[Which interventions can be performed on an outpatient basis in pediatrics].
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Ambulatory Surgical Procedures↗
Biomedical subjects
T A Angerpointner
Publications and source records attributed to T A Angerpointner.
[Ambulatory pediatric surgery--indications, results and limits].
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Adolescent↗
Surgery for benign and malignant diseases of the thyroid gland in childhood.
From 1970 to 1986, 51 children and adolescents aged 5-18 years were operated on for diseases of the thyroid gland, among them 42 with benign diseases (juvenile goiter 21, adenoma 17, Graves' disease 3, Hashimoto's thyroiditis 1) and nine with malignancies (papillary carcinoma 4, follicular carcinoma 3, medullary carcinoma 1, anaplastic carcinoma 1). In benign entities, females were three times as often affected as males, whereas both sexes were equally affected in malignancies. Positive family histories were found in 23.3% of the children with adenomas in 71.4% of the children with juvenile goiters. Subtotal strumectomy was carried out in 30 instances and enucleation in 12. Iodized salt and L-thyroxine were given postoperatively as recurrence prophylaxis. Recurrence was seen in two children (4.8%) who had no recurrence prophylaxis. Symptoms in children with malignancies were palpable cervical lymph nodes and solitary nodes in the thyroid gland. Total thyroidectomy was done in all instances, followed by radio-iodine treatment in eight cases and cobalt 60 irradiation in one case. Two children died, of diffuse metastases and irradiation fibrosis of the lung respectively. The peculiarities of diseases of the thyroid gland in childhood that require surgery are discussed.
Adenocarcinoma↗
[Ambulatory surgery in pediatric surgical practice--results of a questionnaire review of 467 children].
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Adolescent↗
[Ambulatory pediatric surgery--possibilities and limits].
Pediatric surgical operations performed on an ambulatory basis in a practice are still rare in Germany. Prerequisites, indications, possibilities and limitations are presented. Some 869 operations were performed under general anesthesia within 21 months. Of the children 70% were under 5 years of age. The postoperative results were evaluated by means of a questionnaire in 352 children. Early complications occurred in five instances (1.4%) and late complications in one child (0.3%); hernia recurrence). Observing the possibilities and limitations, ambulatory pediatric surgery yields good results and takes the peculiarities of children into consideration.
Adolescent↗
Haemostasis in injuries of parenchymatous organs by infrared contact coagulation.
A series of 11 children aged from 1 day to 12 years is reported in which infrared contact coagulation with a sapphire coagulator was used for haemostasis in liver and splenic injuries. Seven children were cured. The four deaths were not related to the injuries of parenchymatous organs. Infrared contact coagulation is a suitable and cheap method for organ preservation in injuries or other pathological conditions of parenchymatous organs in childhood.
Adolescent↗
Course of pregnancy, family history and genetics in children with spina bifida.
Course of pregnancy, family history and genetics were evaluated in 257 children with spina bifida and compared with 537 non-malformed controls investigated under the same criteria. Birth data exhibited a significant seasonality with a maximum in January and a minimum in July which differed from the average distribution of birth data in Bavaria (maximum April, minimum October). The total number of pregnancy disturbances was 60.6% in mothers of spina bifida children, whereas this figure amounted to 30.1% in mothers of the control group. This high incidence of pregnancy disturbances in spina bifida was due to a high rate of diseases (6 times above controls) and drugs (6 times above controls) during early pregnancy. In 22.9% of children with spina bifida malformed relatives were found, whereas this was the case in only 6.4% of the children of the non-malformed control group. Not only malformations of the central nervous system but also malformations of other organ systems were found to be increased in relatives. This is a pointer not only to genetic influences as well-known aetiological factor, but also towards a generally higher susceptibility to malformation genesis in a relatively small group of persons. Risk of recurrence was 0.5% if one parent was affected and 4% if a sibling was affected.
Abnormalities, Multiple↗
Catamnestic investigations in children with congenital hydrocephalus.
Catamnestic investigations on the course of pregnancy, family history and genetics were carried out in 141 children suffering from congenital hydrocephalus. The results were compared with those obtained from a group of non-malformed controls investigated by the same criteria. There was a considerably higher incidence of pregnancy disturbances (i.e. diseases, drugs, haemorrhage etc.) in mothers who later gave birth to a child with congenital hydrocephalus, than mothers of the control group (congenital hydrocephalus: 61.3% vs. controls: 30.1%). This high incidence of pregnancy disturbances could be particularly referred to a sevenfold increased rate of diseases and a fourfold increased rate of drug intake during the first trimester. There was also a higher rate of malformed relatives in children with congenital hydrocephalus (16.7%) than in controls (6.4%); not only were malformations of the central nervous system found to be increased but also malformations of other organ systems in relatives. This is interpreted as a hint not only at genetic influences but also at a generally higher incidence of malformations in a relatively small group of persons. Calculated figures of recurrence risk were in accordance with empirical data used in genetic counselling.
