Diagnosis and management of pyeloureteral necrosis following renal transplantation.
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Adolescent↗
Biomedical subjects
J Mandell
Publications and source records attributed to J Mandell.
Chorioallantoic membrane grafting of the embryonic murine kidney. An improved in vitro technique for studying kidney morphogenesis.
Previous experimental investigations of embryonic kidney development with in vitro organ culture techniques have been limited by the short duration of explant viability. Utilization of chick chorioallantoic membranes for transplanting undifferentiated murine kidney rudiments has allowed vascularization of the grafts with advanced maturation and the appearance of early nephron units.
Allantois↗
Utilization of the chick chorioallantoic membrane for in vitro growth of the embryonic murine kidney.
Previous experimental investigations of embryonic kidney development with in vitro organ-culture techniques have been limited by the short duration of graft viability and lack of detailed anatomic development. In a modified application of the chick chorioallantoic-membrane (CAM) grafting technique, we have transplanted 11-day-old undifferentiated embryonic murine kidney rudiments and studied their differentiation and early morphogenesis. Surviving grafts, maintained for 5-10 days on the CAM, demonstrated well-developed convoluted secretory tubules and highly branched collecting ducts. Definitive glomeruli were also identified in these grafts by the presence of efferent tubules, visceral and parietal epithelium, capillary tuft, and Bowman's space. In vitro branching of the ureteric bud preceded formation of definitive tubules. Sections of the CAM grafts appeared histologically comparable to the 14-15-day in vivo embryonic metanephros. Grafts of 10-day-old rudiments showed minimal kidney development; fewer grafts survived, fewer tubules were formed, and fewer glomeruli developed. Our results indicate that the CAM is an efficient site for in vitro murine kidney development with both vascularization of the explant and extensive maturation, including the appearance of primitive nephron units.
Animals↗
Ureteroceles in infants and children.
Ureteroceles in childhood have a broad spectrum of presentation, anatomy and pathophysiology and, thus, treatment must be individualized. We evaluated 64 children with 72 ureteroceles who underwent operation. Their presentation, radiographic findings, operative management and postoperative results are discussed. Simple or orthotopic ureteroceles often require no operation unless they are large enough to obstruct the urinary tract. Then excision of the ureterocele and ureteral reimplantation are recommended. There are a number of options available for the management of ectopic ureteroceles. The procedure of choice is upper pole heminephrectomy and partial ureterectomy in the majority of ureteroceles associated with a poorly functioning upper renal segment. Specific indications for each of the other surgical techniques considered acceptable at present are discussed.
Adolescent↗
Urethral narrowing in region of external sphincter: radiologic-urodynamic correlations in boys with myelodysplasia.
Narrowing of the urethra in the region of the external sphincter as seen during voiding cystourethrography has routinely been termed sphincter spasm. This diagnosis was found to be incorrect in a significant percentage of boys with myelodysplasia. Thirty boys with myelodysplasia and dysfunction of the lower urinary tract, in whom voiding cystourethrography revealed narrowing in the area of the external sphincter, underwent urodynamic evaluation. Incoordination of the bladder and the sphincter (sphincter spasm) was found in only 16 (52%). In the other 14 (48%), there was either relaxation of the sphincter or absent electrical activity; atrophy and fibrosis of the striated muscle of the external sphincter (documented in six patients) probably resulted from chronic denervation. Thus, voiding cystourethrography only reveals narrowing of the urethra in the region of the external sphincter. However, when it is combined with urodynamic evaluation, the dynamics of the function of the sphincter can be defined and a rational approach to treatment planned.
Child↗
Occult spinal dysraphism: a rare but detectable cause of voiding dysfunction.
Certain signs and symptoms should alert the clinician to a diagnosis of spinal dysraphism, one of the underlying causes of voiding dysfunction in children. The type of bladder and sphincter dysfunction found in eight children wit spinal dysraphism and the modes of therapy employed are discussed.
Adolescent↗
"Real time" ultrasonic evaluation of the breast.
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Breast Neoplasms↗
Coma and hyperchloremic acidosis.
