Richard Bellah

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Cross-fused ectopic multicystic dysplastic kidney with associated ureterocele

Urology, 2005

We describe a case of the unique congenital anomaly of cross-fused ectopic multicystic dysplastic... more

Giant Bladder Diverticula Causing Bladder Outlet Obstruction in Children

Journal of Urology, 2004

Congenital giant diverticulum of the bladder is a consequence of deficiency in the detrusor muscu... more Congenital giant diverticulum of the bladder is a consequence of deficiency in the detrusor musculature and has been reported in male infants as a rare cause of bladder outlet obstruction. A 10-year retrospective review revealed 4 patients (3 boys and 1 girl) with bladder outlet obstruction due to a giant bladder diverticulum. Prenatal and postnatal clinical and imaging records were reviewed. Prenatal sonography was unremarkable in all patients. Three males (ages 4 months, 10 months and 3 years) had no medical history of voiding dysfunction, and 1 female (11 years) had the Ehlers-Danlos syndrome. While the girl presented with urinary tract infection, all patients presented with progressively decreasing urinary stream and urinary retention. Each patient underwent voiding cystourethrography (VCUG) and ultrasound. In each patient VCUG showed a giant (greater than 7 cm) bladder diverticulum that descended below the bladder neck and compressed the urethra during voiding. Vesicoureteral reflux was seen in 2 patients. Ultrasonography demonstrated moderate unilateral hydronephrosis in 2 patients. Bladder diverticulectomy was successfully performed in all patients, with ureteral reimplantation in 3. A giant congenital bladder diverticulum, when noted on VCUG to descend below the bladder neck, may lead to bladder outlet obstruction. To our knowledge we report the first case of a female presenting with bladder outlet obstruction due to a giant bladder diverticulum. Children with connective tissue disorders may be predisposed to this disorder, which must be excluded, regardless of gender, in all patients presenting with voiding abnormalities. Surgical diverticulectomy, often with ureteral reimplantation, is the preferred treatment, with excellent long-term results.

Meconium Hydrocele in a Female Newborn: An Unusual Cause of a Labial Mass

Journal of Urology, 1995

Meconium peritonitis results from in utero perforation of the bowel and subsequent spillage of me... more Meconium peritonitis results from in utero perforation of the bowel and subsequent spillage of meconium into the peritoneal cavity. Free communication of the peritoneal space with the processus vaginalis during gestation permits formation of a meconium hydrocele. Meconium hydrocele has been reported in the newborn scrotum but to our knowledge there has been no previous report of meconium hydrocele in the labium of a female neonate. The predominance of meconium hydrocele in the male infant may be due to the obliteration of the processus vaginalis occurring later in the male than in the female fetus.

Genitourinary Malformations in Chromosome 22q11.2 Deletion

The Journal of Urology, 2002

We reviewed our experience with genitourinary malformations associated with chromosome 22q11.2 de... more We reviewed our experience with genitourinary malformations associated with chromosome 22q11.2 deletion. We retrospectively reviewed patient intake charts at the 22q clinic at our institution. We assessed 73 renal/bladder ultrasounds and 7 autopsies performed between 1998 and 2000 for renal and bladder malformations. A total of 149 male patients were evaluated for possible testicular and urethral malformations. Of 80 patients 25 (31%) had a structural urinary tract anomaly. Another 8 patients had renal agenesis or multicystic dysplastic kidney, 4 had hydronephrosis and 5 had vesicoureteral reflux or an irregular bladder, while 8 of 73 (11%) had dysfunctional voiding, 9 of 149 (6%) had undescended testes and 12 of 149 (8%) had hypospadias. Screening renal/bladder ultrasound, careful voiding history and medical but not surgical therapy are recommended for renal and bladder anomalies associated with 22q11.2 deletion. The need for surgery for cryptorchidism and hypospadias is slightly higher than in the general population.

Postaxial polydactyly, ulnar ray dysgenesis, and renal cystic dysplasia in sibs

American Journal of Medical Genetics, 1999

We describe two brothers with variable expression of a unique syndrome. One sib has postaxial pol... more We describe two brothers with variable expression of a unique syndrome. One sib has postaxial polydactyly of the right hand and feet, two digits on the left hand (a thumb and first digit), bilateral ulnar ray dysgenesis, ectrodactyly of one hand, and ultrasonic evidence of cystic kidneys. His brother has postaxial polydactyly and small kidneys. The parents and a third sib are normal. They do not have the Pallister ulnar-mammary syndrome but may have an unusual form of the Weyers oligodactyly syndrome. This appears to be the first report of an acro-renal syndrome with ulnar dysgenesis, oligodactyly, polydactyly, and dysplastic kidneys.

Cystic kidney disease in Hajdu‐Cheney syndrome

American Journal of Medical Genetics, 1995

We report on 2 unrelated patients with Hajdu‐Cheney acroosteolysis syndrome, who had cystic kidne... more We report on 2 unrelated patients with Hajdu‐Cheney acroosteolysis syndrome, who had cystic kidneys with ultrasono‐graphic changes similar to those of auto‐somal dominant polycystic kidney disease. Neither had a family history of Hajdu‐Cheney syndrome or polycystic kidneys, nor manifestations of any other syndrome. On the basis of the findings in these 2 patients and a review of published cases, we suggest that cystic kidneys are an important component of Hajdu‐Cheney syndrome. © 1995 Wiley‐Liss, Inc.

