Pediatric Urology Medal. John K. Lattimer: renaissance man.
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Awards and Prizes↗
Biomedical subjects
R M Ehrlich
Publications and source records attributed to R M Ehrlich.
A technique for ureteral stump ablation.
A total of 5 children underwent successful electrofulguration of a distal ectopic ureteral stump with reflux. Electrofulguration was performed endoscopically in 4 girls and in 1 boy the stump was ablated during an open operation. The procedure, which is simple and safe, obviates the potential nidus for recurrent infection.
Choristoma↗
Surgical treatment of the incontinent female patient with myelomeningocele.
Surgical therapy was required for 42 incontinent female patients with myelomeningocele who had urodynamically documented high pressure bladders. Conservative treatment consisting of cholinolytic and alpha-adrenergic agents, and intermittent self-catheterization had failed. The surgical approach consisted of perivesical denervation (for hyperreflexia), Burch bladder neck suspension, enlargement cystoplasty and ureteral reimplantation when required. Among 33 patients (79 per cent) there was no incontinence on intermittent self-catheterization and 6 (14 per cent) had improvement with rare urgency or stress incontinence. In 3 patients (7 per cent) sphincteric incompetence required a transvaginal sling procedure.
Adolescent↗
Fascial sling to correct male neurogenic sphincter incompetence: the McGuire/Raz approach.
We report the surgical approach used in 4 male myelomeningocele patients suffering from severe urinary incontinence owing to poor bladder compliance and sphincter incompetence. While bladder compliance was corrected by enlargement cystoplasty the sphincteric incompetence was treated by an autologous fascial sling around the bladder neck with excellent results. We consider this operation as an alternative to the artificial urinary sphincter in cases of male neurogenic sphincter incontinence.
Adolescent↗
Vascular integrity of the distal ureter following combined tapering and cross trigonal reimplantation.
Massive unilateral hydroureteronephrosis was created in 20 female dogs by ligating the urographically normal prevesical ureter. Over a 14-day period the obstructed ureter dilated to an average of 15.3 mm. A ureteral tapering procedure was performed by lateral darting and posterior folding of the resultant flap, followed by a cross-trigonal reimplantation. One anastomotic stricture resulted; in the remaining 19 animals, ureteral peristalsis was restored, the ureteral diameter was reduced 61.9 per cent and hydronephrosis was resolved. Histological studies on the tapered segments of these 19 animals showed that the subadventitial blood supply was preserved with fibrotic occlusion of the folded flaps. These results demonstrate that no significant vascular compromise after ureteral tapering and cross-trigonal reimplantation occurs. Success rates comparable to those of conventional ureteral tailoring can be achieved by this technically simplified form of reconstructive surgery.
Animals↗
Use of fine needle aspiration cytology for the diagnosis of testicular relapse in patients with acute lymphoblastic leukemia.
The testis frequently is the site of relapse in male patients with acute lymphoblastic leukemia. While many patients with testicular involvement by acute lymphoblastic leukemia have enlarged or firm testes, clinical examination alone is insufficient to establish or exclude the diagnosis completely. Open biopsy generally has been used to document the presence of acute lymphoblastic leukemia. However, this procedure requires general anesthesia and hospitalization. We studied 11 patients with a history and/or physical findings suspicious for testicular acute lymphoblastic leukemia relapse to determine the efficacy of fine needle aspiration cytology in the evaluation of the testes for leukemic infiltration. Of the 11 patients fine needle aspiration cytology correctly identified all 5 patients with histologically proved testicular acute lymphoblastic leukemia, it was negative in 5 with no histological evidence of leukemia and it demonstrated rare atypical cells that were not evident on subsequent histological examination in 1. No adverse effects were encountered in this series. Fine needle aspiration cytology appears to be a safe, reproducible alternative to open biopsy in the evaluation of patients for testicular relapse of acute lymphoblastic leukemia.
Adolescent↗
Specific intellectual deficits in children with early onset diabetes mellitus.
