Biomedical subjects
Publications and source records attributed to G Brandesky.
Retrospective analysis of 324 childhood appendectomies revealed microscopic signs of previous inflammation in 66 out of 111 acute cases and in 162 of 182 cases of "chronic" cases presented with a long history of recurrent abdominal pain. Thus a somewhat liberal indication for appendicectomy in childhood seems justified in the appropriate cases.
Explore the source record for details and available documents.
Chronic intermittent duodenal obstruction caused by stenosis of the distal duodenum is a rare disease. Tight fixation of the ligament of Treitz, compression due to mesenteric lymphomatas or abnormal attachment of the mesocolon can cause intermittent impairment of intestinal passage. It will be necessary to differentiate this against genuine arterio-mesenteric duodenal obstruction as well as nerve motility disorders. History in the appropriate cases reports on postprandial episodes of regurgitation, sensation of fullness, nausea, vomiting and paroxysmal upper abdominal colicky pain. Radiograms always reveal gastroptosis and a varying degree of duodenal obstruction, usually with retroperistalsis. The passage is markedly delayed, with an impairment sometimes at the site of the duodenojejunal flexure. Therapy is always surgical. 8 own cases were cured by leftsided duodenal mobilisation according to Clairmont with additional caudad positioning and fixation of the duodenojejunal flexure.
Contrary to Kiely and Spitz we have been using gastrostomy in almost all cases of oesophageal atresia treated with primary anastomosis. Gastro-oesophageal reflux has never been a major problem and during 25 years of personal paediatric surgical experience we have never performed any type of antireflux surgery. To confirm this we have followed up 71 out of 77 survivors who underwent primary anastomosis and gastrostomy in 3 Departments of Paediatric Surgery. The patients were examined 13 months to 17 years, in average 7 years postoperatively. 50 children were free from symptoms, the remainder complained of increased susceptibility to broncho-pulmonary infections. These children were younger than 4 years. X-ray controls could be performed in 50 patients. The vast majority showed motility disorders of the oesophagus, well known as Yo-Yo-phenomenon with swaying of the dye and delayed clearing of the oesophagus. Distinct gastro-oesophageal reflux was detected in 3 of the 50 cases, but there were no signs of oesophagitis or stricture and the patients were free of symptoms. There were no late strictures and no late mortality. We consider proper conservative management especially with oblique positioning as used in hiatal hernias most important in the treatment of the oesophageal motility disorder as well as gastro-oesophageal reflux in the early postoperative period and advocate routine gastrostomy and insertion of an endless thread for routine bougienage.
We have found that following lung resection in childhood, one-third of the patients followed-up at least 10 years postoperatively presented mainly minor complaints. Compared with follow-up examinations about 8 years age [4], findings had changed only in two bronchiectasis patients. In both cases a moderate exertion dyspnea had occured. Although pulmonary function tests still showed normal values, the radiologic findings according to residual bronchiectasis had increased. Altogether, pulmonary function tests, however, sometimes show a considerable interference with lung ventilation, which seems to be astonishingly well compensated in childhood. They should not be neglected, however, with regard to strains and physiological changes in later life. Therefore, the indications for pulmonary resection in childhood have to be evaluated very carefully and the extent of the resection should be kept as small as possible.
An investigation was undertaken in a series of 10 children operated upon for congenital diaphragmatic defects in regard to the value of simple thoracic X-ray pictures for functional assessment of the repaired diaphragm. The radiographs were taken in forced inspiration as well as in forced expiration and indices were calculated for the mobility of the diaphragm and the costophrenic angle. Moreover, an attempt was made to estimate diaphragmatic contraction by comparing the length of the hemidiaphragm during inspiration and during expiration. The obtained results gave sufficient information for routine investigations of diaphragmatic function and compared well with those of radiocinescopy. An impairment of the mobility of the diaphragm and the costophrenic angle was statistically demonstrated in our follow-up series as compared with a control group of healthy children.
Explore the source record for details and available documents.
Rives muscle plasty using a pediculate flap of the latissimus dorsi muscle is an approved method for correction of large congenital diaphragmatic defects. To study morphology and function of the transplanted muscle flap 10 beagle dogs were operated upon bilaterally in two stages. Thus a total of 20 muscle transplants was evaluated. A standard Rives plasty was performed, emg electrodes were inserted into the diaphragm as well as into the muscle transplant. The surgical procedure was tolerated very well, there was no operative mortality. The period of observation varied between 18 and 48 weeks, the average being 30 weeks. Postoperatively there was no electric activity found in the muscle transplants, whereas the diaphragm showed its characteristic interference pattern during inspiration. In 5 cases, however, action potentials appeared in the muscle flap after 12 to 16 weeks. They had the semblance of fibrillation potentials and short sharp waves and were considered to be preceding reinnervation potentials, which occured 24 to 32 weeks postoperatively in these cases. In 2 cases the emg findings were inconstant, in the residual 13 cases there was no electrical activity in the muscle transplant during all the observation time. The emg findings corresponded to the histological postmortem findings. These showed in altogether 6 cases numerous intact muscle fibres as well as nerve trunks with neurites, especially in the neighbourhood of the diaphragm. In the middle of the flap and even more near the thoracic wall the number of intact muscle fibres decreased. Thus a partial reinnervation due to muscular neurotization starting from the diaphragmatic margin was assumed in these cases. In the rest of the flaps the muscles were largely atrophic and showed considerable lipomatosis, only minor fibrosis and never a distinct scar formation. Therefore, the flaps represented living tissue with intact vascularization and functionally good adaptability. Reinnervation, observed in some cases, is not the main factor for the good clinical results obtained with Rives muscle plasty, but can improve adaptability and elasticity of the transplant considerably. According to the lack of scar formation and the preponderance of fatty tissue an increase of the transplant considerably. According to the lack of scar formation and the preponderance of fatty tissue an increase of the transplants size during growth seems possible. Thus Rives muscle plasty using a flap of the latissimus dorsi muscle to cover large congenital diaphragmatic defects seems morphologically as well as functionally superior to other procedures especially those using plastic material.
Experiences and results are reported of Pickrell's gracilis sling transplantation in 30 cases. 24 cases could be followed up. In 21 of these there was definite improvement of continence. The favourable results are attributed to the contractibility of the muscle after transplantation. After high anal and rectal atresiae, a maturation of anorectal structures and a belated rectal adaption reaction may be observed, which can be attributed to the gracilis sling operation. It seems, therefore to be sensible to perform the operation earlier than has been practised hitherto.
Lidaprim, a new bactericidal combination of trimethoprim and sulfametrol, was administered to 20 patients of a paediatric surgical ward over a period of 7 or more days. Analytic determination of plasma and urine concentrations of the chemotherapeutic agent showed homogeneous drug levels at the chosen dosage. No cumulation was observed. Drug tolerance was excellent. Only one patient developed urticaria when the substance was given together with penicillin, but it was not necessary to stop medication in this case.
A series of 13 cases is reported in which gracilis muscle transplantation according to Pickrell was carried out. In half of the cases a modification using bilateral gracilis muscle transplants was performed. 10 children were followed up; 8 of them showed an improvement in faecal continence. Preserved contractility of the transplanted gracilis muscle seemed to be responsible for this improvement. Since maturation of anorectal structures after surgical correction of high anorectal atresias and late development of anorectal mechanisms seems possible and might to be assisted by transplantation, early surgery -- about the fourth year of life -- is recommended.
Explore the source record for details and available documents.