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Biomedical subjects

E J Kass

Publications and source records attributed to E J Kass.

At least 37 records · Page 2Linked to original sources
PubMed1993

Do all children with an acute scrotum require exploration?

A total of 77 consecutive children ranging in age from 1 day to 17 years was evaluated for an acute scrotum by a single examiner (E. J. K.). In 10 children a definite diagnosis of acute spermatic cord torsion was made based upon the history and physical examination. No imaging studies were performed and torsion was confirmed at surgery in 9 children. The diagnosis of testis torsion was not as clear-cut in the remaining 67 children and, therefore, a color Doppler ultrasound was performed before any surgical intervention. The study demonstrated normal or increased blood flow in 55 of these children and none proved to have testicular torsion, although other scrotal pathology requiring surgery was noted in 5 children. Twelve children did not demonstrate evidence of testicular blood flow on the color Doppler ultrasound and all had surgical confirmation of testis torsion. We conclude that in our experience the majority (71%) of children with an acute scrotum did not require immediate surgical exploration. Color Doppler ultrasound can reliably identify those children with an acute scrotum who require exploration and spare the majority needless surgery. Routine scrotal exploration is no longer necessary for all children with an acute scrotum.

Acute Disease↗
PubMed1992

The sensitivity of renal scintigraphy and sonography in detecting nonobstructive acute pyelonephritis.

Recently it has been demonstrated that any child with proved acute pyelonephritis may be at risk for parenchymal scarring, whether or not reflux is present. Since cortical renal scintigraphy has been shown to detect accurately renal inflammation, we compared cortical scintigraphy with renal sonography in 46 children with documented acute pyelonephritis to determine which modality is best to detect patients at risk for renal injury. Cortical scintigraphy was abnormal in 36 children (78%) and renal ultrasonography was abnormal in 5 (11%). Reflux was demonstrated in only 20 cases (43%). We conclude that cortical scintigraphy is the preferred imaging technique for diagnosing renal inflammation, and it should be used routinely in every child with suspected acute pyelonephritis. A new imaging protocol is proposed.

Acute Disease↗
PubMed1992

Results of varicocele surgery in adolescents: a comparison of techniques.

We report our experience using 3 different operative techniques for varicocele ligation in adolescents. Between August 1985 and April 1991 we performed 102 varicocelectomies on 91 adolescents. Varicocele persistence rate was 16% with a modified Ivanissevich inguinal approach and 11% using a selective high retroperitoneal technique with preservation of the internal spermatic artery. Intraoperative post-ligation spermatic venography did not significantly improve the results with the artery sparing techniques. Palomo mass high retroperitoneal ligation of the internal spermatic vessels produced significantly better results compared to the artery sparing techniques. Testicular atrophy did not occur in any patient regardless of the surgical technique used. These data suggest that the Palomo technique results in a significant decrease in the operative failure rate compared to the artery sparing procedures and it should be the preferred technique for varicocele ligation in the adolescent.

Adolescent↗
PubMed1991

The significance of elevated scrotal temperature in an adolescent with a varicocele.

Simultaneous measurements of left and right scrotal, and axillary skin temperatures were recorded in 58 consecutive adolescents (mean age 14.4 years) with a grade II-III left sided varicocele, and nine control adolescents without genital pathology (mean age 15.7 years). Left and right testicular volumes were determined in both groups. The adolescents with a varicocele had a significant bilateral elevation of the scrotal temperatures compared to the control subjects. This relative hyperthermia was present in both supine and standing positions. The mean left scrotal temperature of varicocele patients was significantly higher in the standing position than in the supine position, which may reflect the dependent venous filling of the varicocele. Those varicocele patients who maintained a left scrotal temperature at least 1.4 degrees C cooler than axillary did not have significant left testicular volume loss, whereas those whose left temperature was approximately equal to axillary did have significant growth retardation of the left testis. Following successful varicocele surgery, left scrotal temperatures were significantly cooler, and statistically indistinguishable from controls. The left testicular volumes were also significantly improved with respect to corresponding right testicular volumes. These observations suggest that adolescents with a moderate to large left varicocele have a significant bilateral loss of testicular thermoregulation. In those individuals with a significantly warmer left hemiscrotum, there is a definite increased potential for left testicular volume loss. Varicocele surgery can reverse this process.

