Listeria meningitis presenting as enteritis in a previously healthy infant: a case report.

A previously healthy 1-year-old infant was admitted with pyrexia and mild gastro-intestinal symptoms. A blood culture, taken on admission, showed growth of Listeria monocytogenes (serotype 4b) on the 3rd day, at which time a lumbar puncture revealed a listeric meningitis. Despite the delay of antibiotic treatment, the infant never showed any neurological symptoms. She recuperated without any residual effects.

Scintigraphic assessment of lower urinary tract function in children with and without outflow tract obstruction.

Analysis of lower urinary tract function with an extension of standard renography with 123I-hippurate was carried out in 199 children. Maximum bladder capacity, voiding and residual bladder volumes, average and maximum urine flow rates and urine flow patterns were estimated. The index of urine transport (IUT), representing the relationship between urine flow rate and bladder volume, was introduced as a measure of outflow capability. Of 129 children without evidence of outflow obstruction, 90% had a normal urine flow pattern; in 96% the average IUT was 0.8 or higher and in 87% the maximum IUT was 1.2 or higher. A sawtooth-shaped pattern with both normal and abnormal IUT values was observed in 10% of these children. In 63% of the children with outflow tract obstruction there was a low, flat urine flow pattern together with decreased IUT values. A sawtooth-shaped pattern with varying IUT values was observed in 15%, whereas in 20% the urine flow pattern and IUT values were normal. This extension of standard radionuclide renography as a method of screening lower urinary tract function is recommended. It is at least as good as conventional direct urine flow rate recording, it has the advantage of being non-invasive and it is also part of an established urological investigation.

Urodynamics: a noninvasive screening of lower urinary tract function in children with radioisotopes.

A noninvasive intravenous assessment of lower urinary tract function with 123I-hippurate was carried out in 129 children without suspicion of lower urinary tract outflow pathology. Without increasing the radiation burden standard renography was extended by lower urinary tract function analysis in the same session. The maximum bladder capacity, voiding and residual bladder volumes, average and maximum urine flow rates were calculated and the relation between the urine flow rate and bladder volume expressed as the index of urine transport (IUT). This index seems to be a much more reliable standard than isolated measurements of urine flow rates and bladder volumes in screening lower urinary tract function. Three different urine flow patterns were recognized: a single sharp peak (in 70%) and a biphasic curve (in 20%) were considered to be normal. A sawtooth-shaped pattern, observed in 10% of the children, may be caused by detrusor malfunction. The prolonged time necessary for this more extensive analysis of the lower urinary tract is well compensated by the additional information gained.

Twin pregnancy: case reports illustrating variations in transfusion syndrome.

The twin transfusion syndrome is diagnosed in 5.5% to 14.6% of monochorionic twins and the classical picture reveals a small anemic donor and a large plethoric recipient. Many other clinical discrepancies have been described. Today, by ultrasound it is possible to diagnose the syndrome in (early) pregnancy. In these case reports different clinical pictures and the importance of ultrasound are described. In twin pregnancies repeated ultrasound examinations should be considered with the consequences of vascular anastomoses.

Cystathioninuria in patients with neuroblastoma.

Urinary excretion of cystathionine and dopa metabolites was analyzed in 61 patients with active neuroblastoma before, and at regular intervals during treatment. Thirty-seven patients with clinical evidence of active neuroblastoma excreted elevated levels of cystathionine before treatment was initiated; six other patients showed cystathioninuria at some time during treatment with chemo- or radiotherapy. The cause of the cystathioninuria remains unidentified. No relationship between excessive cystathionine excretion and liver impairment or liver metastases was established; nor was there evidence to support a consistent correlation with the ratio of the sum of the excretion values for vanilglycolic acid and vanilglycol to the excretion of vanilacetic acid. Our results indicate that absence of cystathioninuria correlates with an early clinical staging and thus with a favorable prognosis. Isolated cystathioninuria does occasionally occur in patients with neuroblastoma, permitting a presumptive diagnosis until later evidence can be obtained. Determination of cystathionine excretion is essential for an extensive biochemical evaluation of patients with neuroblastoma.