The anatomical aspects of a surgical approach through the floor of the fourth ventricle

Summary In 1993 Kyoshimaet al. introduced safe entry zones in the region of the 4th ventricle floor: infrafacial triangle and suprafacial triangle. Is it possible to demarcate these zones precisely in every case intra-operatively? A postmortem study of 40 brainstems of patients who had died of non-brain disease was performed to evaluate the degree of individual morphological and morphometrical variability of the 4th ventricle floor. The purpose of this study was to find constant landmarks and distances within the rhomboid fossa region which would help a neurosurgeon to determine safe approach zones through the 4th ventricle floor to brainstem lesions. Several anatomical landmarks — median sulcus, obex, vestibular area, vagal triangle, hypoglossal triangle — were found to be sufficiently visible in all examined brainstems. However, the facial colliculus which is a border structure between the infrafacial and suprafacial safe approach zone was poorly visible in about 37% of the analyzed material. The striae medullares were not found to be good orientation structures as they were not visible in 30% of the material and exhibited individual variability of a high degree in relation to their number and arrangement. In the morphometrical study analyzed measurements were taken by utilizing the digital image analyzer MULTISCAN. Based on the results obtained the authors suggest new borders of the infrafacial safe approach zone and morphometrical directions to determine the suprafacial safe approach zone in cases when the facial colliculus is not clearly visible or invisible intra-operatively.     

Lhermitte-Duclos disease (diffuse hypertrophy of the cerebellum). Report of two cases

Summary Two cases of Lhermitte-Duclos disease or diffuse hypertrophy of the cerebellum are presented. This brings the total number of such cases reported in the literature to 42. Pathologically the disease is characterized by a circumscribed cerebellar lesion consisting of thickening of the cortex with closely packed dysplastic ganglion cells in the granular layer and with large myelinated axons in the molecular layer. Purkinje cells are missing and the central white matter is greatly reduced.The first patient, a man 39 years of age, had, in association to the cerebellar lesion, a megalencephalic brain (2320 g). He had suffered from epilepsy since he was 24-years-old and died with metastasizing colon carcinoma. An electron microscopic study of the cerebellar lesion disclosed perikarya containing large amounts of rough endoplasmic reticulum, cell processes filled with coated and dense core vesicles. In addition, there were numerous enlarged myelinated axons in the molecular layer.The second patient, a woman 74 years of age, had a small area of diffuse hypertrophy of the left cerebellar hemisphere measuring one centimeter in diameter.Specific symptoms were very scant in the first case and absent in the second one indicating a very slow evolution — if any — of the disease process. The etiology and pathogenesis remain unknown. However, the organoid structure of the lesion, the frequent association of megalencephaly and other congenital abnormalities, and the occurrence of familiar cases would favor the disease being basically a developmental disorder.Dedicated to Professor Dr. K. J. Zülch on the occasion of his 70th birthday.     

Biomechanical and hormonal factors in the etiology of congenital dislocation of the hip joint

Summary Perinatal dislocation of the hip — C. D. H. — is influenced by mechanical and hormonal factors. The authors' experiments on rats confirm that persistent knee extension, ovariectomy and administration of progesterone increased the rate of dislocation, whereas division of either iliopsoas or the hamstring muscles or administration of oestrogen had a protective effect. The hormonal changes greatly influenced the collagen and elastin content of the joint capsule.

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Résumé La luxation congénitale de la hanche (C. D. H.) survient sous l'influence de facteurs mécaniques et hormonaux. L'expérimentation pratiquée par les auteurs sur le rat confirme que l'extension prolongée du genou, l'ovariectomie et l'administration de progestérone augmentent la fréquence des luxations tandis que la section de l'iliopsoas ou des ischiojambiers ainsi que l'administration d'oestrogènes ont un effet protecteur. Les modifications hormonales ontune influence considérable sur la proportion de fibres collagènes et élastiques de la capsule articulaire.

