In 1968 the first contacts were arranged with the publishing house of Urban & Schwarzenberg concerning the establishment of a periodical to be produced in English with the aim of publishing important scientific work in pediatric surgery and related disciplines. I thought especially of certain excellent inaugural disser tations and theses. When Urban & Schwarzenberg promised to start such a series, I recruited Peter Rickham, then in Liverpool and now in Zurich, and Jean Prevot of Nancy as executive editors. We chose the title Progress in Pediatric Surgery - Fortschritte del' Kinderchirurgie - Acquisitions en Chirurgie Enfantile as the name of our new series. The first volume was published in 1970, followed by another 16 volumes during the next 14 years. At the suggestion of Michael Urban, we turned from the publication of long papers to theme-based volumes, which proved to be extraordinarily useful. Mr. Urban, the head of Urban & Schwarzenberg, told us in 1982 that his firm could no longer look after Progress in Pediatric Surgery. With the agreement of Mr. Urban, we had to look for another' publisher and found Springer-Verlag, who agreed to continue publishing Progress in Pediatric Surgery in the approved lay-out. We cordially thank Dietrich G6tze of Springer-Verlag for his helpful support. This volume (No. 18) is the first of Progress in Pediatric Surgery to appear under the guidance of Springer-Verlag. We want to express our thanks to Mr. Urban and Dr."

At first sight it may appear strange that a volume of Progress in Pediatric Surgery should be devoted to the history of our specialty. One assumes that progress is concerned primarily with recent developments whilst history deals with matters of the past. However, in the past there has also been considerable progress in the development of our understand ing of paediatric surgical problems, otherwise we would not have pro gressed to our present achievements. The editors, therefore, do not apologize for compiling this volume but, on the contrary, feel that the publication of this volume is most timely. Modern paediatric surgery has now been practised for three genera tions. The handful of pioneers who were the founders of our specialty worked mainly before the last world war. A few dozen of the inter mediary generation started work immediately after the war, while the new generation who are now dominating our specialty must be counted in thousands. Two factors have radically altered paediatric surgery as practised by the intermediary and the present generation of surgeons."

This book is the product of long years of close collaboration between two physicians, a pediatric endocrinologist and a pediatric surgeon, who are interested in the complex field of human malformations. Their efforts have set a new standard in the treatment of children with intersexual or mal formed female genitalia. It is impossible to convey the details of complex surgical procedures without the help of meticulous illustrations. It is fortunate that happened to meet an academically trained artist, Mrs. Siri Mills, M.A., while visiting in the United States. Her excellent knowledge of anatomy, her remarkable skills as an artist and technical illustrator, and her readiness to include all details of interest to the surgeon have found their fruitful expression in the illustrations of this book. We express our thanks to Springer-Verlag and especially to Prof. Diet rich Goetze, at whose suggestion this book was written, for their amiable compliance with all our wishes, and particularly for their willingness to retain Mrs. Mills as our illustrator. Munich, May 1985 WALDEMAR HECKER Contents In trod ucti on 1 Part 1: Endocrinologic Diagnosis in Pediatric Patients with Genital Anomalies General Rules . . . . . . . . . . . 4 Endocrinology of Antenatal Sex Differentiation 6 Male Differentiation 6 Female Differentiation 7 Specific Endocrinologic Diagnosis and Therapy 8 Virilization of the Female External Genitalia 8 Congenital Adrenogenital Syndrome with a Defect of 21-Hydr- ylase . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Intersexual Genitals Due to Deficient Androgenization of the Male 11 Defects of Testosterone Biosynthesis 11 Androgen Receptor Defects . . ."

It is estimated that the functionally significant body of knowledge for a given medical specialty changes radically every 8 years. New specialties and "sub-specialization" are occurring at approximately an equal rate. Historically, established journals have not been able either to absorb this increase in publishable material or to extend their readership to the new specialists. International and national meetings, symposia and seminars, workshops, and newsletters suc cessfully bring to the attention of physicians within developing spe cialties what is occurring, but generally only in demonstration form without providing historical perspective, pathoanatomical corre lates, or extensive discussion. Page and time limitations oblige the authors to present only the essence of their material. Pediatric neurosurgery is an example of a specialty that has de veloped during the past 15 years. Over this period neurosurgeons have obtained special training in pediatric neurosurgery and then dedicated themselves primarily to its practice. Centers, Chairs, and educational programs have been established as groups of neuro in different countries throughout the world organized surgeons themselves respectively into national and international societies for pediatric neurosurgery. These events were both preceded and fol lowed by specialized courses, national and international journals, and ever-increasing clinical and investigative studies into all aspects of surgically treatable diseases of the child's nervous system."

