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Biomedical subjects

H M Snyder

Publications and source records attributed to H M Snyder.

136 records · Page 8Linked to original sources
PubMed1983

Vesicostomy for neurogenic bladder with spina bifida: followup.

Of 260 patients being actively followed in a myelodysplasia clinic 48 have had a vesicostomy. Vesicostomy was done because of hydroureteronephrosis in 44 cases, infection in 3 and failure of clean intermittent catheterization in 1. Of the 48 patients 16 underwent closure of the vesicostomy, generally between ages 6 and 10 years, an age when the child is prepared to begin clean intermittent catheterization and is motivated to achieve continence. Two children underwent early vesicostomy closure because the bladder emptied adequately and neither has yet begun clean intermittent catheterization. Two children on clean intermittent catheterization are not acceptably continent. The remaining 12 patients are continent for at least 4 hours on clean intermittent catheterization, some with adjuvant drug therapy. No child has exhibited loss of bladder volume while diverted. Vesicostomy offers excellent temporary decompression of the urinary tract in children with spina bifida and neurogenic bladder, and has no long-term harmful effects on the bladder.

Child↗
PubMed1983

Feminizing genitoplasty: a synthesis.

The female child with the adrenogenital syndrome is subject to a variable degree of masculinization. Surgery should be directed to 3 goals: 1) removing the corpora and preserving the glans with its innervation to create a clitoris with normal sensation, 2) creating a normal-appearing introitus by fashioning labia minora from phallic skin and foreskin, and 3) vaginoplasty to provide an adequate opening for the vagina onto the perineum. The entire repair may be completed before the age of 6 months unless the vagina enters the urogenital sinus at a high level in which case vaginoplasty should be delayed until the child is older. The evolution of this operative approach is described and the details of the operative technique are presented.

Adrenal Hyperplasia, Congenital↗
PubMed1981

Congenital mesoblastic nephroma: relationship to other renal tumors of infancy.

Although nephroblastomas (Wilms tumor) do occur in the newborn most of the solid renal tumors in this age group constitute a distinctly different pathologic entity, congenital mesoblastic nephroma. While a more cellular histologic variant of congenital mesoblastic nephroma has been recognized recently, which occasionally may follow a malignant course, the tumor with conventional histology has never been reported to metastasize and follows a benign course when treated by adequate local excision alone. We report our 50-year experience with 11 cases of this tumor (9 cases with conventional histology and 2 with cellular variant histology). Typically, the tumor presented in the newborn as a large asymptomatic mass. Local invasion was never seen and the tumors were resected without difficulty. Grossly, the tumors usually resembled a uterine "fibroid" and, unlike nephroblastomas, rarely exhibited hemorrhage or necrosis. Microscopically, the conventional histologic congenital mesoblastic nephroma was composed of sheets of spindle-shaped cells. The cellular variant of congenital mesoblastic nephroma exhibited increased cellularity and a higher mitotic index. The relationship of congenital mesoblastic nephromas to other neonatal renal tumors is discussed and a unifying schema of neoplasia in infantile renal tumors is proposed.

Diagnosis, Differential↗
PubMed1978

Orthotopic ureteroceles in children.

Experience with 20 simple ureteroceles in 18 children is reviewed. In most cases hydroureteronephrosis of various grades of severity was present. In 5 cases the related kidney was non-functioning. The ureterocele generally is seen on excretory urography, either as a positive cobra-head dilatation or as a negative filling defect in the cystogram when renal function is impaired. Cystoscopy is diagnostic but confusion may occur when a lax ureterocele is compressed and emptied or even everted by a high intravesical pressure. Expectant management is warranted in the absence of upper tract dilatation but operative intervention is needed in most cases. Nephroureterectomy may be unavoidable if the kidney is afunctional. Simple unroofing or incision of the ureterocele is followed by vesicoureteral reflux and ascending infection. The preferred technique is total excision of the ureterocele and reimplantation of the ureter into the bladder by an antireflux technique.

Child↗
PubMed1977

Idiopathic scrotal edema.

An eight-year experience consisting of 30 cases of idiopathic scrotal edema has been analyzed. The condition is characterized by a minimally painful scrotal swelling produced by subcutaneous edema. A normal testis and cord enable one to differentiate it from some other causes of scrotal swelling such as torsion of the testis and epididymo-orchitis. A connection with trauma, periurethral disease, or streptococcal disease appears unlikely. A localized allergic phenomenon, perhaps a local form of angioneurotic edema appears to be the most likely etiologic factor.

Angioedema↗
PubMed1976

Urodynamics in the prune belly syndrome.

Urodynamic studies have been carried out in 10 boys with the prune belly syndrome. In spite of gross radiological changes the condition is compatible with normal voiding dynamics. Filling cystometrograms show a marked shift to the right. Pressure/flow studies may demonstrate an unbalanced voiding mechanism which can be treated by urethrotomy. Following urethrotomy urethral pressure profiles showed a significant fall, flow rates increased and residual urine volumes were reduced. Urological treatment in the prune belly syndrome should be directed at producing a bladder which empties well: a balanced voiding mechanism. Urodynamic investigations are helpful in achieving this aim. Residual urine determination and flow rates should be used in routine follow-up. Urethrotomy to lower bladder outflow resistance is advocated as one of the first steps in treating the unbalanced voiding mechanism that is often found in the prune belly syndrome.

Abdominal Muscles↗