Table Of ContentProgress in Pediatric Surgery
Volume 26
Co-founding Editor:
P. P. Rickham
Editors:
T. A. Angerpointner
M. W. L. Gauderer . W. Ch. Hecker
J. Prevot . L. Spitz
U. G. Stauffer . P. Wurnig
Surgery
for Endocrinological Diseases
and Malformations
in Childhood
Volume Editors
M. W. L. Gauderer and T. A. Angerpointner
With 45 Figures
and 33 Tables
Springer- Verlag
Berlin Heidelberg New York
London Paris Tokyo
Hong Kong Barcelona
Budapest
MICHAEL W. L. GAUDERER, MD
Rainbow Babies and Childrens Hospital
2074 Abington Road
Cleveland, OH 44106, USA
Priv.-Doz. Dr. THOMAS A. ANGERPOINTNER
ZenettistraBe 48/III, D-8000 Munich 2 (W)
Federal Republic of Germany
Volumes 1-17 of this series were published
by Urban & Schwarzenberg, Baltimore-Munich
Library of Congress Cataloging-in-Publication Data
Surgery for endocrinological diseases and malformations in childhood 1
volume editors, M. W. L. Gauderer and T. A. Angerpointner. p. cm. -
(Progress in pediatric surgery; v. 26)
Includes bibliographical references. Includes index.
TSBN-13: 978-3-642-88326-2 e-TSBN-13: 978-3-642-88324-8
DOT: 10.1007/978-3-642-88324-8
1. Thyroid gland - Surgery. 2. Endocrine glands - Surgery. 3. Pediatric endocrinology.
I. Gauderer, Michael W. L. II. Angerpointner, Thomas. III. Series.
[DNLM: 1. Abnormalities. 2. Endocrine Diseases - in infancy & childhood. 3. Endocrine Glands
- surgery. WS 330 S961]
RD137.A1P7 vol. 26 [RD599.5.T.46] 617'.98 s - dc20 [617.5'39059] DNLMIDLC
for Library of Congress 91-4593 CIP
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© Springer-Verlag Berlin Heidelberg 1991
Softcover reprint of the hardcover I st edition 1991
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23/3145-543210 Printed on acid-free paper
Preface
Endocrine conditions requiring surgical intervention in the pediatric age
group are uncommon. When diagnosed, they are the source of great in
terest and, often, considerable debate. This is understandable, since few
centers and even fewer individual surgeons can draw on vast experience
of this subject. The great divergence of opinion regarding management
is also understandable in that pediatric endocrine lesions often differ
considerably from their adult counterparts in histology, natural history
and response to treatment. Pediatric endocrine lesions are also, as a
rule, less frequently malignant. In addition to the great strides made in
surgical and anesthetic technique and operative monitoring, progress in
four areas has substantially advanced the management of endocrine dis
orders in the pediatric age group in the last decade: imaging, pathology,
pharmacology and genetics.
The new imaging tools, ultrasonography, computed tomography and
magnetic resonance imaging, have added great diagnostic possibilities.
More recent developments, such as radio nuclide imaging for the adrenal
gland and the possibility of using tagged antibodies, promise to expand
our imaging horizons even further. In the field of pathology, the develop
ment of immunocytochemical markers (e.g., monoclonal antibodies), the
refinement in special stains and the continuous perfection of fine needle
aspiration biopsies offer great new diagnostic as well as research capabil
ities. Newer pharmacological agents, such as the alpha and beta blockers,
the calcium channel blockers and thyroxine analogs, add a whole new level
of safety to the management of the potentially lethal pheochromocytoma.
The improved understanding of inheritance patterns, as well as a better
definition of the multiple endocrine adenopathies, allows for screening
of families and the identification and protection of children at risk.
In the present volume, the reader will find valuable information from
experts on some of the more regularly encountered pediatric endocrine
lesions that are managed surgically. Although the main purpose of this
volume is to update health care professionals dealing with the pediatric
age group, it is also intended to stimulate the application of the exciting
new technical advances to these endocrine afflictions of children.