The comparison of established methods in surgery is necessary in order to evaluate the advantages or disadvantages of each. We have therefore tried to include discussions of all the problems which arise in the treat ment of long-gap esophageal atresia. The long-term results of different types of colonic interposition, of different "stretching" procedures, and of simple staged surgery seemed especially worthy of discussion. It was also important to describe the role of complications caused by special pathology of the trachea in esophageal atresia and their management. Second, new problems continue to arise with regard to the prenatal diagnosis of malformations. These new aspects will continue to exert an influence on our surgical field. Malformations pose severe problems for parents, the growing fetus, and the doctors and are lasting burdens on our task. PETER WURNIG, Vienna Contents I. Long-gap Esophageal Atresia Current Surgical Strategies in Long-gap Esophageal Atresia with Regard to Endoscopy Anastomosis. D. BooB and J. Kotlarski. With 7 Figures .......................... 1 Long-gap Esophageal Atresia: Experience with Kato's Instru mental Anastomosis, with Cervicothoracic Procedure and P- mary Anastomosis, and with Retrosternal Colonic Interposition. W. Ch. Hecker. With 6 Figures . . . . . . . . . . . . . . . . .. 9 Esophagus Replacement by Free, Autologous Jejunal Mucosa Transplantation in Long-gap Esophageal Atresia. H. Halsband. With 10 Figures ......................... 22 The Outcome of Colonic Replacement of the Esophagus in Ch- dren. A. Ahmed and L. Spitz. With 3 Figures ........ 37 Gastric Tube Esophagoplasty. K. D. Anderson. With 1 Figure 55 The Significance of Tracheal Stenosis in Esophageal Atresia."

A clinician's guideline for intra-abdominal infections written by experts in the field.

- A manual to help physicians to quickly recognize and better understand the pathogenesis of intra-abdominal
infections
- Includes several high-quality black and white and color photographs from real-life clinical cases
- Adheres to a simple format to serve as essential and quick reference guide for all non-surgical residents and physicians

The first edition of Surgery of the Hip loint has had certain measures of success. Its cover won the Outstanding Award for art at a publishers trade show. A year later it was translated into Spanish for exposure to the vast world of the Spanish speaking peoples. As I traveled through Europe, it was repeatedly a pleasant surprise to have the book recognized as an authorita tive reference. This was a great tribute to the experts whose diligent efforts made it all possible. Apparently the book has stood the test of time to judge from the many inquiries and constructive comments made toward urging us on to write a second edition. It was not an easy task to gather another cadre of authorities to update our knowledge of the hip joint. People who have earned respected positions in their field are unavoidably burdened with a busy schedule, so a chapter in this text must be appreciated as coming from someone devoted to giving up some of his precious time for the sake of sharing his knowledge with peers and students."

This volume is dedicated to the Third International Symposium on Microneurosurgical Anastomoses for Cerebral Ischemia, which took place in Rottach-Egern, June 2&-30, 1976, under the sponsorship of Professor F. Marguth, Director of the Depart- ment of Neurosurgery, Ludwig-Maximilians-University of Munich (West Germany). It contains the continuing devel- opments of the extra- intracranial arterial bypass (EIAB) for cerebrovascular occlusive disease since the First International Symposium in Lorna Linda, California, in June, 1973, and the Second International Symposium in Chicago, Illinois, in June, 1974. The EIAB was developed by Donaghy and Yasargil, and it consists of a microsurgical anastomosis of the superficial tem- poral artery or the occipi tal branch of the external carotid artery to the middle cerebral artery on the surface of the brain and, very recently, the anastomosis of the occipital artery to the posterior-inferior cerebellar artery for the treatment of verte- brobasilar insufficiency. From the presentations at the sym- posium it became evident that the greatest potential in the pre- vention of a stroke in a susceptible patient is the presence of an adequate collateral cerebral blood flow. The basic diagnostic procedure is cerebral angiography in- cluding both carotid and vertebral arteries. Regional cerebral blood flow (rCBF) studies and computerized tomography add further diagnostic information and are particularly important in the selection of potential surgical candidates.

