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Experience with 60 consecutive hypospadias repairs using the Horton-Devine techniques
INTERNATIONAL ABSTRACTS Lack of Protection by Pneumococcal Vaccine after Splenoctomy in Mice Challenged with Aerosolized Pneumococci.
J. C. Herbert, R. L. Gamelli, J. D. Dickerman, et al. J Trauma 23:1-6, (January), 1983. In a study comparing survival after an aerosolized pneumococcal challenge, mice were initially divided into two groups: (1) spteneetomy with pneumococcal immunization 48 hours later and (2) sham operated. In a second experiment three groups underwent either splenectomy or sham operations and immunization two days later. Seven days later a group of sham-operated mice underwent splenectomy while others underwent another sham operation. In the first group of mice, mortality rates were as follows: (1) unimmunized, splenectomized 100%, (2) unimmunized 84%, (3) vaccine and sham operation 64%, (4) vaccine and splenectomy 96%. In the second group, mice immunized a week prior to splenectomy had a mortality similar to immunized shamoperated mice (25% versus 29%) and significantly less mortality than mice immunized after splenectomy (75%). At autopsy all mice succumbed to pulmonary pneumococcal infections. This study confirms the clinical studies in humans which reveal higher levels of protection when the pneumococcal vaccine is given prior to splenectomy.--Randall IV. Powell The Effects of Splenectomy and Splenic Implantation on Alveolar Macrophage Function. H, Shennib, R. Chiu, and
D. S. Mulder. J Trauma 23:7-12, (January), 1983. The authors report the decreased ability of pulmonary alveolar macrophages (AM) to phagocytize pneumococci type 14, 4 to 6 weeks after splenectomy in young rats by 15% and 30%, respectively. This decreased ability returned to normal as the rats grew to adulthood. There was no effect noted on pneumococci type 3, but the phagocytosis of Pseudomonas aeruginosa was also suppressed. This defect could be partially corrected by splenic implantation. The authors postulate that this modulatory effect on the pulmonary AM may explain the increased risks of invasive pneumococcal disease with decreased lung immune defense secondary to splenectomy.--Randall W. Powell
GENITOURINARY TRACT Bladder Capacity (Ounces) Equals Age (Years) Plus 2 Prodicts Normal Bladder Capacity and Aids in Diagnosis of Abnormal Voiding Patterns. R. M. Berger, M. Maize~s, G. C.
Moran, et al. J Urol 129:347-349, (February), 1983. Standardization of the bladder capacities of children will improve the precision of urodynamic evaluation. In an attempt to develop a practical guide to predict the normal bladder capacity during childhood, the bladder capacities of 132 children without a clinically abnormal pattern of voiding were measured. When the bladder capacities are correlated by age, the following linear relationship exists: normal bladder capacity (ounces) equals age (years) plus 2. The bladder capacities of 68 children with primary enuresis, frequency, or infrequent voiding were then measured. Children with clinically infrequent voiding demonstrated large bladder capacities, and those with frequency or enuresis demonstrated small baldder capacities when compared to normal children. The
649
formula appears to be a useful guide to predict normal bladder capacity by age and also to aid in the diagnosis of abnormal voiding patterns.--George Holcomb, Jr. Urologic Implications of the VATER Association. D. T.
Uehfing, E. Gilbert, and R. Chesney. J Urol 129:352-354, (February), 1983. Among 23 children with the VATER association, 21 had significant genitourinary involvement. The extent of these genitourinary anomalies is not generally appreciated. The principal renal anomalies were renal agenesis (7 cases), ureteropelvic junction obstruction (5 cases), crossed fused ectopia (5 cases), and severe reflux (9 cases). Since corrective urologic surgery is commonly beneficial for children with the VATER association, an early and appropriate urologic evaluation is indicated.--George Holeomb, Jr. Experience with 60 Consecutive Hypospadias Repairs Using the Horton-Devine Techniques. J. F. Redman. J Urol
129:115-118, (January), 1983. Sixty consecutive patients with hypospadias repair using the techniques of Horton and Devine are reported. The overall complication rate was 43.3%, with 28% of the patients requiring a second procedure to correct either a fistula or meatal stenosis. Second procedures were short and uncomplicated. Excellent functional and cosmetic results can be expected with these techniques.--George Holcomb, Jr. The Management of Distal Hypospadias with MeataI-Based, Vascularized Flaps. E. T. Gonza/es, Jr., K. .4. Veeraraghav-
an, andJ. Delaune. J Urol 129:119-120, (January), 1983. In 63 children distal hypospadias was repaired using a meatal-based, vascularized flap. An acceptable glandular meatus was achieved in 62 children. Complications requiring further operation occurred in five children (8%) and all were repaired successfully with only one other procedure. The technique has proved successful and rewarding in managing these distal lesions.--George Holcomb, Jr. Cowper's Syringocele: A Classification of Dilatations of Cowper's Gland Duct Based Upon Clinical Characteristics of 8 Boys- M. Maize/s, F. D. Stephens, L. R. King, et al.
J Urol 129:111-114, (January), 1983. The urethrographic and endoscopic characteristics of dilated Cowper's gland ducts noted in eight boys are grouped as a simple classification. The dilated Cowper's duct is referred to as a syringocele (Greek syringe-tube plus celeswelling). There are four groups of Cowper's syringoceles: (1) simple syringocele--a minimally dilated duct, (2) perforate syringocele--a bulbous duct that drains into the urethra via a patulous ostium and appears as a diverticulum, (3) imperforate syringocele--a bulbous duct that resembles a submucosal cyst and appears as a radiolucent mass, and (4) ruptured syringocele--the fragile membrane that remains in the urethra after a dilated duct ruptures. Marsupialization of the syringocele cures urinary infection and hematuria, but voiding symptoms may persist.--George Holcomb, Jr.
