Renal Doppler ultrasonography in infants with hydronephrosis.

The objective was to evaluate the importance of obstruction in unilateral hydronephrosis by using renal Doppler ultrasonography. A total of 19 infants were examined. It was revealed that patients of group with obstruction have in the affected kidney a higher mean resistive index [RI = 0.77 +/- 0.04] than in the healthy kidney [RI = 0.69 +/- 0.02] [p < 0.001]. In patients of group with nonobstructive dilatation this difference was not observed. In infants it is not possible to evaluate only absolute changes of the resistive index. It is much more useful to compare values of RI of both kidneys using the above indices. The determination of RI, RIR and delta RI can be helpful in distinguishing obstructed from non-obstructed hydronephrosis.

Heart rate variability and cardiovascular tests in young patients with diabetes mellitus type 1.

The aim of this study was to obtain information about parameters of heart rate variability (HRV) in three frequency bands (high frequency - HF, low frequency - LF and very low frequency - VLF), the sensitivity of cardiovascular tests, and subjective feelings depending on autonomic nervous system balance in a group of young patients with diabetes mellitus type 1 (IDDM). Sixty-four subjects were examined: 32 patients with diabetes with a mean age of 16.1 +/- 0.7 years and a mean duration of IDDM of 6.3 +/- 0.8 years, and 32 healthy controls matched for age, sex and BMI. Shorter R-R intervals and abnormal values reflecting HRV were found in the diabetic group. In particular, parameters of total power, and HF and LF bands were reduced. The ratio VLF/HF power revealed predominance of sympathetic tone in the diabetic subjects. Although relative power VLF was increased in the supine position, the reactive rise of the VLF band activity in orthostasis was lower in the IDDM group. Using cardiovascular tests (deep breathing, Valsalva, orthostasis), significant differences in reactions were found only in the deep breathing test. Evaluation of sympathetic:parasympathetic:indifferent subjective feelings by questionnaire did not reveal any differences between the diabetic and healthy groups.

Contribution to occupational angiopathy diagnosis using special examination method.

The authors presented 1642 cases of professional diseases caused by vibrations (VD) and 435 cases of extremity overload disease (EOD) diagnosed in the years 1974-1993. In addition to the standard rheoplethysmography there were evaluated the results of digital laser Doppler flowmetry (Moor instruments, UK) in 104 workers exposed to vibration (EV) and 25 controls with the age and smoking habit standardisation. In the selected subgroup were used continual measurements of digital blood pressure (Finapress, Ohmeda), digital LD flux and speed and the measuring of digital skin and central body temperature simultaneously. The records before and after 10 min of local cooling test (Rejsek method) and postocclusive hyperemic tests were summarized (computer evaluation, program STATGRAPHICS, T-test). Vasoconstriction to local cooling persisted in EV for longer time. The records of digital skin flux and speed, digital blood pressure reactions of EV were significantly different (EV/controls) also in the 10th min after cooling. Postocclusion hyperemic tests revealed good functional capacity also in EV. Advantages and disadvantages of methods were discussed. The results found by non-invasive methods in VD were in good relation to images obtained by means of radionuclides (clearance and cumulative tests). Cumulative tests (after 99m--pertechnetate i.v.) can be used in the selected differential diagnostic cases of angiopathies to help to distinguish degree of angiospastic and angioparalytic changes in the hands of VD, and also in special cases at angiopathies connected with EOD.

[Evaluation of blood flow in the renal artery and intraparenchymal arteries in neonates using color doppler sonography]. / Hodnotenie prietokov krvi a. renalis a intraparenchýmovými artériami novorodencov pomocou farebnej dopplersonografie.

The authors examined 25 kidneys in 14 healthy neonates in order to evaluate the resistive index (RI) calculated from the maximal systolic and end-diastolic rate of blood flow in the renal artery and some intraparenchymatous arteries. They revealed a significant drop of all absolute rates of blood flow in arteries in the direction to the renal periphery. Consistent with rather few data in the literature, they assessed a normal RI value of intraparenchymatous arteries in healthy neonates (0.76 +/- 0.04) which differs significantly from values assessed in the renal artery (0.82 +/- 0.05) (p < or = 0.001). The authors discuss the normal RI value in the neonatal period. In the conclusion they mention that the RI can be obtained much more easily from the blood flow in the renal artery than the blood flow in intraparenchymatous arteries but the former does not reflect representatively the intraparenchymatous conditions in the kidneys and this restricts its use in evaluations of intraparenchymatous renal processes.

