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Tissue expansion facilitates operation of large myelomeningoceles
INTERNATIONAL
ABSTRACTS
633
tioned less well than the contralateral non-refluxing kidney. Seven of the 10 kidneys in the follow-up period (20 to 36 months) demonstrated an almost normal appearance or function. Those kidneys noted to be abnormal were abnormal during the neonatal period also.-Prem Pun’
Current Management of Childhood Neurogenic Bladder: Review of 156 Cases. A.M.K. Rickwood and A.J. Arnold. Z Kinder-
formed in 9 cases. Twenty-six children were operated on and 3 were not, 1 of which died of severe congenital heart disease. Age at operation was under 6 months in 14 cases and between 6 and 12 months in 8. Four children developed hypertension preoperatively, but hypertension disappeared within 1 week postoperatively in all cases. Indication for surgery seems clear in symptomatic cases. In the asymptomatic patient, the complications of multicystic kidney such as hypertension, malignancy, infection, and pain suggest a surgical approach at around 6 months of age.-Thomas A. Anger-
chir 45238-241. (August), 1990.
pointner
The management of neuropathic bladder aims at maintaining renal function and securing appliance-free continence. Because of recent advances, both objectives are theoretically attainable. The authors’ present scheme of management, based on preliminary videourodynamic assessment, is outlined. A total of 156 children suffering from neuropathic bladder were treated. In 5% of cases the upper renal tracts had deteriorated on treatment. In patients presenting with upper tract dilatation, improvement was obtained in 68%. Twenty-five percent of the patients were considered too disabled generally to achieve appliance-free continence. These have been managed by penile appliance, indwelling urethral catheter, or, occasionally, urinary diversion. Seventy-five percent of the patients, mostly ambulant, have tried to attain appliance-free continence. Sixty-eight percent have been managed nonsurgically and 32% surgically. Reliable day-time continence has been achieved in 78% of the former and 86% of the latter (80% overall).Thomas A. Angerpointner
Duration and Severity of Congenital Hydronephrosis as a Cause of Smooth Muscle Deterioration in Pyelo-Ureteral Junction Obstruction. C.A. deN’Agnola, L.M. Carmassi, D. Merlo, et al. Z Kinderchir 45286-290, (October), 1990.
A potential relationship between duration and severityof obstructive hydronephrosis and the histological structure of the upper urinary tract smooth musculature has been studied in a series of prenatally diagnosed cases. Between 1981 and 1988, 55 monolateral pyeloureteral junction obstructions (PUJO) diagnosed prenatally (16th to 37th week of gestation) underwent pyeloplasty between 4 and 90 days of life. Gestational age at diagnosis, duration of hydronephrosis from first detection in utero to surgery, and volume of the hydronephrotic kidney were related to muscle hypotrophy and fibrosis of both pelvis and ureter just above and below the junction. A close correlation between duration and the severity of affection of the upper urinary tract was found. The larger the hydronephrotic volume, the more severe the muscular damage. In long-term follow-up, poor results were obtained in only 5 of the 19 newborns who had severe hypotrophy and fibrosis of the pelvis. In conclusion, the shorter the duration and the lower the hydronephrotic volumes, the better smooth musculature of the upper urinary tract can be expected in PUJO.--Thomas A. Anger-
Comprehensive Management of Renal Failure in Infants. D. Tapper, S. Watkins, M. Bums, et al. Arch Surg 125:1276-1280,
(October), 1990. During a 3-year period, 23 infants required peritoneal dialysis within the first 6 months of life. With modifications to conventional peritoneal dialysis infants were successfully dialyzed for prolonged periods without bowel perforations. Eight of the 23 infants developed end-stage renal failure. Four of the eight recovered having related transplants performed after weight gain of 10 kg. All had a gastrostomy done to supplement oral nutrition. One child died prior to transplantation; another transplant was complicated by a technical problem necessitating a return to peritoneal dialysis. Kidney function, growth, and development in survivors were excellent.-George A. Rowe
NERVOUS
SYSTEM
Conditioning Factors for Shunt Insufficiency After Posthemorrhagic Hydrocephalus in Preterm Babies. B. Resch, W Miiller, and R. Oberbauer. Z Kinderchir 45:203-208, (August), 1990.
