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Biomedical subjects

S B Bauer

Publications and source records attributed to S B Bauer.

At least 109 records · Page 6Linked to original sources
PubMed1984

Urinary tract infection in boys.

Considerable literature exists regarding the evaluation and treatment of children with urinary tract infection yet little has been reported solely about boys. We reviewed retrospectively 83 boys who were seen after an initial urinary tract infection. Fever was the most common presenting sign (50 per cent) and the most common organisms encountered were of the gram-positive group of bacteria. Escherichia coli accounted for only 21 per cent of the infections. Of the boys 75 per cent (62 patients) had an anatomic abnormality, most commonly vesicoureteral reflux, although more than 25 per cent of our patients had obstructive lesions. Renal scarring was present in half and 58 per cent required early surgical intervention. Urinary tract infection seems to have a higher morbidity in boys and the finding of an atypical organism is to be expected. Based on our findings, we strongly recommend an excretory urogram and a voiding cystourethrogram as the minimal evaluation of boys following an initial urinary tract infection.

Adolescent↗
PubMed1984

The megacystis-megaureter syndrome.

The term megacystis-megaureter describes the radiologic appearance of a large capacity thin-walled bladder and massive primary vesicoureteral reflux. The pathophysiology of these massively dilated ureters and the large capacity bladder is the constant recycling of large volumes of refluxed urine. We treated 29 children between 1 day and 13 years old with this syndrome. Urinary tract infection was present in 74 per cent of the cases. Of these children who presented before 1975, 14 were misdiagnosed primarily as having bladder outlet obstruction, which resulted in inappropriate treatment in 13 and renal deterioration in 5. The remaining 15 children treated after 1975 by means of antireflux surgery alone have remained well with stable renal function and virtual elimination of residual urine. Initial therapy should be aimed at correction of the massive reflux, rather than surgical reduction of bladder capacity or relief of presumed bladder outlet obstruction.

Child↗
PubMed1984

Genitourinary problems in adolescence.

Urinary tract abnormalities in adolescent girls can range from previously unrecognized anatomic problems to metabolic diseases (which may lead to stone formation) to voiding patterns that can produce urinary incontinence. This paper reviews the various abnormalities and describes their pathophysiology so that practitioners can increase their understanding of these entities and improve their diagnostic acumen.

Adolescent↗
PubMed1983

Large-cell calcifying sertoli cell tumor of the testis. An ultrastructural, immunocytochemical, and biochemical study.

This report describes the ultrastructural and hormonal characteristics of the recently described large-cell calcifying Sertoli cell tumor of the testis, a rare subtype of pure Sertoli cell tumor. The ultrastructural findings showed similarity to normal Sertoli cells, pure Sertoli cell tumors, Sertoli cells in azoospermic human testes, and the Sertoli cell component of Sertoli-Leydig cell tumors. Ultrastructure indicated features common to steroid-producing cells. Testosterone and estradiol were demonstrated in the tumor by immunocytochemical and biochemical methods.

Basement Membrane↗
PubMed1983

Nevoid basal cell carcinoma syndrome associated with renal cysts and hypertension.

A case of nevoid basal cell carcinoma syndrome with a coincidental finding is presented. In addition to the odontogenic cysts, hypertelorism, scapula deformity, rib fusion, dural calcification, and short fourth metacarpal bones of the syndrome, the patient had cystic disease of both kidneys with a large cyst of the right kidney. This case also illustrates that the presence of painful jaw lesions may lead the patient with this syndrome to seek treatment initially.

Basal Cell Nevus Syndrome↗
PubMed1983

Evaluation and management of children with sacral agenesis.

Sacral agenesis is a rare congenital anomaly of the lower vertebral column which usually produces lower urinary tract dysfunction. Sixteen children with varying degrees of sacral agenesis and urinary symptoms were extensively evaluated. The neurologic lesion varied from no denervation to a complete loss of sacral motor and sensory function. The treatment instituted was individualized and based on specific urodynamic and radiologic findings. Overall, 12 of the 16 children (75%) achieved continence. Clues to the diagnosis including symptoms, physical findings, and the relationship to maternal diabetes are discussed.

Abnormalities, Multiple↗
PubMed1983

Feminizing genitoplasty: a synthesis.

The female child with the adrenogenital syndrome is subject to a variable degree of masculinization. Surgery should be directed to 3 goals: 1) removing the corpora and preserving the glans with its innervation to create a clitoris with normal sensation, 2) creating a normal-appearing introitus by fashioning labia minora from phallic skin and foreskin, and 3) vaginoplasty to provide an adequate opening for the vagina onto the perineum. The entire repair may be completed before the age of 6 months unless the vagina enters the urogenital sinus at a high level in which case vaginoplasty should be delayed until the child is older. The evolution of this operative approach is described and the details of the operative technique are presented.

Adrenal Hyperplasia, Congenital↗
PubMed1982

The management of vesicoureteral reflux in children with myelodysplasia.

We treated systematically 36 children with myelodysplasia and vesicoureteral reflux in an attempt to control infection, eliminate reflux and preserve renal function without diversion. The reflux resolved in 9 of 21 children on intermittent catheterization and remained stable without recurrent infection in an additional 7. Cutaneous vesicostomy in 6 infants temporarily eliminated reflux in 3. Ureteral reimplantation was performed in 11 children (17 ureters) and was successful in all. Transureteroureterostomy was done in 2 children. External sphincterotomy failed to cure reflux in 5 children. Five infants with mild grades of reflux were managed expectantly and 1 had spontaneous resolution of the reflux. Over-all, this systematic approach resulted in cure in 23 patients (64 per cent), stable but persistent reflux without recurrent infection or renal deterioration in 11 (30 per cent) and failure in 2 (6 per cent). No child required urinary diversion. The indications for each treatment modality are discussed.

