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Biomedical subjects

R D Jeffs

Publications and source records attributed to R D Jeffs.

At least 127 records · Page 7Linked to original sources
PubMed1980

Renal function in continent patients after surgical closure of bladder exstrophy.

We assessed the upper urinary tracts and renal function in 22 children who had achieved continence after staged correction of bladder exstrophy. All patients had been followed for an average of 8 years after completion of the reconstructive operation. In 15 patients the upper urinary tract was normal and only 1 of the remaining 7 required surgical correction (transureteroureterostomy) of the residual anomaly. Renal function was normal in all children. We attribute these satisfactory results to careful selection of patients, improved surgical techniques and good postoperative care.

Adolescent↗
PubMed1980

Neonatal bilateral ureteropelvic junction obstruction.

The incidence of bilateral ureteropelvic junction obstruction appears to be higher in patients less than 1 year old. The aggressive surgical reconstruction of bilateral ureteropelvic junction obstruction in 3 neonates resulted in good renal function, even in an apparently dismal clinical setting.

Female↗
PubMed1979

Ovarian involvement in neuroblastoma.

A case of neuroblastoma involving the ovaries bilaterally at diagnosis is reported. A review of previous cases of neuroblastoma at Johns Hopkins Hospital revealed no previous occurrence of ovarian metastatic disease at diagnosis, but involvement in about one-third of cases at autopsy. This appears to be a more common site of metastatic disease than has been previously recognized. The significance of this site of metastases in neuroblastoma is unknown.

Adrenal Gland Neoplasms↗
PubMed1979

Primary massive reflux in children.

Over a ten-year period, of more than 1,000 children whose primary vesicoureteral reflux was treated surgically, there were 54 children with 80 single ureters which were massively dilated. Primary reconstruction with ureteral tailoring was done in 25 ureters with a success rate of 92 per cent. Forty-five ureters were temporarily diverted because of uncontrolled infection and/or azotemia. In almost half of these instances, temporary diversion resulted in improvement in ureteral caliber to such an extent that nontailored reimplantation could be performed with a success rate of 87 per cent. Six kidneys were removed and four have been maintained in the diverted state with severe renal dysplasia. Eighty-eight per cent of the refluxing megaureters were reconstructed with a success rate of 89 per cent.

Child↗
PubMed1979

Surgical management of massive neurogenic hydronephrosis.

Permanent urinary diversion has been the standard recommended treatment of massive dilatation of the upper tracts in the child with neurogenic vesical dysfunction. Reimplantation of relatively normal caliber ureters into neurogenic bladders has been shown to be effective. However, attempts to save urinary diversion in 39 neurogenic megaureters have been unrewarding, with the salvage rate of 15 per cent, and 64 per cent have been diverted permanently. Upper tract decompression by continuous or intermittent catheterization, nephrostomy or end cutaneous ureterostomy was used in this series. When ureteral caliber responded to decompression a reasonable success rate from non-tailored reimplantation may be anticipated. However, in those instances in which ureteral caliber failed to respond or when tailoring or ureteral caliber was done in conjunction with reconstruction the success rate was much lower.

Adolescent↗
PubMed1979

Upper tract management when posterior urethral valve ablation is insufficient.

Of 105 boys with posterior urethral valves managed during a 10-year period most were managed by primary valve ablation. However, 39 of these boys required concomitant or additional procedures to 71 massively dilated ureters because of azotemia, infection and/or progressive upper tract deterioration. In 17 boys 25 ureters could be reconstructed primarily by varying degrees of ureteral tailoring. When there was severe infection, azotemia and/or doubt as to the function of the affected renal unit, staged reconstruction was initiated by cutaneous ureterostomy. One-fourth of these ureterostomy diverted children died of azotemia despite free urinary drainage. Those who went on to have staged reconstruction, despite multiple surgical procedures, retained intact urinary systems with acceptable function.

Bacterial Infections↗
PubMed1979

Urogenital sinus abnormalities in the female patient.

Three patients with a urogenital sinus and 1 with a cloaca presented with complex diagnostic and therapeutic anomalies. A classification of these and other vaginal anomalies is based on the theory that they all represent an arrest in normal embryological development. Six categories are described, including vaginal agenesis, urogenital sinus, vaginal atresia, vaginal septa, vaginal stenosis and cloaca.

Cloaca↗
PubMed1979

Salvaging the iatrogenic megaureter.

From 1965 through 1975 we treated 30 children with 44 megaureters that were acquired after the reimplantation of normal caliber ureters. One-third of these children had had at least 2 prior surgical procedures on the bladder and 30 per cent were azotemic. There was no difference in the salvage rate of acquired megaureters with reflux versus obstruction. Temporary proximal diversion often was useful in the short-term management. Only 70 per cent of the patients completed reconstruction and only 70 per cent of those reconstructed were successful by all parameters. Ureteral tailoring was generally a necessary adjunct to successful repeat reimplantation. There was a significantly lesser salvage rate in those ureters that had had more than 1 prior surgical procedure. The best results were obtained when all surgical maneuvers were done transvesically because there was a significant incidence of acquired atonic vesical dysfunction after repeated dissections in the perivesical area.

