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Clinical significance of plasma endothelin levels in patients with biliary atresia
INTERNATIONAL
ABSTRACTS
1047
uneventful. Cholangitis was not encountered in any patient. Ultrasonography showed normal intrahepanc bile ducts after operation. In four cases. SPECT (single proton em&ton computerized tomography) was performed, whtch showed patent extrahepatic bile ducts. The authors conclude that this ts a promising technique for the management of choledochai cysts.--l: Wester Clinical Significance of Plasma Endothelin Levels in Patients With Biliary Atresia. H. Kobayaski, I: Miyano, K. Horikoshi. et ul. Pediatr Surg Int 13:491-493, (September), 1998. The purpose of this study was to assess the climcal tmportance of plasma endothelin levels in children with biliary atresia after hepatoportoenterostomy. Nineteen patients with operated biliary atresia were divided into two groups. The first group had jaundice and abnormal glutamic oxaloacetic transaminase, glutamic pyruvic transaminase. and gamma glutamyl transpeptidase. The second group did not have jaundice, and the laboratory parameters were normal. Ten normal children served as controls. Plasma endothelin was measured with the ELISA technique. Plasma endothelin levels were higher in patients with biliary atresia than in controls. Furthermore, the levels were higher in the first group. with unfavorable prognosis compared with the second group. The authors conclude that plasma endothelin concentration may be valuable as a prognostic indicator in patients with biliary atresm-P Puri Giant Omphalocele Filled A. Giirpinar, and H. Dogruyol. 1998.
by a Duplication Cyst. I. Kiristzoglu, Em J Pediatr Surg 8:315-316, (October),
Ileal duplication cysts withm a giant omphalocele are very rare. The authors report on a newborn with a giant omphalocele having an ileal duplication cyst. detected by prenatal ultrasonography and diagnosed at surgery after birth. The postoperattve course was uneventful. This case illustrates the diagnostic and therapeutic problems during pregnancy and the neonatal period.-Thomas A. Angerpointnez Systemic LuQ, J.K. 1998.
Spread Wilmanrz,
of Meconium et al. Pediatr
Peritonitis. WL. Radio1 28:714-716,
Patton, A.M. (September),
Meconmm peritonitis 1s a benign chemical peritonitis sometimes needing surgical intervention. The authors present the case of a newborn with meconium peritonitis who had infarcts in several organs. Special staming showed squamous cells and keratinous debris, representing mecomum within the vessel supplying the infarcted tissue. Intravascular meconium emboh were found in the liver, spleen, pancreas, left kidney, and lungs. A mediastinal lymph node had widened lymphoid smuses filled with meconium. Various possible mechamsms by which meconium from the peritoneal cavity could spread to the systemic circulation are discussed. The authors report this as the first case in the literature of meconium peritonitis with systemic spread of meconium resulting in embohc infarcts in multiple organs -A.B Matlzur
GENITOURINARY Posterior squences. 13:504-507.
Urethral Valves After A. Krishna, II Lul, A. (September), 1998.
TRACT Infancy-Urodynamic Gupta, et al. Pediatr
ConSurg Int
The authors evaluated six late-presentmg boys, aged 6 to 12 years, with posterior urethral valves. The patients were evaluated with renal function tests, urinalysis, ultrasonography, voiding cystourethrography, uroflowmetry, and renal scans. Fulguration of the valves was perfotrned after stabilizatton of the patient and treatment of Infection. Six months after surgery. the patients underwent urodynamic studies (uroflowmetry
and cystometry). Two patients had chronic renal failure at presentation. Two presented with hematuria; one presented with acute respuatory distress and acidosis. Three of the six patients had normal upper urinary tracts, whereas reflux was found in two of them. Three patients had bilateral hydroureteronephrosis. In three boys, the urine flow rate preoperatively was low and did not improve considerably after operation. These cases had loss of compliance at low bladder volumes. At follow-up. the residual urine volume was considerable. In the patients with normal upper urinary tracts, urine flow was improved after surgery. Cystomeuy also showed good compliance and normal functional bladder capacity. The authors conclude that in boys presenting with posterior urethral valves after 4 years of age, high storage bladder pressures may accompany renal deterioration. In some cases, upper urinary tracts remain unchanged. resulting m good bladder dynamics after operation. Cystometty is recommended as a predictor of future outcome in patients with posterior urethral valves-p Pun’ The Role of Bladder Biofeedback in the Treatment of Children With Refractory Nocturnal Enuresis Associated With Idiopathic Detrusor