Atherosclerosis across 4000 years of human history: the Horus study of four ancient populations.

Background: Atherosclerosis is thought to be a disease of modern human beings and related to contemporary lifestyles. However, its prevalence before the modern era is unknown. We aimed to evaluate preindustrial populations for atherosclerosis.

The museum's mummies: an inside view.

We applied medical and scientific methodology in a study of the mummies in the Metropolitan Museum of Art in New York, New York, by computed tomographic scanning and other radiographic methods. These noninvasive procedures allow us to "unwrap" these mummies without unwrapping them. This is, in effect, technology transfer of routine diagnostic techniques used in medicine to Egyptology.

Thoracolumbar accessory penis: etiology, diagnosis, and management.

Human sacral appendages have rarely been reported. We present a neonate with a thoracolumbar appendage resembling a penis, and discuss the nature of the anomaly and its diagnosis and management.

Diagnostic flexible peritoneoscopy: assessment of the contralateral internal inguinal ring during unilateral herniorrhaphy.

Background: Inguinal hernia is the most common pediatric surgical condition, with 75% of cases presenting unilaterally. No diagnostic study exists to determine preoperatively which children are at risk for subsequent contralateral hernia. The literature is not clear in advising whether surgeons should explore the contralateral side at the time of initial unilateral herniorrhaphy.

Flexible transinguinal laparoscopy to assess the contralateral ring in pediatric inguinal hernias.

The incidence of contralateral patent processus vaginalis (CPPV) is >50% in infants with clinical unilateral inguinal hernia (CUIH) and decreases only slowly with advancing age. Laparoscopy through the hernia sac (transinguinal laparoscopy) to detect suspected CPPV is a safe and efficient way to minimize routine contralateral inguinal exploration, but can be technically difficult. We used flexible urologic instruments and/or angled cystoscopic lenses to make transinguinal laparoscopy easier.

Laparoscopic surgery in children with ventriculoperitoneal shunts: effect of pneumoperitoneum on intracranial pressure--preliminary experience.

Objectives: We monitored changes in intracranial pressure (ICP) in 2 children with myelodysplasia undergoing laparoscopic bladder autoaugmentation. Both children had ventriculoperitoneal shunts (VPS) secondary to Arnold-Chiari malformations (type II).

Methods: ICP was monitored through a 23-gauge needle placed into the shunt reservoir and connected to a pressure transducer and drainage system.

Laparoscopic laser assisted auto-augmentation of the pediatric neurogenic bladder: early experience with urodynamic followup.

Purpose: We report our initial experience with laparoscopic laser assisted bladder auto-augmentation for treatment of the symptomatic pediatric neurogenic bladder.

Materials And Methods: Laparoscopic auto-augmentation of the bladder was performed in 2 children with myelodysplasia and high pressure neurogenic bladders unresponsive to medical management. Detrusorotomy was done using the KTP-532 laser.

Laparoscopic orchiopexy: clinical experience and description of technique.

Purpose: We reviewed the experience, early followup and technique of laparoscopic treatment of the nonpalpable undescended testis at our institution.

Materials And Methods: Charts of patients who underwent laparoscopic treatment of an intra-abdominal testis from September 1992 to October 1994 were reviewed.

Results: A total of 13 laparoscopic orchiopexies was performed on 11 children with nonpalpable undescended testes.

Laparoscopic laser-assisted bladder autoaugmentation.

Objectives: The purpose of this study is to examine the feasibility of performing a laparoscopic bladder autoaugmentation and to assess the urodynamic characteristics of an autoaugmented bladder.

Methods: Laparoscopic bladder autoaugmentation was performed in 9 female canines (20 to 30 kg). Following laparoscopic access to the peritoneal cavity, a midline bladder seromyotomy was performed using the potassium titanyl phosphate 532 nm laser.

Chromophore enhanced laser welding of canine ureters in vitro using a human protein solder: a preliminary step for laparoscopic tissue welding.

Laser welding of the genitourinary tract has the potential advantage of forming an immediate watertight seal. It may obviate the need for sutures, eliminate the inherent lithogenic reaction to suture, and potentially improve healing. In the current study we employed a KTP-532 laser in vitro to weld canine ureters.

Patch graft urethroplasty using dye enhanced laser tissue welding with a human protein solder: a preclinical canine model.

We investigated the use of the KTP-532 laser to perform a patch graft urethroplasty in 24 adult male dogs using the inner preputial skin as the donor site. In group 1 (12 dogs) repairs were completed with conventional microsuturing techniques, while in group 2 (12 dogs) they were completed using the KTP-532 laser. In the laser welding group the addition of a protein solder (40% human albumin) doped with fluorescein was used.

Use of tissue expanders in final reconstruction of infrapubic midline scar, mons pubis, and vulva after bladder exstrophy repair.

Two patients following bladder exstrophy repair presented for final cosmetic reconstruction with the characteristic lower abdominal midline scar, bisected mons pubis, and laterally displaced labia majora. Tissue expanders were used to obtain additional skin and subcutaneous tissue. After adequate serial expansion, the expanders were removed, scar tissue excised, and primary approximation of healthy tissues performed.

Antisperm antibodies in cryptorchid boys.

To explore whether the development of antisperm antibodies might play a role in inhibiting the future fertility of cryptorchid boys, 32 boys who underwent orchiopexy and 21 boys who underwent other inguinal surgeries were examined for the presence of antibodies to donor sperm. This group was compared to 23 boys who underwent noninguinal surgery or who had unrelated medical conditions. Using the indirect immunobead assay, 28% of the boys in the study group were found to have antisperm antibodies.

Anti-Müllerian hormone in three intersex conditions.

Anti-Müllerian hormone (AMH), secreted by embryonic testicular Sertoli cells, inhibits the development of Müllerian ducts in the male. An enzyme-linked immunoassay (ELISA) for AMH was used to investigate three intersex infants. The AMH level was correlated with each patient's degree of Müllerian duct development.

Laser welding of pedicled flap skin tubes.

The efficacy of the carbon dioxide laser used at high power levels for tissue destruction is well established. This laser at lower power levels has been used to incise and anastomose blood vessels, tendons, nerves, dura, bowel, fallopian tube, vasa deferentia, ureters and skin. Laser welding is faster, reduces surgical manipulation and introduces less foreign material into the wound than conventional suturing techniques.

Posterior urethral valves. Role of temporary and permanent urinary diversion.

Between 1960 and 1983, 67 boys were treated for posterior urethral valves. Despite adequate valve ablation, azotemia eventually developed in 19, and they underwent permanent urinary diversion. Normal renal function was not achieved in any of these children.

Extracorporeal shock-wave lithotripsy for children.

We report the cases of 17 children between the ages of 3 and 17 years who underwent 19 treatments using extracorporeal shock-wave lithotripsy. Stone size averaged 14.9 mm, with a range of 3 to 25 mm.

Childhood retroperitoneal fibrosis.

Retroperitoneal fibrosis is rarely considered in the differential diagnosis of ureteral obstruction in children even when clinical presentation and radiologic findings are typical. In a 12-year-old boy admitted with a 2-week history of flank pain computed tomography showed an enhancing mass obstructing the left ureter. Pathologic examination of the mass and adjacent segment of ureter revealed retroperitoneal fibrosis.

The epididymis and testicular descent.

The surgical findings in 197 consecutive cases of cryptorchidism demonstrate a 63% incidence of unfurled epididymides. This anomaly was more prevalent with bilateral cryptorchidism. The associated hernias, testicular and epididymal appendages were also more common in the unfurled epididymides cases, particularly in those that were bilateral.