Progress in pediatric surgery最新文献

{"title":"Monoclonal antibodies as targeting agents for cytotoxic compounds in vivo: a current assessment.","authors":"J T Kemshead,&nbsp;D H Jones,&nbsp;L Lashford,&nbsp;J Pritchard,&nbsp;I Gordon,&nbsp;F Breatnach,&nbsp;H B Coakham","doi":"10.1007/978-3-642-72643-9_2","DOIUrl":"https://doi.org/10.1007/978-3-642-72643-9_2","url":null,"abstract":"<p><p>Monoclonal antibodies have proved useful in the in vitro diagnosis of tumour type. Radiolabelled antibodies have also been investigated as targeting agents for the in vivo diagnosis of tumour metastasis. These studies have revealed the potential of using 'targeting agents' to identify tumours, but in addition have exposed some of the problems associated with the technique. This review describes our experiences using radiolabelled antibodies for the identification and treatment of tumours arising from the neuro-ectoderm. Based on a small number of 4 patients studies, we conclude that there are limitations on the use of radiolabelled antibodies for targeting isotopes to primary tumour masses. In addition, we outline a possible important role for antibodies in targeting therapeutic agents to minimal residual disease and diffuse tumours presenting as micro-metastasis.</p>","PeriodicalId":76378,"journal":{"name":"Progress in pediatric surgery","volume":"22 ","pages":"30-44"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13639172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgery on solitary kidneys in childhood.","authors":"H D Jaeger,&nbsp;G Gutsche","doi":"10.1007/978-3-642-74241-5_5","DOIUrl":"https://doi.org/10.1007/978-3-642-74241-5_5","url":null,"abstract":"<p><p>From 1969 to 1984, 31 children were operated on for a diseased solitary kidney. There was a peak of incidence during the first 2 years of life, due mostly to congenitally malformed solitary kidneys. In contrast, operations in older children became necessary for diseased residual kidneys. In some children, secondary or even multiple operations had to be performed in order to maintain satisfactory organ function. Except in three preuraemic patients, renal functions were fully compensatory during a follow-up of 1-16 years. Former reservations regarding surgical intervention in solitary kidneys should be dropped in the face of these good operative results.</p>","PeriodicalId":76378,"journal":{"name":"Progress in pediatric surgery","volume":"23 ","pages":"55-9"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13642570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bladder shrinkage as a complication of long-term supravesical urinary diversion in children with solitary kidneys.","authors":"M Gharib,&nbsp;R Engelskirchen","doi":"10.1007/978-3-642-74241-5_7","DOIUrl":"https://doi.org/10.1007/978-3-642-74241-5_7","url":null,"abstract":"<p><p>Failures in the treatment of terminal ureteral stenosis are not seldom burdened by considerable bladder shrinkage, particularly in infants. Congenital anomalies of the urinary tract such as bilaterally ectopic ureteral ostia can also lead to bladder shrinkage, even in newborns. Using examples from our patient series, we discuss problems of contracted bladder in children and describe a method of continuous bladder distention by means of catheters with different balloon volumes and a simultaneous, intermittent, hydrostatic bladder dilatation. This method enables reintegration of a bladder which has been excluded from the urinary drainage system for a long period of time into the urinary tract, even in complicated cases, thus avoiding a permanent supravesical urinary diversion.</p>","PeriodicalId":76378,"journal":{"name":"Progress in pediatric surgery","volume":"23 ","pages":"69-80"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13642572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Problems in severe bilateral urinary tract anomalies.","authors":"O H Nielsen,&nbsp;J Thorup","doi":"10.1007/978-3-642-74241-5_8","DOIUrl":"https://doi.org/10.1007/978-3-642-74241-5_8","url":null,"abstract":"<p><p>Management of children with severe infravesical or bilateral ureterovesical obstruction with or without reflux is difficult. Our experience over 10 years includes 29 such children, 19 of whom presented in the first 3 months of life. At the time of diagnosis, 13 had severe disturbance of renal function. There were two deaths. Five children have severe and two a moderate reduction of renal function; twenty good renal function. There were ten nephrectomies and four heminephrectomies. Seven patients had a temporary and eight a permanent urinary diversion. However, four of the latter were later undiverted. Removal of an obstruction is not always followed by full restitution of function. It seems probable that renal dysplasia and developmental injury to the ureterovesical musculature set a limit to the therapeutic possibilities. Careful management is important, especially in neonatal cases, where extensive reconstructive procedures are technically demanding and the rate of complications is high.