RESUMO
INTRODUCTION: We present a novel approach to the treatment of membranous duodenal stenosis (MDS). To our knowledge this is the first paper to describe balloon dilatation for this entity. MATERIAL AND METHODS: Four children, 2 boys and 2 girls, aged between 8 and 28 days, underwent duodenal balloon dilatation. Balloon dilatation was performed under general anaesthesia using standard angiography balloons per os. Balloon diameters ranged from 6 to 14 mm. RESULTS: All balloon dilatations were successful. None of the procedures showed procedural or post-procedural complications. None of the patients subsequently required surgical intervention. To date all children are doing well. DISCUSSION: The initial experience with balloon dilation of MDS showed a 100% success rate, without procedural or post-procedural complications. The results obtained in this small group of patients suggest that the use of balloon dilatation in cases of MDS may be a safe technique that can be readily performed by an experienced interventional radiologist.
Assuntos
Cateterismo , Duodenopatias/terapia , Obstrução Intestinal/terapia , Meios de Contraste , Duodenopatias/diagnóstico por imagem , Feminino , Humanos , Recém-Nascido , Obstrução Intestinal/diagnóstico por imagem , Iohexol , Masculino , Radiografia Intervencionista , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Epidemiological data implicate puberty as a factor in the initiation of diabetic nephropathy. However, the mechanism remains unclear. We hypothesized that puberty would result in an increase in glomerular hypertrophy and hypertension; these two early concomitant events are seen as pivotal to the pathophysiology of diabetic nephropathy. We studied the effect of pubertal duration on three surrogate markers of glomerular hypertrophy/hypertension: kidney volume (KV), microalbuminuria (MA), and Na-Li countertransport (CT). We recruited 177 subjects (87 female and 90 male; aged 6.2-22.1 years) with IDDM of 5 to 10 years' duration (6.8 +/- 1.6 years) into three groups with different pubertal duration: prepubertal since IDDM diagnosis; prepubertal at diagnosis, now pubertal; or early puberty at diagnosis, now postpubertal. KV was measured by ultrasound and corrected for body surface area; MA was defined as urinary albumin excretion of 15-200 micrograms/min in two of three 24-h samples, and Na-Li CT was measured in erythrocytes. As pubertal duration increased, there was a disproportionate increase in mean KV (prepubertal, 247 +/- 6 [SE] ml/1.73 m2; pubertal, 282 +/- 7/1.73 m2; postpubertal, 295 +/- 7/1.73 m2, P = 0.001), prevalence of nephromegaly (KV > 300 ml/1.73 m2) (14, 31, and 45%, respectively, P = 0.001), and prevalence of MA (0, 9.7, and 20.5%, respectively, P = 0.003). Subjects with KV > 300 ml/1.73 m2 were eight times more likely to have MA than those with KV < 300 (odds ratio 8.1, 95% confidence interval 2.4-27.4, P = 0.0001). There was no effect of pubertal duration on Na-Li CT. Multiple regression with KV as the dependent variable found an association with pubertal duration, MA, Na-Li CT, and current HbA1c (P < 0.0001). Our findings indicate that pubertal duration is an important determinant of both KV and MA and suggest that nephromegaly precedes microalbuminuria. We postulate that these effects are attributable to the influence of the pubertal milieu on glomerular hypertrophy/hypertension.
Assuntos
Diabetes Mellitus Tipo 1/complicações , Hipertensão Renal/fisiopatologia , Glomérulos Renais/fisiopatologia , Rim/patologia , Puberdade/fisiologia , Adolescente , Adulto , Albuminúria/complicações , Transporte Biológico , Biomarcadores , Criança , Diabetes Mellitus Tipo 1/metabolismo , Diabetes Mellitus Tipo 1/urina , Nefropatias Diabéticas/etiologia , Nefropatias Diabéticas/fisiopatologia , Eritrócitos/metabolismo , Feminino , Humanos , Hipertrofia , Glomérulos Renais/patologia , Lítio/metabolismo , Masculino , Sódio/metabolismoRESUMO
A pilot study on the percutaneous introduction of a cecostomy tube for colonic irrigations in the treatment of children with fecal incontinence is described. The results were good, and the technique is recommended for certain patients.
