Short-term changes in renal function after extracorporeal shock wave lithotripsy in children.

PURPOSE: To our knowledge despite numerous studies the biological effect of extracorporeal shock wave lithotripsy (ESWL, Dornier Medical Systems, Inc., Marietta, Georgia) on the function of the immature kidney has not yet been evaluated. We determined the short-term effect of ESWL on renal function in children. MATERIALS AND METHODS: In a 5-year period 65 children were treated for 77 kidney stones by ESWL and followed regularly at our department. In 16 children the short-term effect of shock wave energy was studied by measuring blood parameters (sodium, potassium, urea, creatinine and C-reactive protein), urinary electrolytes (sodium, potassium and creatinine), urinary enzyme activity (aspartate transaminase, alanine transferase, alkaline phosphatase and lactate dehydrogenase) and the excretion of beta 2-microglobulin. Samples were obtained immediately before and 2 hours after ESWL, and on days 1, 2, 8, 15, 30 and 90 after treatment. RESULTS: Morphological changes in the kidneys were not detected by ultrasound during followup. No significant changes were noted in overall renal function, serum parameters or urine electrolytes. A significant elevation in the excretion of aspartate transaminase, alkaline phosphatase, lactate dehydrogenase and beta 2-microglobulin was observed, indicating proximal tubular dysfunction and cell destruction. Enzyme levels returned to baseline within 15 days. CONCLUSIONS: Our results demonstrate that shock wave energy induces transient functional damage of tubular function in children. Minimizing the kV. and number of shocks may decrease the deleterious effect. When considering functional regeneration time, the minimal interval between 2 shock wave treatments should be at least 15 days. The long-term effect needs further investigation.

High frequency of metastatic Leydig cell testicular tumours.

690 patients were treated for testicular tumour in the course of 18 years. The histology of 7 cases showed Leydig cell tumour. In 4 of the 7 cases, a metastatic process leading to death was observed. At the time of diagnosis, 5 patients were found to have low stage, whereas 2 of the patients had advanced lymphatic involvement. The hematogenous and lymphatic metastases proved to be resistant to chemotherapy. Contrary to the major part of the literature, retroperitoneal lymphadenectomy should be performed with this histological type for the exact pathological staging immediately following orchiectomy.

[Extracorporeal shockwave therapy in childhood]. / Húgyúti kövek extracorporalis lökéshullámú kezelése gyermekkorban.

In 27 children aged 4-17 years extracorporeal shock wave lithotripsy (ESWL) was performed for renal and ureteral calculi between January 1 1993 and December 31 1994 at the University Medical School of Pécs. A total of 32 calculi was treated requiring 34 ESWL sessions. All treatments were done with the standard Dornier Compact Mobile Lithotripter device. The mean size of the stones was 10.65 mm and the number of shock waves averaged 2607. No serious intraoperative or postoperative complications were encountered. No auxiliary procedures were performed. The stonefree rate was 27/32 stones (84.4%) 3 months after treatment. 5 patient has residual stone fragments. Lithotripsy using Dornier Compact Mobile device in our series of pediatric patients was found safe and effective.

Therapy of gonadal stromal cell testicular tumours.

At our regional centre, 504 patients with testicular tumour were treated from 1 January 1980 to 31 December 1993. In the course of the treatment, 10 patients (2%) with gonadal stromal cell testicular tumours were found. Histopathological examination identified Sertoli cells in 3 cases, granulosa cells in 1 case, and Leydig cell primary tumours in 6 cases. Leydig cell testicular tumours, the most significant clinically, should not be regarded as benign. In 3 of 6 cases metastatic processes developed. Three patients died in spite of the surgical and chemotherapeutic interventions. Analysis of these cases suggests that, following the semicastration of Leydig cell testicular tumours, a primary retroperitoneal lymph node dissection should be performed, and an exact identification of the pathological stage should be carried out.

An assessment of simple referee methods for the prediction of lean in pig carcasses.

A study was carried out in which carcass characteristics of 36 gilts were evaluated: 18 originated from the Hungarian 'Hungahyb' cross-breed, another 18, with undefined genetic background, from small private household plots. Two, rather simple substitute reference methods, called referee methods, were evaluated: measurement of carcass weight without skin and subcutaneous fat ('meat + bone'), and measurement of carcass weight without skin, subcutaneous fat and bone ('boneless meat'). Both methods gave a rather close relationship with the Kulmbach reference lean; however, removal of bone had presumably a beneficial effect on stability of prediction. The importance of preliminary information in quantitative form, giving a theoretical background for prediction equations, was presented as an example. Simple material balances could be formulated between reference lean and 'meat + bone' or 'boneless meat' content. Such material balances could not be set up with the indirect, rapid surrogate methods using mainly linear measurements (e.g. fat and muscle thickness, etc.) For this reason, as several other publications demonstrated, these latter methods seem to be more susceptible to bias than the referee methods. By determining the lipid content of the homogenised 'boneless meat' component, a 'lean' value adjusted to 3% fat content could be calculated from data which was compared to the dissected reference lean standardised also to contain 3% fat. These relationships, for several reasons discussed in this paper, were not as close as expected. So, further studies are needed to reveal these discrepancies.