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Biomedical subjects

M L Ritchey

Publications and source records attributed to M L Ritchey.

At least 19 recordsLinked to original sources
PubMed1992

Prognosis of patients with unilateral renal agenesis.

The clinical course was reviewed in 157 patients with unilateral renal agenesis and a normal contralateral kidney for the purpose of establishing a prognosis. There were 85 males (54%) and 72 females (46%). The mean age at diagnosis of unilateral renal agenesis was 37 years. The mean years at risk was 56. Proteinuria (> 150 mg/24 h) was found in 19% of the 37 patients tested (P < 0.001), hypertension developed in 47% of the 47 patients tested (P = 0.010), and renal function (adjusted for age and sex) was decreased in 13% of the 32 patients tested (P = 0.001). An increased filtration fraction was found in 7 (54%) of 13 patients evaluated. At the completion of this study, 114 patients (73%) were alive, and the survival rate was similar to that of age-, sex-matched United States life tables. Forty-three patients (27%) died; 6 deaths (4%) were caused by renal failure. Our review indicates that patients with unilateral renal agenesis and a normal solitary kidney are at increased risk of proteinuria, hypertension, and renal insufficiency. Therefore, it is essential to have prolonged and careful follow-up and to employ strategies that maximize renal preservation.

Adolescent↗
PubMed1992

Single system ectopic ureters and ureteroceles associated with dysplastic kidney.

Eight children forming an uncommon subgroup of renal obstructive dysplasia are presented. Each child had a nonfunctioning dysplastic kidney with a single collecting system with ectopic ureteral insertion and/or ureterocele. Five of the children had classic multicystic dysplastic kidneys, one had the hydronephrotic type of multicystic dysplastic kidney and two had hypoplastic kidneys. Other significant medical problems in 5 of the 8 children (63%) included VACTERL association, congenital heart disease and other genitourinary malformations. Unlike some children with unilateral multicystic dysplastic kidney, this subgroup of children has an increased risk of infection. They must be correctly identified on imaging so that tailored clinical management decisions can be made and associated anomalies detected.

Abnormalities, Multiple↗
PubMed1992

Superior mesenteric artery injury during nephrectomy for Wilms' tumor.

Iatrogenic injury to the aorta or its major branches during nephrectomy for Wilms' tumor in children is rarely reported but may be more common than is currently acknowledged. We identified four patients with ligation of the superior mesenteric artery (SMA) that occurred during nephrectomy for nephroblastoma and another child in whom SMA thrombosis developed postoperatively. All of the tumors were on the left side. Interruption of the SMA was recognized intraoperatively in all four children, and primary repair was done. In three patients, appearance of the bowel remained normal before repair of the injury. Three of the arteries were repaired by primary reanastomosis, and one was joined with an interpositioned hypogastric artery graft. None of these patients had gastrointestinal complications postoperatively. In the fifth patient, SMA thrombosis developed after repair of an aortic tear during nephrectomy. This patient required subsequent small bowel resection for bowel infarction and died in the perioperative period. Every surgeon treating children with Wilms' tumor should be aware of the possibly distorted vascular anatomy and take precautions to avoid such a significant injury. Attempts at early ligation of the vessels may not be justified until the renal vasculature is clearly identified.

Child, Preschool↗
PubMed1992

The treatment of urinary incontinence in children using glutaraldehyde cross-linked collagen.

Periurethral injection of polytetrafluoroethylene (PolyTef) paste has been used to correct urinary incontinence for 2 decades. The controversy over distant migration of the paste has led to an interest in alternative materials particularly for the pediatric patient. Glutaraldehyde cross-linked collagen, derived from bovine dermal collagen, is effective in treating urinary incontinence in adults. Eight children with structural urinary incontinence underwent glutaraldehyde cross-linked collagen injection. Fluorourodynamic studies preceded and followed the injections. An average of 10.9 cc glutaraldehyde cross-linked collagen was injected per treatment (range 2.5 to 20). The number of injections per child ranged from 1 to 6 (mean 2.1) and followup averaged 13.75 months (range 6 to 33). Overall, 88% of the patients were cured or improved: 5 (63%) became continent, 2 were improved and 1 had no effect.

Adolescent↗
PubMed1992

Enterocystoplasty and reflux nephropathy in the canine model.

