-
[show abstract]
[hide abstract]
ABSTRACT: The surgeon aims at a direct, complete removal of the pathology. In spite of the modern advancements of imaging facilities and precision instrumentations, unsatisfactory results and recurrences are not uncommon. This paper provides a general review of the four specific areas in surgery that would benefit from Chinese medicine. Extensive searches were made on four surgical areas based on available English language journals, viz. low-back pain, chronic ulcers, renal calculus, and enuresis in children, in the past 10 years. The quoted communications are mainly related to clinical evidences, while a smaller number of crucial laboratory reports are also included. Low-back pain, a most frequent orthopaedic problem, would benefit from acupuncture treatment. Chronic leg ulcers could achieve better results of healing using herbal supplements. Problems of renal stones, besides the conventional methods of removal, could be further supplemented with herbal drinks that aim at prevention of recurrences. Enuresis in children, an untreatable common condition, may respond well to acupuncture. Surgeons should keep an open mind. In case of difficulties, they could seriously consider options of traditional treatment.
Chinese Journal of Integrative Medicine 07/2011; 17(7):548-55. · 0.80 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Our previous results revealed a positive correlation between bladder dysfunction and cortical arousals in children with enuresis. This finding implied an interrelationship between bladder dysfunction and brainstem dysfunction. Thus, we used an animal model to characterize brainstem functional changes in response to altered bladder function.
Adult male New Zealand rabbits weighing 3.0 to 3.5 kg underwent surgical bladder volume reduction (12) or sham operation (12). We performed conventional fill cystometry and brainstem functional magnetic resonance imaging in each group 4 weeks postoperatively. During scanning bladder stimulation was provided by bladder filling up to 70% of maximum capacity. We then compared brainstem activation area(s).
Results revealed voiding dysfunction in animals with altered bladder function. Bladder function was markedly altered in the reduced bladder volume vs the sham operated group, mainly as significantly increased maximum voiding detrusor pressure (mean ± 1 SD 24.4 ± 7.0 vs 0.16.5 ± 7.2 cm water, p <0.05) and markedly decreased cystometric bladder volume (mean 35.3 ± 8.2 vs 71.6 ± 12.9 ml, p <0.05). Functional magnetic resonance imaging results revealed activation of 2 brainstem regions, including in 1) the ventrolateral periaqueductal gray and 2) the dorsolateral pons, in response to bladder distention. Activation in the ventrolateral periaqueductal gray was significantly decreased in the reduced bladder vs the sham operated group with a corresponding decrease in signal size (25% vs 83.3%, signal size 0.7 ± 1.4 vs 3.3 ± 2.1 mm(2)). There was no significant difference in activation of the dorsolateral pons between the groups (83.3% vs 91.7%, signal size 3.7 ± 2.4 vs 0.4.7 ± 3.0 mm(2)).
Functional derangement in brainstem micturition centers can be evoked by bladder dysfunction. In response to bladder dysfunction the ventrolateral periaqueductal gray shows deactivation during bladder distention, suggesting that it has an important role in bladder dysfunction biofeedback.
The Journal of urology 11/2010; 184(5):2186-91. · 4.02 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate bladder function in infants with antenatally diagnosed hydronephrosis (ANH) using dynamic ultrasound protocol. Forty consecutive male infants (mean, 0.25 y) with ANH and 33 age-matched normal controls (mean, 0.49 y) were recruited. Anteroposterior (AP) diameter of renal pelvis (RP) and hydronephrosis index [HI = anteroposterior diameter of RP of kidney divided by urinary bladder volume (BV)] were calculated. Maximum BV (MaxBV) was determined just before voiding. Residual volume (RV) and bladder wall thickness (BWT) were measured after spontaneous voiding. Thirty-one infants (77.5%) showed persistently dilated RP postnatally in which 12 (39%) showed significantly high HI. In general, ANH infants had smaller MaxBV (30.71 versus 52.45 mL), larger residual volume (2.47 versus 1.93 mL), and larger BWT (4.4 versus 3.7 mm) than normal (p < 0.05, Mann-Whitney test). Infants with abnormally high HI had significantly more disturbed bladder parameters [smaller MaxBV (23.33 versus 33.49 mL) and larger BWT (4.67 versus 3.79 mm)] than the normal HI group (p < 0.05, Mann-Whitney test). Abnormal functional bladder parameters were evident in ANH infants. We postulated that immature function in the pelviureteric junction was associated with bladder dysfunction in these infants. Dynamic ultrasound protocol might help to understand the underlying pathophysiology of urinary system in ANH infants. ABBREVIATIONS::
Pediatric Research 04/2010; 67(4):440-3. · 2.70 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Patients with nocturnal enuresis may have small functional bladder capacity or altered bladder fullness sensation. We determined whether reducing bladder volume would affect the central inhibition of voiding that is normally present between birth and 2 weeks of life in neonatal rats.
