Raymond Fay

Segmental renal hypoplasia and hypertension.

The association of hypertension with congenital renal hypoplasia (Ask-Upmark kidney) has been well established. A case is presented that clearly demonstrates the distinctive clinical, roentgenographic and pathologic features. An abnormal production of renin by the affected kidney suggested that the renin-angiotensin-aldosterone axis was involved in the genesis of the hypertension. Hypertension was cured by unilateral nephrectomy.

Renal hypertension in children

Summary The incidence of hypertension in children varied from 1.4 to 2.3 per cent. In contradistinction to adults, essential hypertension is rare in children. Well over 80 per cent of established hypertension is of secondary origin, and in the great majority these cases are secondary to renal disease. The clinical manifestations of renal hypertension in children are variable. They may have no symptoms or may be seen with headache, failure to thrive, visual disturbance, or congestive heart failure. The cure rate following nephrectomy or vascular repair is better in children because of the short duration of their disease. Repair of renal arterial lesions is more difficult in children because of the small size of their vessels. With modern surgical techniques and better case selection, results of renovascular repair are greatly improved. Two cases are reported to illustrate concepts in the management of renovascular and renoparenchymal hypertension. Although the prospects of renal salvage and cure of hypertension are excellent, with segmental renovascular disease unilateral nephrectomy is still applicable for children with renoparenchymal hypertension.

Rhabdomyosarcoma of testis and spermatic cord in children

Abstract Two cases are reported of rhabdomyosarcoma of the testis and spermatic cord in whichthe children survived more than five years. An analysis of 47 boys showed that 35 are alive beyond two years. The results in these patients reviewed from the recent literature indicate that prognosis is improved with aggressive therapy, using a combination of surgical procedures (orchiectomy and retroperitoneal lymphadenectomy), chemotherapy, and radiation.

Arteriography in penetrating renal trauma

Abstract Selective renal arteriography is the most important study in the radiologic assessment of patients with penetrating renal trauma. Case reports selected from our experience are presented to illustrate the value of the procedure. Intravenous urography alone does not provide accurate information about the traumatized kidney. Arteriography allows the surgeon to develop a rational plan for possible renal preservation.

Renal arterial-pelvic fistula

Abstract We illustrate the clinical course of an arterial-pelvic fistula. New concepts of management are outlined and discussed. We believe that with improved techniques of selective renal angiography, hyperosmolar-intracellular perfusate for renal preservation, availability of renal “bench” surgery and autotransplantation, undoubtedly more kidneys will be salvaged.