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Effect of Sodium Meclofenamate on Radiation Induced Esophagitis and Cystitis
RADIOLOGY, NUCLEAR MEDICINE AND SONOGRAPHY
PEDIATRIC UROLOGY Pathophysiological Changes in Rat Kidneys With Partial Ureteral Obstruction Since Infancy
739
urogenital canal, or may be needed to cover a lengthened urethra formed from the mucosa of the ventral portion of the common sinus. These procedures must be deferred until the pubic arch becomes wide enough to permit high retropubic dissection. L. R. K.
B. A. PETTERSSON, A. APERIA AND G. ELINDER, Depart-
ments of Pediatric Surgery and Pediatrics, St. Goran's Children's Hospital, Stockholm, Sweden
Kidney Int., 26: 122-127 (Aug.) 1984 Partial ureteral obstruction was created in 5-day-old rats by implanting the left ureter in the psoas muscle. The surgical technique was modified to produce mild or severe hydronephrosis. The rats were studied when they were 45 to 65 days old with regard to various parameters of renal function. A second set of studies was done to measure glomerular filtration rate after release of obstruction. Reference values were obtained from sham-operated and untouched control rats. As expected, the number of functioning nephrons and the glomerular filtration rate were depressed more significantly in the severely hydronephrotic models. These same rats had elevated stopflow pressures and were hypertensive. The moderately hydronephrotic kidneys showed a compensatory growth of remaining nephrons. On the basis of this model, it appears that partial ureteral obstruction present since infancy will destroy the nephrons in the case of severe hydronephrosis, or elicit an adaptive response that will tend to preserve glomerular filtration rate in the moderately obstructed model. W. J. C. 3 figures, 2 tables, 29 references Hydromet:rocolpos in Neonate Due to Distal Vaginal Atresia
L.
F. M. GUTTMAN, L. S. AHLGREN The Montreal Children's Hospital, Department of Paediatric Surgery, McGill University, Montreal, Quebec, Canada NGUYEN, S. YOUSSEF, AND R. SCHLECHTER,
J. Ped. Surg., 19: 510-514 (Oct.) 1984 The authors report on 2 experiences of neonatal hydrometrocolpos due to distal vaginal atresia. Both cases required laparotomy and abdominoperineal approaches. As a result of their experience, they diagrammed 5 different types of vaginal malformations associated with hydrocolpos. In children with complicated lesions, such as imperforate anus and vaginal atresia, a combined abdominoperineal and abdominosacroperineal approach was used to manage the vagina and rectum, respectively, to avoid difficulties in dissection due to scar tissue. The authors emphasize that each case is unique and requires individual treatment. W. J. C. 7 figures, 13 references Editorial comment. There are many anatomical variants in patients with a common, often narrow, urogenital sinus. If an imperforate anus also is present there also is a fistula between the rectum and the obstructed vagina. The urethra usually is short and empties onto the anterior wall of the urogenital sinus just below the point of entry of the obstructed vagina. The abdominal mass usually is the obstructed vagina, which may become tremendously enlarged. The uterus obviously is displaced greatly but it may not be dilated. The bladder is compressed by the huge vagina. Ectopic ureter, reflux and ureteropelvic junction obstruction also may be present. Complete correction in 1 stage, as advocated, is best when feasible. At times, a labial skin flap must be used to enlarge the
Acute Scrotal Swelling in Children
A.
