Search PubMed⌕ Search

Biomedical subjects

S R Shapiro

Publications and source records attributed to S R Shapiro.

At least 55 records · Page 3Linked to original sources
PubMed1978

Urinary tract infections in children: a review.

Urinary tract infections (UTIs) in children are a common and challenging problem for the primary care physician and continue to be a cause of significant morbidity. Except for the neonatal period, UTIs occur most frequently in girls. The symptoms of UTI in the child may be obscure, and often a high index of suspicion is required. Diagnosis ultimately depends on the urine culture. Current concepts in the diagnosis and therapy of UTIs in children include the use of urine culture for initial diagnosis and home cultures for follow-up. Evidence fully supports the concept that even a single episode of documented bacteriuria, symptomatic or asymptomatic, should be investigated with an intravenous pyelogram (IVP) and voiding cystourethrogram (VCUG).

Anti-Bacterial Agents↗
PubMed1977

Nonrenovascular renal hypertension in children.

Hypertension in children has been reported with increasing frequency because of increased awareness of its occurrence by clinicians. Renovascular lesions have been stressed in the past. However, in recent years, a number of nonrenovascular renal lesions have received attention and form the basis for this report. Unilateral chronic atrophic pyelonphritis, segmental unilateral pyelonephritis, the Ask-Upmark kidney, and unilateral renal hypoplasia have been associated with curable hypertension. The subject of juxtaglomerular cell hyperplasia, which has variably been reported in these cases, is reviewed. Ureteral obstruction, in the form of uretero-pelvic or ureterovesical junction obstruction, solitary renal cysts, the unilateral multicystic kidney, renal trauma, and renal tumors (Wilms' tumor and juxtaglomerular cell tumors) may also be associated with hypertension in children. Pheochromocytoma must be ruled out in all cases. Because of renewed interest, these nonrenovascular renal causes of hypertension are now likely to be diagnosed with increased frequency.

Adolescent↗
PubMed1977

Nonobstructive anuria in children: hemolytic uremic syndrome.

The hemolytic uremic syndrome (HUS) must be considered as a cause of oligo-anuria in a previously healthy young child. This syndrome consists of a viral-like prodromal illness, followed by acute renal failure, thrombocytopenia, and an abnormal blood smear with fragmented erythrocytes. Awareness of this syndrome will permit earlier diagnosis and management and will minimize unneccessary investigation in the anuric child.

Anuria↗
PubMed1977

Isolated partial anomalous pulmonary venous drainage associated with pulmonary vascular obstructive disease.

Five patients with partial anomalous pulmonary venous drainage with intact atrial septum are described. In two patients, pulmonary arterial hypertension and pulmonary vascular disease developed. Both had one or more right pulmonary veins draining anomalously to the right superior vena cava. It is postulated that a combination of increased pulmonary blood flow and reflex pulmonary vascular changes contributes to the production of pulmonary vascular obstructive disease.

Adult↗
PubMed1977

Focal infarction of the testicle in a child simulating testicular tumor.

Enlargement of an undescended testicle in a 6 1/2-month-old-child resulted in radical orchiectomy. Pathological diagnosis was focal infarction of the testicle. This disorder must be considered in the differential diagnosis of testicular enlargement in the infant and child.

Diagnosis, Differential↗
PubMed1977

Pelvic hydronephrosis in children: a review of 219 personal cases.

A series of 238 hydronephrotic kidneys in 219 children is reported. The condition was more common in the male than in the female subject and occurred more frequently on the left side. It was often bilateral, especially in infants, with an abdominal mass as the common presenting feature. Loin or abdominal pain was the most frequent complaint in older children. In some cases hydronephrosis presented as a ruptured kidney following trauma. Only 1 patient was hypertensive. The lesion was asymptomatic in 18 cases and the incidence of urinary infection was low. Dismembered pyeloureteroplasty was the procedure of choice for reconstruction. Preliminary nephrostomy was used rarely and nephrectomy was done in 10 per cent of the kidneys. Of the 7 reoperations 4 were for persistent obstruction and 3 were because stones had formed after the pyeloplasty. The late results, assessed clinically and radiologically, have been entirely satisfactory. Many kidneys of initially doubtful value showed useful improvement after reconstructive operation and no secondary nephrectomies were performed. The only death in the series occurred 2 1/2 years postoperatively and was unrelated to the urinary tract.

