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PEDIATRIC UROLOGY
to read this thorough and thoughtful review carefully.
W. J.
C.
4 tables, 49 references
Can the Human Neonate Mount an Endocrine and Metabolic Response to Surgery?
K. J.
S. ANAND, M. J. BROWN, R. C. CAUSON, N. D. CHRISTOFIDES, S. R. BLOOM AND A. AYNSLEY-GREEN,
Department of Paediatrics, John Radcliffe Hospital, Oxford, Royal Postgraduate Medical School, Hammersmith Hospital, London, and Department of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne, England
J. Ped. Surg., 20: 41-48 (Feb.) 1985 Twenty-six term and 7 pre-term neonates undergoing an operation during the neonatal period were studied relative to the ability to mount an endocrine and metabolic response to the stress of the operation. Factors studied included blood glui:ose, lactate, pyruvate, alanine, hydroxybutyrate, acetoacetate and glycerol levels, as well as plasma insulin, glucagon, adrenalin and noradrenalin levels. Blood samples were drawn immediately before and after the operation, and at 6, 12 and 24 hours postoperatively. The surgical stress was estimated by a complex scoring system that classified patients into minor, moderate and severe groups. All of the patients exhibited a stress response manifested particularly by elevations of adrenalin, noradrenalin and glucose levels but most of these values returned to normal within 24 hours. Pre-term neonates reacted similarly to term neonates except that blood lactate levels were higher in the former. Neonates receiving thiopentone anesthesia exhibited a greater glycemic response than those anesthetized with halothane. Hyperglycemia appeared to be initiated by adrenalin in all neonates but was maintained subsequently by glucagon until approximately 12 to 24 hours postoperatively, when insulin levels increased sufficiently to correct the condition. Hyperglycemia is a particularly worrisome finding in the neonate because the resulting hyperosmolar state can lead to intraventricular hemorrhage. T. D. A. 6 figures, 1 table, 36 references Editorial comment. This study provides additional data suggesting that the otherwise healthy term neonate is a good candidate for an elective operation. The safety of modern pediatric anesthesia with intraoperative monitoring has been proved. Studies such as this are providing an additional rationale for the definitive treatment of urethral valves, ureteral obstruction, ureteropelvic junction obstruction and other serious conditions manifest in the neonatal period that seem technically amenable to early surgical correction. One result of an earlier definitive operation is that cost of treatment is minimized, since increased complication rates have not been observed and fewer reconstructive surgical procedures are needed later. L. R. K.
Hypertension in Children: Increased Efficacy of Technetium Tc 99m Succimer in Screening for Renal Dis~ase
J. INGELFINGER, Department of Radiology/Nuclear Medicine, Children's Hospital, and Department of Medicine, Harvard Medical School, Boston, Massachusetts
P. R. ROSEN, S. TREVES AND
Amer. J. Dis. Child., 139: 173-177 (Feb.) 1985
The efficacy of renal scintigraphy in screening for renal disease and abnormalities was evaluated in 80 hypertensive children and adolt,;scents between January 1 and June 30, 1980. The scintigrams were performed with 99roiechnetium-dimercaptosuccinic acid (99mTc-DMSA) and 99 mTc-diethylenetriaminepentaacetic acid (99mTc-DTPA). Of the patients 22 also underwent excretory urography (IVP), 17 renal ultrasonography and 9 renal angiography. Renal abnormalities were identified in 13 of the 80 patients. IVP and 99 mTc-DTPA scanning were successful in detecting 54 per cent of the abnormalities, while 99 mTc-DMSA scanning identified 92 per cent. The accuracy of the 99 mTc-DMSA scan warrants its inclusion in the initial evaluation of children with hypertension. G. W. K. 3 figures, 4 tables, 21 references
A Simple Estimate of Glomerular Filtration Rate in Adolescent Boys G.
J. SCHWARTZ AND B. GAUTHIER, Departments of Pediatrics, Divisions of Nephrology, Albert Einstein College of Medicine, Bronx, and State University of New York at Stony Brook, Schneider Children's Hospital of the Long Island Jewish-Hillside Medical Center, New Hyde Park, New York
J. Ped., 106: 522-526 (Mar.) 1985 In the past the authors had derived a formula that permitted the estimation of creatinine clearance in patients 1 to 20 years old based on plasma creatinine concentration in mg.jdl. and body length in cm.: creatinine clearance (ml. per minute per 1.73 m. 2 ) = k times length/plasma creatinine, where k is a constant of proportionality and equals 0.55 mg. creatinine. The value of k depends on the relationship between muscle mass and growth as estimated from body weight. Indeed, in full-term infants k was found to be 0.45, partly because the contribution of the muscle mass to body weight is lower than in older children. The authors subsequently evaluated 356 boys and found that an alteration of the formula improved the results by providing an age correction for the glomerular filtration rate, which reflected a greater rate of urinary creatinine excretion (and, thus, muscle mass) per unit of body mass in adolescent boys. The derivation of the formula is contained within the article and the equation is creatinine clearance = 1.5 (age in years)+ 0.5 (length/plasma creatinine). W. J. C. 2 figures, 13 references
Postcatheterization Urethral Strictures Following Cardiac Surgery in Children S. PRABHU, w. COCHRAN, P. A. M. RAINE AND A. F. AzMY, Department of Paediatric Surgery, Royal Hospital for
Sick Children, Yorkhill, Glasgow, Scotland
J. Ped. Surg., 20: 69-71 (Feb.) 1985 Among 221 children undergoing a cardiac operation and requiring placement of a urethral catheter 10 suffered irritative urinary symptoms, usually shortly after removal of the catheter, and 6 of the 10 subsequently had urethral strictures. All catheters were polyvinyl acetate or latex and 5 of the 6 children with strictures had positive urine cultures. Difficulty during catheterization was recorded in 2 cases. The catheter size was 8F or lOF, which was believed to be appropriate for the size of the child. Patient age ranged from 18 months to 9 years at operation. In addition to the usual factors that could have been
211
RADIOLOGY, NUCLEii,,R lviEDICi'.NE AI·JD SONOG·RAPHY
instrumental in causing a stricture in these children, the authors believed that poor tissue perfusion as a consequence of the cardiac anomaly also may have had a role. 14 references
Abstracter's comment. We also have seen several urethral strictures resulting from routine catheterization during a cardiac operation. Strictures can be a major problem that is difficult to treat in these small children. The lesson is that the urethra of a male infant is a delicate structure and should be treated with great respect. I would recommend that only silicone catheters be left indwelling in patients in this age group. T. D. A. Editorial comment. This is a timely study because urethral strictures following Foley catheterization intraoperatively and postoperatively are reported in increasing numbers of children after a cardiac operation. It is interesting that all of the patients who had strictures were from the group with urinary tract infection. Others have implicated the material from which the catheter is made. The consensus seems to be that a stricture is less likely when a silicone catheter is used rather than a latex catheter. L. R. K.
