Transient perioperative metabolic acidosis in a patient with ileal bladder augmentation.
Explore the source record for details and available documents.
Acidosis↗
Biomedical subjects
G F Steinhardt
Publications and source records attributed to G F Steinhardt.
Insulin-like growth factor improves renal architecture of fetal kidneys with complete ureteral obstruction.
Others have previously demonstrated that the administration of insulin-like growth factor-I accelerates recovery from ischemic acute tubular necrosis in the rat kidney. We investigated the effect of insulin-like growth factor-I on the histology of unilaterally obstructed kidneys in the pouch young of the North American opossum, Didelphis virginiana. In this model complete unilateral ureteral obstruction reliably induces statistically significant degrees of caliceal dilatation, tubular cystic change, and cortical and medullary fibrosis in kidneys examined 1 week after the creation of complete obstruction. Cortical and medullary inflammation is also increased after 1 week of obstruction in this model but not to a degree that is statistically different than control (sham operated) animals. We administered insulin-like growth factor-I to opossum pups with complete unilateral obstruction created at a length of 5 cm. (age 25 days, human equivalent 18 to 20 weeks). Insulin-like growth factor-I (400 mcg/kg.) was injected subcutaneously on the day of operation and again on days 2 and 4 postoperatively. The animals were sacrificed 1 week after obstruction and the formalin fixed, paraffin embedded kidneys were assessed histologically. In the obstructed kidney insulin-like growth factor-I ameliorated the development of fibrosis (cortical and medullary) and caliceal dilatation such that these characteristics did not differ significantly from those of sham operated animals. Tubular cystic change in the obstructed kidneys was also decreased by insulin-like growth factor-I administration but not to significant levels. Insulin-like growth factor-I treatment in obstructed animals resulted in significantly more inflammation (cortical and medullary) than in the sham operated animals. We also administered insulin-like growth factor-I to normal pups with no other intervention. These insulin-like growth factor-I treated pups did not differ from sham pups for any characteristic studied. Our study suggests that there is protective effect of insulin-like growth factor-I on renal architecture when administered in the setting of experimental fetal ureteral obstruction.
Animals↗
Experimental ureteral obstruction in the fetal opossum: histologic assessment.
In the North American opossum, Didelphis virginiana unilateral complete ureteral obstruction (ECO) and partial unilateral (EPO) ureteral obstruction were created during the early metanephric stage of kidney development in pups attached to the teat (approximately 4.5 cm. long, 20 days old). At 70 days of pouch life (full-term equivalent in the human) some completely obstructed ureters were unobstructed with reanastomosis in the bladder (RECO). Other pups underwent unilateral complete ureteral ligation at this full-term equivalent (70 days of pouch life) and constituted the late obstruction (LCO) group. Unoperated animals constituted the control (C) group. All animals were harvested when full grown (.7 to 2.2 kg.), and paraffin sections of the kidneys were stained with hematoxylin and eosin and Masson's Trichrome. In each a semiquantitative assessment of 24 histologic features was made and a digital score assigned. All experimental groups except EPO demonstrated significant epithelial and mesenchymal alterations. The changes can be broadly categorized as those secondary to obstruction of urine flow (dilation and cystic changes), those affecting epithelial differentiation in both cortex and medulla and those affecting mesenchymal differentiation. The EPO group demonstrated significantly fewer glomerular generations than did control kidneys. For all other characteristics studied, the EPO group did not differ from control. The ECO group demonstrated significant changes when compared with control for most parameters studied. Medullary dysplasia was more prominent in kidneys obstructed early. Reanastomosis (RECO) at a full-term equivalent did ameliorate the changes of medullary dysplasia and cortical atrophy. More collecting duct hyperplasia, cortical and medullary aplasia were present in the LCO group compared with the ECO. The LCO group also had less primitive duct formation and less medullary dysplasia than the ECO group. Renal blastema, previously unreported in experimental obstruction, was present in 41% of experimental kidneys.
Animals↗
Testicular torsion: pitfalls of color Doppler sonography.
Only 25% of boys with acute scrotal swelling have testicular torsion. A noninvasive test that reliably distinguishes torsed testes from all other acute scrotal conditions would benefit patients presenting with pain and swelling of the scrotum. Recent reports suggest that color Doppler ultrasound may be the long-awaited test that clearly differentiates testes with compromised blood flow from all other conditions. However, we report on 2 patients with positive blood flow on color Doppler ultrasonography who subsequently were found at surgery to have testicular torsion. Inability to distinguish normal testes and normal epididymis on physical examination is still the best indicator to proceed with surgical exploration in pediatric patients with acute scrotal swelling.
