- Email: [email protected]
Neonatal testicular torsion and infarction: Aetiology and management
886
INTERNATIONAL ABSTRACTS
New Method of Hepatocyte Transplantation and Extracorporeal Liver Support. ,4.A. Demetriou, J. Whiting, S.M. Levenson, et el.
Fertility Rates in Female Patients With Congenital Adrenal Hyperplasia Due to 21-Hydroxylase Deficiency. R.M. Mulaikal. CJ.
Ann Surg 204:259-271, (September), 1986.
Migeon, and J.A. Rock. N Engl J Med 316:178-182, (January 22), 1987.
A technique has been developed that allows hepatocyte attachment on collagen-coated microcarriers resulting in prolonged hepatocyte viability and function both in vivo and in vitro. Isolated hepatocytes, harvested from normal rat livers by portal vein collagenase perfusion, can be attached to collagen-coated dextran microcarriers and transplanted by intraperitoneal injection into rats. Survival and function of the transplanted hepatocytes have been demonstrated in mutant rats lacking bilirubin-uridine diphosphate glueuronosyltransferase activity (Gunn strain). An extracorporeal liver perfusion system was devised, using the microcarrier-attached hepatocytes, that was capable of synthesizing and conjugating bilirubin and synthesizing liver-specific proteins. These techniques promise to be useful in the treatment of children with acute hepatic insutficiency.---Scott Adzick The Prenatal Diagnosis of Ventral Abdominal Wall Defects. S.
Hasan and M.C. Hermansen. Am J Obstet Gynecol 155:842-845, (October), 1986. This review of 47 infants with ventral defects was designed to determine the effect of prenatal diagnosis on neonatal outcome. All nine infants with prenatal diagnosis were delivered by cesarean section at tertiary level hospitals. Only 13 (34%) of 38 infants with unsuspected defects were delivered by cesarean section and 15 (39%) were delivered at tertiary level hospitals. There was no difference in mortality between infants with prenatal diagnosis (44%) and those with unsuspected defects (37%). Increased mortality correlated with the presence of other major anomalies (79% mortality), with birth weight < 1,500 g (80%), and with omphaloceles (65%). The results of the study have led the authors to question the usual procedure wherein prenatal diagnosis of a ventral wall defect is invariably followed by cesarean delivery.--Scott Adzick
GENITOURINARY TRACT Neonatal Testicular Torsion and Infarction: Aetiology and Managemont. D.M. Burge. Br J Urol 59:70-73, (January), 1987.
Thirty neonates presented with signs of testicular ischemia over a 20-year period. Eighteen children had primary exploration revealing extravaginal torsion (10), intravaginal torsion (3), infarction without torsion (2), and torsion of the appendix testis (l). The other two children had simple biopsy of necrotic testes. In two instances, the testis was untwisted and retained, but both subsequently atrophied. The remainder underwent orchidectomy. Twelve children did not have initial exploration, and I 1 of these had subsequent testicular atrophy. At eontralateral testis fixation performed in 17 eases, signs of contralateral involvement in the ischemia process were found in seven, suggesting that the primary event in the condition is infarction, with torsion occurring secondarily.--Prem Pur Scope and Limitations of the MAGPI Hypospadias Repair. H.A.
