Gerald W. Friedland

Development and Progression of Clubbing and Scarring in Children with Recurrent Urinary Tract Infections

Recent publications state that development and progression of clubbing and scarring do not occur in children with recurrent urinary tract infections. To test this assertion, we reviewed the excretory urograms of 106 children (208 renal units) with carefully documented recurrent bacterial urinary infections which commenced before the age of 10 years. We followed 93 of these renal units radio-logically for at least two years. In 31 kidneys, scarring and clubbing progressed; 4 previously normal kidneys developed scarring and clubbing. Two factors, infection and reflux, appeared important in the development of these changes. This study demonstrates that clubbing and scarring can develop and that existing lesions can progress in children with recurrent bacterial urinary infections.

Congenital “H-Type” Ano-Urethral Fistula

An anomaly analogous to the congenital “H-type” tracheo-esophageal fistula may occur at the distal end of the gastrointestinal tract. This consists of a congenital ano-urethral fistula without anal atresia, here designated “H-type” ano-urethral fistula. Three boys with this condition are reported. All three also had anterior urethral strictures and other congenital anomalies. The authors present their views of the embryologic development of this anomaly.

Management of children with urinary tract infections The Stanford experience

Two hundred seventy-eight female children with urinary tract infections have been evaluated at Stanford division of urology. All children were followed up for a period of not less than twelve months. Age of onset of infection, clinical presentation, and nature of infecting organisms were observed. The group consisted of 144 children without ureteral reflux and 134 children with ureteral reflux. Sixty-one of the female children with ureteral reflux had ureteral reimplantation, while 73 received medical treatment alone. A study of infection rates in each of the three groups of children indicated a similar infection rate, although those children with reflux experienced a higher incidence of clinical pyelonephritis. Correction of ureteral reflux did not alter the infection rate; however, infections after surgical correction were generally of a type usually associated with children without reflux. Twenty-nine children had urethral dilatation, and the infection rate prior to and following urethral dilatation indicated a similar rate of infection pre- and posturethral dilatation. One hundred nonrefluxing kidneys were observed radiologically: 97 were normal and 3 showed clubbing and scarring. Of 110 refluxing renal units observed, 62 were clubbed and scarred and 48 were normal. Following surgical correction of reflux, renal clubbing and scarring were not observed in previously normal renal units. Of those renal units found to be abnormal at time of surgery, 66 per cent showed progression of clubbing and scarring after surgical correction of reflux. It was observed that the greater the degree of reflux present, the higher the incidence of renal damage. This study suggests that children who experience recurrent urinary tract infections who do not have ureteral reflux are seldom at renal risk; similar children who do have ureteral reflux are at risk unless the infections are controlled or the reflux either disappears or is corrected surgically.

Congenital anomalies of the inferior vena cava: embryogenesis and MR features.

This article describes the MR appearances of the six most common congenital anomalies of the inferior vena cava. As a basis for understanding those anomalies, it describes the embryology of the inferior vena cava, based on an actual study of embryos and fetuses. The article takes a fresh look at the original research in this area, discusses the possible embryogenesis of the relevant anomalies, and describes different opinions on that subject, where different opinions exist.

Comparative anatomy of feline and canine gastric sling fibers. Analogy to human anatomy.

Investigation of the function of human sling fibers is not feasible with the use of technics currently available for animal experiments. Thus, this study examined the anatomy of the gastric sling fibers in 22 dogs and 16 cats to determine if either or both resemble that of the human. In both species, the gastric sling fibers hooked around the notch between the gastric fundus and distal esophagus, and traversed the stomach, anteriorly and posteriorly, parallel to the lesser curve, finally disappearing near the incisura angularis. A constrictor cardiac muscle was found at the upper limit of the sling fibers in both species. The muscularis propria of the distal esophagus of the dog was found to be striated. In contrast, smooth muscle was present in the distal esophagus of the cat. Furthermore, a vestibule, analogous to that described in man, was found in the cat but not in the dog. It has been postulated that the sling fibers play a role in the sphincteric mechanism of the distal esophagus. Our finding that the anatomy of the sling fibers and the distal esophagus in the cat resembles that of man suggests that it would be a more suitable model than that of the dog.

The radiological findings in radiation-induced enteritis and colitis a review of 30 cases

Following radiotherapy to the abdomen, clinically significant radiation damage may occur to the gastrointestinal tract. The disease process when observed directly (as at surgery or at autopsy) may extend far more than that seen on the radiological examination. One radiological finding is a roundish pool of barium due to many loops of small bowel being matted together and encased in a thick, fibrous capsule. Adhesions may also cause tacking down of the mucosa. These adhesions constitute a major surgical problem. Other small bowel changes include nodular filling defects, thickening, straightening and rigidity of mucosal folds, complete absence of the mucosal fold pattern, mural thickening, rigidity of the wall, strictures and functional or mechanical obstruction. Radiation changes in the large bowel may be manifested as (1) an area of marked spasm, (2) stricture which may be short or long, slight or severe, smooth and gently tapering, or abrupt with mucosal irregularity and overhanging edges resembling a carcinoma, (3) ulceration, (4) perforation and abscess formation resembling an acute diverticulitis. Many of the changes induced in the small or large bowel by radiation therapy present radiological appearances closely resembling a recurrence of the malignancy. Laparotomy and biopsy of the abdominal lesions may well be advisable in order to distinguish changes due to metastases from those due to the radiotherapy.

Acquired renal cystic disease and renal neoplasms in hemodialysis patients

Noninvasive imaging studies were performed on 26 patients undergoing chronic hemodialysis. We found cysts in 46% of patients and neoplasms in 7.7%. The cysts were relatively easy to detect. However, the neoplasms were very difficult to detect; this problem has been described before in the literature. The natural history of acquired cystic disease and neoplasms in hemodialysis patients is largely unknown. A review of the problems associated with the imaging and management of these patients is included.

Comparison of methods for acceleration of small intestinal radiographic examination.

Abstract The authors compared transit times of four methods of small bowel examination. Twenty male volunteers were examined at weekly intervals. One examination was a control study in which the subjects were allowed to sit or ambulate between roentgenograms. Modifications included (a) a subcutaneous injection of 0.5 mg neostigmine methylsulfate immediately after ingestion of barium; (b) maintenance of right lateral decubitus position except during roentgenography; (c) addition of Gastrografin to the barium mixture. Eleven subjects received 10 ml Gastrografin and 9 received 30 ml. While the transit time was significantly accelerated by neostigmine, the most effective method was administration of 10 ml Gastrografin.,

Renal ectopia and fusion: Embryologic basis☆

To determine when horseshoe kidneys and crossed fused ectopic kidneys might develop, the authors studied the Carnegie collection of human embryos. They found that renal fusion must occur before the kidneys ascend between the umbilical arteries.

Hiatal hernia and “rumination” in infantsand children

Three children seen over a one-year period with the rumination syndrome were found to have hiatal herniae. Medical treatment with positional therapy in one child and surgical repair of the herniae in the other 2 was curative. Hiatal herniae may regularly be demonstrated in ruminators. The sequence of events during a typical episode of rumination in a child observed roentgenographically is described.