RESUMEN
161 splenectomies are presented with a morbidity of 14.8% and a total mortality rate of 4.3%. The lethality rate due to severe infections (-3.9%), however, was high and mostly caused by an overwhelming postsplenectomy sepsis, pneumonia or meningitis. 61.5% of the infections were caused by pneumococcus. To drop that high lethality rate after splenectomy we replanted splenic tissue in seven patients. Scintigraphic investigations showed in all cases well vascularised splenic tissue. The immunoglobulins were in a normal range. Howell-Jolly bodies, however, did not disappear in all the patients. From our study as well as from the literature one has to conclude that replanted splenic tissue requires immunologic activity but a reduced capacity for phagocytosis. Therefore, in cases of traumatic injury to the spleen it is necessary to try to preserve as much of the organ as possible either by infrared coagulation, gluing with human fibrinogen or partial splenectomy. If these procedures are impossible a replantation of--50% of the original splenic tissue should be done and several thin homogenised particles replanted intra- or retroperitoneally. Out of that a preoperative vaccination against pneumococcal infection is necessary as well as a postoperative penicillin prophylaxis for about three years.
Asunto(s)
Reimplantación , Bazo/cirugía , Esplenectomía , Niño , Preescolar , Humanos , Lactante , Recién Nacido , Penicilinas/uso terapéutico , Infecciones Neumocócicas/complicaciones , Infecciones Neumocócicas/prevención & control , Complicaciones Posoperatorias , Sepsis/complicaciones , VacunaciónRESUMEN
48 children who underwent high ligature of the internal spermatic vein for varicocele were re-examined. In one patient (2,1%) a hydrocele appeared postoperatively. In 30 boys (62,5%) the varicocele disappeared completely following surgery, in 18 patients (37,5%) the varicocele persisted which was in 9 boys only palpable and in another 9 boys clearly visible. High spermatic vein ligature according to Bernardi turned out to be a method providing good postoperative results and with few complications in childhood. In the case of persisting varicocele collateral veins should be considered and ligated in a second operation.