     

The 5th SICOT trainees meeting

The 5th SICOT trainees meetingVienna, Austria — February 10–12, 1994 Organiser Rainer Kotz     

Long-term results of triple osteotomy of the pelvis

Abstract We performed triple osteotomy according to the method of Steel in 14 patients with grade 0 and grade 1 osteoarthritis according to Tönnis classification of dysplasia of the hip. We examined the long-term results at a mean of 24 years, and evaluated whether the aggravation of osteoarthritis could be prevented by pelvic osteotomy. The mean score of the Merle dAubigne and Postel scoring system improved from 4.8 (range, 4–6) to 5.3 (range, 3–6) in pain, from 5.3 (range, 4–6) to 5.5 (range, 4–6) in walking, and from 5.4 (range, 4–6) to 5.4 (range, 4–6) in range of motion. The radiographic evaluation revealed that the mean CE angle improved from—3.9°±2.1° before surgery to 15.5°±2.3° at the follow-up. In the 3 hip joints in which the weight-bearing surface was more than halved after surgery, the postoperative CE angle was 2°, 10° and 7° and acetabular dysplasia remained after surgery; 2 hip joints were in grade 2 and 1 hip joint was in grade 3 osteoarthritis.     

Respiration triggered CO2 laser application in the Larynx — a a possibility to reduce the smoke inhalation of patients ?

The following is a report on a CO2 laser-respiration-triggering with its application in the larynx causing a reduction in the smoke load of the patient. From the result observed — an impro — ved suction capability and a reduced smoke-intensity in the ex —pired respiratory gas — it would appear that this method were suitable for practical application.     

Plastic surgery of the breast

The authors divide the techniques of reduction mammoplasty into two groups. The first one is done by the so-called classical method in which the two important pedicles—th medial (internal mammary artery) and the lateral (lateral thoracic artery)—are preserved. The second one is made through the free transplant of the areolar, chiefly in those cases of large hypertrophic breasts. Both methods give good results in experienced and skillful hands, as well as good satisfaction to the majority of our patients. On the other hand, complications may arise, as in every field of plastic surgery.     

Restoring Rotation Center in Total Hip Arthroplasty for Developmental Dysplasia of the Hip with the Assistance of Three Dimensional Printing Technology: A Pilot Study

ObjectiveTo develop a new method to restore hip rotation center exactly and rapidly in total hip arthroplasty (THA) with the assistance of three dimensional (3D) printing technology and evaluate its clinical and radiological outcomes.MethodsFrom March 2014 to July 2018, a total of 17 patients (five hips of four men and 16 hips of 13 women) with end‐stage osteoarthritis secondary to developmental dysplasia of the hip who underwent THA were analyzed and followed up retrospectively. The average age is 58.00 ± 8.12 years (range from 45 to 71 years). Simulated operations were performed on 3D printed hip models for preoperative planning. The morphology of Harris fossa and acetabular notches were recognized and restored to locate the acetabular center. The size of bone defect was measured by the bone wax method. The agreement on the size of acetabular cup and bone defect between simulated operations and actual operations were analyzed. Harris Hip Score (HHS) was used to evaluate the recovery of hip joint function. The vertical distance and horizontal distance of the rotation center on the pelvis plain radiograph were measured, which were used to assess the efficacy of restoring hip rotation center and acetabular cup migration.ResultsThe mean sizes of bone defect in simulated operations and THA were 4.58 ± 2.47 cm² and 4.55 ± 2.57 cm² respectively. There was no significant difference statistically between the sizes of bone defect in simulated operations and the actual sizes of bone defect in THA (t = 0.03, P = 0.97). The sizes of the acetabular cup of simulated operations on 3D print models showed a high rate of coincidence with the actual sizes in the operations (ICC = 0.93). All 17 patients were available for clinical and radiological follow‐up. The average follow‐up time was 18.35 ± 6.86 months (range, 12–36 months. The average HHS of the patients was improved from (38.33 ± 6.07) preoperatively to the last follow‐up (88.61 ± 3.44) postoperatively. The mean vertical and horizontal distances of hip rotation center on the pelvic radiographs were restored to 15.12 ± 1.25 mm and 32.49 ± 2.83 mm respectively. No case presented dislocation or radiological signs of loosening until last follow‐up.ConclusionsThe application of 3D printing technology facilitates orthopedists to recognize the morphology of Harris fossa and acetabular notches, locate the acetabular center and restore the hip rotation center rapidly and accurately.     

