Biomedical subjects
A Farkas
Publications and source records attributed to A Farkas.
[Ectopic ureter in infancy and childhood].
Two infants, 7 children and 1 young woman have been surgically treated for ureteral ectopy in the Departments of Paediatrics and of Urology of the Medical University of Pécs over the last 15 years (1974-1989). The girl/boy ratio was 8/2. In girls, who were otherwise toilet-trained with a normal voiding pattern, constant wetting and urinary infection were the leading clinical findings. The site of ureteral drainage was the vestibule in 4 patients, the urethra in 3, the vagina in 1, the prostatic utricle in 1, and it could not be determined in 1 girl. Diagnosis was based on intravenous urography, voiding cystourethrography, ultrasonography, isotope scan, endoscopy and filling up of the bladder with a methylene blue solution. The diagnosis was more obscure when the ectopic ureter drained a poorly functioning kidney. Considering that in ectopy with duplicated system the upper pole renal segment is almost always destroyed, upper pole nephrectomy and proximal ureterectomy are advocated. In 1 neonate with esophageal atresia and tracheo-esophageal fistula ultrasonography detected the ureteral malformation. In 1 girl bilateral single ureteral ectopy was found.
Over-transfusion ascites.
A 12-year-old girl was injured in a traffic accident and suffered fractures of all the long bones of both legs. During the operation she received 10 l of lactated Ringer's solution, 3 l of 0.9% NaCl, and 2 l of 5% glucose, until blood was available, because of difficulty in its cross-matching. Her hemoglobin dropped to 4.9 g%. After the operation a distension of the abdomen was noted. An abdominal tap confirmed ascites. A simultaneous intravenous pyelogram and retrograde cystogram revealed no leakage from the urinary tract. An over-transfusion ascites was diagnosed combined with pulmonary edema. The patient was treated for 2 days in the ICU, until she was transferred to the orthopedic department with no signs of ascites.
[Continent urinary diversion in children: enterocystoplasty + appendiceo-cutaneostomy].
A continent urinary diversion was done by bladder augmentation using a cecal-colonic segment in total urinary incontinence in 3 patients aged 13, 16 and 21 years. The distal end of the appendix was brought to the skin. The narrow lumen of the appendix provides a closure mechanism in a low pressure urinary reservoir. A watertight, easily catheterizable urinary diversion might mean that there is no need to implant the distal end of the appendix into the bladder or colon in a submucous non-refluxing fashion as recommended by Mitrofanoff. The intermittent clean catheterization of the augmented bladder via the appendix was carried out at intervals of 3 hrs. 12-24 months after the establishment of urinary diversion the patients are free of complaints, socially fully accepted.
Endoscopic correction of vesicoureteral reflux: our experience with 115 ureters.
Endoscopic subureteral injection of polytetrafluoroethylene was performed in 115 ureters to correct vesicoureteral reflux. We treated primary reflux in 84 single ureters, 16 duplex ureters and 4 megaureters (grade V), and secondary reflux in 11 ureters associated with neurogenic bladder, uncapped ureteroceles and failed ureteroneocystostomy. Followup evaluation consisted of a voiding cystourethrogram, which was done in the operating room immediately after the endoscopic procedure, ultrasound 1 month postoperatively, and a diethylenetriaminepentaacetic acid renal isotope scan and repeat voiding cystourethrogram 6 months after injection. Grades II to IV primary reflux involving single as well as duplex ureters resolved in 94% and 82%, respectively, of the cases after 1 injection and in 98% and 93% of the cases after 2 or more injections. The severely and chronically dilated ureters did not respond to the treatment.
Paravesical granulomas masquerading as bladder neoplasms: late complications of inguinal hernia repair.
Paravesical granuloma formation after inguinal herniorrhaphy is a rare complication due to infected suture material. We present 8 cases of large paravesical granulomas masquerading as bladder tumors. Irritable symptoms predominate the symptom complex and accurate diagnosis can be obtained with multiple, sonographically guided, needle biopsies of the mass. An operation results in complete resolution of the symptoms, while nonoperative management may help to improve but not resolve the symptoms.
Effect of indomethacin on unilateral obstructed renal pelvis and on ureteral peristalsis. Experimental study in awake sheep.
An experimental model to study the physiology of the obstructed kidney in awake sheep is described. Unilaterally, a kidney was obstructed, and the pressure in the renal pelvis was measured before and after intravenous injection of indomethacin. This experiment study on awake sheep enabled us to compare the clinical behavior of the animal with the recorded objective data, to demonstrate the rapid decrease in pressure in the obstructed renal pelvis. In addition, we observed a decrease in ureteral peristalsis frequency following the injection of indomethacin.
[Congenital duodenal obstruction: mortality pattern in the last 30 years].
Data of 57 newborns and infants who underwent on operations having duodenal obstruction were analyzed in a 30 year period between 1955-1986. The patients were classified into 3 prognostic groups regarding to Waterson and the mortality was examined in decades. The mortality showed a continuous decrease during the 30 years, in the last decade this was considerable. Improving operation technique, the advanced peri- and postoperative intensive care are playing role in the decrease of the mortality. In the late follow up, most of the patients were found to be without complaints, however, regarding to some other authors this finding is not precluding the possibility of organic changes, such as delayed gastric passing, gastroesophageal reflux, etc.
Active antireflux mechanism induced by micturition. Experimental study in awake sheep.