It is an honour and a pleasure to welcome you all at this 20th annual International Symposium on Blood Transfusion in the Netherlands. This year you celebrate its 20th anniversary and I congratulate the Staff of the Blood Bank Noord Nederland and especially Dr. Smit Sibinga for this great achievement. As most of you know, the name of the person of Dr. Smit Sibinga is unbreakably con nected with the annual symposium in Groningen which he has organized each year from the very start, 20 years ago. The reputation of any symposium depends heavily on the quality of the lectures. I think it is not possible to organize 20 symposia in a row if the topics lack actual relevance and the speakers are not of excellent reputation. Dr. Smit Sibinga has proven to have a keen eye for selecting interesting themes and eminent speakers. Although a lot of different topics have been dealt with in the past 20 years, which each attracted the attention of a different group in the field of blood transfusion, it is not surprising that after a tradition of 20 years several speakers but also a lot of attendees are not for the first time in Groningen to participate in this event. It gives the symposium a unique atmosphere of intimacy. It is not hard to admit that most of the newer developments in transfusion medicine take place outside the Netherlands."

Distinguishing between CVDs, e. g. , hemangiomas and vascular malformations, often presents special problems. The clinical symptoms can be misleading and di- agnosis requires complete and careful evaluation of the patient's history and in some cases further diagnostic measures. A clear histologic classification is limited to cases in which a surgical resection is indicated and the minimally invasive therapy is no longer possible. However, the diagnosis should be made in a very early stage as the different types of congenital vascular disorders require different types of management. While hemangiomas should be treated in their very early stages, the treatment of some vascular malformations can be postponed until the diagnostic and therapeutic measures are of acceptable risk for the patient. References 1. Belov S, Loose DA, Weber J (1989) Vascular malformations. Einhorn, Reinbeck (Periodica Angiolo- gica 16), pp 19-30 2. Berlien HP, Cremer H, Djawari D, Grantzow R, Gubisch W (199311994) Leitlinien zur Behandlung angeborener GefaBerkrankungen. Paediatr Prax 46: 87-92 3. Finn Me, Glowacki J, Mulliken JB (1983) Congenital vascular lesions: clinical application of a new classification. J Pediatri Surg 18 (6): 894-900 4. Grantzow R, Schmittenbecher PP, Klima-Lange D, Spreng G (199011991) Problematik der Therapie von Riesenhamangiomen. Paediatr Prax 41: 311-320 5. Jacobs AH, Walton RG (1976) The incidence of birthmarks in the neonate. Pediatrics 58 (2): 218-222 6. Philipp e, Poetke M, Berlien HP (199311994) Klinik und Klassifikation angeborener GefaBerkrank- ungen.

In 2006, when my colleague Andrea Renda proposed multiple primary malignancies (MPM) as the subject of the Biennial Report to the 2008 Congress of the Italian - ciety of Surgery, I, together with the Steering Committee, quickly agreed. Recent progress in our understanding of the etiopathology of these neoplasms has led to - novative and significant progress on the clinical level. Importantly, the incidence of the onset of two or more tumors in the same patient suggests a more than casual - lationship. Furthermore, the occurrence of MPM derives from several different me- anisms-viral, iatrogenic, immunologic, environmental, and hereditary-such that any form of treatment must take into account the etiology of these tumors. After an epidemiological introduction, this monograph analyzes various aspects of multitumoral syndromes based on the experience of the Department of Surgical Sciences, along with that of other clinical departments of the University Federico II of Naples. In the discussion of inherited tumors, reference is made to the series of patients treated at the Department of Surgery at the University of Siena. The many topics that comprise this volume range from carcinogenesis to diagnostic strategies, and from epidemiology to innovations in imaging and endoscopic techniques. Among the clinical aspects, particular emphasis is given to sporadic and hereditary syndromes, as these patients are frequently treated by general surgery departments.

