PubMed Health⌕ Search

Biomedical subjects

J Waldschmidt

Publications and source records attributed to J Waldschmidt.

At least 19 recordsLinked to original sources
PubMed2002

Ultrasound examination of paediatric testicles after laparoscopic laser dissection of internal testicular vessels in cryptorchism.

PURPOSE: To evaluate the growth of testicles, their sonographic structure and the recovery of testicular perfusion through collateral vessels after preliminary laparoscopic laser dissection (PLLD) of the internal spermatic artery in cryptorchism. MATERIALS AND METHODS: The postoperative position, the volume increase, the structural and vascular abnormalities and the incidence of epididymal abnormalities were evaluated with ultrasound in 32 children (mean age: 6.5 +/- 1.34 years) after PLLD. The intratesticular blood flow and the flow-in anastomoses from the deferential and cremasteric arteries were assessed using colour and power Doppler US (7.5 MHz transducer). RESULTS: All testicles were permanently positioned in the scrotum and showed growth after surgical treatment. None of the testes showed sonographic signs of atrophy. There were no clear differences in intratesticular perfusion compared to the non-operated testis. A collateral blood flow in the deferential artery was found in 44 cases by colour and/or power Doppler US. A perfusion to the lower testicular pole was detected in 29 cases by power Doppler. Intraoperatively, 12 epididymal inversions were eliminated so that an elongated epididymis was sonographically visualised in three testes. CONCLUSION: Ultrasound can be used for the postoperative control of the testicular structure and the volume increase as well as detection of the flow-in anastomoses. The collateral blood supply after PLLD was sufficient for subsequent growth of testicles in all cases.

Child↗
PubMed2000

Carcinoid tumors of the appendix in children--epidemiology, clinical aspects and procedure.

INTRODUCTION: Incidental detection of a carcinoid tumor of the appendix after appendectomy is often accompanied by uncertainty about the further procedure. The tumor frequency in our own patient population, the further course in these children and a practicable follow-up protocol have to be determined. PATIENTS AND METHODS: All appendectomies performed between January 1, 1982, and December 31, 1996, were retrospectively evaluated with regard to carcinoids, monitoring the clinical course, and follow-up of the patients involved. RESULTS: A total of 4747 appendectomies were performed, 8 children had a histologically manifest carcinoid (0.169%). All patients were symptom-free in the further course, no metastases or signs of a carcinoid were documented during a mean follow-up period of 6.6 years. CONCLUSION: The youngest patient with a metastasizing carcinoid tumor of the appendix reported in the literature was 19 years old. Nevertheless, all younger patients should undergo regular follow-ups; this is done in our department by serum serotonin and chromogranin A determination.

Adolescent↗
PubMed1999

Pulmonary embolism and myocardial hypoxia during extracorporeal membrane oxygenation.

The treatment of a newborn with severe meconium aspiration by venoarterial extracorporeal membrane oxygenation (ECMO) was complicated by myocardial hypoxia with a marked decrease of myocardial contractility. The onset of the cardiac hypoxia was related to a pulmonary artery embolus. The origin of the embolus was a deep femoral vein thrombosis, caused by a central vein catheter, which was inserted 1 day before ECMO by venous cutdown. The possible pathophysiology of myocardial hypoxia in this patient is discussed, especially with regard to myocardial perfusion, supporting the hypothesis of coronary perfusion occuring with blood from the left ventricle and not from the arterial cannula in the aorta.

Catheterization, Central Venous↗
PubMed1999

[Percutaneous removal of a brachiocephalic vein anchored venous catheter with wire loop and mini-laparoscopy scissors].