The preventive-that is with the tumor removal simultaneous-routine solution of the tonsillar and hippocampal herniations

Summary The preventive — i. e. with tumor extirpation simultaneous — routine subpial suction of the herniated tonsils and hippocampus seems to be a valuable factor in the surgery of gliomas as it decrease importantly the number of postoperative complications — claiming reoperations — and the case mortality of the posterior fossa and temporal gliomas.

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Zusammenfassung Die vorbeugende — d. h. gleichzeitig mit der Tumorexstirpation vorgenommene — routinemäßige Aussaugung eingeklemmter Kleinhirntonsillen oder des Hippocampus scheint eine wertvolle Maßnahme in der Chirurgie der Gliome zu sein, welche die Zahl der postoperativen Komplikationen, die eine Nachoperation erforderlich machen, wesentlich vermindert und die Fallmortalität bei Gliomen der hinteren Schädelgrube und des Temporallappens senkt.

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Resumen La extirpación simultánea del tumor y la aspiración subpial preventiva de rutina de las amigdalas e hipocampo herniados parece ser un valioso factor en la cirugía de los gliomas, porque disminuye en gran número las complicaciones operatorias (que exigen reintervenciones) y la mortalidad en los casos de gliomas de la fosa posterior y temporales.

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Résumé Le traitement préventif — c'est-à-dire avec extirpation simultanée de la tumeur — par aspiration de la hernie amigdalienne et hippocampique paraî çtre un facteur valable dans la chirurgie des gliomes car il diminue de façon importante le nombre des complications post-opératoires et la mortalité dans les gliomes de la fosse postérieure et de la fosse temporale.

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Riassunto La suzione subpiale delle tonsille erniate e dell'ippocampo eseguita di routine preventivamente — cioè contemporaneamente alla estirpazione del tumore — sembra costituire un fattore importante nella buona riuscita della chirurgia dei gliomi in quanto riduce notevolmente il numero delle complicazioni postoperatorie — le quali necessiterebbero un reintervento — e la percentuale di mortalità nei tumori della fossa posteriore e nei gliomi temporali.

     

Long‐Term Follow‐Up of Multilevel Thoracic Ossification of the Posterior Longitudinal Ligament Following Circumferential Decompression via Posterior Approach: A Retrospective Study

