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Biomedical subjects

D A Diamond

Publications and source records attributed to D A Diamond.

At least 55 records · Page 3Linked to original sources
PubMed1996

Contralateral reflux after unilateral ureteral reimplantation.

PURPOSE: We analyzed the incidence and outcome of postoperative contralateral reflux after unilateral ureteral reimplantation by the Cohen and Glenn-Anderson techniques. MATERIALS AND METHODS: We retrospectively reviewed the records of 120 patients 3 months to 21 years old in whom unilateral vesicoureteral reflux was treated by unilateral reimplantation. The incidence of postoperative contralateral reflux was documented by followup voiding cystourethrography. RESULTS: Overall 19% of patients who underwent unilateral reimplantation had contralateral vesicoureteral reflux postoperatively, including 21% after the Cohen and 17% after the Glenn-Anderson procedure. Of the cases 61% spontaneously resolved, 13% were surgically corrected and 26% continue to be followed. CONCLUSIONS: The rates of postoperative contralateral vesicoureteral reflux are not significantly different after Cohen and Glenn-Anderson repair. A majority of cases will resolve spontaneously within 2 years. The likelihood of trigonal distortion as the etiology of contralateral reflux is low given the similar incidence in cross-trigonal and ureteral advancement reimplantation.

Adolescent↗
PubMed1996

Transitional cell carcinoma of the bladder in the pediatric patient.

PURPOSE: We report on 5 boys with transitional cell carcinoma of the bladder, describe the identifying characteristics, review the literature, and define the issues of diagnosis, treatment and followup in this rare disease in pediatric patients. MATERIALS AND METHODS: Five boys 11 to 18 years old were identified with transitional cell carcinoma of the bladder. Preoperative imaging and urinary cytology were correlated with cystoscopic and biopsy findings. RESULTS: In all patients evaluation was prompted by gross hematuria. Low grade lesions, definitive cystoscopic management and a low recurrence rate were uniform findings. Preoperative imaging identified the tumor in all cases and bladder ultrasound was the most sensitive scan with 4 of 4 cases identified. CONCLUSIONS: While rare, transitional cell carcinoma of the bladder in children presents a challenge in diagnosis and followup since cystoscopy typically requires general anesthesia in this age group. Bladder ultrasound was found to be extremely sensitive in identifying lesions, and it may be a valuable and minimally invasive surveillance tool.

Adolescent↗
PubMed1996

Bladder neck reconstruction: long-term followup of reconstruction with omentum and silicone sheath.

PURPOSE: In 1986 we reported the placement of a silicone sheath sandwiched between layers of omentum around a newly reconstructed bladder neck. We now present long-term followup of 94 cases of silicone sheath bladder neck reconstruction. MATERIALS AND METHODS: A total of 94 silicone sheaths was placed in 84 patients between August 1983 and October 1992. We retrospectively reviewed our results and divided the reconstructions into 3 groups according to modifications in surgical technique. We report the results of each modification and current recommendations for use. RESULTS: Each sequential modification of silicone sheath bladder neck reconstruction significantly reduced the risk of erosion from 100%, 32% and 7%, respectively (p < 0.05). Erosion was independent of patient age, sex, pathological condition or whether bladder neck reconstruction was a repeat procedure. Patients who had silicone sheath erosion did not have different continence or loss of urethral continuity than those with no erosion. In 13 patients (16%) artificial sphincter placement was clearly facilitated by the silicone sheath. CONCLUSIONS: Modifications in the surgical technique of silicone sheath placement around a reconstructed bladder neck have resulted in a decrease in the erosion rate to 7%. The primary benefit of silicone sheath placement is ease of subsequent sphincter placement. Currently we reserve silicone sheath placement for a small subset of patients who are most likely to benefit from subsequent artificial sphincter placement.

Adolescent↗
PubMed1995

Male epispadias.

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Epispadias↗
PubMed1995

Retroperitoneal laparoscopic nephrectomy in children.

Retroperitoneal pediatric laparoscopic nephrectomy is described in 3 patients requiring 3 to 5 hours with an estimated blood loss of 10 to 60 cc. The children returned to school within 7 days postoperatively. Advantages of this procedure include the avoidance of intraoperative repositioning of the patient and easy conversion to an open lumbodorsal approach, if necessary; early laparoscopic visualization of the renal artery; applicability in cases of previous abdominal surgery, and avoidance of intraperitoneal adhesion.

Adolescent↗
PubMed1994

Detection of hepatitis C viral sequences in formalin-fixed, paraffin-embedded liver tissue: effect of interferon alpha therapy.