A. CALDAMONE, J. R. VALVO, V. K. ALTEBARMAKIAN AND R. RABINOWITZ, Division of Urology, University of Rochester Medical Center, Rochester, New York
J. Ped. Surg., 19: 581-584 (Oct.) 1984
The authors evaluated 150 consecutive male patients (age range newborn to 21 years) with acute scrotal symptoms. Of these patients 38 had testicular torsion, 39 hydatid torsion, 35 epididymitis and 38 miscellaneous conditions. When the cremasteric reflex was demonstrated none of the patients had torsion of the testis. However, the absence of this reflex is not the sine qua non of testis torsion. The authors contend that two-thirds of their patients could be placed in an appropriate diagnostic category on the basis of history, physical examination and presence or absence of the cremasteric reflex. On the basis of these 3 parameters patients were placed into 3 groups: 1) nontorsion (conservative management), 2) torsion (surgical exploration) and 3) equivocal (radionuclide imaging). On the basis of their experience, the authors believe that this approach prevents unnecessary surgical exploration while determining selectively those individuals with torsion who will be helped most by surgical intervention. W. J. C. 2 figures, 3 tables, 24 references Phenylketmmria and its Variants: Observations on Intellectual Functioning W. B. HANLEY AND H. L. RUDNER, Departments of Psychology and Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
C. NETLEY,
Canad. Med. Ass. J., 131: 751-755 (Oct. 1) 1984 A long-term evaluation of 119 patients with phenylketonuria and its variants is presented, with particular reference to time of diagnosis and treatment relating to intelligence. The study has established that classic phenylketonuria retardation gen erally can be prevented if dietary therapy is started before the patients are 2 months old. However, these patients usually have an intelligence quotient 10 points lower than their parents. It is possible that this latter condition is seen because therapy was not instituted in the first 2 weeks of life. A dietary regimen that will keep blood phenylalanine levels between 4 and 15 mg./dl. will not be harmful to the developing brain. J. A. A. 5 tables, 23 references
RADIOLOGY, NUCLEAR MEDICINE AND SONOGRAPHY Effect of Sodium Meclofenamate on Radiation Induced Esophagitis and Cystitis J. L. AMBRUS, C. M. AMBRUS, D. B. LILLIE, R. J. JOHNSON, H. GASTPARAND S. KISHEL, Roswell Park Memorial Institute and Departments of Medicine, Pediatrics, Obstetrics-Gynecol-
740
METABOLISM, ENDOCRINOLOGY AND IMMUNOLOGY
ogy and Urology, State University of New York at Buffalo, BuffaLo, New York and University of Munich, Munich, Germany J. Med., 15: 81-92, 1984 Radiation-induced esophagi tis and cystitis are major limiting factors in radiation therapy of these areas. This effect is pronounced particularly in patients in whom radiation treatment is combined with chemotherapy. Prostaglandins were thought to have an important role in inflammatory reactions, and the level of prostaglandins was found to be high in patients undergoing radiation and chemotherapy. Thus, prostaglandin synthesis inhibitors, such as indomethacin, were found to decrease the side effects of radiation and chemotherapy. The authors explored the effects of sodium meclofenamate on radiation-induced esophagitis and cystitis. This agent inhibits prostaglandin and leukotriene synthesis, competes for binding at prostaglandin receptor sites and is of low toxicity. Sodium meclofenamate was effective in reducing or preventing radiation-induced cystitis and esophagitis. N. V. R. 2 figures, 1 table, 26 references
METABOLISM, ENDOCRINOLOGY AND IMMUNOLOGY
with histologically documented Cushing's syndrome. Each group underwent low dose (0.5 mg. every 6 hours for 2 days) dexamethasone suppression tests, during which serum cortisol concentration was measured at 8 a.m. each day. These results were compared to 24-hour urinary free cortisol levels. Serum cortisol concentration decreased to less than 60 nmol. in 31 patients, while urinary free cortisol levels decreased to less than 110 nmol. in 31. Serum cortisol levels remained above 250 nmol. in 13 patients, while the 24-hour urinary free cortisol level stayed above 180 nmol. in the remaining 13. When the paper was written 1 of the 11 patients with possible Cushing's syndrome was undiagnosed, while the remaining 10 had a definite diagnosis established on the basis of clinical, radiological or biochemical grounds other than dexamethasone suppression. In this study, based on the close correlation of the results of the 2 biochemical tests, a maximum false positive rate of 7. 7 per cent (1 of 13 patients) was seen. No false negative results were noted. Since results in serum cortisol and 24-hour urinary free cortisol determinations correlate closely following low dose dexamethasone suppression, the authors suggest that the serum cortisol test be used to replace the 24-hour urine collection in screening for Cushing's syndrome. The problems inherent in performing this test on an outpatient basis are discussed. R. C.N. 2 figures, 1 table, 15 references