Child↗
PubMed1977

The results of conservative management of neurogenic vesical dysfunction in children.

Ninety-three cases of neurogenic vesical dysfunction were treated between 1957 and 1974, including 68 children with spina bifida, 10 with occult neurogenic bladders, 7 with sacral agenesis, 2 with spinal dysraphism, and 6 with miscellaneous disorders. No attempt at classification into types of neurogenic bladder was made. Three children in the series died, two from renal causes and one from neurosurgical complications. Treatment consisted of antireflux surgery, methods to lower bladder outlet resistance, operations to relieve obstruction or stasis, or urinary diversion as a last resort. Ureteral reimplantation was performed in 25 children. Reflux was cured in 29 of the 34 ureters reimplanted. Bilateral ureteral reimplantation is recommended because of the subsequent development of vesicoureteral reflux on the opposite side in more than half of the cases of unilateral ureteral reimplantation. Bladder outlet resistance must be lowered in most cases at the time of ureteral reimplantation. This was accomplished in these cases and the group of children as a whole by means of Y-V plasty of the bladder neck, transurethral bladder neck resection, urethral dilation, or pharmacological therapy with phenoxybenzamine (an alpha-symphathetic blocking agent). Urinary calculi were removed in six children in order to preserve renal function. Fifteen children underwent urinary diversion becuase of upper tract deterioration, and in eight children this was performed primarily for urinary incontinence. With conservative treatment, it was possible to preserve renal function as determined by intravenous urography in nearly two-thirds of the cases. Urinary incontinence was difficult to manage in most cases. Manipulations of the bladder neck were only occasionally helpful. Results with the Caldwell stimulator were disappointing. Pharmacological therapy was moderately successful. Phenoxybenzamine was the most useful drug. Imipramine was occasionally of benefit. It is concluded that the upper urinary tracts may be preserved in many cases by means of conservative therapy. Urinary diversion has been avoided in most cases because of its disappointing results. We believe that the trend will be towards increasingly conservative therapy of these children for some years to come.

Child↗
PubMed1976

Aortic valve atresia: a new classification based on necropsy study of 73 cases.

Certain clinical and morphologic observations are described in 73 necropsy patients with aortic valve atresia. The mean age at death was 5 days; 80 percent died during the first week of life, and 70 percent were boys. Of the 73 patients, 69 (95 percent) had a hypoplastic left ventricle with intact ventricular septum and either an atretic (25 patients) or hypoplastic (44 patients) mitral valve. The other four patients had a well developed left ventricle with one or more defects in the ventricular septum and either an atretic (one patient) or well developed (three patients) mitral valve. Review of previous reports on aortic valve atresia disclosed that a well developed left ventricle or ventricular septal defect in association with absence of the aortic valve was extremely rare. A new classification for aortic valve atresia is presented based on the status of the ventricular septum, which in turn appears to determine the size of the left ventricular cavity. The predilection for male subjects for all types of aortic valve disease, including atresia, is emphasized.

Aortic Valve↗
PubMed1976

Transureteroureterostomy for urinary diversion in children.

Transureteroureterostomy with cutaneous ureterostomy has been used effectively as a method of external urinary diversion in ten children. Of the 20 renal units involved, 15 showed pyelographic improvement and 5 stabilized after diversion. The method requires that at least one ureter is sufficiently dilated to provide a stoma of adequate caliber. It avoids the disadvantages or complications associated with most other forms of external diversion.

Adolescent↗
PubMed1976

Recovery of renal function after prolonged unilateral ureteral obstruction.