To determine the effect of interferon-alpha (IFN) therapy on hepatitis C virus (HCV) in liver, reverse transcription "nested" polymerase chain reaction (RT-PCR) was applied to detect HCV RNA in formalin-fixed, paraffin-embedded liver biopsy specimens obtained before and at the end of IFN therapy in 42 patients with chronic HCV infection. Results were correlated with the clinical and biochemical outcome in 36 cases. Fifteen patients were nonresponders to IFN; 13 patients had a complete response to IFN but relapsed shortly after IFN was stopped (responders who relapsed); and 8 patients showed a complete and sustained response to IFN therapy (sustained responders). Total RNA was extracted using proteinase K digestion and phenol/chloroform/isoamyl alcohol extraction, and HCV RNA was detected by standard RT-PCR using primers from the highly conserved 5' untranslated region. HCV RNA was detected in 41 of the 42 pretreatment specimens. Of the 36 patients with paired posttreatment samples, HCV RNA was detected in all 15 patients who did not respond to IFN and 9 of 13 who responded to IFN but relapsed shortly after IFN was stopped. In contrast, only one of the eight patients who had a sustained response to IFN therapy had HCV RNA detected by RT-PCR (P < 0.04). These data confirm 1) the feasibility of detecting HCV RNA in formalin-fixed, paraffin-embedded tissue from patients with chronic HCV infection, 2) show that sustained response to IFN is associated with loss of liver HCV RNA at the end of IFN therapy, and 3) offer an explanation for recurrence in patients who relapse.

Base Sequence↗
PubMed1994

Infection stones in children: a twenty-seven-year review.

OBJECTIVE: The objective of this study was to determine the relationship between urinary tract infection and pediatric urolithiasis and to characterize the pediatric infection stone former. METHODS: Two hundred seventy consecutive pediatric stone formers presenting over a twenty-seven-year period were studied. Of these, 161 children (60%) had infection-related stones. Account was taken of stone composition, anatomic location, associated anatomic lesions, and the rate of stone recurrence over a median follow-up of three years. RESULTS: The mean age of children with infection stones was 4.9 years, with two-thirds being under six years of age. Proteus mirabilis accounted for 82 percent of pure urine cultures. Seventy percent of stones were renal and 30 percent were ureteral or intravesical. One-third of patients had anatomic lesions (pelviureteric obstruction, primary obstructed megaureter, and others) contributing to stone formation. Recurrent stones occurred in 14 percent of cases. CONCLUSIONS: This study reaffirms the predominance of urinary tract infection secondary to P. mirabilis as the leading cause of pediatric urolithiasis in the United Kingdom. The significant recurrence rate suggests the importance of prophylactic antibiotics, surgical correction of congenital anomalies, and long-term follow-up of this patient population.

Adolescent↗
PubMed1994

Improved glanuloplasty in epispadias repair: technical aspects.

An improved surgical approach to glanuloplasty in male epispadias repair is reported. The 3 essential steps of this repair include 1) reverse meatal advancement and glanuloplasty, 2) excision of redundant glans wing tissue bilaterally and 3) creation of a glandular urethra with a 2-layer glans closure. In more than 200 cases this technique has proved successful in producing a cosmetically satisfactory glans with a low rate of fistula formation (less than 5%).

Adolescent↗
PubMed1994

Clinical outcome and management of prenatally diagnosed primary megaureters.

The objective of this study was to evaluate the clinical outcome of infants diagnosed perinatally with primary obstructive megaureter, and to determine which anatomical and physiological indexes best predict such outcome. A total of 67 megaureters thought to be due to primary vesicoureteral junction obstruction was detected in 53 newborns as a result of prenatally diagnosed hydronephrosis or hydroureteronephrosis. These patients were followed nonoperatively using periodic ultrasound and 99mtechnetium-diethylenetriaminepentaacetic acid (Tc-DTPA) renal scans. After a mean followup period of 3.1 years 23 dilated ureters (34%) spontaneously resolved while 33 (49%) persisted. Repair was performed on 11 megaureters (17%) because of breakthrough urinary infections in 3 and deteriorating renal function in 8. Postoperatively, all renal units showed improved drainage on 99mTc-DTPA renal scan, while half of those with decreased renal function regained the lost function. None had further deterioration in renal function. Of the clinical indexes studied ultrasonographic ureteral diameter (less than 6 mm. good, greater than 10 mm. poor prognosis) and drainage on 99mTc-DTPA renal scan correlated best with outcome. We conclude that the majority of primary megaureters detected in the perinatal period can be followed conservatively using periodic ultrasound and 99mTc-DTPA renal scans. Relatively few cases required surgical intervention and those at risk were identifiable by a diameter greater than 10 mm. and poor drainage on 99mTc-DTPA renal scan.

Dilatation, Pathologic↗
PubMed1994

Prevalence of the vanishing testis in boys with a unilateral impalpable testis: is the side of presentation significant?

A total of 208 boys with a unilateral impalpable testis and a contralateral descended testis was studied to correlate the probability of finding blind-ending vas and vessels (vanishing testis) with the side of presentation of the impalpable testis. Of 142 boys with a left impalpable testis 93 (65%) had a vanishing testis and of 66 boys with a right impalpable testis 38 (58%) had a vanishing testis (p < 0.28). These data indicate that impalpable and vanishing testes are more likely to occur on the left side in boys with a unilateral impalpable testis but the likelihood of having a vanishing testis is similar regardless of the side of presentation.

