[Diagnosis, therapy and follow-up of infants with urethral valves, treatment concept in the 1st year of life]. / Diagnostik, Therapie und Verläufe von Säuglingen mit Harnröhrenklappen, Behandlungskonzept im 1. Lebensjahr.

Within the framework of a joint follow-up we report on the treatment of 57 infants with urethral valves (35 babies from Munich and 22 from Siegen) in the first year of life, studied between 1974 and 1986. In 16 newborn the diagnosis and initiation of treatment was effected during the first four weeks of life (Group I) and in 41 babies during the 2nd to 12th month (Group II). In three cases, diagnosis of suspected urethral valve was made prenatally. Primary management and the concept of further treatment are described. Primary therapy is determined by the general condition after birth, presence of urosepsis and the extent of any existing renal insufficiency. 2 children died, both from Risk Group I. 5 children are in a state of compensated renal insufficiency. In 2 newborn we were compelled to perform supravesical urinary drain and in 3 children a suprapubic drain. Secondary nephrectomy became necessary in 4 children, 3 of whom belonged to Risk Group I. In 23 of 57 children valve resection followed by transurethral drainage was the only therapy. In 22 of 57 children corrective surgery was performed subsequently (neo-implantation, with and without modellage, stenosis of the ureter exit). The article reports on the course in each case.

Urological operations for solitary kidneys in children.

Depending on the underlying disease, children with solitary kidneys who have to undergo urological operations have the same good or poor prognosis as children with two kidneys (Whiting et al. 1983; Redman and Birsada 1976; Stackl et al. 1983). However, the problem of long-term prognosis persists. It is similar to that for children who have undergone surgery for reflux: a certain number of them will develop renal insufficiency in 20-30 years. Nephrologists estimate that 20% of adults who suffer from renal insufficiency and become dialysis dependent formerly had reflux nephropathy. The influence of reimplantation, performed with good results during the past few years, cannot be assessed so far. Large prospective studies are needed.

Pyonephrosis in childhood--is ultrasound sufficient for diagnosis?

The validity of ultrasound in the diagnosis of pyonephrosis in infants and children was retrospectively investigated in 14 patients. The disease was unilateral in 13 patients and bilateral in one. The diagnosis was proven by percutaneous nephrostomy in 7 and by operation in 7 patients. Ultrasound was true positive in 9 patients (10 kidneys) and false negative in 5. Large staghorn calculi were present in 2 of the 5 false negative cases. A group of 20 patients with simple hydronephrosis, investigated by percutaneous punctures, served as a control group. There were two false positive cases in this group. The sensitivity of sonography for the diagnosis of pyonephrosis was only 66.7%, which is considerably lower than in previous reports. We therefore recommend early sonographically guided percutaneous puncture of the renal pelvis whenever pyonephrosis is suspected.

Infundibulopelvic stenosis--evaluation of diagnostic imaging.

Infundibulopelvic stenosis is a very rare kidney disease. This congenital disorder must be differentiated from multicystic dysplastic kidney, polycystic kidney disease, simple renal cysts and mega-(poly)-calicosis. Associated abnormalities of the ureter are rare. Ureteric obstruction was associated in our two patients, and in one case agenesis of the bladder and a duplicated genital tract were also present.

[Diagnosis and therapy of pyonephrosis in infancy and childhood]. / Diagnostik und Therapie der Pyonephrose im Säuglings- und Kindesalter.

A diagnostic schedule in pyonephrosis was followed in thirteen infants and children. Obstruction of the urinary tract could be demonstrated in 12 patients, non-obstructive pyonephrosis was present in one case. Congenital obstructive malformation of the urinary tract was found in 7 patients, obstruction was acquired in 5. Sonographically, pyonephrosis could be diagnosed in 8 patients (64.3%). Excretory urography (10/13) was helpful in no actual case. Sonographical-guided percutaneous nephrostomies were performed in 5 patients and operative nephrostomies in 4. Emergency-nephrectomies were done in 4 patients. A tap of the renal pelvis is the best way for early diagnosis whenever pyonephrosis is clinically suspected.

[Acute multifocal gastric hemorrhage in non-Hodgkin's lymphoma of the upper digestive tract in a 7-year-old female]. / Akute multifokale Magenblutung bei Non-Hodgkin-Lymphom des oberen Digestionstraktes eines 7jährigen Mädchens.

The acute gastric bleeding of children out of multifocal ulcers is an unusual leading symptom of systemic malignancy. Lymphomas of the gastrointestinal tract in children mostly are localized in the ileocoecal region and seldom in the stomach. The Zollinger-Ellison syndrome - only sporadically seen in childhood - is the first differential diagnosis. Therapy of acute ulcer bleeding consists of oversewing and medical prophylaxis of relapse and covers the directions of therapy of Zollinger-Ellison syndrome. Specific therapy of malignant lymphomas including polychemotherapy and radiation isn't possible before end of wound healing.