Adolescent↗
Acute urinary retention in children.
Acute urinary retention (AUR) is an uncommon diagnosis in childhood, associated with a variety of causes. The emergency physician is often the first to be called upon to evaluate and treat these children. To assist in making the diagnosis, we present our five-year experience with AUR presenting to the pediatric urology service, often through the pediatric emergency department. We present and discuss examples of not only the common reasons for AUR but also uncommon diagnoses and, in two cases, etiologies for retention we believe have not been previously described in the pediatric literature.
Acute Disease↗
Urinary PGE2 in rats with chronic partial unilateral ureteral obstruction.
Urinary prostaglandin E2 (PGE2) was measured in Munich-Wistar rats with surgically created chronic partial unilateral ureteral obstruction (UUO). Mean values of bladder urine PGE2 were higher in sham than in UUO (24.5 +/- 14.4 vs 12.9 +/- 8.2 ng/mg creatinine, respectively, P less than 0.05). Following diuresis, both ureters were cannulated and urine was collected. PGE2 excretion was increased in sham (66.5 +/- 34.4 and 70.1 +/- 44.5 ng/mg creatinine, left and right, respectively). But in UUO, the obstructed kidney excreted less PGE2 than the contralateral kidney (32.1 +/- 6.0 vs 62.3 +/- 40.4 ng/mg creatinine, obstructed vs contralateral, respectively, P = 0.08). PGE2 synthesis was then determined in separated renal medullary and cortical slices. Renal medullary slices from kidneys with severe obstruction synthesized less PGE2 than the contralateral unobstructed side (3.30 +/- 1.22 vs 10.52 +/- 3.23 ng/mg wet wt-30 min, respectively, P less than 0.05) and failed to respond to arachidonic acid stimulation with any significant increase in PGE2 synthesis (3.30 +/- 1.22 vs 4.47 +/- 1.04 ng/mg wet wt-30 min, baseline vs stimulated). In contrast, contralateral unobstructed kidney slices responded with a significant increase in PGE2 synthesis (10.52 +/- 3.23 vs 21.10 +/- 2.50 ng/mg wet wt-30 min, baseline vs stimulated, P less than 0.05). We conclude that chronic partial UUO in the Munich-Wistar rats resulted in significantly less PGE2 elaboration.
Animals↗
Calcified hydronephrosis and pelviureteric junction obstruction.
Explore the source record for details and available documents.
Adolescent↗
Comparison of antiadherence activity of bladder extracts from interstitial cystitis patients with recurrent urinary tract infections.
Explore the source record for details and available documents.
Animals↗
Medicolegal aspects of testicular torsion.
Testicular torsion is a surgical emergency which requires prompt exploration, detorsion, and bilateral orchiopexy. The authors present information helping to explain why testicular torsion often leads to lawsuits for physicians.
Adolescent↗
Malignancy associated with ureterosigmoidostomy: detection by mucosa ornithine decarboxylase.
Urinary diversion into the gastrointestinal tract (ureterosigmoidostomy) is associated with stepwise malignant degeneration of colonic mucosa. Early detection of such malignancy can be difficult. Ornithine decarboxylase (ODC) is an enzyme that initiates polyamine synthesis that is elevated in malignant colonic mucosa, but its level in premalignant mucosa after ureterosigmoidostomy is unknown. Ten Wistar rats underwent urinary diversion (bladder trigone to sigmoid colon), and were maintained on a regular diet with antibiotics for 6 months, then killed. All animals developed metaplastic changes histologically at the anastomosis. Mean ODC levels of colonic mucosa at the anastomosis v normal colon 8 cm proximal were 515 +/- 177 pmole v 24.5 +/- 4.4 (P less than .01). These data show that premalignant changes in colonic mucosa after ureterosigmoidostomy can be detected by elevated colonic biopsy ODC levels. Periodic sigmoidoscopy with colon mucosa biopsy for histology and ODC levels in children with ureterosigmoidostomy is recommended.
Adenocarcinoma↗
Induced renal dysplasia in the young pouch opossum.
Using the North American opossum, Didelphis virginiana, we have developed a new model for studying the effects of early fetal urinary obstruction on subsequent renal development. We have successfully induced renal dysplasia in the marsupial that has a typically mammalian kidney.
Animals↗
Defective antiadherence activity of bladder extracts from patients with recurrent urinary tract infection.
