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Renal transplantation in children and adolescents
596
ABSTRACTS
Macroemylasemia. A. R. Colon, R. A. Felder, and R. M. Ryan. J Pediatr 96:64-66, (January), 1980,
A 12-yr-old boy with intermittent abdominal pain is reported to have macroamylasemia. Serum and urinary amylase concentrations may be measured in the course of evaluating the patient with acute or recurrent abdominal pain. The finding of low urinary amylase in the presence of elevated serum concentrations of amylase should alert the clinician to the presence of decreased renal clearance of amylase. This patient's abdominal pain gradually diminished without intervention but the circulating macroamylase did persist. The amylase-complex is probably, therefore, a biochemical aberration and its importance lies in the distinction from pathologic hyperamylasemia.--George Holcomb, Jr. Perspectives in Management of Trauma to the Spleen: 1979 Presidential Address, American Association for the Surgery of Trauma. R. Sherman. J Trauma 20:1-13, (Janu-
ary), 1980. This paper is a thorough review of the management of splenic trauma including 186 references. The first portion of the article deals with the history of splenectomy dating to 1549. The author then presents evidence for the function of the spleen in infection and presents the most recent data on postsplenectomy sepsis. The evidence is quite clear that bacterial sepsis is directly related to splenectomy performed at any age. The conservative management both operative and nonoperative of ruptured spleen is reviewed based on 81 cases of non-operative and 226 cases of splenic salvage. It was concluded that with proper selection, non-operative treatment is quite safe for the pediatric age group so long as careful observation and follow-up are performed. It is also clear that polyvalent pneumococcal vaccine and/or antibiotic prophylaxis with penicillin will not eradicate the problem of post-splenectomy sepsis. It is not clear at present how much splenic tissue is necessary to prevent the threat of sepsis nor is it simply the amount of splenic tissue or whether there are other factors such as blood flow to the organ involved.--Jack H. T. Chang GENITOURINARY TRACT Simple Cysts of the Kidney in Children. M. J. Siegel and HI. H. McAlister. J Urol 123:75-78, (January), 1980.
Five children with simple renal cysts are discussed, two of whom were initially diagnosed as having a Wilms tumor or a mesoblastic nephroma. The most common presenting feature is a palpable mass in an infant or a young child. In older children characteristic radiographic features suggest a correct preoperative diagnosis. However, distinguishing a simple cyst from a solid tumor with necrotic degeneration preoperatively may not be possible in the infant and young child. Surgical exploration will be necessary in those situations.--George Holcomb, Jr. Acute Renal Failure Secondary to Bilateral Retrograde
Pyelography. R. M. Hurley. Clin Pediatr 18:754-756, (December), 1979. A 5-yr-old girl developed acute renal failure following a bilateral retrograde pyelogram to evaluate recurrent episodes
of abdominal pain. The catheterization was difficult and extensive pyelosinus reflux of dye occurred. Peritoneal dialysis was utilized for 24 hr and normal renal function returned in 8 days. Acute renal failure following retrograde pyelography may be caused by several mechanisms. Ureteral trauma from instrumentation can cause edema that can result in ureteral obstruction. Pyelorenal extravasation may cause an intrarenal nephropathy due to mechanical factors (osmotic or tissue damage factors) or a drug induced interstitial nephropathy. Both mechanisms are transient and prognosis for return of normal renal function is excellent with appropriate supportive measures during the acute e p i s o d e . Randall W. Powell
Renal Transplantation in Children and Adolescents. R. S.
Fennell 111, E. H. Garin, HI. Pfaff, et al. Clin Pediatr 18:518-532, (September), 1979.
Fifty-one kidney transplants in 44 patients varying in age from 4 to 21 yr (median 12) were performed over a 4.5-yr period. Thirty-six transplants utilized living related donors with cadaver kidneys utilized in 15 transplants. Thirty-seven of the 44 recipients (84%) have functioning allografts (29 first and 8 second transplants) with 6 patients awaiting a second transplant. One patient died due to systemic candidiasis yielding a 98% survival rate. The 2-yr graft survival rate utilizing living related donors was 83% while the 1-yr graft survival in cadaver kidneys was 51.1%. Graft loss due to acute rejection occurred in 6 living related allografts while chronic rejection claimed one living related and 5 cadaver allografts. Recurrent glomerulonephritis occurred in four patients. Steady growth occurred in both male and female recipients under 12 yr of age. Females, transplanted beyond 12 yr of age, experienced suboptimal growth while males over 12 had growth patterns similar to the under 12 age group. The authors conclude that renal transplantation improves the quality of life, carries a low mortality, and offers an opportunity for social rehabilitation.--Randall W. Powell MUSCULOSKELETAL SYSTEM TransUiac Lengthening of the Lower Extremity: Modified |nnominate Osteotomy for the Treatment of Postural Imbalance. M. B. Millis and J. E. Hall. J Bone Joint Surg
61A:1182-1184, (December), 1979. Twenty patients with unilateral leg length abnormalities, ranging from ages 5 to 20 yr, were treated with transiliac hemipelvic lengthening. Follow-up ranged from 2 to 6 yr. Indications and contraindications for the procedure are defined, as are the surgical technique. Lengthening ranged from 1.6 to 3 cm with an average of 2.3 cm being obtained. Complications included 3 wound infections without permanent sequelae; 1 postoperative loss of lengthening and 1 femoral neck fracture, treated without residuals. The authors also report a lengthening of 3.5 cm, associated with a partial sciatic nerve palsy, requiring re-operation to reduce the lengthening to 2.5 cm and ultimate resolution of the sciatic palsy. With properly selected patients, this is a valuable adjunct to the armamentarium of those who deal with leg length discrepancies.--Anthony 11. Alter
