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Biomedical subjects

R L Lebowitz

Publications and source records attributed to R L Lebowitz.

At least 19 recordsLinked to original sources
PubMed1992

Urinary tract infection in infants in spite of prenatal diagnosis of hydronephrosis.

The efficacy of preventing neonatal urinary infection in infants by diagnosing hydronephrosis in the fetus on obstetrical ultrasonography was studied. 426 infants had uroradiologic evaluation between 1984 and June 1991 because they had hydronephrosis detected in utero. Thirteen with posterior urethral valves were excluded. Of the remaining 413, 13 (3.1%) presented with urinary infection in the first 6 months of life. Ten of the 13 were boys and 7 were not circumcised. Eleven of the 13 infants less than 2 months old were formula-fed. The causes of hydronephrosis were reflux alone in 6, ureteropelvic junction obstruction in 6 (with coexisting ipsilateral reflux in 4), and primary megaureter in 1. Ultrasonography alone was insufficient to exclude reflux. Amoxicillin-resistant bacteria were the causative organisms in all 10 for whom bacteriology data was available. Four categories of management failure were identified: 1) failure of communication of the prenatal findings, 2) antibiotics not prescribed, 3) antibiotics prescribed but not administered, and 4) infection in spite of continuous antibiotic prophylaxis. Uncircumcised formula-fed male infants with reflux seemed to be at special risk for infection.

Anti-Bacterial Agents↗
PubMed1992

Urolithiasis in a children's hospital: 1985-1990.

We performed a retrospective study of patients who had urinary tract stones and were seen at our hospital from 1985-1990. The study was intended to determine the prevalence of urolithiasis and optimal approaches to imaging. Clinical data and imaging studies of 87 patients were reviewed. The mean age was 15.7 years with a range of 3 months to 44 years. Fifty-four percent of patients were male. Most patients had a known predisposing cause for urolithiasis; patients with myelodysplasia and structural urologic problems predominated. Plain films were performed in 77 patients; 57% showed stones. Ultrasonograms were performed in 71 patients; 77% showed stones. Excretory urograms (EU) were performed in 49 patients; 84% showed either stones or their effect on the urinary tract. Computed tomographic (CT) scan was performed in 25 patients; all showed stones.

Adolescent↗
PubMed1992

Primary megaureter in infants and children: a review.

Primary megaureter is a common cause of obstructive uropathy in children. The imaging studies and records of 75 infants and children with primary megaureter seen at Children's Hospital were reviewed. We describe our findings and illustrate the clinical presentations, diagnosis, and treatment of this entity.

Child↗
PubMed1992

Prenatal diagnosis of the megacystis-megaureter association.

A total of 11 male neonates with hydronephrosis and a large bladder in utero had the megacystis-megaureter association. Prenatal ultrasound findings included bilateral hydroureteronephrosis; a large, smooth, thin-walled bladder, and normal volume of amniotic fluid. Postnatal studies demonstrated grades 4 to 5 bilateral reflux, a large bladder without obstruction and in 2 infants nonfunction of a kidney or renal moiety. Of 7 infants initially managed nonoperatively 5 have undergone surgery due to persistent reflux or breakthrough urinary infections. The prenatal diagnosis of the megacystis-megaureter association can be suspected with reasonable accuracy. Prompt postnatal continuous antibiotic prophylaxis and uroradiological confirmation allow for nonemergency management of this condition with excellent results.

Female↗
PubMed1992

The detection and characterization of vesicoureteral reflux in the child.

Voiding cystourethrography or radionuclide cystography should be performed in the child in whom it is important to know whether reflux is present. Voiding cystourethrography is more accurate in characterizing and grading reflux, and monitoring is intermittent. Conversely, radionuclide cystography uses a lower radiation dose and its continuous monitoring leads to fewer false negative results but its ability to characterize reflux is poor. The performance of voiding cystourethrography or radionuclide cystography to detect reflux is an art as well as a science. These tests are done best by those who are experienced and interested in imaging the urinary tract of the child. At our hospital we perform voiding cystourethrography in all young children with urinary tract infection to detect and precisely characterize reflux to enable intelligent planning of management. In older patients, when it is less likely that reflux is present but it is still desirable to ensure that reflux is not occurring, radionuclide cystography is performed. If reflux is present, then a decision is made on an individual basis as to whether additional characterization by voiding cystourethrography is needed. Radionuclide cystography is also used for family screening, for periodic followup of reflux being managed nonoperatively and to ensure that reflux has been eliminated after antireflux surgery.

Child↗
PubMed1979

Rectourethral fistula on the urethrogram.

Radiologic demonstration of a rectourethral fistula is of importance in the evaluation of the male neonate with imperforate anus. After pull-through operation a remnant of the fistula may remain as a small unimportant sinus tract or may cause problems.

Adult↗
PubMed1979

Neonatal hydronephrosis caused by vesical diverticula.