Ultrasonographic features of gastrointestinal duplications

Journal of Ultrasound in Medicine, 1994

The variable sonographic appearance of duplication cysts is presented. Eighteen sonograms from 14... more The variable sonographic appearance of duplication cysts is presented. Eighteen sonograms from 14 patients, aged 1 day to 8 years, were reviewed over an 8 year period. Water and other aqueous contrast agents were used in six patients as part of the sonographic evaluation. All lesions were confirmed by surgery. All but two patients were symptomatic. Twenty-four cysts were detected, ranging in size from 1.7 to 15.5 cm. The duplication cysts revealed a spectrum of sonographic findings (cystic to solid appearing masses). The mass characteristics, including the &quot;muscular rim sign,&quot; and internal debris or hemorrhage, were demonstrated. Multiple unsuspected cysts (3 of 14 or 20%) and complications such as perforation were readily seen with ultrasonography. Serial sonograms demonstrated the changing morphology of two cysts. Other unsuspected intra-abdominal and pelvic pathologic conditions, including pyloric stenosis and ovarian cysts, were identified. Identification of the muscular rim sign is the most reliable indication of a duplication cyst. Multiple masses as well as possible accompanying anomalies in the abdomen and pelvis are readily evaluated with sonography. Lesions are easily followed with serial studies if there is no surgical intervention.

Pediatric Uroimaging

Pediatric Nephrology and Urology, 2004

Standardizing treatment of preterm infants with post-hemorrhagic hydrocephalus at a single institution with a multidisciplinary team

Child's Nervous System, 2020

Background Preterm infants with post-hemorrhagic hydrocephalus (PHH) are often treated with tempo... more Background Preterm infants with post-hemorrhagic hydrocephalus (PHH) are often treated with temporizing measures such as ventricular access devices (VADs) in order to drain cerebrospinal fluid (CSF) prior to permanent diversion with ventriculoperitoneal shunt (VPS) placement. Local problem There is little consensus on the timing and management of VADs and VPSs. This leads to marked practice variations among treating services that can adversely affect patient outcomes. Methods This is a quality improvement study evaluating practices from February 2011 to September 2017 including infants with PHH in a single level IV NICU. Interventions A multidisciplinary team created a local clinical pathway modified from the Hydrocephalus Clinical Research Network's Shunting Outcomes in Post-Hemorrhagic Hydrocephalus protocol to manage infants with PHH. Methods of CSF diversion and shunt timing were based on weight. Neonatal care providers performed VAD aspiration; timing was guided by imaging and clinical exam criteria. Surgical procedures were performed in the NICU. Results There were 78 patients eligible for the study. Prior to pathway implementation, infections occurred in 4% of VAD and 3% of VPS patients. There have been no infections since inception of the pathway. With pathway implementation, treatment compliance improved from 55 to 86% while conversion compliance rate improved from 89 to 100%. Conclusions Standardization of care for PHH infants leads to improvement in patient outcomes such as a decrease in time to VAD placement. Reservoir aspirations by the neonatology team did not result in an increase in infection rate.

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Diagnostic Accuracy of Ultrasound With Color Flow Doppler in Children With Thyroid Nodules

The Journal of clinical endocrinology and metabolism, 2018

Thyroid nodules are increasingly recognized in children and are associated with a greater risk fo... more Thyroid nodules are increasingly recognized in children and are associated with a greater risk for thyroid cancer compared with adults. Thyroid ultrasound is the favored tool for evaluation of thyroid nodules; however, there are limited data regarding the accuracy of thyroid ultrasound to confirm features associated with a low risk of thyroid cancer in children. We examined whether thyroid ultrasound is capable of accurately identifying thyroid nodules at a low risk of malignancy in children. Using a retrospective cohort study design, we identified children age ≤18 years with thyroid nodules and adequate follow-up. Ultrasound images were reviewed independently by two blinded expert radiologists, and ultrasound characteristics were analyzed to determine optimal predictive value and reliability. A total of 417 subjects were found to have thyroid nodules, and 152 subjects had adequate follow-up; 59 (38.8%) of these were diagnosed with thyroid cancer. We evaluated 236 individual nodules...

Cervical trachea: dynamics in response to herniation of the normal thymus

Radiology, 1993

Trachea: Dynamics in Response to Herniation ofthe Normal Thymus' 383 Nineteen infants aged 2 mont... more Trachea: Dynamics in Response to Herniation ofthe Normal Thymus' 383 Nineteen infants aged 2 months to 2.5 years, first seen predominantly with stridor, were noted to have intermittent soft-tissue mass effect in the upper airway during routine evaluation with fluoroscopic or radiographic methods. The cervicothoracic trachea was always buckled posteriorly and, in almost all instances, to the right during forced exhalation (crying). Real-time ultrasound examination with the neck extended was used in these patients to define the cause of the tracheal dynamics. The intermittent cephalic movement of the homogeneous echotextured thymus from the anterior mediastinum into the neck was determined to be the probable cause of the mass effect in these infants. Magnetic resonance imaging in three infants confirmed this finding. The intermittent, physiologic suprasternal movement of the thymus in these infants did not by itself cause any luminal compromise of the trachea and did not result in any respiratory difficulty in these infants.