ABSTRACTS
Macroemylasemia. A. R. Colon, R. A. Felder, and R. M. Ryan. J Pediatr 96:64-66, (January), 1980,
A 12-yr-old boy with intermittent abdominal pain is reported to have macroamylasemia. Serum and urinary amylase concentrations may be measured in the course of evaluating the patient with acute or recurrent abdominal pain. The finding of low urinary amylase in the presence of elevated serum concentrations of amylase should alert the clinician to the presence of decreased renal clearance of amylase. This patient's abdominal pain gradually diminished without intervention but the circulating macroamylase did persist. The amylase-complex is probably, therefore, a biochemical aberration and its importance lies in the distinction from pathologic hyperamylasemia.--George Holcomb, Jr. Perspectives in Management of Trauma to the Spleen: 1979 Presidential Address, American Association for the Surgery of Trauma. R. Sherman. J Trauma 20:1-13, (Janu-
ary), 1980. This paper is a thorough review of the management of splenic trauma including 186 references. The first portion of the article deals with the history of splenectomy dating to 1549. The author then presents evidence for the function of the spleen in infection and presents the most recent data on postsplenectomy sepsis. The evidence is quite clear that bacterial sepsis is directly related to splenectomy performed at any age. The conservative management both operative and nonoperative of ruptured spleen is reviewed based on 81 cases of non-operative and 226 cases of splenic salvage. It was concluded that with proper selection, non-operative treatment is quite safe for the pediatric age group so long as careful observation and follow-up are performed. It is also clear that polyvalent pneumococcal vaccine and/or antibiotic prophylaxis with penicillin will not eradicate the problem of post-splenectomy sepsis. It is not clear at present how much splenic tissue is necessary to prevent the threat of sepsis nor is it simply the amount of splenic tissue or whether there are other factors such as blood flow to the organ involved.--Jack H. T. Chang GENITOURINARY TRACT Simple Cysts of the Kidney in Children. M. J. Siegel and HI. H. McAlister. J Urol 123:75-78, (January), 1980.
Five children with simple renal cysts are discussed, two of whom were initially diagnosed as having a Wilms tumor or a mesoblastic nephroma. The most common presenting feature is a palpable mass in an infant or a young child. In older children characteristic radiographic features suggest a correct preoperative diagnosis. However, distinguishing a simple cyst from a solid tumor with necrotic degeneration preoperatively may not be possible in the infant and young child. Surgical exploration will be necessary in those situations.--George Holcomb, Jr. Acute Renal Failure Secondary to Bilateral Retrograde
Pyelography. R. M. Hurley. Clin Pediatr 18:754-756, (December), 1979. A 5-yr-old girl developed acute renal failure following a bilateral retrograde pyelogram to evaluate recurrent episodes
of abdominal pain. The catheterization was difficult and extensive pyelosinus reflux of dye occurred. Peritoneal dialysis was utilized for 24 hr and normal renal function returned in 8 days. Acute renal failure following retrograde pyelography may be caused by several mechanisms. Ureteral trauma from instrumentation can cause edema that can result in ureteral obstruction. Pyelorenal extravasation may cause an intrarenal nephropathy due to mechanical factors (osmotic or tissue damage factors) or a drug induced interstitial nephropathy. Both mechanisms are transient and prognosis for return of normal renal function is excellent with appropriate supportive measures during the acute e p i s o d e . Randall W. Powell
Renal Transplantation in Children and Adolescents. R. S.
Fennell 111, E. H. Garin, HI. Pfaff, et al. Clin Pediatr 18:518-532, (September), 1979.
Fifty-one kidney transplants in 44 patients varying in age from 4 to 21 yr (median 12) were performed over a 4.5-yr period. Thirty-six transplants utilized living related donors with cadaver kidneys utilized in 15 transplants. Thirty-seven of the 44 recipients (84%) have functioning allografts (29 first and 8 second transplants) with 6 patients awaiting a second transplant. One patient died due to systemic candidiasis yielding a 98% survival rate. The 2-yr graft survival rate utilizing living related donors was 83% while the 1-yr graft survival in cadaver kidneys was 51.1%. Graft loss due to acute rejection occurred in 6 living related allografts while chronic rejection claimed one living related and 5 cadaver allografts. Recurrent glomerulonephritis occurred in four patients. Steady growth occurred in both male and female recipients under 12 yr of age. Females, transplanted beyond 12 yr of age, experienced suboptimal growth while males over 12 had growth patterns similar to the under 12 age group. The authors conclude that renal transplantation improves the quality of life, carries a low mortality, and offers an opportunity for social rehabilitation.--Randall W. Powell MUSCULOSKELETAL SYSTEM TransUiac Lengthening of the Lower Extremity: Modified |nnominate Osteotomy for the Treatment of Postural Imbalance. M. B. Millis and J. E. Hall. J Bone Joint Surg
61A:1182-1184, (December), 1979. Twenty patients with unilateral leg length abnormalities, ranging from ages 5 to 20 yr, were treated with transiliac hemipelvic lengthening. Follow-up ranged from 2 to 6 yr. Indications and contraindications for the procedure are defined, as are the surgical technique. Lengthening ranged from 1.6 to 3 cm with an average of 2.3 cm being obtained. Complications included 3 wound infections without permanent sequelae; 1 postoperative loss of lengthening and 1 femoral neck fracture, treated without residuals. The authors also report a lengthening of 3.5 cm, associated with a partial sciatic nerve palsy, requiring re-operation to reduce the lengthening to 2.5 cm and ultimate resolution of the sciatic palsy. With properly selected patients, this is a valuable adjunct to the armamentarium of those who deal with leg length discrepancies.--Anthony 11. Alter