Abnormalities, Multiple↗
Resection of an intrathoracic tracheal stenosis in a child.
A 6-year-old boy sustained a severe head injury during a traffic accident. He was first treated at another hospital. Despite a short intubation period of only 3 days, within 4 weeks he developed severe tracheal stenosis, with a residual lumen 3 mm in diameter and a total length of 2.3 cm, ending 3 cm above the carina. After initial bougienage enlarging the lumen to 6 mm in diameter, surgery was performed at our hospital 6 weeks after the accident. The stenosis was resected in toto, and tracheal continuity was restored by interrupted sutures using the Grillo technique. The postoperative course was uneventful. Follow-up tracheoscopy 3 months later showed a residual stenosis of 20% within the anastomotic region, and the patient was free of symptoms.
Child↗
Historical aspects of hydrocephalus.
From early days on physicians took interest in hydrocephaly because of its grotesque appearance. Already Hippocrates recommended decompression-trepanation for the treatment of hydrocephalus. Only since anatomy and pathophysiology of hydrocephalus as well as production and absorption of the cerebrospinal fluid was clarified, more effective operative techniques could be developed. Conservative treatment was unsuccessful or was useful only as temporary or adjuvant therapy supporting surgical procedures. A great variety of operative methods was described since the middle of 19th century which yielded, however, unsatisfactory results in most instances. Results improved since the introduction of effective valve systems in combination with ventriculoatrial and ventriculoperitoneal shunts. Despite of improved results, the treatment of hydrocephalus remains problematic as is shown by the still high complication rate and the restless search for more effective ways of treatment.
Bibliographies as Topic↗
Progress in the diagnosis of gastroesophageal reflux in childhood: 24-hour pH monitoring.
Twenty-four-hour pH monitoring is a reliable and secure method for use in the diagnosis of gastroesophageal reflux (GER). Compared with other methods, this technique is well tolerated and without complications. In contrast to other techniques (cineradiography, manometry, scintiscanning, endoscopy), long-term pH monitoring is the only method to measure the dynamics in the distal esophagus under nearly physiological conditions and to register the data obtained via pen writer for any time desired. Thus, 24-h pH monitoring is the most sensitive and expressive method for the diagnosis of GER in childhood, providing more secure operative indications combined with other methods.
Child, Preschool↗
[A case of ruptured congenital neuroblastoma caused by birth injury].
A 3,900 g full-term male newborn had to be operated on for suspected intraabdominal bleeding due to birth injury. Intraoperatively, a tennis-ball sized, ruptured tumor between right kidney and liver was found to be the source hemorrhage. The tumor was excised in toto. The newborn died 25 hours after the end of operation from protracted shock and renal failure. Post mortem examination did not reveal further malformations or metastases. Histological diagnosis: congenital neuroblastoma of the adrenal gland. Improved antenatal ultrasound diagnosis followed by cesarian section could help to improve the prognosis in such cases in future.
Abdominal Neoplasms↗
[Preoperative risk assessment in pediatric surgery].
The further development of the risk score presented by us in 1976 combined with Peter's score now permits a satisfactory preoperative risk estimation in pediatric surgery for all age groups. The score includes 18 lines for all significant preoperative parameters and the procedure planned. Each parameter is judged by a number of points according to its significance (1-4 points). An increasing number of points indicates an increasing operation risk. The evaluation of 533 cases using this core proved it to be a reliable preoperative risk estimation.
General Surgery↗
Hypospadias--genetics, epidemiology and other possible aetiological influences.
Questionnaires relating to 515 children with hypospadias were evaluated in respect of course of pregnancy, family history and epidemiology. The domiciles were more often in rural areas as compared to the average population in South Bavaria. A seasonal trend favouring the six months' period December to May could be observed. Children with hypospadias especially of higher degree were more often preterm and more frequently firstborn. 59 children (11.5%) had associated malformations particularly of the urogenital tract. Mothers of children with high-degree hypospadias were remarkably young and conspicuously often wives of farmers. There was a clear correlation between the degree of hypospadias and threatened abortion, drugs, sexhormones and other disturbances during early pregnancy. The trend to lower age classes could be also observed in fathers. The incidence of hypospadias in fathers was 5-fold and in brothers 30-fold above average. The risk of recurrence was 1.4% if the father had a hypospadia and 6% if a brother had hypospadias. The incidence of other malformations did not seem to be enhanced in relatives.
Adult↗
[Time of death in diseases with lethal outcomes in a pediatric surgery department and a pediatric hospital].
