Prospective management of neonates with pelviureteric junction stenosis. Therapeutic strategy based on 99m Tc-DPTA studies

A prospective therapeutic strategy based on separate glomerular filtration rate (SGFR) was evaluated in 14 prenatally detected asymptomatic neonates, suspected of having pelviureteric junction obstruction. The patients with low SGFR were referred for pyeloplasty with the hope to improve the renal function. A marked improvement occurred in only one patient, although the drainage function (furosemide test) did improve in all cases. A conservative attitude was adopted for those children with normal SGFR. In 6 of them, a progressive increase of SGFR was noted, related to the normal maturation of the function, followed by a stabilization in the normal range. In 1 patient, a sudden decrease of SGFR was observed around 1 year and the patient was shifted into the surgical group. In this patient, an initial partial response of the kidney to a furosemide injection changed into a persistent non-response, whereas in the other non-operated patients, partial or good response was always recorded, although the responses were essentially variable on successive tests. On the basis of these data, the protocol was slightly modified, the patients with persistent non-response to furosemide after 6 months of life being shifted to the surgical group.

Long-term follow-up of separate glomerular filtration rate in partially obstructed kidneys. Experimental study

An often encountered assumption is that non-relieved renal obstruction will lead soon or late to progressive deterioration of the renal function. The effect of non-relieved partial ureteral obstruction on the separate glomerular filtration rate (SGFR) was studied throughout the whole life of a series of rats, who were submitted at the age of 3 months to partial obstruction of the left ureter. An initial and variable postoperative SGFR decrease was gradually observed, but after this period, SGFR remained stable until the natural death of the animal.

99Tcm-DMSA uptake in obstructed kidneys. How inaccurate are the 5 h measurements?

Partial obstruction of the left ureter was created in 19 rats and a relative 99Tcm-DMSA uptake was obtained 5 and 24 h after intravenous injection of the tracer. A systematic and variable overestimation of the left to right uptake ratio was found at 5 h, with a mean error of 15.8% (S.D. = 12.2).

Radioisotopic evaluation of the renal parenchymal function in children with ureteropelvic junction obstruction. A retrospective study

Separate glomerular filtration rates were evaluated in 21 children with uni- or bilateral ureteropelvic junction stenosis, using the Tc-99m DTPA complex and the scintillation camera. The grade of alteration seen on urograms has influenced the surgeon in his decision to use a conservative or a surgical treatment, whereas the type of intervention (pyeloplasty or nephrectomy) was mainly based on the scintigraphic quantitation. The morphological data provided by an excretory urogram could not predict the degree of functional impairment. The scintigraphic evaluation of single kidney clearance was useful in the evaluation of the effects of medical and surgical treatment.

Technetium-99m DMSA imaging and the obstructed kidney

Although several authors have claimed that the function of an obstructed kidney could be overestimated on Tc-99m DMSA imaging, the clinical importance of such an overestimation has not been well documented. Partial obstruction of one ureter was created in a rat, and a relative Tc-99m DMSA uptake was obtained 4 hours after intravenous injection. By puncture of the isolated obstructed kidney, it was shown that the function of that kidney was overestimated by at least 17%.

Effect of retinoids on the growth, ultrastructure, and cytoskeletal structures of malignant rat osteoblasts

A clonal rat osteogenic sarcoma cell line, UMR 106-06, was used to study the effects of retinoic acid (RA) on its growth and morphology. Retinoic acid caused a reversible, time and dose-dependent inhibition of growth. RA-treated cells were larger, were more adherent to the substratum, and contained fewer mitotic figures. Half-maximal growth inhibition was observed at 10(-8) M. Among the naturally occurring retinoids, RA was clearly the most potent while the arotinoids, Ro 13-7410 and Ro 13-6298, were approximately 50 times more potent than was RA. A similar range of potencies was observed in the cloning efficiencies of the cells in soft agar. Fluorescence microscopy revealed that RA treatment increased the cellular content and organization of F-actin fibers. Ultrastructural changes include decreased chromatin dispersion and increased number of nucleoli per nucleus, decreased rough endoplasmic reticulum, decreased electron density and number of mitochondria, and increased formation of microfilaments and microtubules. These results identify this clonal cell line, which has been extensively characterized as the malignant counterpart of the normal osteoblast, as a target for vitamin A action.

Sensitivity of cortical transit and furosemide response in the diagnosis of renal obstruction. An experimental model

Several radionuclide parameters are routinely used for the diagnosis of renal obstruction. In order to evaluate the sensitivity of those parameters, an experimental model of partial ureteral obstruction in rats was used. Neither the cortical transit time, nor the response to furosemide could serve to discriminate between obstructive and nonobstructive kidneys. These parameters were, however, more or less related to the degree of impairment of the single kidney glomerular filtration rate and should probably be considered as functional parameters reflecting the grade of the obstructive phenomenon.

[Evaluation of medical and surgical treatment of intussusception in children apropos of a review of 100 consecutive cases]

Evaluation of medical and surgical treatment of intussusception in children (a revue of 100 consecutive cases). The authors analysed 100 consecutive cases of intussusception hospitalized in the Department of Paediatric Surgery of the Brugmann University Hospital in Brussels. 90 baryum enemas were performed, 43 of which were curative, 57 children were operated upon. Their age varied from 3 months to 10 years, but 77% of the children were less than 2 years old. The authors paid particular attention to the observations of children who had surgical treatment. This study points out the importance of early diagnosis and treatment. After a delay of 24 hours, 81% patients needed surgery compared to 41% of those who presented earlier.

[Bochdalek's congenital diaphragmatic hernia: a clinical review of 114 cases]

During a retrospective multicentric study of the encountered congenital pathology of the diaphragmatic domes, we focused our special attention on the prevalence of the congenital Bochdalek hernia. 140 charts were statistically analysed. The seriousness of the medical and surgical emergency situation enticed the authors to examine the most important prognostic clinical features. The interval between diagnosis and surgical therapy should be as short as possible. Respiratory acidosis and resuscitation were a common denomination in all infants who succumbed in the post-operative period. The early occurrence (less than 6 hrs) of respiratory distress disclosed the seriousness of the associated pulmonary hypoplasia. Surgical technical problems were rare. This in contrast to the struggle against pulmonary arterial and capillary hypertension. Pulmonary vasodilator drugs have not convinced those who initiated their use.

[Anti-infections prophylaxis of infantile burns (author's transl)]

Analysis of 300 consecutive hospitalized children with burns. To prevent infection, patients are given a bath with chlorhexidine (0.03%) every day and their burns covered by silver sulfadiazine (1%) and occlusive dressings. In 5.3% of the children positive swabs were obtained during hospitalization and in only 2.3% on several occasions. No case of septicemia could be documented.

[Surgical treatment of deep burns in children (author's transl)]

The clinical material is described and the principles of burn wound treatment are indicated: --excision and grafting of third degree burns: early whenever possible, delayed if the diagnosis or the limits are difficult to appreciate;--local treatment with Silver-Sulfadiazine of second degree burns, and those of undetermined depth. The difficulty of diagnosing the exact depth of the burn as well as the problem of the sequelae are stressed. The treatment of the complications is mentioned, particularly of the large hypertrophic scars. More than ever, prevention seems to be essential, but also possible.