International Abstracts604

injection. Only 1 patient required an second treatment. There were no

complications. The success rates and complications of injection treatment

for RP reported in the literature differ for each sclerosing agent. 15% saline

is preferable because of the high cure rate, the safety of the procedure and

the lack of complications.—Thomas A. Angerpointner

Critical assessment of the methods used for detection ofbacterial translocation

Oliveros FH, Zou V, Lopez G, et al. Pediatr Surg Int 2004 (April);20:

267-270.

Bacterial translocation (BT) is indicative of a breakage of the intestinal

barrier. It can be assessed in experimental models by blood and lymph node

cultures as well as by polymerase chain reaction (PCR) detection of DNA

of enteric bacteria. The last method is particularly sensitive for demon-

strating BT. The authors investigated BT by blood and lymph node cultures

and by E. coli DNA amplification in animals with or without an temporary

clamping of the mesenteric vessels.

Rats were sham operated (laparotomy and bowel evisceration alone) or

had 15 min clamping of portal vein and mesenteric artery for ischemia-

reperfusion (IR) trauma. Animals were killed on postoperative day 2 or day

7. Regional lymph nodes, portal vein blood and vena cava blood samples

were cultured. E. coli DNA was assessed in blood samples by PCR,

genomic DNA was extracted and amplificated. The presence of any

amplificated DNA was considered as evidence of BT. Bacterial material in

portal blood or lymph nodes showed pre-hepatic BT. In peripheral blood

post-hepatic BT was indicated.

No significant difference was found between sham-operated (SO)

animals and those with ischemia-reperfusion (IR). In the post-hepatic blood,

bacterial evidence was found in 1/6 SO animals and in 0/6 IR rats at day 2, in

1/6 and 3/6 on day 7. In the pre-hepatic samples, BT of gram-negative

bacteria was found in 1/6 and 2/6 on day 2, in 1/6 and 1/6 on day 7. Taking

gram-positive bacteria into account, the values were 4/6 . /. and 4/6 . /. 5/6 on

day 2 and day 7 respectively.

BT is found in up to 59% of patients with intestinal obstruction, in around

5% of surgical patients without obstruction and in 10% of SO animals. BT is

thought to contribute to multiple organ failure and infectious complications.

Bacterial cultures are often negative. But BT from the intestine is difficult to

demonstrate in human beings because the analysis of lymph nodes and portal

blood are not feasible and post-hepatic blood could be contaminated from

other origin. In this study, DNA amplification of gram-negative bacteria,

which is a very sensitive method, failed to show any effect by IR. It is

possible that clamping time was too short or the timing of sampling 2 days

after IR was too late. The results can be useful for further experiments, but

clinical application is still to be settled.—Peter Schmittenbecher

Abdomen

Surgery in biliary atresia—futile or futuristic?

Petersen C. Eur J Pediatr Surg 2004 (August);14:226-229.

Kasai’s portoenterostomy is, so far, the only option for patients with biliary

atresia (BA) to survive with their own liver. The long-term results are

closely related to the timing of the procedure and to the expertise of the

center. However, optimal conditions cannot guarantee stable liver function.

Unfortunately, the majority of patients with BA eventually need liver

transplantation, making them the largest group of pediatric organ

recipients. Thus, surgery in patients with BA treats only the symptoms,

but never the cause of the disease. In order to focus on this point,

international and interdisciplinary cooperation is mandatory to improve

early and effective diagnosis, to optimize surgical treatment, and to

coordinate clinical and basic research. Uncovering its unknown etiology is

crucial for developing and modifying new therapeutic attempts to treat the

disease, including the opportunities for prophylaxis. Until then, surgical

treatment is still the best approach for BA and, so far, no further prospects

are apparent.—Thomas A. Angerpointner

Postcholecystectomy syndrome with special regard to children—A reviewUre BM, Jesch NK, Nustede R. Eur J Pediatr Surg 2004 (August);14:

221-225.

The incidence of abdominal symptoms after cholecystectomy in adults is

high. Up to one third of the patients consult a doctor because of abdominal

complaints within 1 year after the operation. In addition, a higher incidence

of colon carcinoma after cholecystectomy has been reported in female

patients. This article reviews the known facts on the bpostcholecystectomy

syndromeQ. However, little is known about postcholecystectomy symptoms

in children. Reports on cholecystectomy in children deal more with

feasibility than long-term outcome. Therapeutic concepts for children with

symptomatic gallstone disease should consider the differences in the

etiology of gallstone formation between children and adults. Therefore,

the authors recommend a specific concept, including laparoscopic chol-

ecystotomy, for children with temporary disorders causing gallstones, and

laparoscopic cholecystectomy for all other patients. The impact of these

procedures on postcholecystectomy symptoms in children and the impact of

cholecystectomy during childhood on the incidence of right-sided colonic

carcinoma remains to be determined.—Thomas A. Angerpointner

Large supraumbilical pseudocystic tumor due to ectopic pancreatictissue located in a rest of the omphaloenteric ductTillig B, Gerein V, Coerdt W, et al. Eur J Pediatr Surg 2004 (April);4:

126-129.

Ectopic umbilical pancreatic tissue is extremely rare. The authors report a

two-year-old boy who suffered from a large recurrent supraumbilical tumor

with central cystic degeneration. Ectopic pancreatic tissue was located within

the submucosal layer of an umbilical rest of the omphaloenteric duct. Peptic

erosion and inflammatory alteration of the tissue surrounding the umbilical

vein caused recurrent bleeding and formation of a pseudocyst as well as

chronic inflammatory granulations within the abdominal wall. The

pseudocyst was completely excised. Postoperative recovery was uneventful.

— Thomas A. Angerpointner

Il-1beta Induces an Exaggerated Pro- and Anti-inflammatory Responsein Peritoneal Macrophages of Children Compared With AdultsBarsness KA, Bensard DD, Patrick DA, et al. Pediatric Surg Int 2004

(April);20:238-242.

Infants and children have a lower incidence of post-traumatic multiple

organ failure (MOF). Their injury pattern is not characterized by the classic

sequential organ failure (pulmonary, hepatic, renal). Acute lung injury is

reduced by more than 50%, ARDS occurs infrequently and mortality rate is

low. This could be explained by an attenuated pro-inflammatory response

(IL-6, IL-8, TNFalpha) or an exaggerated anti-inflammatory effect (IL-10).

Peritoneal cell suspensions were received during elective laparoscopic

procedures in otherwise healthy children (fundoplication) and adults

(cholecystectomy) by instillation of normal saline into the peritoneal cavity

for two minutes, collection, centrifugation and resuspension of the cells in

culture media. 24 hours later stimulation with 200 ng/ml human IL-1beta as

a potent pro-inflammatory stimulus took place.

In the basal state, pediatric and adult macrophages showed similar

production for IL-6, IL-8 and TNFalpha. IL-1beta induced a 6-fold increase

of TNFalpha in adults and a 15-fold increase in children. The difference in

IL-6 production was less accentuated, and in IL-8, the increase was

comparable between children and adults. A basal anti-inflammatory IL-10

production was found only in children. Following IL-1beta stimulation, and

11-fold increase in children, but no response in adults was found.

Serum levels of cytokines do not correlate well with tissue-specific

levels. An increased anti-inflammatory cytokine production takes place at

the local site of an injury. Therefore, peritoneal macrophages were chosen

because these terminally differentiated cells are dominant cytokine-