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  • 1
    Keywords: PREVALENCE ; METAANALYSIS ; TECHNOLOGY ; descriptive epidemiology ; BIRTH-DEFECTS ; CONGENITAL-MALFORMATIONS ; IN-VITRO FERTILIZATION ; INFANTS BORN ; CHILDREN BORN ; IVF-METHODS
    Abstract: Background: The use of assisted reproductive techniques (ART) for treatment of infertility is increasing rapidly worldwide. However, various health effects have been reported including a higher risk of congenital malformations. Therefore, we assessed the risk of anorectal malformations (ARM) after in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). Methods: Data of the German Network for Congenital Uro-REctal malformations (CURE-Net) were compared to nationwide data of the German IVF register and the Federal Statistical Office (DESTATIS). Odds ratios (95% confidence intervals) were determined to quantify associations using multivariable logistic regression accounting for potential confounding or interaction by plurality of births. Results: In total, 295 ARM patients born between 1997 and 2011 in Germany, who were recruited through participating pediatric surgeries from all over Germany and the German self-help organisation SoMA, were included. Controls were all German live-births (n = 10,069,986) born between 1997 and 2010. Overall, 30 cases (10%) and 129,982 controls (1%) were born after IVF or ICSI, which translates to an odds ratio (95% confidence interval) of 8.7 (5.9-12.6) between ART and ARM in bivariate analyses. Separate analyses showed a significantly increased risk for ARM after IVF (OR, 10.9; 95% CI, 6.2-19.0; P 〈 0.0001) as well as after ICSI (OR, 7.5; 95% CI, 4.6-12.2; P 〈 0.0001). Furthermore, separate analyses of patients with isolated ARM, ARM with associated anomalies and those with a VATER/VACTERL association showed strong associations with ART (ORs 4.9, 11.9 and 7.9, respectively). After stratification for plurality of birth, the corresponding odds ratios (95% confidence intervals) were 7.7 (4.6-12.7) for singletons and 4.9 (2.4-10.1) for multiple births. Conclusions: There is a strongly increased risk for ARM among children born after ART. Elevations of risk were seen after both IVF and ICSI. Further, separate analyses of patients with isolated ARM, ARM with associated anomalies and those with a VATER/VACTERL association showed increased risks in each group. An increased risk of ARM was also seen among both singletons and multiple births.
    Type of Publication: Journal article published
    PubMed ID: 22978793
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  • 2
    Keywords: EUROPE ; FAMILIES ; BIRTH-DEFECTS ; BORN ; TECHNOLOGIES
    Abstract: Purpose: We assessed the risk of exstrophy-epispadias complex in children conceived by in vitro fertilization or intracytoplasmic sperm injection. Materials and Methods: Data from the German Network for Congenital Uro-REctal malformations were compared to nationwide data from the German In Vitro Fertilization Register and the German Federal Statistical Office. Odds ratios (95% CI) were determined to quantify associations using logistic regression. Results: A total of 123 patients with exstrophy-epispadias complex born in Germany between 1997 and 2011 were recruited through participating departments of pediatric urology and pediatric surgery throughout the country as well as the German self-help organizations Blasenekstrophie/Epispadie e.V. and Kloakenekstrophie. All German live births (10,069,986) between 1997 and 2010 comprised the controls. Overall, 12 subjects (10%) and 129,982 controls (1%) were conceived by in vitro fertilization or intracytoplasmic sperm injection. Conception by assisted reproductive technique was associated with a more than eightfold increased risk of exstrophy-epispadias complex compared to spontaneous conception (OR 8.3, 95% CI 4.6-15.0, p 〈 0.001). Separate analyses showed a significantly increased risk of exstrophy-epispadias complex in children conceived by in vitro fertilization (OR 14.0, 95% CI 6.5-30.0, p 〈 0.0001) or intracytoplasmic sperm injection (OR 5.3, 95% CI 2.2-12.9, p 〈 0.0001). Conclusions: This study provides evidence that assisted reproductive techniques such as in vitro fertilization and intracytoplasmic sperm injection are associated with a markedly increased risk of having a child born with exstrophy-epispadias complex. However, it remains unclear whether this finding may be due to assisted reproduction per se and/or underlying infertility/subfertility etiology or parent characteristics.