Adolescent↗
PubMed1994

Tailored low-dose fluoroscopic voiding cystourethrography for the reevaluation of vesicoureteral reflux in girls.

OBJECTIVE: Radionuclide voiding cystography is generally advocated for the reevaluation of proved vesicoureteral reflux. The purpose of this study was to assess the efficacy of tailored low-dose fluoroscopic voiding cystourethrography for this purpose. SUBJECTS AND METHODS: Forty-five girls (2 years 9 months to 19 years 7 months old; mean, 7.4 years) who had proved reflux were examined with tailored low-dose voiding cystourethrography. The technique used a low-dose fluoroscopic system and a computer-based video frame grabber that produced frame-averaged digital video fluoroscopic hard copies. A tailored voiding cystourethrographic protocol was designed to minimize ovarian radiation dose. Digital images were compared with standard 105-mm spot films in a similar group of 25 children. RESULTS: The tailored low-dose fluoroscopic technique produced diagnostically adequate images in all patients that were comparable in quality to standard spot films. The ovarian dose was 1.7-5.2 mrad (0.017-0.052 mGy) with a mean of 2.9 mrad (0.029 mGy). This compared favorably with the lowest reported doses with the radionuclide technique. CONCLUSION: Tailored low-dose fluoroscopic voiding cystourethrography is an attractive and practical alternative to the radionuclide technique in girls with proved vesicoureteral reflux.

Child↗
PubMed1993

Discrepancy between biochemical and virological responses to interferon-alpha in chronic hepatitis C.

Serial serum samples and pretreatment and post-treatment liver tissue from patients with chronic hepatitis C virus (HCV) infection were tested for HCV RNA by reverse-transcription polymerase chain reaction and branched DNA signal amplification assays. At the end of treatment with interferon-alpha (IFN alpha), 4 of 5 patients showing no biochemical response (in alanine aminotransferase activity), 4 of 5 with transient responses, and 1 of 5 showing complete and sustained responses had HCV RNA detectable in serum. The corresponding numbers for liver tissue were 5, 5, and 0 (of 4). However, all 5 complete responders had virological relapses within 6 months. Biochemical response may not reflect virological profile during IFN alpha treatment of HCV.

Adult↗
PubMed1992

Neonatal gross hematuria as a presenting sign of posterior urethral valves.

Neonatal gross hematuria is a rare clinical entity. Only occasionally is it associated with obstructive uropathy in the neonate. We report a case in which gross hematuria was the presenting sign in a patient with posterior urethral valves. The differential diagnosis of neonatal gross hematuria with particular attention to obstructive uropathy is reviewed.

Hematuria↗
PubMed1992

The value of laparoscopy for 106 impalpable testes relative to clinical presentation.

Laparoscopy was done in 104 consecutive patients with 106 impalpable testes. Three clinical presentations were identified and the value of laparoscopy in each was analyzed. 1) For unilateral impalpable and contralateral normal testes laparoscopic identification of testicular absence was made in 27% of the cases and intra-abdominal testes were found in 16%. Therefore, laparoscopy was of value in 43% of the cases. 2) For bilateral undescended testes (1 or both impalpable) laparoscopy was diagnostic in 75% of the cases (17% had blind-ending spermatic vessels above the internal ring and 58% had intra-abdominal testes). 3) For patients with previous negative inguinal exploration laparoscopic diagnosis was made in 100%.

Adolescent↗
PubMed1992

The effects of an LHRH agonist on testicular function in the cryptorchid rat.

To assess the effects of an LHRH analog (LHRH-ethylamide des gly10 D-Leu6) on the function of the cryptorchid testis, an animal model was created, using prepubertal male Sprague-Dawley rats (21 days old). The animals were divided into six groups: 1) sham operated; 2) sham + LHRH treated; 3) cryptorchid; 4) cryptorchid + LHRH treated; 5) cryptorchid and orchidopexed; 6) cryptorchid, LHRH treated and orchidopexed. Two weeks post cryptorchidism, the animals were treated with either saline or LHRH-analog (one microgram./rat/day) subcutaneously for a total of twenty five days. Orchidopexy was performed following hormonal treatment. The effects of treatment were assessed in terms of body and reproductive organ weights, serum testosterone and LH levels, sperm counts and motility and fertility. The results demonstrated that experimental cryptorchidism impaired reproductive function, which was restored by orchidopexy, alone. Treatment of cryptorchid rats (groups 4 and 6) with LHRH did not produce any lasting improvement in spermatogenesis or fertility.

Animals↗
PubMed1992

Melanotic neuroectodermal tumor of infancy: an important mimicker of paratesticular rhabdomyosarcoma.

We report a case of a paratesticular tumor in a 6-month-old infant. This tumor was originally believed to represent a poorly differentiated sarcoma of the cord but upon further pathological consultation it was recognized as a rare melanotic neuroectodermal tumor of infancy involving the epididymis. Since the former is a highly aggressive lesion and the latter an indolent tumor, treatment of these 2 entities differs markedly. Therefore, although the histological distinction between these lesions is often difficult, it is of critical importance.

Diagnosis, Differential↗