Search

To assess the effect of implementing an emergency surgery track for testicular torsion transfers. We hypothesized that transferring children from other facilities diagnosed with torsion straight to the operating room (STOR) would decrease ischemia time, lower costs, and reduce testicular loss.Demographics, arrival to incision time, hospital cost in dollars, and testicular outcome (determined by testicular ultrasound) at follow-up were retrospectively compared in all patients transferred to our tertiary care children's hospital with a diagnosis of testicular torsion from 2012 to 2016. Clinical data for STOR and non-STOR patients were compared by Wilcoxon rank-sum, 2-tailed t test, or Fisher exact test as appropriate.Sixty-eight patients met inclusion criteria: 35 STOR and 33 non-STOR. Children taken STOR had a shorter median arrival to incision time (STOR: 54 minutes vs non-STOR: 94 minutes, P .0001) and lower median total hospital costs (STOR: $3882 vs non-STOR: $4419, P .0001). However, only 46.8% of STOR patients and 48.4% of non-STOR patients achieved surgery within 6 hours of symptom onset. Testicular salvage rates in STOR and non-STOR patients were not significantly different (STOR: 68.4% vs non-STOR: 36.8%, P = .1), but follow-up was poor.STOR decreased arrival to incision time and hospital cost but did not affect testicular loss. The bulk of ischemia time in torsion transfers occurred before arrival at our tertiary care center. Further interventions addressing delays in diagnosis and transfer are needed to truly improve testicular salvage rates in these patients.

We investigated the photopolymerization kinetics of a low glass transition temperature (Tg) urethane acrylate network as a model soft coating system. We used real-time Fourier transform infrared (RT-FTir) spectroscopy to measure the acrylate conversion and fast sampling photorheology to measure the developing mechanical properties during cure. Experiments were conducted using a 395 nm LED ultraviolet (UV) source at different incident intensities ranging from 5 to 200 mW/cm2 at 25 °C. We found that the maximum rate of conversion and rate of complex shear modulus development scaled with incident UV intensity (I0) to an exponent (β) ≈ 0.53. This finding is consistent with the classical prediction of free radical photopolymerization that cure speed should increase to the ½ power of intensity when a bimolecular termination mechanism takes place during the reaction. A consequence of this is that the degree of conversion and complex shear modulus were not constant at a fixed energy dose (I0t) when intensity was varied illustrating that this system does not obey the exposure reciprocity rule. Instead we observed that the degree of cure and rheological properties were a universal function of I0βt. We also found that β increased only slightly throughout the reaction reaching a value of 0.65 at 95% conversion. This result indicates that bimolecular termination was predominant throughout nearly the entire reaction due to a high degree of molecular mobility in this flexible network.

Clostridioides difficile causes severe colitis in people and is a significant enteric pathogen in many species of animals, including swine, horses, and potentially cattle. C. difficile is shed in feces, and transmission occurs horizontally via the fecal-oral route. Livestock has been suggested as a potential reservoir for C. difficile, and while studies have shown that swine and farm workers can be colonized with identical clones of C. difficile, the zoonotic transmission of C. difficile from livestock to people has not been definitively demonstrated. The goal of this study was to determine whether dairy calves and dairy farm workers harbored genetically similar isolates of C. difficile. First, we validated a glove juice protocol for detecting C. difficile on farm workers’ hands. We then visited 23 farms and collected 1) fecal samples from 92 dairy calves, 2) hand rinsates from 38 dairy farm workers, and 3) fecal samples from five of the dairy farm workers who were willing to submit them. All samples underwent anaerobic culture and qPCR to detect C. difficile. C. difficile was detected on 15 of the farms (65.2%, 95% confidence interval (CI) 42.7%–83.6%) and in 28 calves (30.4%, 95% CI 21.2–40.9%) but in none of the hand rinsates or human fecal samples. Thus, the zoonotic transmission of C. difficile on dairy farms could not be demonstrated, and dairy farmers did not appear to be at increased risk of acquiring C. difficile via the fecal-oral route.

