Diagnostic workup of urinary tract infections within the first 24 months of life, in the era of prenatal diagnosis. The contribution of different imaging techniques to clinical management.

AIM: The aim of this study was to evaluate the role of different techniques in the diagnostic workup of children with negative prenatal ultrasonogram, referred for urinary tract infection (UTI) within the first 24 months. METHODS: One-hundred and forty-seven patients, 71 males/76 females were studied. All patients were submitted to renal ultrasonogram (RUS) and to micturating cystourethrogram (MCU) independently from the results of RUS. In a small group (48 children) DMSA scan was performed independently from the results of RUS and MCU. Sensitivity and predictive value of RUS for vesicoureteric reflux (VUR) were estimated. Multiple regression analysis was performed on a selected number of signs to evaluate their predictive value. The group investigated by DMSA scan was analysed to evaluate how the presence of VUR on MCU anticipated renal damage. RESULTS: Nineteen (21%) patients with normal RUS, had VUR. Predictive value of RUS (0.21) was influenced by the grade of the VUR but more than 30% of high grade refluxing renal units appeared normal at initial ultrasonography. DMSA scan was abnormal in 27% of 48 patients; its result was independent from the presence of VUR of whatever grade. CONCLUSIONS: The increasing number of renal abnormalities detected before birth reduces the possibility of late abnormal RUS findings. It makes RUS screening for abnormalities, after a first episode of UTI, scarcely useful. VUR may be easily missed when RUS resulted normal and MCU is omitted. Negative MCU cannot exclude renal damage in presence of UTI. Renal defects at DMSA scan may be unrelated to a demonstrable VUR and could have a different pathogenesis.

Endometrial adenocarcinoma and life expectancy in elderly women.

One hundred and six patients with endometrial adenocarcinoma, aged over 70 years, admitted to Gynaecologic Oncological department of Gynecology and Obstetrics Institute of Padua University, from 1/01/1974 to 31/12/1994, were studied. The life expectancy of these women was good, with a personalized abdominal or vaginal surgery, alone with or without lymphadenectomy, or, in advanced stages, associated with integrated therapies. In our case series an increasing frequency of this neoplasia in elderly women appears significant.

Use of 131I-19-cholesterol in functional dynamic studies of the adrenals in vivo. II. Clinical application.

Functional dynamic studies of the adrenal in vivo employing 131I-19-cholesterol were carried out as a further screening test, according to the method previously described (Pavonia and Magrini, 1977), on seven patients in whom hyperadrenocorticism was suspected on the basis of clinical symptoms. The data obtained in basal conditions, under ACTH stimulation, and under dexamethasone suppression, compared with each other and supported by the results of conventional examinations, demonstrate that the quantitative information provided by this radioisotope test is correlated with the functional state of each adrenal, thus confirming the potential value of the method for diagnostic purposes. The functional dynamic test proposed does not require a higher dose of tracer than morphologic studies and the radiation risk (approximately 2.5 rad to the ovaries or gonads) seems acceptable in adult subjects.