Ozen andtt. Whitaker. Br J Urol 59:81-83, (January), 1987. Results and complications are reported in 67 boys who underwent a modified MAGPI procedure for hypospadias between 1981 and 1986. Excellent cosmetic and functional results were achieved in 91% of the patients. Some degree of chordee can be corrected by this procedure, but severe degrees of chordee were associated with an increased complication rate.--Prem Purl
Of 158 female patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency, 80 were available for study as to fertility. Forty had the simple virilizing form, and 40 had the salt-losing form. The final adult height of 156.8 _+ 1.1 em was significantly greater in the salt-losing form than in the simple virilizing form (153.3 +_ 0.9 cm). The status of the introitus seemed to have a more important role in sexual activity than did the degree of prenatal exposure to androgen, which was highest in the salt-losing form. Fifty-two reported having an adequate introitus and vagina, 33 (83%) with the simple virilizing form, and 19 (48%) with the salt-losing form. Of those who had intercourse (15 of 25 patients with the simple virilizing form), 25 pregnancies resulted in 20 normal children. Only one of 15 women with the salt-losing form became pregnant, and this pregnancy was aborted electively. Low fertility was felt to be related to several factors: (1) noncompliance with therapy as suggested by hirsutism and poor endocrine follow-up in 25% of patients; (2) 49 patients had regular menstrual periods, 14 had irregular periods, I 0 amenorrhea, five had undergone hysterectomy, and two had entered menopause; (3) 87% of patients with salt-loss and 50% with simple virilization had remained single; (4) the vaginal introitus was reported to be inadequate for intercourse by 35% of patients, (53% with salt-loss and 18% with simple virilization; (5) heterosexual activity was reported less frequently among patients with an inadequate introitus. This experience indicates that improved surgical correction of the vaginal introitus and better follow-up with better compliance with therapy will be necessary to improve fertility rates in these women.--Eugene S. Wiener Didelphys With Unilateral Vaginal Obstruction and Ipsilateral Renal Agenesis--Neonatal Management. LS. Reid. Pediatr Surg
lnternat 1:254-256, (November), 1986. The syndrome of duplication of the uterovaginal tract with unilateral vaginal obstruction and ipsilateral renal agenesis is well described as presenting in the teenage female with hematometrocolpos. The author presents two patients who were diagnosed in the neonatal period when they presented with perineal cystic swellings. The patent vagina was seen as a slit-like opening on the side of the cyst. Diagnosis is made by vaginogram through this slit and injection of radioopaque material into the cyst. Intravenous pyelography is essential. Management is by simple "deeapping" of the cyst and vaginal dilatations.--Prem Puri Trans Appendix Continent Vesicostomy. A Study About 30 Cases.
P. Mollard, T. Basset, and P. Mouriquand. Chir P~diatr 27:121123, (May), 1986. Continent vesicostomy using the appendix (Mitrofanoff's technique) was performed in 30 children with myelomeningocele. After closure of the bladder neck and mobilization of the bladder, vascularized appendix was implanted in the posterolateral bladder wall with a large and long antireflux submucosal tunnel. The other end of appendix was anchored to the skin. The follow-up was 1 to 7 years. Twenty-six patients are well with normal kidneys (86%). All are continent, but the rate of complications (77%) was high: eight leakages through the bladder neck with three single reoperations and five double reoperations. Ten ureterohydronephroses related to a small and hypertonie bladder necessitating 11 secondary enterocystoplasties, five lithiasis, and two perforations of the intestinal conduit are also reported. Three stenoses of the cutaneous stoma have been
INTERNATIONAL ABSTRACTS
New Method of Hepatocyte Transplantation and Extracorporeal Liver Support. ,4.A. Demetriou, J. Whiting, S.M. Levenson, et el.
Fertility Rates in Female Patients With Congenital Adrenal Hyperplasia Due to 21-Hydroxylase Deficiency. R.M. Mulaikal. CJ.
Ann Surg 204:259-271, (September), 1986.
Migeon, and J.A. Rock. N Engl J Med 316:178-182, (January 22), 1987.
A technique has been developed that allows hepatocyte attachment on collagen-coated microcarriers resulting in prolonged hepatocyte viability and function both in vivo and in vitro. Isolated hepatocytes, harvested from normal rat livers by portal vein collagenase perfusion, can be attached to collagen-coated dextran microcarriers and transplanted by intraperitoneal injection into rats. Survival and function of the transplanted hepatocytes have been demonstrated in mutant rats lacking bilirubin-uridine diphosphate glueuronosyltransferase activity (Gunn strain). An extracorporeal liver perfusion system was devised, using the microcarrier-attached hepatocytes, that was capable of synthesizing and conjugating bilirubin and synthesizing liver-specific proteins. These techniques promise to be useful in the treatment of children with acute hepatic insutficiency.---Scott Adzick The Prenatal Diagnosis of Ventral Abdominal Wall Defects. S.
Hasan and M.C. Hermansen. Am J Obstet Gynecol 155:842-845, (October), 1986. This review of 47 infants with ventral defects was designed to determine the effect of prenatal diagnosis on neonatal outcome. All nine infants with prenatal diagnosis were delivered by cesarean section at tertiary level hospitals. Only 13 (34%) of 38 infants with unsuspected defects were delivered by cesarean section and 15 (39%) were delivered at tertiary level hospitals. There was no difference in mortality between infants with prenatal diagnosis (44%) and those with unsuspected defects (37%). Increased mortality correlated with the presence of other major anomalies (79% mortality), with birth weight < 1,500 g (80%), and with omphaloceles (65%). The results of the study have led the authors to question the usual procedure wherein prenatal diagnosis of a ventral wall defect is invariably followed by cesarean delivery.--Scott Adzick
GENITOURINARY TRACT Neonatal Testicular Torsion and Infarction: Aetiology and Managemont. D.M. Burge. Br J Urol 59:70-73, (January), 1987.