Rationale & Objective Although maintaining high fluid intake is an effective low-risk intervention for the secondary prevention of urinary stone disease, many patients with stones do not increase their fluid intake. Study Design We describe the rationale and design of the Prevention of Urinary Stones With Hydration (PUSH) Study, a randomized trial of a multicomponent behavioral intervention program to increase and maintain high fluid intake. Participants are randomly assigned (1:1 ratio) to the intervention or control arm. The target sample size is 1,642 participants. Setting & Participants Adults and adolescents 12 years and older with a symptomatic stone history and low urine volume are eligible. Exclusion criteria include infectious or monogenic causes of urinary stone disease and comorbid conditions precluding increased fluid intake. Interventions All participants receive usual care and a smart water bottle with smartphone application. Participants in the intervention arm receive a fluid intake prescription and an adaptive program of behavioral interventions, including financial incentives, structured problem solving, and other automated adherence interventions. Control arm participants receive guideline-based fluid instructions. Outcomes The primary end point is recurrence of a symptomatic stone during 24 months of follow-up. Secondary end points include changes in radiographic stone burden, 24-hour urine output, and urinary symptoms. Limitations Periodic 24-hour urine volumes may not fully reflect daily behavior. Conclusions With its highly novel features, the PUSH Study will address an important health care problem. Funding National Institute of Diabetes and Digestive and Kidney Diseases. Trial Registration Registered at ClinicalTrials.gov with study number NCT03244189 .

The microbial ecology of the rumen microbiome is influenced by the diet and the physiological status of the dairy cow and can have tremendous influence on the yield and components of milk. There are significant differences in milk yields between first and subsequent lactations of dairy cows, but information on how the rumen microbiome changes as the dairy cow gets older has received little attention. We characterized the rumen microbiome of the dairy cow for phylogeny and functional pathways by lactation group and stage of lactation using a metagenomics approach. Our findings revealed that the rumen microbiome was dominated by Bacteroidetes (70%), Firmicutes (15-20%) and Proteobacteria (7%). The abundance of Firmicutes and Proteobacteria were independently influenced by diet and lactation. Bacteroidetes contributed to a majority of the metabolic functions in first lactation dairy cows while the contribution from Firmicutes and Proteobacteria increased incrementally in second and third lactation dairy cows. We found that nearly 70% of the CAZymes were oligosaccharide breaking enzymes which reflect the higher starch and fermentable sugars in the diet. The results of this study suggest that the rumen microbiome continues to evolve as the dairy cow advances in lactations and these changes may have a significant role in milk production.

Adult and pediatric urologists, gynecologists, and surgeons are often faced with primary reconstruction of complex congenital defects of the vagina as seen in cloacal anomalies, disorders of sexual development (DSD), and vaginal agenesis as well as with the secondary repair of post-surgical or radiation-induced vaginal stenosis or foreshortening. Many options have been reported and the choice of a particular method is influenced by surgeon experience, regional trends, availability of multidisciplinary teams and many other social and age-related factors. No one option has become the solution for all patients of all ages and anatomical challenges. Here we discuss a newer approach that can be used as an option for bridging the gap in young patients with a long distance from the perineum to the vaginal structures, for total vaginoplasty in some cases of primary vaginal agenesis in adolescents or young adults, and for correction of stricture in patients who have undergone previous reconstructions. Our initial experience using autologous buccal mucosa for reconstructions on eight patients with varying diagnoses is retrospectively reviewed.

Over the past 3 decades, minimally invasive stone surgery has completely overtaken open surgical approaches to upper tract pediatric urolithiasis. Progressing from least to most minimally invasive, extracorporeal shock wave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy are the surgical methods of today for kidney and ureteral stones. The choice of treatment modality is individualized in children, considering patient age, stone size, number, location, and anatomic and clinical contributing factors. The purpose of this article is to review these techniques for pediatric upper urinary tract stones and summarize outcomes and complications.

