Biomedical subjects

George F Steinhardt

Publications and source records attributed to George F Steinhardt.

10 recordsLinked to original sources

PubMed2006

An approach for using full thickness skin grafts for complex penile surgeries in children.

PURPOSE: Many problems in pediatric urology derive from a paucity of penile skin resulting from prior surgical interventions. While hypospadias surgery is most often responsible for creating this problem, excessive circumcision also can leave a patient with too little skin to cover the penis. To our knowledge we describe the first series of pediatric patients in whom FTSGs were used in a variety of difficult circumstances where penile skin was lacking. MATERIALS AND METHODS: We retrospectively studied a cohort of 11 children 2 to 13 years old who underwent urethral repair and adjunctive skin grafting due to circumcision injuries (4 patients), traumatic urethral injury (1) or congenital lymphangiectasis (1), or for congenital hypospadias with previous failed surgery (5). In our patients available penile skin was used to reconstruct the urethra, while full thickness inguinal skin grafts were fashioned to resurface the denuded penis following reconstruction. RESULTS: All patients underwent successful reconstruction and grafting. There were no intraoperative complications. There was 100% take of the grafts. Average followup was 23 months (range 3 weeks to 8.6 years). One patient had slight chordee at 6 years postoperatively, and 1 had development of a urethrocutaneous fistula at 8.6 years. All patients reported normal caliber urinary streams. CONCLUSIONS: Use of full thickness inguinal skin grafts to resurface the penis provided patients with an esthetically acceptable result, and where necessary allowed penile skin to be used for urethroplasty. This technique is useful and justifies consideration in appropriately selected patients.

Adolescent↗

PubMed2005

Voiding dysfunction: outcome in infants with congenital vesicoureteral reflux.

OBJECTIVES: To assess the rate of development of voiding dysfunction as an outcome in patients with congenital vesicoureteral reflux. METHODS: A computerized database was used to review the medical records of all patients with congenital reflux diagnosed before 6 months of age from 1988 to 2002. Only those infants with reflux who were followed up for at least 6 months past the age of toilet training were included. The parameters tabulated in this group included the presence of frequency, daytime wetting, urge incontinence, and infrequent voiding. The variables were summarized using contingency tables, and associations were evaluated using chi-square analysis and Fisher's exact test. RESULTS: Of 342 patients (145 boys and 197 girls) with reflux, 67 (19.6%) developed voiding dysfunction (17.9% boys and 20.8% girls). No statistically significant difference was found between high grade (IV and V) and low grade (I and II) or grade III reflux, or between unilateral and bilateral reflux for the development of voiding dysfunction. Of the patients with reflux who had renal damage on dimercaptosuccinic acid scan, 24.3% of girls and 30.4% of boys developed voiding dysfunction, which was not significantly different from those without renal damage. CONCLUSIONS: Approximately 20% of patients with vesicoureteral reflux diagnosed before 6 months of age demonstrated dysfunctional voiding after the age of toilet training. Voiding dysfunction occurred independent of sex, laterality, or severity of vesicoureteral reflux. Infants with renal damage on dimercaptosuccinic acid scan developed dysfunctional voiding only at a slightly greater, but not significantly different, rate than those with normal kidneys.

Female↗

PubMed2005

A multivariable assessment of renal size and growth of scarred kidneys in children.

PURPOSE: We applied a recently developed multivariable renal size nomogram to sonographic measurements of kidneys with known scarring to assess systematically their sizes and growth patterns compared to normal kidneys. MATERIALS AND METHODS: We retrospectively reviewed renal sonograms of 138 kidneys (55 right and 83 left) with known scarring. The sizes of these scarred kidneys were compared to the 95% prediction limits calculated according to the multivariable renal size nomogram, adjusting for patient age, gender, race, weight and height. The growth of scarred kidneys was evaluated by fitting individual linear regression lines using serial sonographic measurements and comparing the results with normal predicted values. RESULTS: The sizes of 89.1% of the right and 81.9% of the left scarred kidneys were within the 95% normal prediction limits. Only 17 of 138 of the scarred renal units showed smaller kidney sizes compared to the normal prediction limits. Serial sonographic measurements revealed that compared to normal predicted values, 24 of 60 left and 16 of 38 right scarred kidneys grew within +/- 1.0% annually of the boundaries of normal predicted values. Additionally, 8 left and 7 right scarred kidneys indicated a growth rate of more than 1% annually higher than the normal predicted values. CONCLUSIONS: Multivariable analyses of renal sonographic measurements provided a dynamic picture of kidney well-being in children with renal scarring. We found that the majority of scarred kidneys were within the normal predicted limits, and a large proportion of these kidneys grew equally well compared to those with normal anatomy.