J. C. Herbert, R. L. Gamelli, J. D. Dickerman, et al. J Trauma 23:1-6, (January), 1983. In a study comparing survival after an aerosolized pneumococcal challenge, mice were initially divided into two groups: (1) spteneetomy with pneumococcal immunization 48 hours later and (2) sham operated. In a second experiment three groups underwent either splenectomy or sham operations and immunization two days later. Seven days later a group of sham-operated mice underwent splenectomy while others underwent another sham operation. In the first group of mice, mortality rates were as follows: (1) unimmunized, splenectomized 100%, (2) unimmunized 84%, (3) vaccine and sham operation 64%, (4) vaccine and splenectomy 96%. In the second group, mice immunized a week prior to splenectomy had a mortality similar to immunized shamoperated mice (25% versus 29%) and significantly less mortality than mice immunized after splenectomy (75%). At autopsy all mice succumbed to pulmonary pneumococcal infections. This study confirms the clinical studies in humans which reveal higher levels of protection when the pneumococcal vaccine is given prior to splenectomy.--Randall IV. Powell The Effects of Splenectomy and Splenic Implantation on Alveolar Macrophage Function. H, Shennib, R. Chiu, and
D. S. Mulder. J Trauma 23:7-12, (January), 1983. The authors report the decreased ability of pulmonary alveolar macrophages (AM) to phagocytize pneumococci type 14, 4 to 6 weeks after splenectomy in young rats by 15% and 30%, respectively. This decreased ability returned to normal as the rats grew to adulthood. There was no effect noted on pneumococci type 3, but the phagocytosis of Pseudomonas aeruginosa was also suppressed. This defect could be partially corrected by splenic implantation. The authors postulate that this modulatory effect on the pulmonary AM may explain the increased risks of invasive pneumococcal disease with decreased lung immune defense secondary to splenectomy.--Randall W. Powell
GENITOURINARY TRACT Bladder Capacity (Ounces) Equals Age (Years) Plus 2 Prodicts Normal Bladder Capacity and Aids in Diagnosis of Abnormal Voiding Patterns. R. M. Berger, M. Maize~s, G. C.
Moran, et al. J Urol 129:347-349, (February), 1983. Standardization of the bladder capacities of children will improve the precision of urodynamic evaluation. In an attempt to develop a practical guide to predict the normal bladder capacity during childhood, the bladder capacities of 132 children without a clinically abnormal pattern of voiding were measured. When the bladder capacities are correlated by age, the following linear relationship exists: normal bladder capacity (ounces) equals age (years) plus 2. The bladder capacities of 68 children with primary enuresis, frequency, or infrequent voiding were then measured. Children with clinically infrequent voiding demonstrated large bladder capacities, and those with frequency or enuresis demonstrated small baldder capacities when compared to normal children. The
649
formula appears to be a useful guide to predict normal bladder capacity by age and also to aid in the diagnosis of abnormal voiding patterns.--George Holcomb, Jr. Urologic Implications of the VATER Association. D. T.
Uehfing, E. Gilbert, and R. Chesney. J Urol 129:352-354, (February), 1983. Among 23 children with the VATER association, 21 had significant genitourinary involvement. The extent of these genitourinary anomalies is not generally appreciated. The principal renal anomalies were renal agenesis (7 cases), ureteropelvic junction obstruction (5 cases), crossed fused ectopia (5 cases), and severe reflux (9 cases). Since corrective urologic surgery is commonly beneficial for children with the VATER association, an early and appropriate urologic evaluation is indicated.--George Holeomb, Jr. Experience with 60 Consecutive Hypospadias Repairs Using the Horton-Devine Techniques. J. F. Redman. J Urol
129:115-118, (January), 1983. Sixty consecutive patients with hypospadias repair using the techniques of Horton and Devine are reported. The overall complication rate was 43.3%, with 28% of the patients requiring a second procedure to correct either a fistula or meatal stenosis. Second procedures were short and uncomplicated. Excellent functional and cosmetic results can be expected with these techniques.--George Holcomb, Jr. The Management of Distal Hypospadias with MeataI-Based, Vascularized Flaps. E. T. Gonza/es, Jr., K. .4. Veeraraghav-
an, andJ. Delaune. J Urol 129:119-120, (January), 1983. In 63 children distal hypospadias was repaired using a meatal-based, vascularized flap. An acceptable glandular meatus was achieved in 62 children. Complications requiring further operation occurred in five children (8%) and all were repaired successfully with only one other procedure. The technique has proved successful and rewarding in managing these distal lesions.--George Holcomb, Jr. Cowper's Syringocele: A Classification of Dilatations of Cowper's Gland Duct Based Upon Clinical Characteristics of 8 Boys- M. Maize/s, F. D. Stephens, L. R. King, et al.
J Urol 129:111-114, (January), 1983. The urethrographic and endoscopic characteristics of dilated Cowper's gland ducts noted in eight boys are grouped as a simple classification. The dilated Cowper's duct is referred to as a syringocele (Greek syringe-tube plus celeswelling). There are four groups of Cowper's syringoceles: (1) simple syringocele--a minimally dilated duct, (2) perforate syringocele--a bulbous duct that drains into the urethra via a patulous ostium and appears as a diverticulum, (3) imperforate syringocele--a bulbous duct that resembles a submucosal cyst and appears as a radiolucent mass, and (4) ruptured syringocele--the fragile membrane that remains in the urethra after a dilated duct ruptures. Marsupialization of the syringocele cures urinary infection and hematuria, but voiding symptoms may persist.--George Holcomb, Jr.