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We report an unusual case of a patient with an epidural fluid collection with signal characteristics mimicking an epidural hematoma. The patient presented with myelopathy caused by thoracic spinal cord compression after a traumatic injury to the chest and back. The injury was caused by high-pressure injection of industrial-grade lubricant grease. This case demonstrates that cord compression can be caused by exogenous material in the setting of trauma that can mimic an acute epidural hematoma.

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Blunt tracheobronchial injuries in children are rare and are associated with many diagnostic problems. Based on the successful outcome in a seven- and a twelve-year-old patient operated within 12 hours after the accident the authors discuss the development of the symptomatology and early clinical, X-ray, bronchoscopic and CT diagnosis of rupture which are, if intensive care and early treatment of the injury are ensured, the basis for preserving normal pulmonary function and ensure prevention of sequelae due to obstruction and infection. The children were admitted to hospital for 22 and 14 days resp. and discharged in a good condition. The check-up examinations of both patients are within the normal range and there are no limitations as compared with healthy children of the same age.

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A retrospective study of the clinical and histopathological picture of acute appendicitis in children confirms agreement of the evaluation of the finding on the appendix made by the surgeon and pathologist in 72.2% and disagreement in 27.8%. The finding is overrated in 11.3% and underrated in 16.5%. Agreement is closest in phlegmonous appendicitis (88.1%) and lowest in gangrenous appendicitis (54.9%). The most frequently overrated finding is in catarrhal appendicitis (20.7%). The number of missed appendectomies is from the pathologist's point of view significantly lower (21.8%) than from the surgeon's point of view (34.7%). This indicates obviously that it is not possible to make an accurate macroscopic assessment of the progress of appendiceal inflammation. The number of "negative" appendectomies is according to the surgeon 15.8% and according to the pathologist 16.8%, i.e. almost equal.

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Abdominoscrotal hydrocele is encountered rarely in child age. The authors present an account on two patients with abdominoscrotal hydrocele in a three- and fifteen-year-old boy. They discuss its development, draw attention to the not very marked clinical manifestations, diagnostic pitfalls and the contribution of sonography to diagnosis.

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Mechanism-based inactivators of beta-lactamases are used to overcome the resistance of clinical pathogens to beta-lactam antibiotics. This strategy can itself be overcome by mutations of the beta-lactamase that compromise the effectiveness of their inactivation. We used PCR mutagenesis of the TEM-1 beta-lactamase gene and sequenced the genes of 20 mutants that grew in the presence of ampicillin-clavulanate. Eleven different mutant genes from these strains contained from 1 to 10 mutations. Each had a replacement of one of the four residues, Met69, Ser130, Arg244, and Asn276, whose substitutions by themselves had been shown to result in inhibitor resistance. None of the mutant enzymes with multiple amino acid substitutions generated in this study conferred higher levels of resistance to ampicillin alone or ampicillin with beta-lactamase inactivators (clavulanate, sulbactam, or tazobactam) than the levels of resistance conferred by the corresponding single-mutant enzymes. Of the four enzymes with just a single mutation (Ser130Gly, Arg244Cys, Arg244Ser, or Asn276Asp), the Asn276Asp beta-lactamase conferred a wild-type level of ampicillin resistance and the highest levels of resistance to ampicillin in the presence of inhibitors. Site-directed random mutagenesis of the Ser130 codon yielded no other mutant with replacement of Ser130 besides Ser130Gly that produced ampicillin-clavulanate resistance. Thus, despite PCR mutagenesis we found no new mutant TEM beta-lactamase that conferred a level of resistance to ampicillin plus inactivators greater than that produced by the single-mutation enzymes that have already been reported in clinical isolates. Although this is reassuring, one must caution that other combinations of multiple mutations might still produce unexpected resistance.

