Initial collection of an inadequate 24-hour urine sample in children does not predict subsequent inadequate collections.

INTRODUCTION: Approximately half of adult stone formers submit specimens that are either under or over collections as determined by 24-h creatinine/kg. Previously identified predictors of inadequate collection in adults include female sex, older age, higher body mass index (BMI), vitamin D supplementation, and weekday collection. OBJECTIVE: The objective of this study is to determine risk factors for inadequate 24-h urinary specimen collection in the pediatric population. STUDY DESIGN: A retrospective analysis of all children (<18 years of age) with renal and/or ureteral calculi evaluated at the study tertiary care pediatric center from 2005 to 2015 was performed. Those who had at least one 24-h urinary metabolic profile after a clinical visit for kidney and/or ureteral stones were included; children with bladder stones were excluded. Adequate collections had a urine creatinine of 10-15 mg/kg/24 h. A bivariate analysis of potential factors associated with inadequate collection of the initial urinary metabolic profile, including child demographics, parental socio-economic factors, history of stone surgery, and weekday vs. weekend urine collection, was performed. A mixed-effects logistic regression, controlling for correlation of specimens from the same patient, was also performed to determine whether an initial inadequate collection predicted a subsequent inadequate collection. RESULTS: Of 367 patients, 80 had an adequate collection (21.9%): median age, 13 years (interquartile range, 8-16); 61.1% female; 93.5% white; 19.5% obese; and 13.0% overweight. No parental or child factors were associated with inadequate collection (Summary Table). Of inadequate collections, more than 80% were over collections. In the 175 patients with more than one 24-h urinary specimen collection, the effect of an initial inadequate collection on subsequent inadequate collections was not significant after controlling for the correlation of samples from the same patient (p = 0.8). DISCUSSION: Any parental or child factors associated with the collection of inadequate 24-h urine specimens in children were not found. An initial inadequate collection does not predict subsequent inadequate collections. It was surprising that >80% of the inadequate collections were over collections rather than under collections. Possible explanations are that children collected urine samples for longer than the 24-h period or that stone-forming children produce more creatinine per 24-h period than healthy children due to hyperfiltration. CONCLUSION: Inadequate collections are very common, and the risk factors for them are unclear. A repeat collection would be suggested if the first is inadequate. Further studies must be planned to explore barriers to accurate specimen collection using qualitative research methodology.

The ability of a limited metabolic assessment to identify pediatric stone formers with metabolic abnormalities.

INTRODUCTION: American Urological Association guidelines recommend a urinary metabolic evaluation after the first stone event in all pediatric stone patients. Prior studies identified hypercalciuria and urine hypovolemia as the most common abnormalities in children with urolithiasis. Recent data suggest that hypocitraturia is most prevalent. It was hypothesized that a limited evaluation would detect the majority of clinically significant metabolic abnormalities in pediatric stone formers. MATERIAL AND METHODS: A retrospective analysis of all children (<18 years of age) with renal/ureteral calculi evaluated at the study institution from 2005 to 2015 was performed. Children with ≥ one 24-h urinary metabolic profile after a clinical visit for renal/ureteral calculi were included. Those with bladder stones and those with undercollection or overcollection or missing urinary creatinine were excluded. Demographics and data from the first urinary metabolic profile and stone analyses were collected. The sensitivity, specificity, and positive and negative predictive value (NPV) of a limited urinary metabolic evaluation consisting of four parameters (24-h calcium, citrate, and oxalate and low urinary volume) were compared to a complete urinary metabolic profile. The number and type of metabolic abnormalities that would have been missed with this limited evaluation weredetermined. RESULTS: Of 410 patients, 21 were excluded for age ≥18 years, 13 for bladder stones, 248 for overcollections, 38 for undercollections, and 10 for missing creatinine. This left 80 patients for inclusion: median age 11.4 years, 60% female, and 96.3% white. Of the entire cohort, 69.6% had hypocitraturia, 52.5% had low urine volume, and 22.5% had hypercalciuria. Sensitivity was 87.5%. Specificity could not be calculated because no patients had a normal complete metabolic evaluation. The NPV was zero, and the positive predictive value was 100%, but these are artifacts resulting from the absence of patients with a normal complete metabolic evaluation. Of the 80 patients, 10 had at least one abnormality missed by a limited metabolic evaluation (Table 1). The missed abnormalities were high pH (n = 6), abnormal 24-h phosphorus (low in 1 patient and high in 1 patient), low 24-h magnesium (n = 3), low 24-h potassium (n = 3), and high 24-h sodium (n = 4). DISCUSSION: A limited urinary metabolic evaluation would have detected the vast majority of clinically significant metabolic abnormalities in the study sample. Approximately two-thirds of the study patients submitted inadequate 24-h urine specimens. CONCLUSIONS: A simplified approach to metabolic evaluation in first-time stone formers with a stone analysis available was proposed. This streamlined approach could simplify the metabolic evaluation and reduce health care costs.

