ABSTRACT
OBJETIVO: Analizar la utilidad de la ecografía realzada con un medio de contraste ecopotenciador (ecocistografía) para diagnosticar el reflujo vesicoureteral, comparando los resultados de esta nueva modalidad de imagen con los de la cistouretrografía miccional convencional (CUMS). PACIENTES Y MÉTODOS: Se incluyeron 169 pacientes (293 unidades renales) con edades comprendidas entre 3 días y 18 años y se estudiaron con ultrasonidos para valorar la existencia de reflujo vesicoureteral, después de rellenar la vejiga con suero salino mezclado con una suspensión de galactosa y ácido palmítico (Levograf(r)) que actúa como agente ecopotenciador. Se obtuvieron imágenes ecográficas tanto durante el llenado vesical como durante la micción. Esta exploración fue siempre seguida de una CUMS durante la misma sesión diagnóstica. RESULTADOS: En 50 unidades renales se detectó reflujo vesicoureteral pasivo tanto en ecocistografía como en la CUMS. En 22 unidades se detectó reflujo pasivo únicamente en la ecocistografía y en tres se detectó reflujo pasivo en la CUMS y la ecocistografía fue negativa. En 56 unidades renales se detectó reflujo activo por ambos procedimientos. En 17 unidades se objetivó reflujo activo en la ecocistografía y la CUMS fue normal y en cinco se observó reflujo activo en la CUMS y la ecocistografía no consiguió demostrarlo. Considerando el reflujo globalmente, de las 293 unidades renales totales, en 204 (69,6 por ciento) no se encontró reflujo vesicoureteral por ninguno de los dos procedimientos y en 63 (21,5 por ciento) unidades se detectó reflujo en ambos, independientemente de si éste era activo o pasivo. En 19 unidades se observó reflujo vesicoureteral (activo o pasivo) sólo en la ecocistografía y en siete unidades se encontró únicamente en la CUMS. La sensibilidad de la ecocistografía para detectar reflujo frente a la CUMS fue del 90,5 por ciento y la especificidad del 91,4 por ciento. CONCLUSIÓN: La ecocistografía es una modalidad de imagen útil para diagnosticar el reflujo vesicoureteral, suficientemente sensible y específica, y presenta la ventaja sobre la CUMS de que no es necesario utilizar radiaciones ionizantes (AU)
Subject(s)
Child , Child, Preschool , Adolescent , Male , Infant, Newborn , Infant , Female , Humans , Sensitivity and Specificity , Sex Factors , Vesico-Ureteral Reflux , Models, Theoretical , Contrast Media , Age Factors , Kidney , Image Enhancement , Fluoroscopy , Urinary BladderABSTRACT
AIM: To analyze the utility of contrast enhanced ultrasonography of the bladder and kidneys (cystosonography) for the diagnosis of vesicoureteral reflux (VUR) by comparing the results of this new imaging modality with those of micturating cystourethrography (MCU). PATIENTS AND METHODS: A total of 169 patients (293 kidney units) aged between 3 days and 18 years were sonographically evaluated for the presence of VUR after filling the bladder with saline and a galactose and palmitic acid suspension (Levograf) as an echoenhancing agent. Ultrasonographic images were obtained during bladder filling and micturation. This procedure was always followed by MCU during the same diagnostic session. RESULTS: In 50 kidney units both cystosonography and MUR detected VUR during bladder filling. In 22 units, only cystosonography detected passive reflux during bladder filling and in 3 only MCU did so. In 56 units, both methods detected active VUR during micturation. In 17 units, only cystosonography detected active reflux during micturation, the results of MCU being normal, and in 5, only MCU detected active reflux. Overall, of the 293 kidney units, VUR was not detected by either of the imaging modalities in 204(69.6%) and was detected by both methods, irrespective of whether it was active or passive, in 63(21.5%). In 19 units, VUR (active or passive) was observed only by cystosonography and in 7 only by MCU. When MCU was used as the reference method, cystosonography had a sensitivity of 90.5% and a specificity of 91.4%. CONCLUSIONS: Contrastenhanced cystosonography is a reliable modality, with sufficient sensitivity and specificity in the diagnosis of VUR and does not expose patients to ionizing radiation.
Subject(s)
Vesico-Ureteral Reflux/diagnostic imaging , Adolescent , Age Factors , Child , Child, Preschool , Contrast Media , Female , Fluoroscopy , Humans , Image Enhancement , Infant , Infant, Newborn , Kidney/diagnostic imaging , Male , Models, Theoretical , Sensitivity and Specificity , Sex Factors , Ultrasonography , Urinary Bladder/diagnostic imagingABSTRACT
We studied the birthweight by gestational age and sex from a population of 14,097 liveborns without congenital defects who were monitored by the Spanish Collaborative Study of Congenital Malformations (ECEMC). We have calculated the curves of percentiles for gestational age in males and females. As our sample size is very large, and it includes births from almost the whole country, we think these curves are enoughly representative of the Spanish population, fitter than the Denver's (1) which are widely utilized. On the other hand, we stress our attention in making curves of birthweight for malformed and not malformed babies separately.
Subject(s)
Birth Weight , Congenital Abnormalities , Female , Gestational Age , Humans , Infant, Newborn , Male , SpainABSTRACT
We analyzed the effect that number of gestations, smoking and number of cigarettes per day during pregnancy have on the birthweight using a sample of 14,097 liveborns without birth defects identifiable within the first three days of life. To our purposes, we controlled the effect of gestational age, sex and maternal age through multiple regression analysis. From the results we concluded that the birthweight is increased 39.80 g per each pregnancy of mothers, showing a progressive but smoothed increase by a negative quadratic effect. Smoking in mothers decreases the weight of newborns and has no effect on the gestational age. The decrease of birthweight was stronger when we looked at the number of cigarettes per day, showing a diminishing trend when the number of cigarettes per day, showing a diminishing trend when the number of cigarettes is increased, but again smoothed by a positive quadratic effect. From the multiple regression analysis controlling some factors we got a formula that permitted to us to estimate the average in decreasing weight depending on the number of cigarettes that mother smokes during pregnancy.
