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Exstrophy of the cloaca
months. Vesico-nrctcric reHI1x was prt’vented in all. LJrinar\ infection disappeared in 31 children. Iniravenolls pyelograph! showed obstruction onlv in :L sinsle case, who had to be re-oper~~ted. These remarkable results are due iu a great part to the x’er\ careful choice of the patients (“itliopachic” reHnx) and to the ver\. selective intlicatiou for slqerv.--XI. RcMex.
III 15 )‘ears 80 have been treated.
cases of ec:opin vesicae of which 39 were coo-
sidered unsuitable for primary repair because the bladder was small or its muco:sa polypoid. In most of the remaining 51 cases operation was done between 6 and 12 lnonths of age. The reconstruction has been preceded b! a bilateral iliac osteotonly dnring the past 10 years to allow approximation of the pubic bone. There were 2 deaths. breakdown of thr wound or fistula were the most common early complications (in 9 cases). Five patients (4 girls) were considered continent. In future the operation will be done only on a selected group of patients.--R. R. Znchq.
In an effort to improve npon ileal loop for urinar\~ diversion.
the classical this limited
rspcrinlentnl surviving
stlltlv 02 22 mongrel dogs (1:3 the opcarative procedure) presents an intriglling and possible significant step forward. In an effort tk overcome the secretor\ ant1 al)sorpti\ c capacit\ of i1orI11a1 ilral lIIIIcos;I, the authors I”‘?pared ileal loops dennded of mucosa and
strldied the absorptive capacitv of the new]\ created loops. Interestingly kongh if adic1nate stripping of the mucosa (the musc11laris m~~cosa had to I,e stripped to insure against return of nonllal intestinal mllcosa) a neo-epithelium of ;I transitional-type regenerated. This regeneration occurred whether or not nrine was in contact with the reslllting seronlIIscnlar tube. The nroc@heliurn ot a transitional-type failed to real)sorb to the degree that the normal ilral n~I~cosi\ absorbed as shown b\, absorption studies using tritiatetl labeled water which was perfused through the experimental loops. Excellent photomicrographs accompan! the article. Ilowever. line drawings of the operative technic are too small to be anything nlore than of limited value. The bibliographyis far from complete. The significance of this paper lies with the demonstration of the development of ;I irt,o-epithelilm) of a transitional nature at least in the canine. Intriguing will be the next step to demonstrate the same tion in the hllman sllhjwt.-Rohcrt
regeneraJ. Ixnlt.
.lr. bK:OSSTHUCTIOS
OF
THb
~X!,TROPHIEI)
Innes Williams ~1~1 J. S~~cug:(~.Brit. J. Snrg. 53:168. hfarch 196fi.
BLADDER.
D.
The \troph\
pathologic ;ltlato:nv of cloaca1 cxis tlescribc~tl. Thr .lllost satisfactor\ rxplalktion of the enlbrvoqenesis is that drI hiscence of an abllormall\~ extensive cloaca1
nrembrane occurs before the formation of the lmxectal septum at the 5 mm. stage leading to the formation of a central bowel field between 2 bladder fields. Dehiscence at a later stage. after the completion of the Irrorectal septum leads to exstrophy of the bladder. Three cases are described which represent the ocutrrence of exstrophy at an intermediate stage. In these, the esstrophic bowel In\ caudul to the exstrophic bladdel with thi genitalia between them.--J, H. Johnsto,~.
HEAIATUHIA
CAUSEIJ
1%~ VAHICELLA
STOM 1s THY BI.ADDER. A. J.A.M.A. 196:450, May 1968.
U.
I,EAmar.
In a 5 !-ear old boy with hrmatlnk, frec(uency, and dysuria, 9 days after the appearance of a varicelln rash. cl stoscopy re\-e&d 5 to 7 mm. ring-shaped ecchymoses. several with sloughing centers. Similar le
III 15 )‘ears 80 have been treated.
cases of ec:opin vesicae of which 39 were coo-
sidered unsuitable for primary repair because the bladder was small or its muco:sa polypoid. In most of the remaining 51 cases operation was done between 6 and 12 lnonths of age. The reconstruction has been preceded b! a bilateral iliac osteotonly dnring the past 10 years to allow approximation of the pubic bone. There were 2 deaths. breakdown of thr wound or fistula were the most common early complications (in 9 cases). Five patients (4 girls) were considered continent. In future the operation will be done only on a selected group of patients.--R. R. Znchq.
In an effort to improve npon ileal loop for urinar\~ diversion.
the classical this limited
rspcrinlentnl surviving
stlltlv 02 22 mongrel dogs (1:3 the opcarative procedure) presents an intriglling and possible significant step forward. In an effort tk overcome the secretor\ ant1 al)sorpti\ c capacit\ of i1orI11a1 ilral lIIIIcos;I, the authors I”‘?pared ileal loops dennded of mucosa and
strldied the absorptive capacitv of the new]\ created loops. Interestingly kongh if adic1nate stripping of the mucosa (the musc11laris m~~cosa had to I,e stripped to insure against return of nonllal intestinal mllcosa) a neo-epithelium of ;I transitional-type regenerated. This regeneration occurred whether or not nrine was in contact with the reslllting seronlIIscnlar tube. The nroc@heliurn ot a transitional-type failed to real)sorb to the degree that the normal ilral n~I~cosi\ absorbed as shown b\, absorption studies using tritiatetl labeled water which was perfused through the experimental loops. Excellent photomicrographs accompan! the article. Ilowever. line drawings of the operative technic are too small to be anything nlore than of limited value. The bibliographyis far from complete. The significance of this paper lies with the demonstration of the development of ;I irt,o-epithelilm) of a transitional nature at least in the canine. Intriguing will be the next step to demonstrate the same tion in the hllman sllhjwt.-Rohcrt
regeneraJ. Ixnlt.
.lr. bK:OSSTHUCTIOS
OF
THb
~X!,TROPHIEI)
Innes Williams ~1~1 J. S~~cug:(~.Brit. J. Snrg. 53:168. hfarch 196fi.
BLADDER.
D.
The \troph\
pathologic ;ltlato:nv of cloaca1 cxis tlescribc~tl. Thr .lllost satisfactor\ rxplalktion of the enlbrvoqenesis is that drI hiscence of an abllormall\~ extensive cloaca1
nrembrane occurs before the formation of the lmxectal septum at the 5 mm. stage leading to the formation of a central bowel field between 2 bladder fields. Dehiscence at a later stage. after the completion of the Irrorectal septum leads to exstrophy of the bladder. Three cases are described which represent the ocutrrence of exstrophy at an intermediate stage. In these, the esstrophic bowel In\ caudul to the exstrophic bladdel with thi genitalia between them.--J, H. Johnsto,~.
HEAIATUHIA
CAUSEIJ
1%~ VAHICELLA
STOM 1s THY BI.ADDER. A. J.A.M.A. 196:450, May 1968.
U.
I,EAmar.
In a 5 !-ear old boy with hrmatlnk, frec(uency, and dysuria, 9 days after the appearance of a varicelln rash. cl stoscopy re\-e&d 5 to 7 mm. ring-shaped ecchymoses. several with sloughing centers. Similar le