annals 1-2.qxd - Centrum Zdrowia Dziecka

More documents

Recommendations

Info

22 are in agreement with the results achieved in the presented series. However the role of secondary OLT in patients with recurrence of tumour after primary treatment by traditional hepatic resection remains unclear. It seems that the indications for OLT after primary unsuccessful traditional liver surgery may be limited due to the high incidence of recurrence of malignancy after OLT [21, 22]. In the presented series, out of two patients who underwent secondary OLT, one patient with TLCT died because of disseminated malignancy, and the follow-up of another patient with FL-HCC, because of typical tumour recurrences even after several years [9, 11, 23], is not long enough to allow any prognostic conclusions. Results of the presented series together with the results of other already published series seem to document the need to differentiate between treatment strategies for malignant liver cell tumours. This differentiation must consider not only the size and location of the lesion but also the tumour’s nature and type, which may lead to different biological behaviour determining the long-term results. The use of traditional liver surgery (hepatectomy procedures) seems to be appropriate for the treatment of smaller lesions of all types and in the majority of radiologically documented, evidently resectable HBL cases, with the predictable possibility of microscopically radical surgery. In cases of giant tumours and majority of HCC and TLCT cases, the indications for liver transplantation as a primary surgical treatment should be considered. Such a strategy based on the biological behaviour of different malignant liver cell tumour will increase the possibility of full surgical microscopic radicality significantly determining the final treatment outcome. References 1. Achilleos O, Buist L, Kelly D, et al (1996) Unresectable hepatic tumours in childhood and the role of liver transplanatation. J Pediatr Surg 31:1563–1567 2. AL-Qabandi, Jenkinson HC, Buckels JA, et al (1999) Orthotopic liver transplantation for unresectable hepatoblastoma: A single center’s experience, J Pediatr Surg 34:1261–1264 3. Bismuth H, Houssin D, Castaing D (1982) Major and minor segmentectomies “reglees” in liver surgery. World J Surg 6:10–24 4. Bismuth H (1982) Surgical anatomy and anatomical surgery of the liver. World J Surg 6:3–6 5. Brown J, Perilongo G, Shafford E, et al (2000) Pretreatment prognostic factors for children with hepatoblastoma-results from the International Society of Paediatric Oncology (SIOP) Study SIO- PEL1. Eur J Cancer 36:1418–1425 6. Couinaud C (1957) Le foie. Etudes anatomiques et chirurgicales. Paris, Masson 7. Czauderna P (2002) Hepatocellular carcinoma in children-treatment perspectives on the basis of international SIOPEL 1 trial experience. Ann Diagn Paed Pathol 6:51–55 8. Dover N, Smith L (2000) Liver transplantation for malignant liver tumors in children. Med Pediatr Oncol 34: 136–140 9. Greenberg M, Filler M (1997) Hepatic tumors. In: Pizzo P and Poplack D (eds): Principles and Practice of Pediatric Oncology, Lippincott-Raven Publishers, Philadelphia 10. Gulglielmi M, Perilongo G, Cecchetto G, et al. (1993) Rationale and results of the International Society of Pediatric Oncology (SIOP) Italian pilot study on children with hepatoma: Surgical resection d’ emblee or after or after primary chemotherapy J Surg Oncol 3:122–126 11. Howard ER, Heaton ND (1991) Benign and malignant tumours, w Howard ER (ed): Surgery of Liver Disease in Children, Oxford, Great Britain, Butterworth 12. Kaliciñski P, Kamiñski A, Paw³owska J, Prokurat A et al. (2000): Liver transplanatation in children – The Children’s Memorial Health Institute experience Surg Childh Intern 8:135–141 13. Proceedings of International Research Workshop on Pediatric Liver Tumours (1999) “Into the Year 2000”. Berno Switzerland, 18-20 March 14. Prokurat A, Chrupek M, Polnik D, Kaliciñski P (1999) Use of fibrin glue in the prevention of biliary and haemorrhagic complication after liver resection in children. Surg Childh Internat 7: 26–31 15. Prokurat A, Chrupek M, Kluge P, et al. (2000) Treatment of hepatocellular carcinoma in children – 16 years experience in a single center. Surg Childh Intern 8:196–202 16. Prokurat A, Zimmermann A, Kluge P, et al. (2000) Hepatoblastoma of young children and adolescents-the same or different entity. Surg Childh Intern 3: 190–195 17. Prokurat A, Kluge P, Chrupek M, Koœciesza A (2002) Possibilities and limitations in the treatment of heparocellular carcinoma in children. Ann Diagn Paed Pathol 6:51–55 18. Prokurat A, Kluge P, Kosciesza A, Perek D, Kappeler A, Zimmermann A (2002) Transitional liver cell tumours (TLCT) in older children and adolescents: A novel group of aggressive hepatic tumours expressing beta-catenin, Med Ped Oncol 39:510–518 19. S. I. O. P. International Society of Paediatric Oncology (1990–1999) Materials of Liver Tumour Studies, SIOPEL 1 (1990–1994), SIOPEL 2 (1995–1998), SIOPEL 3 (1999) 20. Schmidt D., Harms D., Lang W. (1985) Primary malignant hepatic tumours in childhood. Virchows Arch 407:387–405 21. Superina R, Bilik R (1996) Results of liver