The influence of increased bladder pressure on ureteral peristalsis is described in the literature. All experiments were done on anesthetized animals and vesical contractions were electrically induced. We present an experiment on awake sheep. The animals voided spontaneously while a recording of the peristaltic pressure of the lower ureter was recorded. A rise in the peristaltic pressure in both ureters was observed during micturition. We suggest that the rise in ureteral pressure participates in the antireflux mechanism.
The nature of the defect in familial male pseudohermaphroditism in Arabs of Gaza.
Studies in six Arab individuals from Gaza with familial male pseudohermaphroditism (MPH) due to 17-ketoreductase deficiency revealed several metabolic aberrations associated with the disorder. Plasma LH, FSH, testosterone, and androstenedione concentrations were low in the two prepubertal patients. After hCG administration plasma androstenedione increased markedly. The four postpubertal MPH patients had very high plasma gonadotropin and androstenedione concentrations, the latter increasing further after hCG administration. Plasma testosterone concentrations in all six patients were moderately low or normal for age and increased little after hCG administration. Spermatic venous testosterone concentrations, measured in three adults, were within the normal range in two and low in one, while androstenedione concentrations were markedly elevated (15- to 32-fold) in all three patients. Kinetic analyses of progesterone and androstenedione metabolism were performed in testicular tissue of these patients and compared to the results in two control subjects. While testicular tissue from the two prepubertal patients metabolized progesterone only to androstenedione, and that to a limited extent, the tissue from the four postpubertal patients metabolized progesterone to 16 alpha- and 16 beta-hydroxyprogesterone, 17 alpha-hydroxyprogesterone, androstenedione, and testosterone and metabolized androstenedione to testosterone. The Michaelis constants of these reactions were similar in the tissue from the MPH and the control subjects. The production of 16 alpha- plus 16 beta-hydroxyprogesterone was 5.4- to 10.3-fold greater, and 17-hydroxylase activity was 5.8- to 8.1-fold lower in the testes of the postpubertal MPH patients compared to values in the control subjects. The preference of androstenedione production through the delta 4- or delta 5-pathways was examined in the testes of two adult MPH patients using an equimolar concentration of [14C]progesterone and [3H]pregnenolone as substrates. While the flow of substrates in the control testes was equal or slightly greater through the delta 4-pathway, the delta 5-pathway predominated in the testes of the MPH patients. A large amount of dehydroepiandrosterone accumulated when NAD, the cofactor for 3 beta-hydroxysteroid dehydrogenase-isomerase, was omitted, supporting the contention that androstenedione was produced in the testes of the MPH patients mainly through the delta 5-pathway. Additional support for this suggestion was the finding that the 3H/14C ratio in androstenedione and testosterone produced from both substrates was 8 times higher in the testes from MPH patients than in those from the control subjects.(ABSTRACT TRUNCATED AT 250 WORDS)
[Upper gastrointestinal endoscopy in childhood].
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Observations on micro-encapsulated erythromycin (Eryc capsule) in the treatment of various infections of adults.
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Male pseudohermaphroditism due to 17 beta-hydroxysteroid dehydrogenase deficiency: gender reassignment in early infancy.
Male pseudohermaphroditism due to 17 beta-hydroxysteroid dehydrogenase (17 beta-HSD) deficiency has a high prevalence within the Arab population of the Gaza strip and is characterised by marked virilization at puberty, leading in many cases to the spontaneous adoption of a male gender role. As a result of this, parents of 7 affected male infants (aged 1-10 months) born with female phenotype requested early gender reassignment. Diagnosis was suspected in 5 on the basis of a positive family history, but confirmed in all cases by the finding of low to normal testosterone levels (30-184 ng/dl) with high delta 4-androstenedione levels (188-808 ng/dl), after hCG. Treatment with im testosterone oenanthate (25-50 mg/dose) was given in one to three 3-months courses and penile size was increased into the normal range without evoking a significant increase in height velocity or skeletal maturation. Five patients underwent the first stage of male genitoplasty between 2 and 3 years of age. This consisted of bilateral orchidopexy, chordee release and penile lengthening - yielding finally an anatomically normal-sized and shaped penis. Androgen responsive male pseudohermaphroditism due to 17 beta-HSD deficiency or a similar defect and diagnosed in infancy should be treated as soon as possible with systemic testosterone before considering any sex change, and in preparation for male genitoplasty. Early gender reassignment according to genetic and gonadal sex is probably the management of choice for these cases since this may result in a normal adjustment to the male gender role, particularly after puberty.
High serum bile acid level in obesity: its decrease during and after total fasting.
Elevated serum bile acid levels were observed in overweight subjects as compared to those with an ideal weight. Fasting for 14 days resulted in a gradual decrease to the normal level of serum cholic, chenodeoxycholic and deoxycholic acid concentrations. There was no change in the serum bile acid level during a two days refeeding period. The findings suggest that, in addition to the beneficial weight reduction, normalization of bile acid homeostasis can be achieved by fasting in obesity.
Effect of cimetidine (Histodil) injection in upper gastro-intestinal haemorrhage.
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Medical officer in the Transkei.
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Neonatal solitary renal cysts associated with posterior urethral valves.
Large simple cysts of the kidney are common findings in adults but are extremely rare in neonates. Three cases of large solitary renal cysts in newborn boys associated with posterior urethral valves are described. The pathogenesis, diagnosis, treatment, and differentiation from urinoma secondary to spontaneous urinary extravasation are discussed.
Transvaginal milking of lower ureteric stones into the bladder.
In a selected group of adult female patients, stones in the lower ureter were transvaginally milked into the bladder. The transvaginal milking of lower ureteric calculi into the bladder is easy and safe and is recommended in the poor surgical risk patient.