Preoperative assessment of neurovesical function in children with anorectal malformation: association with vertebral and spinal malformations.

PURPOSE: We preoperatively assessed neurovesical function and spinal cord function in children with anorectal malformations. In cases of neurovesical dysfunction we looked for an association with vertebral malformation or myelodysplasia. MATERIALS AND METHODS: We prospectively evaluated 80 children with anorectal malformations via preoperative urodynamics and magnetic resonance imaging of the spine. Bladder compliance and volume, detrusor activity and vesicosphincteric synergy during voiding allowed urodynamic evaluation. Results were reported according to Wingspread and Krickenbeck classifications of anorectal malformations. RESULTS: Urodynamic findings were pathological in 14 children (18%). Pathological evaluations did not seem related to type of fistula or level of anorectal malformation. Vertebral anomalies were seen in 34 patients (43%) and myelodysplasia in 16 (20%). Neither vertebral anomaly nor myelodysplasia seemed associated with type of fistula or severity of anorectal malformation. Of 14 children with pathological urodynamics no vertebral anomaly or myelodysplasia was found in 7. Of 66 children with normal urodynamics 40 presented with vertebral or spinal malformation. CONCLUSIONS: Lower urinary tract dysfunction is common in patients with anorectal malformations. Normal spine or spinal cord does not exclude neurovesical dysfunction. Myelodysplasia or vertebral anomaly does not determine lower urinary tract dysfunction. Thus, we recommend preoperative urodynamic assessment of the bladder and magnetic resonance imaging of the spine in children with anorectal malformations.

[Antenatally detected hydronephrosis: practical approach for the pediatrician]. / Dilatation pyélocalicielle chez le nouveau-né: attitude pratique pour le pédiatre.

Approximately 1% of the fetuses present some dilatation of their urinary tract in utero. More than 50% of these antenatally detected hydronephrosis will disappear spontaneously after birth. The other 50% comprises ureteropelvic junction obstruction, vesico-ureteral reflux and primary megaureters. Postnatal radiological evaluation (renal ultrasonography and VCUG) is performed in every infant with a significantly dilated renal pelvis (> 8 mm between 20 and 30 weeks or > 10 mm after 30 weeks in utero). Renal nuclear scan should be done in every child with significant/worsening post-natal hydronephrosis. Antibioprophylaxis will be started from birth to prevent urinary tract infection. Medical or surgical approach will be chosen in the light of the uroradiological exam results and the clinical progress.

Augmented hemoperfusion for hyperbilirubinemia.

Exchange transfusions and phototherapy are used to treat hyperbilirubinemia, each method having its own disadvantages. Hemoperfusion with coated activated charcoal (CAC) produces low removal rates due to the strong binding of bilirubin to albumin. Biocompatible chemical agents were investigated to selectively unbind the bilirubin into solution just prior to CAC exposure. In batch mock solution tests, the addition of sodium benzoate resulted in a 69% equilibrium bilirubin removal at 50 mM and 96% removal at 100 mM. During flow tests, adsorptive removal of sodium benzoate was so rapid that the CAC had to be pretreated with sodium benzoate solutions. In the absence of sodium benzoate, the outlet bilirubin was 50% of the inlet concentration at the passage of one void volume, with a rapid increase to 70% (30% removal). With sodium benzoate at 100 mM, the same 50% outlet/inlet percent was observed at one void volume throughput, but the outlet concentration fell to 6% of the inlet at 12 column void volumes (94% removal). Similar experiments with bovine plasma/blood and human plasma resulted in an average increase in bilirubin removal of 25% for the bovine and human plasma and 35% for the bovine blood at 100 mM benzoate. A significant decrease in platelet aggregation was measured with the addition of sodium benzoate, which makes this augmented hemoperfusion removal of bilirubin clinically attractive.