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Ultrasound screening of healthy infants for urinary tract abnormalities
1208 Hydronephrosis Secondary to Colonic Intussusception. M . H . Sie-
gelbaum and H.H. Rabinovitch. Urology 32:421-423, (November), 1988. The authors report a 2-month-old infant with an ileocolic intussusception that was diagnosed and reduced by barium enema. A renal ultrasound was performed because of an elevated serum creatinine and demonstrated right hydronephrosis. Following reduction of the intussusception and hydration, the serum creatinine became normal. A follow-up renal ultrasound 4 weeks later demonstrated resolution of the right hydronephrosis and no evidence of renal obstruction. The authors presume that the colonic obstruction with consequent edema at the level of the ascending colon and hepatic flexure was significant enough to cause mechanical obstruction of the renal pelvis or proximal ureter, simulating a ureteropelvic junction obstruction. They suggest that if intussusception is suspected, ultrasonographic studies should be performed to rule out hydronephrosis.--George W. Holcomb III Lower Pole Ureteropelvie Junction Obstruction and Incomplete Renal Duplication. D.B. Joseph, S.B. Bauer, A.H. Colodny, et al. J
Urol 141:896-899, (April), 1989. The rare finding of lower pole ureteropelvic junction obstruction and incomplete renal duplication in five children is discussed. The children were divided into two groups, those with short (less than 0.5 era) and with long (greater than 4 cm) lower ureteral segments. Short ureteral segment obstruction was managed by total excision of the narrow ureteral segment and end-to-side pyeloureterostomy. Obstructions associated with long lower ureteral segments were treated by excising the ureteropelvic junction and performing a standard Anderson-Hynes pyeloplasty. A thorough preoperative evaluation is helpful for successful management.--G. IV. Holcomb, Jr Renal Malformation in Patients With Turner Syndrome: Imaging in
141 Patients. B. Lippe, M.E. Geffner, R.B. Dietrich, et aL Pediatrics 82:852-856, (December), 1988. Turner syndrome occurs in every 1 in 2,000 to 1 in 5,000 live births. Renal abnormalities are often present. The authors reviewed 154 girls with the diagnosis of Turner syndrome, all of whom were screened for renal anomalies. Those evaluated prior to 1980 underwent an intravenous pyelogram (IVP); the remainder were screened with ultrasonography, then followed with an IVP or voiding cystourethrography when indicated. Abnormal results were identified in 47 patients (33%). Virtually the entire spectrum of renal anomalies known to occur with Turner syndrome was seen. Four patients required surgery, two with ureteropelvic junction obstruction and two with ureterovesical obstruction. The authors recommend that all patients with Turner syndrome undergo initial ultrasound screening for renal malformations.--Jeffrey L. Zitsman Intraoperative Sonography for Localisation of Renal Calculi in Children. St. Kellnar and Ch. Deindl. Z Kinderchir 43:347-349,
(October), 1988. Application and technique of intraoperative ultrasound has proved useful for localization of renal calculi. Use of ultrasound rather than x-rays has the advantage that it can be used continuously during the whole operation without any radiation exposure. Concretions can also be seen with ultrasound that are usually not revealed when using conventional radiography.--Thomas A. ,4ngerpointner Ultrasound Screening of Healthy Infants for Urinary Tract Abnormalities. J.M. Steinhart, J.P. Kuhn, B. Eisenberg, et al. Pediatrics
82:609-614, (October), 1988. In order to determine the prevalence of undetected urinary tract abnormalities in healthy infants, the authors performed routine
INTERNATIONAL ABSTRACTS
ultrasonographic examinations on a series of 437 babies who represented approximately 25% of the patients in a private pediatric practice to whom the test was offered. Six infants (1.37%) were found to have abnormalities that required surgical intervention, including two with ureteropelvic junction obstruction, one with a duplicated collecting system and superior pole hydronephrosis, and three with significant vesicoureteral reflux. Eight infants had minor abnormalities that proved to be nonsignificant on subsequent evaluation. There were three false-positive examinations that were subsequently shown to be normal. Although the benefit of diagnosis of congenital urinary tract abnormalities in the asymptomatic patient is unclear, the authors feel that both morbidity and perhaps monetary cost may be reduced by early detection.--Jeffrey L. Zitsman Ultrasound Diagnosis of Fetal Hydronephrosis: Fetal Renal Pelvic Size Correlated to Postnatal Outcome. C. Jorgensen and C.M.
