OBJECTIVES To show that hydronephrosis (HN) can be tracked by the quantitative reproducible hydronephrosis index (HI) and that HI is useful for serial ultrasound (US) studies to determine whether HN is improving or deteriorating.METHODS We found 60 hydronephrotic kidneys in 46 study patients. The other 32 kidneys were normal or absent. Serial US studies were performed more than I month apart over a 3-year period. Hydration was maximized with oral fluids. Cases ranged in age from 2 days to 13 years. We determined HI as follows: Operators outlined the perimeters of the kidney and dilated renal pelvis in the maximal longitudinal view. Respective areas were automatically calculated. We obtained HI by outlining the area of the kidney and separately outlining the area of the dilated renal pelvis within the kidney. We calculated HI percentage as 100 X (Total area of kidney minus area of dilated pelvis and calices)/(Total area). This percentage calculation represents the renal area determined reproducibly in a standardized fashion as if the calices were not there and is recorded as a dimensionless number.RESULTS Hydronephrosis for 30 of 60 kidneys (50%) showed decreasing HN, and for 17 of 60 kidneys (28%) showed increasing HN. In 13 of 60 (22%) HN was unchanged. Statistical analysis showed that HI was determined with an objectivity of 99.8%.CONCLUSIONS Hydronephrosis is the most common abnormality detected with ultrasonography. The quantitative method for HI provides a reproducible measure of HN. With longtitudinal studies, the quantitative HI shows whether HN is improving or deteriorating.

Abstract Three children with pulmonary atresia and ventricular septal defect with absent central pulmonary arteries underwent successful complete correction following preliminary staging procedures for unifocalization and deletion of multiple major aortopulmonary collateral arteries. The unifocalization procedures were accomplished using valveless pulmonary arterial cryopreserved allografts. This technique was found to facilitate and simplify the final repair. All patients survived the complete correction. The patients have been followed for 1½-4 years following the final surgery. One child died two years after repair from pneumonia complicated by asthma. One patient appears to have progression of pulmonary vascular disease despite the complete repair, and one patient continues to do well both symptomatically and hemodynamically. The results suggest that this method of unifocalization solves many of the problems inherent to more classical techniques, but the overall prognosis of patients in this diagnostic entity has yet to be completely defined.

Recent reports document the success of balloon aortic valvuloplasty (BAV) in children with congenital aortic stenosis.1 Conduction system abnormalities including severe bradycardia,2 prolongation of the corrected QT interval3 and ventricular arrhythmias,1,4 have been reported during and after BAV. There have been no reports documenting the frequency of dysrhythmias both immediately before and after BAY. This study assesses rhythm abnormalities by Hoher monitor recordings before and after BAV in children.

Data on 111 lesions, in addition to pulmonary valve, aortic valve, branch pulmonary stenosis, native coarctation and recoarctation, were submitted to the Valvuloplasty and Angioplasty of Congenital Anomalies Registry. Because there was a very heterogenous group of lesions both in types of lesions and techniques of dilation, only minimal data can be offered concerning the efficacy of the dilation of any or all of these lesions. The registry data do, however, demonstrate the safety of these dilations compared to alternative surgical therapy.

Endomyocardial biopsy was performed in 20 symptomatic pediatric patients with the following clinical diagnoses: dilated cardiomyopathy in 16, hypertrophic cardiomyopathy in 2 and myocarditis in 2. Transfemoral biopsy was performed without complications in patients aged 2 months to 16 years; 6 were less than 1 year old. An average of five right ventricular specimens were obtained for histologic and ultrastructure study from each patient. In 16 patients with the clinical diagnosis of dilated cardiomyopathy, biopsy findings were compatible with the diagnosis in 8, but changed the diagnosis as follows in the other 8: myocarditis, 4; hypertrophic cardiomyopathy, 2 and carnitine deficiency syndromes, 2. In two patients with the clinical diagnosis of hypertrophic cardiomyopathy, biopsy findings confirmed the diagnosis in one and were normal in the other who had an encapsulated cardiac fibroma at operation. In two patients with the clinical diagnosis of myocarditis, biopsy findings confirmed the diagnosis in one and suggested dilated cardiomyopathy in the other. In the entire series, 25% had biopsy evidence of inflammatory disease. Biopsy findings were confirmed at subsequent autopsy in five cases.

The "buried penis" occurs in a spectrum which varies from slight with only ventral webbing to almost complete burying of the penis dorsally in the prepubic fat pad and ventrally in the scrotum. From 1979 to 1985, the author operated on 80 children with these problems. Indications for surgery varied from unsatisfactory appearance of the penis before or after circumcision to almost complete concealment of the penis. Satisfactory cosmetic and functional results were achieved in most cases utilizing several surgical principles. The limitations of these procedures and their possible complications are described.

