Contrast-induced central nervous system toxicity after radiographic evaluation of the lower urinary tract in myelodysplastic patients with ventriculoperitoneal shunts

INTERNATIONAL

751

ABSTRACTS

Managing Apparent Ureteropelvic Junction Obstruction in the Newborn. P.C. Curtwright. J. W. Duckerr, M.A. Keating et cd. 5 Ural

14X:122-1-122X. (October).

(VUR) dred

1992.

in infants and small children.

those achieved by convefltional sixty-one

A total of 97 newborns

with apparent

was evaluated

management

are described.

Of these patients

kidney showing good initial differential ylenerriaminepentaacetic

( < 35%)were

function tventualiy

required

ureteropelvic

junction

from mid 1984 to 1989. Evaluation

and

39 with an affected

function (> 35%) by dieth-

acid scan and two showing diminished followed nonoperatively.

pyeloplasty

Six patients (15%)

for diminishing

function

ofcolic (I).

nary tract infections (I), or symptoms

(4).

uri-

The four patient5

with diminishing function improved after pyeloplasty to at least the initial

level.

(greater

A

total

than 35?i)

of

I2

patients

with

good

initial

of the affected kidney underwent

plasty (within 6 weeks of diagnosis). They were compared similar group of patients managed nonoperatively sequential

renal scans. Eventual

functicm in the nonoperative and +A.

I “;.

group)

ditference

uretrropelvic

junction

nonopcrativc

approach

changes in percentage

differential

wrrr

morphology kidneys

the kidney

and good function,

with sequential

renal scan follow-up

retlux had been identified primary

vesicoureteral

(SO

reflux (I5

isotope

vesi-

and (3) infected primary

In 20 pattern

I kidneys (83%)

were

normal.

In

renal

loss: that is. small kidneys rather

was a potent

of fetal vesicoure-

cause of renal damage

with total OI- near total loss of function

in seven of nine refuxing

unit\ ;tssoci;lted with posterior

valves and in two kidneck

urethral

with sscondary ureteropelvic

junction obstruction.

focal scarring were confined

in pattern

This overall incidence

was lower than expected.

Appearances

of detectable

Even when

The

of

3 and were found in four infection

renal damage

occurs. prenatal

diagmjsis may lessen the risk of scarring by enabling

treatment

to

lindings suggest that uncomplicated

retlux is a relatively benign insult to the fetal

kidney and that reilux nephropathy

found in children

clinically is the result of infected vesicoureteral life. Any comparison

of published

there is a more standardized patient selection.-(;corl,

presenting

retlux in postnatal

studies will prove difficult until

approach

to imaging technique

and

H: Holcor~~h. Jr

Cyclic Direct Radionuclide Voiding Cystography: Increasing Reliability in Detecting Vesicoureteral Reflux in Children. J.J. ~FI/I(./I crnrl R.R. Kvml~r. Pediatr Radio1 32:337-338. (September-). IYY,. The authors attempt clidc ioidingcystogr;lphy

evaluation

of children

with myelomeningo-

tion. The authors report on two patients with ventriculoperitoneal rupture

contra>t media via or around

of the bladder.

Reflux of

the ventriculoperitonral

shunt into

insult

neurological

contrast-induced

recovery-Gc,orxc

in severe

\sentrlculitis

H’ !I&

;~nd

omh, ./r

NEOPLASMS Outcomes in Low-Risk Babies Treated With Half-Dose Chemotherapy According to the Third National Wilms’ Tumor Study. B. W. Corn. J. W. Golduviu. 1. ELY~~I.\. cr rrl. J Clin Oncol IO: IiOS1309. (August).

in detecting

varied

1992.

In the National and favorable

Wilms’

Tumor

less than

I year

Study-3.

the chemotherapeutic

with stages I, II, and III disease

histology were halved by protocol. This report of the

study group indicates

that compared

to their older counterparts

with the same stage of disease, the infants with reduced chemotherapy regimen did comparably

well. Four-year

babies were 91% (I). 9Sqf. (II). chemotherapy

provided

survival rates for 256

and 00% (111). The less aggressive

acceptable

morbiditv

levl-lx without com-

P. Hir.dr

promising survival.-Miclmel

Infants With Neuroblastoma and Regional Lymph Node Metastases Have a Favorable Outlook After Limited Postoperative Chemotherapy: A Pediatric Oncology Group Study. R.P. Custlzheyv. J.J. Shmtrr, G. .A/trhukr, (‘I 01. J (‘Iin Oncol t I):1?YY1304. (August). This

ureteral

reftux

lYY2.