[Practical comments on the diagnosis of so-called functional proteinuria and suggestions for a diagnostic algorithm]. / Praktické poznámky k diagnostike tzv. funkcných proteinúrií a návrh algoritmu diagnostiky.

The submitted paper, based on the authors' experience, summarizes basic findings pertaining to isolated proteinuria. In addition to a simple classification the authors outline in a diagram the differential diagnostic procedure in patients with isolated proteinuria.

[Radionuclide scintigraphy in the diagnosis of Meckel's diverticulum]. / Vyuzitie rádionuklidovej scintigrafie pri diagnostike Meckelovho divertiklu.

In the submitted case-history the authors draw attention to the advantage of radionuclide diagnosis of ectopic gastric mucosae located in Meckel's diverticula. Diagnosis with 99mTc is according to the authors the treatment of choice in acute haemorrhage into the GIT with an obscure aetiology.

[Mechanisms of thermoregulation in fetuses and children]. / Mechanizy termoregulácie u plodov a deti.

In the submitted review the authors discuss the problem of thermoregulation in foetuses and children. Attention is devoted in particular to the action of thermoregulating nervous and hormonal mechanisms.

[Neonatal sepsis--still a real problem]. / Novorodenecká sepsa--stále aktuálny problém.

Neonatal sepsis is characterized by bacteraemia and clinical symptoms caused by microorganisms or their toxic products. The authors pay attention to epidemiological and predisposing factors, to the aetiology, pathogenesis, clinical signs and conditions for assessment of the diagnosis of neonatal sepsis as well as its therapy and prognosis.

Salicylate intoxication after use of topical salicylic acid ointment by a patient with psoriasis.

The authors describe a therapeutically well managed case of severe salicylate intoxication in a patient with psoriasis who treated himself with 40 percent salicylic ointment applied to approximately 41 percent of his body surface. Nineteen hours after the application of salicylic acid, his blood level of the agent was 6.04 mmol/liter. The patient underwent hemodialysis and was discharged after fourteen days in good general health.

[Advantages of the new radiopharmaceutic agent, 99mTC-mercaptoacetyltriglycine (99mTc-MAG3), in the diagnosis of kidneydiseases. A comparative study with 131I-OIH, 99mTc-DTPA and 99mTc-DMSA]. / Prednosti nového rádiofarmaka 99mTc-merkaptoacetyltriglycínu (99mTc-MAG3) v diagnostike ochorení obliciek. Porovnávacia stúdia s 131I-OIH, 99mTc-DTPA a 99mTc-DMSA.

The properties of 99mTc-mercaptoacetyltriglycine (MAG3), a new radiopharmaceutic for dynamic renal scintigraphy, were assessed in a series of 138 patients with different diseases of the uropoietic system. The physiological values of renographic curves were determined as well as the characteristics of MAG3 excretion, which closely resembled the values for 131I-OIH. On comparing the values of separate MAG3 clearance with standard radiopharmaceutics in 26 subjects examined, very good correlation coefficients (r) were obtained: 0.98, 0.96, and 0.92 for 131I-OIH, 99mTc-DMSA, and 99mTc-DTPA, respectively. Global MAG3 clearance reached 0.64 of the OIH value. The higher quality of scinfigraphic imaging than seen with the substances used so far, the favorable pharmacokinetic properties and the low radiation load (H(E) = 0.51 mSv in adults) of MAG3 determine the indication spheres in which it can best be used to advantage. Of the radiopharmaceutics used to date, MAG3 yields the best results. It can well substitute 123I-OIH, which is not readily available in our conditions, and can thus be expected to be widely used in clinical practice.

[The effect of extrarenal factors on certain functions of the kidney and urinary tract. A radionuclide study]. / Vplyv mimooblickových faktorov na niektoré funkcie obliciek a mocových ciest. Rádionuklidová stúdia.

The authors present their experiences concerning the effect of extrarenal factors on the results of radionuclide examination. Functional and functional-morphological examinations of the kidneys and urinary tract can be negatively affected particularly by emotional stress, orthostasis, dehydration, increased kidney motility, address administered drugs during examination (diuretics), drug treatment of the primary disease, muscular strain, cold, pain, increased pressure in the vicinity of the kidney, hypertension, hypotension, as well as further conditions. Radionuclide methods can objectify these processes, the given negative effects can however be presumed to occur also at other examination procedures of the kidney and urinary tract. The conditions of examinations have thus to be optimized and standardized. The examining physician has to know which drugs the patient is receiving and he has to know their effect on renal function.

