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Closed traumatic rupture of the upper ureter in children
ABSTRACTS
260 of steroids, or renal function. Patients with steroid-resistant nephrotic syndrome have poor prognosis and the disease may recur in the transplants. Prolonged dialysis may reduce this tendency. Hypertension has been a problem during the postransplant period and requires vigorous antihypertensive measures to avoid central nervous system changes. Transplants performed in infants aged 2-4 mo were technically successful but one infant rejected the transplant 3 mo later and the other died suddenly on the second postransplant day. --Frank G. DeLuca
Cadaveric Renal Transplantation in Children. R. N. Fine, H. H. Edelbrock, L. B. Brennan, C. M. Grushkin, B. M. Korsch, H. Riddell, Q. Stiles, and E. Lieberman. Lancet 1:1087-1091 (May), 1971.
Although cadaveric renal transplantation is an accepted method of treatment for endstage renal disease in adults, its use in the treatment of uremic children is still controversial. In a study of 29 children aged 18 mo to 18 yr., 32 cadaveric renal transplants were made between February 1968 and August 1970. Twenty-five children (86%) and 22 allograFts are surviving 6-32 mo after transplantation. Ten kidneys were lost. Six were removed for irreversible rejection: one for hyperacute rejection, three for acute rejection within 2 mo of transplantation, and two for chronic rejection 17 mo after transplantation. Three kidneys were lost because the recipients died from causes unrelated to rejection: two allografts were functioning and one patient was recovering from acute tubular necrosis at the time of death. The tenth allograft was removed 1 hr after transulantation because of functional venous obstruction. Six children received second allografts from a cadaver donor. Three had previously rejected a parental donor transplant and one had a previous cadaver al!ograft removed for technical reasons. Four of the six second allografts are surviving 6-21 mo after transplantation with excellent function. Two second transplants were removed for rejection. Details of transplantation, histocompatibility, and growth of recipients are given.W. M. Dennison
Experimental
Bridging
of Ureteral
Defects
by Free Ureteral Grafts: A Study in Dogs. R. S. Sethi, Amarjit Singh, and Waryam Singh. Ind. J. Surg. 32:358-364 (July), 1970. Twenty-four mongrel dogs were nephrectomized on one side, and free autogenous ureteral grafts 3.5 cm in length were used to bridge the ureteral defect of the same length on the other side. They were divided into three groups. In one no attempt was made to improve the blood. supply of the graft; in the second group the graft was wrapped in omentum; and in the third group it was tunneled subserously through the wall of the sigmoid colon. Results were best in the last group.-R. K. Gandhi Closed Traumatic Rupture of the Upper Ureter in Children. M. Lacheretz, M. Lejeune, D. Barberis, and J. De/hay, Ann. Chir. Inf. 12:125-132, 1971. The authors report a case of traumatic rupture of the upper ureter following a traffic accident in a child aged 7 yr. Ureteral rupture following abdominal contusion is rare. Only 23 cases have been reported in the past 20 yr, of which nine were younger than 10 yr of age. The ureteral rupture is always accompanied by polytraumatism. The diagnosis is very difficult, as the symptoms are latent. The diagnosis can be made by the finding of urine in the lumbar fossa by the IVU or the formation of a pseudocyst. In most cases, there is an absence of hematuria. Before 1950, nephrectomy was usually done but more recently pyeloureteral anastomosis has been successfully performed. The prognosis is more favorable if the pyelo-ureteral anastomosis is done during the first month after accident.F. Hsu and M. Bettex Longitudinal Ureteroplasty (Hendren’s Operation). G. Monfort, J. P. Giraud, 13. Unal, and M. Carcassonne. Ann. Chir. Inf. 12: 221-224,1971. The authors report 22 cases of longitudinal ureteroplasty: five aged over 2, II aged between 3 mo and 2 yr, and six under the age of 3 mo. The authors list the merits of Hendren’s operation, mentioning especially the possibility of using this method on infants. Of the first group of five children
260 of steroids, or renal function. Patients with steroid-resistant nephrotic syndrome have poor prognosis and the disease may recur in the transplants. Prolonged dialysis may reduce this tendency. Hypertension has been a problem during the postransplant period and requires vigorous antihypertensive measures to avoid central nervous system changes. Transplants performed in infants aged 2-4 mo were technically successful but one infant rejected the transplant 3 mo later and the other died suddenly on the second postransplant day. --Frank G. DeLuca
Cadaveric Renal Transplantation in Children. R. N. Fine, H. H. Edelbrock, L. B. Brennan, C. M. Grushkin, B. M. Korsch, H. Riddell, Q. Stiles, and E. Lieberman. Lancet 1:1087-1091 (May), 1971.
