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Biomedical subjects

W Snodgrass

Publications and source records attributed to W Snodgrass.

At least 19 recordsLinked to original sources
PubMed2000

Histology of the urethral plate: implications for hypospadias repair.

PURPOSE: We define the histology of the urethral plate in boys with hypospadias. MATERIALS AND METHODS: Subepithelial biopsies of the urethral plate were obtained in 17 boys, including 13 with distal and 4 with penoscrotal hypospadias. Ventral penile curvature was noted in 5 cases. Specimens were evaluated by 7 light microscopy after hematoxylin and eosin staining. RESULTS: All biopsies demonstrated well vascularized connective tissue comprised of smooth muscle and collagen. There was no evidence of fibrous bands or dysplastic tissue. CONCLUSIONS: The urethral plate consists of epithelium overlying connective tissue. We found no histological evidence of fibrous cords historically considered responsible for chordee.

Child↗
PubMed1999

Does tubularized incised plate hypospadias repair create neourethral strictures?

PURPOSE: Boys in whom hypospadias was repaired by tubularized, incised plate urethroplasty were evaluated to determine whether dorsal incision of the urethral plate results in strictures of the neourethra. MATERIALS AND METHODS: Postoperative followup of the initial 72 patients was reviewed and then attempts were made to contact these boys for delayed assessment more than 1 year after surgery. Periodic neourethral calibration was routinely done during year 1 postoperatively and at delayed followup. Urethroscopy was performed for a decreased urinary stream or during anesthesia for other procedures. Uroflowometry was done at the delayed assessment of toilet trained boys. RESULTS: The urethra was calibrated in 85% of the patients with no strictures noted. Urethroscopy in 10% of the boys demonstrated a healthy appearing neourethra. Uroflowometry was possible in 34% of the toilet trained patients with all results within the 95% confidence levels of standard curves for age. CONCLUSIONS: The dorsal relaxing incision of tubularized, incised plate hypospadias repair did not result in neourethral strictures.

Adolescent↗
PubMed1999

Suture tracks after hypospadias repair.

OBJECTIVE: To determine the incidence of suture tracks after hypospadias repair in which 6-0 chromic catgut was used to close the skin. PATIENTS AND METHODS: From an initial series of 72 boys undergoing tubularized, incised-plate hypospadias repair, 23 (32%) were evaluated 1 year or more after surgery. RESULTS: Of the 23 boys, 10 (43%) were found to have suture tracks. In all cases tracks were located on the ventral shaft skin and did not involve the glans or dorsal aspect of the circumcision. These tracks had not been detected at an earlier follow-up. CONCLUSIONS: Tracks resulting from small absorbable sutures may not be apparent soon after surgery because the sinus is small. With time, the sinuses fill with keratin and thereby become obvious. The location of these tracks suggests that relative hypovascularity of ventral shaft skin may contribute to their development. The use of subcutaneous sutures may diminish the incidence of this minor complication of hypospadias surgery.

Catgut↗
PubMed1999

Changing concepts in hypospadias repair.

After more than 100 years of innovation in hypospadias repair, new concepts regarding penile curvature, the urethral plate, and the means for urethroplasty are changing surgical practices. With the introduction of the tubularized incised plate technique it is possible to simplify decision-making algorithms in hypospadias surgery, while achieving good functional and cosmetic results.

Humans↗
PubMed1998

Tubularized incised plate hypospadias repair for proximal hypospadias.

PURPOSE: We report a multicenter experience using tubularized incised plate urethroplasty for proximal hypospadias. MATERIALS AND METHODS: From August 1993 to December 1996 tubularized incised plate urethroplasty was performed in 27 boys 6 months to 3 years old with mid shaft and penoscrotal hypospadias. In 7 other boys complex reconstruction combined the tubularized incised plate technique for the glanular urethra with other repairs for the proximal urethra. RESULTS: Tubularized incised plate surgery created a functional neourethra even in penoscrotal hypospadias. Complications of the primary repair developed in only 3 of 27 patients (11%). No complications were attributed to use of the technique for the glanular urethra in complex repairs. CONCLUSIONS: Tubularized incised plate urethroplasty is a versatile operation that corrects proximal hypospadias defects with few complications and superior cosmetic results.