Does the presence of an occlusal indicator product affect the contact forces between full dentitions?

Studies have explored occlusal marking interpretation, repeatability and accuracy. But, when an occlusion detection product is interposed between teeth, direct tooth-tooth occlusal contact relationships are replaced by tooth-material-tooth structures. Thus, the marks cannot reflect the original contacts. This has been shown for single tooth pair contacts. The purpose of this laboratory study was to similarly examine full dentitions. A dentiform was set into Class I centric occlusion with the mandible supported by a load cell. The maxillary arch was guided by precision slides. As the weighted (~52 N) upper assembly was lowered onto and raised off the mandibular arch, the loads on the mandible were measured. With and without (control) occlusal marking material, the steps were as follows: (cleaning - control 1 - material 1) … (cleaning - control 6 - material 6). The six materials were as follows: Accufilm I and II, Rudischhauser Thick and Thin, Hanel Articulating Silk and T-Scan. Then, the six sets of (cleaning - control - material) measurements were repeated with the mandibular assembly shifted, in turn, by 0·1 mm in the Anterior, Posterior, Right and Left directions. The five (Centric and four 0·1 mm shifted) occlusal relationships produced grossly different tooth-tooth (control) load profiles. And, in general, these controls were affected, in different ways, by the marking products. Among the five conventional products, the Rudischhausers fared the worst and the electronic T-Scan was an extreme outlier. Thus, in general, popular occlusal detection products alter the occlusal contact forces, and therefore, their markings cannot characterise the actual occlusion.

Validation of antibiotic charges in administrative data for outpatient pediatric urologic procedures.

INTRODUCTION: The use of administrative health data for research has prompted questions about its validity for this purpose. OBJECTIVE/STUDY DESIGN: The purpose of this study was to determine the concordance of Pediatric Health Information System (PHIS) perioperative antibiotic charges with the institution's medication administration data for males <10 years old and who underwent outpatient penile/inguinal procedures from July 2013 to March 2015. RESULTS: There was 93.9% positive and negative agreement between perioperative antibiotic charges versus administration. The sensitivity and specificity were 96.8% and 87.2%, respectively. The positive and negative predictive values were 94.6% and 92.2%, respectively. CONCLUSION: This study indicated strong agreement between PHIS pharmacy charges and medication administration.

Combined FDG and [F-18]fluoride whole-body PET: a feasible two-in-one approach to cancer imaging?

PURPOSE: To evaluate the diagnostic usefulness of the combined application of 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG; for the evaluation of soft tissue) and [F-18]fluoride (for the evaluation of the skeleton) in positron emission tomography (PET) of cancer. MATERIALS AND METHODS: Sixty consecutive patients (23 women, 37 men; mean age +/- SD, 51 years +/- 14; age range, 13-76 years) were entered into this prospective study. Thirty patients underwent only FDG PET. Thirty patients underwent combined FDG and fluoride PET. The PET findings were correlated with the findings of other imaging modalities. Interobserver agreement for the anatomic lesion localization was calculated with the use of the kappa statistic. RESULTS: All 30 combined FDG and fluoride studies yielded high-quality whole-body images. PET findings correlated with other imaging findings in 54 (78%) of 69 lesions in the control group and with 64 (88%) of 73 lesions in the combined group. Interobserver agreement in the control group was 0.74; it was 0.95 in the combined group. CONCLUSION: Combined FDG and fluoride PET is an advanced metabolic imaging approach for the evaluation of cancer.

[Whole body positron emission tomography in breast cancer]. / Ganzkörper-Positronen-Emissions-Tomographie beim Mammakarzinom.

The value of whole body positron emission tomography using F-18 2-deoxy-2-fluoro-d-glucose in primary work-up and follow-up was prospectively evaluated in 37 patients with primary or metastatic breast cancer. From 20 primary breast masses 15 from 16 malignant and 4 from 4 benign lesions confirmed by biopsy, were detected. In 3 out of 21 patients in correlation to morphologic imaging, respectively biopsy, no metastatic disease was not identified. Generally speaking, whole body positron emission tomography appears to be a suitable diagnostic staging tool in breast cancer.

