Congenital reflux nephropathy: a follow-up of 108 cases diagnosed perinatally.

OBJECTIVE: To determine: (i) the proportion of vesicoureteric reflux (VUR) associated with congenital renal damage and whether it can be severe enough to cause renal impairment from birth: (ii) to evaluate the distribution of males and females affected; and (iii) to describe the course of congenital damage in the first years of life. PATIENTS AND METHODS: A total of 108 children (76 male and 32 female, M:F 2.3:1), whose VUR was diagnosed before any infection, were followed from birth for a mean (range) of 4.3 (1-10) years. Renal damage was defined by serum creatinine concentration, creatinine clearance and renal imaging (ultrasonography and renal scintigraphy) performed within the first month of life and periodically thereafter. RESULTS: Of the 108 children, 58 had bilateral and 50 unilateral reflux (total number of refluxing units, 166). High-grade VUR (grade > or = 4) was found in 96 (58%) refluxing renal units (RRUs). Males had a prevalence of bilateral severe (> or = grade 4) reflux (M:F 5.2:1), while in those wit unilateral VUR, the M:F ration was 1.5:1. At birth, mild to moderate damage was present in 56 (36%) RRUs and only associated with VUR of grade > or = 3. Bilateral reflux of grade > or = 4 was associated with congenital moderate/severe renal failure in nine neonates (seven males). In infants with grade > or = 4 VUR who underwent surgical correction, VUR resolved in 92% of cases. In infants with VUR of grade > or = 4 followed medically, the reflux spontaneously resolved in 42% and ameliorated in 16% after 18 months. Serial renal scans during the follow-up showed no progression of renal damage. CONCLUSIONS: VUR diagnosed at birth on prenatal ultrasonography is associated with congenital damage, with males affected more often than females. The damage involves both kidneys in a consistent proportion and is an important cause of chronic renal impairment from birth. It does not progress in the first years of life if infections are prevented. It is suggested that males with this condition may constitute a major group at risk of developing chronic renal failure in later life.

Potentiating effect of galanin on GHRH-induced GH release. Comparison between old and young subjects.

The aim of our study was to investigate the effect of galanin on basal and GHRH-stimulated GH secretion in a healthy group of elderly subjects and in a healthy group of young subjects for comparison. Ten old subjects (mean age 75 +/- 1.15 years) and an equal number of healthy young volunteers (mean age 26 +/- 0.71 years) underwent three stimulation tests in random order. Galanin infusion for 60 minutes (10 micrograms/kg in 100 ml saline) failed to provoke an appreciable release of circulating GH in old subjects, while it induced a significant increase of plasma GH in the young adults; GHRH administration i.v. in bolus (100 micrograms in 1 ml saline) elicited a significant GH response in both groups; however, in the older group GH response was significantly (p < 0.05) lower than in the young adults. The administration of galanin (10 micrograms/kg in 100 ml saline as an i.v. infusion for 60 min) plus GHRH (100 micrograms in 1 ml saline i.v. in bolus), potentiated GH response in old and young subjects. The combined administration of two peptides was able to elicit a clear GH release even in the older subjects who were hyporesponsive/unresponsive to galanin and/or GHRH alone. In the elderly, plasma GH values observed after the combined stimuli overlapped with GH values observed after GHRH alone in the young adults. In conclusion, our study confirms that galanin has a synergic effect with GHRH on GH release both in younger and elderly subjects. Moreover, our data confirm an impaired responsivity to GHRH in the elderly and demonstrate that galanin is able to normalize response of somatotrophs to GHRH in old people.

[Retrocaval ureter in children: a rare form of obstructive uropathy]. / L'uretere retrocavale nel bambino: una rara forma di uropatia ostruttiva.

Retrocaval ureter is a rare anomaly, often misdiagnosed for years, presenting with sign of urinary infections and obstruction. Recognition of this anomaly is rare in childhood. We report a case of a 9 years old boy, who was successfully treated by ureteral section, excision of the retrocaval segment and uretero-ureteral anastomosis. Current diagnostic procedures and different methods of treatment are reviewed.

[Infections of the urinary tract persisting in successful outcome of vesico-ureteral reimplants for primary reflux]. / Infezioni delle vie urinarie persistenti in esiti favorevoli di reimpianto vescico-ureterale per reflusso primitivo.

Persistence of urinary tract infections after successful ureteric reimplantation for vesico-ureteric reflux has been reported with an incidence varying between 20-30% according to different series. The Authors analyze their own experience with 99 patients successfully operated for primary VUR during a five year period. In 22 patients (22.2%) there was evidence of persistent UTI, which were almost exclusively low and asymptomatic (91%) and occurring within 6-12 months after the antireflux surgery. A single UTI was documented in over 60% of the patients. There was strong female prevalence (21 patients) and 50% were more than 6 years old. No significant relationship was found between grade of VUR, renal scarring, type of germ and number of preoperative infections and incidence of post-operative UTI. On the other end, voiding and continence disorders and cystoscopic evidence of cystitis cystica would both indicate to be predisposing factors. In these specific cases it is mandatory an accurate pre-operative evaluation of the voiding habits, in order to better define the treatment strategy, not only limited to the surgical correction of the associated reflux.

[Congenital intrapericardial diaphragmatic hernia associated with an omphalocele in a newborn infant]. / L'ernia diaframmatica intrapericardica congenita associata ad onfalocele nel neonato.

The authors present a case of congenital intraperichardic diaphragmatic hernia and omphalocele, diagnosed on post birth day 11. The patient underwent an emergency procedure with evidenced an abdomino-perichardic hernia with perichardic sca due to the presence of a "breach gap" in the central-anterior region of the diaphragm. This rare malformation could be related to a development anomaly of the septum trasversum.

Three years of bacteriological monitoring in the Department of Paediatric Surgery.

The results of three years of bacteriological monitoring in the Department of Paediatric Surgery at the Ospedale Maggiore Ca'Granda in Milan are reported. The tests carried out involved the patients (faeces, urine, and pus cultures), the environment (operating theatre, incubators), and healthy carriers (upper respiratory tract of nursing and paramedical staff). The aetiopathogenesis of the post-operative infectious complications that occurred in 1974-1975 was investigated with the aid of surveys of the causative pathogens, the type of the surgical interventions, the atmospheric pollution in the operating theatre (mean indicative values), the number of operations per month, and the frequency of positive findings among the carriers. As a parallel investigation, between 1971 and the time of writing of this report the authors monitored the resistance to gentamicin of bacteria belonging to the family Pseudomonadaceae isolated from patients, in view of the constant threat posed by the vicinity of the burns department.