Although cadaveric renal transplantation is an accepted method of treatment for endstage renal disease in adults, its use in the treatment of uremic children is still controversial. In a study of 29 children aged 18 mo to 18 yr., 32 cadaveric renal transplants were made between February 1968 and August 1970. Twenty-five children (86%) and 22 allograFts are surviving 6-32 mo after transplantation. Ten kidneys were lost. Six were removed for irreversible rejection: one for hyperacute rejection, three for acute rejection within 2 mo of transplantation, and two for chronic rejection 17 mo after transplantation. Three kidneys were lost because the recipients died from causes unrelated to rejection: two allografts were functioning and one patient was recovering from acute tubular necrosis at the time of death. The tenth allograft was removed 1 hr after transulantation because of functional venous obstruction. Six children received second allografts from a cadaver donor. Three had previously rejected a parental donor transplant and one had a previous cadaver al!ograft removed for technical reasons. Four of the six second allografts are surviving 6-21 mo after transplantation with excellent function. Two second transplants were removed for rejection. Details of transplantation, histocompatibility, and growth of recipients are given.W. M. Dennison
Experimental
Bridging
of Ureteral
Defects
by Free Ureteral Grafts: A Study in Dogs. R. S. Sethi, Amarjit Singh, and Waryam Singh. Ind. J. Surg. 32:358-364 (July), 1970. Twenty-four mongrel dogs were nephrectomized on one side, and free autogenous ureteral grafts 3.5 cm in length were used to bridge the ureteral defect of the same length on the other side. They were divided into three groups. In one no attempt was made to improve the blood. supply of the graft; in the second group the graft was wrapped in omentum; and in the third group it was tunneled subserously through the wall of the sigmoid colon. Results were best in the last group.-R. K. Gandhi Closed Traumatic Rupture of the Upper Ureter in Children. M. Lacheretz, M. Lejeune, D. Barberis, and J. De/hay, Ann. Chir. Inf. 12:125-132, 1971. The authors report a case of traumatic rupture of the upper ureter following a traffic accident in a child aged 7 yr. Ureteral rupture following abdominal contusion is rare. Only 23 cases have been reported in the past 20 yr, of which nine were younger than 10 yr of age. The ureteral rupture is always accompanied by polytraumatism. The diagnosis is very difficult, as the symptoms are latent. The diagnosis can be made by the finding of urine in the lumbar fossa by the IVU or the formation of a pseudocyst. In most cases, there is an absence of hematuria. Before 1950, nephrectomy was usually done but more recently pyeloureteral anastomosis has been successfully performed. The prognosis is more favorable if the pyelo-ureteral anastomosis is done during the first month after accident.F. Hsu and M. Bettex Longitudinal Ureteroplasty (Hendren’s Operation). G. Monfort, J. P. Giraud, 13. Unal, and M. Carcassonne. Ann. Chir. Inf. 12: 221-224,1971. The authors report 22 cases of longitudinal ureteroplasty: five aged over 2, II aged between 3 mo and 2 yr, and six under the age of 3 mo. The authors list the merits of Hendren’s operation, mentioning especially the possibility of using this method on infants. Of the first group of five children