[Usefulness of ultrasound in the diagnosis of vesico-ureteral reflux in neonates and infants]. / Az ultrahangvizsgálat alkalmazhatósága újszülött- és csecsemökori vesicoureteralis reflux gyanúja esetében.

PURPOSE: Postnatal ultrasound (US) findings were assessed in an infant population with primary vesicoureteral reflux (VUR) and the findings of voiding cystourethrography (VCUG) were compared with those of sonography. MATERIALS AND METHODS: Between 1988 and 1997 55 babies (43 boys and 12 girls) with primary VUR were diagnosed. US criteria for suspected VUR included unexplained or transient fullness of the collecting system, pelvic wall thickening and signs of renal dysplasia. RESULTS: Among 55 patients reflux was unilateral in 32 cases, and bilateral in 23 patients, altogether 78 refluxing units were investigated. VUR Grade III-V, were detected in 62 units (79%). At least one US anomaly was present in 66 units (85%). No ultrasound anomaly was found in 12 renal units (15%). In 34 cases (44%) conservative treatment was performed, 40 renal units (51%) underwent ureteric reimplantation, and in 4 (5%) cases nephrectomy was carried out. CONCLUSIONS: The correct detection and grading of reflux is not reliable by sonography, although with careful US examination of the neonatal urinary tract in 85% of VUR cases at least one sonographic abnormality has been found. However, the US negative group, (15%) showed severe reflux on VCUG in a few cases. Therefore, all neonates with ultrasound pathology of unknown origin detected prenatal or postnatal, should undergo VCUG to exclude VUR.

The role of ultrasound in the follow-up of postoperative changes after pyeloplasty.

BACKGROUND: Pyeloplasty is an established treatment for pelviureteric junction (PUJ) obstruction. The postoperative change in the size of the renal pelvis and the kidney parenchyma are variable. OBJECTIVE: To document the changes in renal pelvic size and renal parenchymal thickness following pyeloplasty and to establish that improvement of both parameters are good markers for improved urine flow. MATERIALS AND METHODS: A group of 267 newborns and young infants with suspected PUJ obstruction were investigated by ultrasound. Pyeloplasty was performed on 102 babies, and 165 patients were followed conservatively. Postoperative ultrasonography at 6 and 12 months was available in 88 patients. RESULTS: One year after surgery, the renal pelvis was smaller in 76 % of the cases. The renal parenchyma was normal or had increased in 92 % of cases. CONCLUSION: Resolution of hydronephrosis after surgery is relatively slow, but renal parenchymal growth is rapid. Mild postoperative pelvic dilatation is frequent and does not indicate continued obstruction.

Renal excretion of endothelin in children.

Endothelin (ET) is a peptide with profound vasoconstrictive potential. First isolated from porcine endothelial cell supernatant, it is produced also by smooth muscle, epithelial and circulating cells. Besides vasoconstriction, a wide spectrum of biological activities of ET (via activation of membrane receptors) has been described. These include regulation of other hormones and neurotransmitters, cellular growth and proliferation, bronchoconstriction, and, in the kidney, natriuresis and water diuresis. ET exerts its effects mainly in an autocrine and paracrine fashion. A high concentration of ET is found in urine, compared with plasma originating mainly from the kidney itself. In this review we focus on the role of urinary excretion of ET in children. ET excretion was determined under different physiological and pathological conditions. In premature infants and newborns, the daily excretion of ET (corrected for body surface) was higher than in older children; it was constant, and comparable to the values in healthy adults after the age of 2 years. Renal ET excretion correlated positively with urine flow in both healthy and sick children. Conditions with tubular and/or collecting duct cell damage, such as severe hypoxia, hemolytic-uremic syndrome, renal transplantation, diabetes mellitus, chronic renal failure, and contrast media cytotoxicity were characterized by elevated urinary excretion of ET. In conclusion, the renal excretion of ET is influenced by several factors, probably reflecting the intrarenal ET production. ET has a low specificity with regard to renal injury.

[Diagnosis of neonatal liver hemangioma]. / Az újszülöttkori májhaemangioma diagnosztikája.

