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Biomedical subjects

J F Redman

Publications and source records attributed to J F Redman.

At least 37 records · Page 2Linked to original sources
PubMed1996

Applied anatomy of the cremasteric muscle and fascia.

PURPOSE: Although the cremasteric muscle is a prominent structure of the inguinal canal, specific details of its anatomy are seldom discussed in either anatomical or surgical texts. Therefore, a detailed description of the anatomy of the cremasteric muscle and fascia is provided, followed by descriptions of new applications of this knowledge for operations on the inguinal canal. MATERIALS AND METHODS: Observations are described based on more than 1,000 operations on the inguinal canal conducted during a 15-year period. Magnification of 3.5 x was used in all dissections. RESULTS: Careful dissections of the cremasteric muscle and fascia allowed for development of new approaches to enhance exposure of the inguinal canal and internal ring, and to mobilize the spermatic cord and testes. CONCLUSIONS: Knowledge of the anatomy of the cremasteric muscle and fascia, and techniques for dissection are adjuncts to surgery of the inguinal canal, including inguinal hernia repair and orchiopexy.

Abdominal Muscles↗
PubMed1996

Association of epididymal anomalies with patent processus vaginalis in hernia, hydrocele and cryptorchidism.

PURPOSE: We performed a prospective study to assess the relationship between epididymal anomalies and patency of the processus vaginalis in boys presenting with hernia, hydrocele or cryptorchidism. MATERIALS AND METHODS: The degree of patency of the processus vaginalis (closed, partially closed or open) and morphology of the ipsilateral epididymis were recorded in 159 consecutive inguinal explorations. RESULTS: A closed, partially closed and open processus vaginalis was associated with an abnormal epididymis in 14, 36 and 69% of cases, respectively. Epididymal anomalies were more frequent in association with undescended (72%) than descended (34%) testes. CONCLUSIONS: These data confirm the observation of a higher incidence of epididymal anomalies associated with patency of the processus vaginalis irrespective of testicular position, and they support the theory that androgenic stimulation may be required for closure of the processus vaginalis as well as epididymal development.

Abnormalities, Multiple↗
PubMed1995

Circumcision revision in prepubertal boys: analysis of a 2-year experience and description of a technique.

Neonatal circumcision may result in an unsightly redundancy of preputial skin, which may cause parents to elect circumcision revision. Redundant residual prepuce becomes stretched or elongated, producing a mushroom-like widening of the distal shaft and preputial skin. The standard sleeve technique for circumcision is not effective for revision in these cases. A 2-year consecutive series of prepubertal boys who underwent circumcision revision is reported and a technique for revision is described.

Child↗
PubMed1995

A technique for atraumatic scrotal pouch orchiopexy in the management of testicular torsion.

PURPOSE: Scrotal pouch orchiopexy without suture fixation will result in strong atraumatic fixation of the testis in the management of undescended testis. We describe a similar technique that is effective in the management of testicular torsion. MATERIALS AND METHODS: A total of 19 scrotal pouch orchiopexies was performed in 11 boys with testicular torsion. Age ranged from 10 to 17 years (mean 14). Orchiopexy was done using a scrotal pouch without transparenchymal suture fixation of the testis. The partial serosal sac was obliterated, placing the testis in a secured extravaginal position. RESULTS: Followup ranged from 17 to 33 months (mean 25.6). There were no instances of infection, hematoma, wound dehiscence, atrophy or recurrent torsion. CONCLUSIONS: Scrotal pouch orchiopexy as described is recommended to prevent torsion of the testis.

Adolescent↗
PubMed1994

Cutaneous vesicostomy with direct intravesical application of formalin: management of severe vesical hemorrhage resulting from high dose cyclophosphamide in boys.

A severe form of hemorrhagic cystitis occurs when high doses of cyclophosphamide are administered before bone marrow transplantation. Severe vesical bleeding in male children is difficult to manage because the small urethra precludes the use of large catheters for bladder irrigation and clot removal. We report on the use of cutaneous vesicostomy with the instillation of 4% formalin to control bleeding in 3 boys.