Pharmacologic Toxicity of Cimetidine on Hepatic and Renal Drug Metabolism
K. B. SOLANGI, J. D. LUTTON, J. A. SVOGUN, N. G. IBRAHAM, A. I. GOODMAN AND R. D. LEVERE, Departments of Medicine and Pharmacology, New York Medical College, Valhalla, New York Res. Comm. Chem. Path. Pharm., 45: 19-35 (July) 1984 The authors determined the effects of cimetidine on several liver enzymes, since this drug is known to be associated with some hepatic and renal dysfunction. Aminolevulinic acid and heme oxygenase activity were studied, as well as the effect of cimetidine on a cytochrome P-450 dependent metabolizing enzyme, such as aniline hydroxylase and aminopyrine-N-demethylase, and the metabolism of allylisopropylacetamide (AIA) and phenobarbital. Most of these enzymes were selected because abnormalities in these enzyme systems had been reported previously. Cimetidine did not alter significantly the action of the porphyric agents phenobarbital or AIA on the cytochrome P-450 system. However, when combined with phenobarbital plus cimetidine there was impairment of the AIA synthase. Cimetidine also decreased the drug metabolizing enzymes aniline hydrox ylase and aminopyrine-N-demethylase. C. L. P. 4 tables, 27 references Serum Cortisol Concentrations During Low Dose Dexamethasone Suppression Test to Screen for Cushing's Syndrome L. KENNEDY, A. B. ATKINSON, H. JOHNSTON, B. SHERIDAN AND D.R. HADDEN, Sir George E Clark Metabolic Unit, Royal Victoria Hospital, Belfast, Ireland Brit. Med. J., 289: 1188-1191 (Nov. 3) 1984 The authors divided 44 patients into 3 groups: 1) 23 obese controls not suspected of having Cushing's syndrome, 2) 11 subjects with possible Cushing's syndrome and 3) 10 patients
Treatment of Cushing's Disease With Low Dose Radiation Therapy S. R. AHMED, S. M. SHALET, C. G. BEARDWELL AND M. L. SUTTON, Department of Endocrinology, Christie Hospital and Holt Radium Institute, Manchester, England Brit. Med. J., 289: 643-646 (Sept. 15) 1984 In conventional irradiation of the pituitary for Cushing's disease 4,000 to 5,000 rad are given with a reported response rate of 29 to 50 per cent. Of 19 patients treated by the authors with 2,000 rad 8 had a significant response measured by a decrease in the urinary free cortisol level to below 105 µ,g. per 24 hours or a decrease in the urinary 11-hydroxycorticosteroid excretion to less than 378 µ,g. per 24 hours. This finding represents a 42 per cent response rate accomplished by use of a smaller dose of irradiation than usual. This dosage was given from a 8 MV. linear accelerator with a 3-field technique during a 10-day period. No complications, such as hypothyroidism or hypogonadotropism, were noted. No other type of irradiation complications were noted. Low dose pituitary irradiation is suggested as initial therapy for Cushing's disease, particularly in areas in which neurosurgical skills for microadenomectomy are not available. J. A. A. 2 figures, 2 tables, 28 references Interpreting the Fractional Excretion of Sodium
R. W. STEINER, Department of Medicine, University of California at San Diego School of Medicine and The Rees Stealy Medical Group, San Diego, California Amer. J. Med., 77: 699-702 (Oct.) 1984 The fractional excretion of sodium is the quotient of the plasma-to-urine creatinine ratio divided by the plasma-to-urine sodium ratio. In most euvolemic subjects with normal renal function and a moderate salt intake the fractional excretion of
PEDIATRIC UROLOGY Pathophysiological Changes in Rat Kidneys With Partial Ureteral Obstruction Since Infancy
739
urogenital canal, or may be needed to cover a lengthened urethra formed from the mucosa of the ventral portion of the common sinus. These procedures must be deferred until the pubic arch becomes wide enough to permit high retropubic dissection. L. R. K.