Assuntos
Cateteres de Demora , Cecostomia/instrumentação , Incontinência Fecal/cirurgia , Adolescente , Adulto , Criança , Estudos de Viabilidade , Incontinência Fecal/diagnóstico por imagem , Incontinência Fecal/etiologia , Feminino , Humanos , Masculino , Projetos Piloto , Radiografia , Irrigação Terapêutica/instrumentaçãoRESUMO
Percutaneous insertion of a cecostomy tube, performed under local anesthesia, to facilitate antegrade colonic cleansing, has been an invaluable advance in the management of fecal incontinence. However, the patient is left with a length of tubing (2 to 4 inches) protruding from the cecostomy site that has to be taped down to the abdominal wall. Available devices for insertion in place of the cecostomy tube are cumbersome and have a relatively high profile, projecting more than 1 cm from the surface of the abdominal wall. Worn under a swimsuit, they are clearly discernible. The inflated balloon within the cecum can occasionally break. Furthermore, in the individual with a relatively thick abdominal wall, such devices are too short to reach from the skin to the cecum. A new form of low-profile trapdoor device has been developed that overcomes the above shortcomings of other available "buttons." It has been successfully used in a clinical setting in 49 patients.
Assuntos
Cateteres de Demora , Cecostomia/instrumentação , Incontinência Fecal , Criança , Desenho de Equipamento , Humanos , Qualidade de VidaAssuntos
Nutrição Enteral/métodos , Falência Renal Crônica/terapia , Nutrição Parenteral/métodos , Desnutrição Proteico-Calórica/terapia , Adolescente , Criança , Pré-Escolar , Terapia Combinada , Feminino , Gastrostomia/métodos , Humanos , Lactente , Falência Renal Crônica/etiologia , Masculino , Peritonite/etiologia , Peritonite/terapia , Desnutrição Proteico-Calórica/etiologia , Fatores de RiscoRESUMO
OBJECTIVE: To determine the major complication rate in the first 30 days after enterostomy tube insertion in infants with spinal muscular atrophy (SMA) type 1. STUDY DESIGN: A retrospective case review of all children with SMA type 1 who had a gastrostomy or gastrojejunostomy tube placed by the image-guided technique at the Hospital for Sick Children from 1994-2004. Major complications were classified as peritonitis, aspiration pneumonia, respiratory failure, nonelective admission to the pediatric intensive care unit, and death. RESULTS: Twelve children were identified as having SMA type 1 with an enterostomy tube insertion. The median age at tube insertion was 6.1 months (range 2.2 to 15.8 months). Major complications in the first 30 days after the procedure included aspiration pneumonia (5/12 patients [41.6%]), respiratory failure requiring admission to the pediatric intensive care unit (4/12 [33%]), and death (2/12 [16.7%]). Children with development of aspiration pneumonia were significantly older at time of tube insertion (P < .05) than those with no aspiration. CONCLUSIONS: Major complications including death are seen in children with SMA type 1 in the first 30 days after enterostomy tube insertion.
Assuntos
Nutrição Enteral/efeitos adversos , Nutrição Enteral/instrumentação , Enterostomia/efeitos adversos , Enterostomia/instrumentação , Atrofias Musculares Espinais da Infância , Humanos , Lactente , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Atrofias Musculares Espinais da Infância/terapiaRESUMO
OBJECTIVE: This study was undertaken to validate the outcome of interventional drainage and IV antibiotics for the treatment of appendiceal abscesses in children. MATERIALS AND METHODS: Between March 1991 and March 1995, 46 children with one or more intraabdominal appendiceal abscesses were seen at a tertiary care referral center. The children received IV antibiotics and underwent interventional drainage of their collections. All procedures were performed in the radiology intervention suite using IV sedation and, in one patient, a general anesthetic. All patients were followed up for at least 1 year. RESULTS: The 46 patients underwent 64 procedures. These included the insertion of 34 percutaneous drainage catheters, the insertion of 25 transrectal drainage catheters, and five needle aspirations. Four patients did not respond to their initial treatment and required surgery. One patient developed a colonic fistula that resolved spontaneously. CONCLUSION: Successful treatment of 42 patients (91%) justifies image-guided drainage and IV antibiotics as appropriate management for appendiceal abscesses in children.
