Biomedical subjects

C F Firlit

Publications and source records attributed to C F Firlit.

At least 19 recordsLinked to original sources

PubMed1992

Favorable experience with pre-emptive renal transplantation in children.

We retrospectively examined our experience with live-related donor kidney transplants in 66 children during the 7-year period 1984-1990. We compared the clinical courses of 26 children who did not receive any dialytic therapy prior to transplantation with 40 children who were dialyzed (27 via peritoneal dialysis and 13 via hemodialysis). We did not find any statistically significant differences in patient or graft survival between these three groups with a follow-up period of 6-87 months. Based on our results, we conclude that pre-emptive transplantation is an acceptable treatment for children who will inevitably require renal replacement therapy.

Adolescent↗

PubMed1992

Grading nephroureteral dilatation detected in the first year of life: correlation with obstruction.

To understand better the significance of pediatric idiopathic nephroureteral dilatation the renal ultrasound images of patients less than 1 year old with hydronephrosis or hydroureteronephrosis were graded and compared to the radiological diagnosis of obstruction as determined by diuresis renography and/or urography. The study included 73 boys and 30 girls with hydronephrosis (76 patients) or hydroureteronephrosis (27). For hydronephrosis obstruction was diagnosed in 56 children (74%) and involved 61 of 97 kidneys (63%). For obstructed kidneys the mean grade of hydronephrosis (3.4 +/- 0.7 standard deviation) was statistically different from that of nonobstructed kidneys (1.6 +/- 0.8 standard deviation) (p less than 0.05). When the value to predict obstruction was set at grade 3 hydronephrosis or greater there was an 88% sensitivity and 95% specificity. For hydroureteronephrosis obstruction was diagnosed in 15 of 27 children (56%) and involved 17 of 34 kidneys (50%). The degree of dilatation was weighted as a score to assess the grades of hydronephrosis and ureteral dilatation, namely hydroureteronephrosis score equals grade of hydronephrosis plus grade of ureteral dilatation. In obstructed megaureters the mean hydroureteronephrosis score (5.8 +/- 1.0) was statistically different from that for nonobstructed megaureters (mean hydroureteronephrosis score 2.7 +/- 1.9) (p less than 0.001). When the value to predict obstruction was set at hydroureteronephrosis score of 5 or greater there was a 94% sensitivity and 80% specificity. Although ultrasound examination alone cannot be used to diagnose urinary obstruction, the radiological diagnosis of obstruction is linked with the grade of hydronephrosis or score of hydroureteronephrosis.

Age Factors↗

PubMed1992

Selective sacral rhizotomy in children with high pressure neurogenic bladders: preliminary results.

Recent successful introduction of selective rhizotomy in the management of lower extremity spasticity in patients with myelodysplasia has prompted us to use it as a means of managing high pressure neurogenic bladders occasionally encountered in myelodysplastic patients. During the last 1 1/2 years 8 children have undergone selective sacral rhizotomy in an attempt to avert urinary diversion or bladder augmentation. Patient age ranged from 6.5 to 18.5 years. The level of the respective lesions was evenly distributed throughout the spine. At spinal surgery each patient had an electrode placed in the detrusor of the bladder via a suprapubic approach, electromyography electrodes were placed in the perineum and slow fill water cystometry was performed throughout the procedure. Standard electrophysiological stimulation of the nerve roots was performed to identify the rootlets that would only affect the detrusor and spare the external sphincter. Postoperative followup has been obtained on all patients. Of the patients 4 have exhibited significant improvement and they have not required augmentation, 2 have not shown any further deterioration in bladder function, 1 has demonstrated deterioration and 1 still lacks urodynamic followup. Postoperative cystometric studies have revealed a bladder capacity increase of 69% for the group. Uninhibited bladder contractions were abated in all but 1 patient. No patient has been rendered incontinent of urine from the procedure and no patient has had a problem with stool continence as a result of the rhizotomy. It appears that selective rhizotomy of the sacral roots has been able to increase bladder capacity as well as compliance in patients who normally would have been relegated to either bladder augmentation or urinary diversion. While these are encouraging results, some further followup is required to ascertain if the early improvements will be long-lasting.

Adolescent↗

PubMed1990

Insertion of testicular prosthesis: use of vaginal speculum.

We have used a vaginal speculum to insert a testicular prosthesis through the inguinal approach over the past four years. We have found this technique to be easily performed and reproducible in allowing the testicular prosthesis to be placed in the normal dependent position in the scrotum.

Adolescent↗

PubMed1990

Fibrinolytic therapy for renal vein thrombosis in the child.

