Split renal function in young children with unilateral pelvi-ureteric junction obstruction using [99m]Tc-DTPA or [99m]Tc-MAG[3]

Cases of unilateral hydronephrosis in pediatric patients are mostly due to pelvi-ureteric junction obstruction [PUJO] that causes hindrance in the drainage of urine outflow, leading to kidney function impairment The impaired excretory drainage is expected to have diminished or normal split renal function [SRF] on the affected side. However, in a significant number of patients with severe PUJO an elevated SRF can be found. The aim of this work was to estimate the frequency of various grades of SRF in children with PUJO. Secondly, to find out whether there is a difference between [99m]Tc-DTPA or[99m]Tc-MAG3 in assessing the SRF in these children. Fifty-eight children with unilateral PUJO referred for dynamic renography were included in this study on retrospective basis. Twenty-four patients underwent dynamic renography using [99m]Tc-DTPA while 34 were evaluated using [99m]Tc-MAG3. For both [99m]Tc-DTPA and [99m]Tc-MAG3, the dynamic renography started by perfusion phase [1 frame/ sec for 1 min] followed by 15-sec frames for 29 minutes. In all patients frusemide was given at a dose of 1mg/kg at 10 minutes post injection, In the DTPA and MAG3 studies, glomerular filtration rate [GFR] and renal plasma flow [ERPF] were estimated respectively and SRF was calculated from both figures. The normal range for SRF was considered 45% to 55%, In all patients, diagnostic ultrasound was done prior to isotopic renography. The mean age of the studied children was 18 +/- 10 months. The children in the DTPA and MAG3 groups were age and sex-matched. In the DTPA group 25% of the patients had a diminished SRF [< 45%], [46%] had normal SRF and 29% showed paradoxical SRF [> 55%]. In the MAG3 group, 32% of patients had diminished SRF, 41% had normal SRF and 26% showed paradoxical SRF of > 55%. There was no significant difference between DTPA and MAG3 in estimation of SRF in those with normal and suprnormal SRF [P value = 0.0865 and 0,094 respectively] however MGA3 tends to be superior to DTPA in cases of impaired renal function [P value < 0.05. The obstructive renogram patterns define the functional significance of the various grades of hydronephrosis detected by ultrasound. Both [99m]Tc-MAG3 and [99m]Tc-DTPA are comparable and can estimate the SRF in young children with unilateral PUJO, however, in cases of impaired renal function [99m]Tc-MAG3 tends to be better than [99m]Tc-DTPA. Impaired and Paradoxical supranormal split renal function are significantly present in young children with unilateral PUJO

Chronic constipation in Egyptian infants and children: some common etiologies

Constipation is a common complaint heard in clinical Pediatrics. In most children, constipation is functional that is without objective evidence of a pathological condition. The aim of the present work was to identify some of the different etiologies of chronic constipation and to investigate the possible relation between constipation and cow milk allergy [CMA]. 30 consecutive infants and children with chronic constipation, attending the outpatient clinic of Cairo University Children Hospital, were studied. Beside the careful history taking and clinical examination, children were subjected to different investigations to diagnose the possible etiology of chronic constipation. In addition, diagnosis of CMA was done by challenge test to CM and blood tests including blood eosinophilic count, total serum IgE and specific IgE to cow milk proteins [ELISA technique]. Out of the 30 studied cases, the etiology of constipation was dietetic in 60%, CMA in 26.7%, Hirshsprung disease [HD] in 10%, and psychological constipation in only one patient [3.3%]. The diagnosis of dietetic constipation and CMA were significantly more common than HD [P = 0.0001]. The mean age and age of onset were not significantly different between the 3 groups. No sex predilection for the prevalence of constipation was found in different age groups [<12 months and >/= 12 months] [P = 0.7]. Most of patients were 6 months of age while CMA-related constipation was more common in patients

