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Biomedical subjects

R B Filmer

Publications and source records attributed to R B Filmer.

16 recordsLinked to original sources
PubMed1999

Duplicate bladder exstrophy: a unique approach to initial repair.

OBJECTIVES: To describe a unique approach to the management of duplicate bladder exstrophy combining initial bladder closure and epispadias repair. Bladder exstrophy has been successfully managed by staged surgical repair with early bladder closure, subsequent epispadias repair, and, finally, bladder neck reconstruction. Duplicate bladder exstrophy is a rare variant of the exstrophy complex with fewer than 20 cases reported. METHODS: A male newborn presented with the appearance of both bladder exstrophy and a ruptured omphalocele. Repair of the omphalocele and bilateral orchiopexy was performed shortly after birth, but bladder closure was delayed until there was complete healing of the omphalocele defect, and the investigators believed the infant was ready for abdominal wall and bladder exstrophy closure. At age 8 months, bladder closure was performed with the intraoperative finding of a duplicate bladder lying posterior to the exstrophied bladder. The left ureter drained on the exstrophic bladder plate, and the right ureter drained into the posterior (internalized) duplicate bladder. After anterior innominate and vertical iliac osteotomies, the left ureter was reimplanted into the posterior bladder. A portion of the exstrophied bladder was then tubularized to construct a neourethra of the epispadic penis. RESULTS: The child has done well with an excellent cosmetic appearance of the abdominal wall and a straight phallus. The bladder subsequently required a Mitrofanoff-type continent stoma along with bladder augmentation, which was performed at the time of his Young-Dees-Leadbetter bladder neck reconstruction (age 3.5). The child is currently continent but requires intermittent clean catheterization through his appendicovesicostomy. CONCLUSIONS: The investigators report a unique and unexpected variant of bladder exstrophy and its successful management.

Bladder Exstrophy↗
PubMed1987

Volume expansion diuretic renal scan in urinary tract obstruction.

The diuretic renal scan is used to differentiate the obstructed dilated urinary system from the nonobstructed dilated system. The technique, however, has a false-positive and indeterminate rate of 10%-15%. This usually is due to variables such as the degree of dilatation of the pelvicalyceal system or ureter, the degree of bladder distention, the diuretic dose, and the state of hydration. We developed the volume expansion diuretic renal scan (VEDRS) to overcome these variables and to improve the accuracy of the technique. Twelve patients who had obstructive patterns on the diuretic renal scan were evaluated. Ten patients were shown to be dilated but not obstructed. Two patients were confirmed as obstructed. This technique improves the accuracy of the diuretic renal scan.

Adolescent↗
PubMed1978

Followup of cutaneous ureterostomy in children.

Thirty-two children with cutaneous ureterostomies are reviewed, of whom 27 were evaluated with an average followup of 3 years 8 months. Of these 27 patients 26 had successful stabilization of the upper tracts as determined by gross radiographic and renal function parameters. The incidence of stomal stenosis and revisions is no worse than the reported rates in cases of ileal conduits followed for a comparable length of time. Proper patient selection and careful long-term followup are mandatory for the successful application of this procedure in children.

Adolescent↗
PubMed1976

Glomerulocystic kidney. Report of a case.

We describe a rare type of congenital renal cystic disease involving the Bowman capsule and adjacent abnormal tubules. The patient had a moderate degree of proteinuria, but otherwise normal renal function. Two subcapsular hepatic cysts manifested the only other visceral involvement. This case is morphologically similar to one previously reported. A purely descriptive morphologic term is suggested for this distinctive lesion, viz, glomerulocystic kidney.

Autopsy↗
PubMed1975

Direct and indirect radionuclide cystography.

Direct radionuclide cystography, using short half-life radiopharmaceuticals, is considered to be more reliable for detecting vesicoureteral reflux than conventional roentgenographic techniques. In addition to the detection of vesicoureteral reflux, other parameters determined include the bladder volume when reflux occurs, calculation of volume of fluid that has refluxed, accurate calculation of residual urine volume, estimation of reflux drainage time, and the visualization and diagnosis of gross anatomic abnormalities. Currently, a major disadvantage is poor resolution, prohibiting analysis of small bladder defects and urethral abnormalities. The major advantage of nuclear cystography is the small radiation dose delivered with its use. It is estimated that at least 100 radionuclide studies can be performed for the same radiation expense as a single roentgenographic study.

Child↗
PubMed1975

Metaplastic cartilage in nondysplastic kidneys.

Four hundred ninety-seven patients representing the 525 total or polar nephrectomies performed at the Children's Memorial Hospital from 1938 to 1973 (excluding 1947), were reviewed retrospectively to determine the incidence and characteristics of renal dysplasia. The 46 specimens with this histologic diagnosis all exhibited typical primitive ducts with 13 being also associated with cartilage formation. In five patients, kidney showed focal chondrous metaplasis of the interstitium in association with chronic inflammation but without primitive ducts. The findings strongly suggest that the renal interstitium occasionally may react to injury by chondrous metaplasia and that, in the absence of primitive, ducts, cartilage in the kidney is not pathognomonic of renal dysplasia.

Adolescent↗
PubMed1973

Adrenal corticosteroid-induced renal cystic disease in the newborn hamster.

A new model of renal cystic disease was developed in newborn Syrian hamsters by the repeated injection of 9-fluoroprednisolone acetate (9-FPA), a long-acting adrenal corticosteroid. Kidneys harvested from the tenth to the fourteenth day of age showed diffuse cystic dilatation of nearly all cortical convoluted tubules. Microdissection revealed that cystic changes primarily involved proximal convoluted tubules and, to a lesser degree, the distal tubules. Electron microscopy showed immaturity of development and varying degrees of degeneration of the cells of the proximal convoluted tubule. Intraluminal obstruction was not detected and therefore could not account for the cystic changes. Analysis of electrolytes in serum and selected tissues showed a significant reduction in potassium and sodium of serum, and significant depletion of potassium, magnesium and calcium in the skeletal muscle. Thus, there was no direct relationship between an electrolyte deficiency and the cystic changes.

Animals↗