Adolescent↗

PubMed2004

Endocrine disruption and hypospadias.

The complexity of human biology makes it impossible to know for certain if endocrine disruption accounts for human penile deformities. Toxicologists point out that an overall assessment of risk must include other factors in addition to exposure including absorption, metabolism, excretion, bioaccumulation and other chemical interactions (Harrison et al., 1997). Many skeptics observe lack of analytic ability to document contaminant levels during critical windows of exposure (Safe, 2000). Further, the environmental estrogens studied (DDT, PCB and bis-phenol A) are quite weak compared to the well studied potent estrogen DES which did not cause penile deformities (Joffe, 2001). While environmental estrogens may be unlikely in contributing to penile deformities, the antiandrogens (phthalates, vinclozolin and DDE) are more plausible is this regard, as maleness is critically dependent upon androgen action. Observers note that, in general, the environmental concentrations of persistent organochlorine compounds have been decreasing over the past two decades. Some feel that our current levels of exposure are too low and the potency of the anti-androgens too weak to account for any significant developmental genital effect (Williams et al., 2001). Caution and restraint are always reasonable in matters of data intrepretation. Past researchers were reassured that pthtalate esters were quite safe when they first were assessed for possible harmful effects on male fertility. Unfortunately it took different models, analyzing transgenerational effects, before it became crystal clear that these compounds can dramatically affect male genital development following experimental maternal exposure at dosages and concentrations currently present in most women. We can not now be so reassured that our male development is unaffected by any of the over 65,000 manmade organochlorine compounds on the planet. Multiple observations from diverse disciplines provide credible evidence that proliferation of xenobiotic chemicals can cause potentially disastrous unintended consequences for the male gender, and upon reflection, our species.

Animals↗

PubMed2004

Epididymal cysts in children: natural history.

PURPOSE: We reviewed the outcome of conservative management of epididymal cyst in children at our institution. MATERIALS AND METHODS: We retrospectively reviewed the records of all patients with epididymal cyst from 1991 to 2002. Age and mode of presentation as well as time to complete involution of the cysts were studied. Diagnosis of epididymal cyst was confirmed by scrotal ultrasound in all cases. RESULTS: A total of 20 patients were identified with epididymal cyst. Average patient age at presentation was 10.5 years. Fifteen patients presented with scrotal mass and 4 with scrotal pain. Cysts were between 3 and 30 mm. Only 1 patient required surgical excision due to persistent pain. Epididymal cysts resolved in 10 patients who completed followup. Average time to complete regression was 17 months. None of our patients had a history of exposure to diethylstilbestrol, cryptorchidism, cystic fibrosis or von Hippel-Lindau disease. CONCLUSIONS: Our findings imply that most epididymal cysts involute with time.

Adolescent↗

PubMed2004

A multivariate analysis of dysfunctional elimination syndrome, and its relationships with gender, urinary tract infection and vesicoureteral reflux in children.

PURPOSE: We explored and quantified the relationships between dysfunctional elimination syndrome (DES), and gender, urinary tract infection (UTI) and vesicoureteral reflux (VUR) in children. MATERIALS AND METHODS: Data on 2,759 pediatric patients treated at a referral practice who underwent renal sonography and voiding cystourethrography were summarized. The patients were children with VUR or normal genitourinary anatomy who presented with UTI or dysfunctional voiding and children screened for genitourinary problems such as hematuria, sibling reflux or bedwetting. A multivariate logistic regression approach was used to model and quantify the associations between DES and other pediatric urology factors. RESULTS: Of the girls 36.0% with unilateral VUR had DES, while 36.1% with bilateral VUR had DES. The corresponding rates for boys were 20.5% and 21.2%. The higher rate of DES in girls was independent of UTI and VUR status. While UTI was not associated with DES in boys or girls without VUR, in patients with VUR and UTI the risk of DES almost doubled (OR 1.97). Reflux alone without UTI was negatively associated with DES in boys (OR 0.50, 95% CI 0.34, 0.73) and girls (OR 0.26, 95% CI 0.19, 0.36). CONCLUSIONS: Girls had a significantly higher rate of DES than boys in all UTI and VUR subgroups in the current data. UTI significantly impacts the DES occurrence in patients with VUR. No statistically significant difference was detected in the DES rate between the unilateral and bilateral VUR groups, and the reflux group as a whole did not seem to have a higher rate of DES in boys or girls.

Child↗

PubMed2003

Infant vesicoureteral reflux: a comparison between patients presenting with a prenatal diagnosis and those presenting with a urinary tract infection.

