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Congenital urethral polyp in the infant: Case report and review of the literature
ABSTRACTS
796
ureter, because of the associated vesical and sphincteric defects, is best managed by urinary diversion, although in rare instances functional reconstruction has been successful.-R. L. Kroovand
Experimental Ureteric Obstruction. D. Osborn, J. Lee, and G. Williams. Br. J. Ural. 46: 18-23 (February), 1974. The influence of hydration in nephron recovery after ureteral obstruction was studied in rats. End ureteric pressure, urine volume, urine osmolarity, and insulin clearance were measured after short-term (less than 2 hr) and long-term (6 hr) ureteral obstruction. Urine osmolarity is a sensitive index of nephron damage. The authors concluded that in shortterm ureteral obstruction, ureteric end pressure is significantly higher in hydrated rats and that nephron recovery after release of ureteral obstruction is greater in dehydrated rats, irrespective of the duration of the ureteral obstruction. Direct application of these data to the human situation is not possible.-R. L. Kroovand
A Classification and Quantitative Histological Study of Abnormal Ureters in Children. J. L. Emery and G. W. Gill. Br. J. Ural. 46: 69-79 (February), 1974. The authors conducted a gross and quantitative study of muscle, connective tissue, and elastic tissue of 78 embryologically normal, but secondarily altered ureters. Five groups of ureters evolved: (a) normal, (b) ureters with irregular dilatations, (c) slightly dilated ureters with muscle hypertrophy and hyperplasia, probably compensated, (d) elongated and dilated ureters with muscle hypertrophy and hyperplasia, but probably decompensated, (e) grossly dilated and elongated ureters having increased elastic tissue but with no comparable muscle hypertrophy and hyperplasia. Abnormal ureters had uniformly distributed varying degrees of muscle hypertrophy and hyperplasia. The form of the ureter (a,b,c,d, or e) seemed to be related to whether the muscle hypertrophy and hyperplasia were adequate to compensate for the increased luminal diameter.-R. L. Kroovand
The Post-natal Development of the Muscle and Connective Tissue of the Normal Ureter-A Quantitative Study. G. W. Gill and J. L.
Emery.
Br. J. Utol.
76: 81-90. (February),
1974. A quantitative study of 50 normal ureters in children aged 0 to 6 yr revealed that intramural and extravesicai ureteral length is directly related to height. Intramural uretetal length is related to the state of the bladder distention and increases with increasing age. In the group and increases with increasing age. In the age groups studied the growth of ureteral muscle and connective tissue is uniform and progressive.-R. L. Kroovand Review of the Management of 140 Cases of Extrophy of the Bladder. M. Megalli and J. K. Lather. J. Urol. 109: 246-248 (February), 1973. One of sixty-seven patients, a female, has satisfactory bladder control after anatomic closure, though with some restrictions. Twentysix of sixty-three have been diverted after an initial primary closure. Fifty-nine patients have teflux and only 18% of the antireflux procedures were successful. Sixty-five per cent of the patients have recurrent urinary tract infections and 15% developed stones. Of 30 patients with ureterosigmoidostomy followed for 5-25 yr, 26 had some degree of upper tract deterioration on one ot both sides, I5 underwent a subsequent diversion. There ate 45 patients who have undergone diversion (30 ileal, nine colonic, six uteterostomies). There has been satisfactory upper tract maintenance in 32 patients. The authors feel that only two female patients had a successfully closed exttophy of the bladder. Their view is that supravesical diversion has the best social and psychological result and least morbidity at the present.S. Kim Congenital Urethral Polyp in the Infant: Case Report and Review of the Literature. W. C. Dewolf. and E. E. Farley. J. Urol. 109:515516 (Match), 1973. A case report of a transutethtal removal of a urethral polyp in a 3-wk-old infant. Left hydronephrosis and hydroureter with bilateral reflux were found on radiologic investigation. A retrograde urethrogram showed a filling defect present in the urethra on a stalk. This was removed through a perineal urethrostomy using the infant resectoscope. One year later, the
797
ABSTRACTS
child had sterile urine and a normal gram.-S. Kim
cysto-
Congenital Torsion of the Penis. J. E. Mobley. J. Ural. 517-519 (March), 1973. This is a case report of a 2-yr-old boy with a 180” torsion of the penis associated with marked chordee and hypospadias. The usual torsion of 90’ or less in and of itself is usually not corrected without symptoms. In the literature, 350/, of cases had chordee and about the same percentage had hypospadias. Correction included chordee excision, correction of torsion by the method of Kulp, and final urethroplasty.-X Kim MUSCULOSKELETAL
SYSTEM
Blind Pinning of Displaced Supracondylar Fractures of the Humerus in Children: Sixteen Years Experience with Long-Term Follow-Up. C. Flynn, J. G. Matthews and R. L. Eenoif. JBJS 56A: 263-272 (March), 1974. The authors review 72 completely displaced supracondylar humeral fractures in youngsters, treated by a percutaneous crossed Steinman pinning, after closed reduction of these fractures. The advantages of the procedure were firm immobilization and short hospitalization. Complications of the pinning were one case of transient ulnar neuropathy, one pin extrusion, and one pin tract infection. The complications of the fracture per se included I3 vascular complications and eight neural complications. One child had myositis ossificans in the brachialis muscle. One patient was pinned in a malaligned position. The complication rate is somewhat high, which the authors attribute to the fact that many of the patients had faradvanced neurovascular problems prior to the reduction and procedure.-Anthony H. Alter The Elbow in Arthrogryposis. Peter F. Williams. JBJS 55B: 834-840 (November), 1973. There are two main types of elbow deformity in arthogryposis: (I) the elbow is fixed in flexion and function is usually good; (2) the joint is fixed in extension usually with only the slightest degree of movement. This paper refers to the surgical treatment of the second group where one of the most important objects is to make it possible for the child to feed himself.
