Frequency Of Anomalies Research Articles

Bilateral Ureterocele

THE FOLLOWING case of bilateral ureterocele is believed to be of interest because it further confirms the very favorable— in this case dramatic—results 0 btained with conservative transurethral fulguration. In addition, it was possible to obtain very satisfactory roentgenograms of the anomalies by a modification of the routine method. The diagnostic and therapeutic measures were performed aboard a United States Navy Hospital Ship. A ureterocele is a saccular dilatation of the lower end of the ureter into the bladder. It is usually considered to be the result of increased intraureteral pressure acting against a combination of two congenital anomalies: atresia or stenosis of the ureteral orifice and a deficiency of connective-tissue attachment (Waldeyer's sheath) of the ureter to the bladder. The characteristic roentgen finding in ureterocele is a cystic ballooning or spherical dilatation of the lower end of the ureter as seen on intravenous urography or retrograde pyelography. The cystogram may show a spherical filling defect in the region of the ureteral orifice. In addition, evidence of obstructive uropathy, including dilatation of the renal pelvis and blunting and clubbing of the calices, may be noted on the affected side. While ureteroceles are relatively frequent urological anomalies Herman (5) states that they are bilateral in only 10 per cent of cases. Gutierrez (4) and Thompson and Greene (7) have shown that for the ureterocele of average size transurethral fulguration through the entire thickness of its wall is a satisfactory method for enlarging the stenosed ureteral orifice. It is also the consensus of opinion that with bilateral ureteroceles only one should be treated at a time. Case Report An 18-year-old white seaman was admitted to the urological service of the hospital ship from an aircraft carrier on March 1, 1947, complaining of “blood in the urine” of seven days duration. He gave a history of intermittent gross hematuria accompanied by burning but no pain. The blood was described as being throughout the urinary stream. No blood clots were observed. Four days before admission the bleeding stopped spontaneously. At that time a vague suprapubic discomfort was noticed. Nearly two years earlier the patient had an acute non-specific urethritis, which was treated successfully with sulfadiazine. For the past year he had had slight difficulty initiating the urinary stream. The family history revealed that his mother had “kidney disease” many years ago, from which she had apparently recovered uneventfully. On admission to the hospital ship, the patient was completely asymptomatic except for slight difficulty in starting the. urinary stream. The only positive finding on physical examination was a slightly boggy left lateral lobe of the prostate, indicating a lowgrade chronic prostatitis.

Syndrome of the Anterior Spinal Artery of the Medulla Oblongata

In previous communications on the syndromes of the cerebellar arteries 1 it was shown that, in contrast to cerebral vascular insults, occlusion of the cerebellar vessels is rare. Closure of the upper part of the anterior spinal artery supplying the medulla oblongata is even less common. Involvement of this vessel was found in only two instances in a series of about four hundred cases of cerebrovascular disease which came to autopsy. In contrast to the frequent anomalies of the posterior inferior cerebellar arteries, anomalies of the upper portion of the anterior spinal and of the vertebral arteries are less commonly observed. The variability of the symptoms occurring with occlusion of the vertebral artery depends on whether the posterior inferior cerebellar artery arises from the basilar or from the vertebral artery. When this cerebellar vessel has origin from the vertebral artery, it is difficult to state whether the symptoms are due

A frequent obstructive anomaly of the mouth of the left common iliac vein

This study of the opening of the left common iliac vein into the inferior vena cava is based on the examination of 412 bodies: 97 stillborn babies and infants up to 10 months old, 28 children from 1 to 9 years of age, 23 adolescents from 10 to 19 years of age, and 264 adults up to 90 years of age. The width of the opening first increased rapidly with increasing age, and later more slowly. The curve reached its peak during the seventh decade. A valve was found to be normally present in the newborn at the lower pole of the opening, but it appeared to be worn off in an ever greater percentage as age progressed, and more so in obstructed than in normal openings. This observation seems to be significant with regard to the cause of varices of the lower extremities, which have often been explained as a result of venous valvular insufficiency. Obstruction of the orifice in the 399 cases analyzed was observed in 95 instances (23.8 per cent), with a possibility of 16 more instances in the stillborn and infants. It was less common in children and babies (4.7 per cent), although, if the 16 doubtful cases are included, the percentage rises to 17.3 per cent. In those over 10 years of age, it was found 89 times (33.8 per cent). It occurred with equal frequency in males and females, and in whites and Negroes. According to location and other criteria, the obstructions could be divided into five groups (Figs. 3 and 4). The most common site of obstruction was the upper pole of the orifice, where two-thirds of all obstructions were found. Concerning the pathogenesis of the obstructions, few, if any, were thought to be caused by faulty development, per se. They appeared to be acquired during the growth period, rarely before birth, and rarely after adolescence. As to the mechanism involved, it was observed that the obstructions occurred at a point where the right iliac artery crosses and exerts pressure on the vein. This pressure conceivably interferes with the proper development of the opening into the vena cava or causes an injury resulting in organization and fibrosis. In a small number of cases the obstructions could be shown to be organized thrombi. The clinical significance of the obstructions is apparent from the greater frequency of thrombosis in the left than in the right leg. This preponderance could be confirmed in our material, as well as in an analysis of 1,000 consecutive autopsies from one of our hospitals.