This textbook addresses the best way of evaluating patients with rectal prolapse, the underlying pathophysiology, the different surgical approaches, the expected functional results after surgery and the management of complex clinical conditions associated with this condition. It is an essential book that attempts to draw together material that could be of vital importance to surgeons around the world. The pathophysiology of rectal prolapse is still uncertain and its clinical and instrumental diagnostic assessment needs to be clarified.

Every year, in the United States and the third world combined, 13.3 million boys and 2 million girls are circumcised. Whether because of perceived medical, cultural, or religious necessity, most of these parents feel they have no alternative but to allow their children to undergo this surgery. Sparking intense debate, the circumcision of children is a highly controversial and complex phenomenon that touches a variety of sociological areas, such as religious beliefs, identity issues, medical conceptualizations, fear, and superstition. The contributors to this volume comprise an international panel of experts in the fields of medicine, psychology, law, ethics, sociology, anthropology, history, theology, and politics. In 18 chapters they discuss the history of circumcision; document the physical and psychological consequences of circumcision; present the latest anatomical discoveries about the male prepuce; analyze the role of circumcision in various traditions; reveal the medical industry's investment in the practice; describe current legislative efforts to protect children from circumcision; and outline effective, culturally sensitive methods that are being implemented today to safeguard the human rights of at-risk children. For its insights into this troubling aspect of culture, Understanding Circumcision: A Multi-Disciplinary Approach to a Multi-Dimensional Problem is a critically important contribution to the growing body of literature on this subject.

Surgery of the Esophagus and Stomach provides an illustrative, instructive, and comprehensive review that depicts the rationale of basic operative principles essential to surgical therapy of the esophagus and stomach. The chapters provide pertinent and concise summaries of how to deal with various esophagus and stomach disorders, spanning benign and malignant problems and minimally invasive procedures. Stages of operative approaches with relevant technical considerations are outlined in an easily understandable manner. Complications are reviewed when appropriate for the organ system and problem. The text is illustrated throughout by line drawings and photographs that depict anatomic or technical principles. A concise, handbook-sized reference work, this book is a valuable resource for all general surgeons and residents in training.

The only book to deal specifically with constipation for specialists has been updated to include all the new advances since the first edition (1995). These advances include biofeedback, surgery for constipation, sacral nerve stimulation, the use of laparoscopy for rectal prolapse, treament and our understanding of some of the psychological problems of these patients. Innovations also include Professor Norman Williams Malone Procedure and the newer pharmacologic treatments such as nitric oxide and botulinum toxin injections.

New developments in the field of the commonly used photodiagnostic and phototherapeutic methods help to continuously improve the results in the daily practise. Edited by internationally renowned experts, the new edition offers up-to-date, comprehensive and clinically relevant information on every aspect of photodiagnostic and phototherapy. The book is structured in following parts: Photochemotherapy in daily practice, special phototherapeutic modalities and photoprotection in daily practice. Due to the detailed structure this new edition is even more reader-friendly and has a strong focus on clinical aspects. It includes: Guidelines for the treatment selections of specific diseases, practical guidelines for phototherapy with information about basic principles of photobiology, standardized test protocols for photodermatoses and diagnosis for skin tumors.

Over the past ten years, carbon dioxide laser surgery has made impressive strides and is now applied to every field of surgery without exception. It is the intention of this book to record the work done in this field in the Department of Plastic and Maxillofacial Surgery of the Beilinson Medical Center and Tel Aviv University Medical School, Israel, as well as that performed in association with other depart ments. In this context, one feels that it is incumbent upon one to acknowledge the cooperation of the medical and paramedical staff of the Department of Plastic and Maxillofacial Surgery of the Beilinson Medical Center, as well as that of Prof. Yehuda Shindel and Dr. Daniel Katenelson of the Department of Ear, Nose and Throat, Dr. Y ona Tadir of the Department of Obstetrics and Gynecology and Dr. Itamar Kott of the Department of General Surgery. I should like to make special mention of Dr. Ralph Ger of New York, who worked with me on the original clinical trials, and the engineer Uzi Sharon, who developed the Sharplan Laser with me. The progress of Laser Surgery is well demonstrated by the participation in the four meetings of the International Society for Laser Surgery, the first of which was held in Tel Aviv in 1975 with an attendance of 65 and the last in Tokyo in 1981 with an attendance of 1200.