Thirteen hundred twenty five deaths in children were investigated at the Dept. of Pediatric Surgery of the University Children's Hospital Munich and the University-Children's Hospital Giessen in order to evaluate a possible correlation between time of death and time during the day. Subdividing according to age groups and pediatric-surgical and pediatric cases, there was no accumulation of deaths between 2 and 6 o'clock a. m. as could have been expected according to Aschoff. On the other hand, between 12 und 3 o'clock p. m. there was an increase of deaths which was partly statistically significant and in accordance with Aschoff's findings. One can deduce that during the early afternoon hours technical and nursing potentialities for compensation were not fully used, whereas this seemed to be the case during early morning hours. Therefore it should be attempted to optimize personal and technical expenditures particularly during the early afternoon hours.
Child↗
[Preoperative risk evaluation in juvenile ileus].
Preoperative risk calculation in children with bowel obstruction allows early therapeutic measures to improve prognosis. In a retrospective study the preoperative status was evaluated in 310 newborns and 127 children beyond the newborn period who had to be operated for bowel obstruction. Preoperative parameters were: age, birth weight (newborns), weight, body temperature, red and white blood count, electrolytes, urea-nitrogen, total serum protein, pH, PO2, PCO2 and base excess. These parameters were compared in surviving children and children who died postoperatively. In newborns a statistically significant difference between both groups was found for birth weight, rectal temperature, pH and total serum protein, whereas in children beyond the newborn age the same was true for age, weight and total serum protein. Besides well balanced electrolytes and good management of artificial respiration, total serum protein and in newborns additionally blood-pH and rectal temperature must be normalized preoperatively to reduce the risk in children with bowel obstruction.
Acid-Base Equilibrium↗
Infrared-contact coagulation of parenchymatous organs - report of three cases.
Infrared-contact coagulation of the spleen with an infrared-sapphire-coagulator was applied in two children with subcapsular hematoma and splenic cyst, thereby achieving complete and partial organ preservation, respectively. This method was also used for haemostasis following the dissection of a common liver in Siamese twins. Infrared-contact coagulation is a proper method for organ preservation in injuries or other pathological conditions of parenchymatous organs.
Child↗
The effect of moderate hypoxaemia on cardiac performance in the newborn during anaesthesia and surgery - experimental studies in newborn and two-week-old piglets.
Circulatory adaptation to hypoxaemia was studied under anaesthetic and surgical conditions in 10 newborn (age 8-42 h, weight 850-1800 g) and 8 two-week-old piglets (12-16 days, 1400-3600 g). Arterial PO2 was lowered from 60-100 mmHg to 30-40 mmHg by reducing FiO2 (concentration of oxygen during inspiration) at otherwise constant conditions; control studies were performed under the same standard conditions maintaining normoxaemia during the whole experiment in 8 newborn and 8 two-week-old piglets of comparable weight. In both hypoxic groups a prompt compensatory, statistically significant increase of cardiac performance defined by aortic blood pressure, cardiac output, peak aortic flow, stroke volume and cardiac power appeared within a few minutes of hypoxaemia, reaching a maximum half an hour later. Thereafter cardiac performance decreased steadily leading to cardiac failure. Newborns survived 197 +/- 96 min and two-week-old animals 172 +/- 128 min. Peripheral vascular resistance decreased significantly at the time of compensatory increase of cardiac performance, but increased subsequently to a maximum shortly before cardiac failure. Compensatory increase of cardiac performance was more distinct in newborn than in two-week-old piglets. Heart rate increased steadily during exposure to hypoxaemia in both groups reaching a maximum 110 min later and falling back to pre-experimental levels at the end of study. The newborn normoxic controls tolerated the experimental model significantly longer (461 +/- 167 min; P less than 0.001) than the newborn hypoxic piglets. Their response pattern, however, was basically similar. Increase of cardiac performance reached its maximum not before 130 min after the end of the pre-experimental period with subsequent fatal decrease of cardiac performance leading to cardiac failure. Two-week-old normoxic control animals responded qualitatively identically compared with the two-week-old hypoxic animals. Despite normoxaemia their average survival time did not differ significantly (209 +/- 86 min). In all four groups severe metabolic acidosis appeared in most instances during the study, irrespective of hypoxaemia or normoxaemia. Failure of stress tolerance depended on the decrease of pH per hour. This relation was more distinct in normoxic animals. In both hypoxic groups survival time correlated well with the increase of heart rate during hypoxaemia (R = 0.71 in newborn, P less than 0.05; R = 0.86 in two-week-old piglets, P less than 0.01, respectively). This correlation could not be found in the normoxic piglets.
Adaptation, Physiological↗