Adolescent↗
PubMed1990

Single stage hypospadias reconstruction without fistula.

During a 3 1/2-year period 206 consecutive patients underwent primary hypospadias repair. Of the patients 117 were 6 to 18 months old, 65 were 18 months to 5 years old and 24 were older than 6 years. In 175 patients a single stage reconstruction was performed using a vascularized skin flap for the neourethra. A modified 2-layer closure with optical magnification was performed, and a urethrocutaneous fistula developed in only 1 patient, who had undergone a single stage repair of perineal hypospadias. With the use of contemporary single stage hypospadias reconstructive techniques and a 2-layer closure of the neourethra, urethrocutaneous fistula can virtually be eliminated.

Child↗
PubMed1990

Renal scarring and vesicoureteral reflux in children with myelodysplasia.

The records of 180 myelodysplasia patients followed from 3 to 18 years were reviewed. Studies included cystography to evaluate vesicoureteral reflux and dimercapto-succinic acid renal scintigraphy to identify acute inflammation and renal scarring. Scarring was noted in 28 of 180 patients (15.5%), of whom 68% were girls. Of the patients with renal scarring 75% had associated reflux and 40% over-all were identified as having reflux. Management of patients with vesicoureteral reflux included clean intermittent catheterization, antibiotic prophylaxis and anticholinergics when indicated. Only 17 of 72 patients (24%) had ureteral reimplantation. Surgical indications included persistent high grade reflux and/or progressive upper tract damage. Reflux resolved in 62% of those on medical management. Resolution was not dependent on grade of reflux (as compared to primary reflux). Twenty-one patients are stable and being followed with persistent reflux. In 7 patients new renal scars developed during aggressive medical management, 5 of whom underwent subsequent surgical correction.

Child↗
PubMed1990

Urachal remnants: sonographic demonstration in children.

On 62 of 100 pediatric bladder sonograms a small, elliptical, hypoechoic structure was observed on the middle of the anterosuperior surface of the urinary bladder. One of the these structures was removed surgically, and pathologic examination disclosed a normal urachal remnant. Since it is a common sonographic finding in children, it should not be mistaken for a pathologic process unless it is accompanied by signs and symptoms of infection or bladder obstruction.

Abdominal Muscles↗
PubMed1990

Contemporary techniques for the radioisotopic evaluation of the dilated urinary tract.

Regardless of one's approach to the evaluation of hydronephrosis, nuclear imaging should be part of every child's evaluation, as it is the only imaging modality capable of providing significant renal function information. The studies can easily be performed on an outpatient basis without sedation. Diuretic renal scintigraphy is deceptively simple to perform, and commitment to detail is exceedingly important if the results are to be valid. Radioisotope transit time may also be helpful, although its calculation is technically difficult. Determination of the function of the kidneys individually is possible by several methods.

Child↗
PubMed1989

Adolescent varicocele: objective indications for treatment.

We measured the gonadotropin response pattern to the intravenous injection of luteinizing hormone-releasing hormone in 53 male adolescents 11 to 17 years old (average age 14.2 years) with a grade II to III varicocele. Volume loss of the testis ipsilateral to the varicocele of 2 cc or more was noted in 32 patients. Baseline serum levels of follicle-stimulating hormone, luteinizing hormone and testosterone were determined, and measured again at 15, 30 and 60 minutes following intravenous injection of luteinizing hormone-releasing hormone. Of the patients 23 had an exaggerated response pattern following luteinizing hormone-releasing hormone stimulation, including abnormally high post-stimulation levels of luteinizing hormone only in 6, follicle-stimulating hormone only in 4, and follicle-stimulating and luteinizing hormones in 13. No significant difference in mean age, testosterone levels or loss of testicular volume was noted between the abnormal and normal response groups. This study indicates that approximately 45 per cent of adolescents with a varicocele have evidence of testicular injury. The physical examination was of no value in predicting which patient with a varicocele would display evidence of testicular dysfunction. We suggest that the luteinizing hormone-releasing hormone stimulation test become a routine part of the evaluation of an adolescent with a varicocele.

