before exchange transfusion was performed, this does not seem to play a main rote in the splenic rupture. Perhaps a high capsular tension because of an active extramedullary hematopoiesis, tendency, secondary
hypervolemic circulation, bleeding and histologic changes of the spleen to the erythroblastosis fetalis are the
days only, although
dose was higher. Most patients resumed normal activity several weeks after transplantation and felt much better than during dialysis. In children, unlike in adults. dialysis is not an alternative to transplantation. tion for it. - G. Egli
but a necessary
main factors responsible for the splenic rupture. The diagnosis was based upon the presence of symptoms of internal hemorrhage and aided by plain abdominal x-ray films and peritoneal
Renal Arrest. R. T. Lyon. J. Ural. (April). 1973.
taps. Two of the three patients on whom the diagnosis was made were operated upon and survived. The remaining patient, who had simultaneous massive adrenal hemorrhage and renal vein thrombosis, died 2 wk postopera-
average follow-up of 4; yr presented with urinary tract infection. Intravenous pyelograms on these children were followed for changes in the sizes of the kidneys absolutely and in relation to each other. Six of thirty-two have stayed relatively unchanged after antireflux surgery. In the other 26, the smaller kidney has grown propor-
tively of sepsis.--A.
Two Cases of Gushing’s Syndrome. Tumour and Bilateral Hyperplasia. H. P. J. Pretorius and W. M. Politzer. 48: 72.5 -730 (April), 1974.
A series of 32 children
disease, are presented. In the first case. the syndrome was caused by a tumor of the right adrenal gland which was treated by unilateral adrenalectomy, and the second case was diagnosed as hyperplasia of the left gland, eventually leading to removal cortical tissue.-mmM.R.Q. Davies GENITOURINARY Regular
adrenal of all
tion in Children. E. P. Leumann and F. Largiadkr, Schweiz. Med. Wochenschr. 104:373-394 (March), 1974. Regular hemodialysis has been performed in nine children for periods of 2 to 9 mo. It was, in general, well tolerated, with no complications or major psychological problems. Linear growth rate was depressed in most patients. Seven of these patients received a cadaveric renal transplant. Six children and five allografts survived 2 to 36 mo after transplantation. Rejection episodes occurred in four children. Growth velocity was severely depressed during the first 9 mo (high prednisone dosage). Growth was found to be better with prednisone given
I I5 yr with an
tionately to its mate. The author feels that the observations in this series of patients, support the contention that rather than renal shrinkage occurring, that a cessation of renal growth occurs
Gushing’s syndrome in children has been well documented, although it is a rare condition. The majority of cases have been caused by adrenocortical tumors. A much rarer cause is cortical hyperplasia. Two patients, one with Gushing‘s syndrome and one with Gushing’s
with the infection
and reflux. ~~S. Kin1
Ural. 46: 3-10 (February).
