[Treatment of childhood vesicoureteral reflux with sub-ureteral injection of teflon paste]. / Gyermekkori vesicoureteralis reflux kezelése Teflon-paszta suburetericus injektálásával.

From March 1989 to october 1990, 35 refluxing ureters in 25 children were treated by submucosal injection of Teflon (STING). The overall success rate was 54% after the first injection. The authors detail the procedure and analyse their results which demonstrate that Teflon injection can be safe and effective treatment of vesicoureteral reflux in most cases can replace antireflux surgery.

Carnitine content of red blood cells of human subjects treated with pivampicillin and carnitine.

Total- and free carnitine content of washed pooled red blood cells collected from five children prior to and on the last day of combined pivampicillin and equal molar carnitine treatment were measured. On the last day of treatment (day 7) the level of total carnitine decreased from 47.5 +/- 3.39 to 37.5 +/- 2.48 nmol/ml, mean +/- SEM (p less than 0.05) with a concomitant decrease of free carnitine (from 19.2 +/- 0.97 to 15.5 +/- 0.99 nmol/ml, p less than 0.05) as compared with the pretreatment control day (day 0). The calculated amount of acid soluble carnitine esters also fell (from 28.2 +/- 3.38 to 21.9 +/- 1.78 nmol/ml). The same effects were found when the carnitine levels were referred to haemoglobin or water content of samples. These results demonstrate that in pivampicillin treatment the carnitine pool of erythrocytes also alters. In agreement with previous findings the data presented here suggest, that the administered carnitine was not sufficient to meet the enhanced needs of the organism caused by the pivalate load and that the organism utilized some of its stores for pivaloylcarnitine production. The decreased carnitine ester level of erythrocytes suggest, that the red blood cells do not participate in significant extent in pivaloylcarnitine transport or production.

Differential excretion of xenobiotic acyl-esters of carnitine due to administration of pivampicillin and valproate.

The fate of supplemental carnitine was studied in human subjects treated with drugs known to cause carnitine deficiency. Six children were treated with pivampicillin and equimolar L-carnitine for 7 days. On the last day of treatment, the plasma levels of total and free carnitine were decreased, but acylcarnitine levels were increased. A 12-fold increase in urinary excretion of acylcarnitines was found; it increased from 188.5 +/- 82.7 to 2218.4 +/- 484.1 mumole/day, and 84% was pivaloylcarnitine. Free carnitine excretion was reduced. Ten epileptic children on chronic valproate treatment received equimolar carnitine for a 2-week period. Plasma carnitine levels were elevated on the last day of treatment. A 3.4-fold increase in urinary acylcarnitines was found, but most of the excreted carnitines were free (64.5-fold increases). These data show that pivalate is readily converted to carnitine esters, in contrast to the limited conversion of valproate to acylcarnitines in humans.

Long-term follow-up of patients with persistent/recurrent, isolated haematuria: a Hungarian multicentre study.

A retrospective multicentre study of 341 children with persistent/recurrent, isolated haematuria is described. The haematuria was isolated for at least 6 months at the beginning of observation. The duration of follow-up was 2-5 years in 201, 5-10 years in 119, 10-15 years in 19, and over 15 years in 2 cases. Of these patients 47.8% became symptom-free. In 18.4% the haematuria remained isolated; in 13.8% it was combined with proteinuria over 250 mg/day more than 2 years later. The occurrence of associated proteinuria increased progressively with time. It was 8.6% between the 3rd and 5th years, and 37.0% after the 5th year. Renal biopsy was performed because of the symptoms of glomerular disease in 47 cases at an average time of 12 months following the appearance of proteinuria. Proteinuria appeared after a 2-5, 5-10, 10-15 and more than 15 years follow-up period in 16, 23, 6, and 2 patients respectively; 14 of them had Alport's nephropathy. The percentage of more serious azotaemia was 1.7 (creatinine clearance: 10-50 ml/min per 1.73 m2) and 0.3 (creatinine clearance: less than 10 ml/min per 1.73 m2). Mortality was 0.58%. Most of the patients who developed severe azotaemia had persistent microscopic haematuria at the beginning. The prevalence of hypertension was only 1.2%. The time of its appearance was above 5 years in 2 and below 5 years in 2 cases. All these patients had chronic glomerulonephritis. The haematuria was associated with hypercalciuria in 19.9%. In 14.3% of the overall group of patients urolithiasis developed 2-15 years after onset. All of these had hypercalciuria.(ABSTRACT TRUNCATED AT 250 WORDS)

