Rune Sixt

Renal damage one year after first urinary tract infection: Role of dimercaptosuccinic acid scintigraphy☆☆☆★★★

OBJECTIVEnThe aim of this study was to determine whether age, C-reactive protein (CRP), body temperature, or results of voiding cystourethrography at diagnosis of first-time symptomatic urinary tract infection could predict the risk of renal damage as evaluated by dimercaptosuccinic acid (DMSA) scintigraphy performed 1 year after the infection.nnnDESIGNnThe study included 157 children (median age, 0.4 year, range, 5 days to 5.8 years) with first-time symptomatic urinary tract infection. In children 1 year of age or older, a body temperature of 38.5 degrees C or higher was necessary for inclusion. CRP and body temperature were measured at the time of infection, and voiding cystourethrography was performed shortly thereafter. DMSA scintigraphy was performed 1 year later in all children.nnnRESULTSnAfter 1 year, 59 (38%) of the 157 children had renal damage as evaluated by DMSA scintigraphy, and of these, 28 (47%) had reflux. There was a positive correlation between renal damage and CRP, body temperature, and reflux. Children with high levels of CRP, high fever, and dilating reflux had a risk of renal damage up to 10 times higher than children with normal or slightly elevated CRP levels, no or mild fever, and no reflux.nnnCONCLUSIONnCRP concentration and body temperature at the index infection, in combination with the results of voiding cystourethrography, are useful in classifying children at high and low risk of scintigraphic renal damage 1 year after urinary tract infection.

Relationship between acute pyelonephritis, renal scarring, and vesicoureteral reflux

Acute pyelonephritis (APN) may produce permanent renal damage (PRD), which can subsequently lead to diverse complications. We prospectively evaluated 147 females and 122 males (mean age 3.5xa0years) with APN in order to analyze the relationship between the presence of PRD, at the time of cortical renal scintigraphy, and age, gender, episodes of urinary tract infection (UTI), and presence of vesicoureteral reflux (VUR). There were 152 children studied after the first proven UTI. VUR was present in 150 children. PRD was observed in 170 children. There were no significant differences between boys and girls. PRD was found in 36.4% of children younger than 1xa0year and in 70.1% of those older than 1xa0year (P<0.0001). Of children with VUR, 72% had PRD compared with 52% of children without VUR (P<0.0001). Of children with a first episode of UTI, 55.9% developed PRD as did 72.6% of those with recurrent UTI (P=0.004). Our results showed that PRD in children with APN is important, especially in the presence of VUR, recurrent UTI, and older age.

Guidelines for radioiodinated MIBG scintigraphy in children

These guidelines on the use of radioiodinated 99mTc-MIBG scintigraphy in children, which summarise the views of the Paediatric Committee of the European Association of Nuclear Medicine, provide a framework which may prove helpful to nuclear medicine teams in daily practice. They have been influenced by the conclusions of the Consensus Guidelines for MIBG Scintigraphy (Paris, November 6, 1997) of the European Neuroblastoma Group and by those of the Oncological Committee of the French Society of Nuclear Medicine. The guidelines should be taken in the context of good practice and any local/national rules which apply to nuclear medicine examinations.

The relevance of urodynamic studies for urge syndrome and dysfunctional voiding: A multicenter controlled trial in children

PURPOSEnThe objective of this study was to compare prospectively, in urge syndrome and dysfunctional voiding, clinical patterns with urodynamic patterns, to assess changes in urodynamic patterns after treatment, and to correlate urodynamic patterns and parameters with treatment outcome.nnnMATERIALS AND METHODSnIn the European Bladder Dysfunction Study 97 children with clinically diagnosed urge syndrome received standard treatment, to which was randomly added placebo, oxybutynin or bladder training with online feedback. In a separate branch 105 children with clinically diagnosed dysfunctional voiding were randomly allocated to standard treatment or standard treatment plus pelvic floor training with online feedback. In all children urodynamic studies were performed before and immediately after treatment.nnnRESULTSnIn urge syndrome detrusor overactivity was present in 33% of cases before and 27% after treatment (of which 65% were de novo). Detrusor overactivity did not correlate with treatment outcome. In dysfunctional voiding increased pelvic floor activity during voiding, which was present in 67% of cases before and 56% after treatment (of which 45% were de novo), did not correlate with treatment outcome. In urge syndrome as well as in dysfunctional voiding neither maximum detrusor pressure during voiding, cystometric bladder capacity, bladder compliance nor free flow patterns correlated with treatment outcome.nnnCONCLUSIONSnNeither detrusor overactivity nor increased pelvic floor activity during voiding correlated with treatment outcome. Standard treatment could be the first choice in urge syndrome as well as in dysfunctional voiding, reserving urodynamic studies for patients in whom this first approach fails.