PURPOSE: The use of mini-laparoscopy scissors to remove a central venous catheter inadvertently fixed to the wall of the brachiocephalic vein is described. PATIENT AND METHODS: During a rethoracotomy in a 15-year-old female patient, a central venous catheter preoperatively introduced in the left subclavian vein was inadvertently trapped by a suture and fixed to the wall of the left brachiocephalic vein. The foreign body was removed by use of a transjugularly introduced venous sheath, a catheter wire snare, and mini-laparoscopy scissors. RESULTS: The fixed catheter was freed from the wall of the vein under fluoroscopic control with the help of a mini-laparoscopy scissors. Since the intravasal end of the catheter had already been grasped during mobilization with the wire snare it could be completely removed subsequently without any problem. CONCLUSIONS: The percutaneous, intravascular use of mini-laparoscopy instruments may be considered for foreign body removal in special cases.

Adolescent↗
PubMed1998

Laser treatment of hemangiomas of the larynx and trachea.

BACKGROUND AND OBJECTIVE: Hemangiomas have a typical clinical course and may lead to life-threatening obstruction if the central respiratory tract is involved. STUDY DESIGN/PATIENTS AND METHODS: This was observed in 32 children over a period of 20 years. The radiation parameters and application procedure of Neodymium:Yttrium-Aluminum-Garnet-laser (Nd:YAG-laser) therapy were adjusted for the degree of obstruction and the type of disease. RESULTS: The success rate was 93.8%, of which a maximum of one application was sufficient in 24 children (75.0%). Subglottic cicatricial stenosis was considered a laser-related complication. CONCLUSION: Nd:YAG-laser treatment is a safe and effective therapeutic measure for eliminating respiratory tract obstruction caused by hemangiomas.

Bronchoscopy↗
PubMed1998

Magnetic resonance imaging: controlled interstitial laser therapy in children with vascular malformations.

BACKGROUND AND OBJECTIVE: Interstitial laser therapy (ILT) is a minimally invasive treatment method for congenital vascular malformations (CVM). This study was intended to show whether or not open magnetic resonance imaging (MRI) offers a means of on-line thermometry and procedure control. STUDY DESIGN/PATIENTS AND METHODS: ILT using a bare fiber and an Nd:YAG laser was applied in 20 children with CVM under open MR control. RESULTS: With the open MR systems, needle placement and advancement was excellent in all cases. On-line thermometry was possible in 90% of the therapy spots. The 6 week MR follow-up revealed a 76% reduction in tumor size in 14 patients. Clinical symptoms improved in 85% of the patients. CONCLUSION: MR-guided ILT could become a safe method to treat selected types or selected regions of CVM.

Adolescent↗
PubMed1998

Qualitative and quantitative analysis of synapses in Hirschsprung's disease.

In Hirschsprung's disease (HD), certain intestinal nervous plexuses are absent. Sprouting nerve endings contain different amounts of synaptophysin (SY), a protein and main constituent of acetylcholinesterase (AChE) storage compartments. Due to the lack of specific markers for synapses, a qualitative analysis of nerve endings of intestinal segments affected by HD has not yet been undertaken. For this study, resected colorectal specimens from patients with HD (n = 8, mean age 2.1 years) were investigated in parallel for AChE, SY, and content of small synaptic vesicles by biochemical, immunohistochemical, and electronmicroscopic means. In the microdissected muscular layer, reduced SY (1.4 microgram/mg total protein, normal 24 +/- 0.3) was observed. Immunohistochemistry showed in affected tissues reduced numbers of SY-positive nerve fibers and nerve endings, which in turn were thickened and distorted, in both the muscle proper and the muscularis mucosae. Combining both morphologic and biochemical findings, in HD the number of cholinergic vesicles in the remaining nerve endings seems to be increased as measured by SY, a marker molecule specific for synaptic vesicles. Our data also suggest that nerve endings in HD may contain high concentrations of cholinergic vesicles, paralleling the known high amounts of acetylcholine and AChE found in intestinal segments of patients with HD.

Acetylcholinesterase↗
PubMed1998

Multisystem organ failure and capillary leak syndrome in severe necrotizing enterocolitis of very low birth weight infants.