MICHAEL W. L. GAUDERER, MD
Cleveland, Ohio, USA
Contents
Sonographic Imaging of the Thyroid in Children.
K. SCHNEIDER. With 19 Figures ......... . 1
Surgical Aspects of Diseases of the Thyroid Gland in Childhood.
D. LADURNER and G. RICCABONA ................. 15
Surgery for Benign and Malignant Diseases of the Thyroid Gland
in Childhood.
T. A. ANGERPOINTNER, E. BRITSCH, D. KNORR, and W. Ch. HECKER 21
Indications, Surgical Treatment and After-Care
in Juvenile Hyperthyroidism.
V. RAUH, H. P. KUJATH, C. REIMERS, and B. HbCHT 28
Late Results of Thyroid Surgery for Hyperthyroidism
Performed in Childhood.
G. CSAKY, G.BALAzs, G. BAKo, I.lLYEs, K.KALMAN, and J. SZABO 31
Late Prognosis of Childhood and Juvenile Thyroid Carcinomas.
G. BALAzs, G. LUKAcs, G. CSAKY, P. BOROS, and I. ILYEs.
With 2 Figures .......................... 41
Parathyroid Surgery in Children.
A.J.Ross ........... . 48
Current Status of Pancreatectomy
for Persistent Idiopathic Neonatal Hypoglycemia
Due to Islet Cell Dysplasia.
R.M.FILLER, M.J.WEINBERG, E.CUTZ, D.E.WESSON,
and R. M. EHRLICH. With 5 Figures . . . . . . . . . 60
Surgery for Nesidioblastosis - Indications, Treatment and Results.
B.WILLBERG and E.MoLLER . . . . . . . . . . . . . . . . . . .. 76
Surgical Treatment of Nesidioblastosis in Childhood.
J. DOBROSCHKE, R. LINDER, and A. OTTEN. With 7 Figures 84
VIII Contents
Total Pancreatectomy in a Case of Nesidioblastosis
Due to Persisting Hyperinsulinism
Following Subtotal Pancreatectomy.
P. DOHRMANN, W. MENGEL, and J. SPLIETH. With 2 Figures 92
Pancreatic Head Tumor in a Child.
C. DEINDL. With 3 Figures 96
Pheochromocytoma in Childhood.
E. W. FONKALSRUD. With 1 Figure . . ..... 103
Surgical Treatment of Ovarian Tumors in Childhood.
M. G. SCHWOBEL and U. G. STAUFFER. With 2 Figures . .. 112
Recent Developments in the Management of Neuroblastoma.
M. L. NIEDER and M. W. L. GAUDERER. With 4 Figures 124
Subject Index . . . . . . . . . . . . . . . . . . . . . . . . . .. 137
Editors
Angerpointner, T. A., Priv.-Doz. Dr.
ZenettistraBe 48/III, D-8000 Munchen 2 (W)
Gauderer, Michael, W. L., MD
Rainbow Babies and Childrens Hospital, 2074 Abington Road
Cleveland, OH 44106, USA
Hecker, W. Ch., Prof. Dr.
Kinderchirurgische Klinik im Dr. von Haunerschen Kinderspital
der UniversWit Munchen, LindwurmstraBe 4
D-8000 Munchen 2 (W)
Prevot, J., Prof.
Clinique Chirurgical Pediatrique, H6pital d'Enfants de Nancy
F-54511 Vandrevre Cedex
Rickham, P. P., Prof. Dr.
MD, MS, FRCS, FRCSI, FRACS, DCH, FAAP
UniversiUitskinderklinik, Chirurgische Abteilung
SteinwiesstraBe 75, CH-8032 Zurich
Spitz, L., Prof., PhD, FRCS, Nuffield Professor of Pediatric Surgery
Institute of Child Health, University of London
Hospital for Sick Children, Great Ormond Street, 30 Guilford Street
GB-London WC1N 1EH
Stauffer, U. G., Prof. Dr.
