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Biomedical subjects

M F Bellinger

Publications and source records attributed to M F Bellinger.

At least 37 records · Page 2Linked to original sources
PubMed1993

The limited role of imaging techniques in managing children with undescended testes.

We studied the usefulness of radiography for localization of cryptorchid testes. A total of 23 radiographic studies ordered by referring physicians was done for testis localization in 18 boys. Two patients had retractile testes and were followed expectantly. Ultrasonography failed to detect palpable testes in both cases. A total of 16 boys (19 undescended testes) underwent operative exploration and the findings were compared. Ultrasonography correlated with the operative findings in 7 of 12 cryptorchid testes (58%), while computerized tomography and magnetic resonance imaging correlated in only 4 of 12 (33%) and 0 of 1 (0%), respectively. The overall accuracy of radiological testing was 44%. Physical examination was 53% accurate when performed by the referring physician and 84% accurate when done by the attending pediatric urologist. In no case did radiographic assessment influence the decision to operate, the surgical approach or the viability/salvageability of the involved testes. Preoperative radiography for undescended testes is neither necessary nor helpful.

Adolescent↗
PubMed1993

Subtotal de-epithelialization and partial concealment of the glans clitoris: a modification to improve the cosmetic results of feminizing genitoplasty.

An unsatisfactory appearance of the external genitalia after otherwise successful genitoplasty may result from failure to reduce the size of a hypertrophied glans clitoris and change its appearance from a large bulbous structure to a small conical cap. A more pleasing cosmetic result can be achieved by modifying a technique for glansplasty originally described by Lattimer: subtotal glans de-epithelialization and partial glans concealment. Six patients with virilized external genitalia (3 with congenital adrenal hyperplasia, 2 with gonadal dysgenesis and 1 true hermaphrodite) underwent feminizing genitoplasty using this modified technique at ages 3 to 13 months. All patients have achieved pleasing cosmetic results that are vastly superior to our experience with other methods for clitoral reduction.

Clitoris↗
PubMed1993

The "innocent" cough or sneeze: a harbinger of serious latex allergy in children during bladder stimulation and urodynamic testing.

Latex hypersensitivity is a well documented phenomenon most commonly reported in children with spina bifida during surgical and other procedures involving exposure to latex. IgE-mediated immediate hypersensitivity to the protein or polypeptide components of latex may be severe and manifest as generalized anaphylaxis or cardiovascular collapse. Of 17 children with spina bifida undergoing transurethral electrical bladder stimulation we identified 5 with latex allergy 3 to 9 years old. All 5 patients were noted to manifest sneezing or a cough several minutes before the development of a generalized hypersensitivity reaction, which in several patients progressed to bronchospasm. Subsequent investigations have shown that the inciting agent was the rectal pressure balloon made from a latex finger cot. Recognition of the earliest manifestations of latex hypersensitivity is an important clinical tool in the prevention of severe allergic reactions.

Allergens↗
PubMed1993

Early experience with transurethral electrical bladder stimulation.

Seventeen patients 2.5 to 20 years old with neurovesical dysfunction (10 myelomeningocele, 2 lipomeningocele, 2 spinal cord injury, 2 primary tethered spinal cord, 1 transverse myelitis) completed a total of 41 series (605 individual sessions) of transurethral electrical bladder stimulation. Ultimately, all patients demonstrated detrusor contraction during therapy, and 88% had sensation of contractions, usually developing later in therapy. Of 12 patients with carefully documented serial urodynamic studies 8 (67%) demonstrated a measurable (14 to 158%) increase in bladder capacity but 3 subsequently had capacities near baseline. Two patients demonstrated long-term improvement in fecal continence but none had voluntary control of micturition.

Adolescent↗
PubMed1993

The multicystic dysplastic kidney and contralateral vesicoureteral reflux: protection of the solitary kidney.

The diagnosis of multicystic renal dysplasia is confirmed by a combination of sonography and radionuclide scan. If the contralateral kidney is normal by these criteria, further radiological examination is often omitted. We prospectively studied 29 patients with a diagnosis of multicystic renal dysplasia by voiding cystourethrography to determine the condition of the solitary contralateral kidney. Eight patients (28%) were found to have contralateral vesicoureteral reflux, of whom 6 had normal ultrasound examinations and would not have undergone further radiographic study based on ultrasound criteria alone. Contralateral vesicoureteral reflux in association with multicystic renal dysplasia puts solitary kidneys at risk for pyelonephritic scarring. Therefore, voiding cystourethrography should be performed as part of the initial evaluation of all infants with multicystic renal dysplasia.

Child, Preschool↗
PubMed1993

Ureterocystoplasty: a unique method for vesical augmentation in children.

