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Biomedical subjects

O Reinberg

Publications and source records attributed to O Reinberg.

At least 19 recordsLinked to original sources
PubMed2003

Interstitial cells of Cajal are normally distributed in both ganglionated and aganglionic bowel in Hirschsprung's disease.

Surgery for Hirschsprung's disease is often complicated by post-operative bowel motility disorders. The impact of intestinal neural histology on the surgical outcome has been previously studied, but no information is available concerning the influence of the distribution of interstitial cells of Cajal (ICC) on these complications. These cells are considered to be pacemakers in the gastrointestinal tract. The aim of this study was to assess the distribution of ICC in the proximal segment of resected bowel in Hirschsprung's disease and confront these results with the clinical outcome. Using immunohistochemistry for light microscopy, we compared the pattern of distribution of ICC in the proximal segment of resected bowel in Hirschsprung's disease with that in normal colon. We correlated these results with the corresponding neural intestinal histology determined by CD56 and the protein gene product 9.5 immunohistochemistry. The distribution of ICC in the proximal segment of resected bowel is identical to that of normal colon, regardless of normal or abnormal colon innervation. ICC distribution does not seem to contribute to post-operative bowel motility disorders in patients operated for Hirschsprung's disease

Child↗
PubMed2003

Open or closed pinning for distal humerus fractures in children?

INTRODUCTION: In children, the choice between percutaneous pinning (PP) and open pinning fixation (OPF) for the surgical treatment of fractures of the distal humerus remains controversial, especially the PP method for internal humeral condylar (IHC) fractures. PATIENTS AND METHODS: Eighty fractures of the distal humerus in children were treated surgically in our hospital over a ten year period. 47% (n = 38) were supracondylar (SC), 20% (n = 16) comminuted (COM), 18% (n = 14) internal humeral condylar (IHC), and 15% (n = 12) lateral humeral condylar (LHC). We used PP, OPF and three times osteosynthesis with screws. RESULTS: In comparison to OPF, PP reduced the length of hospitalization in SC fractures (2.8 versus 6.1 days) and IHC fractures (2.4 versus five days). It reduced the risk of extension deficiency (11.1% versus 15%) and of cubitus valgus (0% versus 20%) in SC fractures, and of cubitus varus in IHC fractures (0% versus 11.1%). However it induced a higher rate of cubitus valgus (11.1% versus 20%) in IHC fractures, one persistent neurological motor deficiency (radial nerve) and four cases of transitional neurological involvement (ulnar nerve). CONCLUSIONS: PP is a good surgical method for SC and for also for IHC fractures, if performed by experienced surgeons so as to avoid neurological damage.

Adolescent↗
PubMed2001

Imaging of blunt arterial trauma of the upper extremity in children.

We report four patients with blunt arterial trauma of the upper limb following unusual mechanisms of injury in two patients (one fell on the handlebars of his bicycle, the second was crushed by a moving lawn mower) and due to bicycle accidents in two further patients. The use of digital subtraction angiography (DSA) in all patients, together with colour Doppler imaging (CDI) in one patient, provided optimum preoperative identification and localisation of the arterial lesions.

Angiography, Digital Subtraction↗
PubMed2001

Laparoscopic surgery for gastroesophageal reflux disease during the first year of life.

BACKGROUND: Very few children need gastroesophageal antireflux surgery during their first year of life; hence, no series has been published so far. The authors report their experience in 3 centers. METHODS: From January 1993 to December 1998, 36 infants between 23 days and 13 months of age, suffering from gastroesophageal reflux disease (GERD), underwent surgery by a laparoscopic approach. The patients' weights ranged from 2.4 to 8.5 kg. Preoperative diagnostic studies included esophagograms, manometries, endoscopies, and pH-metries. Fifteen babies (41.6%) had associated anomalies, and 10 (27.7%) were neurologically impaired. Thirty-six laparoscopic fundoplications were performed according to either Toupet's procedure (17 of 36), Rossetti's (10 of 36), Nissen's (8 of 36) or Lortat-Jacob's (1 of 36). Four infants previously had undergone a gastrostomy, whereas 6 needed one during the antireflux procedure. RESULTS: There was no mortality in our series. Three infants (8.3%) had an intraoperative complication: 1 lesion of a diaphragmatic vessel, 1 pneumothorax, and 1 case of severe hiatal hernia requiring conversion to open surgery. During the median follow-up of 22 months, 4 redo procedures were performed (11.1%). CONCLUSIONS: This experience shows the feasibility of laparoscopic fundoplication even in children below 1 year of age. An accurate preoperative diagnostic study is mandatory, because 50% of these patients presented associated anomalies. A long and accurate follow-up is necessary to evaluate long-term results and detect possible complications, which can occur as late as 1 year after surgery. In addition, we believe that redo antireflux surgery is possible by the laparoscopic approach without major difficulties, based on our larger experience with older children.