B. A. PETTERSSON, A. APERIA AND G. ELINDER, Depart-
ments of Pediatric Surgery and Pediatrics, St. Goran's Children's Hospital, Stockholm, Sweden
Kidney Int., 26: 122-127 (Aug.) 1984 Partial ureteral obstruction was created in 5-day-old rats by implanting the left ureter in the psoas muscle. The surgical technique was modified to produce mild or severe hydronephrosis. The rats were studied when they were 45 to 65 days old with regard to various parameters of renal function. A second set of studies was done to measure glomerular filtration rate after release of obstruction. Reference values were obtained from sham-operated and untouched control rats. As expected, the number of functioning nephrons and the glomerular filtration rate were depressed more significantly in the severely hydronephrotic models. These same rats had elevated stopflow pressures and were hypertensive. The moderately hydronephrotic kidneys showed a compensatory growth of remaining nephrons. On the basis of this model, it appears that partial ureteral obstruction present since infancy will destroy the nephrons in the case of severe hydronephrosis, or elicit an adaptive response that will tend to preserve glomerular filtration rate in the moderately obstructed model. W. J. C. 3 figures, 2 tables, 29 references Hydromet:rocolpos in Neonate Due to Distal Vaginal Atresia
L.
F. M. GUTTMAN, L. S. AHLGREN The Montreal Children's Hospital, Department of Paediatric Surgery, McGill University, Montreal, Quebec, Canada NGUYEN, S. YOUSSEF, AND R. SCHLECHTER,
J. Ped. Surg., 19: 510-514 (Oct.) 1984 The authors report on 2 experiences of neonatal hydrometrocolpos due to distal vaginal atresia. Both cases required laparotomy and abdominoperineal approaches. As a result of their experience, they diagrammed 5 different types of vaginal malformations associated with hydrocolpos. In children with complicated lesions, such as imperforate anus and vaginal atresia, a combined abdominoperineal and abdominosacroperineal approach was used to manage the vagina and rectum, respectively, to avoid difficulties in dissection due to scar tissue. The authors emphasize that each case is unique and requires individual treatment. W. J. C. 7 figures, 13 references Editorial comment. There are many anatomical variants in patients with a common, often narrow, urogenital sinus. If an imperforate anus also is present there also is a fistula between the rectum and the obstructed vagina. The urethra usually is short and empties onto the anterior wall of the urogenital sinus just below the point of entry of the obstructed vagina. The abdominal mass usually is the obstructed vagina, which may become tremendously enlarged. The uterus obviously is displaced greatly but it may not be dilated. The bladder is compressed by the huge vagina. Ectopic ureter, reflux and ureteropelvic junction obstruction also may be present. Complete correction in 1 stage, as advocated, is best when feasible. At times, a labial skin flap must be used to enlarge the
Acute Scrotal Swelling in Children
A.