Assuntos
Abscesso Abdominal/terapia , Apendicite/terapia , Drenagem/métodos , Abscesso Abdominal/diagnóstico por imagem , Antibacterianos , Apendicite/diagnóstico por imagem , Cateterismo/métodos , Criança , Pré-Escolar , Quimioterapia Combinada/uso terapêutico , Feminino , Humanos , Injeções Intravenosas , Masculino , Radiografia Intervencionista , Resultado do Tratamento , UltrassonografiaRESUMO
PURPOSE: To compare the effectiveness of radiologically guided transrectal drainage (TRD) of deep pelvic abscesses (DPAs) in children with that of percutaneous and surgical techniques. MATERIALS AND METHODS: Treatment results in 57 children with DPAs were retrospectively evaluated. The following procedures were performed: TRD alone (n = 21), TRD and percutaneous drainage (PD) of multiple abscesses (n = 5), PD alone (n = 19), and open surgical drainage (SD) (n = 8). Four patients were treated medically. Most abscesses were due to either perforated appendix or recent appendectomy. Patients believed to have a perforated appendix underwent interval appendectomy 4-6 weeks after TRD or PD. RESULTS: All patients recovered fully. TRD was tolerated better than PD or SD. Patients were usually ambulatory within 24 hours of the TRD procedure and required minimal analgesia. The average hospital stay was 4.2 days with TRD, 8 days with TRD and PD, 6 days with PD, and 10.5 days with SD. CONCLUSION: Radiologically guided TRD is effective in the treatment of DPAs.
Assuntos
Abscesso/terapia , Drenagem/métodos , Radiologia Intervencionista , Abscesso/etiologia , Apendicectomia/efeitos adversos , Apendicite/complicações , Cateterismo/métodos , Criança , Feminino , Humanos , Perfuração Intestinal/complicações , Tempo de Internação , Masculino , Pelve , Estudos Retrospectivos , Ruptura EspontâneaRESUMO
Two hundred and thirty-five children who underwent percutaneous renal biopsy under real-time ultrasound guidance at The Hospital for Sick Children, between 1 January 1991 and 31 March 1993, were studied to compare the incidence of complications after biopsies with the Trucut needle (TN) and the Bard Biopty gun (BG). Of the 190 cases for which full clinical details were available and in which a single instrument was used for renal biopsy, 157 were biopsied with the BG and 33 with the TN. There was no significant difference between the two groups in variables such as age, weight, sex, number of needle passes and number of tissue cores obtained. The proportion of native and allograft biopsies in each group was similar. More children in the TN group underwent biopsy under general anaesthesia. Adequate diagnostic tissue samples were obtained in 189 of 190 cases. There were more complications in the TN group than in the BG group (P < 0.001). When allograft and native kidney biopsies were analysed separately, this difference in complications remained highly significant for the native kidney group (P < 0.005), though not for the allograft group. When the effect of needle size alone was investigated, there was no significant difference in the incidence of complications when TN biopsies were compared with 14-gauge BG biopsies or when 14- and 18-gauge BG biopsies were compared with each other.
