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Biomedical subjects

J W Duckett

Publications and source records attributed to J W Duckett.

At least 19 recordsLinked to original sources

An absent testis is associated with contralateral testicular hypertrophy.

Surgical exploration was done in 109 boys ages birth through 9 years with unilateral impalpable testes by physical examination under anesthesia. Of the patients 51 (47%) had an absent testis and 58 had intra-abdominal testes. At open biopsy of the contralateral descended testis the 3 dimensions of the exposed testis were recorded and testicular volume was calculated. The mean volume of the contralateral descended testes of boys with an absent testis was greater than that of boys with intra-abdominal testes at all ages. The differences were significant (p = 0.0019 to 0.0117) from birth through year 4 but not from years 5 through 9. However, the standard deviations ranged from 27 to 74% of the means, and there was broad overlap of the volumes of the 2 groups. These findings indicate that, although the volume of the contralateral descended testis of boys with an absent testis is significantly greater than that of boys with intra-abdominal testes, the volume of the contralateral descended testis is not a reliable criterion for differentiating an absent testis from an intra-abdominal testis in a boy with a unilateral impalpable testis. Surgical exploration continues to be the method of choice for making the diagnosis of an absent testis.

Adaptation, Physiological

Management of the abdominal undescended testicle.

Of the orchiopexies performed for abdominal undescended testicles 85 per cent have resulted in satisfactory testicular growth and position. Three-fourths of these cases were in boys with the prune belly syndrome. We are satisfied with our recent experience using the Fowler-Stephens procedure to salvage intra-abdominal undescended testicles. An analysis of the failures in 5 testes early in this series, resulting in partial atrophy, has helped us to avoid technical errors through attention to the following details: 1) preservation of a broad pedicle of peritoneum overlying the mobilized vas, 2) avoidance of any dissection of the spermatic cord and 3) high ligation of the spermatic vessels well above the point of confluence of the vas and spermatic vessels. Although the Fowler-Stephens procedure has some risk of testicular ischemia and atrophy we believe it to be the preferred way to gain mobility on a short tethering gonadal vascular pedicle.

Child, Preschool

Paratesticular rhabdomyosarcoma in children.

The clinical characteristics, surgical treatment, clinical grouping, chemotherapy, radiotherapy, complications and survival of paratesticular rhabdomyosarcoma are discussed. When the combined approach of radical inguinal orchiectomy, retroperitoneal node dissection, chemotherapy and radiotherapy when indicated is used a survivorship in excess of 80 per cent can be anticipated for all stages of disease. A combined multidisciplinary approach to this lesion is stressed to achieve improved survivorship in this previously lethal lesion.

Child

Ketamine as a detumescence agent during hypospadias repair.

Ketamine hydrochloride was used successfully to produce detumescence in 7 children undergoing hypospadias repair. There have been no complications or side effects. We recommend ketamine hydrochloride as a useful adjunct in managing corporeal erections during urologic procedures.

Child, Preschool

Simple serous cysts of the kidney in children.

Simple renal cysts and reported in 9 children. Two children presented with hematuria following trauma and the cyst was demonstrated on the initial excretory urogram. The other 7 had cysts found on excretory urograms in be course of evaluation of various urologic complaints. The diagnostic approach used was identical to that advocated for adults, namely, percutaneous needle puncture once a solid renal mass has been excluded by an appropriate screening procedure such as ultrasonography. These cysts are benign lesions similar to cysts in adults and are probably more common than the few reported cases would suggest.

Adolescent

Renal growth in maternal-fetal axis: clinical and laboratory studies.

A hormone (renotropin) is said to play an important role in compensatory renal growth. The role of renotropin in obligatory growth (normal developmental growth) is unknown. It was observed that contralateral renal size in children with unilateral multicystic kidney was found to be normal at birth but became hypertrophied later. The kidneys of twenty-one-day-old fetal rats were significantly smaller than sham controls in animals whose mothers had uninephrectomies at day 8 (26.5 +/- 1.1 mg. versus 18.5 +/- 1.1 mg.). The mothers' kidneys hypertrophied compared with sham controls (1,065 +/- 23 mg. versus 1,347 +/- 78 mg.). It was concluded that renotropin passes the placenta and modifies so-called obligatory renal growth.

Animals

Single vaginal ectopic ureter: a case report.

The seventh case of a female subject with a single, unilateral ectopic ureter draining to the vagina is reported. The renal unit was located in the renal fossa, wheras in 3 of the 7 cases reported it was within the pelvis. Although ectopia with ureteral duplication is not an uncommon anomaly the single ectopic ureter in the female subject is the rarest form of ureteral ectopia. Use of phenazopyridine hydrochloric acid as an excertory marker was most helpful in locating the vaginal orifice.

Adolescent

Ectopic vas deferens.

Two infants with ectopia of the vas deferens are described. To date 11 cases have been reported, comprising a total of 13 ectopic vas insertions, 2 of which are bilateral. A classification of 2 types of ectopic vas is presented with a discussion of their relationship to ureteral ectopias. An embryological hypothesis of a proximal vas precursor segment of the wolffian duct is related closely to Stephens' theory of ureteral development.

Humans

Penetrating renal trauma in the neonate.

For years the management of blunt and penetrating renal trauma has been the source of controversy in the literature. The indications for a specific therapeutic program vary with each individual case and with the complicating factors involved. An unusual form of penetrating renal trauma in the neonate is presented and the rationale for therapy is discussed.

Amniocentesis

Epispadias.

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Abnormalities, Multiple

Neuroblastoma.

Neuroblastoma is the most common solid malignant tumor in children. The prognosis is poor, and despite varying chemotherapy and radiation regimens, its status has not been altered much in the past 20 years. Seventy per cent of the patients have abdominal neuroblastomas, which carry the worst prognosis of all the possible sites for the disease. Seventy per cent of the patients have metastases at the time of diagnosis. Survival is best in children under one year of age and in those patients (8 per cent) who are fortunate enough to have only stage I disease. Stage IV disease has only a 3 per cent survival rate. Surgical removal of the tumor is still the primary therapy; irradiation is of significant benefit in patients with stage III disease. Immunotherapy offers an optimistic modality for future improvement in survival rates.

Abdominal Neoplasms