One and 3-week-old Sprague-Dawley rats underwent 50% bladder volume reduction by suture closure of the bladder dome. T8-T10 spinal cord injury was done in select animals. Latency of the perigenital-bladder reflex, spontaneous voiding onset and body weight were measured. Cystometry using urethane anesthesia, and measurements of in vitro spontaneous and KCl evoked contractions were done.
Bladder reduction surgery led to the immediate appearance of spontaneous voiding in 1-week-old rats. Cystometry at 2 weeks showed voiding contractions in rats with bladder reduction, which was abolished by acute T8-T10 spinalization. Voiding contractions were not seen in animals with sham surgery or concurrent T8-T10 spinalization and bladder reduction. The perigenital-bladder reflex, somatic growth, spontaneous bladder contractions and bladder contractility were not affected by bladder reduction. Bladder capacity at 9 weeks was significantly larger in animals that underwent bladder reduction at 1 week than in sham treated animals (540 vs 256 microl, p = 0.04) but not in animals that underwent bladder reduction at 3 weeks.
Bladder reduction removes the central inhibition of spontaneous voiding in neonatal rats. This suggests that decreased neonatal bladder capacity may alter how the brain regulates the bladder.
The Journal of urology 11/2009; 183(1):370-7. · 4.02 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Systematic reports on acute upper gastrointestinal bleeding in children/adolescents are scanty. The aim of this study is to analyze its presentation, pathology and outcome in Hong Kong.
A retrospective review of the hospital database for admissions up to the age of 18 years with signs of acute upper gastrointestinal bleeding between 1 June 1996 and 31 May 2006.
During the 10-year period 76 patients (55 boys) were admitted with signs of upper gastrointestinal bleeding. The median age was 13.5 (range 0.25-18) years. Melena and hematemesis were by far the most frequent presentations. Medication was implicated in 16 cases (21%) as the possible cause for the bleeding. Endoscopic findings were a duodenal ulcer in 57 (75%) patients (50 boys) and a gastric ulcer in eight (10.5%). Helicobacter pylori infection was identified in 42 (55%) patients, of which 38 were found in duodenal ulcer patients. Eleven patients (14.5%) had interventions to achieve hemostasis: six epinephrine spray only, three thermal probe and two vessel ligation. After a median follow-up time of 3.5 years six patients had a recurrent duodenal ulcer. Three patients died of unrelated illnesses.
Acute upper gastrointestinal tract bleeding in children and adolescents in Hong Kong is dominated by a duodenal ulcer in 75% of the patients. Acute bleeding is more frequent in boys (boy to girl ratio 2.6:1). Medication is a predisposing factor in 20% of the bleedings. Six patients (8%) have recurrent duodenal ulcers.
Journal of Digestive Diseases 12/2008; 9(4):199-203. · 1.59 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Patients with urinary tract infection (UTI) are known to have impaired bladder function as demonstrated by urodynamic (UD) studies. UD is rarely performed in infants.
To evaluate bladder function in infants with UTI using a dynamic US protocol. Maximal bladder volume (MaxBV), residual volume (RV) and bladder wall thickness (BWT) were measured and compared with values from normal controls.
A total of 57 consecutive infants (47 males, 10 females; mean age 0.48+/-0.30 years) with proven UTI, and 63 age-matched normal controls (37 males, 26 females; mean age 0.47+/-0.37 years) were recruited. MaxBV was determined just before voiding, and RV and BWT were measured after spontaneous voiding.
Infants with UTI had smaller MaxBV (34.89 vs. 42.91 ml), larger RV (3.46 vs. 1.51 ml) and greater BWT (4.21 vs. 3.68 mm) than normal infants (P<0.05, Mann-Whitney test).
Smaller bladder volume, larger residual volume and thicker bladder wall in infants with UTI can be explained by bladder instability, hypercontractility and infection-induced oedema of the bladder wall during UTI. The US measurement of bladder parameters might serve as an objective guide for clinical diagnosis and allow objective evaluation of bladder function during posttreatment follow-up.