Instability and Small Bladder Capacity. L. Hoe,&; J.J. Njmdaele, andA. Vermandel. J Urol 160:858-860. (September), 1998. Not all children with primary nocturnal enuresis, unstable detrusor. and small bladder capacity can be treated successfully with anticholinergics and bladder drill. The authors report the use of bladder biofeedback for patients who did not respond to 3 months of such treatment. A total of 24 patients (median age. 10.4 years) were studied. For bladder biofeedback. a transurethral catheter was placed and connected with a three-way connector. The bladder was filled slowly through this catheter, and the intravesical pressure could be seen on a vertical tube. which also was connected to the transurethral catheter. The perineal bulbar detrusor inhibiting reflex was used m cases of involuntary bladder contraction. During the day, patients retained urine as long as possible and completed a micturition chart, Of the 24 patients, bedwetting stopped completely for 17 and decreased for six. Treatment failed in one, All patients had follow-up for at least 6 months after treatment. There were two cases of recurrence in the group that was “cured.” Intravesical biofeedback can successfully treat patients with refractory primary enuresis associated with unstable detrusor and small bladder capacity.-George W Holcomb. Jr Augmenting the Augmented Bladder: Treatment of the Contractile Bowel Segment, J. C. Pope IS M.A. Keatizzg, A.J. Casale, et al. J Urol 160:854-857. (September), 1998. Bowel used for bladder reconstruction, regardless of detubularization. occasionally retains its con&actile properttes. Of 323 patients who underwent primary enterocystoplasty. 19 were identified who continue to have high pressure bladder contractions and required augmentation of the previously augmented bladder. Reason for repeat augmentation, upper tract changes, original and secondary bowel segments used, and urodynanuc findings were evaluated for all patients. Current status and follow-up were noted. After mitial augmentation, eight patients had persistent incontinence, five bladder perforation, three isolated upper tract changes, two incontinence and bladder perforation, and one incontinence plus intractable pain Preoperative urodynamics showed detrusor pressures of 30 to 100 cm HsO. All patients had adequate bladder outlet resistance. The original bowel segments used were sigmotd in 12 cases, stomach in 4, ileum in 2, and cecum in 1. Bowel segments used for reaugmentation were ileum in 16 cases and sigmoid m three. Of the 11 patients with incontinence, 10 are now dry. All cases of upper tract changes resolved. The mean follow-up time since reaugmentation is 52 months. [f the outcome of bladder augmentation is less than optimal. it is important to reevaluate the bladder dynamics. In rare instances, these patients may contmue to have htgh pressure
ABSTRACTS
1047
uneventful. Cholangitis was not encountered in any patient. Ultrasonography showed normal intrahepanc bile ducts after operation. In four cases. SPECT (single proton em&ton computerized tomography) was performed, whtch showed patent extrahepatic bile ducts. The authors conclude that this ts a promising technique for the management of choledochai cysts.--l: Wester Clinical Significance of Plasma Endothelin Levels in Patients With Biliary Atresia. H. Kobayaski, I: Miyano, K. Horikoshi. et ul. Pediatr Surg Int 13:491-493, (September), 1998. The purpose of this study was to assess the climcal tmportance of plasma endothelin levels in children with biliary atresia after hepatoportoenterostomy. Nineteen patients with operated biliary atresia were divided into two groups. The first group had jaundice and abnormal glutamic oxaloacetic transaminase, glutamic pyruvic transaminase. and gamma glutamyl transpeptidase. The second group did not have jaundice, and the laboratory parameters were normal. Ten normal children served as controls. Plasma endothelin was measured with the ELISA technique. Plasma endothelin levels were higher in patients with biliary atresia than in controls. Furthermore, the levels were higher in the first group. with unfavorable prognosis compared with the second group. The authors conclude that plasma endothelin concentration may be valuable as a prognostic indicator in patients with biliary atresm-P Puri Giant Omphalocele Filled A. Giirpinar, and H. Dogruyol. 1998.
by a Duplication Cyst. I. Kiristzoglu, Em J Pediatr Surg 8:315-316, (October),
Ileal duplication cysts withm a giant omphalocele are very rare. The authors report on a newborn with a giant omphalocele having an ileal duplication cyst. detected by prenatal ultrasonography and diagnosed at surgery after birth. The postoperattve course was uneventful. This case illustrates the diagnostic and therapeutic problems during pregnancy and the neonatal period.-Thomas A. Angerpointnez Systemic LuQ, J.K. 1998.