BACKGROUND: Classification systems for necrotizing enterocolitis (NEC) in preterm infants have been developed to define severity grades relevant for treatment and prognosis. Multisystem organ failure (MSOF) and capillary leak syndrome (CLS) also have prognostic value in these patients. The aim of this retrospective study was to investigate the incidence and predictive value of MSOF and CLS according to the classification criteria. METHODS: The records of 1,022 very low birth weight infants admitted from 1982 to 1996 were reviewed for diagnosis of NEC stage IIA or higher (classification of Walsh and Kliegman). Among those patients (n = 50) the incidence of MSOF and CLS was determined, separately for surgical or conservative treatment. RESULTS: Twelve patients were assigned to stage II, 22 to stage IIIa, and 16 to stage IIIb; 31 infants underwent operation. Mortality rate was not influenced by the grade. In eight patients only gastrointestinal symptoms were found, whereas in 23 patients, up to three organ systems and in 19 patients, four or more organ systems were affected. Mortality depended on the number of involved organ systems. CLS occurred postoperatively in 10 of the 31 infants; eight of them died. CONCLUSION: The prognostic values of MSOF and CLS are higher than that of classification criteria in NEC of VLBW infants.

Capillary Leak Syndrome↗
PubMed1998

Congenital cystic adenomatoid malformation of the lung and fetal hydrops--a case with favourable outcome.

We present a case of congenital cystic adenomatoid malformation of the lung (CCAM) diagnosed at 23 weeks of gestation with concomitant fetal hydrops. The sonographical picture of CCAM disappeared in the third trimester of pregnancy and fetal hydrops resolved under medication with digitalis to the mother. The neonate showed mild dyspnea; the prenatal diagnosis of CCAM was confirmed by chest X-ray and computed tomography. The affected lung segments were dissected at 5 days of age. The diagnosis of CCAM type III was confirmed histologically.

Adult↗
PubMed1998

Vascular lesions in children: percutaneous MR imaging-guided interstitial Nd:YAG laser therapy--preliminary experience.

PURPOSE: To investigate the use of magnetic resonance (MR) imaging to guide interstitial laser therapy of deep hemangiomas and vascular malformations in children. MATERIALS AND METHODS: Sixteen children aged 3 months to 16 years with symptomatic vascular lesions underwent percutaneous laser treatment. MR imaging guidance of the laser applicator and online thermomonitoring with MR imaging were performed with a 0.2-T open MR system. Follow-up studies were performed 2 days and 6 weeks after thermotherapy. RESULTS: Interactive positioning of the laser applicator was possible in all patients. Online thermomonitoring was possible in 122 of 137 therapy spots (89%). There was a good correlation between volumes of coagulated tissue on intraprocedural T1-weighted images and volumes of coagulated tissue on follow-up T2-weighted images. At 6-week follow-up, MR imaging demonstrated a reduction in lesion size in 10 patients (mean reduction, 72%) and an increase in lesion size in two patients (mean increase, 134%). Clinical symptoms improved in 14 of 16 patients (88%). CONCLUSION: MR imaging-guided laser therapy appears to be a safe and potentially effective minimally invasive treatment for selected children with vascular lesions.

Adolescent↗
PubMed1998

[Acute appendicitis in the child].

The appendicitis is the commonest cause of an acute abdomen in children older 1 year of age. Only 5% of children with appendicitis are younger than 2 years of age. There is a familial preponderance. The younger the child the faster the symptoms of the disease are increasing in intensity. The symptoms starts with unspecific periumbilical or epigastric pain, followed by nausea, vomiting and restlessness at night. Finally the pain moves to the position of the appendix. The position of the appendix shows a high variation in children thus the pain characteristic is not uniform. Laboratory tests are not reliable but ultrasonography is recommended to exclude other diseases and to try to confirm the diagnoses. With the technique of "Graded compression Sonography" the rate of non identified appendicitis has been reduced under 5%. Laparoscopy is another option. Its use just for diagnostic purposes is limited but is recommended widely for primary therapeutic treatment with laparoscopic performed appendectomy. Laparoscopy has a special advantage against conventional appendectomy in the diagnostic of recurrent unspecific abdominal pain in children and in cases with interval appendectomy. Finally in pseudoappendicitis and pseudoperitonitis in children with immunvasculitis and other extraabdominal diseases. Letality of the acute appendicitis is zero.