Assuntos
Biópsia por Agulha/métodos , Rim/patologia , Biópsia por Agulha/efeitos adversos , Biópsia por Agulha/instrumentação , Criança , Feminino , Humanos , Incidência , Masculino , Estudos RetrospectivosRESUMO
Radiologic investigation plays an important role in the diagnosis and management of tuberculosis of the odontoid bone. Immediate confirmation of the condition by examination of tissue and surgery may save lives and reduce the morbidity rate substantially. When the clinical history is appropriate, a diagnosis of tuberculosis is strongly suggested by plain films of the cervical spine showing precervical swelling of the soft tissues, narrowing of the disk spaces and focal erosion of the bones and by computed tomography scans demonstrating details of the soft-tissue abnormality, focal bony erosion and sclerosis.
Assuntos
Processo Odontoide/diagnóstico por imagem , Quadriplegia/etiologia , Tuberculose Osteoarticular/complicações , Tuberculose Osteoarticular/diagnóstico por imagem , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: To evaluate the safety, diagnostic yield, and clinical benefits of performing ultrasonography (US)-guided percutaneous splenic core biopsy in children. MATERIALS AND METHODS: US-guided splenic core biopsy was performed in 30 children aged 6 months to 15.3 years (mean, 7.0 years), with focal lesions in 27 patients and homogeneous splenomegaly in three. Four patients underwent repeat biopsy to identify changes in splenic disease. Four types of biopsy needles were used in this series. General anaesthesia was used in 21 patients and conscious sedation in nine. Medical records were reviewed to assess diagnostic accuracy, influence on treatment, and biopsy-related complications. RESULTS: All biopsies were performed without complication. Among the 30 biopsies, an accurate diagnosis was obtained in 25 (83%), a false-negative result was obtained in two (7%), and three (10%) were nondiagnostic. All conclusive results influenced treatment decisions. The mean number of needle passes was 2.7 per patient (range, 2-5 passes). Use of needles was 50%-100% successful in the acquisition of adequate tissue cores. Use of the 18-gauge needle was always successful in the safe acquisition of adequate tissue, with a maximum of three passes. CONCLUSION: US-guided splenic core biopsy is a minimally invasive, simple, and safe procedure for use in children. It provides relatively high diagnostic accuracy while minimizing complications when compared with alternative, more invasive procedures.
Assuntos
Esplenopatias/diagnóstico por imagem , Esplenopatias/patologia , Adolescente , Biópsia por Agulha/instrumentação , Biópsia por Agulha/métodos , Criança , Pré-Escolar , Desenho de Equipamento , Reações Falso-Negativas , Feminino , Humanos , Lactente , Masculino , Agulhas , UltrassonografiaRESUMO
BACKGROUND: The use of gastrojejunostomy (GJ) tubes for feeding pediatric patients who have inadequate oral intake, cannot tolerate gastric feeding, or have significant gastroesophageal reflux may present problems. OBJECTIVE: To report our experience of intussusception associated with GJ tubes, with emphasis on risk factors. MATERIALS AND METHODS: Clinical histories and imaging studies were reviewed for all patients with GJ tube-associated intussusceptions at our institution from January 1995 to March 1999. RESULTS: Of 251 GJ tubes inserted, 40 (16%) intussusceptions occurred in 30 patients (20 males). They ranged in age from 3 months to 17 years (mean 2.6 years) and in weight from 3 to 90 kg (mean 12.5 kg). The underlying diagnosis varied. The main symptom was bilious vomiting. The initial diagnosis was made by sonography in 19 cases and fluoroscopy in 21. Intussusceptions recurred eight times in patients with a distal pigtail (n = 17) but only twice in patients without the distal pigtail (n = 18). CONCLUSIONS: GJ-tube related intussusception is a common, easily diagnosed problem. Predisposing factors appear to be male sex, young children, and presence of a distal pigtail on the tube. Awareness of intussusception is imperative for prompt diagnosis to achieve feeding tolerance.