The European School of Oncology came into existence to respond to a need for information, education and training in the field of the diagnosis and treatment of cancer. There are two main reasons why such an initiative was considered necessary. Firstly, the teaching of oncology requires a rigorously multidiscipli nary approach which is difficult for the Universities to put into practice since their system is mainly disciplinary orientated. Secondly, the rate of technological development that impinges on the diagnosis and treatment of cancer has been so rapid that it is not an easy task for medical faculties to adapt their curricula flexibly. With its residential courses for organ pathologies and the seminars on new techniques (laser, monoclonal antibodies, imaging techniques etc.) or on the principal therapeutic controversies (conservative or mutilating surgery, primary or adjuvant chemotherapy, radiotherapy alone or integrated), it is the ambition of the European School of Oncology to fill a cultural and scientific gap and, thereby, create a bridge between the University and Industry and between these two and daily medical practice. One of the more recent initiatives of ESO has been the institution of permanent study groups, also called task forces, where a limited number of leading experts are invited to meet once a year with the aim of defining the state of the art and possibly reaching a consensus on future developments in specific fields of on cology.

This book provides detailed guidelines to any physician treating patients with emergency vascular disorders. These might include ruptured abdominal aortic aneurysms, acute limb ischemia, vascular trauma, iatrogenic vascular injuries and complications to vascular surgery. The book provides an introduction to vascular surgical operations and focuses on how to manage patients. Numerous figures illustrate the particular points in vascular techniques and diagnostic problems in the emergency situation. This is an indispensable guide for all surgeons dealing with vascular emergencies.

Since the small bowel except the duodenum and (1961), Pygott et al. (1960), Gianturco (1967) terminal ileum is largely inaccessible during en- and Bilbao et al. (1967). doscopic examination, radiology of the small Sellink, however, was really responsible for bowel attains special significance as a diagnostic the widespread recognition of enteroclysis method. Owing to the length and position of (1971, 1974, 1976). In spite of the increasing this organ, good images are difficult to obtain. popularity of this method, the necessity for sub- Furthermore, the considerable variation oftran- stituting this apparently viable method for the sit time, unpredictable response of the contrast peroral examination is still equivocal (Rabe medium, and superimposition with the filled etal. 1981; Fried etal. 1981; Maglinte etal. loops make small bowel radiology difficult. As 1982; Ott et al. 1985). Comparisons of both methods, however, (Fleckenstein and Pedersen a result, few radiologists specialize in this field. With the exception of Crohn's disease, disorders 1975; Sanders and Ho 1976; Ekberg 1977; Val- lance 1980) have confirmed the superiority of of the small bowel are relatively rare. Thus, not many clinicians and radiologists are interested enteroclysis. It achieves a high accuracy (Antes in the small intestine. and Lissner 1983).

One reason for failure to cure solid tumors by surgery appears to be the impossibility of controlling metastases that are present but latent at the time of operation. This failure is a common clinical experience with aggressive neoplasms. but it is not always appreciated in tumors with longer survival times. e. g . breast and colon cancer. In addition. recent evidence indicates that after resection of a primary tumor micrometas tases from it might be enhanced by suppression of immune and reticu loendothelial functions of the host. Other factors, such as increase of coagulability and stress in the perioperative period, can also promote tumor growth. The development of new metastases might be facilitated by cells forced into the circulation during operative manipulations. Such events could be important for the outcome of treatment and it is suggested that preventive measures should be directed to this systemic component of solid tumors. Radical surgery can reduce the number of tumor cells to a subclinical 3 6 stage (10 to 10 cells) in which chemotherapy might be more effective than in advanced stages. Chemotherapy, on the other hand, might aggravate the surgical morbidity by influencing the wound healing pro cess, by decreasing the immune response, and/or by toxicity to the bone marrow and to the gastrointestinal tract, for example."

