The role of micturating cystourethrography in antenatally detected mild hydronephrosis.

BACKGROUND: The postnatal imaging of infants with antenatally detected mild hydronephrosis remains controversial. OBJECTIVE: Our aim was to establish the role and timing of micturating cystourethrography (MCUG) in mild hydronephrosis. MATERIALS AND METHODS: We performed a retrospective study of 61 infants (122 kidneys) referred with an antenatal diagnosis of hydronephrosis who showed persistent postnatal dilatation. All had follow-up postnatal ultrasound (US) and MCUG performed. The degree of dilatation at each follow-up scan was recorded. RESULTS: Of the 122 kidneys, 65 showed mild hydronephrosis. A substantial proportion of these (21.5%) demonstrated reflux. Serial US of these infants showed that the 6-week scan was the most informative and that any changes that warranted further investigation had occurred by this time. CONCLUSION: We recommend that all infants with mild hydronephrosis should undergo MCUG. MCUG need not be delayed until 3 months but could be performed following a 6-week US scan.

The post-angiocardiography urogram in children: should it be abandoned?

This study examines the value of the urogram radiograph taken after angiocardiography, in children with suspected congenital heart disease, to screen for co-existent urinary tract abnormalities. A retrospective audit of post-angiocardiography urograms over a three year period 1990 to 1993 is presented. 184 urograms obtained in 166 children were reviewed (86 males; mean age 18.1 months). Twenty-five urograms (13.6%) were obtained in cases where the urinary tract had previously been investigated. These urograms contributed no additional information. Image quality was suboptimal in 62 examinations (33.7%), due to gas, faeces or poor opacification, and two lesions were undetected on suboptimal radiographs. Urinary tract abnormalities were detected in 17 patients (10.2%). These lesions were also detectable at sonography. We suggest that routine post-angiocardiography urograms can be abandoned in favour of sonographic screening of the urinary tract in children with congenital heart disease.

Chest wall reconstruction after resection of recurrent breast tumours.

A series of 13 chest wall resections for recurrent breast tumours are reported, the defects being closed by synthetic prostheses. In nine patients the prostheses were covered by a latissimus dorsi flap, while in the last eight patients a rigid 'shield' prosthesis of methyl methacrylate was used, and a stable chest obtained. Mechanical ventilation for more than 24 h was not required in those patients in whom a shield was used.

A novel immunohistochemical technique for demonstration of specific binding of human monoclonal antibodies to human cryostat tissue sections.

We describe a novel immunohistochemical technique which permits the detection of specific binding of human monoclonal antibodies (MAb) to cryostat sections of human tissues. The technique overcomes the problem of background staining caused by the presence of endogenous immunoglobulins in tissue sections. This is achieved by the formation of a molecular complex of the primary antibody (a human MAb), horseradish peroxidase-conjugated goat anti-human immunoglobulin, and normal human serum. This complex is then incubated with cryostat sections of human tissue, and binding of the complex is demonstrated using diaminobenzidine/hydrogen peroxide. The method is suitable for immunohistochemical screening of small samples of tissue culture supernatant for the presence of human MAb of potential interest, and for determining the pattern of binding of such MAb to a wide range of normal and pathological human tissues.

A retrospective study of colostomies, leaks and strictures after colorectal anastomosis.

A review was undertaken of 360 patients undergoing elective left-sided colonic or rectal resections with primary anastomosis, under the care of one surgeon, over a nineteen year period. The incidence, aetiology and management of anastomotic leaks and strictures was studied and the role of proximal diverting colostomy considered. Perioperative mortality was 2.7%. The incidence of anastomotic leaks was 24.4%. Leaks were more common when anastomoses were low, were sutured or were constructed by trainees. Strictures developed in 5.8%. Local recurrence of tumour was the cause of 25% of these strictures. Anastomotic leakage was the principal cause of benign strictures; those developing in association with leaks were more likely to require surgical intervention. There was no evidence that delay in colostomy closure contributed to the development of benign anastomotic strictures. It was not possible to determine whether the presence of a colostomy affected the incidence of leaks but the local effects of such leaks were mitigated in patients with colostomies. Where a minor leak had occurred it was not necessary to wait for complete anastomotic healing before closing the colostomy. After major leaks, colostomy closure before complete healing was associated with further anastomotic problems in 16.0% of cases.

Immunodetection of human tumour-associated cell-bound antigens by human monoclonal antibodies.

A novel cellular enzyme-linked immunoassay has been developed to detect specific binding of human monoclonal antibodies to target tumour cells obtained by enzymatic disaggregation of surgically resected human colorectal carcinomas. Cell preparations derived from human tissues contain endogenous immunoglobulin. The method described is designed to detect specific binding of a human monoclonal antibody while minimising extraneous background signals caused by the presence of endogenous immunoglobulins in the preparation. This is achieved by first generating immune complexes, which are then incubated with the target cells. The assay is well suited for rapid screening of large numbers of tissue culture supernatants and could be adapted for cells of other tumours. Small quantities of target cells and supernatant are used and the assay can be completed within 5 h.