UHD is reliably diagnosed by an AChE reaction in native biopsy sections from the anocutaneous transitional zone and, potentially, from 3 - 4 cm above the pectinate line. As UHD is always accompanied by aganglionosis of the distal internal sphincter, an increase in AChE activity is observed in the nerve fibres of the MCCA. The therapy of choice is a partial myectomy of the distal internal sphincter.
Patient controlled analgesia (PCA) has not yet gained universal acceptance for the management of postoperative pain in paediatric surgery. In a prospective study we evaluated feasibility and complications of PCA following 90 cases of laparoscopic or open appendicectomy. PCA proved to be a safe and feasible method with few complications (2% of medical complications, no abort of application, 17 technical checks in a total running time of 4125 h). Acceptance by patients was high and children of all age groups worked the system properly. Assessment of application protocols showed, that the consumption of analgesics was significantly reduced following laparoscopic appendicectomy (P < 0.05). PCA is a safe and feasible method for the management of postoperative pain in children and PCA recording provides an excellent insight into the consumptional behaviour of patients, enabling staff to evaluate postoperative pain for various procedures.
Hepatic mesenchymal hamartoma is a rare benign tumour in children. It is often large and centrally located in the liver at diagnosis, making surgical resection difficult; thus non-radical resection has been proposed in the past as acceptable management. However, a literature survey and a case with recurrence associated with cytogenetic anomalies suggest that radical liver surgery (resection with a margin of normal liver parenchyma, as for malignant tumour) should be recommended for mesenchymal hamartoma.
The content of chlorinated hydrocarbons (CHC) was determined by means of capillary column gas chromatography in samples of fat tissue from 183 healthy children, 46 children with malignant tumors and 33 children with benign tumors or congenital malformations. The highest concentrations were found for total polychlorobiphenyls (PCB) (mean = 1.614 ppm), followed by the DDT group (mean = 0.556 ppm, HCB (mean = 0.097 ppm), the HCH isomers (mean = 0.083 ppm), dieldrin (mean = 0.020 ppm) and total heptachlor (mean = 0.010 ppm). Neonates displayed high concentrations in the adipose tissue before the first uptake of food. In the first six months of life, the concentrations of total PCB, the individual PCB components as well as DDT and HCB decreased significantly. In the second year of life, they rose again to the initial values and then remained relatively constant during the rest of childhood. The regional differences with regard to total CHC residues were slight, so that the CHC exposure cannot be reduced by a change of domicile within West Germany (FRG). Children with congenital malformations or benign or malignant tumors do not display raised concentrations of CHC.
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