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The authors describe 3860 child patients operated on account of acute appendicitis and analyse the data with regard to age, sex, year of incidence and surgical finding. The highest incidence of acute appendicitis is between 8 and 11 years with a peak at the age of 10 years. It is more frequent in boys (58.3%) than in girls (43.7%), the ratio being 1.3:1. It occurs more often during the cold months (46.5%), in autumn (27.3%) and in winter (25.7%). The number of gangrenous appendicitis is 34.7%-56.7% in boys and 43.5% in girls. The highest rate of missed appendicitis is at the age of the highest incidence (15.2%) with a peak at the age of 10 years (17.8%) and in January (13.3%). The highest incidence of perforated appendicitis is also at the age of the highest incidence (14.9%) with the peak at the age of 8 years (15.6%) and in June (13.5%). Perforation is more frequent in boys (58.1%) than in girls (49.9%). The number of "negative" appendicitis is 15.8%. Prevention of acute appendicitis still remains open due to lack of knowledge of its etiopathogenesis.

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Based on an analysis of 10 patients after a feminizing operation of a virilized genital in female pseudohermaphroditism caused by congenital adrenal hyperplasia on account of 21-hydroxylase deficiency the authors emphasize in conjunction with multidisciplinary collaboration the necessity of early modification and surgical repair with adjustment of the external genital before the age of two years. An excellent anatomical and cosmetic result of reconstruction with clitoroplasty emphasizes the importance of preserving the clitoris and erectile tissue to ensure adequate social, psychic and sexual development of the patient.

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Idiopathic (autoimmune) thrombocytopenic purpura (ITP, AITP) represents a relatively frequent impairment. It involves a syndrome of various diseases with a shortened thrombocytes survival caused by anti-platelet antibodies. The majority of cases are of secondary character. Spleenectomy often evokes a complete remission of thrombocytopenia. The study describes morphologic findings in spleens of 30 patients with the clinical diagnosis of ITP/AITP. The findings were gained by light microscopy from formol-paraffin blocks and histochemical findings from cryostat sections of non-fixed tissue. The alcaline and acidic phosphatases, nonspecific esterase, chloracetate esterase, and dipeptydilpeptidase IV were investigated enzymohistochemically. Immunoglobulins were examined immunohistochemically and T lymphocytes by means of monoclonal antibodies. The affinity HPA--Helix pomatia agglutinin, PHA--phytohemagglutinin from Phaseolus vulgaris, SBA--soy-bean agglutinin from Glycine max. and PSA--peas bean agglutinin from Pisum sativum were investigated by means of specific antilectin antibodies. The human spleen during idiopathic thrombocytopenic purpura accumulates neutrophilic polymorphonuclear granulocytes; platelets-stagnate and are destroyed. These processes can be identified in histologic sections e.g. also by means of anti-fibrinogen antibodies. The red pulp contains foam cells to various extent. Besides generally known processes, the white pulp also displays alterations in composition of cellular compartment of the periarterial lymphatic sheaths. Human spleen distinguishes modified blood platelets as alien corpuscles, and thus eliminates them from the blood circulation system by its immunologic and other mechanisms, the details of which still remain to be clarified. (Fig. 6, Ref. 44.)

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The authors present the results of bacteriological analysis of scrapings from the appendical mucosa of 24 rabbits with appendicitis induced by obstruction of the appendix lumen and of 5 rabbits with healthy appendices (controls). In dependence on the duration of inflammation, the recovery of aerobic bacteria was decreasing and that of anaerobic nonsporulating bacteria was increasing. In the group of anaerobic bacteria, gram-negative rods were predominant (number of isolated colonies: 2973 = 79.9%, variation range of occurrence: 10(5)-10(8) per 1 gram of material) with a remarkable prevalence of the genus Bacteroides and particularly of the species Bacteroides fragilis. Compared to the occurrence in appendices with inflammation, the recovery of bacteria in controls was minimal. The work served as model in studying pathogenesis of acute appendicitis in human medicine. (Tab. 3, Ref. 12.)

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The aim of the study was to establish the rate of sterility in women who had been operated on in childhood for perforated and non-perforated appendicitis. The group with perforated appendicitis consisted of 58 women who had been operated on at the age of 3 to 15 years and at the time of the follow-up examination they were in the age range of 23 to 41 years. Of these women 51 were married and 49 of them had one to three children. Two women (3.9%) were sterile. One had been operated on in adulthood for tubo-ovarial abscess in the right and pyosalpinx in the left tube and the other one was treated for repeated adnexitis in adulthood. The group with non-perforated appendicitis consisted of 168 women who had been operated on at the age of 3 to 15 years and at the time of the follow-up examination they were in the age range of 23 to 40 years. Of these women 145 were married and 141 had one to four children. Four women (2.8%) with the history of noncomplicated appendicitis were sterile. Our retrospective study showed no statistically significant difference in the occurrence rate of sterility in women operated on in childhood for perforated and non-perforated appendicitis.