[Accomplishments of tumor surgery in pediatric nephroblastoma]. / Leistungen der Tumorchirurgie beim kindlichen Nephroblastom.

The cure rate of Wilm's tumor in childhood could be increased to more than 80% by systemic adjuvant chemotherapy in combination with operation and radiation. The importance of histological grading is discussed. Especially preoperative chemotherapy has made progress possible in reducing risks of operative techniques and has improved the prognosis for survival.

[Diagnostic and therapeutic aspects of antegrade ureteropyelography and percutaneous nephropyelostomy in childhood]. / Diagnostische und therapeutische Aspekte der antegraden Ureteropyelographie und der perkutanen Nephropyelostomie im Kindesalter.

In a sample of 18 children aging one day to eighteen years 21 percutaneous nephrostomies and 27 antegrade pyelographies were performed using sonography and fluoroscopy. Thirteen patients had both nephrostomy and pyelography and 5 had only pyelography. Three of 13 patients needed bilateral nephrostomies. The results indicate that the combination of percutaneous nephrostomy and antegrade pyelography is helpful in diagnosis and treatment of various obstructive disorders of the urinary tract especially in the newborn period.

[Surgical separation of symmetrical conjoined ischiopagus twins]. / Zur Trennung eines symmetrischen Ischiopagenpaares.

This is a case report on symmetrical ischiopagus tetrapus. We made exact preoperative examinations of the topographic anatomical relationships before performing the separation at the age of ten months. Both twins survived the operation without complication. A second procedure to correct the misformed pelvices of both children was successfully performed. The twins have been released from the hospital. One child, who can walk, lives with his parents. The second child has a perinatal brain defect, and as such is cared for in a nursing home.

[Improved prognosis in Wilms' tumor due to adjuvant combination drug therapy]. / Verbesserte Prognose beim Wilms-Tumor durch adjuvante Kombinationschemotherapie.

78 children with Wilms' tumor stage I--IV diagnosed since 1960 are presented. There were two groups of patients: one group consisting of 35 patients which received adjuvant chemotherapy for 1 year, the other group consisting of 43 patients which received no chemotherapy. Surgical excision and irradiation was identical in both groups. The prognosis was greatly improved by adjuvant chemotherapy: 4-year survival rates increased from 25 to 69%. Late side effects from radiation and chemotherapy were noted: 15/78 patients suffered from scoliosis and all patients treated by chemotherapy had a decreased lymphotoxin activity over years. The following factors appear to be related to prognosis: the extent of disease in patients determined by better techniques, histopathology of the tumor, and the nature of treatment.

[The use of split and regional renal clearance for indication for surgery in pediatric urology (author's transl)]. / Stellenwert der seitengetrennten und regionalen Nieren-clearance für die Operationsindikation in der Kinderurologie.

The differential and ipsilateral clearance of Hippuran allows for a quantitative assessment of the function of both kidneys, a single kidney and a part of one kidney. We have performed this investigation 179 times in 156 children in relation to dysplastic kidneys, obstructive lesions in the upper urinary tract, duplex kidneys and in follow-up situations. In many of these patients this investigation produced an indication for an organ-preserving operative procedure. The radiological findings are compared with the clinical picture.

[Eventration of diaphragm on both sides (author's transl)]. / Der seltene Fall einer doppelseitigen Relaxation des Zwerchfells.

There is reported about a patient, who was treated for a complete eventration of diaphragm on the right side and a partial on the left. Diagnostical advancements and operative procedure are discussed.

Plasma testosterone in male puberty. II. hCG stimulation test in boys with hypospadia.

Plasma testosterone was determined by radioimmunoassay in 36 prepubertal boys with hypospadia prior to and 3 days after stimulation with 5000 IU of human chorionic gonadotrophin (hCG). As a control group, 30 boys of comparable age, predominantly with unilateral cryptorchidism, were studied. The increase in plasma testosterone levels after hCG was (median and range) 204 (83-393) ng/100 ml in the control group, whereas in the hypospadiac group a median increase of only 90 (33-272) ng/100 ml was found. The difference between the median testosterone levels after hCG stimulation in the two groups investigated is statistically highly significant (P less than 0.0001). After hCG stimulation, 13 out of the 36 boys with hypospadia did not reach the lowest stimulated testosterone level (87 ng/100 ml) found in the control group. It is concluded that a substantial portion of the aetiologically obscure cases of hypospadia are caused by an endocrine testicular insufficiency.

[Ultrasound in the differential diagnosis of Wilms tumors (author's transl)]. / Ultraschall in der Differentialdiagnose des Wilms-Tumors

The usefulness of ultrasound for distinguishing between Wilms tumor and hydronephrosis is shown in a case where radiographic signs were not clear. Ultrasound always permits differentiation between cystic and solid tumors.