The hepatic hemangiomas of infancy are rare, benign vascular tumours, differentiated in their morphologic and clinical appearances. They may manifest either as asymptomatic liver masses, or with the potentially fatal complication of congestive heart failure. They can be large in infancy, act as arteriovenous fistulas and may result in massive arteriovenous shunt. Multiple imaging modalities have been employed in the diagnosis, including ultrasonography (US), computed tomography (CT), radionuclide studies, angiography, magnetic resonance (MR) imaging. Generally the US, Doppler and CT appearances of hepatic hemangiomas may be diagnostic. Biopsy in often needed for diagnosis, especially if classic signs and symptoms are lacking. The diagnostic possibilities and difficulties in three patients are discussed. Different US images were present in all three cases, with atypical CT appearance in one. Doppler signals were lacking in two cases. Sonographic appearance of infantile hepatic hemangioma is variable, non-specific, but Doppler US is useful as a non-invasive method in the follow-up of hemangiomas.

Elevated urinary excretion of endothelin in insulin-dependent diabetes mellitus: no influence of physical exercise.

The urinary excretion of endothelin was measured by radioimmunoassay in children with diabetes mellitus in metabolically stable condition before and after ergometric exercise. Apparently healthy children served as normal controls. The excretion of endothelin, calculated for 24h and the ratio of endothelin/creatinine in urine were also significantly higher in diabetic children compared to normal controls. Physical exercise had no influence on renal endothelin excretion. In diabetic children the volume of diuresis was higher compared to controls. Physical exercise had no influence on diuresis. In a previous study we found a positive correlation between diureses and endothelin excretion. Therefore, the increased endothelin excretion in the diabetic patients may be at least partially the consequence of the higher diuresis values. It cannot be excluded, however, that it may be a sign of altered renal function as well. Furthermore, the present study suggests that in patients with diabetes mellitus elevated sympathetic nerve activity as a result of physical activity does not influence renal endothelin production.

[Postoperative ultrasonic studies in infants undergoing surgery for pyeloureteral obstruction]. / Posztoperatív ultrahangvizsgálatok pyeloureteralis obstructio miatt operált csecsemöknél.

134 newborns and young infants were investigated by ultrasound because of pelviureteric junction obstruction. Operation has been performed in 47 babies, 87 patients were followed nonoperatively. The results of the ultrasound studies were elaborated in 35 patients in 6 and 12 months postoperatively. One year after surgery pyelectasy decreased in 77 percent of the cases, the size of the renal parenchyma was normal or increased in the 91 percent of the cases. The postoperative mild dilatation of the pelvis is often observed without any sign of obstruction.

Endothelin excretion during ketoacidosis does not correlate with tubular dysfunction.

Urinary excretion of endothelin was measured by radioimmunoassay in children with diabetes mellitus during severe ketoacidosis and 12 days later when blood pH and blood glucose concentrations were normal. Metabolically stable diabetic children served as controls. Results from apparently healthy children without diabetes mellitus were used as normal values. Renal tubular injury was evaluated by the urinary excretion of the proximal tubular marker alpha 1-microglobulin and the distal tubular marker Tamm-Horsfall protein (THP). During ketoacidosis we detected a decreased glomerular filtration rate associated with highly significant changes in the excretion of alpha 1-microglobulin, indicating proximal tubular damage, and THP, suggesting disturbance of cells of the ascending loop of Henle. The daily excretion of endothelin was unaltered but the ratio of endothelin/creatinine or endothelin excretion/creatinine clearance were significantly enhanced. In conclusion, we could demonstrate that, despite a proximal and distal tubular cell dysfunction, endothelin excretion is not elevated during ketoacidosis. The increased endothelin excretion when related to creatinine clearance may be a consequence of disturbed proximal tubular function or dysfunction of the renal medulla.

Renal excretion of endothelin in children is influenced by age and diuresis.