Vesical augmentation may be accomplished by using small bowel, large bowel or stomach, and by detrusor myotomy or the autoaugmentation technique. The use of intestinal segments is associated with variable mucus production, electrolyte absorption and the risk of malignant transformation. Autoaugmentation is free of these potential risks but may be unsuccessful in creating sufficient improvement in vesical compliance and capacity. Ureterocystoplasty with a bladder based native ureteral flap has been used in neurovesical dysfunction in association with a nonfunctional refluxing kidney, in a noncompliant valve bladder associated with posterior urethral valves and a nonfunctional kidney, and in augmentation of a small bladder after closure of cloacal exstrophy. Adequate bladder capacity and compliance have been achieved without the use of extra urinary epithelium. The surgical approach is simple and uncomplicated. Ureterocystoplasty in selected cases will provide for adequate bladder capacity and compliance when augmentation cystoplasty is required.

Child↗
PubMed1989

Orchiopexy: an experimental study of the effect of surgical technique on testicular histology.

Orchiopexy was performed in 35 mature Sprague-Dawley rats using absorbable suture, nonabsorbable suture or a classical dartos pouch technique without suture fixation. Examination of the chromic-fixed testes revealed severe acute inflammation of the suture site and most of the parenchyma in 76 per cent, with abscess formation in 65 per cent, complete absence of spermatogenesis in 82 per cent and evidence of tubular necrosis in 88 per cent. Nylon-fixed testes were adherent only at the sutures, with absent spermatogenesis in 29 per cent, moderate to severe tubular necrosis in 29 per cent and tubular atrophy in 58 per cent. Dartos-fixed testes demonstrated complete circumferential adherence, normal spermatogenesis in 94 per cent and minimal focal tubular atrophy in 23 per cent. Contralateral testes appeared normal in all animals.

Animals↗
PubMed1989

Serial renal function in an ovine model of unilateral fetal urinary tract obstruction.

Renal tubular and glomerular function following ovine fetal urinary tract obstruction has been studied predominantly in anesthetized, exteriorized fetuses immediately after relief of obstruction. Since surgery and anesthesia may alter fetal cardiovascular and renal physiology, we developed a chronically catheterized, ovine model of unilateral fetal urinary tract obstruction to compare function of the unobstructed and obstructed kidneys repeatedly after relief of obstruction. Split renal function of the previously obstructed kidneys and unobstructed kidneys was measured serially in 7 fetal sheep after obstruction at 55 to 85 days per 147 days of gestation for 30 to 49 days. Seventy-five split clearances were determined on days 1, 2, 3 to 4 and 5 to 6 postoperatively. Not every fetus was studied each day. By 2-way ANOVA, renal function was stable on day 1 after surgery and did not change with time. Previously obstructed kidneys had lower creatinine clearance (0.16 versus 0.71 ml. per minute, p equals 0.0001), higher fractional sodium excretion (33.04 versus 6.02 per cent, p equals 0.0001) and higher urine sodium/creatinine ratio (4.80 versus 0.90 mEq. per mg., p equals 0.0001). Urine flow in the unobstructed kidneys did not differ significantly from that of the obstructed kidneys (0.122 versus 0.083 ml. per minute, p equals 0.35). Obstruction reduced kidney weight (4.7 versus 9.7 gm., p equals 0.0006), cortical thickness (-39 per cent) and nephrogenic zone (-59 per cent), and it increased collecting duct dilatation and medullary fibrosis. No cysts or dysplasia was noted. Fetal urinary tract obstruction for 39.7 days alters renal histology, glomerular function and tubular function. Renal function is stable by 1 day after catheterization and does not change from days 1 to 6 following relief of obstruction.

Animals↗
PubMed1988

Postoperative necrotizing fasciitis in children.

Necrotizing fasciitis is a rapidly progressive soft tissue infection, involving the skin, subcutaneous tissue, and superficial fascia. It is a rare but life-threatening complication in the postoperative patient. In the last 7 years, we have treated four children in whom necrotizing fasciitis developed after appendectomy for ruptured appendix, bilateral inguinal herniorrhaphy, or gastrostomy closure. These four patients and seven well-described children from the literature with necrotizing fasciitis following surgery form the basis of this review. The ages ranged from six days to 15 years (mean 4.5 years). There were eight boys and three girls. There were five clean, five clean-contaminated, and one contaminated surgical procedures. No patient had evidence of malignancy or diabetes. Two of our four patients had evidence of failure to thrive. Only one patient had an intraabdominal abscess. In ten, the infection started in the abdominal wall; in one, the infection started in the chest wall. In our four patients, three had neutropenia and fever, four had tachycardia, and two had wound crepitation and radiographic evidence of subcutaneous gas. Cultures of all ten wounds were positive for bacteria; six were positive for more than one organism. Blood culture results were positive in five of five patients who died and in only two of five patients who survived. All survivors had wide surgical debridement and were treated with broad-spectrum antibiotics. The mortality rate was 45% in the whole series.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

Renal function in the fetal lamb: a chronic model to study physiological effects of ureteral ligation and deligation.

Between 53 and 98 days of gestation 11 fetal lambs were subjected to unilateral ureteral ligation. In 8 fetuses re-exploration was performed 35 to 41 days after ligation. Chronic catheterization of the obstructed kidney, bladder and fetal vascular system was used for analysis of physiological data. Average creatinine clearance was 1.35 +/- 0.067 ml. per minute in the control kidney and 0.226 +/- 0.057 ml. per minute in the obstructed kidney after diversion. Free water clearance, osmolar clearance and fractional sodium excretions were not statistically significantly different in control and obstructed kidneys.

