- Email: [email protected]
Post operative fatality in pediatric urology
ABSTRACTS
only one death, a patient with unilateral adrenal hemorrhage. All the infants were boys and the male preponderance of this disorder is discussed. The right side was more commonly affected than the left, a feature which has been noted in previous articles. There does not appear to be any single factor in the causation of this disorder. It is notable that six infants weighed over 3.5 kg at birth. only one was under 3 kg and the remaining one did not have birth weight recorded.--l). G. Young Two Cases of Masculinizing Adrenal Tumors in Infants. J. P&of. M. Mow-or. G. Lascombes and D. Olive. Ann. Chir. Infant 13: 3277338 (September/October), 1972. Two cases of masculinizing adrenal tumors in girls aged 6 and 15 mo, respectively, are presented. The first child presented with increased stature, virilization syndrome, and hypertension. Abdominal film revealed a spherical paravertebral mass with multiple calcifications. Intravenous pyelogram showed the mass to be suprarenal. All l7-ketosteroids were elevated, especially DHA and its precursors. Estrogens were also elevated although not pathologically. 17-OH steroids were abnormal by chromatography. Operation through a thoracophrenic laparotomy revealed a IO-cm encapsulated lobulated, supple, brown adrenocortical tumor which was very anaplastic by histology. Postoperatively the patient did well and all symptoms regressed. The second case was less obvious with only clitoral enlargement and some pubic hair growth. There was a palpable mass in the left hypochondrium. Only the l7ketosteroids were elevated at the upper limits of normal. Abdominal film and intravenous pyelogram showed a mass but were otherwise noncontributory. Arteriography did not further elucidate the problem. The patient was operated on through a left thoracophrenic laparotomy and a 6-cm. spherical, encapsulated. polylobulate. red tumor of the superior lobe of the left kidney was found and removed without difficulty. Biopsy revealed a malignant adrenocortical tumor. These cases are thought to be exemplary of various presentation and diagnosis of this tumor. Other diagnostic procedures such as Dexamethasone and ACTH stimulation for differential diagnosis are discussed as are histologic and therapeutic problems. -J. Daevq, Phaeochromocytoma in Childhood. Report of 3 Cases. M. J. Robinson. M. Kent. and J. Stocks.
849
Arch.
Dis.
Child.
48:137
142. (February),
1973. Two typical cases of phaeochromocytoma. one rn a 9-yr-old girl and the other in a 9-yr-old boy are described. The second child had a right adrenal tumor with paraaortic lymph nodes which also histologically had phaeochromocytoma in them. Five years later he had a left adrenal phaeochromocytoma. Three years after this he was restudied because of a persistent rise in catecholamine excretion. A tumor in the bladder wall was removed endoscopically. The duration of follow-up to the present time is not given, A third patient, a girl of I4 yr had a 3-mo history of lethargy. anorexia, and weight loss. She had episodes of loss of consciousness for brief periods and ran a fluctuating fever. Blood pressure was normal but after removal of a right adrenal tumor she had hypotension which required vasopressor therapy. The details of her complicated postoperative course are recorded. Histology showed this tumor to he a phaeochromocytoma. A high level of noradrenaline. adrenaline, dopamine. and dopa in the urine are recorded on the day of operation. These levels all returned to normal and the results are tabulated for the first and second postoperative days. D. G. Young
GENITOURINARY
TRACT
Post Operative Fatality In Pediatric Urology. A. Basso and V. F. Marshall. J. Ural. 108: 177 -179 (July),
1972.
Four hundred fifty-four children with major urologic problems admitted to a major hospital were reviewed over a IO-yr period. Of 419 children operated upon, nine died. The causes of death were infection in six. metabolic disturbances with prematurity in one. cardiac arrest during operation. and postoperative hemorrhage in one. The authors compare this with an adult service in the same hospital where the overall incidence was I .3’,, mortality. Leading causes in the adult group were renal failure, infection, cardiovascular disease, and cancer. The authors emphasize the differences between adult and pediatric urological causes 01 fatalities. -S. Kim Renal Trauma in Children. N. Javadpocrr. Parric,k Guinan. and Irving M. Bush. Surg. Gynecol. Obstet. 136:237 240 (February), 1973.