ObjectiveTo examine the postoperative progression of multilevel thoracic posterior longitudinal ligament (OPLL) at circumferential decompression (CD) levels and evaluate the long‐term results after CD via the posterior approach.MethodsClinical data from 16 patients with thoracic myelopathy secondary to OPLL who underwent CD at a single center were evaluated retrospectively from 2007 to 2014 and were followed up for more than 60 months. Patients of all sexes and ages were included in the study. Thin‐slice computed tomography scans obtained at the time of surgery and the most recent follow‐up were analyzed. The ossified area was measured on the axial reconstructed scan of the most obvious protrusion of ossification at the CD level. The neurological outcomes were evaluated using modified Japanese Orthopaedic Association (JOA) scores and Hirabayashi recovery rates (HRRs). Continuous variables were presented as the mean ± standard deviation and were analyzed using the Student''s t‐test, while categorical variables were tested using Fisher''s exact test.ResultsAmong all patients, the most predominant type was the mixed type (9/16, 56.3%), while the circumscribed type was only found in two patients (12.5%), and the continuous type was found in five patients (31.2%). Six cases were associated with ossification of the ligamentum flavum, and two cases were combined with cervical OPLL. The OPLL area at the CD level increased in all patients. The mean follow‐up period was 5.5 ± 0.92 years (range 5–8 years). The mean area of ossification increased from 35.63 ± 39.23 mm² at the time of surgery to 99.94 ± 65.39 mm² at the last follow‐up visit (P < 0.01). There was no internal fixation disorder on any computed tomography scan after the operation. The average JOA score of all patients improved from 4.2 ± 2.2 points before surgery to 8.4 ± 2.6 points at the final follow‐up (P < 0.01). The overall HRR was 61.8%. None of the patients exhibited any neurological deterioration due to OPLL progression. One patient developed a severe gait disturbance due to worsening lumbar canal stenosis, an unrelated cause, but the other 15 experienced gait disturbance improvements.ConclusionsAccording to the long‐term follow‐up results, although OPLL progression did not decrease or stop after removing the OPLL mass, CD is a safe and effective procedure that can provide adequate reserve ventral space to cope with postoperative OPLL progression.     

Malignant fibrous histiocytoma of the aorta complicated by anuria

Tumors of the aorta have been reported infrequently in the literature. We report a case of a 63-year-old woman diagnosed with maligant aortic fibrous histiocytoma (also known as fibroxanthosarcoma). She was referred to us with suspected occlusion of the right renal artery in a single functioning kidney, with a clinical picture of anuria during the previous 48 hours. We also review 31 previously published cases in the literature.Presented at the annual meeting of the Sociedad Española de Angiologia y Cirugia Vascular—5th Congress of the European Chapter of the International Union of Angiology, May 30–31, June 1–2, 1990, Barcelona, Spain.     

Commentary on the 2014 BP Guidelines from the Panel Appointed to the Eighth Joint National Committee (JNC 8)

The recently published article “2014 Evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8)” (James et al., JAMA 311: 507–520, 2014) has generated considerable controversy. In this commentary, we evaluate the document and compare the recommendations contained within it with those of the JNC 7 and other national and international guidelines. The evidence quality rating approach followed by the article “2014 Evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8)” (James et al., JAMA 311: 507–520, 2014) disqualified nearly 98% of previous studies from review; as a result, some of the key recommendations were on the basis of expert opinion alone. We are especially concerned that the recommendation to raise the systolic/diastolic BP levels at which treatment is initiated to ≥150/≥90 mmHg in adults≥60 years old may affect cardiovascular and renal health in these patients. Additionally, we recommend that hypertension guidelines should be updated every 3–4 years with a fresh approach to the definition of target BP levels, the use of modern technology in the diagnosis of hypertension, and the treatment of hypertension in special populations not addressed in earlier guidelines.     

Borderline Developmental Dysplasia of the Hip: A Risk Factor Predicting the Development and Poor Prognosis after Core Decompression for Idiopathic Osteonecrosis of the Femoral Head

