ABSTRACT
The varying clinical manifestations of Lyme borreliosis, transmitted by Ixodes ricinus and caused by Borrelia burgdorferi, frequently pose diagnostic problems. Diagnostic strategies vary between early and late disease manifestations and usually include serological methods. Erythema migrans is pathognomonic and does not require any further laboratory investigations. In contrast, the diagnosis of neuroborreliosis requires the assessment of serum and cerebrospinal fluid. Lyme arthritis is diagnosed in the presence of newly recognized arthritis and high-titer serum IgG antibodies against B. burgdorferi. The committee concludes the following recommendations: Borrelial serology should only be ordered in case of well-founded clinical suspicion for Lyme borreliosis, i.e., manifestations compatible with the diagnosis. Tests for borrelial genomic sequences in ticks or lymphocyte proliferation assays should not be ordered. When results of such tests or of serological investigations that were not indicated are available, they should not influence therapeutic decisions. Laboratories should be cautious when interpreting results of serological tests and abstain from giving therapeutic recommendations and from proposing retesting after some time without intimate knowledge of patient's history and disease manifestations.
Subject(s)
Borrelia burgdorferi/isolation & purification , Lyme Disease/diagnosis , Adolescent , Animals , Antigens, Bacterial/immunology , Arthritis, Infectious/diagnosis , Borrelia burgdorferi/immunology , Child , Erythema Chronicum Migrans/diagnosis , Humans , Ixodes/microbiology , Lyme Disease/blood , Lyme Disease/cerebrospinal fluid , Lyme Neuroborreliosis/diagnosisSubject(s)
Adolescent Health Services/organization & administration , Child Health Services/organization & administration , Comprehensive Health Care/organization & administration , Delivery of Health Care/organization & administration , Adolescent , Child , Forecasting , Germany , Hospital Departments , Humans , Pediatric NursingABSTRACT
In a number of diseases in childhood (vesico-ureteral reflux, myelodysplasia, recurrent urinary tract infection, enuresis) it is important to evaluate the functional patterns of the micturition phase. The therapeutic regimen is influenced especially by changes of the urethral flow resistance. The value of urodynamic methods which are available for the characterization of the micturition phase is limited because of the small anatomic conditions in childhood. The presented method of measurement of the intraurethral urinary flow using an ultrasound doppler technique is recommended as an alternative technique because of its superior diagnostic safety and unrestricted application in childhood.
Subject(s)
Ultrasonography/instrumentation , Urination Disorders/diagnosis , Urodynamics , Child , Female , Humans , Image Interpretation, Computer-Assisted/instrumentation , Male , Urethra/physiopathology , Urination Disorders/physiopathologySubject(s)
Urination Disorders/physiopathology , Urodynamics , Adolescent , Child , Enuresis/physiopathology , Female , Humans , Male , Myelodysplastic Syndromes/physiopathology , Urinary Bladder/physiopathology , Urinary Bladder, Neurogenic/physiopathology , Urinary Tract Infections/physiopathology , Vesico-Ureteral Reflux/physiopathologySubject(s)
Arginine Vasopressin , Deamino Arginine Vasopressin , Kidney Concentrating Ability/drug effects , Kidney Function Tests/methods , Administration, Intranasal , Adolescent , Child , Child, Preschool , Humans , Infant , Infant, Newborn , Reference Values , Water-Electrolyte Balance/drug effectsSubject(s)
Kidney Concentrating Ability , Pyelonephritis/urine , Urine/analysis , Adolescent , Child , Child, Preschool , Chronic Disease , Conductometry , Female , Humans , Male , Pyelonephritis/physiopathology , Recurrence , Reference Values , UrodynamicsABSTRACT
In 48 patients a heminephrectomy was carried out on account of a chronic relapsing pyelonephritis when a double kidney was present which for the largest part was combined with vesico-ureteral reflux, pyelectasia and hypertension. The partly severe histologic changes found in more than 80% in the resection preparation confirmed the supposition that in the majority of the cases the chronic relapsing inflammation issues from the hypoplastic renal pole with a decreased function. Also the courses observed in more than 3/4 which had no recidivation after operation show the possibility of the causal-surgical therapy in chronic relapsing pyelonephritis with double kidney, when the indication is correct.
Subject(s)
Kidney/abnormalities , Nephrectomy , Adolescent , Child , Child, Preschool , Chronic Disease , Female , Humans , Infant , Kidney/surgery , Male , Pyelonephritis/surgery , RecurrenceABSTRACT
By a nephroptosis already in childhood an obstruction of the urine flow with reduction of the drainage effect and thus the appearance of a pyelonephritis may develop. Changes at the vascular pedicle are also possible on account of the abnormal mobility of the kidneys so that without treatment from there may result parenchymatous and functional lesions which, as a rule, become manifest only at adult age. On the basis of own experiences which support themselves on the results of 29 children with nephroptosis we recommend the nephropexy in childhood. The operation is an active prophylaxis of the pyelonephritis caused by nephroptosis with its deleterious sequelae.
