Biomedical subjects
Publications and source records attributed to I A Aaronson.
Four infants are presented who in addition to having a posterior urethral valve showed striking clinical and radiological features usually associated with the prune belly syndrome. Evidence is presented which suggests that these two conditions may coexist.
The availability of real time ultrasound units with small transducer heads has made perineal ultrasonography a practical proposition in infants. The findings of a dilated posterior urethra and bladder obstruction in a male infant indicate the high probability of a posterior urethral valve. The features seen in the urethra as well as those in the bladder and kidneys are demonstrated.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
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Three children with equivocal pelviureteric junction obstruction are described. The renal pelves were only slightly dilated and emptied well with posture change or diuresis, but there was disproportionate dilatation of the calices. On direct puncture perfusion of the pelvis there were repeated high pressure contractions which resulted in emptying, but basal pressure remained normal. This condition appears to be analogous to the partially obstructed but compensated bladder.
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A simplified technique of measuring perfusion pressure in the equivocally obstructed upper urinary tract of children is described. Twelve patients with dilated renal pelves or ureters encountered in an 18-month period have been investigated. The findings in the majority of cases were contrary to those anticipated from the radiological appearances. This test of obstruction has wide application in the management of paediatric urological problems.
Thirty-one patients in whom ureterosigmoidostomy had been performed between 1952 and 1974 for a variety of conditions are presented. Twelve patients, or 39%, were subsequently rediverted, mainly for upper tract deterioration. Nineteen patients retaining their ureterosigmoidostomy were evaluated after 3 to 22 yr. Growth was normal in all. Twelve patients required regular alkali and three intermittant antibiotics. In 14 patients, the I.V.U. remained perfect. Each patient was interviewed. Voiding was on average three hourly. Some urgency was common, but soiling was rare. Sleep was disturbed in nearly half the patients but this was usually around dawn. Lessons were rarely interrupted and nearly all took part in sports. The large majority felt no different from their peers. In spite of close initial supervision and significant rediversion rate, ureterosigmoidostomy can provide a very acceptable form of urinary diversion in children.
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An ectopic ureterocoele may present as a diverticular-like structure at the bladder base appearing during voiding cystography. The radiological appearances are described and the mechanism of formation as seen in serial 70 mm film is discussed. The conventional intravesical filling defect of an ureterocoele may not be recognised when the bladder is filled by contrast medium. This sign of extra-vesical intra-ureteric invagination is only seen during voiding.
We reviewed data on 43 patients with gastroschisis treated at The Hospital for Sick Children, London, between 1959 and 1975. In the past five years, the overall mortality has been reduced from 76% to 33%. The introduction of the Silastic silo has been the most important single factor in this improvement. Mortality may be further reduced by achieving all-layer closure following thorough bowel decompression and stretching of the abdominal wall.
All but 17 cm of small intestine was removed in the neonatal period from a child now aged 4 years. Satisfactory growth was achieved by 2 years of age without prolonged intravenous hyper-alimentation. On return to his home environment progress was not maintained, and by 4 years of age, mental and physical retardation were found. Cholestyramine resin was beneficial in reducing stool bulk but had no substantial effect on fat absorption. Compensatory changes in the remaining bowel are recorded.
The cases of three females with deficiency of the abdominal muscles are reported. In one, severe urinary tract changes, typical of the prune belly syndrome in males was found. Twenty-three cases of prune belly syndrome in young females are reviewed. In over half, urinary tract changes were present. Intravenous urography and micturating cystourethrography are indicated in all young females with reduced abdominal musculature.