Esophageal atresia in Bremen, Germany--evaluation of preoperative risk classification in esophageal atresia.

Background/purpose: The current study enrolled 113 patients with esophageal atresia (EA) accompanying tracheoesophageal fistula (TEF) (Vogt type IIIb) who were treated at the Central Hospital St. Jürgen Strasse, Department of Pediatric Surgery in Bremen, Germany between 1978 and 1997.

Methods: These EA patients were classified into patients preoperatively complicated by respiratory distress syndrome (RDS) or pneumonia and those without complications.

Rehbein's procedure for Hirschsprung's disease. An appraisal of 45 years.

A retrospective follow-up study of all children treated for Hirschsprung's disease over the last 45 years at the Department of Pediatric Surgery, Children's Hospital, Bremen was done to evaluate the results of Rehbein's procedure. A total of 416 children underwent Rehbein's lower anterior resection. The postoperative outcome was analysed in detail for early and late complications like wound infection, pelvic abscess, anastomotic stenosis, anastomotic insufficiency, postoperative enterocolitis, persistence of constipation, fecal and urinary incontinence, recurrent achalasia, need for reoperation, adhesion ileus and mortality.

Extracranial non-testicular teratoma in childhood and adolescence: introduction of a risk score for stratification of therapy.

Patients And Methods: According to previous literature incomplete tumor resection, coccygeal or ovarian primary site and immaturity are known risk factors for relapse in teratoma. To establish a risk score points are allocated for resection, primary site and histology in the following manner and added: incomplete resection 4 points, primary site coccyx 3 points, ovary 2 points, other site 1 point, histological grading 0-3 points. This score system is evaluated on 270 extracranial non-testicular teratoma cases collected between 1982 and 1995 in the MAKEI cooperative treatment protocols of the German Society of Pediatric Oncology and Hematology.

Embryonal rhabdomyosarcoma of the common bile duct.

A 2 4/12-year-old boy with obstructive jaundice caused by a tumor of the portal area that proved to be an embryonal rhabdomyosarcoma of the common bile duct is reported. The diagnosis was made clinically, radiographically, ultrasonographically, and histologically. Surgery was elected as the primary therapy; there were no intra- or postoperative complications.

Current surgical strategies in long-gap esophageal atresia with regard to endoscopic anastomosis.

Elongation procedures for long-gap esophageal atresia are discussed. Elongation treatment according to Howard and Myers was performed in seven cases. Primary anastomosis following advance treatment could be carried out five times and esophageal elongation and anastomosis by means of the olive-and-thread method in two cases.

Endoscopic esophageal anastomosis.

This paper describes four cases of esophageal atresia without a lower fistula in which a perlon thread was inserted through the two esophageal segments by an endoscopic method. With the aid of the thread and two metal olives the segments were drawn closer together and finally a communication was established without an operation. The method of introducing the thread and the olive technique are demonstrated in a series of drawings, and the results achieved in the case of four children are also presented.

[Respiratory disturbances caused by vascular tracheal compression after repair of oesophageal atresia (author's transl)].

Interference with respiration, caused by stenosis of the trachea after an operation for oesophageal atresia, is described. The narrowing of the tracheal lumen through blood vessels is particularly mentioned. Tracheal stenoses through the truncus brachiocephalicus, which cause serious symptoms following operation on oesophageal atresia, have a particular part to play.

Discussion on atresia of oesophagus.

Combined malformations and dysmaturity are still the most important causes of postoperative complications and deaths in the treatment of congenital oesophageal atresia. Better results can only be expected if methods of therapy of these associated conditions can be improved.