[Long-term follow up of chronic recurrent isolated hematuria]. / A folyamatos, ill. gyakran ismétlödö, izolált haematuria tartós gondozásának tapasztalatai.

A retrospective multicentre study of 341 children with persistent/recurrent, isolated haematuria is described. The haematuria was isolated for at least half a year in the beginning of observation. 47.8% of the patients became symptom-free. In 18.4% the haematuria remained isolated, in 13.8% it was combined with greater than 250 mg/day proteinuria greater than 2 years later. The occurrence of associated proteinuria was 8.6% between the 3rd to fifth years, and 37.0% after the 5th years. 14 cases had Alport's nephropathy. The percentage of more serious azotaemia was 1.7 (Ccreat: 10-50 ml/min/1.73 m2) and 0.3 (Ccreat: less than 10 ml/min/1.73 m2). Mortality was 0.58%, rate of hypertension 1.2%. Most of the patients who developed severe azotaemia, had persistent microscopic haematuria in the beginning. The haematuria was associated with hypercalciuria in 19.9%. In 14.3% of the overall group of patients urolithiasis developed 2-15 years after onset. All of them had hypercalciuria. Our findings suggest that symptoms of isolated haematuria may last for a long-term period and need systematic control. When proteinuria and/or hypertension associates to haematuria a worse prognosis can be expected.

Medical treatment of vesicoureteral reflux detected in infancy.

Between 1970 and 1982, 41 neonates and infants with grades II and III vesicoureteral reflux (international classification) but with no medical or urological complications were treated medically and followed for an average of 7.5 years. In 33 of the 41 patients the vesicoureteral reflux resolved (group 1) and in 8 it persisted (group 2). The severity and frequency of urinary infection decreased to a greater degree in group 1 (p less than 0.0005) than in group 2 (p less than 0.05). There was no difference in endogenous creatinine clearance between the 2 groups. Comparison of kidney length and bipolar parenchymal thickness revealed that bipolar parenchymal thickness was significantly less in group 2 patients (p less than 0.01). Body weight tended to increase in both groups but it was greater in group 1. In both groups height was lower at the time of detection of reflux and it approached nearly normal values during followup. It is tempting to conclude that early recognition of mild forms of vesicoureteral reflux (grades II and III) and systematic medical treatment can preserve renal function and promote renal and somatic growth. However, this tendency is less pronounced in patients with persistent reflux.

Transverse diameter of the chest and of the heart of infants in the course of physiological cardiorespiratory adaptation.

The morphology of the lungs and heart was analysed in 824 newborn infants with normal cardiorespiratory adaptation. Under normal conditions, the air content of the lungs became satisfactory in the first 6--12 hours and normal in all cases after 24 hours. The values for the transverse diameter of the chest and heart were brought into correlation with birth weight, body length and gestational age. The transverse diameter of the chest and heart did not change during the early postnatal period (between 6--12 hours and 5 days). Both diameters were correlated with birth weight. The closest correlation was found in newborns under 1500 g, a varying one in those between 1500 and 2000 g and a close correlation in the category over 2000 g. The correlation of the two diameters with both length was linear and close, without any difference between the values obtained at different times of examination. A rather loose correlation was found between the transverse diameter of the chest and heart, and gestational age.