Correlation of ultrasound and renal scintigraphy in children with unilateral hydronephrosis in primary workup.

Ultrasound accurately detects hydronephrosis in infants and children, while nuclear medicine techniques quantify relative renal function in addition to characterizing the urodynamic relevance of hydronephrosis. This prospective study was undertaken to examine the relationship between ultrasound morphological findings and relative renal function, quantified with dynamic 99mtechnetium mercaptotriacetylglycine imaging, in the initial diagnostic workup of children with unilateral hydronephrosis. The ultrasound grade of hydronephrosis and relative renal function ipsilateral to the hydronephrosis were inversely related, indicating that with more severe hydronephrosis ultrasound fails to estimate the potential reduction of relative kidney function. Because renal function is not necessarily affected by hydronephrosis, renal scintigraphy is indicated to assess the functional status of hydronephrotic kidneys.

Primary osteosarcoma of the thyroid gland.

Primary extraosseous osteosarcoma of the thyroid gland is a rare tumor which is associated with a poor prognosis. In this report, we discuss such a tumor and its recurrence in a 78-yr-old female with multinodular goiter, focusing on the imaging evaluation of this unusual tumor.

Brain morphology and regional cerebral blood flow in anorexia nervosa.

Cranial computed tomography (CT) was performed in 12 patients with anorexia nervosa, revealing that the majority of the patients displayed ventricular dilatation and/or sulcal widening. In addition, regional cerebral blood flow (rCBF) was measured at admission and once again after weight gain, using xenon-133 dynamic single-photon emission tomography (dSPECT). The mean flow rates assessed at the first examination did not significantly differ from those assessed at the second examination and from those of a control group. There was a significant inverse relationship between the size of the cerebrospinal fluid spaces and the cerebral blood flow in the anorectics; a decrease in ventricular size after weight gain was associated with an increase in cerebral blood flow in this area. This finding, however, has to be interpreted with caution, as partial volume effects render the flow rates ambiguous in brain areas, which, in addition to neuronal tissue, also include ventricular and sulcal structures.

Laminitis and decreased milk production in first-lactation cows improperly fed a dairy ration.

First-lactation cows that were improperly fed a grain ration developed chronic, nonsuppurative laminitis, resulting in profound lameness in all 4 limbs, thin body condition, and poor milk production. Results of ration analysis indicated that the cows were receiving 10% to 40% more energy than that recommended by the National Research Council. The following management changes were instituted for first-lactation cows: the absolute amount of concentrate offered was decreased by 10% to 25% (depending on each cow's milk production), the rate of increase in concentrate fed was lessened to achieve maximal intake in 21 days, feed was made available more frequently and in smaller amounts during the day, sequence feeding was implemented, forage was provided before grain when possible, and sodium bicarbonate (1%, on a dry-weight basis) and fat (5%, on a dry-weight basis) were added to the grain mix. These management changes normalized rumen fermentation, and the clinical problems did not develop in the 20 subsequently fresh heifers. Therefore, the ration should be analyzed when first-lactation cows begin developing lameness and poor milk production.

[Relative determination of hemisphere perfusion and hemisphere circulation. A comparison of the results of computer-assisted radionuclide angiography and dynamic single photon emission CT in patients with unilateral cerebrovascular disease]. / Relativbestimmung von Hemisphärenperfusion und Hemisphärendurchblutung. Ein Ergebnisvergleich von computerassistierter Radionuklidangiographie und dynamischer Single-Photon-Emissions-CT bei Patienten mit einseitiger zerebrovaskulärer Erkrankung.

Ratios of interhemispherical perfusion and blood flow were derived from 72 patients with reversible (TIA, PRIND) or irreversible (completed stroke) ischemic neurologic deficits. Differences from normal mean values (right-to-left: 1.00) were determined by employing CARNA with 99mTc-DTPA (perfusion) or DSPECT with 133Xe-gas (blood flow in ml/100 g/min). These differences were constantly higher for CARNA than for DSPECT. Such an excess for CARNA values was interpreted as the delay portion within the CARNA results, which increased from completed stroke (33% delay) to TIA (62% delay). The complement, i.e. the low flow portion, decreased in this sequence. Separation of CARNA values into delay and flow portions provides further information on the individual severity of cerebrovascular disease by employing a simple nuclear procedure. Moreover, it complements morphological findings from radiographic angiography and transmission CT.

