Urinary undiversion. Montreal Children's Hospital experience.

Nine patients underwent urinary tract refunctionalization after prior supravesical diversion. Emphasis is placed on careful preoperative evaluation of these patients, including studies of renal and bladder function. In 8 patients continuity could be restored without interposition of bowel segment, while in the ninth case, this was necessary because of short ureteral lengths bilaterally. This was the only technical failure in this series requiring restoration of the diverted state. There was a dramatic improvement noted in the quality of life and mental status in the 8 patients in whom the procedure was successful.

Adrenal cortical tumors in children.

A review of the literature reveals 230 cases of adrenal cortical tumors in children. We add an additional 7 cases. Signs, symptoms, laboratory studies, and treatment of this rare rate tumor are discussed.

Unusual case of urethral duplication.

We present a case of unique penile malformation, a child with common prostatic urethra with two normal, double urethras parallel to one another with a bifid glans penis. This case emphasizes how abnormal embryology can contribute to our knowledge of normal development.

Abnormalities of the ureteral bud.

The development and incorporation of the ureteric bud into the developing bladder is a complex process, and it is influenced by events occurring at the same time in the development of other systems in the perineum. Knowledge of the embryology of the ureteric bud and associated wolffian duct is the key to understanding the development of the entire genitourinary system. If the normal embryology is understood, the dysembryogenesis that results in many of the common anomalies of the lower urinary system is simplified. Many of the concepts proposed in this discussion are well substantiated, others are more difficult to prove conclusively. It is believed, however, that the embryologic approach provides a simplified understanding of many of the common problems encountered in pediatric urology. The key in clinical practice to the diagnosis and understanding of these defects is the cystoscopic examination. Careful assessment of the orifice's position, appearance, and tunnel length will allow the interpretation of how the abnormality came about, and also provides valuable information concerning the state of the associated renal segment. This in turn allow better therapeutic management of the problem based on the knowledge of the severity of the renal anomaly associated with the abnormality found in the bladder.

Management of smooth-blunt gastric foreign bodies in asymptomatic patients.

Guidelines for management in the asymptomatic patient with a smooth-blunt gastric foreign body are not well established in the pediatric literature. Questionnaires were sent to pediatricians, family practitioners, pediatric gastroenterologists and pediatric surgeons with an over-all response rate of 62.2%. There was no agreement in regard to how long one should observe such patients before recommending intervention. There was no correlation of years of clinical experience and length of observation recommended either. Review of the pre-endoscopic literature revealed spontaneous evacuation in 93-99% of all types of foreign bodies in 1477 pediatric patients. An observation period of at least eight weeks should be strongly considered in an asymptomatic patient with a smooth-blunt gastric foreign body. Exceptions would include an anatomic abnormality of the gastric outlet, previous gastric outlet surgery as well as a possibly toxic object.

Duplex kidneys: a correlation of renal dysplasia with position of the ureteral orifice.

A study was made of 51 duplex kidneys, ureters and bladders to assess the types of abnormalities seen in duplex kidneys. The abnormalities affected ectopic and orthotopic segments equally. The occurrence of renal abnormality was closely correlated to the abnormal locations of the segment's ureteral orifice. When the orifice was displaced either cranially (orifice positions B, C and D) or caudally (orifices G and H) the orthotopic and ectopic segments, respectively, showed more severe hypoplasia and dysplasia. Faulty embryogenesis is proposed to explain these findings and the importance of endoscopic positioning of the ureteral orifice is emphasized in determining whether heminephrectomy will be necessary.

Metastatic infantile Wilms' tumor and hydrocephalus; a case report with review of the literature.

A case of infantile metastasizing Wilms' tumor is described clinically and pathologically. The presenting feature was congenital hydrocephalus due to cerebral metastases. The literature is reviewed and four similar examples are found. The unusual pattern of clinical presentation and metastases is emphasized as it may be characteristic for this rare entity.

Intestinal absorption of bile salts: immature development in the neonate.

The intestinal absorption of sodium taurocholate was studied in fetuses, neonates, infants, children, and adults. Absorption rates were measured in vitro in everted rings of jejunum and ileum. Mucosal accumulation of 3H-taurocholate against a concentration gradient was consistently demonstrated in rings of ileum from adults, children, and infants older than 8 months, whereas fetal and neonatal ileal mucosal concentrations were not significantly above those in the incubation medium after exposure of the mucosa to 0.003, 0.03, and 0.3 mM taurocholate. There were no significant differences in mucosal uptake of taurocholate by perinatal jejunal and ileal rings. Incubations of mucosa from older infants, children, and adults in 0.3 mM taurocholate exhibited saturation phenomena. It is concluded that the ileal mechanism for active transport of taurocholate is undeveloped in the fetus and newborn infant. It is probable that the enterohepatic circulation of bile salt during the perinatal period is limited to that fraction of bile salt absorbed passively. The results suggest that losses of bile salt from the immature intestine may contribute to the steatorrhea and so-called diarrhea of newborn infants.