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Acidosis↗
Diagnosis and management of hydrometrocolpos in infancy.
Three cases of hydrometrocolpos in infants are presented, which demonstrate that despite thorough documentation of the clinical findings, the misdiagnosis and the ensuing mismanagement of this condition remain a problem. The presence of other genitourinary abnormalities and the association with anomalies of the anorectal area make it imperative that these infants be evaluated, treated and followed by clinicians who are skilled in these areas. Introital revision may proceed at an early age to avoid the necessity of repeated drainage procedures and allow normal voiding but close followup is necessary.
Female↗
Management of the unsuspected ectopic ureterocele.
Five cases of ectopic ureteroceles associated with non-functioning upper pole segments are presented. Diagnosis was not made until the time of operation for correction of vesicoureteral reflux or decompression of the upper tracts through a flank approach. Options in the management of this problem are discussed.
Adult↗
Urologic complications of neonatal umbilical arterial catheterization.
Two cases are presented illustrating the emergent and potentially lethal complications of neonatal umbilical artery catheterization that may confront the pediatric urologist. Immediate aortography via the umbilical artery catheter usually will be diagnostic. Prompt surgical intervention is advocated if uncontrollable renovascular hypertension or a false aneurysm is found.
Catheterization↗
Supravesical hematoma following suprapubic urine aspiration.
A newborn undergoing evaluation and treatment for neonatal sepsis was found to have a pelvic mass. Exploration revealed a large supravesical hematoma thought to be secondary to prior suprapubic bladder aspiration.
Hematoma↗
Hypercalcemia associated with uroepithelial neoplasms.
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Aged↗
Childhood gonadoblastoma and seminoma in a dysgenetic cryptorchid gonad.
A case of gonadoblastoma and seminoma occurring in a genotypic male child with ambiguous genitalia is presented. A review of the literature establishes that children with intersex disorders who possess a Y chromosome and undescended gonads stand a particularly high risk of having this type of gonadal neoplasm and should be explored.
Child, Preschool↗
The place of bone scan in the diagnosis of renal cell carcinoma.
We herein review 12 cases of renal cell carcinoma evaluated by bone scan and skeletal survey. Comparison of these techniques revealed a high incidence of falsely negative results (42 per cent) when using skeletal survey alone. It is now our policy to include the bone scan in our initial evaluation of patients with renal cell carcinoma.
Adenocarcinoma↗
Isolated fractures of the posterior tibial lip at the ankle as demonstrated by an additional projection, the "poor" lateral view.
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Ankle Injuries↗
Minimally traumatic techniques for in utero access and fetal surgery.
BACKGROUND AND OBJECTIVES: Prenatal interventions may prevent some sequelae of congenital anomalies, yet open fetal surgery is limited by pre-term labor. We are developing amnioscopic strategies to reduce risks for in utero surgery. METHODS: Seven fetal sheep were accessed percutaneously under ultrasound guidance, via maternal laparoscopy/transuterine trocars, or via laparoscopically assisted partial uterine exteriorization (mini-hysterotomy). Three fetal immobilization methods were investigated: 2 mm grasping forceps, 2-0 absorbable Roeder loop lasso, and detachable metal T-fasteners. RESULTS: Percutaneous access with 2 mm trocars required accessible amniotic fluid pockets. The laparoscopically assisted method enabled 5 mm trocar placement under direct fetal visualization. Mini-hysterotomy avoided trocars and was leak-proof. 2 mm graspers enabled fetal manipulation with repeatable applications. Roeder loop sutures were not readily repositioned, and required two 3 mm or larger trocars. T-fasteners were easily deployed into fetal skin via the self-contained needle applicator with minimal hemorrhage. Cutaneous marks were present immediately from the grasper and T-fastener, but not at postoperative day 10. The Roeder loop produced no observable effects. All devices demonstrated adequate intrauterine performance. CONCLUSIONS: Minimally invasive fetal surgery promises to lower maternal-fetal risks. All strategies permitted prolonged amnioscopy and fetal manipulation. The 2 mm grasper was easiest to use, producing no observable lasting trauma.
Animals↗