Biomedical subjects
Publications and source records attributed to J Waldschmidt.
This report documents the first resection of a duodenal membrane by laser. Subsequently, however, a laparotomy was required because of an annular pancreas. Nevertheless, it demonstrates that the laser endoscopical resection of a duodenal membrane is technically feasible.
Following small bowel transplantation, new lymph vessel anastomoses form spontaneously. Surgical anastomoses of the lymphatic vessels are unnecessary. The formation occurs in three stages. To the second postoperative day, lymph stays within the lymphatic vessels of the transplant. Following the fourth postoperative day, lymph flows within preexistent adventitial lymphatic vessels along the transplanted mesenteric artery to the arterial anastomosis at the aorta and stops there. From the sixth postoperative day on, lymph crosses the arterial anastomosis for the first time and flows along the recipient's aorta. To the eighth postoperative day a new lymph anastomosis is formed between the adventitia of the aorta and the neighbouring major lymphatic vessels. In the experiments presented here, these are represented by the vasa lymphatica testicularia sinistra of the recipient. Thus, the new anastomosis between lymphatic vessels is complete on the eight postoperative day. These new vessels gradually dilate with time.
Two boys with high undescended testes were submitted to laparoscopic laser transsection of the internal spermatic vessels. Subsequently strong collaterals developed. Definitive scrotal transfer was performed six weeks later through an inguinal incision. Two and a half years later, the testes had recovered very well. Their volume had increased markedly, and further development was normal.
Between 1978 and 1991 a total of 136 operations with the laparoscope have been performed. 79 additional laparoscopies were carried out for diagnostic purposes. The most frequent indications for operative laparoscopy were: adhesions, abdominal cysts, tumors, gonadectomy, appendectomy and cholecystectomy. Diagnostic laparoscopies were performed for the differential diagnosis of cholestasis, chronic abdominal pain, intersex and cryptorchidism. The only complication was a scar hernia in a 1,400 gram preterm baby. We recommend laparoscopy because of its smaller trauma and the reduced postoperative complication rate. Furthermore, an advantage is the magnification by the lupes and video, the excellent illumination and exposure.
Dura can greatly facilitate the closure of abdominal wall defects. However, a main disadvantage of its use are the adhesions which develop between omentum, bowel and dura and may lead to bowel obstructions. In this study various groups of rats had either the anterior wall replaced by untreated dura or by dura covered with fibrin glue prior to implantation. Adhesions were found in 75% of sham operated rats, 100% after untreated dura implantation and 50% after the implantation of fibrin glue treated dura.
Explore the source record for details and available documents.
During the last few years the laser has become a very interesting instrument in pediatric surgery. This is the result of the wide variation in tissue interactions and the possibility of specific applications. The CO2 laser is a highly precise cutting instrument whereas the argon laser has its great advantage in the treatment of superficial vascular anomalies. The most important laser in pediatric surgery is the Nd:YAG laser, on the one hand because its radiation can be transmitted by fibres, on the other because with the relationship between interaction time and power density, and the choice of application, it is possible to change the tissue interaction from precise cutting to specific coagulation and homogeneous coagulation. As a result, indications for lasers in pediatric surgery range from the treatment of superficial haemangiomas to typical endoscopic procedures and the resection of parenchymatous organs and tumours.
In many children with cholestasis, ultrasonography can rule out the possibility of biliary atresia. In the few cases when a diagnosis cannot be established by ultrasonography, laparoscopy is still justified as an initial procedure, as the amount of trauma involved is still minimal. Of the 36 children with cholestasis on which a laparoscopy was performed, one-third eventually underwent laparotomy because of biliary atresia. The question was whether the primary laparoscopy was really advantageous. In comparison to laparotomy no advantages were found with regard to anesthesia time; morbidity, or complications. The diagnostic accuracy was comparable to that of laparotomy. The only complication was a small scar hernia in a premature baby.
Tumours originating from the laryngeal skeleton are a rarity. They occur in most cases in adults aged between 40 and 60 years and are seen four times more often in males than in females. A case study of a congenital chondroma of the larynx is presented that resulted in a connatal stridor. It is emphasised that chondromas of the larynx should be considered in differential diagnosis of congenital anomalies of the larynx. Early excision of the complete tumour with minimal destruction of the adjacent laryngeal tissues is recommended as the treatment of choice.