Lower urinary tract foreign bodies have been reported in both children and adults. It is helpful for urologists to review foreign body case reports to become familiar with alternative approaches for removal that may prove helpful during challenging cases. To our knowledge, we describe for the first time a degraded rare-earth magnet within the body and use of Hartmann ear forceps to remove a foreign body from the urethra under cystoscopic guidance through a limited urethrotomy.

OBJECTIVE Ureteropelvic junction obstruction (UPJ) can be caused by intrinsic disorganization or extrinsic compression from crossing vessels (CV). What is not clear is whether there is also intrinsic UPJ pathology in patients with CV. Recent surgeries, such as the Hellstrom vascular hitch procedure, move the CV cephalad without resecting the UPJ, which presumes no intrinsic narrowing. Our aim was to determine whether the histologic features of the 2 types of UPJ obstruction are distinct enough to enable a blinded pathologist to histologically identify the cause of obstruction. METHODS We reviewed all patients undergoing pyeloplasties from 2000 to 2006. All CV cases with available pathology were selected. A random selection of intrinsic cases was used as controls. One blinded pathologist reviewed the histology, specifically scoring muscle and collagen density. RESULTS Sixteen patients were reviewed. Seven had CV and 9 had intrinsic obstruction. Muscle density was different between the 2 groups with CV denser compared with intrinsic (P = .005). The pathologist correctly assigned the cause of obstruction in 5/7 (71%) of CV and 7/9 (78%) of intrinsic cases (P = .039). CONCLUSIONS Identification of a significant CV intraoperatively does translate to a discernible appearance histologically.

To examine differences in breastfeeding frequency, voids, and stools in infants with weight lossesoror =7% during the postpartum hospitalization.Secondary analysis of data from a primary psychometric study examining the Mother Infant Breastfeeding Progress Tool (MIBPT).A midwestern community hospital in a multicultural racially diverse community.Convenience sample of 53 breastfeeding women and infants hospitalized after birth.Data were collected during a chart review; infants were divided intooror =7% weight loss groups at 2 days postpartum, and breastfeeding frequency, voiding, and stooling were examined between groups and used to predict aor =7% weight loss at 2 days postpartum.Of the 53 infants, 20.8% lostor =7% of their birth weight. Infants who lostor =7% of their birth weight had significantly more total voids and a higher breastfeeding frequency on the day of birth than infants who lost7% of their birth weight. A logistic regression analysis resulted in total voids being the only significant predictor of aor =7% weight loss, with an odds ratio of 1.74 (95% CI=1.09, 2.75, p; .05).In the absence of other indicators of ineffective breastfeeding, breastfeeding infants who loseor =7% of their birth weight during the first 2 days postpartum might be experiencing a physiologic diuresis after birth, unrelated to their breastfeeding behaviors. More research is necessary to determine the cause of aor =7% weight loss in newborns during the first 48 hours after birth.

Laparoscopic radical nephrectomy is emerging as the treatment of choice for localized renal malignancies in adults. Despite the widespread use of laparoscopic nephrectomy for benign renal disease in infants and children, the laparoscopic approach has not been employed for pediatric Wilms' tumor except following systemic chemotherapy. We report the results of laparoscopic radical nephrectomy for removal of unilateral Wilms' tumor prior to the administration of systemic chemotherapy in two patients.

Childhood spontaneous bladder rupture is an uncommon event, usually associated with bladder augmentation. Occasionally it occurs in normal bladders or non-augmented bladders with a predisposing factor. We present a unique case of misdiagnosed spontaneous bladder rupture in a non-augmented bladder exstrophy patient without evidence of lower urinary outlet obstruction. His acute abdomen mimicked appendicitis and was managed with laparoscopic exploration, intraperitoneal fluid drainage, appendectomy and bladder drainage. This case highlights the need for pediatric urological consultation by surgeons in the case of an acute abdomen with free fluid in a patient with an abnormal bladder.

