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Pathologic Significance of Nephromegaly in Pediatric Disease
1490
PEDIATRIC UROLOGY
ureteropelvic junction obstruction and 8 had bilateral disease (ureteropelvic junction obstruction in 5, posterior urethral valves in 1, bilateral reflux in 1 and unilateral ureteropelvic junction obstruction with contralateral multicystic dysplasia in 1). In addition to the usual serum studies the authors examined plasma aldosterone and plasma renin activity with commercially available radioimmunoassays. They found significantly higher serum potassium and plasma aldosterone concentrations in the study group. Persistent distal tubular resistance to aldosterone is derived from the urinary obstruction and it is not reversed by surgical correction of the obstruction. Persistent hyperkalemia has been described in young rats after relief of experimental ureteral obstruction but this finding has not been described previously in humans. G. F. S. 2 figures, 1 table, 9 references
Pathologic Significance of N ephromegaly in Pediatric Disease A. N. BRENBRIDGE, R. L. CHEVALIER, S. EL-DAHR AND D. L. KAISER, Departments of Radiology, Pediatrics and Internal Medicine, University of Virginia Medical Center, Charlottesville, Virginia
Amer. J. Dis. Child., 141: 652-654 (June) 1987 Ultrasound of the kidneys is performed easily in children to obtain renal volume and length. Since measurements may be taken sequentially it may provide a potential method to assess the severity and progression or regression of renal disease. The authors evaluated 59 children with renal ultrasound followed by renal biopsy. No patient had decreased volume or length of the kidney. No correlation could be made between the volume or length of the kidney and either the severity of the disease or type of pathological change found on biopsy. Although the authors did not address the association between severity of disease and volume loss as usually seen in chronic diseases, they conclude that nephromegaly is not an index of the severity of disease. R. K. 1 figure, 4 tables, 14 references
Does an Expanding Fetal Abdominal Mass Produce Pulmonary Hypoplasia? L.
M. R. HARRISON, A. W. FLAKE AND T. R. Fetal Treatment Program, Department of Surgery, University of California, San Francisco, California and the Department of Surgery, Medical College of Virginia, Richmond, Virginia SAUER,
KRUMMEL,
J. Ped. Surg., 22: 508-512 (June) 1987
To investigate the mechanisms by which urinary tract obstruction leads to pulmonary hypoplasia, abdominal masses were produced in fetal rabbits at 24 days of gestation by 2 methods. In 1 group the bladder neck of the fetus was obstructed with a surgical clip, while in the other a small piece of a synthetic polymer that expands 50 times in volume during a 1-week period was placed intraperitoneally. In both groups the fetuses were returned to the uterus postoperatively and carried to term. An abdominal mass of equivalent size was produced in the abdomen of both groups of animals, 1 secondary to an obstructed bladder and 1 to the expanded polymer but only in the group with the obstructed bladder and oligohydramnios was pulmonary hypoplasia noted.
The study gives credence to the belief that the oligohydramnios resulting from the urinary tract obstruction and not the abdominal mass compressing the lungs gives rise to the pulmonary hypoplasia. Based on these findings prenatal intervention because of abdominal distension in the absence of oligohydramnios is not believed to be justified to protect the fetus from the development of pulmonary hypoplasia. T. D. A. 4 figures, 1 table, 24 references
Testicular Histology in the Adolescent With a Varicocele
E. J. KASS, R. S. CHANDRA AND A. B. BELMAN, Departments of Urology, Pathology, and Child Health and Development, Children's Hospital National Medical Center and the George Washington School of Medicine and Health Sciences, Washington, D. C. Pediatrics, 79: 996-998 (June) 1987 Although as many as 39 per cent of all infertile men have a varicocele, few varicoceles are diagnosed before the patient is 10 years old. It is estimated that 15 per cent of all 15-year-old boys will have a varicocele and this prevalence approximates that of healthy men. To discern better the effects of adolescent varicoceles the authors biopsied the ipsilateral and contralateral testes of varicocele patients at ligation. In 14 of 24 patients biopsied the ipsilateral testis was normal histologically even though in 10 of these 14 patients the testicular volume was definitely less than that of the contralateral testes. Of 24 patients 10 had abnormal histological findings: 3 had severe tubular hypoplasia and germ cell maturation arrest, 4 had mild to moderate hypospermatogenesis, 1 had focal germ cell depletion, 1 had mild fibrosis and 1 had focal tubular atrophy believed to be secondary to previous testicular torsion. Biopsy of the contralateral normal testes demonstrated only minor histological changes. The results show that moderate to large varicoceles can be responsible for impaired testicular histology and that surgical correction of the varicocele is warranted. G. F.S. 1 figure, 16 references
Editorial comment. These authors I believe were the first to report lack of growth in the adolescent testis associated with an ipsilateral varicocele. Repair of the varicocele makes good sense in such circumstances. The authors now report maturation arrest in the testis subtended by a varicocele that appears to be reversible by varicocele ligation. A clear case is made for varicocele ligation in such patients. L. R. K. Diagnosis and Management of Hydrohematometrocolpos Syndromes
B. TRAN, R. M. ARENSMAN AND K. W. FALTERMAN, Department of General Surgery, Division of Pediatric Surgery, Louisiana State University Medical Center, and Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, Louisiana