Kullendorff. Pediatr Surg Internat 4:114-117, (February), 1989. Ultrasound examinations during pregnancy are performed partly as a routine and partly on specific indications. Nineteen fetuses with intrauterine hydronephrosiswere diagnosed during a 4-year period. Fifteen were inborns at the Department of Obstetrics in Lund and four were referred from other hospitals. Three cases were diagnosed at the first routine screening in the 17th week of gestation and the remaining 16 at a later screening examination at 32 to 36 weeks gestation. The size of the renal pelvis was measured at two perpendicular diameters in a transverse scan of the fetal abdomen. All infants were examined during the first week postpartum and reexamined within the first month of life with ultrasound and intravenous urography. Increasing dilation of the renal pelvis was an indication for operation. There were no false-positive cases. A significant correlation between the measured mean diameter of the renal pelvis and postnatal treatment was found. When the antenatal pelvic diameter is more than 10 ram, careful postpartum controls are recommended. All kidneys with a pelvic diameter of more than 20 mm were operated on.--Prem Purl Antenatal Diagnosis of Congenital Abnormalities in the Urinary
Tract. J.E.S. Scott and M. Renwick. Br J Urol 62:295-300, (October), 1988. One hundred and sixty-two cases of suspected abnormalities of the urinary tract were studied between 1984 and 1986. Thirty-five cases (22%) proved postnatally to have normal urinary tracts and 21 (13.2%) had unsuspected urinary tract abnormalities. Postnatally, suspected abnormalities were confirmed in 106 suspected cases (65.4%) at perinatal death in 32 and by ultrasound, radiographic, and radioisotope investigation in the remainder. Surgical intervention was required in 34.5% of all urologic cases registered and 75% of the confirmed survivors. Urologic abnormalities comprised over 14% of the total registration and over 0.1% of total births. Fifty-two babies died in the perinatal period (4% of the overall perinatal mortality in the region). The authors recommend that mothers be rescanned at 20 weeks, or if only one scan can be performed, it should be delayed until 18 to 22 weeks.--Amir Azmy M USCULOSKELETAL SYSTEM Anteromedial (Perineal) Dislocation of the Hip: A Case Report. J.C.
Burrell and J.K. Lipinski. Can J Surg 32:72-78, (January), 1989. Anterior dislocation of the hip is uncommon, and when it occurs, the femoral head usually lies in the periarticular position. The authors report a rare case of a 13-year-old girl with a traumatic anteromedial dislocation of the hip in which the femoral head punctured the vaginal wall. Traction would not reduce the hip. However, a push on the femoral head through the tear in the vagina
gelbaum and H.H. Rabinovitch. Urology 32:421-423, (November), 1988. The authors report a 2-month-old infant with an ileocolic intussusception that was diagnosed and reduced by barium enema. A renal ultrasound was performed because of an elevated serum creatinine and demonstrated right hydronephrosis. Following reduction of the intussusception and hydration, the serum creatinine became normal. A follow-up renal ultrasound 4 weeks later demonstrated resolution of the right hydronephrosis and no evidence of renal obstruction. The authors presume that the colonic obstruction with consequent edema at the level of the ascending colon and hepatic flexure was significant enough to cause mechanical obstruction of the renal pelvis or proximal ureter, simulating a ureteropelvic junction obstruction. They suggest that if intussusception is suspected, ultrasonographic studies should be performed to rule out hydronephrosis.--George W. Holcomb III Lower Pole Ureteropelvie Junction Obstruction and Incomplete Renal Duplication. D.B. Joseph, S.B. Bauer, A.H. Colodny, et al. J
Urol 141:896-899, (April), 1989. The rare finding of lower pole ureteropelvic junction obstruction and incomplete renal duplication in five children is discussed. The children were divided into two groups, those with short (less than 0.5 era) and with long (greater than 4 cm) lower ureteral segments. Short ureteral segment obstruction was managed by total excision of the narrow ureteral segment and end-to-side pyeloureterostomy. Obstructions associated with long lower ureteral segments were treated by excising the ureteropelvic junction and performing a standard Anderson-Hynes pyeloplasty. A thorough preoperative evaluation is helpful for successful management.--G. IV. Holcomb, Jr Renal Malformation in Patients With Turner Syndrome: Imaging in