transplantation in children with unresectale liver tumours. J Pediatr Surg 31:835–839 22. Tagge E, Tagge D, Reyes J (1992) Resection including transplantation for hepatoblastoma and hepatocellular carcinoma: impact on suevival. J Pediatr Surg 27:292–296 23. Tagge E, Tagge D (1997) Hepatoblastoma and hepatocellular carcinoma. In: Oldham K, Colombani P and Foglia R (eds) Surgery of Infants and Children, Lippincott-Raven Publishers, Philadelphia 24. von Schweinitz D, Hecker HJ, Harms D, et al. (1995) Complete resection before development of drug resistance is essential for survival from advanced hepatoblastoma-a report from the German Cooperative Pediatric Liver Tumour Study HB 89. J Pediatr Surg 30: 845–852 25. Weinberg A., Finegold M. (1983) Primary hepatic tumours of childhood. Hum Pathol 4:512–537
Annals of Diagnostic Paediatric Pathology 2006, 10(1–2):23–29 © Copyright by Polish Paediatric Pathology Society Annals of Utilization of internal sphincter in the reconstruction of anorectal malformations in girls Andrzej Igor Prokurat 1,2 , Ma³gorzata Chrupek 1,2 , Roman KaŸmirczuk 3,4 , Przemys³aw Kluge 5 Diagnostic Paediatric Pathology 1 Department of Paediatric Surgery 3 Department of Anaestesiology and Intensive Care Unit L. Rydygier Collegium Medicum N. Copernicus University in Toruń, Poland 2 Department of Paediatric Surgery and Organ Transplantation 4 Department of Anaestesiology and Intensive Care Unit 5 Department of Pathology The Children's Memorial Health Institute in Warsaw, Poland Abstract Recto-cutaneous or recto-vestibular fistulas are the most common types of anorectal malformations in girls. Among the different methods of reconstruction of these defects the most frequently recommended are posterior sagittal anorectoplasty (PSARP) as described by Peòa and anterior sagittal anorectoplasty (ASARP) as described by Mollard; both of these procedures exist in several modifications. The aim of the study is to compare the results after surgical treatment of girls with anorectal malformations and external fistula using both approaches. The results in 55 girls with anorectal malformations and external fistula (recto-cutaneous, recto-vestibular, recto-vaginal, and recto-cloacal) were analysed. In 28 girls posterior sagittal anorectoplasty (PSARP) as described by Peòa with resection of the end of fistula was performed. In 27 girls anterior sagittal anorectoplasty (ASRP), a modification of Okada operation with preservation of the external fistula, was performed. In both groups of the defects congenital associated anomalies were noted. Reconstructive surgery in all girls operated on with ASARP procedure was preceded by a daily dilatation of the fistula to obtain an appropriate diameter size as well as manometric studies of the fistula to assess the quality of internal sphincter muscle. After reconstruction of ARMs in both groups the postoperative results of continence were clinically assessed with the use of 4 clinical methods and anorectal manometry. In the group having undergone ASARP operation the presence of the internal sphincter was confirmed before and after reconstruction of defects. In the group having undergone PSARP operation the presence of an internal sphincter was confirmed after operation only in 3 children. The best functional results as demonstrated by both clinical and manometric studies occurred in the group of girls operated on with ASARP technique in whom the whole external fistula was preserved. In conclusion, the results achieved demonstrated the need of internal sphincter saving procedures by utilizing the whole fistula during reconstruction of anorectal malformations to improve the results of postoperative continence. Key words: Anorectal malformations; internal sphincter; manometry Address for correspondence Prof. Andrzej I. Prokurat Phone: +48 52 585 40 15 Department of Paediatric Surgery L.Rydygier Collegium Medicum Fax: +48 52 585 40 95 N. Copernicus University in Toruñ, Poland E-mail: aprokurat@cm.umk.pl ul. M. Sk³odowskiej-Curie 9 04-736 Bydgoszcz, Poland
Page 1 and 2: This issue includes the proceedings
Page 3 and 4: Annals of Diagnostic Paediatric Pat
Page 9 and 10: 9 Table 1 Nongastrointestinal sympt
Page 11 and 12: 11 Screening tests Screening tests
Page 15: 15 Discussion Fig. 3 PAN - Stage A
Page 18 and 19: 18 Introduction Primary malignant l
Page 20 and 21: 20 Table 6 Microscopic radicality a
Page 24 and 25: 24 Introduction Recto-cutaneous or
Page 26 and 27: 26 Table 3 Incidence of different t
Page 28 and 29: 28 value of MARP between manometric
Page 33 and 34: 33 Fig. 2 The level of pro-allergic
Page 35: 16. Salama M, Sandine W, Giovannoni
Page 38 and 39: 38 Patients, material and methods T
Page 40 and 41: 40 A D B C Fig. 1 Demonstration of
Page 42 and 43: 42 12. Raweily E, Gibson A, Burt A
Page 44 and 45: 44 pulation and occur mostly in old
Page 46 and 47: 46 composite pheochromocytomas / pa
Page 48 and 49: Szanowni Pañstwo, Mamy zaszczyt za
Page 50 and 51: 50 10 CZERWCA (sobota) 7.30 - 8.30
Page 52 and 53: 52 Leczenie operacyjne guzów chrom
Page 54 and 55: 54 Paediatric differentiated thyroi

annals 1-2.qxd - Centrum Zdrowia Dziecka

Create successful ePaper yourself

Delete template?

Save as template?