Assuntos
Intestino Delgado , Intubação Gastrointestinal/efeitos adversos , Intussuscepção/etiologia , Adolescente , Criança , Pré-Escolar , Feminino , Fluoroscopia , Humanos , Lactente , Intussuscepção/diagnóstico por imagem , Masculino , Recidiva , Fatores de Risco , UltrassonografiaRESUMO
OBJECTIVE: We describe antegrade intussusceptions of duodenum and jejunum around gastrojejunostomy tubes seen on sonography and fluoroscopic contrast tube studies. Reduction of the intussusception was achieved by bolus injection of air or contrast medium through the tube or exchange over a wire. CONCLUSION: Sonography and fluoroscopic contrast tube studies permit diagnosis of intussusception around gastrojejunostomy tubes.
Assuntos
Duodenopatias/diagnóstico , Intubação Gastrointestinal/efeitos adversos , Intussuscepção/diagnóstico , Intussuscepção/etiologia , Doenças do Jejuno/diagnóstico , Pré-Escolar , Duodenopatias/diagnóstico por imagem , Duodenopatias/etiologia , Nutrição Enteral , Feminino , Fluoroscopia , Humanos , Lactente , Intubação Gastrointestinal/instrumentação , Intussuscepção/diagnóstico por imagem , Doenças do Jejuno/diagnóstico por imagem , Doenças do Jejuno/etiologia , Masculino , Estudos Prospectivos , UltrassonografiaRESUMO
PURPOSE: To evaluate the technique used for and long-term results of percutaneous cecostomy tube placement for the treatment of fecal incontinence in children. MATERIALS AND METHODS: After an initial pilot study in 15 patients, 42 additional patients with fecal incontinence aged 2-20 (mean, 11.5) years and weighing 9.9-109.0 (mean, 39.2) kg underwent percutaneous cecostomy tube placement. Twenty-nine patients had spina bifida, nine had imperforate anus, three had cloacal anomalies, and one had Hirschsprung disease. Mean follow-up was 265 days (range, 8-503 days). RESULTS: Tube placement was successful in all patients. One patient developed local inflammation after accidental early retention-suture removal, which was treated with suture replacement and intravenous antibiotics. Another developed postprocedural ileus, which resolved. Late complications included constipation in one patient (treated with diet alteration), granulation tissue in seven patients (treated with silver nitrate cautery), and accidentally dislodged tubes in three patients (two successfully replaced at home and one replaced at the radiology suite). Vomiting related to the phosphate enema occurred in two patients. Resolution of soiling was achieved in all patients. CONCLUSION: Percutaneous cecostomy and antegrade enemas are very successful in achieving fecal continence and patient independence and acceptability, with minimal early and late complications.
Assuntos
Cecostomia/métodos , Incontinência Fecal/cirurgia , Adolescente , Adulto , Antibacterianos/uso terapêutico , Anus Imperfurado/cirurgia , Peso Corporal , Doenças do Ceco/etiologia , Cecostomia/efeitos adversos , Cecostomia/instrumentação , Criança , Pré-Escolar , Cloaca/anormalidades , Constipação Intestinal/etiologia , Enema/efeitos adversos , Falha de Equipamento , Incontinência Fecal/terapia , Feminino , Seguimentos , Tecido de Granulação/patologia , Doença de Hirschsprung/cirurgia , Humanos , Inflamação , Obstrução Intestinal/etiologia , Masculino , Fosfatos/efeitos adversos , Projetos Piloto , Estudos Prospectivos , Nitrato de Prata/uso terapêutico , Disrafismo Espinal/cirurgia , Técnicas de Sutura , Vômito/etiologiaRESUMO
PURPOSE: To assess the feasibility and complications of peripherally inserted central catheters (PICCs) in pediatric patients. MATERIALS AND METHODS: The authors attempted to place PICCs in 122 patients aged 9 days to 19 years (mean, 6.82 years; median, 5 years). Catheters were placed to allow prolonged administration of antibiotics or chemotherapeutic agents (n = 50), provide total parenteral nutrition (n = 41), and establish prolonged intravenous access for blood draws and fluid administration (n = 31). Silicone catheters measuring 3, 4, and 5 F were inserted in either basilic or cephalic veins and positioned at the junction of the superior vena cava and right atrium under fluoroscopic guidance. Patients were monitored for complications until devices were removed. RESULTS: Fluoroscopically guided PICC placement was successful in 137 of 148 attempts. Postinsertion complications included mechanical defects of the catheter, PICC-related infection, occlusion of the PICC, and venous stasis. Complications occurred at a rate comparable to those seen with blind insertion. CONCLUSION: Fluoroscopically guided PICC placement is feasible and safe in pediatric patients.