Sonographic abnormalities of the gallbladder in children receiving ceftriaxone

Ceftriaxone, a third-generation cephalosporin is a popular antibiotic in treating pediatric infections because it has a wide spectrum of antimicrobial activity and a long plasma half-life, which allows once a day administration. Sonographic abnormalities of the gallbladder have been reported in patients who received ceftriaxone; some of these patients also had symptoms of gallbladder disease. Although most patients with these abnormal sonographic gallbladder findings are asymptomatic, biliary symptoms can occur and may be severe enough to require discontinuation of ceftriaxone therapy. The purpose of this study was to investigate the incidence and outcome of biliary complications in children receiving ceftriaxone. The study included 69 children admitted to Abou-Elrish hospital during the period from September 2002 to May 2003 and required ceftriaxone therapy for 7 days for various infections. The drug was given in a dose of 100 mg/kg once daily by intravenous route. Abdominal Ultrasonography for gallbladder abnormality was performed within the 1st 2 days of starting treatment; another examination was performed on the 7th day, once more during the course of treatment, its time was variable among our patients; and finally just after the end of treatment. Patients with abnormal sonographic findings were followed every one to two weeks till resolution of the abnormal findings with a follow up period extended to 21-90 days after stoppage of treatment. According to the results, patients were divided into 2 groups according to sonographic findings; group I included 54 patients [78%] with negative sonographic findings of gall-bladder disease, group II included 15 patients [22%]. Twelve of group I1 patients [80%] demonstrated abnormal sonographic findings as semilunar well defined structures showing posterior acousting shadowing, while three patients of them [20%] demonstrated the abnormal sonographic findings as an echogenic material without acousting shadowing i.e. sludge. These abnormal sonographic findings were detected 7-35 days after starting treatment with mean of 18 +/- 11 days, and were completely resolved in 12 patients 14-30 days after stoppage of treatment [17.7 +/- 5.1 days]. However, 3 patients showed incomplete resolution, during a follow up period of 21-90 days with a mean of 57 +/- 34.6 days from the stoppage of treatment. The duration of treatment was significantly longer in-group II than group I [P-value= 0.07]. No statistically significant differences were found between the 2 groups regarding the age, weight and laboratory findings

Conclusion: ceftriaxone-induced biliary pseudolithiasis is asymptomatic, transient and generally resolves spontaneously following discontinuation of the drug in most cases

Non-invasive versus invasive assessment of pulmonary artery branches in pediatric patients with tetralogy of fallot

This study was based on two issues, the 1[st] one was that the pulmonary artery anatomy is the key factor that determines the type of surgical treatment required in tetralogy of Fallot [TOF]. The 2[nd] one was that many studies showed a good correlation of the echocardiographic measurements of cardiac structures with the angiographic and pathological findings. So, the aim of this work was to evaluate the reliability of echocardiography in assessment of the pulmonary blood flow status in pediatric patients with TOF. Only patients with the usual anatomy of TOF were included in this study. It included 68 patients distributed into two groups; group I included 18 patients [26.5%], their mean age was 29.1 +/- 21.4 months and their mean weight was 11.2 +/- 2.1 kg. Group II included 50 patients [73.5%], their mean age was 34 +/- 23 months, their mean weight was 12.6 +/- 4.1 kg. We tested the accuracy of the 2-D echocardiography in measuring the right and the left pulmonary arteries [RPA and LPA] and compared them to the measurements taken by angiography [group I] as well as to the measurements taken at surgery [group II]. The standard deviation unit [Z value] for the RPA and LPA was calculated as well as the pulmonary artery index [PAI] from echocardiographic and angiographic measurements for group I and from echocardiographic and surgical measurements for group II. The results showed that For group I patients, there was statistically significant difference in the measurements of RPA and LPA and consequently the calculated Z value and the PAI between echocardiographic and angiographic modalities. Similarly, group II patients demonstrated a statistically significant difference in the measurements of RPA and LPA and consequently the calculated Z value and the PAI between the echocardiographic and surgical methods. Despite these significant differences found in both groups, the echocardiographic measurements correlated well with the angiographic measurements in group I as well as with the surgical measurements in group II. The differences detected between the echocardiographic and the surgical measurements were less than the differences detected between the echocardiographic and angiographic measurements. This mostly related to our earlier experience in measurement of the pulmonary artery branches using 2-D echocardiography in group I, but with time, we got more experienced in this issue, thus the differences in measurements were minimized in group II. The maximum difference between the echocardiography and surgery for the RPA and LPA was 2.1 mm and 2.0 mm and the mean difference was 0.71 +/- 0.45 and 0.63 +/- 0.46 mm respectively. Our results reflect a clinically acceptable accuracy of 2-D echocardiography in estimation of the pulmonary artery branches and thus surgical management of TOF, guided by echocardiography alone, can be confidently performed in selected infants and children. Cardiac catheterization should be reserved for patients in whom the echocardiographic measurements are not fully certain or suggest association of cardiovascular malformation