SYNDROME OF THE ANTERIOR SPINAL ARTERY OF THE MEDULLA OBLONGATA

In previous communications on the syndromes of the cerebellar arteries 1 it was shown that, in contrast to cerebral vascular insults, occlusion of the cerebellar vessels is rare. Closure of the upper part of the anterior spinal artery supplying the medulla oblongata is even less common. Involvement of this vessel was found in only two instances in a series of about four hundred cases of cerebrovascular disease which came to autopsy. In contrast to the frequent anomalies of the posterior inferior cerebellar arteries, anomalies of the upper portion of the anterior spinal and of the vertebral arteries are less commonly observed. The variability of the symptoms occurring with occlusion of the vertebral artery depends on whether the posterior inferior cerebellar artery arises from the basilar or from the vertebral artery. When this cerebellar vessel has origin from the vertebral artery, it is difficult to state whether the symptoms are due

Meckel's diverticulum: An analysis of eighteen cases with report of one tumor

The lesions of this common anomaly are so manifold that it should be entertained in every puzzling abdominal diagnosis. Because of its varied and bizarre morbid states, no one definite syndrome can be ascribed to it. The recent numerous articles on the subject have given this frequent and dangerous anomaly a deserved place, for more and more think of it in differential diagnoses. In reviewing the literature, one is impressed with the frequency of secondary laparotomies following appendectomy or salpingectomy, etc., for the removal of a troublesome Meckel's diverticulum. Many unnecessary operations and failure of an appendectomy to relieve vague abdominal pains have been now explained by the fact that a Meckel's diverticulum was overlooked. Surgeons have not searched for this frequent anomaly, estimated as occurring in 1.5 to 3 per cent of all persons. The argument “to leave well enough alone” is to be condemned, for the diverticulum resembles and yet is so unlike the appendix, that when both are present, the chance of morbid pathology in the diverticulum because of its position, structure and development, is tenfold that of the appendix vermicularis. The appendix, however, is removed at laparotomy in the majority of cases; a second operation, therefore, is deprecated. The diagnosis could be made more frequently, for quite often the “sign on the door” is overlooked. The presence of an umbilical adenoma, a history of fecal discharge from the umbilicus or of cryptic rectal hemorrhages should be pointers. The admonition of Cullen remains unheeded. In his book, “The Umbilicus and its Diseases,” the following paragraph appears in large print: In every case of umbilical polyp it is the duty of the family physician or surgeon to explain carefully to the parents the possible coexistence of an intra-abdominal portion of the omphalomesenteric duct, which may be adherent to the umbilicus and later give rise to intestinal obstruction. Their parents should be instructed to watch such children carefully, and if later in life the slightest sign of intestinal obstruction develops an abdominal operation should be immediately undertaken, the surgeon making an incision encircling the umbilicus and looking immediately for an adherent Meckel's diverticulum. If this review and analysis of cases does nothing more than impress the reader with the necessity of looking for a Meckel's diverticulum, when feasible, in all laparotomies, it has served its purpose. It is hoped that with the gradual correlation of symptoms manifested by this group complex and the spreading of its knowledge, the diagnosis will be made oftener in its earlier phases and surgical treatment will be more efficacious.

CONGENITAL RECTOVESICAL ANASTOMOSIS

The case of congenital rectovesical anastomosis reported here is one of unusual rarity. In books on anatomy, pathology and embryology one finds reference to the condition of imperforate anus as a relatively frequent congenital anomaly. Congenital absence of the anus with associated patent connection between the intestinal and urinary systems is a condition referred to but rarely in the literature and makes this case worthy of consideration. REPORT OF CASE History.—F. P., a white boy, aged 2 days, was admitted to the surgical service of the Holy Name Hospital, Teaneck, N. J., on July 15, 1932. There was a history of his having passed fecal material by way of the urethra since birth, forty-eight hours previous to admission. Delivery had been normal in every respect. On examination it was found that there was a congenital imperforate anus. There was marked abdominal distention, and the baby was in poor condition.

RECURRENT SPONDYLOLISTHESIS, WITH PARALYSIS; BONE-SPLINT TRANSPLANTATION

The fifth lumbar vertebra is subject to many abnormalities of development which may cause mechanical trouble. The most frequent anomaly is probably in the shape or size of the transverse processes. This will not be considered here. Next in frequency is a variation in the articular processes, which may vary in size, in shape, or in direction. If the articulation be of the lumbar type, with the long axis of the joint antero-posterior, and the flat facets facing to the side, it is possible for the vertebra to slide forward on the sacrum when the spine is straight or extended, especially if the articular processes be small and the ligaments weak. If the processes be of the dorsal type, and this is by no means rare, flexion of the spine, with violence, may cause the facets to override; more easily, again, if these facets be small and the ligaments be

THE CLINICAL RECOGNITION OF THE SCAPHOID TYPE OF SCAPULA AND OF SOME OF ITS CORRELATIONS

In my communication, Scaphoid Scapula, a Frequent Anomaly in Development of Hereditary, Clinical and Anatomic Significance,1 presented to the St. Louis Medical Society, Feb. 5, 1910, I indicated the relative frequence of the scaphoid type of scapula in our population in dry bones and in fetal, embryo and monster forms. The main thesis of that communication was: The scaphoid scapula is an anomaly in development originating in the progeny from some abnormal circumstance operating in the parents, is thereafter transmitted from parent to child, and so on through several generations, and unless the abnormal circumstance again becomes operative in the descendants, the scaphoid scapula finally disappears and the racial type again becomes dominant. I showed that it occurred most frequently in individuals deviating from the average in physical or mental endowments, or both, and stated that the natural habitat of the scaphoid scapula was in the deviate. I showed