Roy Filly

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.

The ultrasonographic spectrum of abdominal and pelvic Hodgkin's disease and non-Hodgkin's lymphoma

Diagnostic B‐scan ultrasonography has the capacity to evaluate many potential sites of abdominal and pelvic involvement by Hodgkins disease and non‐Hodgkins lymphoma. The varying ultrasonographic features of lymphomatous involvement in the peritoneal cavity and retroperitoneal space are described and potential diagnostic pitfalls are discussed.

Routine full-lung tomography in the initial staging and treatment planning of patients with Hodgkin's disease and non-Hodgkin's lymphoma.

The yield of additional information from anteroposterior full‐lung tomograms that changed stage or treatment, in comparison to that obtained from routine chest radiographs, was prospectively evaluated in 243 previously untreated patients with Hodgkins disease and non‐Hodgkins lymphoma. Although new information was found in 21.4% of all patients, in only 1.2% did these additional data change patient staging. In 3.3% of the other patients the tomograms provided information that affected radiotherapy treatment planning as practiced in our institution.

Posterior urethral valves

During the past decade some urologists and radiologists have doubted the existence of posterior urethral valves. It has been suggested that the primary lesion in patients thought to have urethral valves is bladder neck obstruction. During the past seven years we have seen an average of three new cases of posterior urethral valves per annum. In all cases the valves themselves, not the bladder neck, obstructed the urethra. The urologist may miss valves at urethroscopy, but use of the new fibreoptic endoscope has improved his chances of seeing them. Posterior urethral valves may not be demonstrated radiologically if the radiologist does not use a rapid recording device or if the patient does not micturate forcefully during micturating cystourethrography. Failure to detect the valves may lead to an erroneous diagnosis of bladder neck obstruction.

The postcricoid impression masquerading as an esophageal tumor.

SummaryA case has been reported of a 57-year-old man who underwent negative neck exploration for an apparent mass, supposedly lying between the esophagus and trachea, which was seen elsewhere on an esophagram and at bronchoscopy. A postoperative esophagram performed at Stanford demonstrated a typical postcricoid impression. This impression forms on the anterior esophageal wall, immediately below the slight impression which the cricoid cartilages posterior lamina sometimes produces. It can assume seven different shapes. Unlike a tumor, it is transient and varies in size and shape.

LATE URETERIC OBSTRUCTION FOLLOWING URETERAL REIMPLANTATION FOR REFLUX" A Warning

Abstract Ureterovesical junction obstruction is a well-known complication following ureteral reimplantation to cure reflux. However, little attention has been paid to obstruction as a late complication of ureteral neocystostomy. Two cases of late obstruction following ureteral reimplantation are presented as a warning that intermittent routine excretory urography should be performed in these children even in asymptomatic cases.

Distance of Upper Pole Calyx to Spine and Lower Pole Calyx to Ureter as Indicators of Parenchymal Loss in Children

The authors analyzed the excretory urograms of 177 female children whose ages ranged from infancy to eleven years. The purpose of the study was to discover whether the upper pole calyx moves closer to the spine and the lower pole calyx moves closer to the ureter in the presence of calyceal clubbing and parenchymal scarring. This study confirms these observations but shows that considerable overlap occurs between normals and abnormals. This overlap is greatest in the younger age group and in the lower pole calyx to ureter measurements.

Appearing and disappearing calyces

The excretory urograms of 51 children under the age of 12 years who had 167 excretory urograms, an average of 3.3 per patient, were carefully examined. It was found that an average of 2 calyces per kidney per patient did not fill during excretory urography on the left, and just over 2 calyces per kidney per patient did not fill during excretory urography on the right. Neither the intravenous injection of large amounts of contrast medium nor the use of ureteral compression were of particular use in filling the calyces. Calyces did not always fill with a vigorous injection during retrograde pyelography. A poorly filed calyx, therefore, may be misdiagnosed as abnormal, or a clubbed calyx not filled during the examination may be missed.

Evanescent colitis in a child

The clinical and radiographic features of evanescent colitis in a child are described. Previously reported cases have occurred in adults.

Demonstration of vestibular implantation of ectopic ureters on an excretory urogram

The authors describe a patient in whom they demonstrated ectopic vestibular ureteral implantation on excretory urography. They indicate that this simple rechnique should be fully exploited before doing vaginograms or other more exotic examinations.