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Surgery for duplex kidneys with ectopic ureters: ipsilateral ureteroureterostomy versus polar nephrectomy.

Conventional surgery for the ectopic ureter stresses polar nephrectomy, while preserving a functioning upper pole by ipsilateral ureteroureterostomy is performed less commonly. During the last 15 years we operated on 35 children for ectopic ureter. High ipsilateral ureteroureterostomy (15 patients) was performed when the upper pole cortex appeared to be smooth and pink, and the anastomosis was surgically feasible. Upper pole nephrectomy and upper ureterectomy (21 patients) were performed when the involved segment appeared grossly to be pale, cystic or otherwise abnormal. One low ipsilateral ureteroureterostomy was performed concomitant with contralateral ureteral reimplantation. Complications after ipsilateral ureteroureterostomy and partial nephrectomy were similar. Histological evidence of dysplasia of the polar nephrectomy specimens was focal in 7 patients (33 per cent), marked in 2 (10 per cent) and not detected in 12 (57 per cent). Ipsilateral ureteroureterostomy is an appropriate means to manage the ectopic ureter in selected cases because dysplasia in these upper pole renal units seldom is significant, and because ipsilateral ureteroureterostomy and polar nephrectomy have similar postoperative morbidity rates.

Child↗

Single unilateral vaginal ectopic ureter: is it really a rarity?

Although previously regarded as a rarity, 13 of the 20 published cases of single unilateral vaginal ectopic ureter have been reported within the last year. We have seen 4 cases of a single unilateral vaginal ectopic ureter within a 4-month interval. The relationship of vaginal ureteral ectopia to müllerian and mesonephric duct anomalies is discussed. If the ureteral bud originates laterally from the mesonephric duct then the ureter may retain its connection with the mesonephric duct while failing to connect to the bladder. This condition combined with persistence of the distal mesonephric (Gartner's) duct, which ruptures vaginally, accounts for vaginal ureteral ectopia and incontinence. The diagnostic studies for vaginal ureteral ectopia include excretory urography, radionuclide scanning, ultrasonography and administration of oral phenazopyridine in conjunction with careful vaginoscopic examination. The combination of lifelong wetting and solitary kidney on excretory urography should alert the urologist to this syndrome. The single unilateral vaginal ectopic ureter may be more common than has been suggested previously.

Child↗

Two cases of ectopic ureter opening into the ejaculatory duct: double vas deferens revisited.

We report 2 rare cases of single ectopic ureter simulating double vas deferens. Clinical, radiographic and macroscopic signs at operation indicated a single ectopic ureter opening into the seminal tract. However, histological examination of the surgical specimen revealed that the lumen of the supposed ureter was lined in part by columnar epithelium, although chiefly by transitional epithelium. The wall of the ureter contained 3 well defined muscular coats in case 1 but only 1 layer was distinguishable in case 2. Histological composition of the structure removed from the cranial site resembled that of the epididymis. A review of the literature revealed a few comparable cases. Analysis of these cases suggests that double vas deferens and a single ectopic ureteral opening into the seminal tract are such that their differentiation may only have semantic significance. We speculate that these 2 diseases are included as 1 entity, only to be distinguished by the difference of ureterization of the ureteral bud.

Adult↗

Single ectopic ureter.

We report on 17 female and 4 male patients with single ectopic ureters, 9 of whom also had vaginal ectopic ureters. The clinicopathological features and surgical management are presented, with particular emphasis on the associated renal dysplasia and the complete excision of the ectopic ureteral stump. Although single ureteral ectopia with drainage to the vagina is rare in the English literature the condition is common in Japan.

Adolescent↗

Ectopic adrenal in inguinal hernia sacs.

Nodules of the ectopic adrenal cortex were identified in hernia sacs in 5 men. This condition seems to result from developing adrenal cortical tissue accompanying a descending testis. Ectopic adrenal must be distinguished from metastatic clear cell carcinoma. Such ectopic foci could potentially result in neoplasms or be a source of hormone production after adrenalectomy.