Administration, Topical↗
PubMed1993

Observations on course of cremasteric muscle in perineal testes with commentary on gubernaculum.

Three instances of perineal testes are described including the fourth reported case of bilateral perineal testes. In each instance the course of the cremasteric muscle was traced distally and was found to terminate in the perineum. It is suggested that if the cremasteric muscle forms in the periphery of the gubernaculum, then the cremasteric muscle should be indicative of the course and the termination of the gubernaculum.

Child, Preschool↗
PubMed1993

Results of undiverted simple closure of 51 urethrocutaneous fistulas in boys.

Urethral fistulas are an inherent risk of hypospadias repair. Present-day repairs of hypospadias in which redundant skin is held to a minimum limit the applicability of skin flap advancement technique for closure. To avoid altering the cosmesis of the prior hypospadias repair, 51 urethrocutaneous fistulas were closed using a three-layer simple closure technique without urinary diversion. An 80 percent success rate was achieved following the initial closure. A second simple closure of those which failed also succeeded in 80 percent of the cases.

Adolescent↗
PubMed1993

Translocation (7;7)(p13;q21) in a Wilms' tumor.

Reports of single chromosome aberrations in Wilms' tumors are rare, with most tumors being characterized by multiple complex karyotype aberrations. An 11-month-old female patient with Wilms' tumor and a derivative chromosome 7 resulting from t(7;7)(p13;q21) as the sole cytogenetic aberration is described.

Chromosomes, Human, Pair 7↗
PubMed1992

Regulation of platelet-activating-factor receptors and the desensitization response in polymorphonuclear neutrophils.

Platelet-activating factor (PAF) desensitizes as well as stimulates its various target cells, We find that human polymorphonuclear neutrophils (PMN) exposed to PAF became maximally unresponsive to a second PAF challenge within 15-90 s in assays of Ca2+ mobilization and degranulation. The cells regained full PAF-sensitivity over the ensuing 20-40 min. These effects correlated with changes in PAF receptor availability. PMN treated with PAF, washed in regular buffer and assayed for PAF binding exhibited falls (maximal in 15 s), followed by rises (reaching control levels by 60 min), in the number of high-affinity PAF receptors. However, tracking studies showed that [3H]PAF accumulated on the cell surface for approximately 2 min before being internalized. Regular-buffer washes did not remove this superficial PAF, whereas a washing regimen using excess albumin to adsorb PAF removed 99% of the surface compound. PMN washed by the latter regimen after PAF exposure lost PAF receptors relatively slowly (maximal at approximately 5 min), but the ultimate extent of this loss and the rate at which receptor expression normalized were similar to those of cells washed in regular buffer. Neither cycloheximide nor actinomycin D influenced the course of the receptor changes, but two protein kinase C (PKC) blockers, staurosporine and 1-(5-isoquinolinesulphonyl)piperazine, inhibited the receptor-receptor-depleting actions of PAF. Indeed, a phorbol diester activator of PKC also caused PMN to decrease high-affinity PAF receptor numbers, and the two PKC blockers antagonized this action at concentrations that inhibited PAF-induced PAF receptor losses. We conclude that: (a) PAF induces PMN to down-regulate and then to re-express PAF receptors independently of protein synthesis; (b) these changes are likely to underlie the later stages and reversal of desensitization; (c) the onset (t < or = 2 min) of desensitization, however, precedes receptor down-regulation and must be due to receptor uncoupling from transductional elements; and (d) down-regulation of receptors for PAF appears to be mediated by PKC and/or elements inhibited by PKC blockers.

Calcium↗
PubMed1992

Ureteropelvic junction obstruction caused by accessory renal vessels in association with preureteral vena cava and vena caval duplication.

An apparent ureteropelvic junction obstruction on the right side may herald an array of anomalous conditions for which the surgeon should be prepared. A case is presented in which ureteropelvic junction obstruction caused by accessory renal vessels was found in association with a preureteral vena cava and a vena caval duplication on the right side. The embryology of caval anomalies associated with preureteric vena cava is reviewed.