    Type of Publication: Journal article published
    PubMed ID: 23201374
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  • 3
    ISSN: 1432-1440
    Keywords: Folic acid ; acute renal failure ; macula densa ; peripheral plasma renin activity ; hemorrhage ; Folsäure ; akutes Nierenversagen ; Macula densa ; periphere Plasma-Reninaktivität ; Hämorrhagie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die periphere Plasma-Reninaktivität war bei Ratten mit akutem Nierenversagen, das durch eine einmalige i.v. Injektion von Folsäure (250 mg/kg KG, gelöst in 0,3 M NaHCO3) erzeugt worden war, während der ersten 6 Std normal und nach 24 Std und 4 Tagen harabgesetzt. Hämorrhagie verursachte jedoch am 4. Tag nach Folsäuregabe einen starken Anstieg der Plasma-Reninaktivität. Für eine Beteiligung des Renins an der Entwicklung des folsäurebedingten funktionellen und morphologischen Nierenschadens ergab sich kein Anhalt.
    Notes: Summary Peripheral plasma renin activity in acute renal failure induced in rats by a single i.v. injection of folic acid (250 mg/kg b. w., dissolved in 0.3 M NaHCO3) remained normal during the first 6 hours and fell to low levels 24 hours and 4 days following the injection. Bleeding, however, induced a considerable increase of plasma renin activity on the 4th day after folate injection. There was no evidence of a participation of renin in the development of the functional and morphological renal disturbances produced by folic acid.
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  • 4
    ISSN: 1435-2451
    Keywords: Splenectomy ; Immunodeficiency ; Follow-up examination ; Immundefekt ; Splenektomie ; Nachuntersuchung
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Von 1974–84 wurden an der Chirurgischen Universitäts-Klinik Tübingen 163 Patienten wegen eines Traumas splenektomiert. Bei der Nachuntersuchung fanden wir keine erhöhte Infektanfälligkeit und kein OPSI-Syndrom. Nahezu 40% unserer Patienten hatten noch funktionsfähiges Milzrestgewebe im Szintigram auf Grund spontaner Splenosis peritonei, Autotransplantation oder wegen einer Nebenmilz. Die Bestimmung der Serumimmunglobuline IgM, A, G, des Antikörpertiterverlaufs nach Tetanusimpfung, der Lymphocytenstimulation durch ConA, PHA, PWM und der Granulocytenphagocytose zeigte keinen Unterschied zwischen splenektomierten Patienten mit oder ohne Milzrestgewebe und einer Kontrollgruppe.
    Notes: Summary From 1974 to 1984, 163 patients underwent splenectomy for traumatic rupture of the spleen. On follow-up, no cases of OPSI syndrome and no increase in the rate of infections occurred. Nearly 40% of the patients displayed partial splenic function on99mTc sulfur scintigraphy because of peritoneal splenosis, accessory spleens or autotransplantation. Measurement of the levels of immunoglobulins M, A and G, the immune response to tetanus vaccine, the stimulation of lymphocytes by ConA, PHA and PWM and the phagocytic capacity of granulocytes showed no difference between patients with no splenic function, those with partial splenic function or a group of normal individuals used as a control.
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  • 5
    ISSN: 1435-2451
    Keywords: Hirschsprung disease ; Adult ; Megacolon congenitum ; Erwachsenenalter
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Es wird über 10 Patienten (10–67 Jahre) mit Obstipation von Kindheit an berichtet, die zwischen 1968 und 1979 wegen histologisch gesicherten Megacolon congenitum behandelt wurden. 6 Patienten wurden im Erwachsenenalter erstmals operiert, 2 waren mehrfach unzureichend voroperiert und kamen zur Resektion des aganglionären Segments. Bei 2 Patienten trat Jahre nach Resektion des aganglionären Rectosigmoids im Kindesalter erneut eine Hirschsprung-Symptomatik auf infolge sekundärer Aganglionose oral der Anastomose. Ein sogenanntes symptomatisches Megacolon (z. B. bei Hypothyreose) schließt ein Megacolon congenitum nicht aus.