Pediatric Radiology 10/2008; 38(10):1084-8. · 1.67 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Congenital bladder anomalies are a major challenge to pediatric urologists. Understanding the mechanism of bladder development is crucial for advancing patient treatment. Current evidence suggests that Shh (R&D Systems) is an epithelial signal regulating bladder development, although the mechanism of the regulation is still unclear. We examined the regulation of bladder mesenchymal development.
Mutation analysis, immunohistochemistry, immunoblot, in situ hybridization, and primary cell culture and transfection were performed. The mesenchyma proximal to the epithelium was defined as the inner zone and that distal to the epithelium was defined as the outer zone.
We found that the Shh transcriptional factor Gli2 and the Shh target gene Bmp4 (R&D Systems) were expressed in the inner mesenchymal zone of the bladder, where active cell proliferation was observed. In Gli2(-/-) bladder primary mesenchymal cell cultures transfection with adenoviruses expressing DeltaNGli2, a constitutionally active form of Gli2, up-regulated Bmp4 expression and promoted cell proliferation. In the outer mesenchymal zone, where Gli2 and Bmp4 expression was not detectable, smooth muscle alpha-actin was expressed. In Gli2(-/-) embryo bladders Bmp4 expression in the inner zone was lost and ectopic smooth muscle was detected in the inner mesenchymal zone. Exogenous Bmp4 (10 ng/ml) in primary smooth muscle cell culture repressed smooth muscle differentiation and repression was partially rescued by the Bmp4 antagonist Noggin (R&D Systems) (300 ng/ml).
Our data suggests that the Shh transcriptional factor Gli2 regulates radial patterning of the bladder mesenchyma.
The Journal of urology 08/2008; 180(4):1543-50. · 4.02 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Data of Helicobacter pylori prevalence in children and its risk factors provide clues to the health authority to estimate burden of H. pylori-associated diseases usually encountered in adulthood and facilitate healthcare planning.
A cross-sectional population-based study was conducted in Chinese children in elementary and high schools. Schools were selected from all three major areas of Hong Kong. H. pylori infection was defined by a positive (13)C-urea breath test. Study subjects were stratified into six age groups for estimation of prevalence. Potential risk factors were analyzed from data of self-administered questionnaires.
A total of 2480 children (aged 6-19, male: 47.3%) participated in the study. Overall, 324 (13.1%) were positive for H. pylori. There was no difference in prevalence between sexes, and no statistical trend in the prevalence across the six age groups. Multivariate logistic regression identified lack of formal education of mother (OR = 2.43, 95%CI 1.36-4.34), family history of gastric cancer (OR = 2.19, 95%CI 1.09-4.41), and household member > 5 (OR = 1.57, 95%CI 1.12-2.19) to be positively associated with H. pylori infection in our children.
The H. pylori prevalence of Hong Kong children is comparable to the data of developed countries. The association with family history of gastric cancer justifies further study to investigate the cost-benefit of community screening program for such children to decrease the incidence of gastric cancer in adulthood.
Helicobacter 06/2008; 13(3):219-24. · 3.15 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Sacrococcygeal teratoma (SCT) is one of the most common tumors encountered in the neonatal period. Traditionally, a large abdominal incision is required for the combined abdominal perineal approach for the complete resection of type II-IV tumors. In this paper, we report our experience of using the combined laparoscopic perineal approach in treating these tumors.
Between November 2000 and September 2004, 4 patients with SCT were treated by the combined approach. The operation was started with the laparoscopic mobilization of the pelvic part of the tumor, followed by the completion excision and tumor retrieval through the perineal route.
The operation was successfully completed in all patients, with a mean operative time of 279 minutes. There was no complication related to the laparoscopic dissection. Postoperative recovery was uneventful in all patients, except in 1 with a minor wound problem. At a median follow-up of 46.5 months, there was no recurrence encountered in all these patients and the cosmetic result was excellent. Functional outcome was satisfactory, except in the patient with spinal metastases.
The combined laparoscopic and perineal approach provides a safe, excellent access in removing type II-IV SCT in infants.
Journal of Laparoendoscopic & Advanced Surgical Techniques 05/2008; 18(2):296-301. · 1.40 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Recently, gas amniodistension has been advocated for fetoscopic surgery to employ ergonomics similar to laparoscopy. However, neither the optimal type of gas nor its physiological influence on the fetus have been clearly outlined yet. This study investigates the impact of helium (HE) vs nitrous oxide (N2O) on fetal goats during fetoscopy.