Adrenal Cortex↗

Ectopic single ureter and severe renal dysplasia: an unusual presentation.

An ectopic single ureter in the male subject is a rare anomaly, which commonly drains a dysplastic kidney to the prostatic urethra or the seminal vesicle. The further the ureteral orifice is located from the trigone of the bladder, the more severe is the ipsilateral renal dysplasia. A case is described in which an ectopic ureter and ectopic and dysplastic kidney were found at the time of inguinal herniorrhaphy. The ureter was connected to the epididymis of the testicle. This is the most severe form of ureteral ectopia and it has not been reported previously.

Abnormalities, Multiple↗

Ectopic ureteroceles in children.

An ectopic ureterocele may be defined as a cystic dilatation of the distal submucosal or intravesical portion of a ureter that is associated with the ectopic moiety of a completely duplicated system or, in the absence of duplication, associated with a ureter draining into an ectopic position. Using this definition, we reviewed our experience with 22 children treated during a 7-year period. More than 50 per cent were less than 3 years old at the time of presentation. The female preponderance was 3 to 1. Urinary infection was the most frequent mode of presentation. The diagnosis is made most easily when there is a high index of suspicion. Although treatment must be tailored to the situation, in general total heminephroureterectomy and excision of the ureterocele are the preferred choice. Eighty-seven per cent of the patients so treated has a satisfactory result.

Age Factors↗

Adenomas of the breast and ectopic breast under lactational influences.

The tubular adenomas, lactating adenomas, and ectopic lactation- or gestation-associated benign lesions of the breast diagnosed during a 22-year period are reported. Forty-two breast adenomas (in 28 patients) that demonstrated lactational changes are reviewed, with special attention to classification and clinical presentation. Five ectopic lactating adenomas--three axillary or in the chest wall and two vulvar, the latter occurring in the same patient--were identified in three patients. The lesions in the remaining cases were fibroadenomas with lactational changes (16 patients) and lactating or tubular adenomas (nine patients). Striking histologic and clinical similarities between the tubular and lactating adenomas and the lesions identified as lactational changes within a fibroadenoma were observed, with foci of tubular adenomatous change present within otherwise typical fibroadenomas. The overlapping morphologic spectrum and the strong association with pregnancy or lactational influences blur the distinction between these entities and suggest a common pathogenesis. The cytologic features of lactational lesions of the breast and ectopic breast pose special problems in diagnosis by fine needle aspiration.

Adenofibroma↗

Transitional cell carcinoma in a single ectopic ureter opening into the ejaculatory duct.

The incidence of an ectopic ureter in male patients is low. The ectopic ureter in men often ends at the seminal tract in association with renal dysgenesis. Malignant transformation of this closed, nonfunctional urothelial system has been reported only once. To our knowledge, we report the first case of primary transitional cell carcinoma in a single ectopic ureter with a dysplastic kidney that terminated in the ejaculatory duct.

Abnormalities, Multiple↗

Cervical ectopic thymus: a case report and review of the literature.

Ectopic cervical thymic tissue is rarely reported in medical literature, but it should be included in the differential diagnosis of neck masses, especially in children. The authors present the case of a young male with a soft right mid-cervical mass. The patient underwent complete excision of the lesion and histological examination showed an ectopic thymic cyst. The embryological development, clinical presentation and management of ectopic thymic lesions are discussed together with a review of the literature.

Child↗

[Ectopic ureter as cause of urinary incontinence in girls].

Continuous urine dripping together with normal micturition is the classical picture of ectopic ureter in girls. During the years 1982 to 1996, eleven girls with such abnormality have been treated at our department. The diagnostic work-up included: intravenous pyelogram (IP), ultrasonography (US), renal scintiscan, cystogram, cystoscopy and/or vaginoscopy, as well as a thorough exam of the external genitalia under general anesthesia. Ten girls had a double renal system, one of them being bilateral; one girl had simple kidneys with renal ectopia. Treatment was heminephrectomy with ureterectomy in 9 cases, ureteroureterostomy with preservation of the hemikidney in one case, and nephrectomy with ureterectomy in the case with a simple system. Urinary incontinence in girls due to ectopic ureter is an uncommon disease. Eigthty-five% of the cases are associated to renal duplication. IP is highly sensible to defect renal duplication; direct vision of the ectopic ureter meatus, canalization and roentgenologic confirmation of the suspected diagnosis are required prior to surgery. Heminephrectomy has been the most common treatment; however, early diagnosis by means of US will promote more conservative surgical approaches.

