Biomedical subjects
Publications and source records attributed to F F Marshall.
Long blind-ending ureteral duplications can be symptomatic and require surgical intervention. Three patients with long blind-ending ureteral duplications had prominent reflux and required either resection of the blind ureter and ureteral reimplantation or nephroureterectomy.
Crossed renal ectopia is an unusual congenital anomaly, probably produced by abnormal development of the ureteral bud. The deformity itself produces no symptoms and the clinical presentation generally is for obstruction and infection. In our series the adult patients presented most commonly with urinary tract infections, while the pediatric patients presented most often with multiple congenital anomalies, especially of the skeletal system.
The ACI rat provides a mammalian model for the study of spontaneously occurring defects of partial uterine agenesis and renal agenesis. A variable uterine deformity also occurs with hydronephrosis. A mesonephric duct defect appears responsible for these anomalies.
The embryologic development of the vagina is still disputed. The urogenital sinus and the mesonephric (wolffian) and paramesonephric (müllerian) ducts probably all play a role in the development of the vagina. Duplication, agenesis, mesonephric duct remnants, and hymen abnormalities are among the more common congenital anomalies of the vagina.
The urinary and genital systems are closely related in their development so that dividing them into separate divisions is often artificial. The lower urinary system begins as a cloaca. The urorectal septum then divides the cloaca into a ventral urogenital sinus and a dorsal hindgut. The ureteral bud forms off the mesonephric duct. The male and female genital systems are the same until the gonad assumes characteristics of the testis or ovary in the eighth week of gestation. It is not until the eleventh or twelfth week that the external genitalia assume specific sexual characteristics. Anomalies of the urethra and bladder can vary from a severe epispadias-exstrophy complex to a minimal Type I urethral valve. Ureteral anomalies include duplications, ectopia, and ureteroceles. An undescended testis is probably the most common anomaly in the male genital tract. Female genital anomalies can include a variety of uterine duplication anomalies. Gonadal abnormalities are often created by a chromosomal defect and are ultimately reflected by abnormal sexual differentiation.
We reviewed 29 cases of congenital multicystic dysplastic kidneys. Isolated renal pelvic atresia has an excellent prognosis but lower ureteral atresias are associated with a high incidence of contralateral renal disease and have a worse prognosis.
A 7 1/2-year-old boy sustained severe trauma to the upper abdomen, including transection of the common bile duct, transection of the second part of the duodenum, contusion of the head of the pancreas, traumatic thrombosis of the left renal artery, thrombosis of the right lower pole renal vasculature and avulsion of the right renal pelvis. A staged elective repair of the upper urinary tract, and later the upper gastrointestinal tract, was accomplished when he was referred 5 1/2 months after the initial injury.
A case of partial duplication of the male urethra (bifid urethra) is presented. This case is unusual because of the late presentation with incontinence, the normality of the primary urethra and the markedly lateral course of the accessory urethra. An anatomic and embryological classification is presented.
A simple technique for open ureterocolonic anastomosis is presented. This technique provides adequate exposure for mucosal-to-mucosal approximation and allows the construction of an antireflux ureterocolonic anastomosis.
Sex cord-stromal (gonadal stromal) tumors of the testis account for less than 4 per cent of the testicular tumors. The Leydig cell tumor in a child may produce isosexual virilization (case 3). In the adult it may have no endocrine manifestation (case 1) or gynecomastia and decrease in libidio may result from production of estrogens (case 2). Sertoli cell tumors (case 4) and granulosa cell tumors (case5) are rare.
Renal cell adenocarcinoma can be one of the great masqueraders in medicine. More common extrarenal manifestations of renal cell carcinoma include fever, anemia and gastrointestinal symptoms. Other rarer systemic symptoms are caused by amyloidosis, neuromyopathy and tumor thrombus. Humoral manifestations include polycythemia, hypercalcemia, galactorrhea and Cushing's syndrome. Metastatic disease commonly presents as the initial symptom.
Of 400 patients who underwent ileal conduit diversion between 1963 and 1972, 18 (4.5 per cent) had parastomal hernias. A poorly fitting appliance was the most common presenting symptom. The hernia was found most often in the superolateral quadrant of the stoma at the site of mesenteric attachment of the conduit. In situ and translocation repairs of the stoma are discussed.
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Nonneoplastic renal vein thrombosis (RVT) is a clinical dilemma that poses a problem both from a clinical and diagnostic imaging perspective. An accurate noninvasive study to diagnose nonneoplastic RVT would be desirable. Magnetic resonance flow imaging is a noninvasive method of assessing vascular patency and depiction of thrombus. Its use for detection of nonneoplastic RVT is reviewed and our experience illustrated. We reviewed retrospectively the MRI studies in 41 patients evaluated for RVT and correlated them with other imaging studies where possible. Twenty patients had either ultrasound or venography. There were no correlative imaging studies done in 21 patients, 19 of whom had normal MRI, with normal clinical follow-up. In others there was good agreement between MRI and ultrasound in 16 of 19 cases. There were five patients with renal venography, of which the MRI agreed with the results in 3 of 5. Magnetic resonance imaging offers a noninvasive approach to the difficult diagnostic dilemma of RVT.