This book has its roots in a monograph on cancer of the esophagus and gastric cardia edited by us in 1965 and published in Chinese on ly. Along with a number of colleagues in various fields, we summa rized our work in the epidemiology, pathology, diagnosis, radiother apy, and surgery of carcinoma of the esophagus and gastric cardia, carried out chiefly at Peking Union Medical College Hospital, Fu wai Hospital, and the Cancer Institute of the Chinese Academy of Medical Sciences during the 25 years from 1939 to 1964. In the 18 years since the publication of that monograph, further progress has been made in China in various aspects of research and surgical treatment. Abundant material has been accumulated on the long term results of surgery, and a number of newer principles and meth ods for diagnosis and management have been evolved. In order to meet the need for the exchange of scientific and technical informa tion, both domestically and internationally, we have invited a group of our current colleagues working on the different aspects of carci noma of the esophagus and gastric cardia to contribute to the pre sent volume, which is being printed in both Chinese and English. The Chinese edition, like the original monograph, is being publish ed by Shanghai Science and Technology Publishers. Through the kind invitation of Dr. Heinz Gotze, the English text is being publish ed for international circulation by Springer-Verlag.

With improvements in respirator therapy and intensive care, congenital malformations and various acquired pathologic deformities of the trachea or bronchi are more often observed than used to be the case. For a while it seemed that tracheostomy would be unnecessary, but it has since become quite clear that severe disturbance of the trachea would be the outcome owing to primary or secondary pathologic changes that had not been given adequate consideration previous. These changes can lead to urgent life-threatening episodes or definite mutilation for the rest of the child's life. Tracheal surgery thus repre sents a new and special challenge for the pediatric surgeon. A solution to these serious problems must be found and merits discussion. Further more, it seems worthwhile to review cases of surgical pulmonary dis eases, except for the already widely discussed problems ofempyemas or bronchiectasis. P. WURNIG, Vienna Contents Pathophysiology of Subglottic Tracheal Stenosis in Childhood. B.MINNIGERODE and H.G.RICHTER. With2Figures 1 Subglottic Stenosis in Newborns After Mechanical Ventilation. M.MARCOVICH, F.POLLAUF, and K.BURIAN. With 3 Figures ... 8 Treatment of Congenital Cricoid Stenosis. R.N. P. BERKOVITS, E.J. VAN DER SCHANS, and J. C. MOLENAAR. With 7 Figures . . .. 20 Surgical Correction of Laryngotracheal Stenoses in Children. E. HOF. With 6 Figures . . . . . . . . . . . . . . . . . . . . .. 29 Surgical Treatment of Congenital Laryngotracheo-oesophageal Cleft. R.N.P.BERKOVITS, N.M.A.BAX, and E.J. VAN DER SCHANS."

The development and improvement of new technologies have made pancreatic disease more accessible to diagnosis in the last decade. The cooperation and coordination of experts in the fields of gastro enterology, radiology, biochemistry, immunology, and pathology are necessary if the methods are to be made available and the progress made to be fully exploited. Each of the new methods requires special training, and extensive experience is needed to guarantee high standards in the diagnosis of pancreatic disease. New methods have to be tested carefully against established diagnostic procedures, though at the same time we must be ready to adopt a new approach to diagnosis. The aim of this book is to update the material already published and to focus on the various imaging methods and functional tests currently available, the features specific for each, and their integrative potential in the detection of pancreatic disease. The various pathologic findings are analyzed with reference to the clinical stages of pancreatic disease. As an introduction to the morphological and functional features of acute pancreatitis, chronic pancreatitis, and pancreatic cancer revealed by the different imaging methods and functional tests, basic knowledge of the patho-physiological and pathomorphological events is provided by research workers. This knowledge is essential for the understanding and interpretation of the diagnostic findings recorded in pancreatic diseases.

Important contributions about the treatment modalities of breast cancer are presented in this book. The risks and limitations of breast conserving therapy of mammary carcinoma are dealt with. Newest findings show that this form of therapy has the same outcome as conservative treatment modalities. The book also considers controversial issues such as the treatment of mastopathy, precancerous, and non-invasive lesions of the breast. New, but not yet approved, regimes for the prevention of mammary carcinoma and open questions concerning adequate operative treatment are discussed. Latest results presented here show that all modern palliative chemotherapy has a certain but limited effect on outcome and that early detection and preventive therapy (surgical and hormonal) will be of great importance for improved chances of survival of breast cancer.