</p>","PeriodicalId":76378,"journal":{"name":"Progress in pediatric surgery","volume":"23 ","pages":"81-5"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13643888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The importance of oral sodium replacement in ileostomy patients.","authors":"P Sacher,&nbsp;J Hirsig,&nbsp;J Gresser,&nbsp;L Spitz","doi":"10.1007/978-3-642-74493-8_25","DOIUrl":"https://doi.org/10.1007/978-3-642-74493-8_25","url":null,"abstract":"<p><p>The main function of the colon is fluid and sodium conservation. In ileostomy patients these colonic functions are lacking. The consequence is excessive loss of fluid and sodium, failure to thrive, and skin excoriation around the ileostomy. Patients with ileostomies require 6-10 mmol/kg sodium per day. With ordinary feeds, infants receive 2-4 mmol/kg sodium; therefore the sodium deficit may be estimated at 4-6 mmol/kg per day. Monitoring of adequate sodium substitution is best carried out by measuring the concentration of sodium in spot urine. Levels higher than 10 mmol/l sodium signify an adequate oral sodium intake. During the initial period of oral feeding, glucose excretion in the ileostomy fluid must be monitored, as glucose-positive ileostomy effluence necessitates additional sodium substitution in order to activate the sodium and glucose cotransport. Thirty neonates with ileostomies were followed-up retrospectively. All patients received a sodium substitution of at least 4-6 mmol/kg orally per day. The 30 patients had a total of 4769 ileostomy-days. All patients were successfully fed orally and most of them nursed at home until closure of the ileostomy.</p>","PeriodicalId":76378,"journal":{"name":"Progress in pediatric surgery","volume":"24 ","pages":"226-31"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/978-3-642-74493-8_25","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13656809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgery in solitary kidney and correction of urinary transport disturbances.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76378,"journal":{"name":"Progress in pediatric surgery","volume":"23 ","pages":"1-205"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13644759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis of Hirschsprung's disease by anorectal manometry.","authors":"A Nagasaki,&nbsp;K Sumitomo,&nbsp;T Shono,&nbsp;K Ikeda","doi":"10.1007/978-3-642-74493-8_5","DOIUrl":"https://doi.org/10.1007/978-3-642-74493-8_5","url":null,"abstract":"<p><p>Anorectal manometry was performed in 48 Japanese children with Hirschsprung's disease and 61 normal children. The resting pressure of the rectum and anal canal was not significantly different between these groups of subjects. The frequency of rhythmical contractions of the anal canal of patients was significantly lower than for the normal subjects, but the frequencies overlapped considerably. Therefore, the frequency is an inadequate indicator for identifying these patients. Conventional manometry elicited a distinct rectoanal relaxation reflex from 90% of the normal children, and the rate increased to 98% when indistinct reflexes were regarded as positive. Indistinct reflexes often occur in neonates, possibly because the constriction of the anal canal is weak. However, when prostaglandin F2 alpha was intravenously administered during the examination, all ambiguous reflexes became distinct. Of patients with Hirschsprung's disease, 4% had a distinct reflex and 19% an atypical one. Most of the atypical reflexes were regarded as being artifacts and were mostly attributed to distension by a balloon. In these patients, the reflex was abolished in case of examination with electric stimulation or stimulation with cold water, procedures which do not dilate the rectum. Moreover these atypical reflexes did not fit the criteria for the normal rectoanal relaxation reflex prepared by the Japan Study Group of Pediatric Intestinal Manometry. The use of electric stimulation, cold water, or intravenously administered prostaglandin F2 alpha improves reliability of the conventional anorectal manometry. A clear and accurate definition of the normal reflex should aid in excluding the atypical reflex.</p>","PeriodicalId":76378,"journal":{"name":"Progress in pediatric surgery","volume":"24 ","pages":"40-8"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13656811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of defecation in spina bifida.","authors":"M Maie,&nbsp;M Sakaniwa,&nbsp;H Takahashi,&nbsp;J Iwai","doi":"10.1007/978-3-642-74493-8_11","DOIUrl":"https://doi.org/10.1007/978-3-642-74493-8_11","url":null,"abstract":"<p><p>The main presenting complaint in defecational disorders in spina bifida is constipation. The principal cause of this complaint is hypofunction or paralysis of muscles in the pelvic floor as a result of the spinal cord injuries. To evaluate the present status of defecation, anorectal manometry with special reference to the anorectal pressure profile has been useful. The possibility of using anorectal manometry for the research of anorectal movement and participation of spinal cord was discussed.