The Artificial Urinary Sphincter in Children: Experience With the AS800 Seri.es and Bowel Recol!l.st.ruction
reported case of preperitoneal 11 references
testes.
T. D. A
PediatJric Urologic Radiology: Intervention and Endourology V. S. MANDELL, J. MANDELL AND G. GAISIE, Departments
of Radiology, Urology and Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Ural. Clin. N. Amer., 12: 151-168 (Feb.) 1985 The widespread use of newer radiographic imaging modalities, such as ultrasound, computerized tomography (CT) and nuclear medicine, has made urological diagnosis more precise than ever. In a thorough review of pediatric uroradiology the authors discuss the current trends in standard urography, and the role of ultrasonography, CT and renal nuclear imaging. A detailed discussion of various isotope agents, and evaluation of obstruction and cystographic techniques are presented. A thorough section is provided on interventional techniques for therapeutic and diagnostic endeavors. It is clear that endourology in children has come of age but requires the special efforts of individuals accustomed to dealing with children and a familiarity with congenital abnormalities of the urinary tract. W. J. C.
18 figures, 1 table, 51 references
J. K LIGHT, Department of Urology, and Roy and Lillie Cullen Department of Urological Research, Baylor College of Medicine, and St. Luke's Episcopal Hospital, Houston, Texas UroL Clin. N. Amer., 12: 103-109 (Feb.) 1985 The author reviews his considerable experience with the AS800 series of artificial urinary sphincters, which has as its major improvement a device that can be activated or deactivated by simple manipulation of the pump. To a large extent this device has negated any previous debate on whether primary or secondary activation is necessary, since the operation needed to accomplish activation has been obviated. A further advantage of the AS800 series is the ability to control the time the cuff exerts pressure on tissues. In a separate section the author gives a clear outline for troubleshooting the device, which is most helpful. In addition, there is an extremely helpful section on selection of cuff pressures and long-term assessment. Finally, the author relates his experience with the use of partial or total cystoplasty in conjunction with an AS800 sphincter. While his experience to date has been positive, the author urges careful followup of these patients, since long-term success of sphincters with bowel augmentation is unknown. W. J. C. 3 figures, 10 references
Preperiton.eal Ectopic Testis: A Case Report
D. M. MURPHY AND M. R BUTLER, Department of Urology, Meath Hospital, Dublin, Ireland
J. Ped. Surg., 20: 93-94 (Feb.) 1985 A 5½-year-old boy underwent exploration because of impalpable gonads. The testes were found deep to the anterior abdominal wall muscles but superficial to the peritoneum, and were attached by their gubernaculum to the umbilicus. The cord structures passed inferolaterally toward the deep inguinal rings, then superiorly in the retroperitoneum. Both testes were placed in the scrotum without difficulty. This is only the second
RADIOLOGY, NUCLEAR MEDICINE AND SONOGRAPHY An Improved Technique for Ultrasound Guided Percutaneous Renal Biopsy J. C. BrnNHOLZ, B. S. KASINATH AND H. L. CORWIN, Department of Radiology and Section of Nephrology, Department of Medicine, Rush Medical College and Rush Presbyterian-St. Luke's Medical Center, Chicago, Illinois Kidney Int., 27: 80-82 (Jan.) 1985 Percutaneous renal biopsy has become one of the fundamental diagnostic techniques in nephrology since its introduction in 1951. Biopsy device and guidance methods have been refined progressively during the last 2 decades with the use of surface anatomical landmarks for guidance superseded by radiographic, computerized tomographic or ultrasonic imaging methods. The authors report the application of an orthogonal ultrasonic guidance technique for renal biopsy in which the needle is visualized continuously throughout its placement. This method initially was developed for intrauterine fetal transfusion, and its use has been reported for transuterine fetal procedures and amniocentesis. The patient is placed in a prone position. Both kidneys are surveyed ultrasonically from the back and sides with a sector scanning device during varying inspiratory efforts. Unless clinical conditions specifically dictate selection of 1 kidney, the authors select the kidney for which the lower pole descends below the last rib, and the lower pole is visualized satisfactorily with the ultrasonic probe positioned laterally along the posterior or mid axillary line. The probe is returned to the back and centered over the lower pole, rotated from sagittal to transverse viewing planes and repositioned as needed until the central ray of the image passes through the proposed biopsy site. This