Correction of vesicoureteral reflux at enterocystoplasty is often recommended to prevent the development of reflux nephropathy. Children with enterocystoplasty who require intermittent self-catheterization invariably have asymptomatic bacteriuria. In patients with persistent vesicoureteral reflux after enterocystoplasty the risk of renal damage from this asymptomatic bacteriuria is unknown. Detubularized ileocystoplasty was performed in 17 dogs with either direct nontunneled reimplantation or unroofing of the intramural tunnel and incision of the ipsilateral hemitrigone to create vesicoureteral reflux. Fluoroscopic urodynamic studies were performed 1 month later and unilateral vesicoureteral reflux was present in 6 dogs. All animals had low intravesical pressure and excretory urograms were performed to exclude obstruction. The 6 dogs with reflux were euthanized 3 months postoperatively and the kidneys were examined for histological evidence of pyelonephritis. In 5 of 6 dogs bacterial bladder colonization and subsequent renal pelvic colonization developed on the side of the vesicoureteral reflux. All of these animals had histological evidence of pyelonephritis in the refluxing kidney, whereas only 1 of 6 nonrefluxing control kidneys had any evidence of pyelonephritis (p = 0.031). Our results suggest that vesicoureteral reflux in association with enterocystoplasty leads to chronic upper tract infection and pyelonephritis in a majority of animals, despite creation of a low pressure urinary reservoir. Correction of vesicoureteral reflux at enterocystoplasty should be considered to prevent upper tract damage.

Animals↗
PubMed1992

Prognosis of children with solitary kidney after unilateral nephrectomy.

The clinical course of 138 children who underwent unilateral nephrectomy and had a normal contralateral kidney at the time of nephrectomy was reviewed. The diagnosis leading to nephrectomy included obstructive uropathy in 46% of the cases, reflux or pyelonephritis in 30%, Wilms tumor in 15%, hypertension in 4%, dysplastic kidney in 2% and trauma in 2%. Mean age at nephrectomy was 7.3 years and median followup was 24.7 years. Of the 138 patients 121 (88%) are well and 17 died, including 14 secondary to metastatic Wilms tumor and 1 of renal failure. Survival of nonWilms tumor patients was similar to that of an age-matched control group. In 30 patients 24-hour creatinine clearance and 24-hour urinary protein excretion were measured. Proteinuria (greater than 150 mg./24 hours) was found in 8 of the 30 patients (27%) (p less than 0.001), renal insufficiency developed in 9 (30%) (p less than 0.0001) and hypertension occurred in 10% (p greater than 0.10). Children with an acquired solitary kidney are at increased risk for proteinuria and renal insufficiency.

Child↗
PubMed1992

Retroperitoneal neurogenous choristoma.

A 6-year-old girl with urinary complaints underwent ultrasonography, which revealed a retroperitoneal cystic mass adjacent to the left kidney. Computerized tomography did not demonstrate whether the mass was an adrenal cyst or a duplicated upper pole segment. Exploration revealed a neurogenous choristoma, which is a collection of histologically normal tissue that is ectopically situated. We believe that this is the first report of this rare entity occurring in the retroperitoneum.

Child↗
PubMed1992

Surgical complications after nephrectomy for Wilms' tumor.

We reviewed the charts of 1,910 children enrolled in the Third National Wilms' Tumor Study who underwent primary nephrectomy. Four hundred and ninety-five surgical complications occurred in 379 children (19.8 percent). Patients with inoperable tumors, bilateral renal tumors, peroperative therapy and those who refused treatment were excluded from this review. The most common complication was intestinal obstruction, which occurred in 132 patients (6.9 percent). This was followed by extensive intraoperative hemorrhage (112 patients), defined as blood loss exceeding 50 milliliters per kilogram of body weight. Intraoperative injuries to other visceral organs (including intestine, liver and spleen) occurred in 21 children and extensive vascular injuries were reported in 27 patients. There were nine deaths attributed to surgical complications (0.5 percent), only one of which was intraoperative. Survival of patients with complications was similar to patients without complications when stratified by histologic study and stage. Factors associated with the development of surgical complications included advanced local tumor stage at diagnosis, intravascular tumor extension and resection of other visceral organs at the time of nephrectomy. Complete removal of the tumor is important, but not at the expense of radical removal of adjacent structures, because of gross appearances at operation. They are often not invaded by the tumor, but rather are compressed, distorted or adherent without tumor infiltration. Identification of these groups will aid the surgeon in choosing the appropriate management for these patients at high risk. When initial exploration and precise surgical staging indicate that only a formidable operation will achieve total excision, shrinkage of the tumor with selective use of chemotherapy or radiotherapy, or both, may facilitate removal and decrease surgical morbidity. Preoperative therapy may also be the preferred approach for children with extensive intravascular tumor.

Actuarial Analysis↗
PubMed1991

Complications of the Heitz-Boyer urinary diversion: case report of late development of malignancy.

We report on 3 patients with bladder exstrophy followed for more than 15 years after having undergone Heitz-Boyer urinary diversion. One patient had adenocarcinoma at the ureterocolonic anastomoses 16 years after diversion. To our knowledge this is the first reported case of a malignancy developing after a Heitz-Boyer procedure. The other 2 patients had significant problems with urinary incontinence and recurrent urinary tract infections. Initial success with this form of urinary diversion can be followed by significant long-term complications.

Adenocarcinoma↗
PubMed1991

Viability and functional characteristics of enterocystoplasty after ligation of the vascular pedicle.