ObjectiveIt is unclear whether idiopathic osteonecrosis of the femoral head (ONFH) is associated with borderline developmental dysplasia of the hip (BDDH). This study aimed to compare the incidence of BDDH between patients with idiopathic ONFH and matched control subjects and determine the influence of BDDH on poor prognosis after core decompression (CD).MethodsWe retrospectively examined 78 consecutive patients (111 hips) with idiopathic ONFH undergoing CD and 1:2 matched with 156 control subjects (222 hips). The anteroposterior pelvic radiographs were used to measure the acetabular anatomical parameters and divide included subjects into BDDH or non‐BDDH group. The incidence of BDDH and acetabular anatomical parameters were compared between patients with idiopathic ONFH and matched controls. Clinical outcomes, such as Harris Hip Score (HHS), progression of collapse, and conversion to total hip arthroplasty (THA), were compared between patients with BDDH and without BDDH in the idiopathic ONFH group, with a mean follow‐up of 72.1 ± 36.6 months.ResultsPatients with idiopathic ONFH had a significantly higher incidence of BDDH than matched controls (29.7% vs 12.2%, p < 0.001). Less acetabular coverage was also found in patients with idiopathic ONFH than in matched controls as demonstrated by lower CEA (28.5° ± 4.7° vs 33.1° ± 5.7°, p < 0.001), AHI (82.4 ± 5.0 vs 86.3 ± 5.4, p < 0.001), ADR (299.6 ± 28.4 vs 318.8 ± 31.3, p < 0.001), and a higher sharp angle (40.0° ± 3.4° vs 37.4° ± 3.7°, p < 0.001). In patients with idiopathic ONFH, the BDDH group had a significantly lower mean HHS at the last follow‐up (83.5 ± 17.4 vs 91.6 ± 9.7, p = 0.015) with a different score distribution (p = 0.004), and a lower 5‐year survival rate with both clinical failure (66.7%, 95% CI 52.4%–84.9% vs 83.7%, 95% CI 75.2%–93.1%; p = 0.028) and conversion to THA (74.6%, 95% CI 60.7%–91.6% vs 92.1%, 95% CI 85.6%–99.0%; p = 0.008) as the endpoints than the non‐BDDH group.ConclusionThe incidence of BDDH was significantly higher in patients with idiopathic ONFH than matched controls, and idiopathic ONFH patients who underwent CD with BDDH had lower mean HHS as well as 5‐year survival rate than those without BDDH. Therefore, BDDH should be considered a risk factor predicting the development of idiopathic ONFH as well as poor prognosis after CD.     

Bone loss and forms of tibial condylar fracture

Summary Bone loss and fracture type were determined in 358 tibial condylar fractures. Degree of osteoporosis at the knee was defined by analogy to Singh's grades of osteoporosis at the hip and to Jhamaria's classification of osteoporosis at the calcaneum: grade V — normal; grade IV — slight reduction of trabecular bone; grade III — osteoporosis, predominantly of trabecular bone; grade II — osteoporosis of trabecular and cortical bone. Five fracture types were distinguished, with the component of trabecular bone compression increasing from a to e: a — pure split fractures; b — split fractures with displacement of a piece of the articular surface; c — split compression fractures; d — local compression fractures; e — compression of a whole condyle. There was a highly significant rank correlation between the two sets of ordered categories. Fractures in osteoporotics tended to involve the lateral condyle; this is explained by the fact that crush fractures occurred more frequently at the lateral condyle. The influence of bone loss on fracture type was demonstrated to be independent of age. A clear understanding of these associations concerning three variables at a time was reached by the use of log-linear-model analysis for cross-classified qualitative data.

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Zusammenfassung Bei 358 Frakturen der proximalen Tibia wurden der röntgenologisch erkennbare Knochenschwund und die Frakturform festgestellt. Entsprechend dem Singh-Index zur Bestimmung der Osteoporose am proximalen Femur und der Klassifikation der Trabekelstruktur am Fersenbein nach Jhamaria wurden folgende Osteoporosegrade am Knie definiert: Grad V — normal, Grad IV — Spongiosastruktur leicht vermindert, Grad III — Osteoporose betrifft vorwiegend die Spongiosa, Grad II —Osteoporose von Spongiosa und Kompakta. Fünf Frakturformen wurden unterschieden, wobei das Ausmaß der Spongiosakompression von a bis e ansteigt: a — reine Spaltfrakturen, b — Spaltfrakturen mit Abscherung eines Gelenkflächenteiles, c —Spaltkompressionsfrakturen, d — Frakturen mit lokaler Kompression, e — Frakturen mit Kompression eines ganzen Kondyls. Zwischen diesen beiden Merkmalen, deren Ausprägungen Rangklassen bilden, war eine hochsignifikante Rangkorrelation nachzuweisen. Brüche osteoporotischer Knochen betrafen vermehrt den lateralen Gelenksknorren, was dadurch statistisch zu erklären war, daß dieser sich für Kompressionsfrakturen als anfälliger erwies. Die Beziehung zwischen Osteoporose und Frakturform war nicht abhängig vom Lebensalter. Solche Zusammenhange zwischen je drei Variablen konnten übersichtlich dargestellt wurden, indem die Häufigkeitstabellen durch Log-lineare Modelle interpretiert wurden.