Objective Urachal anomalies are rare. Variable presentations can be a diagnostic challenge. We combine our series with a review of literature to delineate the most common presentations, highest yield diagnostic studies and a diagnostic algorithm. Methods We reviewed records of 22 boys and 15 girls with the diagnosis of a urachal anomaly from 2000 through 2005. This revealed 19 cysts, seven patent urachuses, five sinuses, four patients with unspecified “urachal anomalies,” and two patients with no urachal anomaly by surgical exploration. Ultrasound was the most common diagnostic study, followed by computed tomography (CT), voiding cystourethrogram and sinogram. Thirty-five of 37 patients underwent surgery. Results Clinical presentation included periumbilical leakage in 54%, pain in 30%, periumbilical mass in 22% and irritative voiding symptoms in 14%. In many patients diagnosis was made on clinical examination alone. When an ultrasound was used it was diagnostic for 82% of cysts, 100% of sinuses and 100% of patent urachuses. A voiding cystourethrogram was diagnostic for 100% of patent urachuses, but less successful in the other anomalies. CT scans correctly diagnosed 71% of cysts. Overall complication rate was 9%, all wound infections. Conclusion Reviewing the results of this and four other large series showed that the most common anomaly is the urachal cyst followed by urachal sinus and patent urachus. Periumbilical drainage is the most common presentation. Physical exam alone can be diagnostic. When this is not possible ultrasound is our recommended initial study, followed by a CT scan if unsuccessful.

PURPOSE: Despite extensive research, the molecular basis of hypospadias and anorectal malformations is poorly understood, likely due to a multifactorial basis. The incidence of hypospadias is increasing, thus making research in this area warranted and timely. This review presents recent molecular work broadening our understanding of these disorders. MATERIALS AND METHODS: A brief review of our recent work and the literature on the role of Eph/ephrin signaling in hypospadias and anorectal malformations is presented. RESULTS: Genetically engineered mice mutant for ephrin-B2 or EphB2;EphB3 manifest a variety of genitourinary and anorectal malformations. Approximately 40% of adult male heterozygous mice demonstrate perineal hypospadias. Although homozygous mice die soon after birth, 100% of homozygous males demonstrate high imperforate anus with urethral anomalies and 100% of homozygous females demonstrate persistent cloaca. Male mice compound homozygous for EphB2(ki/ki);EphB3(Delta/Delta)/ also demonstrate hypospadias. CONCLUSIONS: These mouse models provide compelling evidence of the role of B-class Eph/ephrin signaling in genitourinary/anorectal development and add to our mechanistic and molecular understanding of normal and abnormal embryonic development. As research on the B-class Ephs and ephrins continues, they will likely be shown to be molecular contributors to the multifactorial basis of hypospadias and anorectal malformations in humans as well.

Although fathers play a key role in helping their children develop ideas about gender relations and close relationships, they have been largely overlooked as a resource to help prevent violence against women. This paper explores some of the reasons why fathers have not been successfully engaged in violence prevention. Engaging fathers to promote wider definitions of masculinity for themselves and their children is presented as a major mechanism by which fathers could help prevent violence against women. The information-motivation-behavior model of change, developed for preventing high-risk sexual behavior, is applied to the area to provide structure for understanding previous and current attempts to engage fathers. Examples of innovative programs are used to highlight the application of this model.

Megalourethra is a rare spectrum of urologic malformations of penile corporal structures frequently associated with multiple congenital anomalies, such as prune belly syndrome or vertebral, anorectal, cardiac, trachea-esophageal, renal, and limb (VACTERL association) defects. A 6-year-old boy with VACTERL association and proximal urethral atresia with distal fusiform megalourethra underwent staged reconstruction, including appendicovesicostomy, perineal urethrostomy, and first-stage urethroplasty with a dorsal inlay free graft of megalourethra tissue to the proximal urethral atretic region, followed by second-stage urethroplasty. At 2.6 years of follow-up, he was continent, voids per urethra without postvoid residual urine volume, and no longer performs clean intermittent catheterization by way of the appendicovesicostomy.