Assuntos
Cateterismo Venoso Central/instrumentação , Cateterismo Venoso Central/métodos , Adolescente , Adulto , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Veia Axilar , Infecções Bacterianas , Veias Braquiocefálicas , Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora/efeitos adversos , Criança , Pré-Escolar , Falha de Equipamento , Estudos de Viabilidade , Feminino , Hidratação/efeitos adversos , Hidratação/instrumentação , Fluoroscopia , Antebraço/irrigação sanguínea , Átrios do Coração , Humanos , Lactente , Recém-Nascido , Masculino , Nutrição Parenteral/efeitos adversos , Nutrição Parenteral/instrumentação , Radiologia Intervencionista , Silicones , Veia Cava Superior , Insuficiência Venosa/etiologiaRESUMO
Malignant pulmonary nodules in a patient with neoplasia alters clinical staging and therapy. Although it may be difficult, it is imperative to obtain a tissue diagnosis of such nodules. We describe a coaxial technique using controlled respirations, which we have found useful for biopsy of small pulmonary nodules in children. Clinical records, imaging and pathology (histology and cytology) were reviewed for 17 children who had 18 nodules biopsied in the method described. A diagnosis of malignant or benign tissue was made in 15 nodules. One biopsy was inadequate and there was one false-negative. Adequate cores were obtained in 15 nodules, cytology in 2 and inadequate material in 1. There was no significant morbidity.
Assuntos
Biópsia por Agulha/métodos , Neoplasias Pulmonares/patologia , Nódulo Pulmonar Solitário/patologia , Tomografia Computadorizada por Raios X , Adolescente , Criança , Pré-Escolar , Diagnóstico Diferencial , Erros de Diagnóstico , Estudos de Viabilidade , Feminino , Humanos , Pneumopatias/diagnóstico por imagem , Pneumopatias/patologia , Pneumopatias/cirurgia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Masculino , Estudos Retrospectivos , Nódulo Pulmonar Solitário/diagnóstico por imagem , Nódulo Pulmonar Solitário/cirurgia , ToracotomiaRESUMO
We prospectively studied Retrograde Percutaneous Gastrostomy (RPG) in 57 children (age 3 weeks-17 years, 1.7-48 kg) as the feasibility and complications of this technique have not been reported in a large series of children. We used IV sedation (42), oral sedation (4 neonates), general anaesthesia or local anaesthesia only. The retrograde approach for gastrostomy or gastrojejunostomy catheter placement is described. Catheter placement was unsuccessful in only one child, due to the presence of marked hepatosplenomegaly. Catheters were successfully placed in all the other 56 children. In one of these, catheter misplacement occurred due to retraction of the stomach from the anterior abdominal wall during its insertion. This was recognized during the procedure. The catheter was removed and reinserted on the same occasion. One catheter was accidentally pulled out after six days and was subsequently replaced. Two children had mild, local abdominal tenderness and fever for up to 48 hours but post procedure septicemia or significant infection were not encountered. All children benefitted from gastrostomy feeding and gained weight.