A substantial body of animal work indicates that the initial first line defense against invading microorganisms in the urinary tract is the antiadherence activity of the surface mucin layer. Previous work has demonstrated that bacterial adherence to anion exchange resin can be used as a model for adherence to the mucin deficient rabbit bladder. This anion exchange resin adherence model can also be used as a rapid screen for potential antiadherence agents. In vitro saline extracts of bladder mucosa from various mammalian species including man have been shown to inhibit bacterial adherence to both anion exchange resin and the mucin deficient rabbit bladder. The present report investigates the ability of in vivo saline bladder washes from several groups of patients to inhibit bacterial adherence to anion exchange resin. This has an advantage over other methods of quantitation or visualization of mucin since it is the ability of the bladder extract to prevent bacterial adherence, and not merely the quantity of mucin, that determines the effectiveness of the mucin lining in preventing bacterial attachment. Bladder washes from patients with recurrent urinary tract infection were significantly less potent at inhibiting bacterial adherence than extracts from other groups of patients. This decreased functional antiadherence activity of bladder extracts may help explain the frequency of urinary tract infection in this group of patients.
Adult↗
Salmonella urinary tract infection associated with ureteropelvic junction obstruction.
Although rare, urinary tract infections in children by salmonella species have been associated with a high incidence of structural anomalies. We report on a 5-year-old patient with Salmonella enteritidis urinary tract infection associated with ureteropelvic junction obstruction.
Child, Preschool↗
Prostatic suppuration and destruction in patients with myelodysplasia: a newly recognized entity.
Prostatic abscess is an unusual occurrence in the era of modern antibiotics. In 5 patients with myelodysplasia extravasation of contrast material to the boundaries of the prostate was noted on voiding cystourethrography. All patients were adolescents who, with varying degrees of compliance, had managed the neurogenic bladder with intermittent catheterization since childhood. All patients had chronic urinary tract infections. In 2 patients subjected to transurethral resection the prostatic parenchyma was completely replaced by the suppurative process. Neither patient demonstrated much clinical improvement after resection. The possible etiological factors and various therapeutic options are discussed for the previously unreported condition of chronic prostatic abscess in myelomeningocele patients.
Abscess↗
The effect of intravesical pressure on glomerular filtration rate in patients with myelomeningocele.
Numerous investigators have demonstrated the development of hydronephrosis and renal deterioration in patients with myelomeningocele who have high pressure bladders. By drawing blood at sequential intervals during 99mtechnetium-diethylenetriaminepentaacetic acid renal scanning we are able to generate nuclide clearance curves that correlate well with glomerular filtration rate. Renal scanning is done most frequently with the bladder catheterized and left to gravity drainage. By filling the bladder under manometric control to a pressure of 35 to 40 cm. water we have followed routine scanning with continued blood sampling to generate nuclide clearance at low and high bladder pressures. In 5 myelomeningocele patients so studied we found consistent and significant decreases in glomerular filtration rate at high bladder pressures.
Adolescent↗
Glomerulosclerosis in obstructive uropathy.
Obstructive uropathy is said to result in populations of remnant nephrons subject to hyperfiltration. We studied all obstructed renal tissue removed at our pediatric institution during a 10-year period for focal segmental glomerulosclerosis, which is the histological hallmark of hyperfiltration. Over-all, the histological specimens from 20 patients with ureteropelvic junction obstruction, 14 who underwent heminephrectomy for duplication anomalies and 5 with posterior urethral valves who underwent native nephrectomy were studied. Focal segmental glomerulosclerosis was one of the most common histological findings in these obstructed kidneys but it almost always was found in association with intense interstitial and periglomerular inflammation. We conclude that although focal segmental glomerulosclerosis is common in obstructive uropathological conditions it results from the inflammatory response within the renal parenchyma and not from the hyperfiltration of remnant nephron populations.
Child↗
Gonadoblastoma presenting as isosexual precocious puberty in a genetic female.
A 6 1/2-year-old female with pseudoprecocious puberty was found to have a gonadoblastoma. Her karyotype was 46, XX; serum estradiol level was markedly elevated; and androgens were within the range of normal. The importance of the Y chromosome and dysgenetic gonad in the predisposition to development of a gonadoblastoma is reviewed. A further categorization of gonadoblastomas based on the presence or absence of the Y chromosome is suggested.
Child↗
Male urethral diverticulum: the double density sign.
An anatomic defect of the urethra is occasionally the cause of voiding dysfunction in the young male patient. A urethral diverticulum can often be overlooked if retrograde urethrography is not performed properly. Two cases are presented along with a discussion of the technique for dynamic retrograde urethrography. The description of a new radiologic sign indicative of a posterior bulbar urethral diverticulum, is presented.
Adult↗