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Biomedical subjects

B M Churchill

Publications and source records attributed to B M Churchill.

At least 91 records · Page 5Linked to original sources
PubMed1989

Rhabdomyosarcoma of the prostate in childhood: current challenges.

Since 1978, six boys with prostatic rhabdomyosarcoma have been treated at our institution. Three had localized disease and were managed by initial biopsy, vincristine, actinomycin-D, and cyclophosphamide (VAC) chemotherapy, and bladder-sparing surgery with or without irradiation. Further combination chemotherapy ("pulse" VAC, Adriamycin, VP-16, cisplatin, and ifosfamide) was continued for 20 to 22 months following the induction course. Two boys had microscopic residual disease undetected by frozen section and unresponsive to radiotherapy. Subsequent total cystectomy 4 and 7 months later resulted in eradication of disease. In one patient, preservation of the bladder was achieved at the age of 3 months for 8 years. Artificial sphincter inserted to cure his urinary incontinence failed because of ischemia secondary to cuff compression and scar tissue. He is alive today with a modified Koch pouch urinary diversion. Of the 50% who had metastatic disease at presentation, two were dead within 12 months despite aggressive chemotherapy and irradiation. The third is currently on treatment. Although chemotherapy has markedly improved the prognosis, surgery is still necessary in most cases for cure. Bladder salvage is a desirable goal; however, residual microscopic disease, difficulty with frozen-section disease detection, and poor tissue vascularization for subsequent sphincter replacement remain significant obstacles.

Adolescent↗
PubMed1989

The influence of HLA matching on renal allograft survival at a single pediatric center.

Between January 1, 1969, and February 2, 1988, 331 pediatric renal transplants were performed at a single pediatric center. Of these 225 were first cadaveric allografts. Graft allocation was independent of the outcome of human lymphocyte antigen (HLA) matching. The results of class I antigen matching were analyzed in 224 transplants, and actuarial graft survivals were calculated. Class II antigen matching was analyzed in 80 patients from January 1, 1982, and submitted to the same analysis. HLA matching could not be demonstrated to be beneficial. It is proposed that any matching benefit is small and obscured in our series by the dominance of other factors.

Cadaver↗
PubMed1989

Closure of the exstrophic bladder: an evaluation of the factors leading to its success and its importance on urinary continence.

To determine what factors could affect the success of initial bladder closure in classical bladder exstrophy, 80 patients who have completed staged bladder reconstruction were reviewed. Evaluations comparing early bladder closure performed with or without bilateral iliac osteotomy versus delayed closure performed with iliac osteotomy revealed no statistical difference among the 3 populations in regard to the development of bladder dehiscence or onset of urinary continence (p greater than 0.5). Individuals undergoing delayed bladder closure without iliac osteotomy had no notable difference in the incidence of bladder dehiscence (p greater than 0.5) but they had a statistically significant difference in the ability to gain urinary continence (p less than 0.01). Bladder prolapse, abdominal distension or loss of urinary drainage catheters was significantly related to bladder dehiscence (p less than 0.02). Urinary continence was obtained in 75 per cent of the patients with successful bladder closure, compared to 30 per cent if the initial closure dehisced (p less than 0.01).

Anti-Bacterial Agents↗
PubMed1989

Phallic reconstruction in cloacal exstrophy.

During the last 25 years 8 genotypic male subjects with cloacal exstrophy have undergone phallic reconstruction. All 8 patients had phallic inadequacy after completion of the reconstruction with penile lengths at or below 2 standard deviations below the mean. Of the patients 4 have reached puberty and 2 have documented physiological impotence by nocturnal penile tumescence testing. Three patients have required intensive psychiatric counseling, ranging from 18 months to 3 years because of feelings of sexual inadequacy. Of 2 patients who have attempted sexual relations 1 is unable to penetrate the vagina because of phallic size and 1 is presently engaged in successful vaginal intercourse. As a consequence of phallic inadequacy and its associated psychological trauma in these individuals we strongly recommend sexual conversion as part of the initial management plan.

Adult↗
PubMed1989

Urethral replacement with tunica vaginalis: a pilot study.

A vascularized tube flap of tunica vaginalis was used to replace the penile urethra in 12 rabbits. Ten flaps were available for assessment, 2 flaps became necrotic as a result of compression of the vascular pedicle and 1 rabbit had a proximal anastomotic stricture. The healing process was satisfactory clinically and histologically in the remaining 7 flaps.

Animals↗
PubMed1989

99mtechnetium-dimercapto-succinic acid renal scanning and excretory urography in diagnosis of renal scars in children.

We compared the ability of excretory urography (without tomography) and 99mtechnetium-dimercapto-succinic acid renal scanning to detect renal scars in 32 children with primary vesicoureteral reflux. These children did not have hydronephrosis, renal failure or urinary tract obstruction. In all cases both studies were conducted within a 10-month period. The findings from both modalities were in agreement for 51 of the 64 renal units evaluated (80 per cent). Evaluation of the excretory urogram indicated 6 cases of diffuse and 2 of focal scarring that were not detected by evaluation of the renal scan. The sensitivity of excretory urography to detect renal scars was 84 per cent and the specificity was 83 per cent. The 99mtechnetium-dimercapto-succinic acid renal scan showed 5 cases of focal renal scarring not detected by excretory urography. The sensitivity of the renal scan to detect renal scars was 77 per cent and the specificity was 75 per cent. We conclude that neither study alone could effectively replace the other for the detection of renal scars, and recommend that both be included in the initial evaluation and followup of patients with renal scars.

Adolescent↗
PubMed1989

Nonrefluxing colonic conduits: a long-term life-table analysis.