Thirty neonates presented with signs of testicular ischemia over a 20-year period. Eighteen children had primary exploration revealing extravaginal torsion (10), intravaginal torsion (3), infarction without torsion (2), and torsion of the appendix testis (l). The other two children had simple biopsy of necrotic testes. In two instances, the testis was untwisted and retained, but both subsequently atrophied. The remainder underwent orchidectomy. Twelve children did not have initial exploration, and I 1 of these had subsequent testicular atrophy. At eontralateral testis fixation performed in 17 eases, signs of contralateral involvement in the ischemia process were found in seven, suggesting that the primary event in the condition is infarction, with torsion occurring secondarily.--Prem Pur Scope and Limitations of the MAGPI Hypospadias Repair. H.A.
Ozen andtt. Whitaker. Br J Urol 59:81-83, (January), 1987. Results and complications are reported in 67 boys who underwent a modified MAGPI procedure for hypospadias between 1981 and 1986. Excellent cosmetic and functional results were achieved in 91% of the patients. Some degree of chordee can be corrected by this procedure, but severe degrees of chordee were associated with an increased complication rate.--Prem Purl
Of 158 female patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency, 80 were available for study as to fertility. Forty had the simple virilizing form, and 40 had the salt-losing form. The final adult height of 156.8 _+ 1.1 em was significantly greater in the salt-losing form than in the simple virilizing form (153.3 +_ 0.9 cm). The status of the introitus seemed to have a more important role in sexual activity than did the degree of prenatal exposure to androgen, which was highest in the salt-losing form. Fifty-two reported having an adequate introitus and vagina, 33 (83%) with the simple virilizing form, and 19 (48%) with the salt-losing form. Of those who had intercourse (15 of 25 patients with the simple virilizing form), 25 pregnancies resulted in 20 normal children. Only one of 15 women with the salt-losing form became pregnant, and this pregnancy was aborted electively. Low fertility was felt to be related to several factors: (1) noncompliance with therapy as suggested by hirsutism and poor endocrine follow-up in 25% of patients; (2) 49 patients had regular menstrual periods, 14 had irregular periods, I 0 amenorrhea, five had undergone hysterectomy, and two had entered menopause; (3) 87% of patients with salt-loss and 50% with simple virilization had remained single; (4) the vaginal introitus was reported to be inadequate for intercourse by 35% of patients, (53% with salt-loss and 18% with simple virilization; (5) heterosexual activity was reported less frequently among patients with an inadequate introitus. This experience indicates that improved surgical correction of the vaginal introitus and better follow-up with better compliance with therapy will be necessary to improve fertility rates in these women.--Eugene S. Wiener Didelphys With Unilateral Vaginal Obstruction and Ipsilateral Renal Agenesis--Neonatal Management. LS. Reid. Pediatr Surg
lnternat 1:254-256, (November), 1986. The syndrome of duplication of the uterovaginal tract with unilateral vaginal obstruction and ipsilateral renal agenesis is well described as presenting in the teenage female with hematometrocolpos. The author presents two patients who were diagnosed in the neonatal period when they presented with perineal cystic swellings. The patent vagina was seen as a slit-like opening on the side of the cyst. Diagnosis is made by vaginogram through this slit and injection of radioopaque material into the cyst. Intravenous pyelography is essential. Management is by simple "deeapping" of the cyst and vaginal dilatations.--Prem Puri Trans Appendix Continent Vesicostomy. A Study About 30 Cases.
P. Mollard, T. Basset, and P. Mouriquand. Chir P~diatr 27:121123, (May), 1986. Continent vesicostomy using the appendix (Mitrofanoff's technique) was performed in 30 children with myelomeningocele. After closure of the bladder neck and mobilization of the bladder, vascularized appendix was implanted in the posterolateral bladder wall with a large and long antireflux submucosal tunnel. The other end of appendix was anchored to the skin. The follow-up was 1 to 7 years. Twenty-six patients are well with normal kidneys (86%). All are continent, but the rate of complications (77%) was high: eight leakages through the bladder neck with three single reoperations and five double reoperations. Ten ureterohydronephroses related to a small and hypertonie bladder necessitating 11 secondary enterocystoplasties, five lithiasis, and two perforations of the intestinal conduit are also reported. Three stenoses of the cutaneous stoma have been