Prognostic value of the acute DMSA scan in children with first urinary tract infection.

We attempted to verify in a group of 101 children with first urinary tract infection whether it was possible to identify groups of patients with different risks of developing renal scarring by taking into account both the extent of kidney involvement documented in the acute phase of infection using a dimercaptosuccinic acid (DMSA) scan, and the presence or absence of vesicoureteral reflux (VUR). The frequency of persistent lesions in kidneys with mild-moderate lesions (less than 50% of kidney involvement) in the presence of VUR or in non-refluxing kidneys was similar (P=0.1447), while the frequency of persistent lesions in kidneys with severe lesions in the presence of VUR was significantly higher than the frequency of persistent lesions in non-refluxing kidneys (P=0.0089). The extent of kidney involvement and the presence of VUR make possible the identification of different categories of risk of scarring: in the "low risk group" (normal kidney with/without VUR) the risk of scarring is 0%; in the "intermediate risk group" (mild lesions with/without VUR; extensive lesions without VUR) the risk of scarring is between 14% and 38%, while in the "high risk group" (extensive lesions with VUR) the risk of scarring is 88%. Quantifying the risk of scarring could help in planning the treatment or in modifying the later strategy.

Acute renal cortical scintigraphy in children with a first urinary tract infection.

This prospective study, performed in 101 children with a first symptomatic urinary tract infection (UTI), evaluates the diagnostic value of clinical, biological, and ultrasound parameters in detecting children with acute renal infection documented by dimercaptosuccinic acid (DMSA) scintigraphy. In children with a positive DMSA scan, mean C-reactive protein (CRP) was higher than in children with a normal DMSA scan (114+/-64 vs. 67+/-38 mg/dl, mean+/-SD, P=0.0002). The sensitivity and specificity of CRP was 64% and 68%, respectively. In children with severe kidney involvement, mean CRP and white blood count (WBC) were higher than in children with mild/moderate disease (151+/-83 vs. 92+/-55 mg/dl for CRP, P=0.0149; 20,100+/-6,854 vs. 15,023+/-6,145 WBC/ mm3 for WBC, P=0.0131). The sensitivity and specificity was 85% and 20% for CRP, and 77% and 18% for WBC, respectively. One or more areas of abnormal cortical echogenicity were documented in 3% of kidneys with positive DMSA scans. Dilatation of the collecting system was observed in 24% of kidneys. The sensitivity and specificity of ultrasonography was 27% and 89%, respectively. In conclusion, clinical, biological, and ultrasound parameters do not accurately distinguish cystitis from pyelonephritis in children with UTI and do not identify children with severe renal damage. Accordingly, we recommend that DMSA scan should be added to the initial work-up of children with UTI.

Dose-dependent effects of deflazacort and prednisone on growth and skeletal maturation.

Deflazacort (DFZ), a new glucocorticoid which has recently become available, is expected to have less negative effects on growth and skeletal maturation than conventional steroids, in children treated long term. To verify this hypothesis, a multicentre trial was organized to evaluate the effects of DFZ vs prednisone (PDN) on statural growth and skeletal maturation in a group of prepubertal children requiring glucocorticoid therapy for at least 6 months/year. The results of an analysis of 55 children (aged 3-12 years, 24 with connective tissue disease and 31 with kidney glomerular disorders) treated randomly with either DFZ (31 patients) or PDN (24 patients) and followed for a mean period of about 22 months (16 months under steroid therapy) are presented. The observation period was split up into the following phases according to dose and administration regimen: daily, high-dose therapy; alternate-day, high-dose therapy; low-dose therapy; suspension of treatment. The height, statural age, skeletal age and body weight velocities (i.e. the increase/year) were considered. In spite of large intra-individual and inter-individual variability, the results suggest that DFZ has a lower negative impact on indicators of growth. During high-dose daily administration, the height velocity tended to be lower in the PDN group and the impairment of skeletal maturity was significantly less for DFZ than for PDN. During an alternate-day regimen, height velocity was slightly higher in the PDN group and skeletal age velocity was higher in the DFZ group. It seems that steroid effects on statural growth and bone maturation occur in parallel.(ABSTRACT TRUNCATED AT 250 WORDS)

[3 new cases of infantile transient hyperphosphatemia. Description and etiopathogenetic discussion]. / Tre nuovi casi di iperfosfatasemia transitoria infantile. Descrizione e discussione etiopatogenetica.

Three patients with transient hyperphosphatasemia of infancy are described and compared to other 79 cases reported in literature. Etiopathogenesis is discussed and the good prognosis of this condition is emphasized.

[Histiocytosis X. 3 different cases: eosinophilic granuloma, Hand-Schueller-Christian disease, Abt-Letterer-Siwe disease]. / L'istiocitosi X. Tre diversi casi: granuloma eosinofilo malattia di Hand-Schuller-Christian malattia di Abt-Letterer-Siwe.

The authors present three different cases of histiocytosis X: the eosinophilic granuloma, the Hand-Schuller-Christian syndrome and the Letterer-Siwe syndrome. As it appears in the main articles concerning this argument, the Aa. emphasize the common features belonging to the three different forms of histiocytosis: the involvement of the bones and of other tissues. Moreover the prognosis is defined as good in the first case, uncertain in the second case and severe in the third.

[Bladder neck and urethral obstructions in childhood. Radiological study (review and personal case reports)]. / Ostruzioni cervico-uretrali nell'infanzia. Studio radiologico (rassegna e indagini personali).

In the first part the authors report a nosological review of the obstructions of the bladder neck and urethra in childhood and present the most typical radiological aspects of the most important obstructive uropathies. In the second part they illustrate their cases, that include 11 patients between 0 and 10 years, of which 4 males, with urethral valves; 2 females, with external urethral meatus stenosis; 1 male, with non valvular stenosis of urethra: 2 one male and one female, with extrinsic obstruction by ectopic ureterocele; and 2 females, with neurologic bladder. The authors point out the cases with obstruction by posterior urethral valves and by ectopic ureterocele, mainly for the severe hydrodynamic effects of low obstruction on bladder, ureters and pelvis; the authors present, in some cases, also later radiological examinations, obtained after surgical removal of the obstruction. The two cases of neurological bladder are presented in order to point out the difficulty of an exclusively radiological differential diagnosis between some cases of true mechanical obstruction and obstruction caused by neuromuscular disorder of low urinary tract. At last the Authors confirm again the usefulness, but also the limits, of the radiological examination alone in diagnosis of the obstructions of bladder neck and urethra in childhood.

[Carrot soup as the cause of methemoglobinemia in an infant. Case report]. / La zuppa di carote come causa di metaemoglobinemia nel lattante. Contributo casistico.

The AA. report a typical case of methemoglobinemia from carrot soup ingestion in an infant. In the discussion they point out: first, clinical findings for diagnosis of methemoglobinemia; second, criteria for an etiological diagnosis; third, they analyse the pathogenesis of methemoglobinemia resulting from carrot soup in infants. At last the AA. briefly indicate how to prevent and treat this complication.

[Some clinical aspects of celiac disease (author's transl)]. / Alcuni aspetti clini della malattia celiaca.

220 jejunal biopsies have been performed in 146 children. Out of these, thirteen have been recognized as suffering from celiac disease. Furthermore, the possibility of celiac disease being associated with other gastrointestinal disorders, either of the stomach or of the sigma and rectum has been considered. Any explanation for this association can only be hypothetical, because the pathogenesis of celiac disease needs further study.