Adolescent↗

[A diagnostic pitfall: papillary adenocarcinoma arising in ectopic thyroid tissue within a branchial cyst].

A case of thyroid papillary carcinoma arising in ectopic thyroid tissue within a branchial cleft cyst is described. Complete dissection of the thyroid gland was necessary to rule out the differential diagnosis of primary thyroid carcinoma. The thyroglossal duct tract is an unusual localization for thyroid carcinomas in ectopic thyroid tissue. Thyroid carcinoma arising in ectopic thyroid tissue within a branchial cyst is extremely rare. Complete thyroidectomy may be necessary to eliminate an occult thyroid carcinoma.

Adenocarcinoma↗

Plasma progesterone kinetics following surgical treatment of ectopic pregnancies.

OBJECTIVES: Comparative study of plasma progesterone and betaHCG kinetics following surgical treatment of ectopic pregnancy. STUDY DESIGN: Prospective study involving 62 patients with tubal ectopic pregnancies. Study of the kinetics of plasma progesterone and betaHCG, and the correlation coefficient between plasma progesterone and betaHCG levels during post-operative follow-up. RESULTS: Thirty-nine patients were treated by salpingostomy and 23 by salpingectomy. Analyzing the betaHCG kinetics according to treatment revealed that both curves were convergent on day 2. Progesterone kinetics differed greatly in that they appeared "parallel and confused". Analyzing the correlation between betaHCG and progesterone levels proved the absence of a significant link. CONCLUSIONS: Studying the kinetics of plasma progesterone after surgical treatment of ectopic pregnancies revealed a fast decrease in progesterone. Statistical analysis of the progesterone concentration showed that post-operative kinetics is fully independent from that of betaHCG. Progesterone therefore cannot be substituted to betaHCG for post-operative follow-up.

Chorionic Gonadotropin, beta Subunit, Human↗

Ectopic overexpression of c-mpl by retroviral-mediated gene transfer suppressed megakaryopoiesis but enhanced erythropoiesis in mice.

In this report, we tested whether ectopic overexpression of a cell surface receptor cDNA could be used to explore the physiological roles of that receptor. We generated c-mpl overexpressing animals by reconstituting mice with retroviral vector-transduced bone marrow (BM) cells. We observed that platelet counts in the c-mpl overexpressing mice failed to recover to normal levels and remained at <200 x 10(6)/mL post-transplantation, while platelet numbers in the control mice returned to > 800 x 10(6)/mL by 4 weeks post-transplantation. However, platelet counts in the c-mpl overexpressing mice could be stimulated to normal levels after administration of rhMGDF. No significant changes in peripheral leukocyte counts were observed, although the number of CFU-E, GM-CFC, and CFC-multi were reduced two- to threefold in the BM of the c-mpl overexpressing mice. In addition, enhanced erythropoiesis was observed in the c-mpl overexpressing mice. The mpl receptors on erythroid cells were functional as demonstrated by tyrosine-phosphorylation of mpl receptor on RBC and by in vitro erythroid colony-formation in response to MGDF stimulation, respectively. These results suggested that ectopically expressed mpl receptors competed for ligand in vivo leading to an insufficient amount of circulating thrombopoietin (Tpo) for the development of megakaryocytic lineage. These results further suggest that, in addition to sequestering circulating Tpo, overexpression of the mpl receptor on erythroid progenitors may directly contribute to enhanced erythropoiesis in vivo. Our studies demonstrate that ectopic overexpression of a receptor by retroviral-mediated gene transfer provides an approach to explore the biological roles of novel receptors.

Animals↗

Perforant path activation of ectopic granule cells that are born after pilocarpine-induced seizures.

