intervention can be avoided in most instances. (8) Regular follow-up studies are mandatory (sonography, radiography, endoscopy, urodynamics).-Thomas A. Angerpointner
J Neural Neurosurg
Psychiatry 52:778-781, (June), 1989. Single-Stage
J Urol 143:776-778, (April), 1990.
The authors present a modified technique for feminization genitoplasty, which combines the main features of the Hendren and Crawford pull-through operation and the Kogan reduction clitoroplasty. The unique features of the operation are (1) the use of a flap of preputial skin to construct the vestibule and the anterior vaginal wall, and (2) the universal use of the urogenital sinus to form the distal urethra, which avoids creation of female hypospadias. The new introitus is ample, and because there is no cut-back of the urogenital sinus, accidental incision of the urethral sphincter with the resultant potential for urinary incontinence are avoided. There is no pullthrough of the vagina because the introitus is created by mobilization of anterior and posterior skin flaps. The clitoris and neourethra are exteriorized through the folded preputial skin, which simulates normal female anatomy. The cosmetic and functional results in nine children who have undergone this procedure have been excellent.George
Br J Urol65:164-
167, (February), 1990. The urodynamic findings in 214 patients with congenital neuropathic lower urinary tract dysfunction were studied, and it was found that the intermediate type is more common. The acontractile group accounts for only 9% and commonly requires surgical treatment (artificial urinary sphincter). The intermediate group accounts for 60% of patients and usually requires surgery. A clam ileocystoplasty alone is performed if there is no significant sphincter weakness incontinence. A “clam and cuff’ procedure is performed with implantation of the remainder of artificial urinary sphincter at a later date (if required) in cases with sphincter weakness incontinence. The contractile group accounts for 31% of patients and rarely requires surgery.-Amir
in The patients.
J Urol 143:779-782, (April),
A 16-year-old boy and a 17-year-old girl underwent successful closure of a meningomyelocele defect in childhood but continued to suffer incontinence of stool and urine. After a 5-day trial with percutaneous electrostimulation of the pudendal nerve, both patients received permanent neuroprosthetic implants. They became completely continent of stool and exhibited greater than 90% improvement in urinary control. These patients demonstrate that there is a small subset of meningomyelocele patients who, despite absence of spontaneous reflex tonus in the urinary and bowel sphincters, nevertheless have preserved motor capabilities.-George Holcomb, Jr. Fibroepithelial
in a Solitary
Clin Radio1 41:21 l-213, (March),
1990. This is the first reported case of congenital mesoblastic nephroma arising in a solitary kidney. The literature and radiological features are reviewed.-Amir Azmy Mesenchymal
et al. Br J Urol 65:214-216,
Arch Surg 125:598-600,
(May), 1990. During the past 35 years, 18 patients were observed with mesenchymal hamartoma of the liver. The mean age at presentation was 16 months. Thirteen patients presented with increasing abdominal distention, and physical examination showed an abdominal mass or hepatomegaly. Ultrasonography and computed tomography were most useful in diagnosis. Fourteen patients underwent resection; nine underwent hepatic resection and five underwent excision of the tumor only. One patient had marsupialization, one underwent biopsy only, and two were found incidentally at autopsy. Thirteen patients were available for follow-up and all were alive and well 1 month to 24 years after diagnosis. Recurrence or malignant transformation was not noted. Complete tumor excision is recommended with expectation of complete recovery.-George A. Rowe Leukemia
J.R. W. Parry,
Three adults with seizures arising during childhood were eventually diagnosed as having benign brain tumors. Because diagnosis was late, these were mainly incompletely excised in adult life, and the patients continued to have either seizures and/or neurological deficits. The authors postulate that the prognosis would have been improved with earlier diagnosis by computed tomography or magnetic resonance imaging scan. Benign supratentorial tumors have a favorable outcome if diagnosed early.--R.J. Brereton
N Engl J Med 322:7-13, (January), 1990.
An international collaborative group of cancer registries and hospitals was used to investigate the effect of different treatments for Hodgkin’s disease on the risk of leukemia. A case-control study format was used involving 163 cases of leukemia following treatment for Hodgkin’s disease, in which for each case patient with leukemia, three matched controls were chosen who had been treated for Hodgkin’s disease but in whom leukemia did not develop. The use of chemotherapy alone to treat Hodgkin’s disease was associated with a markedly increased risk of leukemia as compared with the use of radiotherapy alone. The peak of leukemia came about 5 years after chemotherapy began, and a large excesspersisted for at least 8 years after it ended. Another interesting finding was that patients who had undergone splenectomy had at least double the risk of leukemia of patients who had not. In addition, an advanced stage of Hodgkin’s disease carried a somewhat higher risk of leukemia than stage I disease.-N. Scott Adzick
(February), 1990. This is a report of two children aged 5 years who had fibroepithelial polyps at the pelviureteric junction. Resection of the polyps and dismembered pyeloplasty was successfully performed in both of them.-Amir
2 Kinderchir 45:52-55, (February), 1990.
Carcinoma of the breast in children is an extremely rare disease, only 44 cases having been reported in the literature. The authors add