The effect of hypoglycemic seizures on cognitive function in children with diabetes: a 7-year prospective study.

Sixteen children with insulin-dependent diabetes mellitus were evaluated at diagnosis and after 1, 3, and 7 years. They showed significant declines in verbal but not visuospatial abilities, particularly if they had any seizures from hypoglycemia. At the 7-year assessment those with hypoglycemic seizures showed deficits on perceptual, motor, memory, and attention tasks.

A new technique for correction of the hidden penis in children and adults.

PURPOSE: A phenomenon known as hidden penis has numerous origins, including congenital buried penis and obesity with descent of the escutcheon. No previous report to our knowledge mentions abnormal hypermobility of ventral skin and dartos fascia, which is a major cause of surgical treatment failures. Because the skin and dartos fascia are inadequately attached to Buck's fascia, the corporeal bodies telescope proximally inside the scrotum and pubis. Therefore, the subdermis of the penoscrotal junction must also be tacked to the tunica albuginea ventrally to stabilize the proximal penile skin and prevent the penis from retracting into the scrotum. The surgical technique for correction of the hidden penis in adult and pediatric patients with adequate penile shaft skin is described. MATERIALS AND METHODS: Surgery for hidden penis from multiple causes was performed in 6 adults and 7 children. Tacking sutures were taken from the subdermis of the ventral penoscrotal junction to the tunica albuginea in all cases. A combination procedure with either suprapubic dermatolipectomy, tacking of the penopubic subdermis to the rectus fascia, penoscrotal Z plasty, circumcision revision or lateral penile shaft Z plasty also was performed in some patients. RESULTS: Improvement was noted in all cases. One child requires suprapubic lipectomy for optimal improvement and 3 minor wound problems occurred. CONCLUSIONS: Surgery for hidden penis achieves marked aesthetic and often functional improvement. Surgical failure can be diminished by placing ventral tacking sutures from the tunica albuginea to the subdermis of the penoscrotal junction.

[Current status of laparoscopic surgery in pediatric urology]. / Derzeitiger Stand der laparoskopischen Chirurgie in der pädiatrischen Urologie.

The current world-wide experience with laparoscopy in the field of pediatric urology is summarized. Based on significant personal expertise, the operative technique and instrumentation of the different procedures are described. Herein standard indications (i.e., diagnosis and therapy of cryptochidism, bilateral varicoceles) can be distinguished from rather infrequent procedures (i.e., renal cyst resection, nephrectomy) and experimental indications (case reports) such as bladder "auto" augmentation, antirefluxplasty and pyeloplasty. At the referring centers, laparoscopic surgery in pediatric urology has significantly increased. Therefore, this minimally invasive, delicate technique is becoming more popular.

Addison's disease presenting with cerebral edema.

BACKGROUND: Increased intracranial pressure with encephalopathy has rarely been reported in Addison's disease. METHOD: Case Study. RESULTS: A 16-year-old female who presented with cerebral edema of unknown etiology was eventually diagnosed as having Addison's disease. She had early morning headaches, fatiguability, diarrhea and deterioration in school performance. She was hyponatremic with a serum sodium of 128 mmol/L and hyperkalemic with a serum potassium of 5.9 mmol/L. She had a low serum osmolality (264 mosm), high urine osmolality (533 mosm) and high urine sodium (87 mosm). She had a postural drop in blood pressure and diffuse hyperpigmentation. An ACTH stimulation test revealed a low baseline cortisol and no response to ACTH. Plasma renin activity was increased. Serum ACTH was elevated. She responded well to intravenous fluids and solu-cortef and was discharged on hydrocortisone and florinef. She remains well 18 months after the acute episode with no neurologic complaints or findings. CONCLUSION: Addison's Disease should be considered in the differential diagnosis of symptomatic cerebral edema and idiopathic intracranial hypertension.

Femoral nerve neuropathy after the psoas hitch procedure.

We report the first 3 cases of femoral nerve neuropathy after a psoas hitch vesicopexy, a technique commonly used with ureteroneocystostomy. The condition in 2 patients resolved with conservative therapy, and the third patient required reoperation with removal of an offending suture. All 3 patients recovered completely with no residual neurologic deficit. Urologists who use the psoas hitch must be familiar with this potential complication to prevent its occurrence.

Split-thickness skin graft urethroplasty and tunica vaginalis flaps for failed hypospadias repairs.

PURPOSE: Via a 2-stage procedure, 10 patients with failed hypospadias repairs were treated by a varied combination of split-thickness mesh graft urethroplasty and tunica vaginalis flap. MATERIALS AND METHODS: A bed for the mesh graft in 3 patients was provided by a tunica vaginalis flap. Tunica vaginalis flaps were also used as an intermediate layer during stage 2 of the repair. RESULTS: No strictures or fistulas occurred in 8 patients. Two patients await stage 2 repair after successful stage 1 placement of the mesh graft. CONCLUSIONS: The combination of split-thickness mesh graft urethroplasty and a tunica vaginalis flap appears to achieve success in the difficult patient with complex hypospadias subsequent to multiple failed repairs.

Bone mass in children with congenital hypothyroidism treated with thyroxine since birth.

