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Absorption of Glucose From Urinary Conduits in Diabetics and Non-Diabetics
1026
PEDIATRIC UROLOGY
lymphocytotoxins and evidence indicated that these toxins were circulating as immune complexes. Ten of the 11 patients positive for HLA-DR3 or DR7 produced IgM lymphocytotoxins. The authors conclude that although all transplant recipients are subject to an increased risk of cytomegalovirus infections the formation of immune complexes with subsequent renal damage in response to cytomegalovirus infection may be linked to HLA-DR genes. D. K. M. 2 tables, 25 references
DIVERSION Absorption of Glucose From Urinary Conduits in Diabetics and Non-Diabetics
K. N. SRIDHAR, C. T. SAMUELL AND C. R. J. WOODHOUSE, Academic Unit and Department of Biochemistry, Institute of Urology and St. Peter's Hospitals, London, England Brit. Med. J., 287: 1327-1329 (Nov. 5) 1983 Of 10 patients with urinary conduits studied 7 were nondiabetic and 3 were diabetic. A solution containing 1 per cent glucose and the inert marker phenol red was instilled into each conduit. Traction on a balloon catheter occluded the stoma. Samples of the solution in the conduit were withdrawn at periodic intervals. The urinary conduits in the patients without diabetes did not absorb glucose. However, glucose was absorbed from the conduit of 1 of the 3 diabetic patients. The authors conclude that urinary conduits in patients with diabetes may absorb urinary glucose and, for this reason, blood rather than urinary glucose determinations should be used for the management of the diabetes. D. K. M. 2 figures, 13 references
PEDIATRIC UROLOGY Desmopressin Response of Enuretic Children: Effects of Age and Frequency of Enuresis
E.
M. POST, R. A. RICHMAN, P.R. BLACKETT, K. P. DUNCAN AND K. MILLER, Departments of Pediatrics, Upstate Medical
Center, Syracuse, New York; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; University of Illinois Medical Center, Chicago, Illinois, and Lutheran General Hospital, Park Ridge, Illinois Amer. J. Dis. Child., 137: 962-963 (Oct.) 1983 Desmopressin acetate is a vasopressin analogue that can be administered intranasally. The drug has been advocated for the treatment of enuresis but the authors indicate that previous reports on its efficacy have been based on poorly controlled studies. Working from 3 different medical centers, the authors performed a double-blind crossover study on the efficacy of intranasal desmopressin in 52 children between 6 and lo years old. The frequency of enuretic episodes was ~10 nights per 2-week interval and children with renal disease were excluded. Normal saline was used for a control. Desmopressin was administered in doses of 20 or 40 µg. per night for 2-week intervals. During treatment 6 children (12 per cent) had 13 or 14 dry nights and 15 (29 per cent) had 8 to 12 dry nights. Among 17
children ~9 years old with 4 to 7 dry nights in the control period 12 (71 per cent) responded to desmopressin (8 to 14 dry nights). No children between 6 and 9 years old with <3 dry control nights responded to the drug. Only 4 of the 21 drug responders reported a lasting effect. The authors conclude that desmopressin may be effective in reducing the frequency of enuresis, especially in children >9 years old with less than nightly enuresis. J. H. N. 2 tables, 4 references
Editorial comment. The authors found that desmopressin reduced the incidence of enuresis in 71 per cent of children >9 years old. Cure was not long lasting, since the frequency of enuresis increased shortly after discontinuing the drug in the majority of children. Merely reducing the urine volume produced mechanically does not appear successful as a long-term approach to the management of enuresis. M. M. Megacystis-Microcolon-Hypoperistalsis Syndrome and Anechoic Areas in the Fetal Abdomen
L. H. NELSON AND R. H. REIFF, Department of Obstetrics and Gynecology, Bowman Gray School of Medicine, WinstonSalem, North Carolina Amer. J. Obst. Gynec., 144: 464-467 (Oct. 15) 1982 Diagnosis of congenital anomalies by ultrasound requires considerable skill and advanced equipment. A case of megacystis-microcolon-intestinal hypoperistalsis syndrome is presented and criteria are suggested for use in categorization of various ultrasound findings to isolate the defect to a major organ system. Identifying the involved system should aid in the differential diagnosis. The syndrome of megacystis-microcolon-intestinal hypoperistalsis comprises a rare constellation of findings, the most common of which is a refractory functional intestinal obstruction associated with an enlarged unobstructed bladder. As first described, the syndrome appeared to be limited to female infants but recently has been reported in a male infant. Earlier reports may have represented male involvement with the unrecognized syndrome. A case report of the syndrome in a female infant is presented. Criteria for classifying ultrasound findings according to the appearance of anechoic areas inside and outside the fetal body are developed. Authors' abstract. 2 figures, 1 table, 16 references Fetal Surgery J. F. PEARSON, Department of Obstetrics and Gynaecology, Welsh National School of Medicine, Heath Park, Cardiff, Wales Arch. Dis. Child., 58: 324-325 (May) 1983 The author reviews the state of the art in fetal surgery for bladder outlet obstruction, congenital hydrocephalus and congenital diaphragmatic hernia. With reference to bladder outlet obstruction the ~uthor reiterates the objection ofEidelman that since renal dysplasia occurring before 20 weeks of gestation is irreversible and oligohydramnios occurring before 24 to 26 weeks and lasting 4 to 6 weeks causes severe pulmonary hypoplasia, then fetal surgery is not needed if oligohydramnios is not seen (Obst. Anesth. Digest, 2: 79, 1982). Pearson notes that waiting for oligohydramnios is tantamount to waiting for renal failure to be established firmly and that early decompression could be preventive.
