Biomedical subjects
Publications and source records attributed to M F Bellinger.
An enlarged bladder secondary to posterior urethral valves was detected by ultrasound in a 15-week-old fetus. Autopsy at 18 weeks of gestation revealed severe renal dysplasia. Intervention, even at this early gestational age, would be unlikely to reverse these pathologic changes.
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The presence of an accessory phallic urethra in the female patient is uncommon. Virilization is not a factor and local embryologic interactions seem capable of explaining the varied spectrum of lesions seen. Abnormal descent of the müllerian ducts results in posterior displacement of the vaginal introitus, allows the accessory phallic urethra to form and results in an unusually prominent phallus. Genitoplasty without ablation of the accessory urethra is recommended.
The voiding cystourethrogram has become the accepted standard for detection and grading of vesicoureteral reflux. Although selection of treatment alternatives and interpretation of treatment results are modified by cystographic findings, no uniform grading system exists. This not only makes comparison of different series awkward, but also hampers efforts to understand the prognostic implications of reflux grading. In reviewing the grading systems available, we feel that adoption of the criteria proposed by the International Reflux Committee (originally proposed by Heikel and Parkkulainen in Europe and Dwoskin and Perlmutter in the USA) is superior in its specificity and should be adopted as an International Reflux Classification.
The lacuna magna is a congenital diverticulum embryologically arising from the dorsal aspect of the fossa navicularis. During a 1 year period, lacuna magna was diagnosed in five boys. Another 57 voiding cystourethrograms obtained in boys were reviewed retrospectively. Lacuna magna is demonstrable on properly performed voiding cystourethrography, but can be mimicked by pseudolesions created by improper radiographic technique. Clinical information, urographic evaluation, and methods of treatment are discussed.
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In a long-term study of 166 patients with renal cell carcinoma, the authors found that earlier diagnosis and radical nephrectomy resulted in improved survival in patients with localized lesions, but the outlook for patients with advanced disease showed little improvement. Enhanced diagnostic techniques during the study period include ultrasonography and radionuclide scanning with technetium glucoheptonate. Therapeutic advances include renal artery embolization and bench surgery, with autotransplantation or donor transplantation of limited value in selected cases.
The fifteenth reported case of paratesticular liposarcoma is presented, together with a review of the literature. The prognostic and therapeutic implications of this particular neoplasm are discussed.
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