    Notes: Summary Ten cases of congenital megacolon in adolescents and adults are reported, operated on 1968–1979. The diagnosis was based on a history of chronic constipation since infancy, histologic investigation of biopsy specimens, and X-ray examination. Six patients were operated on only as adults. Two had undergone surgery previously without excision of the aganglionic segment. Two patients with excision of the aganglionic rectosigmoid colon in infancy developed symptoms of Hirschsprung's disease in adolescence due to ganglion cell degeneration orally to the site of primary anastomosis. Congenital aganglionic megacolon should be considered even in adult megacolon.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1435-2451
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Langenbeck's archives of surgery 364 (1984), S. 233-237 
    ISSN: 1435-2451
    Keywords: The burned child ; Hypermetabolism ; Mixed grafts ; Thermisches Trauma ; Katabolismus ; Gemischte Hauttransplantate
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Im Gegensatz zum Erwachsenen führt der Protein- und Energieverlust beim Kind rasch zu einer katabolen Stoffwechsellage, weil seine Glykogen- und Fettreserven begrenzt sind. Ausdruck des Katabolismus ist das rasche Abmagern durch Abbau der Strukturproteine. In diesem Referat werden die therapeutischen Konsequenzen erörtert. Außerdem wird dargestellt, wie ausgedehnte drittgradige Verbrennungen mit gemischten allogenen/autologen Transplantaten behandelt werden können.
    Notes: Summary In contrast to adults the protein and energy loss leads to hypermetabolism in the burned child. This is because their glycogen and fat reserves are limited. The catabolism finds expression in the rapid loss of weight resulting from reduction of the structure proteins. Therapeutic consequences will be discussed in this paper. Furthermore cases will be demonstrated where extensive third degree burns were able to be treated by mixed allografts and autografts.
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  • 8
    ISSN: 1435-2451
    Keywords: Renal insufficiency ; Megaureter ; Hydronephrosis ; Niereninsuffizienz ; Refluxive und obstruierende Megaureter ; Hydronephrose
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Unter 1500 Kindern mit congenitalen Harntransportstörungen beobachteten wir 65 kompensiert niereninsuffiziente. Heute streben wir eine frühzeitige, häufig jedoch mehrzeitige operative Korrektur an. Bei Urosepsis und gleichzeitiger Obstruktion erfolgt eine percutane Entlastung, verbunden mit Rehydrierung und antibiotischer Therapie, der eigentliche Korrektureingriff wird verschoben. Bei subvesicaler Abflußstörung erfolgt bis zur Normalisierung der Retentionswerte eine suprapubische Ableitung. Refluxierende Megaureter führen wir nach ausreichender Hydrierung und bei Infektfreiheit der Primärkorrektur zu. Die obstruierenden Megaureter, häufig mit dysplastischen Nieren verbunden, entlasten wir mit einem Sober-Loop. Die Modellage und Ureteroneostomie können wir dann zeitlich nicht gebunden später durchführen.
    Notes: Summary Partially compensated renal insufficiency was observed in 65 of 1,500 children with congenital urological defects. We attempted early operative correction which otherwise is accomplished in several sittings. Urosepsis with concommitant urinary obstruction is treated by percutaneous nephrostomy, rehydration, and antibiotics; operative correction is postponed. Subvesical urinary obstruction is managed by suprapubic vesicostomy until normalization of retention values occurs. Primary correction of refluxive megaureters is achieved after sufficient hydration and in infection-free cases. Obstructive megaureters, often associated with dysplastic kidneys, are relieved by Sober's ureterostomy. The modeling of the ureter and its neostomy are performed in separate sittings later.
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