Animals↗
PubMed1986

Malignant hyperthermia and pediatric urology.

The malignant hyperthermia syndrome is a rare drug-induced hypermetabolic syndrome characterized by muscular rigidity, hyperpyrexia and systemic acidosis. Malignant hyperthermia developed in 2 boys during anesthesia for hypospadias repair and both had a favorable outcome. Recognition of the early signs and symptoms of malignant hyperthermia, and prompt treatment using dantrolene sodium require an increased index of suspicion and familiarity with this symptom complex, which has an increased incidence in children.

Child, Preschool↗
PubMed1986

Normal renal growth in children with myelodysplasia.

Optimum urologic management of children with myelodysplasia includes periodic assessment of upper tract anatomy and renal growth. To investigate the perception that many children with spina bifida but without a history of intrinsic renal disease have small kidneys when compared with age-matched standard renal growth charts, 212 children with spina bifida were studied retrospectively, measuring renal length on excretory urograms. Patients with known vesicoureteric reflux of grade 2 or greater, congenital renal anomalies, hydronephrosis, renal scarring, or urinary diversion were excluded. For 95 patients aged 2 days to 19 days, 249 urograms were available for evaluation. Renal lengths were measured on the supine 5-min urogram. Mean values and standard deviations were calculated for each age group. Mean renal length for each age group fell below the mean of the standard curves devised by Hodson and Currarino, with increasing deviation from the mean with age.

Adolescent↗
PubMed1985

Bladder diverticulum associated with ureteral obstruction.

A ureter entering a bladder diverticulum almost always has associated vesico-ureteric reflux but rarely obstruction. We present the clinical and radiologic data on a patient with an ectopic ureteral insertion into a bladder diverticulum, with associated obstruction but not vesico-ureteric reflux. Periureteral fibrosis secondary to chronic inflammation is thought to be the underlying cause.

Child↗
PubMed1985

The blind-ending vas: the fate of the contralateral testis.

From August 1980 to January 1983, 48 testes were explored for orchiopexy (28 unilateral and 20 bilateral testes). Unilateral anorchism (surgically identified blind-ending vas and vessels) was found in 7 of 48 cases (14.5 per cent). One simultaneous and 5 secondary contralateral scrotal explorations confirmed abnormal testicular fixation (bell-clapper deformity) in 5 of 6 testes (83 per cent). During documentation of unilateral anorchism, simultaneous contralateral scrotal exploration should be performed.

Adolescent↗
PubMed1985

The management of vesicoureteric reflux.

An increasingly large volume of data is being accumulated regarding the effects of vesicoureteric reflux on the kidney, data that influence clinical management. Although concrete guidelines cannot be drawn that will apply to all patients, important considerations include the following: All children with documented urinary infections should have a voiding cystourethrogram. The voiding cystourethrogram may correlate with probability of spontaneous resolution of vesicoureteric reflux. Younger patients have a higher chance of spontaneous resolution of vesicoureteric reflux. There is a definite familial tendency to vesicoureteric reflux, and patients with significant vesicoureteric reflux and scarring are more likely to have affected siblings. DMSA renal scanning is highly sensitive in the detection of scarring. Cystoscopy may play a role in the evaluation of the refluxing ureterovesical junction, but does not have as much prognostic significance as the voiding cystourethrogram. Urodynamic investigation may be important in evaluating children with urinary infections, reflux, and symptoms of voiding dysfunction. High-grade vesicoureteric reflux is associated with an increased incidence of renal scarring, and the answer to optimal management is not yet available. Most scarring occurs in infancy or childhood. Nonoperative management, especially in moderate degrees of reflux, can achieve a high rate of success. Nonoperative management requires continuous antibiotic prophylaxis. Breakthrough infections or lack of compliance with nonsurgical management have a high complication rate and must be managed aggressively. Antireflux surgery can be performed with a minimal complication rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Bacterial Agents↗
PubMed1984

Ureterostomy in situ as an aid to reconstructive urologic surgery.

Ureterostomy in situ is a valuable adjunct to reconstructive urologic surgery. While acting as a ureteral splint and safety valve ureterostomy, it offers access for antegrade radiologic and manometric studies and may be used in conjunction with indwelling splints.

Adolescent↗
PubMed1983

Lacuna magna: a hidden cause of dysuria and bloody spotting in boys.

Intermittent hematuria, dysuria, or bloody spotting of underwear are symptoms occasionally seen in young boys. The lacuna magna (valve of Guerin) is a common embryologic remnant often found to be the cause of these symptoms. While retrograde urethrography may occasionally be helpful, voiding films that include the distal penile urethra usually establish the diagnosis. Transmeatal excision or incision of the valve-like leaflet is curative, but often the problem is benign and self-limiting even without treatment.

Child↗