A. CALDAMONE, J. R. VALVO, V. K. ALTEBARMAKIAN AND R. RABINOWITZ, Division of Urology, University of Rochester Medical Center, Rochester, New York
J. Ped. Surg., 19: 581-584 (Oct.) 1984
The authors evaluated 150 consecutive male patients (age range newborn to 21 years) with acute scrotal symptoms. Of these patients 38 had testicular torsion, 39 hydatid torsion, 35 epididymitis and 38 miscellaneous conditions. When the cremasteric reflex was demonstrated none of the patients had torsion of the testis. However, the absence of this reflex is not the sine qua non of testis torsion. The authors contend that two-thirds of their patients could be placed in an appropriate diagnostic category on the basis of history, physical examination and presence or absence of the cremasteric reflex. On the basis of these 3 parameters patients were placed into 3 groups: 1) nontorsion (conservative management), 2) torsion (surgical exploration) and 3) equivocal (radionuclide imaging). On the basis of their experience, the authors believe that this approach prevents unnecessary surgical exploration while determining selectively those individuals with torsion who will be helped most by surgical intervention. W. J. C. 2 figures, 3 tables, 24 references Phenylketmmria and its Variants: Observations on Intellectual Functioning W. B. HANLEY AND H. L. RUDNER, Departments of Psychology and Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
C. NETLEY,
Canad. Med. Ass. J., 131: 751-755 (Oct. 1) 1984 A long-term evaluation of 119 patients with phenylketonuria and its variants is presented, with particular reference to time of diagnosis and treatment relating to intelligence. The study has established that classic phenylketonuria retardation gen erally can be prevented if dietary therapy is started before the patients are 2 months old. However, these patients usually have an intelligence quotient 10 points lower than their parents. It is possible that this latter condition is seen because therapy was not instituted in the first 2 weeks of life. A dietary regimen that will keep blood phenylalanine levels between 4 and 15 mg./dl. will not be harmful to the developing brain. J. A. A. 5 tables, 23 references
RADIOLOGY, NUCLEAR MEDICINE AND SONOGRAPHY Effect of Sodium Meclofenamate on Radiation Induced Esophagitis and Cystitis J. L. AMBRUS, C. M. AMBRUS, D. B. LILLIE, R. J. JOHNSON, H. GASTPARAND S. KISHEL, Roswell Park Memorial Institute and Departments of Medicine, Pediatrics, Obstetrics-Gynecol-
740
METABOLISM, ENDOCRINOLOGY AND IMMUNOLOGY
ogy and Urology, State University of New York at Buffalo, BuffaLo, New York and University of Munich, Munich, Germany J. Med., 15: 81-92, 1984 Radiation-induced esophagi tis and cystitis are major limiting factors in radiation therapy of these areas. This effect is pronounced particularly in patients in whom radiation treatment is combined with chemotherapy. Prostaglandins were thought to have an important role in inflammatory reactions, and the level of prostaglandins was found to be high in patients undergoing radiation and chemotherapy. Thus, prostaglandin synthesis inhibitors, such as indomethacin, were found to decrease the side effects of radiation and chemotherapy. The authors explored the effects of sodium meclofenamate on radiation-induced esophagitis and cystitis. This agent inhibits prostaglandin and leukotriene synthesis, competes for binding at prostaglandin receptor sites and is of low toxicity. Sodium meclofenamate was effective in reducing or preventing radiation-induced cystitis and esophagitis. N. V. R. 2 figures, 1 table, 26 references
METABOLISM, ENDOCRINOLOGY AND IMMUNOLOGY
