ABSTRACT
A group of 54 children with vesicoureteral reflux recognized in the first 3 years of life was analysed. All of them received adequate nonoperative treatment including prolonged antibacterial therapy and management of cystitis and urodynamic disorders of the lower urinary tract. According to the degree of vesicoureteral reflux (VUR), the children were divided into two groups. Group 1 consisted of 29 children with Degrees I-II VUR in 37 ureters. Nonoperative treatment was effective in 75% of cases. Retrospective appraisal of urograms revealed no signs of cicatricial-sclerotic changes in the parenchyma of the kidneys. In five children with Degree II VUR of long duration the kidneys were smaller than the normal size of their age. Group 2 was made up of 24 patients with Degrees III-V VUR into 34 ureters. No changes were found in the renal parenchyma on urograms made during the first examination. During follow-up, however, signs of reflux-nephropathy (RN) were detected, which according to the recommendations of the International group for reflux study were evaluated as Degree I RN--10 cases, Degree II RN--12 cases, Degree III RN--8 cases, and Degree IV RN--4 cases. The authors believe nonoperative treatment of children with Degrees I-II VUR to be justified, patients with Degrees III-V VUR call for active surgical intervention from the moment that the reflux is recognized.
Subject(s)
Vesico-Ureteral Reflux/therapy , Child , Child, Preschool , Chronic Disease , Combined Modality Therapy , Female , Humans , Male , Pyelonephritis/diagnostic imaging , Pyelonephritis/etiology , Pyelonephritis/therapy , Radiography , Recurrence , Ureter/diagnostic imaging , Urinary Bladder/diagnostic imaging , Vesico-Ureteral Reflux/complications , Vesico-Ureteral Reflux/diagnostic imagingABSTRACT
In 40 out of 45 children dead from sepsis in 1974--1976 the development of the syndrome of disseminated intravascular coagulation was proved on the grounds of the pathologic picture. In 27 cases histological changes were combined with characteristic clinico-laboratory manifestations of the syndrome. The latter was not found in 10 children who died of a severe local purulent process.
