Urinary tract infection in infants and children evaluated by ultrasound

Fifty-nine pediatric patients with urinary tract infection (UTI) underwent renal ultrasonography, excretory urography, and voiding cystourethrography. The imaging procedures were analyzed retrospectively to determine their relative effectiveness in detecting abnormalities that might predispose the patient to UTI. Voiding cystourethrography provided valuable information, particularly the presence or absence of vesicoureteral reflux, that could not be obtained from the other procedures. Excretory urography was less specific than ultrasonography in the majority of patients, with the exception of those who had renal scarring. The authors recommended ultrasonography as the initial imaging procedure in the evaluation of children with UTI. When the sonogram is normal, excretory urography is not considered necessary, but voiding cystourethrography is thought to be essential. If sonography is abnormal, excretory urography and/or other follow-up studies are indicated.     

Intracerebral pneumatocele: CT findings

Two cases of intracerebral pneumatocele following trauma are presented. One to two months after initial treatment both patients had deteriorating neurologic status. The diagnosis was made by radiography. When a pneumatocele is suspected clinically, computed tomography can play a vital role in determining the precise location of the gas collection, its relationship to the fracture site, and the amount of mass effect on the brain.     

Enzyme Loading of Erythrocytes

We demonstrated that beta-glucosidase and beta-galactosidase can be trapped inside erythrocytes by rapid hemolysis of the cell in the presence of these enzymes. Enzyme enters only during hemolysis, and optimum uptake occurs within 60 sec. There is no loss in cell number after hemolysis-induced enzyme uptake, and the ghosts have only a slightly increased mean cell volume. Smaller proteins enter more readily than larger proteins, although enzymes with a molecular weight of at least 180,000 can be readily entrapped by erythrocytes. This finding may provide a useful approach to the problem of enzyme replacement in certain diseases, including Gaucher's disease.     

Comparison of the Beckman Auto ICS and the Syva Autolab 6000 for determination of gentamicin levels in serum.

Two fully automated drug-monitoring systems, the Syva Autolab 6000 and the Beckman Auto ICS, were compared in terms of accuracy, precision, speed of operation, and cost effectiveness in the determination of gentamicin levels in serum. Within-run and between-run precision for both systems were acceptable (coefficient of variation, 2.0 to 6.9%), and patient sample comparisons resulted in an intermethod correlation coefficient of 0.96. When reference samples (prepared to contain 1.2 to 10 micrograms of gentamicin per ml) were assayed, the Syva Autolab 6000 obtained concentrations within 8% of expected values, whereas the Beckman Auto ICS reported values up to 17% higher than target values. In a time and cost comparison, reagent costs for the Beckman system were ca. 50% less than for the Syva Autolab 6000; the Syva system, however, determined patient results two to three times faster than the Beckman Auto ICS.     

Incidence of end-stage renal disease in medically treated patients with severe bilateral atherosclerotic renovascular disease

Incidence of end-stage renal disease in medically treated patients with severe bilateral atherosclerotic renovascular disease. Atherosclerotic renovascular disease is an important cause of end-stage renal disease (ESRD). The exact incidence of ESRD and the rate of decline in glomerular filtration rate (GFR) in patients with this condition is unknown. We report the mortality, the rate of decline in renal function, and incidence of ESRD in 51 patients with bilateral atherosclerotic renovascular disease followed-up for a median period of 52 months. None of these patients had undergone any surgical or radiological intervention. Renal function was determined by serial measurements of serum creatinine. Bilateral atherosclerotic renovascular disease was associated with a high mortality rate; the crude mortality rate at 60 months was 45%. Assessment of renal function showed impaired renal function at time of angiography and a nonuniform and variable decline in renal function during the period of observation. The median GFR decreased from 39 mL/min (range, 15 to 80 mL/min) at time of angiography to 31 mL/min (range, 10 to 70 mL/min) and 24 mL/min (range, 10 to 40 mL/min) at 24 and 60 months, respectively (P < 0.05). The calculated mean rate of decline in GFR for all patients was 4 mL/min/yr (range, 1 to 16 mL/min/yr). Over the 5 years, there was a progressive increase in the incidence of ESRD. Of the original 51 patients who underwent angiography, six patients reached ESRD. The crude incidence of ESRD was, therefore, 12%. Patients who reached ESRD were characterized by advanced azotemia at the time of angiography (median GFR, 25 mL/min) and a rapid decline in GFR (8 mL/min) compared with patients who did not reach ESRD during the observation period (median GFR, 43 mL/min and an average rate of decline GFR of 3 mL/min).