We insufflated either HE or N2O in 12 pregnant goats (15 fetuses; HE = 7, N2O = 8), then increased the pressures from 0, 4, 7, to 10 mm Hg in 30-minute intervals and recorded the fetal and maternal vital parameters. Finally, whole-body computed tomography to asses for intracorporeal gas was performed.
All fetuses survived. Mean fetal vital signs showed no significant differences between HE or N2O at specific pressure levels. In detail, HE/N2O at 0 vs 10 mm Hg caused a fetal temperature decrease (32.9 degrees C/33.2 degrees C vs 32 degrees C/32.5 degrees C), heart rate increase in the N2O group (100/102 vs 102/121 beats per minute), and no significant change in arterial pressure (45.8/48.3 vs 53.7/46.7 mm Hg). The PO2 was adequate (3.7/3.3 vs 3.7/2.9 kPa), whereas the pH remained unchanged (7.4/7.3 vs 7.3/7.3). However, fetal pCO2 was elevated in the N2O group before insufflation (5.5/7.2 vs 6.8/8.0 kPa) owing to maternal hypoventilation (maternal PCO2: 4.9/5.8 vs 5.0/5.4 kPa), correction of which was slower in the fetus than in the maternal animal. Computed tomography ruled out intracorporeal gas accumulation.
Neither HE nor N2O impose significant physiological harm for the fetus. Heating of the gas and maternal anesthesia seem essential. Considering the potential teratogenicity of N2O, however, HE could be the favorable environment for fetoscopic procedures under gas amniodistension.
Journal of Pediatric Surgery 08/2007; 42(7):1255-8. · 1.45 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This paper is a comprehensive review of the Doppler waveform appearance of ureteric jets. Six jet waveform patterns have been identified: monophasic, biphasic, triphasic, polyphasic, square and continuous. Details of the physical properties of jet patterns and their changes under various physiological conditions are illustrated. The immature monophasic ureteric jet pattern is common in infancy and early childhood up to around 4 years of age. This pattern is also noted to have a high incidence in older children with urinary tract infection/vesicoureteric reflux, nocturnal enuresis and in other special physiological conditions such as in children undergoing general anaesthesia, in women during pregnancy, and in patients who have had ureteric transplantation. A hypothesis of dual myogenic and neurogenic components is proposed to explain the mode of action of the vesicoureteric junction (VUJ). The implication of this hypothesis is that it alters the scientific basis of the understanding of the VUJ. Furthermore, the application of colour Doppler US to ureteric jets may provide a non-invasive technique to study the physiology or pathophysiology of the VUJ in humans. This might shed light on new novel approaches to the monitoring and treatment of diseases related to VUJ function.
Pediatric Radiology 06/2007; 37(5):417-25. · 1.67 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To assess the feasibility of dynamic breath-hold MRI for evaluating changes in the anorectal angle and movements of the pelvic-floor musculature (puborectalis) during resting and straining states in pediatric patients presenting with anismus.
Six pediatric patients (7-13 years old) with chronic constipation and manometric evidence of anismus were assessed by dynamic breath-hold MRI. Changes in the anorectal angle, the degree of pelvic-floor descent, and the thickness and length of the puborectalis muscles were measured during rest and straining. The findings were compared with those obtained in six age- and sex-matched controls.
The children with anismus had a smaller anorectal angle during straining, and the angle decreased from rest to defecation. The puborectalis also became paradoxically shortened and thickened during straining in the anismus group. There were significant differences between the two groups in terms of the change of degree of the anorectal angle, and the thickness and length of the puborectalis muscle during straining.
Fast dynamic MRI is feasible for evaluating pelvic-floor movement in pediatric patients. Preliminary results suggest that children with anismus have a smaller anorectal angle and a different puborectalis configuration compared to controls.
Journal of Magnetic Resonance Imaging 06/2007; 25(5):1067-72. · 2.70 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the role of bladder variables measured by ultrasonography (US) in assessing bladder dysfunction in children with urinary tract infections (UTIs).