We evaluated 25 patients undergoing urinary diversion with a nonrefluxing colonic conduit. Renal scarring developed in 10% of the kidneys during a median followup of 12.7 years. In 11 renal units (22%) deterioration of the ureteroenteric anastomosis occurred due to the development of reflux or stricture. Of these kidneys 45% had scarring; no renal unit in which the anastomosis remained intact had renal scars (p less than 0.001). Of our patients 96% had bacterial colonization of the colonic conduit but this was not associated with renal scarring if the urinary diversion was anatomically intact.

Bacteriuria↗
PubMed1989

Age related flow rate nomograms in a normal pediatric population.

Uroflow studies in a normal pediatric population were analysed statistically. Single studies for 511 subjects (272 boys and 239 girls) were reviewed. Nomograms relating peak flow to volume voided and age were established. An acceptable lower limit for peak flow was obtained from the data and a volume voided range was calculated so that both criteria could be used with 90% probability to define the normal voiding situation. The mean values of peak flow rate increased with volume voided in both sexes and also with age in the male population. Different sets of nomograms, which are necessary for daily clinical evaluation, are given. They define the normal values in the normal population.

Adolescent↗
PubMed1989

Body surface related flow rate nomograms in a normal pediatric population.

Uroflow studies for 511 normal pediatric subjects (272 boys, 239 girls) were analyzed statistically. Nomograms relating peak flow to volume voided and body surface were established. An acceptable lower limit for peak flow was obtained from the data and a volume voided range was calculated so that both criteria could be used with 90% probability to define the normal voiding situation. Body surface area was found to be a more reliable index than age in the establishment of nomograms. In the male population the 90% probability applied to a significantly greater volume voided reliability. In the female population mean peak flow rate rose with increased body surface. Finally, in both sexes the 10% lower limit was closer to the regression mean, allowing a tighter distribution around this value.

Adolescent↗
PubMed1988

Management of the hindgut in cloacal exstrophy: terminal ileostomy versus colostomy.

In the management of cloacal exstrophy, controversy exists regarding use of the rudimentary hindgut as a terminal colostomy v salvage of the hindgut for urinary or genital tract reconstruction. Over the past 26 years, 19 patients with cloacal exstrophy have undergone surgical reconstruction at our institution. Ten were managed by terminal ileostomy with an average follow-up of 9 years; nine were managed by permanent colostomy with an average follow-up of 8 years. The number of in-hospital days required due to gastrointestinal (GI) complications and the number of days required for supplemental parenteral hyperalimentation were significantly higher in patients managed by terminal ileostomy than by colostomy (P less than .05 and P less than .03, respectively). All patients have had continued long-term follow-up evaluations in regard to their weight and growth velocities. There is essentially no difference in regard to these characteristics within the two patient population groups. In summary, patients with terminal ileostomies require more frequent hospitalization and prolonged intravenous nutrition during their initial management phase. However, as the child matures and adaptation of the intestine develops, it appears that there are no substantial differences between the growth characteristics of the two patient populations.

Adolescent↗
PubMed1988

Factors influencing patient and graft survival in 300 cadaveric pediatric renal transplants.

We reviewed the results of 300 cadaveric pediatric renal transplantations performed at our institution. The procedures provided significant survival and improvement of the quality of life in the majority of children. Recipient and graft survival was better in patients more than 5 years old than in younger children. Early nontechnical thrombosis was a major specific problem in young recipients. The original disease did affect graft survival. Uncorrected congenital bladder storage and micturition inefficiency adversely affected graft survival.

Adolescent↗
PubMed1988

A comparison of renal function in the exstrophy patient treated with staged reconstruction versus urinary diversion.

To assess the preservation of renal function in bladder exstrophy 91 patients with classical bladder exstrophy managed with either staged reconstruction or urinary diversion were reviewed. Renal damage was defined as the development of a renal scar or a persistent elevation in serum creatinine. Of the patients 72 have completed the bladder reconstruction; 51 (71 per cent) are continent and renal damage occurred in 10 (13 per cent) of the reconstructed patients. Median followup was 12.7 years. In a comparable group of 23 exstrophy patients managed by urinary diversion the occurrence of renal damage was notably higher: 82 per cent for ileal conduits, 22 per cent for nonrefluxing colonic conduits and 33 per cent for ureterosigmoidostomy. Based on these results we believe that staged reconstruction of the patient with classical bladder exstrophy offers a low risk for renal injury, an excellent chance for urinary continence and a more acceptable cosmetic appearance.

Bladder Exstrophy↗
PubMed1988

Determinants of hydronephrosis and renal injury in patients with myelomeningocele.

Renal injury is a major potential complication of patients with neurogenic bladder impairment. There are many clinical, radiological and urodynamic factors that are widely available and that may aid in predicting which patients are at risk of renal injury. This study aims at achieving an objective statistical analysis of these multiple risk factors. We have applied this statistical analysis in a prospective manner to 215 patients with myelodysplasia and neurogenic bladder impairment. Potential risk factors in the lower urinary tract include bladder capacity, contractility and dyssynergia. Each of these factors was assigned a numerical score of 0 to 3, which was correlated with the presence of vesicoureteral reflux. The upper urinary tracts in these patients were assigned a numerical score according to the degree of radiological changes observed. These results then were tested with a stepwise regression analysis using p equals 0.05 as the significance level. In this analysis significant determinants of vesicoureteral reflux included a change in bladder shape, the presence of uninhibited contractions and the presence of dyssynergia. Renal deterioration was noted, and it was predicted by the presence of vesicoureteral reflux, a high ureteral pressure profile and dyssynergia. We conclude from this clinical study that risk of renal injury is present in these children. We also conclude that the risk can be predicted by urodynamic and radiological criteria and that these data can be correlated and analyzed using statistical methodologies.

Child, Preschool↗