Granule cells in the dentate gyrus are born throughout life, and various stimuli can affect their development in the adult brain. Following seizures, for instance, neurogenesis increases greatly, and some new cells migrate to abnormal (ectopic) locations, such as the hilus. Previous electrophysiological studies of this population have shown that they have intrinsic properties that are similar to normal granule cells, but differ in other characteristics, consistent with abnormal integration into host circuitry. To characterize the response of ectopic hilar granule cells to perforant path stimulation, intracellular recordings were made in hippocampal slices from rats that had pilocarpine-induced status epilepticus and subsequent spontaneous recurrent seizures. Comparisons were made with granule cells located in the granule cell layer of both pilocarpine- and saline-treated animals. In addition, a few ectopic hilar granule cells were sampled from saline-treated rats. Remarkably, hilar granule cells displayed robust responses, even when their dendrites were not present within the molecular layer, where perforant path axons normally terminate. The evoked responses of hilar granule cells were similar in several ways to those of normally positioned granule cells, but there were some differences. For example, there was an unusually long latency to onset of responses evoked in many hilar granule cells, especially those without molecular layer dendrites. Presumably this is due to polysynaptic activation by the perforant path. These results indicate that synaptic reorganization after seizures can lead to robust activation of newly born hilar granule cells by the perforant path, even when their dendrites are not in the terminal field of the perforant path. Additionally, the fact that these cells can be found in normal tissue and develop similar synaptic responses, suggests that seizures, while not necessary for their formation, strongly promote their generation and the development of associated circuits, potentially contributing to a lowered seizure threshold.

Animals↗

Tumour necrosis factor-alpha induces ectopic activity in nociceptive primary afferent fibres.

Tumour necrosis factor-alpha, a pro-inflammatory cytokine, is expressed endoneurially following a variety of local and systemic pathophysiological insults which give rise to pain. We administered tumour necrosis factor-alpha to pentobarbital-anaesthetized rats, either topically along a restricted portion of the sciatic nerve or injected subcutaneously within the distribution of the sural nerve. Single nociceptive primary afferent fibres were assessed for ectopic discharge and receptor sensitization. Low concentrations (0.001-0.01 ng/ml) of tumour necrosis factor-alpha applied along the nerve elicited a dose-dependent, rapid onset (1-3 min) increase in discharge; higher concentrations led to reduced firing rates. C-fibres developed higher mean firing frequencies than A delta-fibres. Bursting frequency in both fibre types reached several (6) Hz. No change in mechanical threshold was observed. Intradermal injection (50 pg in 50 microliters) led to ectopic discharge and a decrease in mechanical threshold; these effects developed at different rates, suggesting multiple actions of the cytokine. Our data suggest that acute application of tumour necrosis factor-alpha to the axon can lead to aberrant electrophysiologic activity independent of peripheral receptor involvement. This low level of ectopic firing of nociceptive axons may produce wind-up in dorsal horn neurons or may, by itself, be interpreted as pain.

Animals↗

Ectopic atrial tachycardia after transvenous catheter ablation of a posteroseptal accessory pathway.

Closed chest electrode catheter ablation of a posteroseptal accessory pathway was performed on an 18 year old patient with recurrent supraventricular tachycardia. After the procedure, ectopic atrial tachycardia was observed for the first time. Detailed endocardial atrial mapping revealed that this ectopic atrial tachycardia originated from the first site of catheter ablation. As retrograde conduction resumed, a second ablation procedure was performed, resulting in successful ablation of both the ectopic atrial tachycardia and the accessory pathway conduction.

Adolescent↗

Rupture of ectopic pregnancy after medical therapy with methotrexate: a case series.

Medical treatment of ectopic pregnancy with methotrexate has become the standard of care in many areas of the U.S. Rupture of ectopic pregnancy after medical treatment presents a diagnostic challenge to the Emergency Physician. We review a series of 11 patients with ectopic pregnancy treated with methotrexate who then required surgical treatment for rupture.

Abortifacient Agents, Nonsteroidal↗