Children presenting with recurrent UTI (with or with no vesico-ureteric reflux) were prospectively recruited. At entry, each patient had US and both natural- filling (NFC) and conventional-filling (CFC) cystometry. Bladder volume and wall thickness index (BVWI) was calculated, and based on US studies and the bladder pattern on US, were classified as thick (BVWI <70), normal (70-130) and thin (>130) as previously reported. The criteria for diagnosing urodynamic patterns included normal, overactive and hypocontractile, as reported previously. The correlation between the US measured variables and urodynamic findings were then evaluated. Sixty-one children (38 boys and 23 girls; mean age 4.82 years, range 1-11) were selected for further evaluation.
Of the 61 children, 16 had a normal BVWI, 36 a 'thick' value and nine 'thin'. When the BVWI was correlated with the urodynamic findings, 14 of 16 with a normal BVWI had a normal bladder pattern, whereas 92% of the patients with a BVWI of <70 had overactive bladder (P < 0.001). Among children with a BVWI of >130, six of nine had a hypocontractile pattern. The mean (sd) bladder capacity (on CFC) compared to that expected for age was significantly lower, at 56.7 (32.3)% in 'thick' bladders, vs children with normal and thin bladders, at 91.3 (23.8)% and 98.7 (31.8)%, respectively (P < 0.001). A high voiding detrusor pressure was significantly associated with children who had a thick bladder rather than normal or thin bladder (P < 0.001).
This study further confirmed that the BVWI is a sensitive tool for diagnosing bladder dysfunction in children, and it can be used as a reliable guide for the appropriate choice of further invasive urodynamic studies.
BJU International 04/2007; 99(3):651-5. · 2.84 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We have previously shown that urinary bladder volume index (BVI = length x width x depth of bladder) and bladder volume wall thickness index (BVWI = BVI at full bladder/average bladder wall thickness) are useful indicators of bladder dysfunction in children with enuresis and urinary tract infection. These indices show a good correlation with urodynamic studies. We have expanded the study to include normal paediatric subjects with a wide age range. We illustrate a simple sonography protocol with nomograms of different parameters, which provide useful references for functional assessment in children with urological abnormalities.
To construct nomograms of total renal volume, maximum BVI and BVWI based on a Chinese paediatric population with age range from newborn to adolescence.
Sonography was performed in consecutive children with normal urinary tracts on imaging, using a standardized protocol. Data were collected for construction of nomograms for different parameters.
Nomograms of total renal volume, BVI and BVWI were constructed based on 3,376 consecutive paediatric subjects. All parameters consistently increased with age.
Nomograms of total renal volume, BVI and BVWI could provide useful references for studying bladder dysfunction in children using noninvasive dynamic sonography.
Pediatric Radiology 03/2007; 37(2):181-8. · 1.67 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Our previous study on the Doppler waveform of the urinary jet at the vesicoureteric junction (VUJ) indicates that there is an active sphincteric mechanism in humans. We have also shown that there are immature and mature patterns of the jet, and the VUJ matures around the age of 4 years.
To determine if there is any gender difference in the time of achieving maturity of the VUJ.
The Doppler pattern of the jets from both ureters was recorded in 273 normal boys and 248 normal girls. The subjects were considered to have immaturity of the VUJ if an immature jet waveform was detected in either ureter.
The mean age of VUJ maturity was 4.54 years for the whole population, 4.88 years for boys and 4.34 years for girls. The difference between ROC curves for boys and girls was not significant (P > 0.05, simple Z test).
There is no significant gender difference in the maturation of the VUJ. Detection of a persistent immature jet pattern beyond the age of maturity might have prognostic implications if there is a concurrent pathological condition related to the urinary tract in children.
Pediatric Radiology 02/2007; 37(2):189-93. · 1.67 Impact Factor
-
Tryggve Neve¤,
Alexander Von Gontard,
Piet Hoebeke,
Kelm Hjìlmôs,
Stuart Bauer,
Wendy Bower,
Troels Munch,
Sören Rittig,
Johan Van De Walle, Chung-Kwong Yeung,
Jens Christian Djurhuus
[show abstract]
[hide abstract]
ABSTRACT: Purpose: We updated the terminology in the ¢eld of pediatric lower urinary tract function. Materials and Methods: Discussions were held in the board of the International Children's Con-tinence Society and an extensive reviewing process was done involving all members of the Interna-tional Children's Continence Society, the urology section of the American Academy of Pediatrics, the European Society of Pediatric Urology, as well as other experts in the ¢eld. Results and Con-clusions: New de¢nitions and a standardized terminology are provided, taking into account changes in the adult sphere and new research results. Neurourol. Urodynam. 26:90 ^102, 2007.