A series of 27 low-birth weight infants (mean birth weight, 1,351 g; mean gestational age, 30 weeks) who required shunts for the development of posthemorrhagic hydrocephalus is presented. Revision of shunt was necessary in 78% of the patients with a range of 1 to 11 revisions. Obstruction of the ventricular catheter was the main cause of mechanical complications which occurred in 75%. Preterm infants weighing less than 1,000 g showed an high infection rate of 71%. Initial shunt placement within the first 8 weeks of life was more likely to necessitate shunt revision (94%) than shunt placement at an older age (44%). In comparison with the Codman Uni system, the Heyer-Schulte system was more likely to have mechanical complications. There were differences in shunt revisions between grade III and IV hemorrhage. A large number of erythrocytes and very low glucose levels in the preoperative cerebrospinal fluid indicated more accurately the need for future shunt revisions than did the protein level.-ThomasA. Angerpointner
pointner Tissue Expansion Facilitates Operation of Large Myelomeningoceles. T. Frykberg and L. Olsen. Z Kinderchir 45:242-244, (AuSurgery
in Unilateral
Multicystic
Kidney. C.M. Kidlendorff: Z
Kinderchir 45:235-237, (August), 1990. During a 15-year period, 29 patients were treated for unilateral multicystic kidney. Diagnosis was obtained from prenatal ultrasound in 17 cases, investigation of an abdominal mass in 10, urinary tract infection in 1, and uremia investigation in 1. Eleven patients had associated malformations. Further investigations included ultrasonography, intravenous pyelography, micturition cystography, and, in a few cases, computed tomography scans and dimercaptosuccinic acid (DMSA) scans. Percutaneous pyelography was per-
gust), 1990. Two children had delayed operations for large myelomeningoceles. As a preparatory operation, a Silicon tissue expander was inserted on each side of the lesion and stepwise inflated by weekly saline injections. After 5 to 6 weeks the definitive procedure was performed. The newly formed fibrous capsule greatly facilitated the reconstruction of the spinal canal. The surplus skin and subcutaneous tissue allowed the large defects to be easily closed in the midline. Both children did well postoperatively.-Z7zomasA. Angerpointner
ABSTRACTS
633
tioned less well than the contralateral non-refluxing kidney. Seven of the 10 kidneys in the follow-up period (20 to 36 months) demonstrated an almost normal appearance or function. Those kidneys noted to be abnormal were abnormal during the neonatal period also.-Prem Pun’
Current Management of Childhood Neurogenic Bladder: Review of 156 Cases. A.M.K. Rickwood and A.J. Arnold. Z Kinder-
formed in 9 cases. Twenty-six children were operated on and 3 were not, 1 of which died of severe congenital heart disease. Age at operation was under 6 months in 14 cases and between 6 and 12 months in 8. Four children developed hypertension preoperatively, but hypertension disappeared within 1 week postoperatively in all cases. Indication for surgery seems clear in symptomatic cases. In the asymptomatic patient, the complications of multicystic kidney such as hypertension, malignancy, infection, and pain suggest a surgical approach at around 6 months of age.-Thomas A. Anger-
chir 45238-241. (August), 1990.
pointner
The management of neuropathic bladder aims at maintaining renal function and securing appliance-free continence. Because of recent advances, both objectives are theoretically attainable. The authors’ present scheme of management, based on preliminary videourodynamic assessment, is outlined. A total of 156 children suffering from neuropathic bladder were treated. In 5% of cases the upper renal tracts had deteriorated on treatment. In patients presenting with upper tract dilatation, improvement was obtained in 68%. Twenty-five percent of the patients were considered too disabled generally to achieve appliance-free continence. These have been managed by penile appliance, indwelling urethral catheter, or, occasionally, urinary diversion. Seventy-five percent of the patients, mostly ambulant, have tried to attain appliance-free continence. Sixty-eight percent have been managed nonsurgically and 32% surgically. Reliable day-time continence has been achieved in 78% of the former and 86% of the latter (80% overall).Thomas A. Angerpointner
Duration and Severity of Congenital Hydronephrosis as a Cause of Smooth Muscle Deterioration in Pyelo-Ureteral Junction Obstruction. C.A. deN’Agnola, L.M. Carmassi, D. Merlo, et al. Z Kinderchir 45286-290, (October), 1990.