A canine model was developed to evaluate the effect of ligation of the mesenteric blood supply of enterocystoplasty. In 5 dogs with an ileocystoplasty and 6 with a gastrocystoplasty the blood supply was interrupted 4 months postoperatively. Re-exploration 2 to 8 weeks later revealed sufficient collateral blood flow to maintain integrity of the bowel wall and none of the animals had urine leak or other signs of perforation. Two animals had a significant decrease in the size of the cystoplasty. Intraoperative measurements of bowel viability after pedicle ligation were not predictive of the outcome. The functional outcome after pedicle division seems to be variable and probably reflects how well the patch has been vascularized before interruption of the blood supply. The augmented bladder may remain viable if sufficient time has elapsed to allow revascularization of the intestinal segment before its mesenteric blood supply is divided.

Animals↗
PubMed1991

Anastomotic obstruction after stapled enteroanastomosis.

We have recently treated two cases of anastomotic obstruction after side-to-side stapled enteroanastomosis. Complete obstruction of a stapled small-bowel anastomosis has not been reported to our knowledge. The mechanism of the obstruction appears to be the healing together of the cut edges of viable bowel beyond the inverted stapled lines. An alternative method of constructing the functional end-to-end enteroanastomosis that is offered is intended to prevent the occurrence of postoperative anastomotic obstruction.

Adolescent↗
PubMed1990

Pediatric urological complications with intraoperative radiation therapy.

Intraoperative radiotherapy with variable energy electrons has been used as a supplemental boost to treat 6 children with locally advanced retroperitoneal malignancies. Of the patients 4 had treatment-related injuries to portions of the urinary tract within the intraoperative and external radiation fields. Three patients had significant renal impairment requiring surgical correction. The pathogenesis and management of treatment-induced injury to the urinary tract are discussed.

Adolescent↗
PubMed1990

Renal vein involvement with nephroblastoma: a report of the National Wilms' Tumor Study-3.

The records of children enrolled in the National Wilms' Tumor Study-3 who had Wilms' tumor and thrombosis into the renal vein were reviewed. There were 164 patients with gross involvement of the extrarenal vein and 47 patients with microscopic involvement, an incidence of 11.3% (211 of 1,865 evaluable patients). Two-year survival rates were 90, 79 and 72% for stages II, III and IV, respectively. The most important predictors of survival were histologic pattern and stage. Complete en bloc excision of the tumor and thrombus continues to be the most effective initial management.

Child↗
PubMed1988

Management of müllerian duct remnants in the male patient.

We evaluated 36 patients for müllerian duct remnants that were manifest in several forms. The most common type was an enlarged prostatic utricle communicating with the urethra in 22 younger patients, which was associated with hypospadias or intersex disorders in more than 90 per cent of the cases. A cystic müllerian duct remnant was the other configuration noted in 14 older patients who had normal external genitalia and often presented with a rectal mass. The diagnostic evaluation consists of voiding cystourethrography, retrograde urethrography and cystoscopy. Other useful imaging techniques are ultrasonography and computerized tomography. Careful delineation of the anatomy of the lower urinary and genital tracts will help to plan surgical therapy. Suprapubic excision was the most frequent operation and it was successful in all 18 patients in whom it was performed.

Adolescent↗
PubMed1988

Intracaval and atrial involvement with nephroblastoma: review of National Wilms Tumor Study-3.

We reviewed the records of 77 children enrolled in the National Wilms Tumor Study-3 who had involvement of the inferior vena cava with tumor thrombus. None of these patients received preoperative chemotherapy or radiotherapy. Ultrasonography and inferior venacavography were more helpful than computerized tomography in the preoperative diagnosis. The median followup for the group was 2.7 years. The 3-year survival rates for patients with intracaval involvement were determined by stage (88, 89 and 62 per cent for stages II, III and IV, respectively). The most important prognostic factor was histological type. The level of vena caval involvement had no effect on survival; all 16 patients with atrial involvement survived 3 or more years. We continue to recommend appropriate surgical excision of the tumor and thrombus when it is technically feasible.

Adolescent↗
PubMed1988

Vesical neck reconstruction in patients with epispadias-exstrophy.

Vesical neck reconstruction was performed in 50 male and 12 female patients with the epispadias-exstrophy complex. Of these patients 45 had epispadias and 17 had classical exstrophy. Patient age ranged from 3 to 27 years, with a mean age of 12.6 years. Followup after vesical neck reconstruction averaged 11.6 years. Of the 45 patients with epispadias 35 (78 per cent) and of the 17 with bladder exstrophy 13 (76 per cent) are continent, for an over-all continence rate of 77 per cent. An adequate bladder capacity was one of the most important determinants of continence. In 11 patients with a small capacity or poorly compliant bladder augmentation cystoplasty was combined with vesical neck reconstruction to increase vesical capacity and to produce complete urinary continence.

Bladder Exstrophy↗