Endothelin is a peptide with vasoactive and diuretic potential. Its release has been demonstrated from endothelial and renal epithelial cells. Urinary excretion of endothelin, as shown by others, is thought to reflect intrarenal production. We measured endothelin by RIA in a population of healthy children from Germany and Hungary (group 1), neonates (group 3) and children before and during forced diuresis (groups 2a and 2b). Group 1 consisted of 24 children living in Germany and 13 children resident in Hungary. The age range in this group was 2.9-17 years. Daily excretion correlated significantly with age (r = 0.48, p < 0.001), but endothelin excretion corrected for body surface area remained constant with regard to the age group studied. This indicates that body or kidney size may influence endothelin excretion, respectively. There was no difference in endothelin excretion between the two countries. In premature infants and neonates (group 3), daily excretion of endothelin was highest in infants with very low gestational ages and decreased in full-term neonates to values not significantly different to the group of older children. The high values in premature infants may have been influenced by mechanical ventilation of physical stress, which cannot be differentiated in this study, however. In contrast to reported results in adults, renal excretion of endothelin was correlated positively to urine flow in all groups. Furthermore, the influence of forced diuresis was evaluated in 10 children with oncological disease before (group 2a) and during (group 2b) forced diuresis with fluid load (3 l/m2; n = 4) and fluid load with furosemide injection (0.3-1.0 mg/kg body weight; n = 6).(ABSTRACT TRUNCATED AT 250 WORDS)

[Obstructive ectopic ureterocele: review of the literature in the light of the authors' own experience]. / Obstructiv, ectopiás ureterokele: irodalmi áttekintés, saját eseteink tükrében.

The epidemiology, clinical presentation, evaluation and methods of surgical management of ectopic ureteroceles was studied. The prenatal detection of hydronephrosis of the upper pole of duplex systems allows early surgical correction, and this effectively decreases the risk of urinary tract infection, urosepsis and irreversible loss of renal function. Yet a precise prenatal diagnosis of accompanying ureterocele is not necessary for efficient postnatal management.

[Extrahepatic cholestasis in infancy and childhood: the role of ultrasonography]. / Extrahepaticus cholestasis csecsemö- és gyermekkorban: az ultrahangvizsgálat jelentösége.

Of 23 children with extrahepatic cholestatic syndromes, who were studied with sonography, there were found to have biliary atresia, choledochal cyst, cholelithiasis, stenosis of bile duct, gallbladder duplication, cholecystitis. Ultrasonography is the most useful initial investigation of choice, and in most of the cases the only investigation.

[Pelvic masses in childhood: ultrasonographic imaging]. / Kismedencei terimék gyermekkorban: az ultrahangkép sajátosságai.

The echographic appearance of pelvic masses in children was examined in 38 patients. Sonography was correct in determining the site of origin in all cases. Cystic uterine masses and cystic ovarian masses were the most specific, representing hydrometrocolpos and benign ovarian cysts. A nonspecific sonographic pattern was encountered with complex masses, which proved to be ovarian teratomas, hemorrhagic ovarian cysts and pelvic abscesses. Although a number of characteristic features of teratomes have been described, these signs were seen very rarely in children.

[Importance of pre- and post-natal ultrasonic examination in neonatal hydronephrosis]. / A prae- és postnatalis ultrahangvizsgálat jelentösége az újszülöttkori hydronephrosisban.

The widespread use of obstetric and neonatal sonography has resulted an increasing number of neonatal hydronephrosis, and some of them are asymptomatic. From November 1987 to May 1990 49 neonates with hydronephrosis or multicystic dysplastic kidney were seen. The most common conditions found were obstruction of the distal ureter (10), multicystic dysplatic kidney (12). Fifty-three percent of the cases were discovered on fetal screening during obstetric sonography, seven of them were asymptomatic at birth, but 4 of the asymptomatic babies underwent operation in the neonatal period. Nine of the postnatal diagnosed cases were incidental findings. The major benefit of prenatal echography is to allow early recognition of major uropathic conditions before postnatal infection worsens the prognosis. A correct postnatal ultrasound diagnosis was established in all cases.

[Prenatal diagnosis and postnatal management of urologic abnormalities. Review and personal experiences]. / Pränatale Diagnostik und postnatales Management der urologischen Fehlbildungen. Ubersicht und persönliche Erfahrungen.

The possibilities and the difficulties of prenatal ultrasonography in detecting fetal renal abnormalities are discussed in this review article. The consequences of prenatally diagnosed uropathies are: intrauterine surgery, termination of pregnancy, induction of premature labour and an optimal preparation for the immediate postnatal diagnosis and management.