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Rectal atresia is an extremely rare anorectal malformation. A unique case of rectal atresia presenting as an imperforate membrane associated with congenital cardiac malformations and unilateral choanal atresia in a newborn is reported. Ultrasound examination in the newborn infant located the presence of the rectal membrane which was surgically treated successfully.

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OBJECTIVES: Pectus excavatum is the most common congenital hereditary chest-wall deformity. This study analyses a single-center experience of pectus excavatum-thoracic wall reconstruction using a uniform technique of internal stabilization employing stainless steel struts. METHODS: From June 1984 to December 1997, we performed correction operations on 777 patients with pectus excavatum. The condition occurred more frequently in boys (621 patients) than girls (156 patients). Surgical repair was performed using a standard method of double bilateral chondrotomy parasternally and at points of transition to normal ribs. This was followed by detorsion of the sternum, retrosternal mobilization and correction of the inverted ribs. The anteriorly displaced sternum was stabilized by one trans-sternal and two bilateral parasternal metal struts. RESULTS: The corrections were completed with successful repair in 765 patients (98.5%) with a low complication rate of 6.7%. The follow-up period ranged from 4 weeks to 12 years, mean 6.4 years. Major recurrences were observed in 12 patients (1.5%) and mild recurrence were observed in 35 patients (4.5%). CONCLUSION: Significant reduction in postoperative cardiorespiratory disorders, low lethality, improvement of subjective complaints, satisfactory long-term results and improvement in psychological problems indicate the need to offer this method of surgical correction to low-risk children.

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Gas gangrene is not a frequently encountered toxic wound infection in childhood. We present a case of postoperative Clostridium perfringens infection with proximal forearm myonecrosis. In order to reveal the full extent of tissue viability in the right upper extremity, infrared thermography was performed. Although dyschromia was evident in the proximal forearm, thermographs revealed viable tissue only up to the supracondylar region. Angiography, which provided valuable clues to the patency of the vascular supply, and subsequent intraoperative findings confirmed the extent of tissue perfusion as revealed by infrared thermography.

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Abdominal cysts in girls are frequently observed by abdominal ultrasound (US) and are usually ovarian. In this case a cystic structure located in the right abdomen was seen in a female newborn without symptoms and was initially described as a possible ovarian cyst. Frequent US examinations showed an increase in volume and diameter, and temporary, recurring episodes of hyperbilirubinemia were observed. The US scans showed no relationship to the biliary tree. During a diagnostic laparoscopy, a cystic structure attached to the pyloric region was seen. A laparotomy revealed a cystic duplication of the stomach, which could be resected completely. The finding is discussed emphasizing the importance of clinical findings and diagnostic methods in the diagnosis and management of abdominal cystic masses in females.

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INTRODUCTION: In abdominal tumors in childhood, staging laparotomy is usually an essential diagnostic tool to obtain information about the histology and the extension of the tumor, when less invasive methods do not reach to clarify the process. PATIENTS: In fourteen children between 3 months and 17 years a laparoscopical procedure was performed. MATERIAL AND METHOD: Only in patients without a clear diagnosis after noninvasive exploration were submitted to an explorative laparoscopy in order to define the histology, the extension of the illness or to locate it. The laparoscopical instrumentarium used was from Dufner, adapted to children. RESULTS: The patients tolerated well this procedure, the posoperative period was short (mean 2.07 days), no complications after the operation are reported. Only one case of hemorrhage lead to a conversion after biopsy of a neuroblastoma. In all cases the diagnosis and staging was achieved. CONCLUSIONS: When non invasive diagnostic methods are not conclusive an explorative laparoscopy should be performed because it offers a lot of advantages over a laparotomy.

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The first known case of sternal cleft was described by Torres in 1740. Since then, many publications have appeared concerning sternal cleft, which have led to introduce a classification and some therapeutical procedures. This disease is a developmental anomaly of the sternum that usually shows vascular and cardiac malformations as well as diaphragmatic, abdominal wall, pericard and middle line organs anomalies. Two cases of sternal cleft are presented who have been treated in the neonatal period with different associated anomalies. Diagnostic procedures and therapeutical aspects are discussed.

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Different authors reported about their experiences in laparoscopic splenectomy. The preparation of vessels and ligaments are feasable without major problems. Nevertheless the handling of the organ during the operation and during splenic extraction can be very difficult, especially in larger organs. The authors report experience with the technique of laparoscopic splenectomy and describe a new technical aspect in handling the spleen during this procedure. A loop of an umbilical band is used for retracting the organ during the preparation and placing the spleen into a sterile bag for the removal of the organ. This device helps prevent damages to the capsule caused by forceps. Large organs can be placed into the pelvis, and the bag is placed and opened in the upper abdomen. The authors used this technique successfully in seven patients. The results are compared with previous experiences.

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Intraoperative endoscopy in pediatric surgery was first performed in Germany at the begining of 1972. This method is an optical support for the surgeon to recognize pathological-anatomical alterations by the effect of the diaphanoscopy. It concerns primarily the upper and lower gastrointestinal systems as well as the tracheobronchial system. The endoscope can be placed intraoperative at the predetermined morphological alteration level enabling the surgeon to perform the surgical procedure at that special circumscrip area. This avoids local intensive trauma and protects nerve fibers, blood supply and other organs. Main indications are H-fistulae, tracheal stenosis, esophageal diverticula and perforations, gastroesophageal reflux, gastrointestinal bleeding and supralevator anorectal anomalies. Between 1984 and 1995 we have performed an intraoperative endoscopy in 310 children between the age of one day and 16 years. In a high percent of the explorations the identification of the preoperative findings were confirmed. Advantages of this method are less intraoperative complications concerning bleeding, organic and neurological lesions and a faster functional recovery of the organ due to an atraumatic procedure.

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Gas gangrene is caused by multiple species of Chlostridium, generally as a complication of traumatismus producing necrotic infections. This kind of infection is rare and specially uncommon in childhood. A case of post-traumatic Chlostridium perfringens infection is presented in a two year old girl after an open fracture of the hand. In order to reveal the extension of the process different examinations were performed including radiography of the hand, angiography and infrared thermography. These studies are describen and correlated, specially the angiography and the infrared thermography as a non-invasive method, as well as the treatment and evolution.

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The development of the total implantable catheters has produced a lot of benefits, specially in oncological patients, who save venose punctions for blood controls and for administration of cytostatics. Important conditions for the success of the catheters are to avoid unnecessary manuvres during the surgical act and the postoperative care. In the University Hospital of Münster 68 children have been treated between 1984 and 1988 with this system. The implantation was mostly performed in oncological patients but also in patients who needed a total parenteral nutrition. With optical and electronic microscope studies has been observed that in the inside part of the Port and the catheter, deposits with different characteristics have been found. These deposits could be divided in four groups depending on the structure.

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Specific pediatric surgical problems, specially the hemisplenectomy and the partial liver resection in newborns and small children, offer a new indication for the laser beam. Special morphologic characteristics, like small organs and small vessels diameter, make the laser an useful procedure in children. With help of a histochemical technic could be shown a defined necrosis area - in dependence of the laser dose - in liver, spleen and kidney of rabbits under standard laser photocoagulation. Five days after the partial organ resection one could observe a well defined vital border, and after one week an invasive growing fibrotic tissue into the necrosis area, which would form the new capsula. No cases of infection or bleeding were present (84 partial organ resections). Using known doses one can exactly calculate the area of necrosis and evaporation.

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