Incidence of Vesicoureteral Reflux in Asymptomatic Siblings of Patients with Reflux

PURPOSE: Vesicoureteral reflux(VUR) is defined as a retrograde flow of urine from the bladder into the upper urinary tract. It has been shown to predispose patients to hypertension, renal scarring, and end-stage renal failure if not recognized and treated. The observation that VUR occurs in siblings of children with reflux at a significantly higher rate than the general pediatric population has been recognized for many years and VUR was detected in 26% to 51% of siblings of patients with VUR. The purpose of this study is to determine the incidence of VUR in asymptomatic siblings of children with VUR and to see if this form of screening would be practical. METHODS: We retrospectively reviewed the records of 28 patients with VUR and their siblings. The total number of asymptomatic siblings investigating VUR were 28 persons. All patients and siblings were evaluated for VUR by a voiding cystourethrography and all patients and siblings with VUR were performed 99mTc 2,3-dimercaptosuccinic acid renal scan. RESULTS: A total of 28 patients(14 boys, 14 girls) with VUR were studied; the mean patient age was 2.7 years(range 1 month to 8.4 years). The total number of asymptomatic siblings investigating VUR were 28 persons(17 boys, 11 girls) and the mean age was 3.3 years(range 2 months to 7.4 years). Renal scar was detected in 20 of 28(71.4%) patients with VUR. VUR was noted in three of 28(10.7%) siblings and renal scar was detected in one of three siblings with VUR. CONCLUSIONS: In this study, the predictive value of a positive family history alone in identifying VUR was 10.7%. This incidence suggests more investigation of asymptomatic siblings and continued study of this group of patients at risk is needed for clarifying the family screening of patients with VUR.

A Case of Intestinal Malrotation with Midgut Volvulus Presenting with Intermittent Vomiting and Abdominal Pain / 대한소아소화기영양학회지

Intestinal malrotation is a developmental anomaly resulting from embryologic failure of fixation and rotation of the gut and predisposed to midgut volvulus and small bowel obstruction. Acute midgut volvulus is most often encountered in the newborn period. But older children and adults may have a history of intermittent episodes of partial volvulus presenting with recurrent colicky abdominal pain accompanying bilious vomiting. We experienced a case of intestinal malrotation complicated by midgut volvulus presented with recurrent vomiting and abdominal pain in a 6-year-old boy.

A Case of Posterior Medullary Hemangioblastoma

The source of hemangioblastoma in the hindbrain was considered to be avascular analoge in or adjacent to the posterior medullary velum. In hemangioblastoma of the brain stem, the area postrema has been known as the most common site. Operative and autopsy findings were confirmed by Okawara that the solid lesions are more likely to involve the brain stem. The solid hemangioblastoma is much more difficult to treat and the mortality is higher than the cystic type due to involvement of the brain stem, massive postoperative edema, and intraoperative or postoperative bleeding from the tumor mass. Operative and histopathologic findings of our case are confirmed with solid hemangioblastoma which involves the posterior medullary oblongata and was regarded as arising at the postrema.

A Case of Glosspharyngeal Neuralgia

The authors report a case of glossopharyngeal neuralgia which was successfully treated with intracranial section of the glossopharyngeal and upper two rootlets of the vagus nerves. Despite of the complete section of these nerves, corresponding sensory or motor deficit was not developed. And the histories of this surgery were reviewed.

A Recurred Brain Abscess in Same Area after Complete Enucleation

A brain abscess recurred after complete removal of encapsulated mass on the quite same spot three months later. 23-year-old woman was admitted to our hospital because of headache and vomiting for 3 months. On admission, she was mentally alert but the bilateral optic discs were markedly blurred. Left carotid angiogram and Conray ventriculogram suggested a large space-occupying lesion. At the time of operation, a large mass was removed with slightest occipital damage to the brain. On selection of the extirpated mass, thick purulent liquid came out. After operation, her neurological deficits were markedly improved except the equivocal hemiparesthesia of the right extremity. Postoperative course was quite uneventful and she was discharged. After 3 months postoperatively, she was re-admitted with recurrence of the trouble. She was comatose at this time. Pupillary light reflex was abolished. Pathologic reflexes were positive. The angiography and brain scan revealed recurrence of abscess on the just same area. Puncture for aspiration was immediately performed. Purulent materials were drained about 40ml. After abscess cavity was irrigated with physiologic saline solution, instillation of penicillin and micropaque was done within cavity. After several repeated puncture and aspiration her conditions were dramatically improved. Again, she became almost asymptomatic and was discharged days later her second admission. The results are as following ; 1. Primary focus of bacterial spreading to the brain was not found on both occasions. 2. Pathogenesis of both occasions was not clear. 3. At time of first operation, evidence of local inflammation was not found. 4. Local process and other induration was not found. These were confirmed with the operation and brain scanning. 5. Recurred brain abscess was newly developed. It seems to be hematogenous spreading in anywhere else.