Antisperm autoanitbodies were studied in Fischer and Lewis strains of rats after either vasectomy, vasectomy followed one month later by vasovasostomy, or sham operations. The time course of antibody response to sperm protein autoantigens was assayed by Western blot analysis of sera obtained at intervals up to 3 months. Rats of both strains responded to immunization with isologous spermatozoa with production of high titer hyperimmune sera. Sera from vasectomized Fischer rats showed antisperm antibodies on Western blots, but bands were stained with less intensity and frequency than for Lewis rats. In both Fischer and Lewis strains, major protein autoantigens were observed at 75–83, 68–71, 63, 57, 51, 41, and 21–23 kDa, lending support to the hypothesis that there is a set of dominant sperm autoantigens recognized by a consensus of postvasectomy rat sera. The lesser response of Fisher rats to vasectomy was not due to absence of dominant postvasectomy sperm autoantigens in Fischer sperm extracts, nor was it attributable to inability of Fischer rats to mount an immune response to these antigens, since immunization with isologous sperm was successful in raising antibodies to the dominant autoantigens. Vasovasostomy did not result in a general decrease in antisperm antibodies, and reactions to some antigens actually increased.

Temporal patterns of IgM and IgG autoantibodies to sperm proteins were studied by western blot analysis at intervals after bilateral vasectomy, vasectomy followed one month later by vasovasostomy, or sham operations. Responses were detected to eight major autoantigens at 21-23, 36, 41, 51, 57, 63, 68-71 and 75-83 kDa, by study of staining patterns of sequential serum samples from individual animals and by analysis of the incidence of reaction to each protein. The four lower molecular weight antigens (21-23, 36, 41 and 51 kDa) provoked mainly IgG responses. The strongly stained set of higher molecular weight antigens (57, 63, 68-71 and 75-83 kDa) tended to show more clearly defined temporal patterns of IgM followed by IgG response, including a high incidence of IgM antibody at the 2-week interval. Three of the larger peptides (57, 63 and 68-71 kDa) appeared highly immunogenic, since some reactions were detected even in sham-operated rats. The classical patterns of IgM and IgG antibody responses to the majority of the dominant sperm autoantigens are in accord with the hypothesis that vasectomy mimics immunization with spermatozoa. The high incidence of IgM antibodies in the earliest sample, taken 2 weeks after vasectomy, suggests that the initial immunizing event takes place within about a week after the operation. Vasovasostomy did not bring about a decrease in antisperm antibodies. Instead, some animals demonstrated an increased reaction to certain antigens after reversal of vasectomy, even though the vasovasostomies were anatomically successful.The production of antisperm antibodies is common subsequent to vasectomy and antisperm antibodies frequently persist following the reversal of vasectomy. The number of such antibodies may even increase after vasovasostomy. Using adult male Lewis rats, the authors analyzed the dominant autoantigens which evoke IgM and/or IgG autoantibodies after vasectomy by western blotting (WB) methods, the temporal patterns of IgM and IgG autoantibodies to specific sperm proteins, and the influence of vasovasostomy upon IgM and IgG antisperm autoantibodies. The temporal patterns were studied by WB at intervals after bilateral vasectomy, vasectomy followed 1 month later by vasovasostomy, and fake operations. Responses were detected to 8 major autoantigens of 21-23, 36, 41, 51, 57, 63, 68-71, and 75-83 kDa through the study of staining patterns of sequential serum samples from individual animals and by analysis of the incidence of reaction to each protein. The 4 lower-molecular-weight antigens provoked mainly IgG responses, while the strongly stained higher-molecular-weight antigens showed more clearly defined temporal patterns of IgM followed by IgG response, including a high incidence of IgM antibody at the 2-week interval. The peptides of 57, 63, and 68-71 kDa seemed to be highly immunogenic, since some reactions were detected even in rats which received only a fake operation. Results support the hypothesis that vasectomy mimics immunization with spermatozoa, while the high incidence of IgM antibodies in the earliest sample, taken 2 weeks after vasectomy, suggests that the initial immunizing event occurs within approximately 1 week after the operation. Vasovasostomy caused no decrease in antisperm antibodies.