Concepts of renal counterbalance and animal experiments have long supported nephrectomy for prolonged complete unilateral ureteral obstruction. The situation in humans has been clarified by only a few reported cases. Herein we report 3 cases with relief of obstruction after at least 28, 28 and 150 days. Evidence is presented to support renal preservation in similar cases.

Adult↗
PubMed1976

Anti-reflux surgery in the congenital neuropathic bladder.

42 refluxing ureters were re-implanted into the bladder in 28 children with neuropathy. In each case other measures directed at enhancing bladder emptying were employed. Reflux was cured in 36 of 38 ureters investigated after operation. The incidence of contralateral reflux following unilateral re-implantation was 50%. 1 of 12 undilated units showed late post-operative deterioration. 22 of 28 initially hydroureteronephrotic units either improved or stabilised at a satisfactory level. In 6 children urinary diversion was subsequently performed because of persistent reflux (2 cases), postoperative deterioration (1 case) or failure of severely dilated upper tracts to improve (3 cases). Since reflux from a high pressure bladder can rapidly cause severe renal damage, cystography is indicated when there is clinical or pyelographic suspicion of its existence. Operative cure is needed when reflux is of major degree or if, when of lesser severity, it does not stop spontaneously following improved bladder emptying resulting from therapeutic lessening of the urethral resistance.

Adolescent↗
PubMed1975

Periprostatic abscess. Unusual complication of transurethral prostatectomy.

Many large series analyzing the results and complications of transurethral prostatectomy have failed to mention the occurrence of periprostatic abscess. A case is described which followed perforation of the posterior capsule at the time of transurethral prostatic resection. This complication was successfully managed by transperineal needle aspiration and high-dosage antibiotic therapy.

Abscess↗
PubMed1975

Fate of 90 children with ileal conduit urinary diversion a decade later: analysis of complications, pyelography, renal function and bacteriology.

A study of the long-term results of ileal conduit urinary diversion for non-malignant disease in 90 children has shown that there were 75 survivors after 10 to 16 years. Stomal stenosis and ureteroileal or other intrinsic obstructions requiring ileal loop revisions occurred frequently and as late as 13 years postoperatively. Of 144 renal units 76 per cent improved or remained stable and 69.3 per cent of normal kidneys remained normal after more than a decade of urinary diversion. In order to obtain these results close lifetime followup and aggressive loop revisions have been required. Urine cultures were consistently negative in 70.5 per cent of all patients. Good results were obtained in terms of preservation of renal function in all categories. Creatinine clearance remained in the normal range after 10 years if the excretory urogram remained normal. Ileal conduit urinary diversion remains a major surgical undertaking but it also remains the standard of urinary diversion against which all other methods must be judged. The results in terms of renal preservation are impressive but so too are the significant number of long-term complications. Any other method of diversion (such as the sigmoid conduit) that can improve upon these results will be welcomed. All children with ileal conduit urinary diversion for reasons other than a neurogenic bladder must be considered candidates for urinary reconstruction.

Adolescent↗
PubMed1975

Granuloma inguinale in Vietnam: successful therapy with ampicillin and lincomycin.

Thirty-six patients having granuloma inguinale were treated at the 483 USAF Hospital, Cam Ranh Bay, Republic of South Vietnam between October 1970 and September 1971. In 24 cases biopsy of the genital ulcerations revealed Donovan bodies pathognomonic for the disorder. The lesions generally did not heal during tetracycline therapy. All but 2 of the 31 cases treated primarily with ampicillin responded with complete healing of the local lesions which occurred primarily on the penis or in the groin. Of the remaining 2 patients, one responded to a second course of ampicillin and the other patient responded to a two week course of lincomycin after dorsal slit had been performed for partial phimosis and balanoposthitis. The 5 patients who were allergic to penicillin were treated primarily with lincomycin and all responded with complete healing. No previous reference could be found in the literature for the successful use of lincomycin in patients with granuloma inguinale. Further clinical trials with this medication are indicated.

Ampicillin↗