Spread Wilmanrz,
of Meconium et al. Pediatr
Peritonitis. WL. Radio1 28:714-716,
Patton, A.M. (September),
Meconmm peritonitis 1s a benign chemical peritonitis sometimes needing surgical intervention. The authors present the case of a newborn with meconium peritonitis who had infarcts in several organs. Special staming showed squamous cells and keratinous debris, representing mecomum within the vessel supplying the infarcted tissue. Intravascular meconium emboh were found in the liver, spleen, pancreas, left kidney, and lungs. A mediastinal lymph node had widened lymphoid smuses filled with meconium. Various possible mechamsms by which meconium from the peritoneal cavity could spread to the systemic circulation are discussed. The authors report this as the first case in the literature of meconium peritonitis with systemic spread of meconium resulting in embohc infarcts in multiple organs -A.B Matlzur
GENITOURINARY Posterior squences. 13:504-507.
Urethral Valves After A. Krishna, II Lul, A. (September), 1998.
TRACT Infancy-Urodynamic Gupta, et al. Pediatr
ConSurg Int
The authors evaluated six late-presentmg boys, aged 6 to 12 years, with posterior urethral valves. The patients were evaluated with renal function tests, urinalysis, ultrasonography, voiding cystourethrography, uroflowmetry, and renal scans. Fulguration of the valves was perfotrned after stabilizatton of the patient and treatment of Infection. Six months after surgery. the patients underwent urodynamic studies (uroflowmetry
and cystometry). Two patients had chronic renal failure at presentation. Two presented with hematuria; one presented with acute respuatory distress and acidosis. Three of the six patients had normal upper urinary tracts, whereas reflux was found in two of them. Three patients had bilateral hydroureteronephrosis. In three boys, the urine flow rate preoperatively was low and did not improve considerably after operation. These cases had loss of compliance at low bladder volumes. At follow-up. the residual urine volume was considerable. In the patients with normal upper urinary tracts, urine flow was improved after surgery. Cystomeuy also showed good compliance and normal functional bladder capacity. The authors conclude that in boys presenting with posterior urethral valves after 4 years of age, high storage bladder pressures may accompany renal deterioration. In some cases, upper urinary tracts remain unchanged. resulting m good bladder dynamics after operation. Cystometty is recommended as a predictor of future outcome in patients with posterior urethral valves-p Pun’ The Role of Bladder Biofeedback in the Treatment of Children With Refractory Nocturnal Enuresis Associated With Idiopathic Detrusor Instability and Small Bladder Capacity. L. Hoe,&; J.J. Njmdaele, andA. Vermandel. J Urol 160:858-860. (September), 1998. Not all children with primary nocturnal enuresis, unstable detrusor. and small bladder capacity can be treated successfully with anticholinergics and bladder drill. The authors report the use of bladder biofeedback for patients who did not respond to 3 months of such treatment. A total of 24 patients (median age. 10.4 years) were studied. For bladder biofeedback. a transurethral catheter was placed and connected with a three-way connector. The bladder was filled slowly through this catheter, and the intravesical pressure could be seen on a vertical tube. which also was connected to the transurethral catheter. The perineal bulbar detrusor inhibiting reflex was used m cases of involuntary bladder contraction. During the day, patients retained urine as long as possible and completed a micturition chart, Of the 24 patients, bedwetting stopped completely for 17 and decreased for six. Treatment failed in one, All patients had follow-up for at least 6 months after treatment. There were two cases of recurrence in the group that was “cured.” Intravesical biofeedback can successfully treat patients with refractory primary enuresis associated with unstable detrusor and small bladder capacity.-George W Holcomb. Jr Augmenting the Augmented Bladder: Treatment of the Contractile Bowel Segment, J. C. Pope IS M.A. Keatizzg, A.J. Casale, et al. J Urol 160:854-857. (September), 1998. Bowel used for bladder reconstruction, regardless of detubularization. occasionally retains its con&actile properttes. Of 323 patients who underwent primary enterocystoplasty. 19 were identified who continue to have high pressure bladder contractions and required augmentation of the previously augmented bladder. Reason for repeat augmentation, upper tract changes, original and secondary bowel segments used, and urodynanuc findings were evaluated for all patients. Current status and follow-up were noted. After mitial augmentation, eight patients had persistent incontinence, five bladder perforation, three isolated upper tract changes, two incontinence and bladder perforation, and one incontinence plus intractable pain Preoperative urodynamics showed detrusor pressures of 30 to 100 cm HsO. All patients had adequate bladder outlet resistance. The original bowel segments used were sigmotd in 12 cases, stomach in 4, ileum in 2, and cecum in 1. Bowel segments used for reaugmentation were ileum in 16 cases and sigmoid m three. Of the 11 patients with incontinence, 10 are now dry. All cases of upper tract changes resolved. The mean follow-up time since reaugmentation is 52 months. [f the outcome of bladder augmentation is less than optimal. it is important to reevaluate the bladder dynamics. In rare instances, these patients may contmue to have htgh pressure