141 Patients. B. Lippe, M.E. Geffner, R.B. Dietrich, et aL Pediatrics 82:852-856, (December), 1988. Turner syndrome occurs in every 1 in 2,000 to 1 in 5,000 live births. Renal abnormalities are often present. The authors reviewed 154 girls with the diagnosis of Turner syndrome, all of whom were screened for renal anomalies. Those evaluated prior to 1980 underwent an intravenous pyelogram (IVP); the remainder were screened with ultrasonography, then followed with an IVP or voiding cystourethrography when indicated. Abnormal results were identified in 47 patients (33%). Virtually the entire spectrum of renal anomalies known to occur with Turner syndrome was seen. Four patients required surgery, two with ureteropelvic junction obstruction and two with ureterovesical obstruction. The authors recommend that all patients with Turner syndrome undergo initial ultrasound screening for renal malformations.--Jeffrey L. Zitsman Intraoperative Sonography for Localisation of Renal Calculi in Children. St. Kellnar and Ch. Deindl. Z Kinderchir 43:347-349,
(October), 1988. Application and technique of intraoperative ultrasound has proved useful for localization of renal calculi. Use of ultrasound rather than x-rays has the advantage that it can be used continuously during the whole operation without any radiation exposure. Concretions can also be seen with ultrasound that are usually not revealed when using conventional radiography.--Thomas A. ,4ngerpointner Ultrasound Screening of Healthy Infants for Urinary Tract Abnormalities. J.M. Steinhart, J.P. Kuhn, B. Eisenberg, et al. Pediatrics
82:609-614, (October), 1988. In order to determine the prevalence of undetected urinary tract abnormalities in healthy infants, the authors performed routine
INTERNATIONAL ABSTRACTS
ultrasonographic examinations on a series of 437 babies who represented approximately 25% of the patients in a private pediatric practice to whom the test was offered. Six infants (1.37%) were found to have abnormalities that required surgical intervention, including two with ureteropelvic junction obstruction, one with a duplicated collecting system and superior pole hydronephrosis, and three with significant vesicoureteral reflux. Eight infants had minor abnormalities that proved to be nonsignificant on subsequent evaluation. There were three false-positive examinations that were subsequently shown to be normal. Although the benefit of diagnosis of congenital urinary tract abnormalities in the asymptomatic patient is unclear, the authors feel that both morbidity and perhaps monetary cost may be reduced by early detection.--Jeffrey L. Zitsman Ultrasound Diagnosis of Fetal Hydronephrosis: Fetal Renal Pelvic Size Correlated to Postnatal Outcome. C. Jorgensen and C.M.
Kullendorff. Pediatr Surg Internat 4:114-117, (February), 1989. Ultrasound examinations during pregnancy are performed partly as a routine and partly on specific indications. Nineteen fetuses with intrauterine hydronephrosiswere diagnosed during a 4-year period. Fifteen were inborns at the Department of Obstetrics in Lund and four were referred from other hospitals. Three cases were diagnosed at the first routine screening in the 17th week of gestation and the remaining 16 at a later screening examination at 32 to 36 weeks gestation. The size of the renal pelvis was measured at two perpendicular diameters in a transverse scan of the fetal abdomen. All infants were examined during the first week postpartum and reexamined within the first month of life with ultrasound and intravenous urography. Increasing dilation of the renal pelvis was an indication for operation. There were no false-positive cases. A significant correlation between the measured mean diameter of the renal pelvis and postnatal treatment was found. When the antenatal pelvic diameter is more than 10 ram, careful postpartum controls are recommended. All kidneys with a pelvic diameter of more than 20 mm were operated on.--Prem Purl Antenatal Diagnosis of Congenital Abnormalities in the Urinary
Tract. J.E.S. Scott and M. Renwick. Br J Urol 62:295-300, (October), 1988. One hundred and sixty-two cases of suspected abnormalities of the urinary tract were studied between 1984 and 1986. Thirty-five cases (22%) proved postnatally to have normal urinary tracts and 21 (13.2%) had unsuspected urinary tract abnormalities. Postnatally, suspected abnormalities were confirmed in 106 suspected cases (65.4%) at perinatal death in 32 and by ultrasound, radiographic, and radioisotope investigation in the remainder. Surgical intervention was required in 34.5% of all urologic cases registered and 75% of the confirmed survivors. Urologic abnormalities comprised over 14% of the total registration and over 0.1% of total births. Fifty-two babies died in the perinatal period (4% of the overall perinatal mortality in the region). The authors recommend that mothers be rescanned at 20 weeks, or if only one scan can be performed, it should be delayed until 18 to 22 weeks.--Amir Azmy M USCULOSKELETAL SYSTEM Anteromedial (Perineal) Dislocation of the Hip: A Case Report. J.C.
Burrell and J.K. Lipinski. Can J Surg 32:72-78, (January), 1989. Anterior dislocation of the hip is uncommon, and when it occurs, the femoral head usually lies in the periarticular position. The authors report a rare case of a 13-year-old girl with a traumatic anteromedial dislocation of the hip in which the femoral head punctured the vaginal wall. Traction would not reduce the hip. However, a push on the femoral head through the tear in the vagina