Dynamic SPECT with Xe-133: regional cerebral blood flow in patients with unilateral cerebrovascular disease: concise communication.

To validate xenon-133 dynamic single photon emission tomography (SPECT) clinically, 74 patients were examined. Strictly unilateral cerebrovascular disease was confirmed in 47 patients by clinical history and by transmission computerized tomography (TCT) and contrast angiography. Twenty-seven were excluded, considered normal. SPECT flow maps were evaluated visually (against TCT) or by automated region of interest (ROI) techniques (12 areas per slice) to measure area flow (AF) (ml/100 g-min) and interhemispherical area flow ratios (AR). These were compared with normal values. Minimum AF in affected hemisphere decreased, and AR-to-normal difference increased, with the severity of the disease. Visually, low-flow areas were detected twice as frequently in SPECT as areas of low density of TCT. In reversible episodes, sensitivity of AF alone ws significantly below the sensitivity of combined evaluation of flow and ratio.

[133Xe-DSPECT (Dynamic Single Photon Emission CT). Results of a new noninvasive method for measuring regional cerebral blood flow (rCBF). Comparison with cranial angiography and transmission CT]. / 133Xe-DSPECT (Dynamische Single Photon Emissions CT). Ergebnisse einer neuen nicht-invasiven Methode zur Messung der regionalen Hirndurchblutung (rCBF). Ein Vergleich mit kranialer Angiographie und Transmissions-CT.

133Xenon-DSPECT provides measurement of regional cerebral blood flow (rCBF in ml/100 g/min) during and after inhalation of 133Xe gas. The result is displayed as a flow map of three transaxial slices. ROI divide a slice into 12 areas (SA) computing flow values (FSA). The results in 36 patients with cranial vascular disease are presented in comparison to 12 "normals". In all patients, FSA in the diseased hemisphere were found to be below the standard range of normals. Related to number of SA, this was true in completed stroke (bilateral) in 55% or (unilateral) in 14%, in PRIND in 5% of SA and in TIA in 7%. The absolute flow values did not decrease with the severeness of the disease, presumably depending on patient's age. There were more (p less than 0,005) SA found with decreased rCBF (21%) than areas with low density in T-CT (10%). Since unilateral cerebrovascular findings presented also bilateral reduced FSA, the validity of the method lies in the calculation of flow values, which significantly adds to the results of imaging.

[The iodine 131-hippurate clearance for the determination of the nephrotoxic effect of cis-dichlorodiamino-platin (II) (cis-platin, cis-DDP)]. / Die 131-Jod-Hippuranclearance zur Erfassung der nephrotoxischen Wirkung von cis-Dichlorodiamino-Platin (II) (cis-Platin, cis-DDP).

In 25 patients, who received repeated doses of cis-DDP, we determined iodo-131-hippurate-clearance, creatinine clearance and serum creatinine to assess the nephrotoxic effect induced by cis-DDP. A highly significant decrease in the iodo-131-hippurate-clearance was found between the first and the following cycles. There was no significant change in serum creatinine and creatinine clearance however. The radio-hippurate-clearance showed a clinically not important reduction during several cytotoxic courses in 15/25 patients (60%). A clinically relevant impairment of the radio-hippurate-clearance occurred in 8/25 patients (32%), mainly before the third and fifth cytotoxic cycle. In two patients this clearance did not alter or was even rising. In 12 cases a diminuation of the iodo-131-hippurate-clearance was observed, which in only 5 cases correlated to a decreased creatinine clearance and in only two cases to an elevated serum creatinine. Therefore, we consider neither creatinine nor creatinine clearance nor the combination of both parameters to be appropriate to assess tubular nephropathy induced by cis-DDP. Radio-hippurate-clearance should play a superior role deciding on treatment stop or dose reduction of cis-DDP. The regression of cis-DDP-induced nephropathy was not evaluated.

[Whole-body retention of 99mTc-methylene diphosphonate in skeletal diseases]. / Die Ganzkörperretention von 99mTc-Methylen-Diphosphonat bei Skeletterkrankungen.