VATER association was first described in the early 1970s as the non-random co-occurrence of congenital malformations including: Vertebral defects, Anal atresia, Tracheo-Esophageal fistula (TEF) with or without esophageal atresia (EA), and Radial and Renal dysplasia.1 Following initial reports, it was suggested that “V” should include Vascular anomalies (including single umbilical artery). Cardiac malformations (“C”) and Limb (“L”) anomalies other than radial anomalies were also added, such that the term “VACTERL” became the most common descriptor, despite variable evidence for the inclusion of features such as cardiac or renal anomalies.2–6 The presence of VACTERL association, which usually requires at least 3 component features and the absence of evidence for an overlapping condition, is estimated to occur in approximately 1/10,000–1/40,000 live births.7, 8 Just as there are challenges in defining the condition, there is no standard approach for the initial diagnostic work-up of a neonate with identified or suspected VACTERL association. This can be problematic: missed manifestations may obfuscate the etiological work-up8; delay medical interventions, potentially contributing to higher morbidity and mortality9; result in less informed and effective counseling. To attempt to address these issues, we assembled a multi-disciplinary group of clinicians and researchers whose expertise focuses on VACTERL association and/or its individual component features. Following review of the literature, and based upon our collective experience, we offer suggestions for the evaluation of individuals identified or suspected to have VACTERL association. Literature Search We conducted a PubMed-based literature search for case reports and collections of patients identified or suspected of having VACTERL association and/or associated component features. Search terms included the following: Anal atresia; Anorectal malformations; Cardiac anomalies; Cardiac malformations; Cardiovascular anomalies; Cardiovascular malformations; Esophageal atresia; Genitourinary anomalies; Genitourinary malformations; Imperforate anus; Limb anomalies; Limb malformations; Radial anomalies; Radial dysplasia; Renal anomalies; Renal malformations; TEF; Tracheo-esophageal fistula; VACTERL; VATER; Vertebral anomalies; Vertebral malformations. Only articles describing human patients were considered, and articles were excluded if they did not pertain to component features specifically seen in VACTERL association.

Purpose Persistent cloaca is a rare, severe congenital anomaly. The Eph family receptor tyrosine kinases and their ligands, the ephrin family, mediate diverse embryonic cell-cell recognition events. We previously reported ephrin-B2lacZ/lacZ mice manifest male high imperforate anus and female persistent cloaca (Dravis et al. Dev Biol 2004; 271(2): 272-290). We studied and demonstrated via 3D-reconstruction whether altered ephrin-B2 signaling in female ephrin-B2 lacZ/lacZ mutant mice affect apoptosis, thereby possibly contributing to persistent cloaca malformation. Material and methods Female embryonic days 11.5, 13.5 and 16.5 (E11.5, E13.5 and E16.5) wild type (WT), ephrin-B2lacZ/+ (Z/+) and ephrin-B2 lacZ/lacZ (Z/Z) mice sections were dual labeled for ephrin-B2 and TUNEL immunohistochemistry. Anti-galactosidase antibody detected the ephrin-B2-gal fusion protein in Z/+ and Z/Z mice. WinSurf software was used for 3D reconstructions of the cloacal region. Results In WT E11.5 females, the cloacal membrane (CM) is intact. The urorectal septum (URS) is partially separating the cloaca into urogenital sinus and hindgut; no vagina has developed. In contrast, Z/Z females had poor cloacal development. Z/+ embryos showed widened URS. Apoptosis in WT females occurred prominently in CM, dorsal cloaca, and hindgut. In contrast, apoptosis in Z/Z females was limited to the endoderm of the poorly formed cloaca. These changes progressed throughout E13.5 and finally at E16.5, Z/Z females exhibited persistent cloaca. Conclusions The 3D reconstruction of the cloacal region provides a better understanding of the mechanism by which altered ephrin-B2 signaling yields persistent cloaca via diminished apoptosis in Z/Z mice.