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Enzymo-, immuno- and lactin-histochemical methods were used to study the structure of the rabbit appendix wall. The value of some structural components in the function of this part of the intestine is discussed. Some findings were documented electronmicroscopically. In addition to its resorptive function, the rabbit appendix is equipped with a potent defense mechanism against adverse environmental effects of the appendix content. Individual structures of this defensive barrier are closely characterized with regard to cellular equipment and possibilities of its morphological identification.

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A relatively frequent and alarming complication of appendicitis in children is ileus. The authors submit an analysis of 41 cases of ileus with a time interval of 3 days to 8 years after appendectomy. In eight patients conservative treatment was successful, and 33 children were operated with the finding of intraabdominal adhesions (23 times), bands (3 times), abscesses and adhesions (7 times). Two children were re-operated on account a relapsing ileus. None of the children died. Prophylaxis of ileus after appendectomy is ineffective and uncertain, therefore the authors emphasize early diagnosis and early operation of the appendicitis but warn against inadequately considered appendectomy.

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The authors give an account a less frequent mechanism of burns in older boys during the domestic manufacture of smoke-boxes from a mixture of sodium dithionite (decolourizer) and urea peroxyhydrate (solid hydrogen peroxide). The chemical reaction explains the development of exogenous heat and the depth of burns. The authors analyze their own material of 16 patients and emphasize early necrectomy and prevention.

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The surface relief of the mucous membrane of the normal rabbit appendix was studied under scanning electron microscopy. Two different types of surface relief were identified. One consisted of relatively regular crests and grooves of the mucosa, the other one exhibited scattered crater-like openings into which "heads of lymphatic nodes" were inserted to varying extent and which were separated from the surface mucosa by broad alveolar cavities. Since adequate terminology has not yet been coined for the description of the observed structures, the authors use the terminology of classical histology and from analogous descriptions of other reliefs.

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The binding of PSA, PNA, HPA, WGA, Con A, LCL, RCA, SBA, and PHA lectins to epithelial structures of the normal rabbit appendix was studied. Differences were observed in the affinity of some lectins to the epithelium of the intercryptal lining of the rabbit appendix, to the epithelium hemming the glandules and crypts of the domes of Peyer's patches. The obtained results document the difference in the affinity of individual batches of anti-WGA antibodies to this lectin after its binding to the epithelial structures studied. This implies the possibility that differently reacting antibodies may develop to different commercially available batches of WGA. Precipitation of WGA at sites of alkaline phosphatase occurrence demonstrates the relationship of this enzyme to WGA binding sites in tissues.

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In the course of three years, 1985-1987, 21 children with congenital atresia of the oesophagus were operated, incl. four where the oesophagus had to be replaced by the large intestine. Each operation had unforeseen complications, all children survived, however, and are thriving. The authors describe the case of a girl with atresia type Vogt 1 who had moreover hypochromic anaemia, was a twin, premature, hypotrophic and had harelip. During the planned operation when the oesophagus was to be replaced by the large intestine at the age of 8 months, it was, however, revealed that the child has a narrow mesenterium commune with incomplete rotation. They had to perform a completely modific and improvised selection of the portion of the gut for transposition, a part of the ileum and caecum with another portion, as only that portion could be transplanted with preservation of the nurture. The gut could not be stretched because of the short mesentery. The child is now two years after the operation and development corresponds to age.

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Analysis of 40-year experience with operations for pectus excavatum over the period from 1950-1988 is presented. In a series of 177 children ten different surgical approaches were used in succession. Since 1975 operations were performed exclusively by the method according to Ravitch and Welch which does not apply any fixation splints. The procedure is substantiated by the pathologico-anatomical and metabolic causes of the origin and development of inborn deformities of the chest. The operation consists of several exact procedures on the muscles, cartilages, and sternum, which have to be carried out consistently. The important parts of the surgical procedure are described. Since 1975 the method was used in 28 children, with very good and good results in 92.8%.

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