Child, Preschool↗
PubMed1998

The impact of treated dysfunctional voiding on the nonsurgical management of vesicoureteral reflux.

PURPOSE: We evaluated the impact of dysfunctional voiding on the nonsurgical management of vesicoureteral reflux in toilet trained children. MATERIALS AND METHODS: The study population comprised 107 girls and 21 boys 3 to 10 years old who were diagnosed with vesicoureteral reflux during evaluation for urinary tract infection or dysfunctional voiding. Dysfunctional voiding was identified prospectively on the basis of typical symptoms. All patients with a urinary tract infection received antibiotic prophylaxis and oxybutynin was prescribed for all those with dysfunctional voiding. Girls with dysfunctional voiding who had no history of urinary tract infection were also given daily antibiotic prophylaxis. RESULTS: Of the 128 patients 51 girls and 15 boys had dysfunctional voiding. Reflux spontaneously resolved in 27 of the 44 evaluable girls (61%) with normal and 19 of the 42 (45%) with dysfunctional voiding. A breakthrough urinary infection developed in 18 girls (43%) with versus only 5 (11%) without dysfunctional voiding (p = 0.001). No boys had a breakthrough infection. CONCLUSIONS: Despite anticholinergic therapy and antibiotic suppression 43% of the girls with dysfunctional voiding in whom reflux may otherwise have resolved spontaneously had a breakthrough urinary infection leading to surgery.

Child↗
PubMed1997

A simplified Kropp procedure for incontinence.

PURPOSE: A simplified Kropp bladder neck reconstruction was done to achieve urinary continence. MATERIALS AND METHODS: A total of 23 patients with an incompetent bladder neck underwent the procedure, including 22 with a neurogenic bladder secondary to myelodysplasia and 1 with bladder exstrophy. The bladder neck operation was incorporated into comprehensive lower tract reconstruction that included simultaneous augmentation cystoplasty in 20 patients, ureteroneocystostomy in 6 and appendicovesicostomy in 6. RESULTS: Of the 23 patients 21 (91%) are continent. Complications included difficult catheterization in boys and new onset vesicoureteral reflux. CONCLUSIONS: This operation is easily performed and effective for achieving continence.

Adolescent↗
PubMed1996

Tubularized incised plate hypospadias repair: results of a multicenter experience.

PURPOSE: We report a multicenter experience using tubularized incised plate urethroplasty to correct distal hypospadias. MATERIALS AND METHODS: A total of 148 patients underwent repair by 6 pediatric urologists at different institutions in the United States and Europe. RESULTS: Tubularized incised plate repair created a functional neourethra with a vertically oriented meatus. Complications, including meatal stenoses and fistulas, occurred in 10 patients (7%). CONCLUSIONS: Tubularized incised plate urethroplasty can be performed in most cases of distal hypospadias. Cosmetic results are superior to those of other popular techniques.

Child↗
PubMed1994

Tubularized, incised plate urethroplasty for distal hypospadias.

A technique is described for correction of distal hypospadias with minimal chordee by tubularizing the urethral plate. The key step is deep longitudinal incision of the plate, which allows for tubularization without the need for additional flaps. The resultant neourethra is functionally adequate and an excellent cosmetic result with a vertically oriented meatus is achieved. A total of 16 boys underwent the procedure with no case of meatal stenosis or fistula occurring during a median followup of 22 months.

Child↗
PubMed1991

Relationship of voiding dysfunction to urinary tract infection and vesicoureteral reflux in children.

A total of 109 children were evaluated for urinary tract infections or for voiding dysfunction without infections. The relationship of voiding dysfunction to urinary infection and vesicoureteral reflux was then examined in girls. The number of males studied was too small for statistical analysis. While 40.6 percent of females with infections had voiding dysfunction, in 66.6 percent of those females having voiding dysfunction infections also developed. Voiding dysfunction was noted in 33.3 percent of females with reflux, probably due to the strong association of reflux and infections. However, all of females with voiding dysfunction, only 20.6 percent also had reflux. These findings were statistically significant (p = 0.01) and suggest that voiding dysfunction is common in girls with infections, perhaps even predisposing to the development of infections. However, voiding dysfunction in this population did not predispose to reflux.