Acquired Multiple Cysts of the Kidney in Neuroblastoma Survivors

American journal of kidney diseases : the official journal of the National Kidney Foundation, 2016

Cystic kidney disease includes a wide range of hereditary, developmental, and acquired conditions... more Cystic kidney disease includes a wide range of hereditary, developmental, and acquired conditions of the kidneys. Some of the inherited causes of cystic kidney disease include autosomal dominant polycystic kidney diseases (caused by mutations in PKD1 or PKD2), autosomal recessive polycystic kidney disease, tuberous sclerosis complex, von Hippel-Lindau disease, oral-facial-digital syndrome type I, and Hadju-Cheney syndrome. Acquired cystic kidney disease has been reported in patients receiving long-term hemodialysis or peritoneal dialysis and in children after liver transplantation. Acute kidney injury can occur in patients with neuroblastoma, usually as a result of thrombotic microangiopathy associated with bone marrow transplantation. End-stage renal disease is described in long-term survivors. However, in this case report, we provide what is to our knowledge the first description of multiple kidney cysts in long-term survivors of stage IV neuroblastoma. None of the 7 patients we d...

Paget-Schroetter syndrome in a lacrosse player

Delaware medical journal, 2013

Paget Schroetter Syndrome (PSS) or &quot;effort thrombosis&quot; is a rare form of primar... more Paget Schroetter Syndrome (PSS) or &quot;effort thrombosis&quot; is a rare form of primary upper extremity deep vein thrombosis often seen in individuals with anatomic variants involving the thoracic outlet and exacerbated by repetitive microtrauma to the subclavian vein. Diagnosis can be made with ultrasound and confirmed with MR venography or conventional venography. We report a case of PSS in a young male athlete who was treated with pharmacologic and mechanical thrombolysis.

Advances in uroradiologic imaging in children

Radiologic clinics of North America, 2012

Diagnostic imaging of pediatric urologic disorders is continuously changing as technologic advanc... more Diagnostic imaging of pediatric urologic disorders is continuously changing as technologic advances are made. Although the backbone of pediatric urologic imaging has been ultrasound, voiding cystourethrography, and radionuclide scintigraphy, newer and advanced modalities are becoming increasingly important. This article discusses the techniques and clinical applications of three such imaging modalities as they pertain to pediatric urologic disorders: (1) MR urography; (2) advanced ultrasound (harmonic imaging, three-dimensional, and voiding urosonography); and (3) CT angiography.

Common and uncommon applications of bowel ultrasound with pathologic correlation in children

AJR. American journal of roentgenology, 2014

The purpose of this article is to describe the indications and techniques for bowel ultrasound fo... more The purpose of this article is to describe the indications and techniques for bowel ultrasound for inflammatory bowel disease and other common and uncommon entities and describe and illustrate their imaging appearances, including endoscopic or surgical correlation. Ultrasound is a useful tool for the evaluation of inflammatory bowel disease and many other bowel diseases. Radiologists must become familiar with the full potential of ultrasound in the evaluation of the bowel in children because the need for alternative radiation-free imaging techniques continues to grow.

CT evaluation of tracheobronchial tumors in children

International Journal of Pediatric Otorhinolaryngology, 1992

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Sonography in the Evaluation of Pediatric Urinary Tract Infection

Ultrasound Clinics, 2010

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Pediatric Radiology: State of the Art

Nonoperative management of blunt pediatric major renal trauma

Urology, 1993

Although algorithms exist for the management of renal trauma in adults, guidelines have not been ... more Although algorithms exist for the management of renal trauma in adults, guidelines have not been established in children. Of 1,175 patients entered into our Trauma Registry between 1987 and 1991, 61 (5.2%) presented with gross or microscopic hematuria. Eight of the 58 patients (13.8%) who had blunt abdominal trauma had major renal injuries. Gross hematuria (n = 10) was a significant predictor of major renal injury (n = 5) (p &lt; 0.001). All 3 patients with microscopic hematuria and a major renal injury also had evidence of multisystem trauma. Admission blood pressure, hemoglobin, and trauma score were not predictors of major renal trauma. All cases were managed nonoperatively except for 1 patient who required a partial nephrectomy for continued hemorrhage. These data suggest that hematuria of any degree should be evaluated in the pediatric population, since major injuries can occur with even microscopic hematuria or in the absence of shock. Nonoperative management in this series resulted in no morbidity or delayed complications and suggests that surgical exploration be reserved for ongoing bleeding.

Pediatric Urologic Advanced Imaging: Techniques and Applications

Urologic Clinics of North America, 2010

Richard Bellah

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