     

Twenty years experience of the buried dermis flap operation in the treatment of chronic lymphoedema of the extremities

Summary Existing methods for the treatment of chronic lymphoedema of the extremities by surgery, are briefly reviewed. The results of 20 years experience using the buried dermis flap are presented, as applied to 140 patients, affecting 102 lower limbs and 49 upper. The need for prolonged follow-up is stressed. In the lower limb 88 limbs affected by primary lymphoedema resulted in 51% good results and 32% significantly improved; the corresponding figures in 14 limbs with secondary lymphoedema were 57% and 14%. — In the upper limb, of 49 arms treated, good results were obtained in 61% and significant improvement in 18%. In all cases treated, recurrent attacks of cellulitis were reduced or abolished in the majority. Complications to operation are discussed; the commonest is localised skin flap necrosis, occuring in almost half the cases treated, but requiring formal reoperation and skin grafting in only a minority. — Evidence is submitted that the long-term results obtained, taken into consideration together with the cosmetic values and relative simplicity of the operation, makes it the procedure of choice in the surgical management of this condition.Presented at the 7th International Congress of Lymphology, Florence, Italy. 28 Oct.–2 Nov. 1979     

266. Kolloidosmotischer Druck und postoperative Humanalbumingabe

Zusammenfassung In einer prospektiven Studie wurde der kolloidosmotische Druck (KOD) bei 181 Patienten auf der Intensivstation routinemäßig postoperativ bestimmt, Humanalbumin wurde nur verabreicht, wenn der KOD unter 27 cm H₂O sank. Es ließen sich auf diese Weise — verglichen mit einer Kontrollgruppe, bei der sich die Humanalbuminzufuhr nach der Gesamteiweißkonzentration richtete — erhebliche Mengen Albumin sparen. Folgende Indikationen zur Bestimmung des KOD wurden erarbeitet: Polytrauma — Verbrennung — Oesophagusvaricenblutung — Peritonitis —Sepsis.     

A Comparative Study of Clinical and Radiological Outcomes of Open Reduction Using the Anterior and Medial Approaches for the Management of Developmental Dysplasia of the Hip

BackgroundThe literature is scanty on reports directly comparing the outcomes of anterior open reduction (AOR) and medial open reduction (MOR) in the management of developmental dysplasia of the hip (DDH).Purpose of the StudyTo compare clinical and radiographic outcomes of surgical treatment using either AOR or MOR in children with DDH aged < 24 months and to evaluate the procedure-inherent risks of avascular necrosis of the femoral head (AVN) and need for further corrective surgery (FCS).Methods61 children who underwent surgical treatment for DDH were categorized into two groups: AOR (31 hips of 28 patients) and MOR (39 hips of 33 patients). The mean age was 17 ± 5.85 (range 7–24) months in group AOR and 13 ± 5.31 (range 6–24) months in group MOR. The mean follow-up was 118 ± 41.2 (range 24–192) months and 132 ± 36.7 (range 24–209) months in group AOR and MOR. At the final follow-up, mid- to long-term clinical and radiographic outcomes were assessed. FCS was recorded.ResultsRegarding McKay’s clinical criteria, both groups exhibited similar results (p = 0.761). No significant differences were observed between the groups in both the center–edge–angle (p = 0.112) and the Severin score (p = 0.275). The AVN rate was 32% in the AOR group and 20% in the MOR group (p = 0.264). The FCS rate was 22% in the AOR group and 12% in the MOR group (p = 0.464).ConclusionsThis study showed similar clinical and radiological outcomes with AOR and MOR with no significant relation to AVN and FCS.Level of EvidenceLevel III.     