with histologically documented Cushing's syndrome. Each group underwent low dose (0.5 mg. every 6 hours for 2 days) dexamethasone suppression tests, during which serum cortisol concentration was measured at 8 a.m. each day. These results were compared to 24-hour urinary free cortisol levels. Serum cortisol concentration decreased to less than 60 nmol. in 31 patients, while urinary free cortisol levels decreased to less than 110 nmol. in 31. Serum cortisol levels remained above 250 nmol. in 13 patients, while the 24-hour urinary free cortisol level stayed above 180 nmol. in the remaining 13. When the paper was written 1 of the 11 patients with possible Cushing's syndrome was undiagnosed, while the remaining 10 had a definite diagnosis established on the basis of clinical, radiological or biochemical grounds other than dexamethasone suppression. In this study, based on the close correlation of the results of the 2 biochemical tests, a maximum false positive rate of 7. 7 per cent (1 of 13 patients) was seen. No false negative results were noted. Since results in serum cortisol and 24-hour urinary free cortisol determinations correlate closely following low dose dexamethasone suppression, the authors suggest that the serum cortisol test be used to replace the 24-hour urine collection in screening for Cushing's syndrome. The problems inherent in performing this test on an outpatient basis are discussed. R. C.N. 2 figures, 1 table, 15 references
Pharmacologic Toxicity of Cimetidine on Hepatic and Renal Drug Metabolism
K. B. SOLANGI, J. D. LUTTON, J. A. SVOGUN, N. G. IBRAHAM, A. I. GOODMAN AND R. D. LEVERE, Departments of Medicine and Pharmacology, New York Medical College, Valhalla, New York Res. Comm. Chem. Path. Pharm., 45: 19-35 (July) 1984 The authors determined the effects of cimetidine on several liver enzymes, since this drug is known to be associated with some hepatic and renal dysfunction. Aminolevulinic acid and heme oxygenase activity were studied, as well as the effect of cimetidine on a cytochrome P-450 dependent metabolizing enzyme, such as aniline hydroxylase and aminopyrine-N-demethylase, and the metabolism of allylisopropylacetamide (AIA) and phenobarbital. Most of these enzymes were selected because abnormalities in these enzyme systems had been reported previously. Cimetidine did not alter significantly the action of the porphyric agents phenobarbital or AIA on the cytochrome P-450 system. However, when combined with phenobarbital plus cimetidine there was impairment of the AIA synthase. Cimetidine also decreased the drug metabolizing enzymes aniline hydrox ylase and aminopyrine-N-demethylase. C. L. P. 4 tables, 27 references Serum Cortisol Concentrations During Low Dose Dexamethasone Suppression Test to Screen for Cushing's Syndrome L. KENNEDY, A. B. ATKINSON, H. JOHNSTON, B. SHERIDAN AND D.R. HADDEN, Sir George E Clark Metabolic Unit, Royal Victoria Hospital, Belfast, Ireland Brit. Med. J., 289: 1188-1191 (Nov. 3) 1984 The authors divided 44 patients into 3 groups: 1) 23 obese controls not suspected of having Cushing's syndrome, 2) 11 subjects with possible Cushing's syndrome and 3) 10 patients
Treatment of Cushing's Disease With Low Dose Radiation Therapy S. R. AHMED, S. M. SHALET, C. G. BEARDWELL AND M. L. SUTTON, Department of Endocrinology, Christie Hospital and Holt Radium Institute, Manchester, England Brit. Med. J., 289: 643-646 (Sept. 15) 1984 In conventional irradiation of the pituitary for Cushing's disease 4,000 to 5,000 rad are given with a reported response rate of 29 to 50 per cent. Of 19 patients treated by the authors with 2,000 rad 8 had a significant response measured by a decrease in the urinary free cortisol level to below 105 µ,g. per 24 hours or a decrease in the urinary 11-hydroxycorticosteroid excretion to less than 378 µ,g. per 24 hours. This finding represents a 42 per cent response rate accomplished by use of a smaller dose of irradiation than usual. This dosage was given from a 8 MV. linear accelerator with a 3-field technique during a 10-day period. No complications, such as hypothyroidism or hypogonadotropism, were noted. No other type of irradiation complications were noted. Low dose pituitary irradiation is suggested as initial therapy for Cushing's disease, particularly in areas in which neurosurgical skills for microadenomectomy are not available. J. A. A. 2 figures, 2 tables, 28 references Interpreting the Fractional Excretion of Sodium
R. W. STEINER, Department of Medicine, University of California at San Diego School of Medicine and The Rees Stealy Medical Group, San Diego, California Amer. J. Med., 77: 699-702 (Oct.) 1984 The fractional excretion of sodium is the quotient of the plasma-to-urine creatinine ratio divided by the plasma-to-urine sodium ratio. In most euvolemic subjects with normal renal function and a moderate salt intake the fractional excretion of