Guidelines for direct radionuclide cystography in children

These guidelines, which summarise the views of the Paediatric Committee of the European Association of Nuclear Medicine, provide a framework which may prove helpful to nuclear medicine teams in daily practice. They contain information on the indications, acquisition, processing and interpretation of direct radioisotope cystography in children. The guidelines should be taken in the context of good practice and any local/national rules which apply to nuclear medicine examinations.

Ultrasonography as predictor of permanent renal damage in infants with urinary tract infection.

Aim:u2002 To evaluate the ability of ultrasound (US) in infants (<1 year) with acute urinary tract infection (UTI), to identify those with permanent renal damage (PRD) at scintigraphy 1 year later.

Guidelines for lung scintigraphy in children

The purpose of this set of guidelines is to help the nuclear medicine practitioner perform a good quality lung isotope scan. The indications for the test are summarised. The different radiopharmaceuticals used for the ventilation and the perfusion studies, the technique for their administration, the dosimetry, the acquisition of the images, the processing and the display of the images are discussed in detail. The issue of whether a perfusion-only lung scan is sufficient or whether a full ventilation–perfusion study is necessary is also addressed. The document contains a comprehensive list of references and some web site addresses which may be of further assistance.

Decreased Lung Function and Exercise Capacity in Fontan Patients. A Long-term Follow-up

OBJECTIVEnThe haemodynamic situation for patients with Fontan circulation is characterized by a reduced, non-pulsatile pulmonary blood flow. To evaluate if this has any impact on lung function and exercise capacity, we studied the surviving 20 patients operated upon at our institution between 1980 and 1991. The median age was 17.5 years, the median follow-up time was 11.5 years.nnnDESIGNnLung volumes, flow-volume curves, the ventilatory distribution and the diffusion capacity for carbon monoxide were obtained using routine methods. The exercise tests were performed on a bicycle ergometer with determination of ventilation, oxygen uptake, carbon dioxide production, respiratory rate and heart rate.nnnRESULTSnThe lung volumes, maximal expiratory flows and diffusion capacity were significantly lower than expected. The median maximal oxygen uptake was 1.39 for the females and 1.63 l/min for the males, corresponding to 25.1 and 25.2 ml/kg/min, respectively. The maximal heart rates varied from 104 to 177 beats/min. All patients reached a respiratory exchange ratio above 1.0.nnnCONCLUSIONnFontan patients have small lungs. They have a markedly reduced exercise capacity and a low maximal heart rate.

Determination of the technetium-99m mercaptoacetyltriglycine plasma clearance in children by means of a single blood sample: a multicentre study

A multicentre European study was undertaken in order to determine a reasonable algorithm allowing the determination of overall technetium-99m mercaptoacetyltriglycine clearance using a single blood sample. Employing multiple blood sample clearance as a reference method, it was shown that an acceptable estimation of the MAG3 renal clearance could be obtained using a blood sample taken at any time between 30 and 40 min after tracer injection. After correction for body surface area, comparison of clearance determined using (a) the single blood sample and (b) the multiple blood samples provided a coefficient of correlation of 0.949 and an SEE of 27 ml/min. This algorithm is valid for clearance values higher than 100 ml/min/1.73 m2 and for children older than 1 year of age.

Change of Urodynamic Patterns in Infants With Dilating Vesicoureteral Reflux: 3-Year Followup

PURPOSEnReports concerning bladder dysfunction patterns in infants with high grade vesicoureteral reflux during the first year of life vs older children with reflux are contradictory. To describe the development of bladder function characteristics in children with congenital dilating reflux, we evaluated such infants urodynamically and followed them regularly for a 3-year period.nnnMATERIALS AND METHODSnA total of 89 males and 25 females with grade III to V dilating reflux were evaluated 3 times using videocystometry at mean ages of 6, 20 and 40 months.nnnRESULTSnCharacteristics of the urodynamic pattern at 6 months could not be differentiated from normal patterns for that age, including low and normal bladder capacity, high voiding pressure levels, dyscoordination at voiding (80%) and overactivity during filling (60%). However, at 20 months the overall pattern was different, including increased bladder capacity and residual volume, normal voiding pressure, persistent overactivity during filling and dyscoordination at voiding. Bladder dysfunction was seen in 48 children (42%) at 20 months, of whom 34 primarily had high bladder capacity with incomplete emptying (dilated bladder dysfunction) and 14 had overactive bladder. Predictors for development of dilated bladder dysfunction at followup were high residual urine at 6-month examination and recurrent urinary tract infections. Recurrent infections were significantly correlated to high residual urine at all investigations and to detrusor overactivity at the 20-month examination.nnnCONCLUSIONSnUrodynamic patterns changed between the first and second year of life in patients with dilating reflux, from an immature pattern with high pressure levels to high capacity bladder with incomplete voiding. Therefore, bladder dysfunction, which was seen in 42% of patients, was only possible to diagnose after the first year of life and was mainly seen as high capacity bladder with incomplete voiding.