Blood chimerism in a girl with Down syndrome and possible freemartin effect leading to aplasia of the Müllerian derivatives

Cytogenetic and molecular genetic analysis in a case of sex-discordant dizygotic twins revealed blood chimerism in the girl (46,XY in blood and 47,XX, + 21 in fibroblasts) caused by feto-fetal transfusion from her healthy brother. The girl presented with Down syndrome, aplasia of the uterus and the Fallopian tubes and normal female external genitalia. We propose that the lack of Müllerian structures is caused by the effect of the Müllerian inhibiting substance transferred from the male to the female twin in early pregnancy. This disorder of sex development is known as freemartin phenomenon in female cattle from sex-discordant twin pairs.

Laparoscopic appendectomy in children with Enterobius vermicularis

As surgeons gain more experience with laparoscopy in children, it is becoming apparent that one of the best applications of the technique is for appendicitis. The advantages of laparoscopic appendectomy include a better cosmetic result, particularly in young female patients, a shorter recovery time, and an early return to normal activities. In the differential diagnosis of appendicitis, the association of Enterobius vermicularis (pinworms) inflammation in the pediatric age group is not uncommon. The endo-loop technique for laparoscopic appendectomy is the standard technique used in our department. In three patients with E. vermicularis undergoing appendix removal using this technique, pinworms were found to be set free into the abdomen after dividing the appendix between the loop ligatures. Bipolar coagulating forceps were used carefully to thermally desiccate the worms, which were then removed using a blunt grasper. E. vermicularis being released into the abdomen in children undergoing laparoscopic appendectomy using the endo-loop technique has not been reported. Careful evaluation of the appendix stump and simple but careful thermal desiccation and removal of pinworms, if present, must be considered when using the endo-loop technique.

[Electron microscopy assessment of the effectiveness of intraoperative laser in reoperation of juvenile bone cysts]

The application of the ND-YAG-Laser in juvenile bone cysts prevents recurrencies. That can be put down to the fact that the laser has a deep action which destroys the organells of the cystic tissue up to 2-4 mm irreversibly. By this the whole cystic tissue is being destroyed and recurrencies are being prevented.

[Intraoperative endoscopy in pediatric surgery: indications and results]

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.

[Post-traumatic gaseous gangrene in childhood: a case report]

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.