Child↗
PubMed1984

Management of children with isolated testicular leukemia.

Since 1975, nine children with testicular leukemia were treated at the University of Kansas Medical Center on a standard protocol. Six patients presented with overt testicular leukemia and three patients had microscopic testicular leukemia detected on a biopsy done after 3 years of continuous complete remission. All patients had an M1 bone marrow at the time of testicular relapse and one patient had a concomitant central nervous system (CNS) relapse. Therapy consisted of testicular irradiation, CNS chemoprophylaxis, and systemic reinduction chemotherapy. Systemic maintenance therapy after the testicular relapse consisted of 6-mercaptopurine and methotrexate with vincristine/prednisone pulses administered in the same basic dose and schedule as the patient's original maintenance regimen. These nine patients had a mean duration of first remission of 33 months and a mean duration of second remission of 45+ months. Four patients have relapsed (two bone marrow, one CNS, one CNS + bone marrow), but five patients remain in their second complete remission for 33+ to 94+ months from the time of testicular relapse. These results demonstrate that, in some children, testicular leukemia represents a site of temporary drug resistance and long-term second remissions can be obtained (once local disease is controlled) by using the initial maintenance chemotherapy regimen.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1984

Successful treatment of fetal supraventricular tachycardia with maternal digoxin therapy.

In a fetus with supraventricular tachycardia (SVT) and cardiac failure, normal sinus rhythm (NSR) was restored with maternal digoxin therapy at 26 weeks' gestation. The diagnosis of cardiac failure was based on ultrasound evidence of ascites and scalp edema. Cardiac failure was attributed to the persistent SVT. The infant remained in NSR and was delivered at 36 weeks' gestation because of persistent ascites. Intracardiac anatomy was normal. This case confirms the usefulness of prenatal ultrasound examinations in the diagnosis of fetal SVT and cardiac failure and illustrates the effectiveness and safety of transplacental digoxin therapy in the management of fetal SVT.

Adult↗
PubMed1981

Selenium: childhood poisoning and cystic fibrosis.

Two cases of selenium ingestion in children are described; one child with severe cystic fibrosis died. Both children had cystic fibrosis and both had low serum chloride in association with selenium usage. Neither child was exposed to excessive heat or cold weather, factors known to salt-deplete children were cystic fibrosis, although one child was dehydrated during a summer month on initial presentation. One child had protein-calorie malnutrition, a condition known to enhance selenium toxicity in animals. We conclude that selenium is a potential hazard in its use as a health food fad for children with cystic fibrosis and in overdose ingestions. Thus selenium supplementation may have contributed to the morbidity and mortality reported here.

Adolescent↗
PubMedDate not supplied

Use of medication data to validate an association in community-based symptom prevalence studies.

A chemical spill from an oil refinery in Texas City, Texas, exposed the community to more than 40,000 lbs (18,144 kg) of highly toxic and corrosive hydrofluoric acid. A symptom prevalence study indicated an association between symptom reports, most notably breathing symptoms, and hydrofluoric acid exposure. Although verification of self-reported symptoms by checking medical records or performing clinical tests is theoretically possible, it is not a feasible alternative in dealing with an entire community. Open-ended data on medication use collected in the prevalence study were coded by organ system and analyzed by cross-classification techniques and log linear models. Results showed that the reported use of medication for hydrofluoric acid-related problems was associated with the exposure; medication use for problems unrelated to hydrofluoric acid exposure was uniform across the exposure categories. Moreover, medication use was significantly associated with the severity of breathing-related problems for each exposure category. Medication use, however, may have been under-reported because it seems difficult to conjure up the names of medications that were not taken or medications not taken recently may not be recalled. Nonetheless, open-ended medication data may be a useful surrogate approach to validating an association between an exposure and health outcomes.

Air Pollutants↗