From a total of 174 children treated with malrotations from 1971 to 1988, 148 could be evaluated for long-term results of surgical treatment. The various modalities of treatment were: no correction, dissection of Ladd's bands only, caecoascendopexy, Ladd's procedure and the so-called total correction. Comparing the late results in children with and without correction it was found that those without correction, i.e. without pexy, had to be reoperated in 17% of the cases, whereas the totally corrected children required reoperation in 8% of the cases only. Corrected cases needed to be admitted but not operated later because of pain, constipation, vomiting or poor weight gain in 23%, the uncorrected ones in 6%. Likewise, corrected malrotations resulted in complaints in 27% in contrast to the noncorrected ones in 9%. The conclusion is that total correction results in fewer reoperations but in more symptoms not requiring surgery.
In 6 of 24 infants studied (27th-40th weeks of gestation), acquired and congenital structural anomalies of the airways were detected with an ultrathin flexible fiberscope (Olympus PF18 S, 1.8 mm). Introduction of the fiberscope via a modified four-way T-adapter enabled us to continue artificial ventilation without interrupting oxygen flow or positive pressure ventilation. Tube position, mucus accumulation and partial tube obstruction were determined quickly at the infants' bedside, when problems in artificial ventilation arose.
Malformations of the lung must be detected early before the onset of complications. Therefore invasive diagnostic techniques are increasingly being replaced by less complicated methods such as sonography, colour-coded Doppler sonography, DSA and CT. In certain cases, angiography and thoracoscopy should not be renounced. The use of these methods is preferred in combination with nonoperative techniques: embolisation in av-aneurysms, endoluminal endoscopic resection of congenital bronchial stenoses, stabilization of the bronchial wall in valve mechanisms or thoracoscopical resection of a cyst using fibrin glue to seal the area of resection. These endoscopical procedures are simplified by the application of laser. The smaller the child the more obvious it's advantages.
93 central venous catheters (77 Broviac und 16 ports) were inserted in 79 children with malignant diseases between 1980 and 1988. The median duration of use for Broviac was 5.8 months (0.2-24 months) and for ports 7.5 months (0.8-44 months). The total duration of use was 14 658 days for Broviac catheters and 5970 days for ports. The most frequent complications were dislogements, obstructions and infections. They were observed in 19 out of 77 Broviac catheters (25%) and in 5 out of 16 ports (31%). Because of complications 17 out of 93 catheters were prematurely removed. Complication rates were not significantly different in both systems. The incidence of infections in Broviac catheters was 5% or 0.27 per 1000 days of use, respectively, which is lower than reported by other studies. The consistency in catheter-care procedures can decrease the rates of complications.
The complications of 86 colostomies in 70 patients are reported. The most frequent indications were necrotizing enterocolitis and Hirschsprung's disease. More than half of the children were less than one week of age at the time of surgery. Most frequently transverse colostomies were performed. Most colostomies existed for 1-3 months. In 58% of the children no complications occurred, which could be attributed to the colostomy. Thus, the complication rate of the colostomies was 42%. The most common complications were strictures, adhesions with bowel obstruction, enterocutaneous fistulae, occasionally leading to abscess formation, and candida mycosis.
145 children with duodenal atresia were operated on between 1971 and 1988. 57 were premature, 48 newborn, 11 toddlers and 5 older children. Once the immediate perioperative phase is overcome, the postoperative prognosis is determined only by the severity of associated anomalies. Most atresias were found to be located prepapillary. Trisomy 21, malrotations and vitium cordis were the most frequent associated anomalies. Relaparotomies were required in 21%, mostly because of adhesions.
In newborns with surgically correctable malformations the quality of primary care has considerable influence on the results of the eventual surgical repair. This is particularly true for extensive diaphragmatic and abdominal wall defects as well as for esophageal and intestinal atresia, exstrophy of the bladder and urogenital malformations. The neonatal management comprises measures generally valid for all diseased newborns and measures specific for the particular malformation. The general care concerns heat regulation, fluid balance and other vital functions. Specific regimens are necessary as primary care for diaphragmatic hernia, esophageal atresia, abdominal wall defects and neonatal bowel obstruction. Furthermore this primary management must be extended to include the care of the pregnant mother. Already in utero infants with diaphragmatic and esophageal malformations should be referred to the gynecological-neonatal center.
Laser therapy can be used to great advantage in the treatment of haemangiomas in childhood in specially selected cases. We were able to collect experiences in 101 children and to utilise both the coagulation effect for percutaneous induction of regression and the cutting effect in the resection of haemangiomas at the body surface and the thoracic and abdominal cavities. Among the commercially available laser equipment we would prefer the argon laser for intracutaneous lesions (naevi teleangiectatici, spider naevi, plane haemangiomas), whereas for the cavernous or planotuberous or tuberonodous haemangiomas it is better to use the neodym-YAG laser. Patients must be very carefully selected and selection must be restricted to haemangiomas with complications. Treatment via neodym-YAG laser must be complemented by protecting the skin against cold, by compressing the angiomas and by an appropriate after treatment.
Explore the source record for details and available documents.