Intestinal lengthening is considered to be one of the most effective surgical interventions to improve the deleterious sequelae of short-bowel syndrome. To assess the efficiency of bowel-lengthening procedures in short-bowel syndrome, an animal model was created in minipigs that show malnutrition, weight loss and small-bowel dilatation. Group 1 consisted of three animals with a 95% distal intestinal resection leaving 15 cm of ileum. Group 2 comprised six animals with a 95% distal intestinal resection leaving only 5 cm of ileum, and group 3 consisted of three animals with a 95% distal intestinal resection leaving 5 cm of ileum and construction of a distal small-bowel stenosis by temporary banding. In group 1 there was a significant increase in length of residual bowel at terminal laparotomy at 10 weeks and a significant difference for protein and potassium. No bowel dilatation occurred and no animal lost weight. Group 2 animals showed a continuous loss of weight after the intestinal resection and significantly different values in animal profile were found at 10 weeks but no significant difference in length or in diameter of the residual bowel. In group 3, all animals demonstrated a significant dilatation of the residual small bowel at 1 week when the stenosis was resected and bowel continuity restored. We conclude that in piglets a 95% distal intestinal resection leaving 5 cm of ileum leads to a short-bowel syndrome with malnutrition and weight loss, but no intestinal dilatation. To provoke an additional intestinal dilatation, creation of a distal stenosis is mandatory. Animals of group 3 represent a suitable model to assess the efficacy of short/bowel lengthening procedures.
From 1974 to 1992 fifty-two patients with congenital or acquired skull defects were operated at the Department of Pediatric Surgery of the University Children's Hospital of Zurich. By 1988, in 26 patients conventional methods with PMMA (polymethyl methacrylate) plasties or rib plasties were performed. After 1988, in 26 patients skull reconstruction was done by skull splitting, application of lyophilized bone or cartilage or a combination of both. In the latter period, stabilization and fixation was always provided by biodegradable screws and bands. The results of the different techniques were compared in a retrospective fashion. PMMA plasties provided immediately full stability and good cosmetic results. Another advantage was their availability. In one patient (= 4.8%), a wound infection required the removal of the plasty. In two other patients (9.5%), an increasing mobility of the plasty could be observed during skull growth. Rib plasties were not satisfying. Skull splitting or reconstruction with lyophilized bone or cartilage showed good results with a stable integration within 3-4 months. In one patient (4%), a superficial wound infection occurred, but it did not affect the plasty. From the present study, we conclude that skull splitting or the reconstruction of skull continuity by means of lyophilized bone or cartilage with fixation through biodegradable screws and bands are the methods of first choice in children, because they are fully integrated, avoid foreign material and might have a slightly lower risk of infection. In addition, removal of the implants may be avoided.(ABSTRACT TRUNCATED AT 250 WORDS)
An 11-year-old boy suffered from macroscopic haematuria and bilateral flank pain a few days after uneventful appendectomy for retrocaecal appendicitis phlegmonosa. Ultrasonography revealed a complete bilateral distal obstruction of the ureters. Renal failure due to postrenal anuria resolved completely after intravenous antibiotics.
Neuronal intestinal dysplasia is histologically and histochemically well defined. The resection of the neuronal dysplastic segment is usually recommended in the literature as being curative. Whether a resection is necessary in every case remains to be debated. The case history of a male patient with Hirschsprung's disease and proximal intestinal neuronal dysplasia of the entire colon is presented. After manometrical, radiological and functional examination the aganglionic portion of the gut only has been resected and the neuronal dysplastic part has been left in situ. Several months later the patient is well. It seems possible to avoid in some selected cases a subtotal or total colectomy.
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