OBJECTIVES: To evaluate the severity, laterality, and gender distribution of infant vesicoureteral reflux (VUR) and its potential impact on renal outcome, we compared patients presenting fetally (FDR group) and those presenting with a urinary tract infection (INF group). METHODS: A retrospective review of 202 patients with the diagnosis of VUR before 6 months of age was performed. The grade of VUR, gender, laterality, initial renal scarring, breakthrough urinary tract infections, new renal scarring, and surgical intervention were compared between the INF group (n = 146) and FDR group (n = 56). RESULTS: The male/female ratio in the FDR group was 1.67:1 compared with 0.60:1 in the INF group. The FDR group had more unilateral VUR than the INF group (P <0.001), and no significant difference was found between the two groups in terms of VUR grade distribution (P = 0.13), percentage of initial damage (28% of FDR patients versus 23% of INF patients), or clinical course. In either group, boys and girls exhibited a very similar distribution of grade and renal damage. CONCLUSIONS: Our findings do not support the commonly held belief that fetally diagnosed reflux is an overwhelmingly male, bilateral, and high-grade phenomenon. Few differences were observed between infants diagnosed fetally and those diagnosed subsequent to urinary tract infection. Once diagnosed, from either group, infant reflux has neither great morbidity nor a frequent need for surgery.

Age Factors↗

PubMed2002

The renal length nomogram: multivariable approach.

PURPOSE: We built a multivariate renal length nomogram based on ultrasound measurements in pediatric patients with normal renal anatomy. MATERIALS AND METHODS: Included in the study were 707 children 1 week to 18 years old without vesicoureteral reflux, urinary obstruction or other known anatomical anomalies. Renal length was compared among subgroups of children. Multivariate regression approach was used to model renal length, incorporating important demographic variables. RESULTS: Subgroup comparisons of renal lengths showed diverse patterns of renal length differences in children with various demographic characteristics. In addition to age, factors significant in the multivariate nomogram model of renal length included gender, race, weight and height. CONCLUSIONS: These results show that renal length is not only age dependent, but also significantly correlates with other important demographic variables. Variability in renal length can be better described by multivariate analysis. The multivariate approach provides clinically useful information regarding renal outcomes in individuals. The ability to compare renal length among patient subgroups receiving different interventions adds additional usefulness to this approach.

Adolescent↗

PubMed2002

Evaluation and management of ectopic penile testis.

Ectopic testes are found in the superficial inguinal scrotum, base of penis, perineum, or medial thigh. In cases in which the testis crosses the midline, the cord structures may cross intra-abdominally or after exiting the inguinal canal. We describe a patient with an ectopic testis located on the penile shaft ipsilateral to a scrotal testis. Diagnostic laparoscopy identified the cord structures exiting opposite the testis. A scrotal location was achieved using a single high scrotal incision. This case illustrates the utility of laparoscopy for the evaluation and management of a testis that crosses the midline.

Adolescent↗

PubMed2002

Reduced renin expression and altered gene transcript profiles in multicystic dysplastic kidneys.

PURPOSE: Some patients with multicystic dysplasia experience hypertension in infancy which can be clinically improved with simple nephrectomy. Little is known of the role of renin in multicystic dysplasia and therefore, we studied renin expression in nonhypertensive multicystic dysplasia and compared it with hypertensive multicystic dysplasia. Additionally, global gene transcript profiles were studied in nonhypertensive multicystic dysplasia. MATERIALS AND METHODS: Tissue from 12 patients with multicystic dysplasia without hypertension and 2 patients with hypertensive multicystic dysplasia were compared to normal metanephric mid-term and neonatal kidneys. Renin expression was studied by immunohistochemistry. CD-68, a marker for macrophages, was applied to slides previously stained with renin. GeneChip (Affymetrix, Southern Oaks, California) microarray analysis was performed using total RNA from 2 nonhypertensive multicystic dysplastic kidneys and normal newborn kidney as control. RESULTS: Strong renin staining was present in arteries and arterioles in normal early metanephric kidneys and concentrated in juxtaglomerular cells in neonatal kidneys. Renin was variably decreased in arterioles in multicystic dysplasia and was ectopically expressed in interstitial cells. Renin positive interstitial cells co-expressed CD-68 antigen identifying these cells as macrophages. Ectopic renin production was more pronounced in hypertensive multicystic dysplasia. GeneChip hybridization showed a 60 to 200-fold decrease in expression of renin transcript in multicystic dysplasia relative to normal kidney, concordant with immunohistochemical results. Altered expression of several other candidate transcripts was also identified. CONCLUSIONS: Dramatic renin decrease in multicystic dysplasia suggests that it may participate in the development of dysplastic vessels. Pronounced ectopic renin expression by macrophages in multicystic dysplasia associated with hypertension may be linked to hypertension in multicystic dysplasia. Several other candidate genes whose altered expression may be associated with the pathophysiology of multicystic dysplasia provide intriguing molecular targets for future study.

Antigens, CD↗