only one death, a patient with unilateral adrenal hemorrhage. All the infants were boys and the male preponderance of this disorder is discussed. The right side was more commonly affected than the left, a feature which has been noted in previous articles. There does not appear to be any single factor in the causation of this disorder. It is notable that six infants weighed over 3.5 kg at birth. only one was under 3 kg and the remaining one did not have birth weight recorded.--l). G. Young Two Cases of Masculinizing Adrenal Tumors in Infants. J. P&of. M. Mow-or. G. Lascombes and D. Olive. Ann. Chir. Infant 13: 3277338 (September/October), 1972. Two cases of masculinizing adrenal tumors in girls aged 6 and 15 mo, respectively, are presented. The first child presented with increased stature, virilization syndrome, and hypertension. Abdominal film revealed a spherical paravertebral mass with multiple calcifications. Intravenous pyelogram showed the mass to be suprarenal. All l7-ketosteroids were elevated, especially DHA and its precursors. Estrogens were also elevated although not pathologically. 17-OH steroids were abnormal by chromatography. Operation through a thoracophrenic laparotomy revealed a IO-cm encapsulated lobulated, supple, brown adrenocortical tumor which was very anaplastic by histology. Postoperatively the patient did well and all symptoms regressed. The second case was less obvious with only clitoral enlargement and some pubic hair growth. There was a palpable mass in the left hypochondrium. Only the l7ketosteroids were elevated at the upper limits of normal. Abdominal film and intravenous pyelogram showed a mass but were otherwise noncontributory. Arteriography did not further elucidate the problem. The patient was operated on through a left thoracophrenic laparotomy and a 6-cm. spherical, encapsulated. polylobulate. red tumor of the superior lobe of the left kidney was found and removed without difficulty. Biopsy revealed a malignant adrenocortical tumor. These cases are thought to be exemplary of various presentation and diagnosis of this tumor. Other diagnostic procedures such as Dexamethasone and ACTH stimulation for differential diagnosis are discussed as are histologic and therapeutic problems. -J. Daevq, Phaeochromocytoma in Childhood. Report of 3 Cases. M. J. Robinson. M. Kent. and J. Stocks.
849
Arch.
Dis.
Child.
48:137
142. (February),
1973. Two typical cases of phaeochromocytoma. one rn a 9-yr-old girl and the other in a 9-yr-old boy are described. The second child had a right adrenal tumor with paraaortic lymph nodes which also histologically had phaeochromocytoma in them. Five years later he had a left adrenal phaeochromocytoma. Three years after this he was restudied because of a persistent rise in catecholamine excretion. A tumor in the bladder wall was removed endoscopically. The duration of follow-up to the present time is not given, A third patient, a girl of I4 yr had a 3-mo history of lethargy. anorexia, and weight loss. She had episodes of loss of consciousness for brief periods and ran a fluctuating fever. Blood pressure was normal but after removal of a right adrenal tumor she had hypotension which required vasopressor therapy. The details of her complicated postoperative course are recorded. Histology showed this tumor to he a phaeochromocytoma. A high level of noradrenaline. adrenaline, dopamine. and dopa in the urine are recorded on the day of operation. These levels all returned to normal and the results are tabulated for the first and second postoperative days. D. G. Young
GENITOURINARY
TRACT
Post Operative Fatality In Pediatric Urology. A. Basso and V. F. Marshall. J. Ural. 108: 177 -179 (July),
1972.
Four hundred fifty-four children with major urologic problems admitted to a major hospital were reviewed over a IO-yr period. Of 419 children operated upon, nine died. The causes of death were infection in six. metabolic disturbances with prematurity in one. cardiac arrest during operation. and postoperative hemorrhage in one. The authors compare this with an adult service in the same hospital where the overall incidence was I .3’,, mortality. Leading causes in the adult group were renal failure, infection, cardiovascular disease, and cancer. The authors emphasize the differences between adult and pediatric urological causes 01 fatalities. -S. Kim Renal Trauma in Children. N. Javadpocrr. Parric,k Guinan. and Irving M. Bush. Surg. Gynecol. Obstet. 136:237 240 (February), 1973.