A new approach in radionuclide imaging to ureteric peristalsis using 99Tcm-MAG 3 and condensed images.

A new method for the evaluation of ureteric peristalsis is described. Standard, dynamic renal scintigraphy was carried out using 99Tcm-MAG 3 in 59 patients. Time-activity curves and condensed images over the ureter area were created simultaneously. A six-grade scale (O-V) was chosen for the classification of ureteral function. The results obtained were compared with parameters of renographic curves and other clinical findings. In a group of 13 patients, two different renal radiopharmaceuticals were used: 131I-OIH and 99Tcm-DTPA. The results show that the new method is suitable for the assessment of ureteral disorders, and has some advantages compared with previously described methods. 99Tcm-MAG 3, with a better target-to-background ratio compared to 131I-OIH and 99Tcm-DTPA, is the most suitable radiopharmaceutical for this purpose.

[Clinical evaluation of a new radiopharmaceutical agent 99mTc-mercaptoacetyltriglycine (MAG3)]. / Klinické hodnotenie nového rádiofarmaka 99mTc-merkaptoacetyltriglycínu (MAG3).

In the present clinically oriented study the authors checked the properties of 99mTc-mercaptoacetyltriglycine (MAG3), the new radiopharmaceutical for dynamic scintigraphy of the kidneys, in a group of 30 patients. They positively value particularly the high quality of visualization of the parenchyma and the urinary tract, the pharmacokinetic properties similar to those of 131I-orthoiodhippurate and the capability of representation of the kidneys with their markedly decreased function. They examined the take-up of the pharmaceutical in the liver, which is slightly more marked with the worsening tubular function and partly depends also on the length of the time interval between the preparation and administration of MAG3. No significant changes were found in the clinical and principal laboratory parameters after its administration. In conclusion, the authors point out to advantageous properties of the novel radiopharmaceutical for clinical use in our conditions.

[The significance of a new radiopharmaceutic agent, 99mTc-mercaptoacetyltriglycine (MAG 3), in the diagnosis of diseases of the kidneys and urinary tract in children]. / Význam nového rádiofarmaka 99mTc-merkaptoacetyltriglycínu (MAG 3) v diagnostike ochorení obliciek a mocových ciest u detí.

Using the method of dynamic scintigraphy of the kidneys by means of a new radiopharmaceutical preparation, 99mTc--mercaptoacetyltriglicide [MAG 3], the authors examined 35 children with various urological and nephrological diseases. In indicated cases the examination was supplemented by administration of a diuretic, further projections or indirect mictional cystography. The authors assessed normal parameters of functional curves and their normal extent in a group of 18 healthy kidneys. They did not find a significant difference, as compared with results obtained by means of 131I-OIH. The assessed values of global clearance attained 66% of the 131I-OIH clearance values. In 60% of the patients the visualization of the parenchyma and in 80% the visualization of the efferent urinary pathways was better than when 99mTc-DTPA was used. In all instances the scintigrams were better than when 131I-OIH was used. The new radiopharmaceutical preparation combines the advantages of technetium-labelled preparations and the favourable pharmacokinetic properties of hippuran. It is suitable for quantification of tubular secretion. It is superior to hitherto used substances as regard the quality of visualization and in particular the lower radiation load. Therefore it is particularly suited for paediatric practice.

[Psychotherapy in the treatment of encopresis in children with idiopathic megacolon]. / Psychoterapia v liecbe enkoprézy u detí s idiopatickým megakolonom.

The authors treated by psychotherapy 70 children aged 3 to 15 years with encopresis and constipation. In all irrigographic examination revealed idiopathic megacolon. In the course of treatment and after treatment 93.1% of the children are free from complaints, of these 48% are without any treatment, the others are given intermitently small doses of lactulose and Clavigrenin. 4.6% of children have occasional problems, 2.3% of the patients did not improve. Improvement of the condition depends on the cooperation of the parents, in particular the mothers. In mothers of the treated children by means of Knobloch's test a higher score of neuroticism was found, as compared with mothers of children with common infections.