27 children with early onset (less than 4 years) diabetes (EOD), 24 with late onset (greater than 4.0 years) diabetes (LOD), and 30 sibling controls were compared in their performance on tests of intellectual functioning and school achievement. The results indicated that children with EOD, particularly girls, scored lower than the other groups of diabetic children and siblings on tests of visuospatial but not verbal ability. Many of the children with EOD were also having difficulty at school, and a number were currently receiving special education. Diabetic children with earlier onset had more hypoglycemic convulsions than those with later onset. Regression analyses revealed that duration of illness, age of onset, and hypoglycemic convulsions significantly predicted spatial ability.
Child↗
Effect of temperament on metabolic control in children with diabetes mellitus.
Fifty-one children with insulin-dependent diabetes mellitus (IDDM) and 24 healthy sibling controls were compared on one of two temperament questionnaires completed by parents. Children with IDDM did not provide a characteristic temperament profile or show any problem areas. A regression analysis to predict diabetic control as measured by most recent glycosylated hemoglobin (HbA1c) values revealed that five of the nine temperament scales accounted for a significant 42% of the variance in HbA1c (P less than .001). Children with higher activity levels, greater regularity in routines, milder reactions to external stimuli, distractibility, and negative moods were achieving better glycemic control. The results are discussed in terms of how individual differences in behavioral organization, energy consumption, and stress modulation may affect blood glucose levels.
Blood Glucose↗
The undescended testis.
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Cryptorchidism↗
[A new technic of exclusion of the remaining, refluxing ureteral stump in cases of ectopic ureteral implantation].
Five children underwent successful electrofulguration of a distal refluxing ectopic ureteral stump. This was performed endoscopically in 4 girls and in one boy the stump was ablated during open surgery. The procedure, which is simple and safe, obviates the potential nidus for recurrent infection.
Child↗
The glycaemic index: effect of age in insulin dependent diabetes mellitus.
It has been suggested that age effects the glycaemic index value of foods, although there is no data to support this. We therefore studied the blood glucose responses of bread and lentils in seven children (aged 7-17 years) and 10 adults (aged 27-74 years) with insulin dependent diabetes (IDDM). Although there were small differences in the shape of the blood glucose response curves in adults and children, the mean glycaemic index value for lentils was virtually identical in the two groups being 43 +/- 7 in the children and 44 +/- 10 in the adults. We conclude that, in IDDM, the glycaemic index is not affected by age.
Adolescent↗
Factors affecting and patterns of residual insulin secretion during the first year of type 1 (insulin-dependent) diabetes mellitus in children.
We measured serum C-peptide, glucose, pH, islet antibodies and insulin antibody binding at diagnosis in 84 children with Type 1 (insulin-dependent) diabetes. In a subgroup of 33 children, residual insulin secretion (basal and peak C-peptide response to Sustacal), insulin antibody binding and HbA1c were measured at 10 days, 1, 3, 6 and 12 months. At presentation C-peptide correlated positively with age at onset and negatively with the blood glucose concentration. Median C-peptide concentration at diagnosis was low, rose significantly (p less than 0.05) at 10 days, reached a maximum at 1-3 months and declined gradually to 1 year. C-peptide concentration both at diagnosis and at 10 days correlated with that at 3 and 6 months. Of the factors investigated, only age (p less than 0.005) and sex (higher in females, p less than 0.01) were found to have a significant influence on basal/peak C-peptide levels throughout the first year. In particular there was no relationship between C-peptide, HbA1c and insulin dose during this period. A peak C-peptide response at 3-6 months greater than/less than 0.32 nmol/l was used to divide the group into two: 16 had a peak response less than 0.32 nmol/l (low secretors) while in 17, the peak C-peptide was greater than 0.32 nmol/l (high secretors). While the low secretors had significantly (p less than 0.05) lower C-peptide levels during the first year, there were no differences between low and high secretors in HbA1c or insulin dose.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Neodymium:YAG laser ablation of posterior urethral valves.
