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In conventional partial resection of parenchymatous organs
significant bleeding is one of the main problems, especially in
neonates and infants. The patients rapidly lose considerable
amounts of their small blood volume. Laser light leads to photo
thermal effects in tissue and causes coagulation, drying up,
carbonization and evaporization, depending on the temperature. The
neodymium Y AG laser emits nonvisible light in the near infrared
with a wavelength of l. 0611m. This wavelength implies a relatively
deep penetration into the tissue. This laser system, properly a
coagulation laser, achieves its cutting effect by its high power
density [9]. Because of thermal radiation in all directions, both
sides of the section plane are coagulated as a positive side
effect. Thus, in parenchymatous organs a combination of resection
and sealing of the cut vessels and ducts, up to a limited diameter,
is obtained. Laser Instruments We use a neodymium-YAG laser mediLas
2 (MBB-Medizintechnik, D-8012 Ottobrunn, Federal Republic of
Germany), wavelength l. 0611m, maximal power output around 110 W
(Fig. 1). Normally we prefer to work without tissue contact, Fig.
l. The Nd-YAG laser system mediLas 2 with maximal power output
around 100 W The Neodymium Y AG Laser in Surgery of Parenchymatous
Organs 25 Fig. 2. The focusing handpiece with focal distance of 50
mm 1cm Fig. 3.
Apart from the articles on history and nursing, the con- ditions
discussed include Mediastinal Masses in childhood seen from a
Pathologist's point of view, Intrapulmonary se- questration,
lymphangiomata involving the neck as well as thorax, unusual forms
of Diaphragmatic Hernia and Congenital Heart Disease. Such a volume
would hardly be complete with- out some references to Oesophageal
Atresia and one article discusses The Influence Of Anatomy And
Physiology On The Ma- nagement Of Oesophageal Atresia.
Endocrine conditions requiring surgical intervention in the
pediatric age group are uncommon. When diagnosed, they are the
source of great in terest and, often, considerable debate. This is
understandable, since few centers and even fewer individual
surgeons can draw on vast experience of this subject. The great
divergence of opinion regarding management is also understandable
in that pediatric endocrine lesions often differ considerably from
their adult counterparts in histology, natural history and response
to treatment. Pediatric endocrine lesions are also, as a rule, less
frequently malignant. In addition to the great strides made in
surgical and anesthetic technique and operative monitoring,
progress in four areas has substantially advanced the management of
endocrine dis orders in the pediatric age group in the last decade:
imaging, pathology, pharmacology and genetics. The new imaging
tools, ultrasonography, computed tomography and magnetic resonance
imaging, have added great diagnostic possibilities. More recent
developments, such as radio nuclide imaging for the adrenal gland
and the possibility of using tagged antibodies, promise to expand
our imaging horizons even further. In the field of pathology, the
develop ment of immunocytochemical markers (e. g. , monoclonal
antibodies), the refinement in special stains and the continuous
perfection of fine needle aspiration biopsies offer great new
diagnostic as well as research capabil ities. Newer pharmacological
agents, such as the alpha and beta blockers, the calcium channel
blockers and thyroxine analogs, add a whole new level of safety to
the management of the potentially lethal pheochromocytoma.
Wir berichten tiber 185 Kinder mit unterschiedlichen Erscheinungen,
die her- kommlich als Riesenhamartom, Angiodysplasie, kongenitale
Trophoedem, ort- licher Gigantismus (z. B. Macrodaktylie) usw.
gekennzeichnet werden. Wir schla- gen vor, aIle diese Erscheinungen
als eine Entitat zu verstehen: kongenitale Weich- teildysplasie
(congenital soft-tissue dysplasia, CSTD. Nach jtingsten
embryologischen und zellbiologischen Untersuchungen tritt die CSTD
als Folge embryonaler oder fetaler biosynthetischer
Zellfehlregulation auf. Das Konzept einer CSTD-Entitat fiihrt
sowohl zu einem gemeinsamen Unter- suchungsprotokoll als auch zu
einem gemeinsamen therapeutischen Vorgehen un- ter besonderer
Berticksichtigung der "Stabilitat" und der Gutartigkeit des Zu-
standes. Die Behandlung sollte auf die funktionelle Verbesserung
beschrankt bleiben, anstatt die Korrektur kosmetischer Defekte zu
versuchen. References 1. Andre JM (1973) Les dysplasies vasculaires
systematisees, vol 1. L'expansion scientifique, Paris 2. Andre JM,
Jacquier A, Picard L (1977) La neurofibromatose de Recklinghausen.
Pathogenie - Conception actuelle. Ann Chir Thor Cardiovasc 16:
175-185 3. Andrews EJ, Ward BC, Altman NH (1979) Spontaneous animal
models of human diseases, vols 1 and 2. Academic, New York 4. Azouz
EM (1983) Hematuria, rectal-bleeding and pelvic phleboliths in
children with Klippel- Trenaunay syndrome. Pediatr Radiol 13: 82-88
5. Barksy AJ (1967) Macrodactyly. J Bone Joint Surg 49A(7):
1255-1266 6. Berliner DL, Ruhmann AG (1966) Comparison of growth of
fibroblasts under the influence of II-beta-hydroxy and
ll-keto-corticosteroids. Endocrinology 78: 373 7. Chassaignac C
(1959) Hypertrophie congenitale des 2 membres droits. Bull Soc Coo
Paris 8.
The clinical application of anorectal manometry was pioneered by
pediatric sur- geons. Swenson in 1949 reported that the aganglionic
bowel of patients with Hirsch- sprung's disease did not show any
propulsive movements. In 1967 Lawson and Nixon and Schnaufer et al.
found that the rectosphincteric reflex, which is ob- served in both
normal individuals and patients with chronic idiopathic constipa-
tion, is absent in patients with Hirschsprung's disease, and
suggested anorectal manometry to be useful for the differentiation
of Hirschsprung's disease from chronic idiopathic constipation.
Studies on the pathophysiology of constipation and incontinence
problems have flourished in Japan; the Japanese Research Society
for Anorectal Manometry in Childhood was founded in 1975 by Ikeda,
Okamoto, Katsumata, and Kasai. The Society has contributed greatly
to advances in the clinical application of anorectal manometry.
Basic investigations on the function of the anorectum in both
normal individuals and patients with constipation or incontinence
problems have also been promoted by members of the Society. The
technique of anorectal manometry has been refined and standardized.
The criteria for manometric diag- nosis of Hirschsprung's disease
have been established. And the correlation be- tween postoperative
continence in patients with Hirschsprung's disease or ano- rectal
malformation and manometric findings has been understood. In this
section, works by members of the Society are presented.
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