Crossed fused renal ectopia in children: a review of clinical profile, surgical challenges, and outcome.

INTRODUCTION: Crossed fused renal ectopia is a rare congenital malformation, wherein both kidneys are present unilaterally, with the ureter of the crossed kidney opening into the bladder on the contralateral side. It has varied presentation from incidental detection to renal impairment. In this largest series of crossed fused renal ectopia, the authors assessed the clinical profile of these children and also attempted to shed light on the challenges in the surgical management. METHODS: It is a retrospective study conducted from January 2009 to July 2018, among patients evaluated for crossed fused ectopia, in the Department of Pediatric Surgery, Christian Medical College, Vellore. Electronic medical records of 36 children were reviewed. Imaging modalities and operative interventions were recorded. Results were analyzed. RESULTS: A total of 36 children were found to have crossed fused ectopia, with male preponderance. Most children presented within one year of age with urinary tract infection being the commonest cause. The most common associated anomaly was anorectal malformation. Ultrasound abdomen and pelvis, micturating cystourethrogram, and radionucleotide scans were the imaging modalities preferred for diagnosis and follow-up. Left-to-right ectopia was more common with inferior ectopic variant being the most common. The predominant urological problems include pelviureteric junction obstruction, vesicoureteric junction obstruction, and vescioureteric reflux. Ureteric re-implant was the most common surgery performed followed by pyeloplasty. Pelvi-pelvostomy, uretero-ureterostomy, bladder augment with Mitrofanoff, and other procedures were performed for select cases. CONCLUSION: Crossed fused renal ectopia is a challenging entity which requires individualized management plans based on the predominant urological anomaly and the functional status. Surgical options are diverse and are guided toward the symptomatic urological problem with focus on preserving the renal function. The long-term prognosis is good in these children.

Diabetes enhances periodontal bone loss through enhanced resorption and diminished bone formation.

Using a ligature-induced model in type-2 Zucker diabetic fatty (ZDF) rat and normoglycemic littermates, we investigated whether diabetes primarily affects periodontitis by enhancing bone loss or by limiting osseous repair. Diabetes increased the intensity and duration of the inflammatory infiltrate (P < 0.05). The formation of osteoclasts and percent eroded bone after 7 days of ligature placement was similar, while four days after removal of ligatures, the type 2 diabetic group had significantly higher osteoclast numbers and activity (P < 0.05). The amount of new bone formation following resorption was 2.4- to 2.9-fold higher in normoglycemic vs. diabetic rats (P < 0.05). Diabetes also increased apoptosis and decreased the number of bone-lining cells, osteoblasts, and periodontal ligament fibroblasts (P < 0.05). Thus, diabetes caused a more persistent inflammatory response, greater loss of attachment and more alveolar bone resorption, and impaired new bone formation. The latter may be affected by increased apoptosis of bone-lining and PDL cells.

Electron microscopy of the oxynticopeptic cells of the gastric glands and the intestinal glands of the caecum of the guineapig.

Histomorphology of the gastric and intestinal glands was investigated in 19 sexually mature, adult guineapigs by light and transmission electron microscopy. Gastric glands exhibited the cytological characteristics of oxynticopeptic cells capable of both hydrochloric acid (HCl) and pepsinogen secretion. In the literature, occurrence of oxynticopeptic cells in the proventriculus of the domestic fowl (Toner, 1963; Bell & Freeman, 1971) and in the gastric glands of frogs has been reported (Sedar, 1961; Patt & Patt, 1969; Forte & Forte, 1970). It has been claimed by other investigators (Herriot et al., 1938; Long, 1967) that simultaneous secretion of HCl and pepsinogen by a single, not completely differentiated 'pure' cell type, was highly effective for rapid conversion of the zymogen to active enzyme. Under the light microscope with haematoxylin and eosin stain, the protein secreting activity of gastric glands in guineapigs was masked by the HCl secreting activity, thus morphologically resembling the oxyntic cells. Therefore, different cell types, for example protein-secreting peptic cells and the acid-secreting oxyntic cells, could not be distinguished on the basis of their morphology and staining affinity. For histochemical evaluation of the sections with stains-all method, most cells in the gastric glands responded by a positive reaction to protein. Further, protein containing cells were seen in the intestinal glands of the guineapig caecum. The function of this cell type was correlated with caecotrophic food habits of this species.

Histomorphology of the hamster cheek pouch.

Histomorphology of the cheek pouch was studied in 14 hamsters by light and transmission electron microscopy. The cheek pouch wall was devoid of any lymphatic tissue and dense subepithelial tissue (i.e. the lamina propria) would render lymph drainage almost impossible and might constitute impermeable morphological barrier for non-recognition of transplants evoking a host immune response. Because in the literature it was reported that there is absence of any arteriovenous anastomoses on the pouch wall, and interruption of arterial supply failed to alter the growth rate of tissue grafts, we speculated that epidermal growth factors present in the saliva could play a role in maintaining the growth of tissue transplants.

Synapse formation on quail trochlear neurons transplanted in duck embryos before naturally occurring motor neuron death.