Universitatskinderklinik, Kinderchirurgische Abteilung
SteinwiesstraBe 75, CH-8032 Zurich
Wurnig, P., Prof. Dr.
Facharzt flir Chirurgie und Kinderchirurgie
Schellinggasse 12, A-lOlO Wien
Contributors
You will find the addresses at the beginning of the respective contribution
Angerpointner, T. A. 21 Ladurner, D. 15
Bako, G. 31 Linder, R. 84
Balazs, G. 31,41 Lukacs, G. 41
Boros, P. 41 Mengel, W. 92
Britsch, E. 21 Muller, E. 76
Csaky, G. 31,41 Nieder, M.L. 124
Cutz, E. 60 Otten, A. 84
Deindl, C. 96 Rauh, V. 28
Dobroschke, J. 84 Reimers, C. 28
Dohrmann, P. 92 Riccabona, G. 15
Ehrlich, R. M. 60 Ross, A.J. 48
Filler, R.M. 60 Schneider, K. 1
Fonkalsrud, E. W. 103 Schwabel, M. G. 112
Gauderer, M. W. L. 124 Splieth, J. 92
Hecker, W. Ch. 21 Stauffer, U. G. 112
Hacht, B. 28 Szabo, J. 31
Ilyes, I. 31,41 Weinberg, M.J. 60
Kalman, K. 31 Wesson, D. E. 60
Knorr, D. 21 Willberg, B. 76
Kujath, H. P. 28
Sonographic Imaging of the Thyroid in Children
K. Schneider
Summary
High-resolution sonographic imaging of thyroid disorders in paediatrics has become an extremely
accurate method and is being more frequently used. The need for scintigraphy has therefore
dramatically decreased. The anatomy and sonographic morphology of the thyroid gland (normal
findings, variants) in infants and children are presented, as are patterns of thyroid disorders and
respective algorithms of diagnostic imaging.
Zusammenfassung
Hochauflosende Ultraschalluntersuchungen bei Schilddriisenerkrankungen im Kindesalter sind
zu einer auBerst genauen Methode geworden, die zunehmend haufiger zum Einsatz kommt. Szin
tigraphien haben daher dramatisch abgenommen. Die Anatomie und sonographische Morpho
logie der Schilddriise (Normalbefunde, Varianten) bei Sauglingen und Kindem werden beschrie
ben. Die Charakteristika der Schilddriisenerkrankungen und diesbeziigliche Vorgehensweisen
bei der diagnostischen Bildgebung werden diskutiert.
L'echographie it haute resolution, d'une extreme precision, est employee de plus en plus fre
quemment pour obtenir des images des affections thyroidiennes chez les enfants. En conse
quence, I'importance de la scintigraphie decline rapidement. L'anatomie et la morphologie echo
graphique de la glande tyhroide (resultats normaux, variantes) chez les nouveaux-nes et les
enfants sont decrites. On presente des exemples d'affections thyroidiennes et les algorithmes qui
y correspondent en echographie.
Introdnction
Diagnostic imaging of the thyroid gland was fundamentally changed by sono
graphy. Now, with the use of high-resolution sonography [7, 16], and especially
with computed sonography, many diseases of the thyroid gland can be evaluated
in an optimal and otherwise unattainable quality without the hazards of radiation.
The capabilities of this new diagnostic method on thyroid imaging and diagnostic
workup in children and its perspectives will be discussed.
Rontgenabteilung der Kinderklinik der Universitat, Dr. von Haunersches Kinderspital, Lind
wurmstraBe 4, D-8000 Miinchen 2 (W), FRG.
Progress in Pediatric Surgery, Vol. 26
Gauderer and Angerpointner (Eds.)
© Springer-Verlag Berlin Heidelberg 1991
