László Szabó

Urinary bladder dysfunction in diabetic children with and without subclinical cardiovascular autonomic neuropathy

The aim of this study was to assess the relationship between bladder dysfunction and impaired cardiovascular reflexes in diabetic children with no clinical symptoms of autonomic neuropathy. After 15 ml/kg of water intake, the time to first sensation to void, the voiding volume, the voiding time, the average and maximum urinary flows, and the time to maximum urinary flow were estimated by sonography and uroflowmetry in diabetic children with and without cardiovascular autonomic dysfunction (CAD), and in a healthy control group. The three groups of children were matched for age, weight and height. CAD was considered to be present if the results of cardiovascular tests were more than 2SD from the mean of healthy controls. Diabetic children with and without CAD had increased time to first sensation to void, voiding volume, and average urinary flow when compared with healthy children. Voiding volume and average and maximum urinary flows were higher in diabetic children with CAD than in those without CAD. Diabetic children with CAD had also a higher maximum urinary flow than diabetic children without CAD and healthy children. Diabetic children with CAD had a longer diabetes duration and a higher mean fructosamine level during the preceding 3 years than those without CAD. These findings suggest that diabetic children may have diminished sensation of bladder filling independent of impaired cardiovascular reflexes, however, the degree of bladder dysfunction parallels with CAD, both depending on diabetes duration and long-term glycaemic control.

Executive summary: The International Consultation on incontinence 2008—committee on: “Dynamic Testing”; for Urinary or fecal incontinence. Part 3: Anorectal physiology studies

The members of ‘The International Consultation on Incontinence 2008 (Paris) Committee on Dynamic Testing’ provide an executive summary of the chapter ‘Dynamic Testing’ that discusses testing methods for patients with signs and or symptoms of incontinence. Testing of patients with signs and or symptoms of urinary as well as testing of patients with fecal incontinence is discussed.

Heterotopic gastric mucosa in the gallbladder

Received: 26 February 2003 Accepted: 9 March 2003 Published online: 26 April 2003 Springer-Verlag 2003 Sir, We read with great interest the case report of a child with heterotopic gastric mucosa (HGM) in the biliary tract [1]. The authors presented a 3-year-old girl with recurrent abdominal pain and intermittent episodes of jaundice which were caused by ectopic gastric mucosa in the gallbladder and the biliary tree. We would like to present an 11-year-old boy who underwent ultrasonography for investigation of a suspected urinary tract infection. There were no gastrointestinal symptoms. Ultrasound revealed a soft-tissue polypoid mass in the gallbladder (Fig. 1). It was surgically removed. Histology showed gastric glands located in the mucosa of the gallbladder. Uchiyama et al. [2] published the case of an asymptomatic 23-year-old manwithHGMin the gallbladder.Of the 42 cases that they identified in the literature, only 3 were asymptomatic. We believe that HGM in the gallbladder may exist more frequently than previously believed and that symptoms may develop at any age.

[Wegener's granulomatosis].

Wegeners granulomatosis is a necrotizing inflammation of small and medium size vessels with granuloma formation. It is a very heterogeneous disease in respect of severity and clinical manifestation. While it can be a rapidly progressive disease with fatal ending, there are forms limited only to one organ. Diagnosis is supported by the positivity of anti-neutrophil cytoplasmatic antibody and the presence of the typical histological findings. Unfortunately, these examinations cannot confirm clinical suspicion relatively frequently. In addition, there may be only symptoms related to one single organ for a long time at the beginning of the disease and, therefore, one have to be aware of the clinical signs and symptoms of the different organ systems. This may allow us to make an early diagnosis and start treatment in time.