Bladder diverticula are uncommon in infants and are an uncommon cause of hydronephrosis in newborns but can cause significant problems. A thorough diagnostic approach must include both excretion urography and cystourethrography. Early appropriate surgical intervention will result in preservation of renal function.

Diverticulum↗
PubMed1979

Thymus size and its relationship to the respiratory distress syndrome.

Thymic size can be affected by both exogenous and endogenous glucocorticoids. The risk of respiratory distress syndrome is reduced after maternal steroid administration. To find whether fetal lung maturity correlates with size of the thymus, the cardiothymic:thoracic ratio was measured in 167 newborn infants with and without RDS. Mean CT/T was significantly greater (0.40 vs 0.35; P less than 0.001) in those babies with RDS. This relation was independent of gestational age, although an increase in CT/T with advancing gestational age was shown. Prepartum maternal steroid administration did not result in significant involution of the cardiothymic shadow when compared with control infants with and without RDS. The CT/T may be of use in predicting which premature babies are more likely to develop RDS.

Female↗
PubMed1979

The so-called megaureter-megacystis syndrome.

Megaureter-megacystis describes the appearance of the urinary tract in children with massive primary vesicoureteric reflux and it sequellae. The initial symptoms, radiographic findings, diagnostic misconceptions, and treatment for 22 male children are discussed. Incorrect diagnoses, including obstruction, neurogenic bladder dysfunction, and "megacystis," were made in 16 children; treatment was inappropriate in 14. In only eight boys were diagnosis and treatment prompt and correct.

Child↗
PubMed1978

Diverticula of the bladder in children.

Diverticula of the bladder in infants and children are common and occur when vesical mucosa protrudes through a congenital defect in the muscle wall. Most are primary. Diverticula secondary to obstruction or neurogenic dysfunction are not as common as was once thought. The majority of diverticula are asymptomatic but they can cause vesico-ureteral reflux, obstruction or residual urine. Diverticula also occur after bladder surgery and in association with some syndromes. Voiding cystourethrography is the most reliable method for detection.

Abnormalities, Multiple↗
PubMed1978

Lesions of Cowper's ducts and glands in infants and children.

Lesions of Cowper's duct and gland are more common than previously reported. They may be asymptomatic or may cause micturition difficulties or urinary retention. They may be congenital or acquired (usually inflammatory). Radiographic findings are either a rounded filling defect arising from the floor of the bulbous urethra or reflux into a dilated duct which parallels the bulbomembranous urethra. Panendoscopic fulguration is a simple and effective method of treatment for symptomatic patients with retention cysts. Asymptomatic patients do not need any therapy. A dilated duct should not be confused with partial urethral duplication, a urethral diverticulum, or an ectopic ureter since such an error may lead to an unnecessary operation.

Bulbourethral Glands↗
PubMed1978

Ether cystitis.

Two children are reported in whom chemical cystitis developed when ether was used to dissolve a Foley catheter balloon that would not deflate. The irritative effects of ether and preventive measures are discussed.

Child↗
PubMed1978

Urography in children: when should it be done? 1. Infection.

Radiologic evaluation of urinary tract infection in children should include both excretory urography and voiding cystourethrography. Excretory urography is done to search for anomalies predisposing to infection and for signs of previous episodes of pyelonephritis or reflux and to serve as a baseline for future studies. Voiding cystourethrography is done to search for abnormalities in the natural barriers that protect the renal medulla from infection. If reflux is found to be present and sequential reflux studies are done, they should be performed by the radionuclide method to observe changes in degree or cessation.

Child↗
PubMed1978

Urography in children: when should it be done? 2. Conditions other than infection.

Conditions that are often associated with an increased incidence of renal anomalies include imperforate anus, congenital vertebral abnormalities, and Fanconi anemia; excretory urography should be done if such a condition is present. Urography is also useful to provide baseline data in conditions associated with later development of urinary problems, such as myelodysplasia, prune-belly syndrome, and exstrophy of the bladder. In addition, urography serves as a periodic check for complications of treatment (hydronephrosis, obstruction) in patients with urinary diversion. Certain signs, eg, dribbling, hematuria after mild trauma, unexplained pneumothorax or pneumomediastinum in a neonate, and neonatal abdominal mass, call for immediate urography. In many conditions that were formerly thought to be associated with major urinary abnormalities, urography is not called for. Such is the case in hypospadias, deformities of the external ear alone, and undescended testes. Dehydration is the only absolute contraindication to urography.

Child↗
PubMed1978

Renal malposition associated with omphalocele.

Nine patients with omphalocele had abnormally positioned kidneys; in 8, the kidneys were more cephalad than normal, immediately subdiaphragmatic in position. In one patient the kidneys were more caudal than normal. This renal malposition should be recognized in order to avoid unnecessary imaging procedures in patients with omphalocele.

Adult↗