The 24 h-whole-body retention (WBR), determined by a whole-body counter, may be used to quantify exactly bone seeking properties of a radiopharmaceutical. The 24h-WBR of 99mTc-methylene-diphosphonate was determined in 200 patients and was found to be independent of kidney function if this function was normal or only slightly diminished. The 24h-WBR was slightly dependent on age since it decreased up to 20 years of age, reaching a minimum at 20-25 years, and then increased with increasing age. Normal values of 24h-WBR for individuals of more than 20 years of age were 31.8 +/- 5% of injected dose. Not more than two focal accumulations, i.e. skeletal metastases, failed to elevate the 24h-WBR significantly (p less than 0.1). However, a highly significant (p less than 0.001) difference to normals was found in patients with multiple metastases (24h-WBR: 38.2 +/- 7%), with diffuse osseous involvement as in primary hyperparathyroidism (24h-WBR: 49 +/- 11.7%, p less than 0.001) or with osteoporosis (24h-WBR: 45%). The 24h-WBR was found to be very sensitive in grading diffuse osseous involvement. This was shown in single-tumor patients by follow-up as the 24h-WBR in addition to bone scans was useful to describe progression or remission. Moreover, the 24h-WBR correlated closely with results of bone marrow biopsies in a small group of patients with malignancies of the lymphoreticular system.

A comparison of bone imaging with Tc-99m DPD and Tc-99m MDP: concise communication.

Bone to soft tissue (ST) ratios for both high-uptake bone (sacrum) and low-uptake bone (femoral diaphysis) were obtained with a derivative of phosphonic acid, TC-99m 2,3-dicarboxypropane-1, 1-diphosphonate (DPD), in 26 normal subjects and 177 patients with malignant disease but without metastases. Tests were run 2 hr after tracer injection. Similar ratios were obtained with Tc-99m methylene diphosphonate (MDP) in 220 normal subjects and 451 patients. With MDP, the influence of incubation time (5-10 min in 416 cases, 45 min in 185 cases) on these ratios was determined. DPD was superior to MDP for both ratios. With MDP, prolonged incubation time yielded significantly enhanced ratios; however, the ratios for the DPD were still higher. With either agent and preparation, sacrum-to-ST ratios decreased with increasing subject age, and in patients with malignant disease the ratios tended to be higher than those obtained from normals.

Sensitivity of computer assisted radionuclide angiography in transient ischemic attack and prolonged reversible ischemic neurological deficit. Comparison with findings in radiographic angiography and transmission computerized axial tomography.

Computer assisted radionuclide angiography (CARNA) with 99mTc-DTPA was employed to study 143 patients with transient ischemic attacks (TIA) and 79 patients with prolonged reversible ischemic neurologic deficit (PRIND). The results of CARNA were compared with findings from radiographic angiography (RGA) in 173 patients and with findings in transmission computerized axial tomography (T-CAT) in 154 patients. In patients with TIA, CARNA showed a hemispherical perfusion deficit in 74.8%, and with PRIND 87.3%. This deficit, determined as the relative difference between the involved and the non-involved hemisphere, was significantly (p less than 0.0025) greater in PRIND (minus 23%) than in TIA (minus 17%). Sensitivity of CARNA was independent of the interval from ictus to examination for more than 4 months. RGA in TIA revealed true positives in 82.0%, in PRIND it was 89.5%. T-CAT was positive in TIA in only 16.8% but in PRIND it was 64.4%. Combined sensitivities in TIA (92.4%) and in PRIND (94.0%) were highest with the combination of CARNA and RGA. However, in PRIND the combination of non-invasive methods (CARNA and T-CAT) revealed 93.2% positive findings. Combinations of these evaluation methods may be used to detect cerebrovascular disease in patients with such dysfunction.

Dietary fat effects on blood insulin, glucose utilization, and milk protein content of lactating cows.

Relationships among dietary fat, glucose and insulin in blood plasma, and milk protein were investigated to determine mechanisms by which high fat diets depress milk protein percentage of lactating cows. Glucose clearance, determined by intravenous glucose infusion tolerance tests, of cows fed high fat diets was lower and insulin release higher than of control cows. Negative relationship between glucose utilization rate and insulin release was linear (correlation -.85), suggesting that fat feeding induced insulin resistance. Feeding lipid in a protected supplement did not change production of milk or milk protein but depressed milk protein percentage and increased quantity and concentration of milk fat. Concentrations of total lipids in blood plasma were increased whereas glucose and insulin were reduced by protected lipid supplement. Dietary fat may impair amino acid transport into the mammary gland and milk protein synthesis by inducing insulin resistance.