Abnormalities, Multiple↗
PubMed2001

[Accident prevention in early childhood].

Accidents are the first cause of mortality and morbidity in children and adolescents of both sexes as from their first month of life. Also they are the first cause of hospitalization and thus have an important economical impact. The knowledge of the mechanisms of injury can neither be transposed from a place to another nor be extrapolated with time. For this reason we developed in 1989 a prospective data base for injuries of children and adolescents from 0 to 16 years of age occurring in our state (canton de Vaud, Switzerland). From Jan 1st, 1990 to Dec 31st, 1999, we recorded more than 28,000 cases. Infants and young children are involved in domestic injuries, accidents on playgrounds and in traffic accidents being pedestrians or passengers. We analyze the circumstances of accidents and point out their prevention programs and their efficiency. We try to demonstrate why children injuries are not fatalities but depend on mechanisms which can be predicted inarticular by an adequate information.

Accident Prevention↗
PubMed1999

Tracheobronchial ruptures from blunt thoracic trauma in children.

BACKGROUND/PURPOSE: Tracheobronchial ruptures in blunt thoracic trauma in children are rare. The aim of this study was to suggest the means of an early diagnosis and a conservative management as often as possible. METHODS: Sixteen cases of tracheobronchial ruptures by blunt thoracic trauma were observed over 26 years in 9 regional pediatric centers. RESULTS: There were 12 boys and 4 girls, from ages 1 hour to 17 years. Nine children presented with associated lesions. Fibroscopy established the following diagnosis: 8 tracheal wounds and 8 bronchial wounds. Six children were operated on within 18 hours (on average) after installation of a thoracic drainage. Two lobectomies, 3 ideal tracheal sutures, and 1 bronchial suture were performed. Seven children were treated exclusively by thoracic drainage. Two of them were intubated through the lesion, leading to a transitory endoprothesis accompanied or not by an external thoracic drainage. One infant recovered spontaneously. There were no deaths in this series. Two recurrent postoperative nerve injuries were noted, one of which was a transitory spontaneously resolutive scar bud and one a granuloma treated by laser. Three times, a stenosis occurred after a conservative management. Two were operated on. CONCLUSIONS: Tracheobronchial ruptures in children are rare. An early fibroscopy holds an important place in the approach of this pathology. Treatment is variable, based on thoracic lesions, their tolerance by the child, and associated lesions. Surgery is not the only therapy because conservative treatment by simple thoracic drainage or lesion intubation has proved effective.

Adolescent↗
PubMed1997

Esophageal replacement in children: evaluation of the one-stage procedure with colic transplants.

After having practiced two-stage esophagoplasties by retrosternal Iso-peristaltic colic transplant since 1966, we introduced the one-stage procedure in 1989, placing the transplant in the posterior mediastinum following a closed-chest esophagectomy. We have performed 121 such esophagoplasties in children until now. To evaluate the possible effects of the different techniques as accurately as possible, we recorded two uniform series of 32 and 41 esocoloplasties carried out under identical conditions by two operators respectively. All of the children, aged 1.2 to 13.9 years (mean age: 4.3 years and 4.8 years, limits 1.2-13.9 years), were operated upon for caustic burns of the esophagus. The general concept of both interventions is the same. Improvements such as optimizing the proximal and the colo-gastric anastomosis and the creation of an anterior anti-reflux hemi-valve were aimed for. The one-stage esophagoplasty has become a shorter procedure (mean 4.9 h) than the two-stage one (mean 5.7 h). The one-stage procedure has no higher rate of per-operative complications than those observed during the two-steps of the staged operation. One-stage esophagoplasty provides better morphological results. The redundancy of the transposed colon, the narrowing effect of the upper cervical passage and of the point of re-entry into the abdominal cavity are avoided. The mediastinal colon is straighter, which allows better emptying by gravity. The improvement of the lower anastomosis decreases the reflux rate in the transplant to 12%. Postoperative care demands a longer stay in the intensive care unit because of pharyngeal and left pulmonary respiratory complications. For these reasons we kept our patients intubated for a period of 2 to 5 days (mean period: 3.4 days). All patients survived the intervention.