</p>","PeriodicalId":76378,"journal":{"name":"Progress in pediatric surgery","volume":"24 ","pages":"97-104"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13658082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis of innervation-related motility disorders of the gut and basic aspects of enteric nervous system development.","authors":"J C Molenaar,&nbsp;D Tibboel,&nbsp;A W van der Kamp,&nbsp;J H Meijers","doi":"10.1007/978-3-642-74493-8_19","DOIUrl":"https://doi.org/10.1007/978-3-642-74493-8_19","url":null,"abstract":"<p><p>Motility disorders of the gut in children have become a matter of increasing concern for the pediatric surgeon. Infantile hypertrophic pyloric stenosis is the most common disease requiring surgery in early infancy. While this entity was first described as early as 1888 by Hirschsprung, its etiology and pathogenesis are still an enigma. Fortunately, its surgical treatment is simple and safe, which cannot be said of all other motility disorders of the infantile gut. Dysmotility in small bowel atresia and in gastroschisis is related to damaged smooth muscle cells caused by concomitant ischemia of the bowel wall. In contrast, the temporarily adynamic bowel of the prematurely born child, as well as Hirschsprung's disease and related disorders, is the result of anomalies of the intestinal innervation. The pathogenesis of congenital malformations of the enteric nervous system is still a mystery to surgeons and physicians alike. With his pressure studies of the colon, Swenson first recognized Hirschsprung's disease for what it was. This led to the resection of the manometrically diagnosed abnormal colon, which was found to be aganglionic. Histological investigation of the bowel wall became the decisive tool, replacing manometry, in the diagnosis of Hirschsprung's disease. Histochemical investigation of the bowel wall is not conclusive in other malformations of the enteric nervous system, since the presence or absence of enteric neurons is not the definitive factor discriminating between normally and abnormally functioning bowel. Monoclonal antibodies raised against neuron-specific markers may become important tools for differentiation within the spectrum of congenital malformations of the enteric nervous system. The immunocytochemical technique, however, does not provide sufficient information to explain the cause of innervation disorders of the gut in infancy and childhood. Primary migration disturbances or selective disappearance of enteric neurons following ischemia are highly unlikely to cause aganglionosis of the gut. With respect to the pathogenesis and etiology of Hirschsprung's disease, current research is focused on the embryonic bowel (target organ) in plexus formation. The enteric nervous system is still an enigma, although its origin is known, at least in birds. Why neural crest cells travel, along what paths, how they reach their destination, and what may go wrong during the migratory process, are questions that must be answered. There is increasing knowledge concerning the way in which neural crest cells aggregate and form plexuses in the gut. It is largely unknown why neural crest cells settle, in the bowel, at the sites of the myenteric and submucous plexus.(ABSTRACT TRUNCATED AT 400 WORDS)</p>","PeriodicalId":76378,"journal":{"name":"Progress in pediatric surgery","volume":"24 ","pages":"173-85"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13659665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuronal intestinal dysplasia.","authors":"R Rintala,&nbsp;J Rapola,&nbsp;I Louhimo","doi":"10.1007/978-3-642-74493-8_20","DOIUrl":"https://doi.org/10.1007/978-3-642-74493-8_20","url":null,"abstract":"<p><p>A series of 21 patients with NID is presented. A histologic and histochemical picture of NID was seen in an heterogenous group of patients. NID was associated with bowel obstruction and/or perforation in six neonates and infants. One neonate died. During follow-up the bowel histology gradually normalized in four of the five patients. NID was found incidentally in four patients with anorectal malformations and two with Hirschsprung's disease. Three patients with Hirschsprung's disease and associated NID had chronic proctitis; one patient with an anorectal anomaly had chronic obstipation and megacolon and one proctitis. Two children with multiple endocrine neoplasia 2b syndrome and chronic obstipation had typical NID in their rectum biopsies, as did a 50-year-old woman with CIIP. The clinical heterogeneity of patients with NID suggests that NID may not be a distinct clinical entity but rather a reaction of the neuronal network of the bowel wall and could be caused either by congenital or secondary factors.</p>","PeriodicalId":76378,"journal":{"name":"Progress in pediatric surgery","volume":"24 ","pages":"186-92"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13659666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}