Two types of operation are recommended, tricepsplasty and triceps transfer. The former consists of lengthening the triceps tendon by a UY technique and is of most use in children when triceps action must be preserved or when elbow flexors are already present. The latter operation is the most useful and consists of transferring the triceps tendon forward, attaching it to the radius or ulna 1 inch distal to the elbow. This is the procedure of choice and will allow active Aexion against gravity and resistante. Although there was great variability in results, the reason for which is not obvious, the operation was found to produce greatly increased function in every case.--l. Aitken Epidemiology of Slipped Capital Femoral Epiphysis: A Review of the Literature. J. L. Kelsey. Pediatrics 51:1051-1059 (June), 1973. A review of the literature on the epidemiology of slipped capital femoral epiphysis reveals that the incidence is greatest in early teenage black males. occurring in spring and early summer, more common in families, in the left hip of males, that children are usually tall for their age but are overweight and have undergone slower than average skeletal maturation. Most of the risk factors have been found to play a role in either decreasing the strength of the epiphyseal plate or in increasing the amount of shearing stress to which the plate is subjetted at the time it is most vulnerable. -Clifford Rubin Static and Dynamic Problems in Spastic Cerebral Palsy. Jorgen Reimers. JBJS 55B: 822-827 (November). 1973. The aim of this paper is to survey the static and dynamic relationship of the various postural abnormalities as observed from the side because these postural anomalies illustrate particularly well the functional relationship between the various joints of the lower limbs. Five separate deformities are described and illustrated with excellent diagrams. The correct and faulty treatment of each is outlined. The authors stress that contractures in spastic cerebral palsy should be released from above downward and that the full benefit of operative treatment is only obtained when all the contractures have been corrected. Poor results seen mainly due to operative treatment being too little and too late or in the wrong sequence. -J. Aitken
796
ureter, because of the associated vesical and sphincteric defects, is best managed by urinary diversion, although in rare instances functional reconstruction has been successful.-R. L. Kroovand
Experimental Ureteric Obstruction. D. Osborn, J. Lee, and G. Williams. Br. J. Ural. 46: 18-23 (February), 1974. The influence of hydration in nephron recovery after ureteral obstruction was studied in rats. End ureteric pressure, urine volume, urine osmolarity, and insulin clearance were measured after short-term (less than 2 hr) and long-term (6 hr) ureteral obstruction. Urine osmolarity is a sensitive index of nephron damage. The authors concluded that in shortterm ureteral obstruction, ureteric end pressure is significantly higher in hydrated rats and that nephron recovery after release of ureteral obstruction is greater in dehydrated rats, irrespective of the duration of the ureteral obstruction. Direct application of these data to the human situation is not possible.-R. L. Kroovand
A Classification and Quantitative Histological Study of Abnormal Ureters in Children. J. L. Emery and G. W. Gill. Br. J. Ural. 46: 69-79 (February), 1974. The authors conducted a gross and quantitative study of muscle, connective tissue, and elastic tissue of 78 embryologically normal, but secondarily altered ureters. Five groups of ureters evolved: (a) normal, (b) ureters with irregular dilatations, (c) slightly dilated ureters with muscle hypertrophy and hyperplasia, probably compensated, (d) elongated and dilated ureters with muscle hypertrophy and hyperplasia, but probably decompensated, (e) grossly dilated and elongated ureters having increased elastic tissue but with no comparable muscle hypertrophy and hyperplasia. Abnormal ureters had uniformly distributed varying degrees of muscle hypertrophy and hyperplasia. The form of the ureter (a,b,c,d, or e) seemed to be related to whether the muscle hypertrophy and hyperplasia were adequate to compensate for the increased luminal diameter.-R. L. Kroovand
The Post-natal Development of the Muscle and Connective Tissue of the Normal Ureter-A Quantitative Study. G. W. Gill and J. L.
Emery.
Br. J. Utol.