Adolescent↗
PubMed1979

Vesicoureteral reflux and ureteropelvic junction obstruction: late occurrence of ureteropelvic obstruction after successful ureteroneocystostomy.

Ureteropelvic junction obstruction occurred in 2 patients after successful correction of vesicoureteral reflux. The correction of vesicoureteral reflux does not always allow complete resolution of pelvioureteral tortuosity, kinking and periureteritis. In cases with a severe degree of these changes the possibility of ureteropelvic junction obstruction occurring either early or late after ureteroneocystostomy should be considered when unsatisfactory renal function is noted during followup.

Child, Preschool↗
PubMed1979

Surgical treatment of the massively dilated primary megaureter in children.

From 1964 to 1975, of 83 children with primary megaureter 33 had unilateral and 8 bilateral massively dilated ureters that required surgical treatment, and of these 73% had febrile infection, 5% were septic and 10% were azotaemic. Surgical treatment consisted of ureteric reimplantation with excision of the atonic distal segment, preceded by diversion when indicated. Tailored reimplantation was successful in 98% of ureters and non-tailored reimplantation was uniformly unsuccessful. All failures were successfully corrected by tailored reimplantation. Thus the requirements for successful surgical management of massive ureteric dilatation in children secondary to an atonic ureteric segment are excision of the atonic segment, transvesical or extravesical tailoring of the ureter and reimplantation.

Adolescent↗
PubMed1978

Urinary tract reconstruction in prune belly syndrome.

Fifteen boys with prune belly syndrome cared for over a ten-year period required surgical treatment because of uncontrolled infection and/or progressive azotemia. Five died of renal dysplasia. Primary or staged reconstruction resulted in significant improvement when ureteral reimplantation was combined with tailoring of ureteral caliber.

Abdominal Muscles↗
PubMed1978

Dysgenetic male pseudohermaphroditism.

Dysgenetic male pseudohermaphroditism is a disorder of sexual differentiation in which patients present with bilateral dysgenetic testes, persistent müllerian structures, cryptorchidism and inadequate virilization. There were 10 patients with this syndrome seen at our hospital between 1956 and 1976. In this series, there was a 30 per cent incidence of testicular tumors. Because patients with dysgenetic male pseudohermaphroditism have a high incidence of testicular tumors this disorder, which is actually a variant of mixed gonadal dysgenesis, must be distinguished from the other forms of male pseudohermaphroditism.

Adult↗
PubMed1978

Gas cystometry in cases of continent bladder exstrophy.

Cystometry in 21 cases of closed continent bladder exstrophy revealed that 14 patients had a normal reflexic bladder. A simultaneous anal plug electromyogram showed an appropriate response in all patients when correlated with a cystometrogram.

Adolescent↗
PubMed1978

Continence in cases of bladder exstrophy.

The relationship of the onset of continence, staged surgical procedures and continence length was investigated in 21 patients with closed continent exstrophy. Continence occurred within a year of operation in 13 patients and 10 of these 13 patients had a Young-Dees urethroplasty and Marshall-Marchetti-Krantz suspension. In 11 of these 13 patients the continence length was greater than 1 cm. In the remaining 8 patients continence was delayed beyong a year. Only 1 of these 8 patients had undergone both bladder neck procedures and in 5 patients the continence length was greater than 1 cm.

Adolescent↗
PubMed1978

The influence of etiology on the surgical management and prognosis of the massively dilated ureter in children.

The massively dilated ureter is a major therapeutic challenge that faces the pediatric urologist. In those instances when more conservative measures, such as control of infection or correction of the primary pathology, have failed or are likely to fail surgical treatment must be directed to the massively dilated ureter itself. The goals of reconstructive procedures are the elimination of residual urine, effective ureteral peristalsis, and efficient and/or urgent urinary drainage. We encountered these clinical settings in 244 children with 366 massively dilated ureters from 1965 through 1974. The underlying pathologic processes included primary megaureter, refluxing megaureter, posterior urethral valves, ureteral duplication with upper role ectopic ureterocele or lower pole refluxing megaureter, simple ureterocele, ureterovesical junction obstruction, neurogenic vesical dysfunction, prune belly syndrome and acquired (iatrogenic) megaureter. The results of several reconstructive techniques are reviewed according to the excretory urogram, cystogram, renal function studies and the presence or absence of urinary infection. Analysis of the results with respect to the underlying pathologic entity responsible for the massively dilated ureter indicates that the etiology is a crucial factor in determining whether surgical treatment should be recommended and the type of surgical treatment that will most likely be successful.

Abdominal Muscles↗