About half of the trochlear motor neurons in duck and quail embryos die during normal development. In a previous study the role of target muscle in controlling the number of surviving motor neurons was investigated by reducing the number of neurons innervating the muscle. This was accomplished by removing the midbrain of the duck embryo and grafting in its place the midbrain of the quail embryo before motor neuron death begins. It was observed that the number of surviving trochlear motor neurons in the quail-duck chimera embryos was not significantly different from that of the normal quail. The present investigation was undertaken to determine whether trochlear motor neurons in the chimera embryos received afferent synapses. Brains of duck, quail and chimera embryos on days 16 and 20 were processed for electron microscopical observations. Synapses formed on motor neurons of the chimera embryos. Surprisingly, synapses on motor neurons of quail differed from those of duck, both qualitatively and quantitatively. Synapses on the motor neurons of the chimera embryos developed in a fashion similar to that for the duck motor neurons. Our failure to rescue trochlear motor neurons in the chimera embryos suggests that the developing motor neurons may respond to a larger target muscle only if they received a normal complement of afferent synaptic input.

Comparative morphology of the stomach of some laboratory mammals.

Histomorphology of the stomach of mouse, rat, hamster, guineapig, gerbil, and rabbit was studied. Although a common structural basis existed in the stomach between these species, the occurrence and distribution of various cells in gastric glands differed considerably between them. In mice, rats, hamsters and gerbils, the lower one-third of the glandular lamina propria was seemingly occupied by a varying proportion of parietal and chief cells. In rabbits, the predominantly occurring chief cells were distributed in the lower three-quarters of the glands intermingling with parietal cells, but in guinea-pigs the chief cells were not discernible. In hamsters, there was, however, a gradual increase of chief cells from the junction between nonglandular-glandular stomach toward the pyloric region. In all these species, parietal cells were the predominant cell type in the upper half to upper one-third of the gastric glands, often extending up to the neck of the glands interspersing between mucus neck cells and occasionally between chief cells.

Morphology of the terminal bronchiolar region of common laboratory mammals.

The histomorphology of the terminal bronchiolar region of the mouse, rat, hamster, guinea pig, gerbil and rabbit was studied. Although some general structural similarities existed in the progressive intrapulmonary branching pattern of the airway tree between species, there were conflicting accounts in the literature about the presence of the respiratory bronchioles in common laboratory mammals. In our light microscopy study we failed to detect the existence of typical respiratory bronchioles with characteristic interruptions on their walls projecting into the alveoli. Frequently in these species the terminal bronchioles were short and abrupt, opening directly into several alveolar ductules.

Effect of methoxychlor on reproductive systems of the rat.

Methoxychlor ( MeOCL ), a chlorinated hydrocarbon pesticide, was administered by oral gavage for 70 days to male and 14 days to female rats at dose levels of 100 and 200 mg/kg/day of body weight. Methoxychlor inhibited spermatogenesis in the males and folliculogenesis in female rats. The sustentacular (Sertoli) cells showed degenerative fatty changes as a result of which blood-testis barrier could have been affected. Degenerative changes of the spermatogonia and the spermatocytes and transformation of some of these cells into polynucleated and binucleate cells were observed. Myelin figures and degenerate mitochondria were observed in the binucleate cells at the ultrastructural level. Some of the seminiferous tubules were devoid of all cellular elements with the exception of spermatogonia. The epithelium of the ductus epididymis manifested conspicuous cytoplasmic vacuolations , and near the tail, the duct was distended with fluid which compressed the lining epithelium. Atresia of the ovarian follicles was evident with pyknosis and karyorhexis of the granulosa cells.

Histomorphologic structure of the carotid rete-cavernous sinus complex and its functional importance in sheep (Ovis aries).

Paraffin sections of the carotid rete-cavernous sinus complex of sheep were studied, using different stains. The carotid rete of sheep was composed of medium-sized arteries with smooth muscle layers that were oriented in different directions. The carotid body cells may have migrated proximally in the adventitia of the intracranial portion of the internal carotid artery as its extracranial portion degenerates early in life. The cavernous sinus shared a common tunica adventitia with surrounding rete branches. At places, the wall of the cavernous sinus had a distinct tunica media interposed between the endothelial cells and the tunica adventitia. Therefore, the name cavernous venous plexus has been proposed for the cavernous sinus in sheep.

Histomorphology of the urethral process of the goat (Capra hircus).

The urethral process of the goat was an extension of the pars spongiosa of the male urethra. The erectile (cavernous) tissue of the urethral process was a continuation of the corpus spongiosum penis. The epithelium lining the urethra was stratified transitional. Two compact fibrocartilaginous strands were embedded in the erectile tissue, which were absent towards the tip of the urethral process. Smooth muscle was absent in the tunica mucosa-submucosa of the urethral process. The tunica mucosa-submucosa was richly supplied with blood vessels and nerves and it may be assumed that the urethral process is a sensory structure. Large cavernous sinuses, within the erectile tissue, were lined by endothelial cells. There was a circular fibroelastic layer enclosing the entire corpus spongiosum penis to withstand expansion of the erectile tissue during erection and copulation. The surface epithelium lining the urethral process was stratified squamous. A few connective tissue papillae were observed evaginating into the surface epithelium.