with a reduction in function of 10 per cent or more in the obstructed kidney had severe calicectasis; others with severe calicectasis had minimal functional loss. Renal scanning with dimercaptosuccinic acid discourages surgery in the questionably obstructed kidney and encourages repair in the severely obstructed kidney. In 10 children who had followup renal imaging after repair relative function was not significantly different,--George Holcomb, Jr.
other methods of managing the underlying lower urinary tract dysfunction were deemed appropriate, the vesicostomy was closed. Cutaneous vesicostomy proved to be an effective, simple, and easily reversible means of treating selected infants with lower urinary tract dysfunction.--George Holcomb, Jr.
Vesicoureteral Reflux in Children With Uremia. R. E. Berger, J. S. Ansell, D. B. Shurtleff, and R. O. Hickman. J A M A 246:56-59, (July), 1981.
tion T e c h n i q u e . 1. A. Fraser, M. J. Allen, P. F. Bagshaw, and
The authors delineate a small group of the total number of children with vesicoureteral reflux who have, in addition, the following three findings: (1) a corrected creatinine clearance of less than 25 m L / m i n / s q , (2) 2 ~ or greater reaction for protein on urinalysis that disclosed no infection, (3) body weight below the 5th percentile. Children with all of the above three findings will probably not do well whether or m)t their reflux is corrected. An editorial in the same issue by Barry Bellman emphasizes that such patients usually present initially with urinary infection in addition to their vesicoureteral reflux and empha' sizes that if treated sufficiently early with antibiotics a n d / o r surgery, that the end stage renal disease described by the authors might be prevented David L. Collins Major and Minor Complications of Posterior Urethral V a l v e s . K-H. Kurth, E. R. J. A/leman and F. H. Schroder. J
Urol 126:517 519 (October) 1981 Of 124 boys with posterior urethral valves 76 per cent had only minor secondary abnormalities and 24 percent had secondary problems, such as large parauretcral diverticula, high grade reflux with upper tract damage, megaureter, hydronephrosis and uremia. The diagnosis of posterior urethral valves was based on voiding cystourethrography and endoscopy. Only types l and Ill valves were found in this study. Except for one case, the valves were fulgurated endoscopically. Upper tract drainage was necessary in only four cases and kidney transplantation was required in one. Most patients were cured by valve fulguration. Reflux disappeared in more than 50 per cent. Urodynamic studies in 16 patients with persistent complaints of diurnal and nocturnal enuresis revealed further bladder dysfunction. The authors state it is important to distinguish between true posterior valves which are obstructive and other urethral findings that simulate valves but are not obstructive, such as mucosal folds and megalourethra.--George Holcomb, Jr. Cutaneous Vesicostomy in Infancy. J. Mandell, S. B. Bauer, A. H. Colodny and A. B. Retik. J Urol 126:92-93, (July), 1981.
Cutaneous vesicostomy was performed on 10 infants or young children with hydroureteronephrosis. The etiology of the upper urinary tract dilatation was neurogenic bladder dysfunction secondary to myelodysplasia in eight, and severe vesicoureteral reflux and urinary sepsis in two. The vesicostomy resulted in marked improvement in the drainage and appearance of the upper urinary tract in each child. When
A Randomized Trial to Assess Childhood Circumcision With the Plastibell Device Compared to a Conventional Dissec-
M. Johnstone. Br J Surg 68:593 595, 1981. A randomized trial of routine circumcision in children using the Plastibell device is described and compared to a dissection suturing technique. One hundred children were studied with a mean age of 4.7 years. The device was applicable to all boys up to the 8 yr and a few older. General discomfort was carefully assessed and slightly less common after Plastibell circumcision, but dysuria, more so. No serious complication was encountered with either method; infection was slightly more common after the conventional procedure. Cosmetic results were similar for both methods. It is concluded that the Plastibell device is a satisfactory method for circumcising children of this age. L e w i s Spitz The Treatment of Infantile Embryonal Carcinoma (Yolk-Sac T u m o r ) of t h e T e s t i s in Children. Th. Wohhes, J. Oldho.ffl H. Schrqffbrdt Keeps. J. A. tit" Vries. Z Kinderchir 33:349 354, 1981.
Whereas in adults the germ cell tumor accounts for 95% of all testieular malignant tumors, the corresponding figure in children is 60 76%. The germ cell tumor, however, is rare in childhood, but is mostly seen within the first year of life, A survey of the therapeutic results in five patients is given. Following orchiectomy retroperitoneal lymph node dissection was performed in two patients; inoperable lymph node metastases were found in another patient, lung metastases in 2 children. The authors emphasize that treatment of this tumor is age dependent. They recommend (besides orchiectomy as a conditio sine qua non) operative staging in patients aged 1 2 yr. "Nonoperative" staging (alpha-l- fetoprotein, CT-scan) is possible under 1 yr. Thomas A. Angerpointner Accessory Scrotum. A. A z m y , P. G. Ransley. Z Kinderchir
33:373 374, 1981. A 7 me infant presented with a posteriorly located perineal mass which was covered with typical scrotal skin. The scrotum was normally placed and contained two normal testes. No other genitourinary abnormalities were present. The accessory scrotum was simply excised. Histological examination showed adipose tissue. A search of the literature showed only one similar case of a posteriorly located accessory scrotum.-- Thomas A. Angerpointner MUSCULOSKELETAL SYSTEM In Utero Diagnosis and Treatment of Non-Human Primate Fetal Skeletal Anomalies. M. Michejda and G. D. Hodgen.
J A M A 246:1093-1097, (September), 1981. The authors were able to produce hydrocephalus in fetal rhesus monkeys by giving the mother large doses of cortico-