Microsurgery has grown to be an essential technique in pediatric surgery. Thus, there is an increasing need for basic training and skills maintenance, which require a continuous laboratory training. As an alternative to microsurgical exercises on living animals, a model including a simulation vein, artery and nerve is being introduced. It provides an opportunity to practice microsurgical technique with optimal availability at any time at fairly low cost. Its potentials and limits in the training of microsurgical dissection, anastomosis and quality control are being compared to experiments on anesthetized animals. Although a few exercises on living animals are mandatory to close the gap between the laboratory and the patient, a synthetic model is a valuable tool in microsurgical training and helps to reduce animal experiments.

Evaluation of acute painful scrotum is difficult and imaging studies have been reported to be unreliable in detecting testicular torsion. In order to assess the value of color Doppler sonography in acute scrotal disease, the authors reviewed 65 conseeutive boys, ranging in age from 1 to 16 years. The study demonstrated absent or diminished flow signals in 11 patients. All of them had a surgical intervention, and in 8 of them, a testicular torsion was confirmed. 54 boys had a symmetrical or increased f10w signal on the affected side. Just 5 boys among this group underwent surgical exploration. On follow up, none of the 54 patients with good f10w signals proved to have a testicular torsion. Sonography and color Doppler soriography helped to differentiate epididymitis and torsion of a testicular appendage as a basis for further investigations and correct conservative therapy. In detecting a testicular torsion, color Doppler sonography yielded a positive predictive value of 73 %, a sensitivity of 100 % and a negative predictive value oflOO%. We therefore conc1ude, that Doppler sonography can reliably rule out testicular torsion so that routine scrotal exploration in cases of acute scrotum is no longer necessary. By reducing the number of emergency operations and hospitalization days, color Doppler sonography can cut down the total cost of managing acute painful scrotum in boys.• Key words: Acute scrotum -Testicular torsion -Spermatic cord torsion -Color Doppler sonography -Epididymitis -Chi!-dren -Cost analysis Resume l'evaluation des scrotums aigus douloureux au niveau c1inique est difficile et les investigations radiologiques rapportees dans la litterature ont He decourageantes pour detecter les torsions testieulaires. Afin de dHerminer la valeur diagnostique de I'echo Doppler couleur dans les scrotums aigus, 65 garc;:ons consecutifs entre 1 et 16 ans ont He examines. 11 patients avaient un debit diminue ou absent. leurs testicules ont ete exEur J Pediatr Surg 2000; 10: 235 -241 © Georg Thieme Verlag Stuttgart, New York . Masson Editeur Paris ISSN 0939-7248 plores et le diagnostic d'une torsion testiculaire etait confirme pour 8 garc;:ons. 54 patients avaient un signal symetrique ou augmente sur le cöte douloureux. Seulement 5 garc;:ons de ce groupe ont eu une exploration chirurgicale. Par la suite, aucun des 54 garc;:ons avec un signal symetrique ou augmente en echo Doppler couleur n'a presente une torsion testiculaire. l'echographie et I'echographie Doppler couleur ont aide a differencier entre une epididymite et une torsion des appendices testiculaires pour I'indication d'investigations complementaires et un traitement conservateur correct. Pour le diagnostic d'une torsion testiculaire, I'echo Doppler couleur avait une valeur predictive positive de 73%, une sensitivite de 100% et une valeur predictive negative de 100%. Nous concluons que I'echo Doppler couleur peut correctement exelure une torsion testiculaire en eliminant par la meme la necessite d'explorer tous les scrotums aigus. la diminution du nombre d'ope...

Since 1991 seven children aged between 5-17 years have been treated at the University Children's Hospital in Basel for 10 traumatically partially amputated phalanges with a newly developed external fixator and distractor. Through continual distraction of the osteotomy a phalanx lengthening of 3-10 mm has been achieved (on average 55% of the rest phalanx). The results of this method in distal phalanx amputation with resulting nail dystrophy (claw nail) has shown functional and cosmetic improvements. The average distraction and consolidation phases lasted 5 weeks. The after care lasted 2-12 months. As children have good distraction-histogenesis bone grafting is not necessary. A prerequisite would be, however, an intact or appropriately prepared integument. The advantage of this external fixator and distractor system is that it is suitable for the delicate anatomical structures of a child's hand. The distractor component is only necessary for a distraction step to be carried out. A further advantage of this system is the relatively light but stable construction.

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In three children (2, 4 and 10 years of age) a cervical thymic cyst was removed. We found multilocular cysts with xanthochromic luminal fluid covered with a fibrous capsule. Histological features are lymphatic follicles, partly atrophic, as well as regular thymic tissue with cortex, marrow and Hassall's corpuscles.