From January 1983 to December 1985, 14 procedures were performed in which a free graft of skin from either the foreskin or elsewhere was substituted for the flipped flap in the repair of hypospadias. This obviates the problem of thin skin below the urethral meatus, since a flipped flap in such a case will result in devascularization of the flap. Moderate chordee was not necessarily a contraindication to the use of this procedure, provided the chordee could be corrected without moving the meatus proximally. Cosmetic and functional results have been good, and there was only 1 urethral fistula. Nevertheless, because of the need for a scrotal flap of fat to prevent fistula formation and to ensure vascularization of the graft, and because of the availability of a vascularized flap from the foreskin in most cases, the free graft patch procedure is best reserved for cases in which the foreskin is either absent or deficient.

Critical congenital valvar aortic stenosis in the neonate presents a life-threatening clinical picture different from that seen in older age groups. High mortality and morbidity accompanying a variety of surgical procedures have been associated with intervention at this early age.

No AccessJournal of Urology1 May 1985Re: The Role of Excretory Urography in the Evaluation of Girls with Urinary Tract Infection, by J. F. Redman and J. J. Siebert J. Urol., 132: 953-955, 1984 Stephen R. Shapiro Stephen R. ShapiroStephen R. Shapiro More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)49266-4AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Re: The Role of Excretory Urography in the Evaluation of Girls with Urinary Tract Infection, by J. F. Redman and J. J. Siebert J. Urol., 132: 953-955, 1984." The Journal of Urology, 133(5), p. 864 © 1985 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 133Issue 5May 1985Page: 864 Advertisement Copyright & Permissions© 1985 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Stephen R. Shapiro More articles by this author Expand All Advertisement Loading ...

Anomalous origin of the left coronary artery from the pulmonary artery is associated with myocardial infarction, left ventricular dysfunction, mitral valve dysfunction and, occasionally, intracardiac congenital abnormalities. A technique that utilizes a flap of the anterior wall of the pulmonary artery to serve as a neocoronary artery to direct aortic flow from a created aortopulmonary window to the pulmonary artery orifice of the anomalous left coronary artery was used in five patients aged 2.5 months to 4.75 years. Two patients were less than 4 months of age at operation. There was one death 2 days after operation and one late death. The two youngest patients required mitral valve replacement. Two of the three surviving patients are well at follow-up at 7 to 44 months. One patient has been lost to follow-up study. One patient had postoperative catheterization which showed an intact repair. The pulmonary artery neocoronary procedure is applicable to infants and small patients with anomalous origin of the left coronary artery from the pulmonary artery.

Successful surgical repair of a 4-year-old boy with situs inversus [I, D, D] and corrected transposition of the great vessels (TGV) as well as hemodynamically significant ventricular septal defect (VSD), systemic atrioventricular (tricuspid) valve regurgitation, and atrial septal defect is described. Unique technical aspects of VSD and tricuspid valve repair in association with corrected TGV and situs solitus or inversus are discussed and clarified.

Any surgeon performing hypospadias repair must be prepared to manage the surgical complications. From January 1976 to December 1982, 176 cases of hypospadias treated with a number of different operations were critically analyzed for complications. There were no complications in 143 cases (81 per cent). However, there were 44 surgical complications in the remaining 33 patients (19 per cent), which included stricture formation (11), urethral fistula (11), severe skin edema (2), subcutaneous hematoma (2), persistent chordee (2), scrotal abscess (1) and bladder calculus (1). Treatment of the various complications is discussed along with suggestions on how to avoid them. When only 3 operations are considered (meatal advancement and glanuloplasty, flip-flap procedure and free graft tubed urethroplasty), surgical repair of all types of hypospadias was accomplished, without any complications in 89 per cent of the cases. The results of hypospadias repair have improved because of the availability of these more reliable procedures that provide a lower incidence of complications and improved cosmetic appearance.

During a 28-month period, consecutive 2-dimensional echocardiograms were reviewed to determine the prevalence of left ventricular (LV) false tendons, their associated anomalies and clinical significance. LV false tendons were found in 31 (0.8%) of 3,847 consecutive 2-dimensional echocardiograms. Of 31 LV false tendons, 30 passed longitudinally from papillary muscle to septum and 1 went from free wall to free wall. The 31 patients were aged 1 day to 15 years. Associated heart disease, most often ventricular septal defect, bicuspid aortic valve and coarctation of the aorta, was present in 48%, of whom 73% were girls. Of those without heart disease, 69% were boys. In patients with heart disease, precordial murmurs were due to the underlying cardiac anomaly. Of those without heart disease, 15 of 16 (94%) had a precordial murmur, usually of the Still's type over the lower left sternal border. Four of 31 (13%), 1 with and 3 without heart disease, had unifocal premature ventricular contractions that were rate-dependent in the 2 patients undergoing stress testing. LV false tendons appear to occur in 0.8% of pediatric patients and usually are accompanied by a Still's type innocent murmur if unassociated with heart disease. Some LV false tendons are associated with rate-dependent premature ventricular contractions.