Abdomen, Acute↗
PubMed1998

[Laparoscopy in the newborn infant--indications and procedure].

UNLABELLED: The indications and technical features of minimal invasive surgery, which is of particular interest in neonates, are being discussed. Thirty-three laparoscopies had been performed as of 1997. The youngest child was 2 days old; the smallest one weighted 2150 g. The most frequent indications were clarification of cholestasis, cystic masses, pyloromyotomies and sigmoid resections. Three conversions were necessary (two choledochal cysts, splenic torsion). Complications were one postoperative incisional hernia and two rectal stenoses after sigmoid resection. CONCLUSION: Laparoscopy can even be performed in newborns and meets the requirements of minimally invasive surgery.

Equipment Design↗
PubMed1998

[Transcutaneous and laparoscopic laser treatment in extensive retroperitoneal lymphangiomas in childhood].

Retroperitoneal lymphangiomas are rare congenital vascular malformations. They cannot always be completely excised and are associated with high recurrence, complication and morbidity rates. We therefore utilize an alternative treatment concept in some cases. We excise the cystic types laparoscopically with a Nd: YAG laser (wavelength 1064 nm). Residual tissues are percutaneously managed by interstitial laser therapy under MRI monitoring. The high soft-tissue contrast of the MRI enables exact positioning of the laser fiber. The examination is thermosensitive and provides online and noninvasive demonstration of the interstitial tissue coagulation. We have treated four infants laparoscopically and three other children percutaneously.

Adolescent↗
PubMed1997

Silymarin retards collagen accumulation in early and advanced biliary fibrosis secondary to complete bile duct obliteration in rats.

Silymarin (SIL), a standardized plant extract containing about 60% polyphenole silibinin, is used as a hepatoprotective agent. Its antifibrotic potential in chronic liver diseases has not been explored. Therefore, we applied SIL to adult Wistar rats that were subjected to complete bile duct occlusion (BDO) by injection of sodium amidotrizoate (Ethibloc). This treatment induces progressive portal fibrosis without significant inflammation. Rats with sham-operation that received SIL at 50 mg/kg/d (n = 10) and rats with BDO alone (n = 20) served as controls, whereas groups of 20 animals were fed SIL at a dose of 25 and 50 mg/kg/d during weeks 1 through 6 or doses of 50 mg/kg/d during weeks 4 through 6 of BDO. Animals were sacrificed after 6 weeks for determination of blood chemistries, total and relative liver collagen (as hydroxyproline [HYP]), and the serum aminoterminal propeptide of procollagen type III (PIIINP). BDO in untreated rats caused an almost ninefold increase in total liver collagen (16.1 +/- 3.1 vs. 1.8 +/- 0.4 mg HYP, P < .001). SIL at 50 mg/kg/d reduced total HYP by 30% to 35%, either when given from week 1 through 6 or from week 4 through 6 after BDO (10.6 +/- 2.7 and 10.2 +/- 3.9 mg HYP, both P < .01 vs. BDO alone), whereas 25 mg/kg/d were ineffective. Because SIL at 50 mg/kg/d also reduced the collagen content per gram of liver tissue, it acted as a true antifibrotic agent. The single value of PIIINP at killing paralleled the antifibrotic activity of SIL with 11.6 +/- 3.8 and 9.9 +/- 3.7 vs. 15.3 +/- 5.2 microg/L in both high-dose groups (P < .05 and P < .01, respectively, vs. rats with BDO alone). Except for a decreased alkaline phosphatase and a lower histological fibrosis score in the groups that received SIL, clinical-chemical parameters were not different among all groups with BDO. We therefore conclude that 1) BDO with Ethibloc is a suitable model to test for pure antifibrotic drugs because it induces progressive rat secondary biliary fibrosis without major inflammation; 2) oral SIL can ameliorate hepatic collagen accumulation even in advanced (biliary) fibrosis; and 3) PIIINP appears to be a suitable serum marker to monitor the inhibition of hepatic fibrogenesis in this model of biliary fibrosis.