To determine whether the large doses of thyroxine treatment early in life adversely affect bone mass, we measured bone mass of 20 congenital hypothyroid (CH) patients (8.4 +/- 2.2 years) who were diagnosed and treated since birth. Starting thyroxine dose and current dose were 8.5 +/- 1.9 micrograms/kg/day and 3.1 + 1.2 micrograms/kg/day respectively. Thyroid function and serum biochemical tests for calcium homeostasis were normal at the time of study. Bone mass was measured by dual energy X-ray absorptiometry. Nine siblings served as controls. The patients' bone mineral density was within the normal range of population controls, and was not different from the sibling controls. The patients also had height-adjusted bone mineral content equal to the expected height-adjusted values in the siblings. Our studies indicate that the large doses of thyroxine therapy for CH do not cause osteopenia in childhood.

Transient autonomic neuropathy in an adolescent with insulin dependent diabetes mellitus.

A 15 year-old girl with insulin dependent diabetes mellitus of 11 years duration developed severe neuropathy involving the bladder and stomach. The bladder recovered after 2 months of intermittent catheterization. Metoclopramide relieved the gastric symptoms. Gastric emptying was normal after 2 further months of treatment. The neuropathy developed in spite of a mean HbA1c of 7.4% suggesting that factors in addition to glycemic control play a role in the development of the complications of insulin dependent diabetes mellitus.

Long-term effects of L-thyroxine therapy for congenital hypothyroidism.

OBJECTIVE: To study the effects of initial and concurrent dose levels of L-thyroxine on ability and behavior in children with congenital hypothyroidism. METHODS: An existing database, involving a large cohort of children with congenital hypothyroidism detected by neonatal screening, was analyzed retrospectively. There were 94 children: 89 were assessed at age 7 years for intelligence and selective cognitive abilities, and 87 at age 8 years for behavior, achievement, and selective abilities. RESULTS: Subjects were stratified by median split into low and high starting dose groups. The high-dose group performed better on indexes of intelligence, verbal ability, and memory but had more behavior problems reflecting increased anxiety, social withdrawal, and poorer concentration. The dose of L-thyroxine at age 8 years was negatively correlated with memory task performance. CONCLUSION: A higher starting dose of L-thyroxine is beneficial for subsequent intellectual outcome in children with congenital hypothyroidism but may be associated with internalizing behavior problems.

Laparoscopic renal surgery in children.

A total of 17 laparoscopic renal procedures was performed in children, including nephrectomy (10), nephroureterectomy (4), partial nephrectomy (2) and giant renal cyst excision (1). Patient age ranged from 4 months to 11 years (average age 34 months). The average operating time was 2 hours and 15 minutes, ranging from 1 hour 50 minutes to 2 hours 45 minutes. The usual period of hospitalization was 23 hours, with the longest being 36 hours for 2 patients. No complications ensued. Despite the decreased working space in children, laparoscopic renal surgery offers compelling advantages, including short hospitalization, less perioperative and postoperative pain, improved cosmesis, earlier return to normal unrestricted activities and early return to work for the parents. Methods to accomplish renal laparoscopic surgery safely in children are detailed.

Laparoscopic vesicoureteroplasty in children: initial case reports.

OBJECTIVE: To determine the feasibility of performing laparoscopic vesicoureteroplasty in children. METHODS: Two pediatric patients, a two-year-old boy and a five-year-old girl, underwent laparoscopic vesicoureteroplasty for vesicoureteral reflux. Operating time was two hours fifteen minutes and three hours fifteen minutes, respectively. RESULTS: The reflux was successfully corrected without morbidity, and they required only short hospitalization (23 hours) and exhibited decreased peri- and post-operative pain as well as improved cosmesis. CONCLUSIONS: These cases represent the first implementation of this technique in humans. We stress that this is a preliminary report and suggest that this technique deserves further study.

The endocrine outcome after surgical removal of craniopharyngiomas.

The postoperative course of children undergoing surgery for craniopharyngioma was reviewed. Typically they were below height at presentation. All had an attempt at radical surgical resection of the tumor. Most developed diabetes insipidus in the postoperative period, which was permanent in all but 1 child. 94% required thyroid replacement therapy, and sex steroids were administered in 100% when they reached the age of puberty. 91% required maintenance corticosteroids. 54% required growth hormone replacement, but some children showed continued growth despite apparent growth hormone deficiency. Postoperative obesity develops in one half of patients, and may be improved with administration of growth hormone; a controlled trial is underway.

Gastrocystoplasty without opening the stomach.

We describe a modification of gastrocystoplasty using the GIA stapler to harvest the segment for augmentation without opening the stomach. This simplification reduces operative time and blood loss without introducing complication specific to it and has been successfully used in our first 5 patients.

Laparoscopic seromyotomy (auto-augmentation) for non-neurogenic neurogenic bladder in a child: initial case report.

An eight-year-old boy with lifelong urinary incontinence secondary to non-neurogenic neurogenic bladder underwent successful laparoscopic seromyotomy (auto-augmentation) with resultant cure of his incontinence. The ability to perform this laparoscopically with its seventy-minute operating time, decreased hospital stay, and improved cosmesis militates for its consideration before a standard augmentation is performed.

Umbilicus preservation with total abdominal wall reconstruction in prune-belly syndrome.

A technique to preserve the umbilicus in abdominal wall reconstruction for prune-belly syndrome is presented. Our technique has been utilized in 5 cases with success.