[Pediatric surgery and andrological aspects of varicocele testis].
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Biomedical subjects
Publications and source records attributed to H Schickedanz.
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From 1970 to 1978 22 children with Hodgkin's lymphomas at the age of 4-15 years were treated at the university children's hospital of Jena. There were 16 patients with the first appearance of the disease and 6 with relapses. The stage classification was carried out after the Ann-Arbor-classification. A "staging" operation with laparotomy and splenectomy was performed in 17 children. The histological material was classified after the Rye-modification of the Lukes-Butler-classification. The clinical staging showed 8 patients in stage I, 7 in stage II, 6 in stage III and one child was in stage IV. The therapy consisted of a telecobalt irradiation extended field irradiation, total nodular and local irradiation) with a focal dose of 4500 rad and a chemotherapy (6 cycles COPP). The life-table-analysis for those patients who were primarily treated in Jena showed a complete five-year-remission rate of 92 per cent. The five-year-survival-rate for all patients (with the first appearance of the disease and with relapses) amounts to 77 per cent. After splenectomy we observed two overwhelmingly progressing aetiologically not clear infections and a pneumococcal meningitis.
Between 1970 and 1978 33 children with Non-Hodgkin-lymphomas at the age of 2-15 years were treated at the university children's hospital of Jena. 27 patients showed the first appearance of the disease, 6 patients had already been treated in other hospitals and were admitted with relapses. The biopsy material was classified or re-classified after the Kiel-classification. Beside the histological classification the surface markers of the malignant cells of NHL-patients were determined. 20 of 33 children were already in stage IV (Ann-Arbor-classification). Among our patients were 6 lymphoblastic NHL of Brukitt type, 10 of the convoluted cell type and 16 unclassified and one lymphoblastic lymphoma. The main localization of the NHL were mediastinum [15] and the gastrointestinal tract [10]. The therapy consisted of irradiation and chemotherapy (2 protocols) and, in case of an abdominal localization, in the attempt at a radical operation. Patients of stage I and stage II showed a complete remission rate of 50 per cent for 3 years; patients of stages III and IV of 20 per cent only. NHL of the convoluted cell type and of the Burkitt-type proved to have worse three-year-remission rates (16 per cent and 27 per cent) than unclassified lymphoblastic NHL (42 per cent).
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The continuous inside splinting of the small intestine was carried out in 82 children and adults, because of postoperative ileus, chronic recurrent ileus and diffuse peritonitis. Possibly the splinting had contributed in one case to the perforation of the paralytic small intestine with a fatal outcome. In another case there occurred a relapse of an ileus. All other patients have no complaints in connexion with the splinting operation. Control examinations take place. A "total folding" of the small intestine was not observed by the radioscopy.
The method of defecography first described by Burhenne proved to be best suited in systematic examination to detect the different types of impaired evacuation in the area of the sphincters. Pre-and postoperative results of 116 examinations in 86 children are presented.
The accident morbidity rate in children is growing permanently. Craniocerebral injuries, polytraumatizations, and accident lesions of the abdominal organs exhibit the highest degree of lethality. The prophylactic possibilities have so far by no means been properly utilized. The systematic application of current knowledge in pathophysiology, traumatology, and children's surgery, nervertheless, leads to a decisive reduction of the mortality rate. This statement can be verified by longitudinal investigations (35 years) in 3 selected paedotraumatologic morbidity groups of the Jena clinic. The increasing numbers of treated cases are accompanied by a continuous decrease in lethality.
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From 1968 to 1977 at the Paediatric Surgical Dept. of the Surgical Clinic of Jena/GDR 160 children with gastro-intestinal haemorrhage were seen. Half of them were not older than 1 year. The causes of bleeding are various. Haemorrhage due to insufficiency of the cardia and intussusception dominates.
In the German Democratic Republic a well balanced network of paediatric surgical departments is serving the people. With the help of these specialised institutions the mortality rate of infants and children suffering from surgical diseases could be lowered decisively.
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1. Various weather factors were examined which were operative during the occurence of lung embolism in 915 patients of the Surgical Clinic of the University of Jena for a period of 50 years (1917 to 1966). 2. No relationship could be found between the incidence of pulmonary embolism and temperature (maximal and minimal values, or temperature differences) or with atmospheric pressure. 3. The incidence of pulmonary embolism is significantly higher at days with high rainfall (above 10 mm/m2) and high average humidity (8-10 Torr) values. 4. Thromboembolic complications are less frequent at average values for air humidity (6-7 Torr), at days with a relative air humidity of 70% and with lower rainfall.
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