R. A. Mogg.
Ectopic ureter is a common anomaly, most often associated with multiciplicity of the collecting system. Single ectopic ureter is rare. Normal embryologic development of the ureter is reviewed and contrasted to that of single ectopic ectopic
It is emphasized there is failure
that in single of absorption
of the caudal portion of the mesonephric duct into the bladder, resulting in failure of formation of the trigone and base plate. The ureter and mesonephric duct empty into the urethra. Trigonal and base plate developmental failure produces a wide bladder neck and defective urethral sphincter. Incontinence is a presenting symptom in single ectopic ureter. The bladder is small and cannot attain a normal capacity. The bladder contains only urine refluxed from the posterior urethra. Three cases of single ectopic ureter are reviewed. Treatment is governed by the presence or absence of a normal contralateral renal--ureteral unit and the functional status of the single ectopic ureter and its kidney. Single ectopic ureter in the presence of a normal contralateral renal-ureteral unit may be treated by ureteral reimplantation or nephroureterectomy depending on the functional status of the ectopic ureter and its kidney. Solitary or bilateral single ectopic
ureter, because of the associated vesical and sphincteric defects, is best managed by urinary diversion, although in rare instances functional reconstruction has been successful.-R. L. Kroovand
Experimental Ureteric Obstruction. D. Osborn, J. Lee, and G. Williams. Br. J. Ural. 46: 18-23 (February), 1974. The influence of hydration in nephron recovery after ureteral obstruction was studied in rats. End ureteric pressure, urine volume, urine osmolarity, and insulin clearance were measured after short-term (less than 2 hr) and long-term (6 hr) ureteral obstruction. Urine osmolarity is a sensitive index of nephron damage. The authors concluded that in shortterm ureteral obstruction, ureteric end pressure is significantly higher in hydrated rats and that nephron recovery after release of ureteral obstruction is greater in dehydrated rats, irrespective of the duration of the ureteral obstruction. Direct application of these data to the human situation is not possible.-R. L. Kroovand
A Classification and Quantitative Histological Study of Abnormal Ureters in Children. J. L. Emery and G. W. Gill. Br. J. Ural. 46: 69-79 (February), 1974. The authors conducted a gross and quantitative study of muscle, connective tissue, and elastic tissue of 78 embryologically normal, but secondarily altered ureters. Five groups of ureters evolved: (a) normal, (b) ureters with irregular dilatations, (c) slightly dilated ureters with muscle hypertrophy and hyperplasia, probably compensated, (d) elongated and dilated ureters with muscle hypertrophy and hyperplasia, but probably decompensated, (e) grossly dilated and elongated ureters having increased elastic tissue but with no comparable muscle hypertrophy and hyperplasia. Abnormal ureters had uniformly distributed varying degrees of muscle hypertrophy and hyperplasia. The form of the ureter (a,b,c,d, or e) seemed to be related to whether the muscle hypertrophy and hyperplasia were adequate to compensate for the increased luminal diameter.-R. L. Kroovand
The Post-natal Development of the Muscle and Connective Tissue of the Normal Ureter-A Quantitative Study. G. W. Gill and J. L.
Br. J. Utol.
76: 81-90. (February),
1974. A quantitative study of 50 normal ureters in children aged 0 to 6 yr revealed that intramural and extravesicai ureteral length is directly related to height. Intramural uretetal length is related to the state of the bladder distention and increases with increasing age. In the group and increases with increasing age. In the age groups studied the growth of ureteral muscle and connective tissue is uniform and progressive.-R. L. Kroovand Review of the Management of 140 Cases of Extrophy of the Bladder. M. Megalli and J. K. Lather. J. Urol. 109: 246-248 (February), 1973. One of sixty-seven patients, a female, has satisfactory bladder control after anatomic closure, though with some restrictions. Twentysix of sixty-three have been diverted after an initial primary closure. Fifty-nine patients have teflux and only 18% of the antireflux procedures were successful. Sixty-five per cent of the patients have recurrent urinary tract infections and 15% developed stones. Of 30 patients with ureterosigmoidostomy followed for 5-25 yr, 26 had some degree of upper tract deterioration on one ot both sides, I5 underwent a subsequent diversion. There ate 45 patients who have undergone diversion (30 ileal, nine colonic, six uteterostomies). There has been satisfactory upper tract maintenance in 32 patients. The authors feel that only two female patients had a successfully closed exttophy of the bladder. Their view is that supravesical diversion has the best social and psychological result and least morbidity at the present.S. Kim Congenital Urethral Polyp in the Infant: Case Report and Review of the Literature. W. C. Dewolf. and E. E. Farley. J. Urol. 109:515516 (Match), 1973. A case report of a transutethtal removal of a urethral polyp in a 3-wk-old infant. Left hydronephrosis and hydroureter with bilateral reflux were found on radiologic investigation. A retrograde urethrogram showed a filling defect present in the urethra on a stalk. This was removed through a perineal urethrostomy using the infant resectoscope. One year later, the