The authors wholeheartedly agree that investigation of the use of laparoscopic nephrectomy in the management of Wilms’ tumor must be undertaken with caution and by those surgeons skilled in advanced laparoscopic surgery, including retroperitoneal lymphadenectomy. Certainly improved cosmesis and possible quicker recovery do not warrant the increased risk of tumor recurrence or the added morbidity of adjuvant radiation therapy should further trials show inferior oncologic outcomes with laparoscopic nephrectomy. However, we respectfully differ in opinion with Dr. Ross concerning the question of a trial of laparoscopic nephrectomy being an ‘‘ethical dilemma’’ due to its unproven nature. All current medical therapy once began as unproven treatment. It is the very idea of optimizing outcome while minimizing morbidity that leads our Hematology-Oncology colleagues to conduct well-designed and controlled trials utilizing alternative treatment regimens for a variety of malignancies. These very trials have resulted in the current

Purpose Vaginal replacement surgeries often require donor materials such as skin grafts, myocutaneous flaps, or bowel, each with significant disadvantages. We describe our technique using autologous buccal mucosa grafting for partial or complete neovagina creation. Material and Methods Our indications for buccal mucosa vaginoplasty have included primary repair of congenital defects such as vaginal agenesis (Mayer-Rokitansky syndrome), cloacal abnormalities, and intersex disorders as well as secondary repair of postsurgical vaginal defects like vaginal stenosis after vaginoplasty or pelvic extenteration. This video demonstrates our surgical technique in a Mayer-Rokitansky syndrome patient. Results A transverse incision is made over the mucosal prominence at the level of the expected location of the hymen. Blunt dissection and electrocautery are used to dissect between the urethra and anorectum to depth 8 cm and width 3 fingerbreadths. Bilateral buccal mucosa is harvested, prepared on the bench and sewn end to end. The graft mid-portion is secured with interrupted 4-0 chromic to the apex of the previously dissected vaginal vault. The meshed graft is then stretched and tacked into position with interrupted 4-0 chromic sutures to achieve 360 degree coverage of the entire neovaginal area. A spongy vaginal mold is left in-situ for 5-7 days. Conclusions Buccal mucosa generates a moist, hairless, nonkeratinized neovaginal mucosa with excellent color and texture matching the genital/vaginal skin. It leaves no visible surgical scars, avoids abdominal bowel surgery and has no excess mucous production. It is an ideal replacement material for primary or secondary vaginoplasty with excellent early results.

Purpose To examine whether anteroposterior(AP) pelvic diameter on postnatal renal ultrasound scan (US) can predict both initial differential renal function (DRF) and deterioration in DRF in patients with prenatally diagnosed hydronephrosis.

Ectopic ureterocele with ureteral duplication is the most common type of ureterocele found in children. Early accurate diagnosis is desirable to decrease the risk of urosepsis and renal damage. Prenatal imaging with ultrasonography detects the vast majority of ureteroceles; however, in some cases, the diagnosis may remain in doubt. We report on the use of magnetic resonance imaging to clarify the prenatal diagnosis of a prolapsed ureterocele.

Investigation of proteinaceous components of cerebrospinal fluid (CSF) and possible hormone-barrier characteristics was made in adult female chickens. 1. 1. Fasting for periods up to 72 hr caused mainly a decrease in immunoglobulin levels (G and M), minor transferrin and ultimately major transferrin. Fasting was without significant impact on plasma or CSF glucose and insulin levels. 2. 2. Tolbutamide effected early increases in plasma insulin levels, and to a lesser degree in CSF insulin levels, which subsequently led to a marked hypoglycemia. The transferrin moieties (both) of the disc gel patterns appeared most altered by Tolbutamide in both plasma and CSF. 3. 3. Removal of 99% of the pancreas results four days later in a prominent rise in both plasma and CSF insulin levels. Also, pancreas removal causes alterations in transferrin (both) and IgM in both plasma and CSF.