PEDIATRIC UROLOGY
lymphocytotoxins and evidence indicated that these toxins were circulating as immune complexes. Ten of the 11 patients positive for HLA-DR3 or DR7 produced IgM lymphocytotoxins. The authors conclude that although all transplant recipients are subject to an increased risk of cytomegalovirus infections the formation of immune complexes with subsequent renal damage in response to cytomegalovirus infection may be linked to HLA-DR genes. D. K. M. 2 tables, 25 references
DIVERSION Absorption of Glucose From Urinary Conduits in Diabetics and Non-Diabetics
K. N. SRIDHAR, C. T. SAMUELL AND C. R. J. WOODHOUSE, Academic Unit and Department of Biochemistry, Institute of Urology and St. Peter's Hospitals, London, England Brit. Med. J., 287: 1327-1329 (Nov. 5) 1983 Of 10 patients with urinary conduits studied 7 were nondiabetic and 3 were diabetic. A solution containing 1 per cent glucose and the inert marker phenol red was instilled into each conduit. Traction on a balloon catheter occluded the stoma. Samples of the solution in the conduit were withdrawn at periodic intervals. The urinary conduits in the patients without diabetes did not absorb glucose. However, glucose was absorbed from the conduit of 1 of the 3 diabetic patients. The authors conclude that urinary conduits in patients with diabetes may absorb urinary glucose and, for this reason, blood rather than urinary glucose determinations should be used for the management of the diabetes. D. K. M. 2 figures, 13 references
PEDIATRIC UROLOGY Desmopressin Response of Enuretic Children: Effects of Age and Frequency of Enuresis
E.
M. POST, R. A. RICHMAN, P.R. BLACKETT, K. P. DUNCAN AND K. MILLER, Departments of Pediatrics, Upstate Medical
Center, Syracuse, New York; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; University of Illinois Medical Center, Chicago, Illinois, and Lutheran General Hospital, Park Ridge, Illinois Amer. J. Dis. Child., 137: 962-963 (Oct.) 1983 Desmopressin acetate is a vasopressin analogue that can be administered intranasally. The drug has been advocated for the treatment of enuresis but the authors indicate that previous reports on its efficacy have been based on poorly controlled studies. Working from 3 different medical centers, the authors performed a double-blind crossover study on the efficacy of intranasal desmopressin in 52 children between 6 and lo years old. The frequency of enuretic episodes was ~10 nights per 2-week interval and children with renal disease were excluded. Normal saline was used for a control. Desmopressin was administered in doses of 20 or 40 µg. per night for 2-week intervals. During treatment 6 children (12 per cent) had 13 or 14 dry nights and 15 (29 per cent) had 8 to 12 dry nights. Among 17
children ~9 years old with 4 to 7 dry nights in the control period 12 (71 per cent) responded to desmopressin (8 to 14 dry nights). No children between 6 and 9 years old with <3 dry control nights responded to the drug. Only 4 of the 21 drug responders reported a lasting effect. The authors conclude that desmopressin may be effective in reducing the frequency of enuresis, especially in children >9 years old with less than nightly enuresis. J. H. N. 2 tables, 4 references
Editorial comment. The authors found that desmopressin reduced the incidence of enuresis in 71 per cent of children >9 years old. Cure was not long lasting, since the frequency of enuresis increased shortly after discontinuing the drug in the majority of children. Merely reducing the urine volume produced mechanically does not appear successful as a long-term approach to the management of enuresis. M. M. Megacystis-Microcolon-Hypoperistalsis Syndrome and Anechoic Areas in the Fetal Abdomen
L. H. NELSON AND R. H. REIFF, Department of Obstetrics and Gynecology, Bowman Gray School of Medicine, WinstonSalem, North Carolina Amer. J. Obst. Gynec., 144: 464-467 (Oct. 15) 1982 Diagnosis of congenital anomalies by ultrasound requires considerable skill and advanced equipment. A case of megacystis-microcolon-intestinal hypoperistalsis syndrome is presented and criteria are suggested for use in categorization of various ultrasound findings to isolate the defect to a major organ system. Identifying the involved system should aid in the differential diagnosis. The syndrome of megacystis-microcolon-intestinal hypoperistalsis comprises a rare constellation of findings, the most common of which is a refractory functional intestinal obstruction associated with an enlarged unobstructed bladder. As first described, the syndrome appeared to be limited to female infants but recently has been reported in a male infant. Earlier reports may have represented male involvement with the unrecognized syndrome. A case report of the syndrome in a female infant is presented. Criteria for classifying ultrasound findings according to the appearance of anechoic areas inside and outside the fetal body are developed. Authors' abstract. 2 figures, 1 table, 16 references Fetal Surgery J. F. PEARSON, Department of Obstetrics and Gynaecology, Welsh National School of Medicine, Heath Park, Cardiff, Wales Arch. Dis. Child., 58: 324-325 (May) 1983 The author reviews the state of the art in fetal surgery for bladder outlet obstruction, congenital hydrocephalus and congenital diaphragmatic hernia. With reference to bladder outlet obstruction the ~uthor reiterates the objection ofEidelman that since renal dysplasia occurring before 20 weeks of gestation is irreversible and oligohydramnios occurring before 24 to 26 weeks and lasting 4 to 6 weeks causes severe pulmonary hypoplasia, then fetal surgery is not needed if oligohydramnios is not seen (Obst. Anesth. Digest, 2: 79, 1982). Pearson notes that waiting for oligohydramnios is tantamount to waiting for renal failure to be established firmly and that early decompression could be preventive.