Neurourology and Urodynamics 01/2007; 26:90-102. · 2.96 Impact Factor
-
Tryggve Nevéus,
Alexander von Gontard,
Piet Hoebeke,
Kelm Hjälmås,
Stuart Bauer,
Wendy Bower,
Troels Munch Jørgensen,
Søren Rittig,
Johan Van de Walle, Chung-Kwong Yeung,
Jens Christian Djurhuus
[show abstract]
[hide abstract]
ABSTRACT: PurposeWe updated the terminology in the field of pediatric lower urinary tract function.Materials and Methods
Discussions were held in the board of the International Children's Continence Society and an extensive reviewing process was done involving all members of the International Children's Continence Society, the urology section of the American Academy of Pediatrics, the European Society of Pediatric Urology, as well as other experts in the field.Results and Conclusions
New definitions and a standardized terminology are provided, taking into account changes in the adult sphere and new research results. Neurourol. Urodynam. 26:90–102, 2007. © 2006 Wiley-Liss, Inc.
Neurourology and Urodynamics 12/2006; 26(1):90 - 102. · 2.96 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To test the hypothesis that the presence of nocturnal enuresis is related to increased frequency of immature vesicoureteric function, which is further associated with detrusor overactivity, we compared the incidence of immature monophasic ureteric jet in children with and without nocturnal enuresis. The relationship between monophasic ureteric jet Doppler wave form and bladder wall thickness was further explored in the enuresis group. Ultrasound examinations were performed in 511 children suffering from nocturnal enuresis and 266 normal controls. Doppler wave forms of the ureteric jet on each side and the bladder wall thickness after voiding were recorded. Standard urodynamic studies were obtained in 203 enuretic children for correlations with ultrasound findings. There was a significant increase in the incidence of monophasic ureteric jet waveforms in enuretic children when compared with the controls (19.2% versus 6.4% on the right side, 19.2% versus 8.3% on the left side, all p < 0.01). Furthermore, immature monophasic waveforms were more commonly seen in the enuretic group with markedly thickened bladder wall. Enuretic children with bilateral immature ureteric jet waveforms and markedly thickened bladder wall showed multiple significant urodynamic abnormalities (p < 0.05). The above observations could be accounted for by immaturity of both vesicoureteric junction and detrusor muscle.
Pediatric Research 11/2006; 60(5):582-6. · 2.70 Impact Factor
-
Tryggve Nevéus,
Alexander von Gontard,
Piet Hoebeke,
Kelm Hjälmås,
Stuart Bauer,
Wendy Bower,
Troels Munch Jørgensen,
Søren Rittig,
Johan Vande Walle, Chung-Kwong Yeung,
Jens Christian Djurhuus
[show abstract]
[hide abstract]
ABSTRACT: We updated the terminology in the field of pediatric lower urinary tract function.
Discussions were held of the board of the International Children's Continence Society and an extensive reviewing process was done involving all members of the International Children's Continence Society as well as other experts in the field.
New definitions and a standardized terminology are provided, taking into account changes in the adult sphere and new research results.
The Journal of Urology 08/2006; 176(1):314-24. · 3.75 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Despite the advances in minimally invasive surgery in children, considerable concern exists about employing such techniques in oncologic cases. We report our experience with a 4-year-old girl with a symptomatic tumor in the liver. Contrast-enhanced computed tomography revealed a 3 x 4 cm lesion, confined to segments II and III. Tumor markers were negative and true-cut needle biopsy did not rule out malignancy. We performed a diagnostic laparoscopy using four 5-mm ports. Since the tumor did not cause any alterations of the liver surface, a 5-mm flexible endoscopic ultrasound probe (5 MHz) was applied to reveal the extent of the tumor. Parenchymal dissection was performed with a radiofrequency probe, and the LigaSure device was used to seal larger vessels and bile ducts. The tumor was resected completely and removed in a specimen bag via the umbilical incision. Histology revealed fibrous nodular hyperplasia. The postoperative course was uneventful and the girl was discharged on postoperative day 5. We conclude that laparoscopic resection of confined liver lesions is feasible in children, employing standard principles of oncologic surgery and safety.
Journal of Laparoendoscopic & Advanced Surgical Techniques 07/2006; 16(3):325-7. · 1.40 Impact Factor