Is premature induced labour justified in case of fetal urinary tract dilatation

UNLABELLED There is a decreasing trend in the number of intrauterine interventions performed due to urinary tract dilatations of the foetus diagnosed ultrasonographically. This is due to the low efficacy of the interventions, the high rate of complications and a better knowledge of the foetal physiology. However, the demand for early corrective surgery is still present. In Hungary pre-term caesarean section is performed in many institutions in order to enable the operation of the neonate, despite the fact that the benefits of this intervention have not been established. AIM In order to test the correctness of this practice, the authors conducted a retrospective analysis of the patients of two large case-volume paediatric institutions. PATIENTS In a period of 5 years, 329 neonates were followed due to intrauterine diagnosis of urinary tract dilatations (197 at the Department of Urology, Heim Pál Childrens Hospital in Budapest, whereas in Miskolc 132), including 13 cases where the urological anomaly was the indication for pre-term induction of labour. RESULTS Of the 13 neonates who had been delivered prematurely, none were operated before the postconceptional age of 40 weeks, and 3 subsequently required no surgical intervention. Two neonates developed life-threatening conditions that presumably could have been avoided without the premature caesarean section. CONCLUSIONS The authors conclude that there are several arguments against pre-term delivery: 1. Prenatal diagnostics does not always yield as accurate information as the diagnostic procedures performed in infancy; 2. Intrauterine urinary tract dilatation often resolve spontaneously, superseding the need for both pre- and post-natal surgical interventions. 3. Scientific observations have confirmed that there is no difference between the efficacy of postnatal and pre-term interventions. Based on the above-mentioned, authors emphasize that this outdated practice can no longer be accepted, and call for good cooperation between the obstetrician, the paediatric urologist and nephrologist, to coordinate the management of the case.

Paediatric urinary bladder 'tumour' due to perforated appendicitis

Received: 18 February 2003 Accepted: 26 February 2003 Published online: 6 September 2003 Springer-Verlag 2003 Sir, We read with interest the case report of an 8-year-old girl with acute appendicitis perforated into the bladder [1]. We presented an almost identical case at the 1999 ESPR Congress in Jerusalem [2]. Our patient was a 12-year-old boy with a 4-week history of gross haematuria and right lower-quadrant abdominal pain. Abdominal US revealed urinary bladder wall thickening and a soft-tissue mass with central calcification (Fig. 1). Intravenous urography showed normal pelvicalyceal systems and ureters, and the calcification was seen outside the right ureter. Repeat US failed to identify a target sign or tubular small bowel. There was no pericaecal or perivesical free fluid and no thickened bowel loops or loops with reduced peristalsis – signs which might have suggested a perforated appendix [3]. On the basis of the plain film and US findings, we suggested an appendicolith and inflamed appendix as a diagnosis, but there was no other strong argument to support it. The CT findings were similar to those seen on US with an extravesical mass and central calcification (Fig. 2). At surgery, an inflamed small-bowel mass involving the bladder wall together with a perforated appendix with appendi-

How to get it on paper and in print.

Sir, We were pleased to read Dr. Griscoms paper, aHow to get it on paper and in printo [1], because it gave us much useful advice on preparing a paper. We found this paper exciting because the theme is generally not taught in medical schools or in the departments. We agree with all the authors statements, but would like to make a few comments concerning the paper. 1. Writing well is difficult in the United States, but it is even more difficult in nonEnglish-language countries. In Europe, for example, we not only have to be clear and exact with our research results, but also need to have a good knowledge of the language (different types and versions of English). Many valuable articles are refused because of language problems, but we have to accept this fact. We also have the opposite example where the editors (Pediatric Radiology) help the authors to correct the paper. Thus, we agree that the writing style to use should be simple, short phrases. 2. Writing a paper is very important for doctors (both juniors and seniors) who want to be well-qualified radiologists (clinician) because writing and reading (current literature) go together (if somebody does not write, he/she also does not read and vice versa). However, nowadays it is difficult to choose an appropriate theme that can contain some new information and also be useful for clinical practice. We in Hungary prefer that a person who wants to write a paper presents the theme at a scientific meeting or congress first where the questions and comments of the discussion will help him/her to recognize the problems of the paper. Secondly, it is obligatory, not mandatory, that the authors show their papers to the chief of the department because he/she should be responsible not only for the scientific research in the department, but the career of the staff member. Domestic journals only receive papers with the signature of the chief. 3. The low interest in pediatric radiology in Radiology and AJR is a real surprise; the pediatric pages make up 5% and 7%, respectively, of the monthly published pages of these journals. It would be interesting to know the percentage other subspecialties receive (neuro, gastro, skeletal, etc). This fact is also proved by the circulation of Pediatric Radiology (2000), which is 6% and 8% of Radiology and AJR, respectively. Because of these facts there is a very low impact factor (IF), less interest and fewer citations, although we are convinced that papers published in Pediatric Radiology are as valuable and of as high a standard as papers in the abovementioned journals. Some popular international journals play a very important role in the development of subspecialties (pediatric radiology, nephrology, neurology, etc.) and have high scientific standards, but are at a disadvantage with regard to journals with a general profile. The IF would be more reliable if these subspecialty journals were to get a supplementary point (e. g., +1). The IF plays a central role in the scientific career of (pediatric) radiologists, but everybody knows that the present practice does not serve the real needs. It is important that the authorities reconsider and modify the system of scientific assessment.