76: 81-90. (February),
1974. A quantitative study of 50 normal ureters in children aged 0 to 6 yr revealed that intramural and extravesicai ureteral length is directly related to height. Intramural uretetal length is related to the state of the bladder distention and increases with increasing age. In the group and increases with increasing age. In the age groups studied the growth of ureteral muscle and connective tissue is uniform and progressive.-R. L. Kroovand Review of the Management of 140 Cases of Extrophy of the Bladder. M. Megalli and J. K. Lather. J. Urol. 109: 246-248 (February), 1973. One of sixty-seven patients, a female, has satisfactory bladder control after anatomic closure, though with some restrictions. Twentysix of sixty-three have been diverted after an initial primary closure. Fifty-nine patients have teflux and only 18% of the antireflux procedures were successful. Sixty-five per cent of the patients have recurrent urinary tract infections and 15% developed stones. Of 30 patients with ureterosigmoidostomy followed for 5-25 yr, 26 had some degree of upper tract deterioration on one ot both sides, I5 underwent a subsequent diversion. There ate 45 patients who have undergone diversion (30 ileal, nine colonic, six uteterostomies). There has been satisfactory upper tract maintenance in 32 patients. The authors feel that only two female patients had a successfully closed exttophy of the bladder. Their view is that supravesical diversion has the best social and psychological result and least morbidity at the present.S. Kim Congenital Urethral Polyp in the Infant: Case Report and Review of the Literature. W. C. Dewolf. and E. E. Farley. J. Urol. 109:515516 (Match), 1973. A case report of a transutethtal removal of a urethral polyp in a 3-wk-old infant. Left hydronephrosis and hydroureter with bilateral reflux were found on radiologic investigation. A retrograde urethrogram showed a filling defect present in the urethra on a stalk. This was removed through a perineal urethrostomy using the infant resectoscope. One year later, the
797
ABSTRACTS
child had sterile urine and a normal gram.-S. Kim
cysto-
Congenital Torsion of the Penis. J. E. Mobley. J. Ural. 517-519 (March), 1973. This is a case report of a 2-yr-old boy with a 180” torsion of the penis associated with marked chordee and hypospadias. The usual torsion of 90’ or less in and of itself is usually not corrected without symptoms. In the literature, 350/, of cases had chordee and about the same percentage had hypospadias. Correction included chordee excision, correction of torsion by the method of Kulp, and final urethroplasty.-X Kim MUSCULOSKELETAL
SYSTEM
Blind Pinning of Displaced Supracondylar Fractures of the Humerus in Children: Sixteen Years Experience with Long-Term Follow-Up. C. Flynn, J. G. Matthews and R. L. Eenoif. JBJS 56A: 263-272 (March), 1974. The authors review 72 completely displaced supracondylar humeral fractures in youngsters, treated by a percutaneous crossed Steinman pinning, after closed reduction of these fractures. The advantages of the procedure were firm immobilization and short hospitalization. Complications of the pinning were one case of transient ulnar neuropathy, one pin extrusion, and one pin tract infection. The complications of the fracture per se included I3 vascular complications and eight neural complications. One child had myositis ossificans in the brachialis muscle. One patient was pinned in a malaligned position. The complication rate is somewhat high, which the authors attribute to the fact that many of the patients had faradvanced neurovascular problems prior to the reduction and procedure.-Anthony H. Alter The Elbow in Arthrogryposis. Peter F. Williams. JBJS 55B: 834-840 (November), 1973. There are two main types of elbow deformity in arthogryposis: (I) the elbow is fixed in flexion and function is usually good; (2) the joint is fixed in extension usually with only the slightest degree of movement. This paper refers to the surgical treatment of the second group where one of the most important objects is to make it possible for the child to feed himself.
Two types of operation are recommended, tricepsplasty and triceps transfer. The former consists of lengthening the triceps tendon by a UY technique and is of most use in children when triceps action must be preserved or when elbow flexors are already present. The latter operation is the most useful and consists of transferring the triceps tendon forward, attaching it to the radius or ulna 1 inch distal to the elbow. This is the procedure of choice and will allow active Aexion against gravity and resistante. Although there was great variability in results, the reason for which is not obvious, the operation was found to produce greatly increased function in every case.--l. Aitken Epidemiology of Slipped Capital Femoral Epiphysis: A Review of the Literature. J. L. Kelsey. Pediatrics 51:1051-1059 (June), 1973. A review of the literature on the epidemiology of slipped capital femoral epiphysis reveals that the incidence is greatest in early teenage black males. occurring in spring and early summer, more common in families, in the left hip of males, that children are usually tall for their age but are overweight and have undergone slower than average skeletal maturation. Most of the risk factors have been found to play a role in either decreasing the strength of the epiphyseal plate or in increasing the amount of shearing stress to which the plate is subjetted at the time it is most vulnerable. -Clifford Rubin Static and Dynamic Problems in Spastic Cerebral Palsy. Jorgen Reimers. JBJS 55B: 822-827 (November). 1973. The aim of this paper is to survey the static and dynamic relationship of the various postural abnormalities as observed from the side because these postural anomalies illustrate particularly well the functional relationship between the various joints of the lower limbs. Five separate deformities are described and illustrated with excellent diagrams. The correct and faulty treatment of each is outlined. The authors stress that contractures in spastic cerebral palsy should be released from above downward and that the full benefit of operative treatment is only obtained when all the contractures have been corrected. Poor results seen mainly due to operative treatment being too little and too late or in the wrong sequence. -J. Aitken