Renal vein thrombosis may lead to significant renal impairment, even death, yet therapy remains controversial. Thrombolytic therapy in general may be attended by significant hemorrhagic complications and has not been used widely in children. We treated a 9-year-old boy with antithrombin III deficiency and acute renal vein thrombosis in a solitary kidney with a selective 48-hour infusion of low dose urokinase with return of renal function. Minor bleeding from a fresh surgical incision was the only morbidity. Such use of fibrinolytic agents in children with acute renal vein thrombosis may prevent significant renal impairment and deserves further clinical trials.

Acute Disease↗

PubMed1990

Role of in-office ultrasonography in screening infants and children for urinary obstruction.

With the availability of machines suitable for the office, we studied whether in-office ultrasonography could assist in the management of children with known or suspected hydronephrosis. Of 509 children examined, 81 (16 per cent) had hydronephrosis. In 56 (70 per cent) of these children, ultrasonography was helpful in expediting the diagnosis (9 cases), clarifying the etiology (16 cases), evaluating the condition postoperatively (26 cases), and screening (5 cases). Three incorrect ultrasound diagnoses were encountered. The authors believe that ultrasound is the best initial imaging method for the urinary tract and have shown that it is practical and effective in an office setting.

Child↗

PubMed1989

Ultrasonography and diagnosis of pediatric genitourinary rhabdomyosarcoma.

Rhabdomyosarcoma is the most common tumor of the lower genitourinary tract in children during their first two decades of life. Four patients with genitourinary rhabdomyosarcoma are presented, with ultrasonographic and radiographic findings. The utility of ultrasound in the diagnosis of this pediatric tumor is emphasized.

Child↗

PubMed1989

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↗

PubMed1989

Hypospadias hidden by a complete prepuce.

Nine boys were found to have hypospadias despite the presence of a complete prepuce. The urethral meatus was in the subcoronal position in six boys, the distal shaft position in one boy and on the corona glandis in two boys. Although it is generally thought that boys with hypospadias have a dorsal hooded prepuce resulting from incomplete development of the ventral phallus, we have found hypospadias in boys with complete preputial development. Thus, physicians who perform circumcision should fully retract the prepuce to detect occult hypospadias before completing the procedure. Parents of newborns with hypospadias and a complete prepuce should be told, before circumcision, that preputial tissues may be needed to repair the hypospadias.

Child↗

PubMed1988

Management of cloacal exstrophy.

This case study demonstrates our experience in the very complex management of cloacal exstrophy. It exemplifies the aggressive therapy by a dedicated multidisciplinary health team and the excellent postoperative results.

Abdominal Muscles↗

PubMed1988

Urinary prophylaxis and postoperative care of children at home with an indwelling catheter after hypospadias repair.

This study represents our observations of 50 pediatric patients who underwent urethroplasty for hypospadias and chordee. An indwelling Silastic Foley catheter remained indwelling postoperatively for ten to fourteen days, connected to an antireflux leg drainage bag. Prophylactic antimicrobial therapy was given to all patients from the day of operation until one week after removal of the catheter. Cultures obtained from urine specimens taken directly from the drainage bag revealed that only 16 percent of the cases had a significant bacterial colony count (greater than 100,000/cc). We describe the efficacy of a closed drainage system combined with prophylactic antimicrobials in the management of children after hypospadias surgery.

Catheters, Indwelling↗

PubMed1988

Urological complications in pediatric renal transplantation: management and prevention.

From 1973 through 1986, 166 consecutive renal transplants were performed in 143 patients. Urological complications included ureteral leakage/obstruction/necrosis, urinary tract infection, pyelonephritis, pelvic lymphocele, pelvic abscess, pelvic hematoma, infected hydrocele, bladder calculus, labial edema, renal artery/segmental stenosis, hydronephrosis, urinary incontinence, renal allograft malrotation and kidney rupture. Management options and preventive measures to avoid some of these dilemmas are highlighted.

Adolescent↗

PubMed1988

The P.A.D.U.A. (progressive augmentation by dilating the urethra anterior) procedure for the treatment of severe urethral hypoplasia.

Eight boys with congenital urethral hypoplasia and atresia are described, including 5 with a patent urachus, 2 with an "H" type urethral perineal duplication and 1 with a rectovesical fistula. Of the boys 5 had the prune belly syndrome. The technique of gradual progressive indwelling soft catheter or stent dilation achieved excellent results in 6 boys. This technique is believed to offer the slow stimulus necessary for urethral dilation that is missing in boys with a patient urachus or urethral duplication. The remaining 2 boys were treated with more conventional techniques of urethrotomy or rapid urethral dilation. They eventually achieved a satisfactory result but after significant morbidity. This clinical experience serves to describe and demonstrate how the application of gradual progressive soft, small catheter or stent dilation of severe urethral hypoplasia and atresia results in a functionally normal urethra with minimal morbidity.

