minute volume. RESULTS: An IAP of 12 mm Hg caused significant septal hypokinesia compared with baseline, while anterior and posterior wall motion was not affected. In addition, a lateral hyperkinesia occurred, though this change was not statistically significant. CONCLUSIONS: Pneumoperitoneum may affect LV regional wall motion in paediatric patients undergoing laparoscopic surgery.

Child↗

PubMed2002

Imaging for endoscopic surgery: new developments applicable to pediatric surgical interventions.

To introduce pediatric surgeons to new developments in imaging that are already or soon to become available that permit "in-line" work and three-dimensionality, five new approaches to imaging were evaluated in 419 children over a 3-year period: (1) Image projection onto the abdomen (n = 4). As opposed to conventional video camera positions, with this modality the line of view and the line of work are aligned. (2) Image projection onto a plate mounted just above the abdomen (n = 280). As in the first approach, screen arrangement position obviates looking up at the monitor. (3) A touch screen mounted above the abdomen, enabling the surgeon to not only monitor the procedure, but also to control all the equipment (n = 128). As with the first two modalities, the line of view is aligned with the direction of the work. (4) A three-dimensional (3-D) head display (n = 6). With this approach the use of a headset is required. (5) A 3-D screen (n = 1) for which, no goggles or headsets are required. The 3-D picture can be appreciated from a wide angle of view, and thus can be used by the surgeon and assisting team. Direct imaging projection onto the abdominal surface is a visual process that at present is too complicated for routine surgery. Projection onto a flat plate or touch screen is a major improvement; the surgeon looks and works in the same direction. Headsets for 3-D imaging remain heavy and the image is not as sharp as that provided by two-dimensional monitors. The most significant practical progress was felt to be with the flat 3-D monitor because with this equipment, depth perception and ergonomic positioning were both rated as very good. New imaging modalities are exciting, albeit still in their early developmental stages. The novel imaging provided by a 3-D monitor is most promising, because it combines good depth perception with physiologic in-line visual-manual coordination. These developments should further facilitate the transition from conventional, open techniques to videoscopic approaches.

Adolescent↗

PubMed2002

Jejunal feeding tubes via gastrostomy in children.

BACKGROUND: The implantation of a jejunal feeding tube, via percutaneous endoscopic gastrostomy (PEG), is a possible method for the treatment of inadequate oral feeding in patients who are affected by gastroesophageal reflux. PATIENTS AND METHODS: This study involves a retrospective analysis of all the patients up to 18 years of age, who were treated by means of jejunal feeding tubes at the Universitätsklinikum Benjamin Franklin, Berlin, between 15 September 1995 and 1 August 2000. RESULTS: In all, 76 patients received a PEG, and 12 of them were also given jejunal feeding tubes. One of these patients has experienced no complications. In the other 11 children, 52 changes of jejunal tube have been required. The most important reason for these changes was displacement of the tube into the gastrointestinal tract, resulting from technical problems with the connecting section. CONCLUSIONS: Jejunal feeding tubes in patients with gastrostomy are an alternative to fundoplication and drugs. However, a high rate of changes is to be expected.

Child↗

PubMed2001

Spontaneous reanastomosis between lymphatic vessels following syngeneic transplantation of the small intestine in the rat.

Spontaneous lymphvascular reanastomosis (SLR) following small bowel transplantation in rats is of clinical relevance for the resorption of long chain fatty acids. Detailed morphological and molecular data concerning the process of lymphvascular reanastomosis are not available in the literature. In this study SLR was investigated using microradiology and scanning electron microscopy. Between the 8th and 21st postoperative days following transplantation SLR does not occur between the intestinal trunk of the transplant and the thoracic duct of the recipient. Instead, an indirect connection was observed between the inserted advential lymphatic vessels of the mesenteric artery and lymphatic vessels of the aorta or ductus deferens, which are connected with the thoracic duct.

Animals↗

PubMed2001

Tetrachlorodecaoxide does not jeopardize anastomotic healing: an experimental study in animals.

Tetrachlorodecaoxide (TCDO) is a negatively-charged complex of chlorine and oxygen commonly used for the treatment of infected external wounds. However, it displays antiadhesive properties when applied intra-abdominally. In rats, small-bowel and a large-bowel anastomoses were performed and one-half of the animals received TCDO. It was found that TCDO did not alter the bursting pressures of small and large-bowel anastomoses at 1, 3 and 9 days postoperatively.

Anastomosis, Surgical↗

PubMed2001

Experiences of a parent support group with the long-term consequences of esophageal atresia.

