New quantitative parameters for evaluating radionuclide cystography and their value in understanding the physiology of reflux.

UNLABELLED: In this descriptive study of radionuclide cystography, time-activity curves were generated from renal pelves with reflux and evaluated to reveal the physiology of the reflux. The generated new parameters were also evaluated for any correlation with the frequency of urinary tract infections and renal scarring. METHODS: Thirty-two children with reflux to the renal pelvis (36 refluxing units) were included. Regions of interest were drawn on the pelves and bladder, and time-activity curves were generated. The first reflux phase, the bladder volume at first reflux, and the bladder volume at maximal reflux were defined, and reflux percentages were calculated. Dimercaptosuccinic acid (DMSA) scintigraphy findings and urinary tract infections were used for correlation. RESULTS: New curves from the renal pelvis during bladder filling and bladder emptying were generated and their patterns classified. Episodic reflux to the pelvis was observed on time-activity curves, which demonstrated 4 different emptying patterns during voiding. These patterns were described in detail. Visually, residual activity was present in the renal pelves in 58.8% of patients. The mean number of urinary tract infections per year was 1.07 (range, 0-4; SD, 0.88). The DMSA findings were normal in 57.1% of the patients. CONCLUSION: We obtained and categorized some new time-activity curve patterns from renal pelves with reflux on radionuclide cystography. Discussing these patterns may help physicians understand the physiology of the reflux and the relationship between infections and reflux.

A survey of pediatric intensive care services in Turkey.

The aim of this study was to describe and assess the structure, organization, and staffing of pediatric intensive care services in Turkey. A survey was sent to major university and government hospitals. Out of the 40 hospitals stating to provide pediatric intensive care, 34 responded to the survey (85% response rate). In the majority (81.2%) of hospitals, pediatric intensive care was provided in single room units or within the pediatric ward. Unit size ranged from 1-16 beds with an average of 6.8 +/- 4.2 operational beds per unit. Much of the equipment and a sufficient number of specialists for pediatric intensive care unit (PICU) care were present in the surveyed hospitals. However, only 12 units had a pediatric intensivist on staff and few had special PICU nurses. Many hospitals in Turkey already have various equipment and specialists needed to support pediatric intensive care. Expansion of services and improved care could be achieved if more pediatric intensivists and nurses could be provided and services concentrated in fully equipped tertiary centers.

Nebulised L-epinephrine and steroid combination in the treatment of moderate to severe croup.

OBJECTIVE: To compare the effectiveness of nebulised L-epinephrine in combination with systemic or nebulised corticosteroid with that of cool mist and systemic corticosteroids in the treatment of moderate to severe croup. PATIENTS AND METHODS: Children were eligible for study if they presented to the emergency department with a moderate to severe croup. Patients were randomly assigned to three groups: group 1, cool mist and intramuscular dexamethasone (n = 26); group 2, nebulised L-epinephrine and intramuscular dexamethasone (n = 31); group 3, nebulised L-epinephrine and nebulised budesonide (n = 19). The croup score, vital signs and oxygen saturation were assessed before and after medication. Adverse events, additional L-epinephrine and hospitalisation were recorded. RESULTS: Age, sex, initial croup score and vital signs were similar in all groups. Croup scores were significantly decreased over time in all treatment groups and this decrease was very evident at 30 minutes (p < 0.05). Croup scores of groups 2 and 3 were significantly lower than those of group 1 at 30 and 60 minutes but no difference was observed between groups 2 and 3 at these timepoints. The numbers of patients who had croup scores <2 at 30 and 60 minutes were higher in groups 2 and 3 than group 1 (p = 0.004 and p = 0.032, respectively). More patients in group 1 received additional L-epinephrine treatments (p = 0.014). Changes in vital signs were not different among groups when assessed over time (p > 0.05). CONCLUSIONS: This study demonstrated that with early combination treatment, croup scores improved rapidly and hospitalisation rates were low. Patients with moderate to severe croup presenting to the emergency department should receive nebulised L-epinephrine in combination with intramuscular dexamethasone or nebulised budesonide. No significant adverse effects were observed with L-epinephrine. The use of L-epinephrine has been proposed instead of racemic epinephrine in patients with moderate to severe croup because it is efficacious, well tolerated, less expensive and more readily available in many countries.

Acute disseminated encephalomyelitis presenting with bilateral transient amaurosis.

A 4-year-old male presented with acute disseminated encephalomyelitis with seizures and transient amaurosis after initial symptoms of a flulike febrile infection 1 week earlier. Immunoglobulin M type antibody titers against Mycoplasma pneumoniae were significantly increased in serum and cerebrospinal fluid. The patient improved appreciably on immunosuppressive therapy with immunoglobulin. This patient exemplifies a rare case of acute disseminated encephalomyelitis presenting with bilateral transient amaurosis as a complication of M. pneumoniae infection. Aydin A, Atasever S, Cakmakci H. Acute disseminated encephalomyelitis presenting with bilateral transient amaurosis.