Adolescent↗
PubMed1987

Reversal of testicular growth failure by varicocele ligation.

A total of 20 male patients 11 to 19 years old had a grade 2 or 3 varicocele and volume loss of the testis ipsilateral to the varicocele. None of these patients presented because of subfertility. Following varicocele ligation a significant increase in volume of the testis ipsilateral to the varicocele was observed in 16 of 20 patients. All 20 patients have been followed for 1 to 6 years. Our results suggest that a moderate to large varicocele can be responsible for testicular growth retardation and that early ligation of the varicocele may reverse this process.

Adolescent↗
PubMed1987

Testicular histology in the adolescent with a varicocele.

A varicocele is a common cause of adult male infertility, and surgical ligation is a generally accepted mode of therapy. However, the guidelines for management of the adolescent with a varicocele are not clearly defined. Herein, we describe histologic abnormalities noted on testis biopsy in nine of 24 boys with moderate to large varicoceles. Surgical ligation of the varicocele is recommended when there is volume loss of the testis ipsilateral to the varicocele. All others should be reexamined periodically, and an attempt should be made to obtain a baseline semen analysis.

Adolescent↗
PubMed1985

Comparison of the diuretic renogram and the pressure perfusion study in children.

We evaluated 42 hydronephrotic kidneys with diuretic renography and pressure perfusion studies to diagnose or exclude the presence of obstruction. Both studies were highly accurate but a small number of false positive and false negative studies were observed with each testing modality. The advantages, disadvantages and potential sources of inaccuracy of each study are discussed, and a protocol for the evaluation of hydronephrosis incorporating both studies is proposed.

Adolescent↗
PubMed1985

Traumatic amputation of the left lower renal pole in children.

Four children between 5 and 10 years old suffered traumatic amputation of the left lower renal pole following flank trauma. All patients were evaluated with excretory urography and isotope renography. The renal scan clearly demonstrated failure of perfusion of the lower renal pole and urinary extravasation, and was believed to be more valuable than the standard excretory urogram as a diagnostic tool. All children were managed similarly: delayed (72 to 96 hours) exploration, simple removal of the amputated segment and insertion of a Penrose drain. They all have done well. The patients were normotensive at followup and had excellent function of the remaining portion of the kidney.

Amputation, Traumatic↗
PubMed1985

Evaluation and management of upper urinary tract obstruction in infancy and childhood.

Our clinical experience over the past 5 years would suggest that both the diuretic renogram and the Whitaker study permit an objective and quantitative assessment of urinary obstruction. The diagnostic accuracy of both studies exceeds 90 per cent, although neither study has proved to be infallible. Both have potential sources of error that must be monitored carefully if their reliability is to be maximized. Potential sources of error in the diuretic renogram include the state of hydration, renal functional status, distensibility and volume of the collecting system, a filled bladder, and ability to respond to the diuretic. Its reliability can be increased if the standard testing protocol is followed, the study closely monitored, and the limitations of the test realized. Interpretation of the diuretic renogram based only upon the appearance of the washout curve without consideration of the calculated half time or the sequential analogue images is unreliable and in our experience would have been responsible for an incorrect interpretation in 40 per cent of patients. The diuretic renal scan is used as the initial testing modality because it is reliable, reproducible, noninvasive, and objective and provides important information concerning individual renal function. Over 80 per cent of children with hydronephrosis can be completely evaluated by the diuretic renogram alone without the need for more invasive testing modalities. Nevertheless, the pressure perfusion study will continue to be necessary for the evaluation of certain individuals. Because of its invasive nature, we prefer to reserve this study for very specific, well-defined circumstances.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

Acute and recurrent urinary tract infections in children.

Urinary tract infection is a common problem in children. Significant renal damage can result from the first episode of urinary tract infection. Early diagnosis, treatment, and evaluation can significantly reduce the potential for renal injury. All children with a potential urinary tract infection should have a reliable urine specimen sent for culture, and if infection is documented, a radiographic evaluation of their urinary system is required.

Acute Disease↗