Pediatric

Oncology

Group

(POG)

months of age with clinical neuroblastoma that stage B and stage C patients su~ival\ surGval detinitive

with

limited

the

PO<;

surgical staging may he unnecessary surgical complications when “aggressive.”

POG

< 17

\tagc (‘ showed

chemotherapy.

subsets wah Y3?

recommendations,

study of intents

5 12 months ot age had similar

postoperative

fol- hoth infant

The

Although

suggest\

that

in these patients.

3-year

making

no

aggressive Indeed

the

in the patients were almost excluGvely seen

ie. > 50”; resections were attempted.

Further

studies will be aimed at later reducing chemotherapy

dosing and

toxicity.

of surgical

and establishing

better

guidelines

for extent

staging necess;l~.-?2~ic,~l[~~,~ P. ffirrlf

Hepatoblastoma in a 2-Year-Old Girl With Trisomy 18. K. rcrtIuktr. S. /Imlo[o. K. .4tonurnrr. c’t rrl. Ellr J Pcdiatr Surg 7:19X300, (October). A very rare

to define the role of cyclic direct radionu(RVC)

including

the four

function this took

than focal scarring. In pattern 2 the combination

primary ve>icoureteral

urological

doses in children

as a result

secondary (obstructed)

showed evidence of impaired

promptly.

Routine

cele helps to identify those at risk for upper urinary tract deteriora-

and

patterns of isotope uptake

I1 kidneys):

and ditferential

Prrr;

W. Holrotnh, Jr

scanning. Three

teral refluv and obstruction

he instituted

instead ofconven-

in infants and children.--Prc,m

Contrast-Induced Central Nervous System Toxicity After Radiographic Evaluation of the Lower Urinary Tract in Myelodysplastic Patients With Ventriculoperitoneal Shunts. B. Dulklr~. 1. Frmco. E F. Rrtia. rtul. J Urol 14X:120-121. (July). tYY2.

and has resulted in

at a mean age of 34 days in 32 children

the term of global parenchymal

kidnevs (27’;).

as a standard procedure

protracted

IS kidneys).

( 17’; ) that

cyclic RVC

to diagnose VUR

an initial

retlux (9 patients,

retluu (X infants.

recommend tional RVC

the cerebral ventricles occurred in both patients. rc\ulting

74 kidneys): (2) noninfected

coureteral

tional (first cycle only) RVC’. Based on these results the authors

neurological

subserved: (1) noninfected

children.

were found

apparent

obstruction

ultrasound

where 231 VURS

with

kidney!,) whose vesicoureteral of prenatal

(cyclic RVC).

is

and in

(P < .(I1 ). Cyclic RVC detected 43 ‘; more VURs than the conven-

No statistically

In

imaging with “““‘technetium-dimercaptosuccinic

acid was performed

both cycles combined

was found.

loas of function.-George

isotope

in the first cycle. which

and +O.YCi (surgery group).

Use of 99mTechnetium-Dimercaptosuccinic Acid To Study Patterns of Renal Damage Associated With Prenatally Detected Vesicoureteral Reflux. D.C.G. Cruhee, D.F.M. Thomus, AC. Goraloha.1’1trl. J lirol 14X: 1729-1731. (October). 1992. Static

detected

hhunts who had intraperitoneal

factor were +0.X(;

pyeloplasty as needed appears to be reasonable no permanent

with the

and followed by

and early surgery groups were +1.8q

Irespectively. Changes in extraction

(nonoperative significant

function

early pyelo-

were

to

One hun-

less (P < G!) than in the second cycle (185)

significantly obstruction

VURs

The results are compared

(one cycle only) RVC.

hepatohlatoma right

hepatic

lYY7. cabe of mosaic is described. lohectomy

type trisomy

18 assoclnted

The patient underwent

at 2 years of age. The

with

an extended specimen

was