Adolescent↗
PubMed1995

Imaging evaluation of blunt renal trauma in children: diagnostic accuracy of intravenous pyelography and ultrasonography.

Forty-six consecutive children with blunt renal injury were evaluated retrospectively to assess the diagnostic accuracy of the different imaging methods, including ultrasonography (US), intravenous pyelography (IVP), and computed tomography (CT), and to determine the optimal radiologic management. Doppler ultrasonography was never performed in an emergency. Classification of the 46 renal injuries was as follows: 25 contusions, 4 lacerations, 11 ruptures, and 6 pedicle injuries. The diagnostic accuracy of IVP (80.8%) was superior to the diagnostic accuracy of US (41%) in all types of renal injuries. IVP should be performed as an emergency procedure when macroscopic hematuria is present, or when an isolated renal injury is clinically suspected. Microscopic hematuria alone is no longer an indication to perform IVP. Asymptomatic patients with microscopic hematuria should have US examination and should be observed with performance of serial urine analyses. Multiply injured and hemodynamically stable children should be evaluated by contrast-enhanced CT. Hemodynamically unstable children should undergo immediate exploratory laparotomy, if it is indicated after assessment by imaging.

Child↗
PubMed1994

[Epilepsy and accidents: what is the risk in children?].

BACKGROUND: Constant distress and overprotection of parents result from the apprehension and misinformation received, regarding epilepsy of their children and the risk of accidents occurring due to a seizure. Large retrospective studies show that the epileptic children are not more often concerned than the general population. CASE REPORTS: One hundred and ninety-eight epileptic children without permanent motor or mental handicap were followed between 1971 and 1981, covering 1056 years of child's life. They were compared to 3822 injured children admitted to the surgical pediatric emergency unit between 1983 and 1992. RESULTS: Only six accidents occurred because of a seizure in the first group of epileptic children. There were neither deaths nor sequelae. Four of these six accidents revealed an unknown epilepsy. Among the 3,822 injured children, 19 were epileptic but only four of these 19 accidents were caused by a seizure. There were no sequelae. CONCLUSION: The majority of epileptic children without associated handicap are able to have all the normal activities of healthy children. Only severe epilepsies with frequent refractory seizures, some reflex epilepsies and some cases before the seizures are under control require constant supervision.

Accidents↗
PubMed1994

[Treatment of pediatric fractures by intramedullary stable elastic pinning].

During the past decade several new techniques for the treatment of children's fractures respecting the specificity of the growing bone have been described. The goal of all these techniques was to mechanically stabilise the fracture however to preserve a certain instability of the fracture gap itself inducing early callus formation and subsequent consolidation. The dynamic external fixation as well as the elastic stable intramedullary pinning have become accepted means in the treatment of long bone fractures in the paediatric age group. We report our experience of the last seven years with the intramedullary pinning of 105 fractures. Eighty-four were fractures of the femur, 9 of the humerus, 8 of the forearm, and a further 4 of the tibial shaft. The intramedullary elastic pinning represents a simple technique which supports or even enhances the natural process of fracture healing of the growing bone. The method is not very invasive, is cost effective, and allows short hospitalisation. Early physical activity is guaranteed due to early consolidation of the fracture. Complications are rare and the final orthopedic and cosmetic outcome is excellent.

Adolescent↗
PubMed1993

Predisposing factors in obstetrical fractures.

To compare various obstetrical methods with different types of obstetrical fractures, 29 neonates with fractures were evaluated retrospectively. Plain films of skull, limbs and chest were obtained. Transfontanellar ultrasonography was performed in one case and a computed tomographic scan of the skull in two. We reviewed 12 fractures of long bones, 7 fractures of the skull, and 10 fractures of the clavicle. Ten fractures occurred during caesarean sections and 11 in vaginal delivery requiring medical assistance. Depressed skull fractures were associated with manoeuvres and the use of forceps during delivery. Fractures of the long bones were associated with caesarean section, breech delivery with assistance and low birth weight. All fractures were treated conservatively except for skull fractures with depression of more than 2 cm. Early consolidation occurred in all fractures of long bones. The long-term follow-up of all fractures but one revealed no persisting disability. The belief that obstetrical fractures occur primarily in large babies or after breech delivery is not supported by this study.

Adult↗