[Neonatal asymptomatic and childhood symptomatic hydronephrosis: Are they different nosological entities?]. / Hidronefrosis neonatal asintomática e infantil sintomática: dos entidades nosológicas diferentes?

The authors reviewed two groups of patients with ureteropelvic junction obstructión divided by age and mode of presentation: patients with neonatal asymptomatic hydronephrosis diagnosed by prenatal ultrasonography and patients with symptomatic hydronephrosis. It was assumed that in these patients we are observing a continuous spectrum of the same pathology; nevertheless, some relevant differences were found between the two groups. Diuretic renograms did not show any change in postoperative renal function among prenatally detected cases while a significative improvement followed surgery among most of symptomatic cases. A possible explanation could be found in the obstructive mechanism which was responsible of obstruction in a significative proportion of these patients. Lower polar vessels produce a progressive symptomatic hydronephrosis in an healthy kidney in respect to intrinsic obstruction which are mainly found among prenatally detected cases and which are frequently associated to congenital renal damage unresponsive to surgery.

[Influence of the early renal status on natural history of vesico-ureteral reflux diagnosed in the first six month of life]. / Valore predittivo dello stato renale iniziale sulla storia naturale dei reflussi vescicoureterali diagnosticati entro i primi sei mesi di vita.

INTRODUCTION: Ultrasonographic and radionuclide imaging of kidney in presence of major vesicoureteric reflux, diagnosed in the first months of life, reflects a congenital anomaly of development of ureteric bud and metanephric blastema, more than a parenchymal damage secondary to superimposed infections. These lesions are mainly observed in male infants affected by reflux and referred on the basis of a prenatal diagnosis. The impact of therapy on these kidneys is still debated. PATIENTS AND METHODS: Among 273 pediatric patients with VUR observed between 1991 and 2000, 48 cases have been selected where a reflux grade III or greater had been diagnosed within the first six months of life. Cause of admission was prenatal diagnosis in 29 cases and recurrent infection in 19. Reflux was bilateral in 30 patients. Cases of VUR associated to other urological or neurological anomalies were excluded. A complete ultrasonographic, cystographic and radionuclide study was performed in all patients included in the present study within the fourth month of life. Mean Follow up lasted 17 months. Renal damage was graded by ultrasonography and DMSA renal scan on the basis or of a reduction in total kidney size and a poor radionuclide uptake either of an altered renal profile associated to focal defects of uptake. RESULTS: Resolution of reflux within the mean follow up period, was observed in 16 patients, even with high grade VUR, whenever major renal lesions were absent or focal. When severe renal damage was initially demonstrated the expectancy of reduction or resolution of VUR was significantly reduced and surgical option was considered. CONCLUSIONS: Among patients with major VUR diagnosed in the first months of life, early renal status affects prognosis more than the severity of reflux.

The role of the renal resistive index ratio in diagnosing obstruction and in the follow-up of children with unilateral hydronephrosis.

OBJECTIVE: To assess the role of the renal resistive index ratio (RIR) in discriminating equivocal upper urinary tract dilatation in children, and thus in establishing the need for surgery, in comparison with traditional diagnostic tools. PATIENTS AND METHODS: The study comprised 40 children with unilateral hydronephrosis unrelated to vesico-ureteric reflux, posterior urethral valves, megaureter or a duplex system. In all patients one or more of the following 'indices of obstruction' were positive; an anteroposterior renal pelvic diameter of >20 mm, a half-time diuretic 'washout' (T/2) of > 20 min, a separate renal function of < 40%, and symptoms of obstruction (pain, sepsis). All these variables were measured on admission and after a mean (range) follow-up of 9 (2-24) months. After this period, all patients who were symptomatic or with two or more of the variables above the normal range were considered as obstructed and underwent a dismembered pyeloplasty. The variables were then re-assessed 6 months after surgery. The RIR was evaluated using duplex Doppler ultrasonography with a 3.5-5 MHz transducer, by the same operator. Differences between obstructive and unobstructive unilateral hydronephrosis were estimated from the mean values of the variables assessed and Student's t-test used to determine significant differences. The correlation between the T/2 and RIR before and after surgery was also evaluated. RESULTS: During follow-up the RIR was abnormal in 27 of 30 patients with hydronephrosis who were considered to be 'obstructed'. Twenty-three of these patients, selected for surgery, had a positive diuretic renogram; 11 had loss of differential renal function and 16 had recurrent clinical symptoms. There were significant differences in the mean RIR and T/2 between obstructed and unobstructed patients. Six months after dismembered pyeloplasty, the RIR returned to normal in all patients except three in whom it was previously > 1.1. The diuretic renogram, if initially showing pathology, always became normal. The RIR did not change in patients with an unchanged and severe loss of differential renal function before and after surgery. CONCLUSIONS: In this study the RIR was a good index of obstruction in children with unilateral hydronephrosis and it correlated well with the results of diuretic renography. The specificity of the RIR was reduced whenever there was severe renal damage.

[Deep venous thrombosis and the prevention of a pulmonary embolism with temporary caval filters: the experience in 2 pediatric cases]. / Trombosi venosa profonda e prevenzione dell'embolia polmonare con filtri cavali temporanei: esperienza in due casi pediatrici.

Deep venous thrombosis with pulmonary embolism is considered rare in pediatric population, but a literature review points out this disease more frequent than would be expected in children. The low incidence and the poor consideration of this occurrence in pediatric age group, cause the thromboembolic disease with pulmonary involvement an often missed diagnosis. The illness is usually related to intravenous catheters, surgery, trauma, sepsis, prolonged immobilization, neoplasia, drugs, some congenital or acquired diseases. The Authors report their experience with two pediatric cases of inferior vena cava thrombosis and pulmonary embolism treated with anticoagulant therapy, temporary vena cava filters and locoregional fibrinolysis.