Biomedical subjects
Publications and source records attributed to A F Azmy.
An infant is reported with complete duplication of the colon, rectum, anus, terminal ileum up to the point of Meckel's diverticulum, doubling of the genitalia with completely formed penes, double bladder and urethra, multiple spinal anomalies, omphalocele, and large lower abdominal wall hernia with wide separation of the symphysis pubis.
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OBJECTIVE: To assess the value of antenatal diagnosis of abnormalities of the urinary tract on ultrasonography. DESIGN: Retrospective study. SETTING: Two obstetric units in Glasgow. SUBJECTS: 62 Fetuses in which renal abnormalities were diagnosed on antenatal ultrasonography. INTERVENTIONS: Six fetuses had their bladders aspirated to determine renal function. Fifteen pregnancies were terminated on the basis of the findings on antenatal ultrasonography, and if possible necropsy was performed on the fetuses. In babies who were born alive the final diagnosis was made by postnatal ultrasonography, intravenous urography, radionuclide scanning, cystography, and, in those who died in the early neonatal period, necropsy. Neonates who were referred with a known obstructed kidney had nephrostomy or pyeloplasty. END POINT: Assessment of the value of antenatal diagnosis of renal abnormalities on ultrasonography for babies who had no clinical evidence of disease postnatally. MAIN RESULTS: Eighteen fetuses did not survive birth; the antenatal diagnosis was accurate in all 18. Of the 44 babies born alive, five had normal urinary tracts, in two of whom antenatal ultrasonography had probably indicated a false positive diagnosis. Fourteen babies died during the early neonatal period. Twenty five babies with renal abnormalities were followed up; the antenatal diagnosis was inaccurate for 10 of them, the commonest misdiagnosis being hydronephrosis for multicystic kidney and vice versa, and there was one false positive diagnosis. The initial clinical findings in 14 babies would have led to the early detection of a urological abnormality. In the 30 babies with no clinical evidence of disease the antenatal diagnosis was of definite value in eight, probable value in 15, and marginal value in seven. Overall, an accurate antenatal diagnosis was made in 46 of the 62 cases (74%); in 12 cases renal disease was detected but its specific nature was not determined; and in four cases the diagnosis was misleading. CONCLUSIONS: The overall value of antenatal diagnosis is that it indicates early termination of fetuses with fatal renal disease, prepares parents and medical staff for the likelihood of serious neonatal problems, and shows abnormalities of the urinary tract that may not be detected postnatally.
A case of a 12-year-old boy with tuberous sclerosis who developed life-threatening hematuria is presented. An angiomyolipoma of the lower two thirds of the left kidney resulted in a tumor hemorrhage that was successfully treated by partial nephrectomy.
We report the anomaly of intrarenal duplication seen during the course of investigation of urinary tract infection in 6 children. The anomaly and its embryological basis are described.
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Eight infants with hemangiomata associated with severe consumption coagulopathy are reviewed; three died. The presentations and method of management are discussed. The varied response to different modalities of therapy initiated this report and led to a search of the world literature in an attempt to identify the pattern of response, if any, to particular therapy. From our own experience with two cases and from the review of the literature, it appears that radiotherapy alone or in combination with steroids gives a superior overall treatment in terms of reducing the death rate.
Six children with shunt nephritis are reported of whom two did not show complete recovery of renal function. Follow up and outcome in relation to the delay in diagnosis and renal biopsy appearances are discussed.
Leaving babies and young children out in the sun during periods of unexpected exceptionally fine weather resulted in 142 children being treated for sunburn in the Royal Hospital for Sick Children in Glasgow over a 6-year period. Care-givers should be warned of the potential hazards of overexposure to sunshine.
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We report 13 boys in whom the testis ascended from the normal scrotal position to an undescended position. A patent processus vaginalis was identified in 10 patients at orchidopexy and is believed to have contributed to testicular ascent. The other three patients had retractile testes which were held in the high position by surrounding adhesions.
One hundred and thirteen children with non-metabolic urinary tract calculi were operated on between 1960 and 1983. One hundred were followed up for 3 to 17 years (mean 8.2). Seventeen children (15%) developed recurrent calculi after complete clearance at the initial operation and in 13 of these the stones recurred within 5 years. Proteus urinary infection was a constant feature of stone recurrence. Five patients required re-operation for removal of the recurrent calculus. Small residual caliceal fragments were left behind in 17 children but only 3 required surgical removal.
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We describe the occurrence of antibiotic-associated pseudomembranous colitis in two cases of Henoch Schonlein purpura. We discuss the potential diagnostic difficulties and suggest that Henoch Schonlein purpura may predispose to the development of antibiotic-associated pseudomembranous colitis.
Thirty-seven patients who had necrotizing enterocolitis and required emergency surgical intervention are reviewed. The indications for surgery were intestinal perforation (28), intestinal obstruction (7), clinical deterioration (1) and persistent rectal bleeding (1). The initial procedure was percutaneous peritoneal catheter drainage (13), intestinal diversion alone (8), intestinal resection (14), laparotomy and biopsy (1) and laparotomy alone (1). Twelve patients developed late intestinal strictures. The overall mortality rate was 35 per cent.
A retrospective study of 42 children with hypertension secondary to renal disease is presented. Thirty-three had scarred kidneys, 5 had renovascular disease, 2 had renal venous thrombosis, 1 had an angiomatous malformation of the upper pole of the kidney, and 1 had glomerulonephritis. Twenty-six children were managed surgically. The etiology, presentation, and management are presented. Follow-up varied from 2 to 14 years and the outcome is discussed.