Child↗
PubMed1981

Urinary undiversion in patients with myelodysplasia and neurogenic bladder dysfunction. Report of a workshop.

This workshop was conducted in an attempt to analyze critically the role of reconstruction of the myelodysplastic patient who had undergone urinary diversion and to develop guidelines for selecting those patients in whom urinary undiversion might be undertaken safely. The collective experience initially seems to be acceptable; however, the authors emphasize the gravity of the decision and the complexity of the evaluation which must be undertaken prior to embarking on such reconstructive surgery. Contrary to some reports, we believe that the defunctionalized bladder frequently can be evaluated. Further, many of the contraindications to urinary undiversion have been identified and several of the hazards involved therein can be avoided. We believe that the neurogenic bladder is no longer an absolute contraindication to undiversion. Our experience suggests that undiversion is a reasonable surgical treatment in select patient with neurogenic bladder dysfunction. But, the decision to remove a satisfactorily functioning conduit must not be undertaken lightly. Patients should be selected only after a thorough, detailed, and properly conducted evaluation. A protocol has been developed which will hopefully assist in this evaluation. Perhaps additional shared experience will further refine and delineate the circumstances appropriate for reconstruction of these patients.

Adolescent↗
PubMed1981

Cutaneous vesicostomy in infancy.

Cutaneous vesicostomy was performed on 10 infants or young children with hydroureteronephrosis. The etiology of the upper urinary tract dilatation was neurogenic bladder dysfunction secondary to myelodysplasia in 8, and severe vesicoureteral reflux and urinary sepsis in 2. The vesicostomy resulted in marked improvement in the drainage and appearance of the upper urinary tract in each child. When other methods of managing the underlying lower urinary tract dysfunction were deemed more appropriate, the vesicostomy was closed. Cutaneous vesicostomy proved to be an effective, simple and easily reversible means of treating selected infants with lower urinary tract dysfunction.

Child, Preschool↗
PubMed1981

Ureteral ectopia in infants and children.

The diagnosis of ureteral ectopia may be suspected in the girl who wets constantly or in the young boy with epididymitis. More commonly, however, the diagnosis is made during evaluation of the child with urinary tract infection. The ectopic ureter is most often associated with a poorly functioning dysplastic upper pole of a duplex collecting system and in this instance it is best managed by upper pole heminephrectomy and partial ureterectomy. When associated with a single collecting system, ureteral reimplantation can often be performed if salvageable function is demonstrated by a preoperative renal scan. Based on our experience with 48 ectopic ureters in 41 children operated on during the last 11 years, the correlation of the diagnostic findings and surgical approaches to this entity are discussed.

Child↗
PubMed1981

Congenital mesoblastic nephroma: relationship to other renal tumors of infancy.

Although nephroblastomas (Wilms tumor) do occur in the newborn most of the solid renal tumors in this age group constitute a distinctly different pathologic entity, congenital mesoblastic nephroma. While a more cellular histologic variant of congenital mesoblastic nephroma has been recognized recently, which occasionally may follow a malignant course, the tumor with conventional histology has never been reported to metastasize and follows a benign course when treated by adequate local excision alone. We report our 50-year experience with 11 cases of this tumor (9 cases with conventional histology and 2 with cellular variant histology). Typically, the tumor presented in the newborn as a large asymptomatic mass. Local invasion was never seen and the tumors were resected without difficulty. Grossly, the tumors usually resembled a uterine "fibroid" and, unlike nephroblastomas, rarely exhibited hemorrhage or necrosis. Microscopically, the conventional histologic congenital mesoblastic nephroma was composed of sheets of spindle-shaped cells. The cellular variant of congenital mesoblastic nephroma exhibited increased cellularity and a higher mitotic index. The relationship of congenital mesoblastic nephromas to other neonatal renal tumors is discussed and a unifying schema of neoplasia in infantile renal tumors is proposed.

Diagnosis, Differential↗
PubMed1980

Dilemma of small pyelonephritic kidney associated with vesicoureteral reflux.

Nineteen children with severe unilateral pyelonephritic scarring secondary to reflux and infection were followed up for at least five years after ureteral reimplantation. The small kidneys in these children grew at a rate which paralleled expected normal, and this growth was independent of the degree of hypertrophy in the contralateral kidney or the size difference between each pair of renal units. The authors differentiate between obligate and compensatory renal growth and conclude that children with a small pyelonephritic kidney should undergo reimplantation rather than nephrectomy because of the recuperative powers of the growing kidney and its ability to become a potentially life-sustaining organ in the future.

Adaptation, Physiological↗
PubMed1980

Urinary undiversion in myelodysplasia: criteria for selection and predictive value of urodynamic evaluation.

Urinary undiversion was done in 15 children with myelodysplasia and ileal conduits. The process of evaluation and the criteria for selection are described. Neurologic and psychologic factors have an important role. Electromyography of the external urethral sphincter is helpful in predicting which children would be continent after undiversion and in managing the neurogenic bladder postoperatively. Over-all, a successful outcome has been achieved in two-thirds of the children chosen for undiversion.

Child↗
PubMed1980

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↗