Assuntos
Gastroscopia , Gastrostomia/métodos , Intubação Gastrointestinal/métodos , Adolescente , Criança , Pré-Escolar , Gastrostomia/efeitos adversos , Gastrostomia/instrumentação , Humanos , Lactente , Recém-Nascido , Intubação Gastrointestinal/efeitos adversos , Intubação Gastrointestinal/instrumentação , Estudos ProspectivosRESUMO
Objective. To assess the successful non-operative management in traumatic pancreatic pseudocysts (TPP) associated with duct laceration in children. Surgical therapy (cystogastrostomy or distal pancreatectomy with splenic salvage) has been classically considered the treatment of choice for those pseudocysts. Materials and methods. This report presents the clinical and imaging findings in two children with TPP and pancreatic duct disruption observed either on endoscopic retrograde cholangiopancreatography or injection via catheter drainage. Results. Both children responded to long-term cyst drainage. Conclusion. Although the experience is limited, the authors suggest that pancreatic injury associated with duct laceration can respond to non-operative management.
Assuntos
Pâncreas/lesões , Ductos Pancreáticos/lesões , Pseudocisto Pancreático/terapia , Adolescente , Criança , Colangiopancreatografia Retrógrada Endoscópica , Drenagem , Feminino , Humanos , Pseudocisto Pancreático/etiologia , Somatostatina/administração & dosagemRESUMO
Elevation in the intrarenal resistive index has been suggested by many to be a physiological parameter useful for detecting functionally significant hydronephrosis. It is currently unknown whether the intrarenal resistive index changes truly reflect the changes in collecting system pressure or whether they are simply a coincidental epiphenomenon. The purpose of this study is to establish the relationship between intrarenal resistive index and collecting system pressure. Between August 1992 and October 1993, 9 patients younger than 1 year underwent a percutaneous pressure-flow study as part of hydronephrosis evaluation. During the pressure-flow study intrarenal resistive index was measured serially with simultaneous renal pelvis pressure readings. In all patients the index increased as the renal pelvis pressure increased. Furthermore, using the experimentally derived proximal tubular pressure of 14 cm. water as the probable threshold for functionally normal collecting system pressure, it was found that all intrarenal indexes of 82% or less corresponded to renal pelvis pressures of less than 14 cm. water, while all of those greater than 82% corresponded to renal pelvis pressures greater than 14 cm. water. By combining several lines of evidence, it appears probable that as maximal diuresis induced by physiological and pharmacological means leads to acute transient elevation in renal pelvis pressure in a functionally obstructed collecting system, the intrarenal resistive index is capable of reflecting this dynamic elevation in renal pelvis pressure and potentially able to distinguish physiologically significant upper urinary tract obstruction from nonobstructive dilatation.
Assuntos
Hidronefrose/fisiopatologia , Pelve Renal/fisiopatologia , Artéria Renal/fisiopatologia , Velocidade do Fluxo Sanguíneo , Humanos , Hidronefrose/diagnóstico por imagem , Lactente , Pressão , Artéria Renal/diagnóstico por imagem , Ultrassonografia , Resistência VascularRESUMO
In pursuit of a diagnostic modality better able to assess collecting system urine transport characteristics while operating within physiological ranges, a new set of guidelines for the pressure flow study was proposed. An infusion rate individualized for each patient was chosen based on a calculated estimate of the maximum physiological urine output, adjusted for patient size and age. The upper limit of normal renal pelvic pressure used was 14 cm. water. We evaluated 37 renal units with grade 3 or 4 hydronephrosis with the individualized pressure flow study. Patient age ranged from 0.2 to 12 years (median 1.1). Calculated individualized infusion rates ranged from 1.3 to 12.5 ml. per minute and resulting renal pelvic pressures ranged from 7 to greater than 40 cm. water. In each patient the corresponding renal pelvic pressure resulting from a fixed 10 ml. per minute infusion rate was uniformly equal to or higher than the corresponding individualized study pressures (p < 0.0001). Disagreement between the individualized and fixed rate pressure flow studies was highest in the younger patients. The correlation coefficient between diuretic nuclear renography half-times and individualized pressure flow results was 0.09, indicative of a random association between the 2 variables. By using individualized infusion rates based on the calculated estimate of the maximum physiological urine output, much of the falsely high pressures induced by nonphysiologically high fixed infusion rates in pediatric patients can be avoided.