Ergebnisse der operativen Behandlung der Radiusköpfchenfraktur

Zusammenfassung Bei der Behandlung der Speichenköpfchenfraktur stellt das operative Vorgehen nur eine Therapiemöglichkeit dar. Anhand von 30 operativ versorgten Radiusköpfchenfrakturen wird auf die Indikationsstellung zur operativen Versorgung und auf das jeweilige Verfahren — Resektion oder Rekonstruktion des Speichenköpfchens — eingegangen. Die Nachuntersuchung zeigte für die Rekonstruktion etwas bessere Ergebnisse hinsichtlich der Bewegungseinschränkung und der posttraumatischen Arthrose als für die Resektion, wenn auch die kleine Fallzahl keine Signifikanz zuläßt. Ein Cubitus valgus oder Veränderungen am distalen Radio-Ulnargelenk nach Resektion konnten nicht gefunden werden. Ist die Indikation zur operativen Versorgung einer Radiusköpfchenfraktur gestellt, sollte immer zunächst ein Rekonstruktionsversuch unternommen werden.

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Surgical treatment results in radius head fractures

Summary The operative treatment of radius head fractures represents only one method. Indication for surgical treatment and the method (resection or reconstruction of the radius head) is elucidated based on 30 surgically treated radius head fractures. Postsurgical examinations show better results for the reconstruction method in the limitation of movement and post-traumatic arthrosis than the resection, even though the difference between them shows no significance regarding the small number of cases. Cubitus valgus or changes on the distal radioulnar joint after resection were not found. If there is indication for surgical treatment of a radius head fracture, one should consider using the reconstruction method first.

Vortrag gehalten auf der 96. Tagung der Deutschen Gesellschaft für Chirurgie     

Primary spinal medulloblastomas?

Two cases with spinal medulloblastoma are presented in which even modern neuroradiological methods (computed tomography — CT — and nuclear magnetic resonance imaging — NMR —) did not demonstrate intracranial lesions. These cases should be considered to be primary spinal medulloblastomas, even if until now the existence of real primary spinal medulloblastomas has been doubted.     

81. Angeborene Lungenfehlbildungen als Indikation zu dringlichen Eingriffen im Säuglingsalter

Zusammenfassung Es wird über 7 angeborene Lungenfehlbildungen beim Säugling berichtet, die in den letzten 8 Jahren beobachtet wurden. Es handelt sich um 4 Fälle eines kongenitalen lobären Emphysems, um 2 Fälle von Cystenlunge und um einen dysontogenetischen Tumor — ein sog. Hamartom —, das fast die ganze linke Brusthöhle einnahm. Alle Säuglinge wurden in einem lebensbedrohlichen Zustand infolge einer schweren respiratorischen Insuffizienz aufgenommen. Die Diagnose kann in der Regel an Hand von einfachen Röntgenübersichtsaufnahmen des Thorax in zwei Ebenen gestellt werden. Schnelles chirurgisches Eingreifen ist notwendig. Durch Resektion des betroffenen Lungenteils — meist Lobektomie —kann eine Heilung erzielt werden.

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Summary The author reports on 7 congenital pulmonary malformations in infants which were observed during the last 8 years. 4 cases suffered from congenital lobar emphysema, 2 from cystic lungs and 1 was a dysontogenetic tumor — a socalled hamartoma —, which occupied almost the entire left thoracic cavity. All infants were admitted in critical condition due to severe respiratory failure. Usually the diagnosis can be made on the basis of simple survey radiograms of the thorax in two planes. Quick surgical intervention is necessary. Cure can be effected by resection of the affected pulmonary segment — usually by lobectomy.