Child, Preschool↗
PubMed1991

Tumor necrosis factor-alpha regulates expression of receptors for formyl-methionyl-leucyl-phenylalanine, leukotriene B4, and platelet-activating factor. Dissociation from priming in human polymorphonuclear neutrophils.

TNF-alpha enhances polymorphonuclear responses to many stimuli, including chemotactic peptide FMLP. It also promotes expression of FMLP receptors and thus may prime polymorphonuclear neutrophils to this and other agonists by up-regulating signal recognition molecules. However, we find that the cytokine's actions on FMLP receptors lagged priming of FMLP-induced degranulation. Moreover, TNF-alpha enhanced degranulation responses to leukotriene B4 and platelet-activating factor but paradoxically down-regulated leukotriene B4 receptors and only transiently up-regulated platelet-activating factor receptors. Hence, TNF-alpha has pleiotropic effects on receptor expression; these effects diverge from priming; and a large part of the primed state must reflect enhancement of post-receptor events.

Cell Degranulation↗
PubMed1991

Roles of Ca2+ in human neutrophil responses to receptor agonists.

Previous studies have concluded that cytosolic Ca2+ [( Ca2+]i) transients are essential for neutrophils (PMN) to degranulate and make superoxide anion when challenged with the receptor agonists N-formyl-methionyl-leucyl-phenylalanine, platelet-activating factor and leukotriene B4. This view is based on the profound unresponsiveness of PMN that have their [Ca2+]i fixed at resting levels by removing storage Ca2+ and loading the cells with greater than or equal to 20 microM of a Ca2+ chelator, quin2 AM. We too observed this unresponsive state in PMN loaded with 10-32 microM-quin2 AM, fura-2 AM or 1,2-bis-(2-aminophenoxy) ethane-NNN'N'-tetra-acetic acid (BAPTA). When loaded with less than or equal to 1 microM fura-2 AM, however, Ca(2+)-depleted PMN failed to alter [Ca2+]i appreciably, yet still had substantial degranulation and superoxide-anion-generating responses to the receptor agonists. Function thus did not require [Ca2+]i transients. Moreover, Ca(2+)-depleted PMN had 20-35% decreases in receptor numbers for each of the three agonists, and chelator loading of these cells decreased receptor availability by 30-50%. All receptor losses were reversed by incubating PMN with Ca2+ at 37 degrees C, but not at 4 degrees C, and agonist binding at 4 degrees C was not influenced by the presence or absence of extracellular Ca2+. Ca2+ thus caused PMN to up-regulate their agonist receptors at 37 degrees C, and the effect persisted at 4 degrees C regardless of ambient Ca2+. We conclude that Ca2+ acts in at least three ways to regulate responses to receptor agonists. First, some pool of (probably cellular) Ca2+ maintains receptor expression. Second, [Ca2+]i transients potentiate, but are not required for, function. The [Ca2+]i pool may or may not be the same as that influencing receptors. Finally, another pool(s) of Ca2+ signals or permits responses. This last pool, rather than [Ca2+]i transients, appears essential for the bioactions of standard Ca(2+)-mobilizing stimuli.

Calcium↗
PubMed1991

Hypertrophy of clitoral hood: presenting sign of neurofibromatosis in female child.

Although clitoral involvement with neurofibromatosis is rare, all cases previously reported have described clitoral hypertrophy due to neurofibromas of the clitoral corpora. We report on a patient who had localized enlargement of the prepuce only, with no evidence of neurofibromatous infiltration. In all cases, diagnosis of clitoromegaly requires basic chromosomal and endocrinologic evaluation. However, recognition of its association with neurofibromatosis due to either neurofibromas of the genitalia or localized genital hypertrophy may spare the patient an unnecessary or invasive evaluation. Because of an association with urinary tract neurofibromas, the patient with genital involvement should have cystoscopy. Clitoroplasty with sparing of the neurovascular bundle and glans is the preferred method of management of the enlarged clitoris.

Child, Preschool↗