We report successful neodymium:YAG laser ablation of posterior urethral valves in 6 boys. No strictures or incontinence resulted.
Cystostomy↗
The bladder mucosal graft for urethral reconstruction.
Single stage repairs of a variety of congenital and acquired urethral anomalies were performed in 16 male patients with free grafts of bladder mucosa. Of the patients 10 previously had undergone unsuccessful attempts at urethral reconstruction, including 9 boys with hypospadias. Grafts ranged between 2 and 8.5 cm. long. A fistula occurred postoperatively in 1 patient and it responded to prolonged suprapubic drainage. Meatal stenosis necessitated a further operation in 1 patient. The bladder mucosal graft technique should be considered for urethral reconstruction when prior attempts at repair have failed or when the disorder is primary, and local penile or preputial skin is deficient.
Adolescent↗
Hormonal therapy of cryptorchidism. A randomized, double-blind study comparing human chorionic gonadotropin and gonadotropin-releasing hormone.
We conducted a randomized, double-blind study comparing intranasal gonadotropin-releasing hormone (1.2 mg per day for 28 days) with parenteral human chorionic gonadotropin (3300 IU per week for four weeks) in the treatment of cryptorchidism in 33 boys one to five years old (29 with unilateral and 4 with bilateral cryptorchidism). Testicular descent into the scrotum occurred in 3 of the 16 patients (19 percent) treated with gonadotropin-releasing hormone and in 1 of the 17 (6 percent) treated with human chorionic gonadotropin (P = 0.23). The mean luteinizing hormone and testosterone levels were similar in both groups before treatment. During treatment, the testosterone levels were significantly increased in both groups, but higher levels occurred in the group treated with human chorionic gonadotropin (P less than 0.05). In a parallel (but uncontrolled) study of five boys with retractile testes (defined as a nonscrotal testis that could be manipulated into the bottom of the scrotum) who were originally excluded from the main protocol but were treated with the same regimen of human chorionic gonadotropin, descent into the scrotum occurred in all patients. We conclude that hormonal therapy with either gonadotropin-releasing hormone or human chorionic gonadotropin is, in most cases, ineffective in promoting testicular descent of true cryptorchid testes. However, short-term treatment with human chorionic gonadotropin is very effective in producing descent of retractile testes. These results suggest that the wide discrepancies in apparent efficacy in previous trials of hormonal therapy of cryptorchidism may have been due to inclusion in those studies of various proportions of patients with retractile testes.
Administration, Intranasal↗
Magnetic resonance imaging of Wilms tumor.
Magnetic resonance imaging (MRI) in 4 children with Wilms tumor suggests the usefulness of this newer imaging modality in evaluating the organ of origin and defining the extent of Wilms tumor. Coronal T1-weighted images were the most useful pulsing sequence for evaluating these children.
Child, Preschool↗
Total abdominal wall reconstruction in the prune belly syndrome.
A total of 6 boys with the prune belly syndrome underwent total abdominal wall reconstruction by a technique that permits simultaneous bilateral orchiopexy and/or urinary tract reconstruction. Until now, the psychosocial implications of the abdominal wall disfigurement caused by this syndrome have been ignored. This procedure provides an excellent cosmetic result that, in turn, promotes psychological health and a positive body image in these children.
Abdominal Muscles↗
Bilateral nephrectomy for Wilms tumor.
Bilateral nephrectomy was performed in 4 patients with bilateral Wilms tumor. The current philosophy regarding the need to preserve maximum renal parenchyma is discussed. New guidelines suggested by the National Wilms Tumor Study group discourage unilateral nephrectomy and partial nephrectomy at initial exploration for bilateral Wilms tumor. Alternatively, it is recommended that continued treatment with chemotherapy and/or radiation therapy followed by second and third-look operations to maximize preservation of renal parenchyma be done with bilateral nephrectomy as a last resort option.
Child, Preschool↗