PURPOSE: The aim of this study was to study long-term effects of esophageal atresia based on data from the world's largest parent support group. METHODS: A questionnaire was completed by 128 former patients, now aged 10 to 34 years (median, 14 years), who were all members of the support group. RESULTS: Postoperative bougienage was performed in 70% of patients. The most frequently associated anomalies were skeletal (44%), with 18% of patients having a winged scapula. In 30% of patients, food became trapped; this entrapment continues, although with decreasing frequency. In 38% of patients, recurrent episodes of food lodging in the esophagus lasted only a few years, whereas 32% of patients never experienced any swallowing problems. The foods most often trapped were apples, meat, and bread. Most trapped food is removed by the induction of vomiting, without medical help. Unusual findings of this study were the avoidance of chocolate and sweets by 9% of patients and the habit of eating unorthodox food combinations in 13% of patients. Forty-six percent of patients have gastroesophageal reflux, and 7% have Barrett's esophagus. The most successful antireflux prevention was abstinence from eating late in the evening. Fundoplication was performed in 16% of patients; however, only 25% of these fundoplication operations were successful immediately. Eighty percent of patients had more than 4 lung infections or bronchitis episodes per year. Forty-four percent make noises, such as wheezing or whistling, when breathing or straining. Eighty-eight percent are of normal height, and 70% are of normal weight. Eighty-nine percent of patients attended regular schools, and 52% were above-average students. CONCLUSIONS: Very few pediatric surgeons have had the opportunity to follow into adulthood such a large group of patients with esophageal atresia. Patients themselves feel lost when they undergo the transition from pediatric to adult medical treatment. A support group is able to provide an information database, which helps overcome the isolation because of the rareness of the disease and the separation of patients into different medical specialties. Surgeons should be aware of the difficulties that patients and parents face in later life and should seek cooperation with a support group. J Pediatr Surg 36:605-610.

Adaptation, Physiological↗

PubMed2001

Absorption of intraperitoneal CO2 after laparoscopy in piglets: an experimental study.

PURPOSE: The aim of this study was to study the absorption time of CO(2) after laparoscopy in piglets. METHODS: Laparoscopies were performed on 14 6-week-old piglets. The animals' abdomens were x-rayed immediately after closure 1, 1.5, and 2 hours postoperatively, and thereafter daily. RESULTS: All CO(2) was absorbed completely within 1 day. CONCLUSION: CO(2) absorption may follow a similar time course in small children. J Pediatr Surg 36:913-916.

Absorption↗

PubMed2001

Aortopexy in esophageal atresia: long-term experience of a parent support group.

PURPOSE: The aim of this study was to obtain the parents' view of aortopexy after esophageal atresia. METHODS: A questionnaire was completed by the parents of 24 former patients, now aged from 1 to 15 years (average, 8.9; median, 9.0 years). The respondents were all members of a support group. RESULTS: The median age of the patients receiving aortopexy was 4 months. The 24 procedures were performed in 16 different hospitals. The subjects had experienced a median of 3 apneic attacks. Technical complications occurred in 4 of the 24 children. In 71%, aortopexy was an immediate success. CONCLUSION: Despite its low success rate compared with centers with large cumulative experience, 90% of parents were satisfied with the result.

Aorta↗

PubMed2001

Incidence of contralateral patent processus vaginalis in children with inguinal hernia.

PURPOSE: The aim of this study was to investigate the incidence of contralateral patent processus vaginalis (PPV) in children with inguinal hernia using direct laparoscopic inspection. METHODS: This study evaluates the incidence and size of contralateral PPVs in 143 children (96 boys, 47 girls) with clinically unilateral indirect inguinal hernia who underwent laparoscopic hernia repair. During repair, the contralateral internal inguinal ring was evaluated for PPV. RESULTS: Boys with hernias on the right side had wide-open contralateral PPVs in 26% of cases compared with 11% in girls. Boys with hernias on the left side had wide-open contralateral PPVs in 30% of cases compared with 38% in girls. In all 4 groups, there were small contralateral openings in 15% to 20% of cases. CONCLUSION: Contralateral PPV seems to occur less commonly than previously assumed.

Adolescent↗

PubMed2001

Ciliated epithelium in a midgut enteric duplication: a case report.

We report the case of a 7-year-old male child with a cystic tumour attached to the caecum close to the ileocaecal valve. The histological examination showed that the cyst had a ciliated epithelial lining, containing serous and mucous glands, with surrounding smooth muscle, inner circular and outer longitudinal layers. The cyst was interpreted as an intestinal duplication lined with respiratory epithelium. This structure and its location, originating from the midgut, is not in accordance with the typical conception of the embryogenesis. The clinical picture and treatment are described and compared to other findings in the literature.

Cecal Neoplasms↗

PubMed2001

Three-dimensional reconstruction of the anal striated musculature in a human fetus.

Conflicting opinions in the recent literature indicate that the morphological organization and function of the anorectal continence organ has, up to now, not been clearly understood. But a clear imagination of the spatial arrangements of this compound muscle system is of clinical relevance for the pediatric surgeon performing reconstructive surgery. We analyzed 18-microm sections of the pelvic region of 4 human fetuses in order to describe the individual components of this muscle complex. A series of 630 Azan-stained sections was the base for the computer-assisted 3D reconstruction of the levator ani and the external sphincter complex in a male human fetus (14th week p.c.). In this context, special attention was paid to the intermediate muscle layer of the puborectalis which develops ventrally from the funnel-shaped levator ani and joins the tripartite ring system of the sphincter muscle dorsally. Our findings lead to a clear imagination of the spatial arrangement of this intermediate layer and characterize the anorectal muscle complex as an integrated ensemble in which the puborectalis holds a key position.

Anal Canal↗

PubMed2000

Direct inguinal hernias in children: laparoscopic aspects.

Among 109 children treated laparoscopically for inguinal hernias, 5 had direct hernias, more than would normally be anticipated. Two of the hernias were recurrences of indirect hernias operated upon previously using the open technique. Direct hernias are easier to detect with the laparoscopic technique.

Adolescent↗