Child, Preschool↗

PubMed1988

Pelvic lymphocele after pediatric renal transplantation: a successful technique for prevention.

Pelvic lymph accumulation (lymphocele) is a recognized complication of renal transplantation. During a 12-year period 166 renal transplants were performed in 143 children at our institution. From 1973 to 1979, 5 lymphoceles were treated in 64 children. From 1979 until the present a technique of peritoneal fenestration has been performed in 69 children, in whom 1 lymphocele developed. Lymphoceles required surgical treatment in 5 of the remaining 10 cases that were not fenestrated. Our experience with peritoneal fenestration as a method of lymphocele prevention has been excellent, and we recommend it as a prophylactic addition to renal transplant surgery.

Child↗

PubMed1988

Caution in antenatal intervention.

We assessed 18 fetuses who harbored a urinary tract malformation that was diagnosed by antenatal sonography. The antenatal diagnosis corresponded to the postnatal diagnosis in 66 per cent of the cases. We review the course of 6 fetuses who had catheters placed percutaneously to drain dilated urinary tracts that were believed to be caused by posterior urethral valves (5) or an obstructed megaureter (1). Only 2 of these fetuses exhibited valves postnatally. No fetus had any recognized benefit from the antenatal intervention. We found that sonography may not readily differentiate fetuses with hydronephrosis with obstruction from those without obstruction. From this experience we conclude that intervention in pregnancies suspected of harboring a fetus with a malformed urinary tract should be done cautiously. Antenatal sonography is useful to identify the fetus with a dilated urinary tract. This identification permits perinatal specialists to be alerted so that preparations for reconstructive surgery in such cases can be made early postpartum.

Female↗

PubMed1987

Renal transplantation in children with oculorenal syndrome.

The association of tapetoretinal degeneration with familial juvenile nephronophthisis is a rare oculorenal syndrome. Without treatment all children die of renal failure prior to adulthood. Information regarding renal transplantation is lacking in these children. This article reflects our experience in two children affected with this syndrome who achieved excellent functional results following living-related kidney transplants. Surgery can be done safely in these children with little or no morbidity. We believe that children with this syndrome benefit from transplantation and that this offers a significant improvement in their quality of life.

Blindness↗

PubMed1987

In-office ultrasonography to image the kidneys and bladder of children.

We present the first experience with in-office ultrasonography to further the office evaluation of children with urological problems. Since February 1986 we imaged prospectively the kidneys and bladders of 172 children (100 boys and 72 girls, mean age 6 years) who presented for office evaluation using a portable 5 MHz. real-time linear array scanner. Initially, we gained familiarity with in-office ultrasonography by examining 38 children who presented for evaluation of problems not recognized to be associated with renal malformations (that is undescended testis). In-office ultrasonography showed hydronephrosis in 1 boy with a buried penis that was found later to be owing to ureteropelvic junction obstruction requiring pyeloplasty. Then, in-office ultrasonography was used to supplement the office evaluation of children with a history of urine infection, voiding problems or known malformations of the kidney and/or bladder. The test showed that 12 of 24 children (50 per cent) with a history of urine infection had a thickened detrusor, large bladder capacity with or without residual urine or reduced sensation to void. In-office ultrasonography also showed that 24 of 74 children (32 per cent) with voiding problems had a thickened detrusor, large bladder capacity with or without residual urine, fecal impaction, suspected bladder neck obstruction (which later required internal urethrotomy) or small bladder capacity. In 35 children with known malformations of the urinary tract in-office ultrasonography was useful to assess the progress of hydronephrosis (29) or to clarify the etiology of the hydronephrosis (4). The diagnostic value of this test was evaluated in 98 children in whom enough data were available to compare the results to those of subsequent urography or clinical outcome. In-office ultrasonography had a 98 per cent sensitivity and an 82 per cent specificity rate. We conclude that in-office ultrasonography is a reliable means to identify incomplete bladder emptying in children with urine infection related to dysfunctional voiding, identify detrusor thickening related to the unstable bladder and indicate the likely etiology of hydronephrosis.

Child↗

PubMed1986

Surgical correction of the buried penis: description of a classification system and a technique to correct the disorder.

The concealed penis is a long-standing problem that only recently has begun to receive the attention it deserves. We offer a classification for this general disorder, which facilitates the selection of appropriate surgical procedures for these patients. To correct the most common problem, the buried penis, involves removal of localized deposits of fat from the hypogastrium with open surgical or closed suction techniques followed by anchoring of the skin of the base of the penis to the periosteum of the pubis. During the last year we have used this approach successfully in 7 boys with various forms of penile concealment with good results.

Abdominal Muscles↗