A potential relationship between duration and severityof obstructive hydronephrosis and the histological structure of the upper urinary tract smooth musculature has been studied in a series of prenatally diagnosed cases. Between 1981 and 1988, 55 monolateral pyeloureteral junction obstructions (PUJO) diagnosed prenatally (16th to 37th week of gestation) underwent pyeloplasty between 4 and 90 days of life. Gestational age at diagnosis, duration of hydronephrosis from first detection in utero to surgery, and volume of the hydronephrotic kidney were related to muscle hypotrophy and fibrosis of both pelvis and ureter just above and below the junction. A close correlation between duration and the severity of affection of the upper urinary tract was found. The larger the hydronephrotic volume, the more severe the muscular damage. In long-term follow-up, poor results were obtained in only 5 of the 19 newborns who had severe hypotrophy and fibrosis of the pelvis. In conclusion, the shorter the duration and the lower the hydronephrotic volumes, the better smooth musculature of the upper urinary tract can be expected in PUJO.--Thomas A. Anger-
Comprehensive Management of Renal Failure in Infants. D. Tapper, S. Watkins, M. Bums, et al. Arch Surg 125:1276-1280,
(October), 1990. During a 3-year period, 23 infants required peritoneal dialysis within the first 6 months of life. With modifications to conventional peritoneal dialysis infants were successfully dialyzed for prolonged periods without bowel perforations. Eight of the 23 infants developed end-stage renal failure. Four of the eight recovered having related transplants performed after weight gain of 10 kg. All had a gastrostomy done to supplement oral nutrition. One child died prior to transplantation; another transplant was complicated by a technical problem necessitating a return to peritoneal dialysis. Kidney function, growth, and development in survivors were excellent.-George A. Rowe
NERVOUS
SYSTEM
Conditioning Factors for Shunt Insufficiency After Posthemorrhagic Hydrocephalus in Preterm Babies. B. Resch, W Miiller, and R. Oberbauer. Z Kinderchir 45:203-208, (August), 1990.
A series of 27 low-birth weight infants (mean birth weight, 1,351 g; mean gestational age, 30 weeks) who required shunts for the development of posthemorrhagic hydrocephalus is presented. Revision of shunt was necessary in 78% of the patients with a range of 1 to 11 revisions. Obstruction of the ventricular catheter was the main cause of mechanical complications which occurred in 75%. Preterm infants weighing less than 1,000 g showed an high infection rate of 71%. Initial shunt placement within the first 8 weeks of life was more likely to necessitate shunt revision (94%) than shunt placement at an older age (44%). In comparison with the Codman Uni system, the Heyer-Schulte system was more likely to have mechanical complications. There were differences in shunt revisions between grade III and IV hemorrhage. A large number of erythrocytes and very low glucose levels in the preoperative cerebrospinal fluid indicated more accurately the need for future shunt revisions than did the protein level.-ThomasA. Angerpointner
pointner Tissue Expansion Facilitates Operation of Large Myelomeningoceles. T. Frykberg and L. Olsen. Z Kinderchir 45:242-244, (AuSurgery
in Unilateral
Multicystic
Kidney. C.M. Kidlendorff: Z
Kinderchir 45:235-237, (August), 1990. During a 15-year period, 29 patients were treated for unilateral multicystic kidney. Diagnosis was obtained from prenatal ultrasound in 17 cases, investigation of an abdominal mass in 10, urinary tract infection in 1, and uremia investigation in 1. Eleven patients had associated malformations. Further investigations included ultrasonography, intravenous pyelography, micturition cystography, and, in a few cases, computed tomography scans and dimercaptosuccinic acid (DMSA) scans. Percutaneous pyelography was per-
gust), 1990. Two children had delayed operations for large myelomeningoceles. As a preparatory operation, a Silicon tissue expander was inserted on each side of the lesion and stepwise inflated by weekly saline injections. After 5 to 6 weeks the definitive procedure was performed. The newly formed fibrous capsule greatly facilitated the reconstruction of the spinal canal. The surplus skin and subcutaneous tissue allowed the large defects to be easily closed in the midline. Both children did well postoperatively.-Z7zomasA. Angerpointner