Animals↗
PubMed1997

A 7-year-old child with primary tumour localisation in the distal duodenum--new imaging procedures for an improved diagnosis.

UNLABELLED: Duodenal gastrinomas in childhood are extremely rare and often missed at first medical consultation. We report on a 7-year-old child with sporadic gastrinoma of primary localisation in the distal duodenum. Small metastases in the liver and regional nodes were detected pre-operatively by somatostatin receptor scintigraphy (SRS) but not by other conventional imaging procedures. Diagnostic procedures include pre-operative SRS, endoscopic ultrasound and intra-operative endoscopic transillumination. CONCLUSION: Gastrinomas are rare abdominal tumours in childhood. Pre-operative tumour-specific diagnosis is possible by 111indium pentreotide SRS.

Biomarkers, Tumor↗
PubMed1996

Thoracoscopy in children.

Pediatric surgical experience with video-assisted thoracoscopy is limited. The authors report their experience with 27 thoracoscopies in 22 children. The median age was 6.1 years (range, 1 day to 16 years). The two primary indications for thoracoscopy were management of pneumothorax and mediastinal cysts. Fifteen thoracoscopies accomplished their purpose without complications. Intraoperative complications required conversion to an open operation in three patients. One bronchogenic cyst and four pneumothoraces recurred. The main complications were poor visualization, bleeding from an intercostal artery, and difficulty with suturing. Compared with open thoracotomy, anesthesia time did not differ significantly, and less pain medication was required postoperatively.

Adolescent↗
PubMed1996

Elevated serum aminoterminal procollagen type-III-peptide parallels collagen accumulation in rats with secondary biliary fibrosis.

BACKGROUND/AIMS: The aminoterminal procollagen type-III-peptide, which can be released during collagen type III deposition, has been suggested as a serum marker of fibrogenesis in patients with chronic liver disease. However, longitudinal studies correlating procollagen type-III-peptide concentrations in serum with the evolution of liver fibrosis are still needed. The purpose of the present study was to prove the significance of procollagen type-III-peptide concentrations in serum as a non-invasive marker of liver fibrogenesis in an animal model that best resembles progressive human liver fibrosis. METHODS: In 88 female Wistar rats the biliary system was occluded by double ligation of the choledochal duct followed by retrograde injection of a mixture of prolamine/ethanole (Ethibloc). Sixteen rats served as controls. Groups of 8-10 rats were sacrificed at days 2, 7, 14, 21, 30, 32, 35, 60 and 90 after bile duct occlusion. In the groups histological staging (fibrosis score), determination of total liver hydroxyproline, measurement of serum procollagen type-III-peptide and routine liver function tests were performed. RESULTS: First histological signs of liver fibrosis were seen as early as 7 days after bile duct occlusion. Progressive fibrosis was paralleled by an increase of serum procollagen type-III-peptide. There was a significant correlation between serum procollagen type-III-peptide and histological stages of fibrosis (r = 0.80; p < 0.0001) as well as between serum procollagen type-III-peptide and hydroxyproline in total liver tissue (r = 0.85; p < 0.0001) CONCLUSIONS: These results indicate that: (1) complete bile duct occlusion in rats produces progressive hepatic fibrosis resembling human secondary biliary fibrosis, and (2) procollagen type-III-peptide concentrations in serum reflect ongoing collagen formation in the liver unrelated to serum markers of cholestasis and inflammation.

Animals↗