A. T.
Amer. J. Dis. Child., 141: 632-634 (June) 1987 Ten cases of hydrohematometrocolpos during a IO-year review are presented. Hydrohematometrocolpos caused by an imperforate hymen or vaginal membrane may present in the newborn as a bulging cystic mass at the introitus. This condition may include an easily palpable abdominal mass. In contrast, vaginal atresia does not present with a perinea! mass but
PEDIATRIC UROLOGY
ureteropelvic junction obstruction and 8 had bilateral disease (ureteropelvic junction obstruction in 5, posterior urethral valves in 1, bilateral reflux in 1 and unilateral ureteropelvic junction obstruction with contralateral multicystic dysplasia in 1). In addition to the usual serum studies the authors examined plasma aldosterone and plasma renin activity with commercially available radioimmunoassays. They found significantly higher serum potassium and plasma aldosterone concentrations in the study group. Persistent distal tubular resistance to aldosterone is derived from the urinary obstruction and it is not reversed by surgical correction of the obstruction. Persistent hyperkalemia has been described in young rats after relief of experimental ureteral obstruction but this finding has not been described previously in humans. G. F. S. 2 figures, 1 table, 9 references
Pathologic Significance of N ephromegaly in Pediatric Disease A. N. BRENBRIDGE, R. L. CHEVALIER, S. EL-DAHR AND D. L. KAISER, Departments of Radiology, Pediatrics and Internal Medicine, University of Virginia Medical Center, Charlottesville, Virginia
Amer. J. Dis. Child., 141: 652-654 (June) 1987 Ultrasound of the kidneys is performed easily in children to obtain renal volume and length. Since measurements may be taken sequentially it may provide a potential method to assess the severity and progression or regression of renal disease. The authors evaluated 59 children with renal ultrasound followed by renal biopsy. No patient had decreased volume or length of the kidney. No correlation could be made between the volume or length of the kidney and either the severity of the disease or type of pathological change found on biopsy. Although the authors did not address the association between severity of disease and volume loss as usually seen in chronic diseases, they conclude that nephromegaly is not an index of the severity of disease. R. K. 1 figure, 4 tables, 14 references
Does an Expanding Fetal Abdominal Mass Produce Pulmonary Hypoplasia? L.
M. R. HARRISON, A. W. FLAKE AND T. R. Fetal Treatment Program, Department of Surgery, University of California, San Francisco, California and the Department of Surgery, Medical College of Virginia, Richmond, Virginia SAUER,
KRUMMEL,
J. Ped. Surg., 22: 508-512 (June) 1987
To investigate the mechanisms by which urinary tract obstruction leads to pulmonary hypoplasia, abdominal masses were produced in fetal rabbits at 24 days of gestation by 2 methods. In 1 group the bladder neck of the fetus was obstructed with a surgical clip, while in the other a small piece of a synthetic polymer that expands 50 times in volume during a 1-week period was placed intraperitoneally. In both groups the fetuses were returned to the uterus postoperatively and carried to term. An abdominal mass of equivalent size was produced in the abdomen of both groups of animals, 1 secondary to an obstructed bladder and 1 to the expanded polymer but only in the group with the obstructed bladder and oligohydramnios was pulmonary hypoplasia noted.
The study gives credence to the belief that the oligohydramnios resulting from the urinary tract obstruction and not the abdominal mass compressing the lungs gives rise to the pulmonary hypoplasia. Based on these findings prenatal intervention because of abdominal distension in the absence of oligohydramnios is not believed to be justified to protect the fetus from the development of pulmonary hypoplasia. T. D. A. 4 figures, 1 table, 24 references
Testicular Histology in the Adolescent With a Varicocele
E. J. KASS, R. S. CHANDRA AND A. B. BELMAN, Departments of Urology, Pathology, and Child Health and Development, Children's Hospital National Medical Center and the George Washington School of Medicine and Health Sciences, Washington, D. C. Pediatrics, 79: 996-998 (June) 1987 Although as many as 39 per cent of all infertile men have a varicocele, few varicoceles are diagnosed before the patient is 10 years old. It is estimated that 15 per cent of all 15-year-old boys will have a varicocele and this prevalence approximates that of healthy men. To discern better the effects of adolescent varicoceles the authors biopsied the ipsilateral and contralateral testes of varicocele patients at ligation. In 14 of 24 patients biopsied the ipsilateral testis was normal histologically even though in 10 of these 14 patients the testicular volume was definitely less than that of the contralateral testes. Of 24 patients 10 had abnormal histological findings: 3 had severe tubular hypoplasia and germ cell maturation arrest, 4 had mild to moderate hypospermatogenesis, 1 had focal germ cell depletion, 1 had mild fibrosis and 1 had focal tubular atrophy believed to be secondary to previous testicular torsion. Biopsy of the contralateral normal testes demonstrated only minor histological changes. The results show that moderate to large varicoceles can be responsible for impaired testicular histology and that surgical correction of the varicocele is warranted. G. F.S. 1 figure, 16 references
Editorial comment. These authors I believe were the first to report lack of growth in the adolescent testis associated with an ipsilateral varicocele. Repair of the varicocele makes good sense in such circumstances. The authors now report maturation arrest in the testis subtended by a varicocele that appears to be reversible by varicocele ligation. A clear case is made for varicocele ligation in such patients. L. R. K. Diagnosis and Management of Hydrohematometrocolpos Syndromes
B. TRAN, R. M. ARENSMAN AND K. W. FALTERMAN, Department of General Surgery, Division of Pediatric Surgery, Louisiana State University Medical Center, and Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, Louisiana
A. T.
Amer. J. Dis. Child., 141: 632-634 (June) 1987 Ten cases of hydrohematometrocolpos during a IO-year review are presented. Hydrohematometrocolpos caused by an imperforate hymen or vaginal membrane may present in the newborn as a bulging cystic mass at the introitus. This condition may include an easily palpable abdominal mass. In contrast, vaginal atresia does not present with a perinea! mass but