Percutaneous nephrostomy in infants and children.

RATIONALE AND OBJECTIVES: The purpose of this study was to review the authors' experience with percutaneous nephrostomy during an 11-year period, paying special attention to indications and outcomes. MATERIAL AND METHODS: The records of 71 percutaneous nephrostomy procedures performed on 59 children at the authors' institution from January 1987 through December 1997 were retrospectively reviewed. In these children, ultrasonography was used for puncture and fluoroscopy for catheter insertion. Local anesthesia with sedation was used and later replaced by general anesthesia. Loop-end catheters were employed. The smallest patient weighed 1,200 g, and the mean patient age was 3.4 years. RESULTS: The mean duration of drainage was 60 days, and the longest time was 11 months. Indications were mainly obstructions, with congenital obstruction (n = 28) and postoperative obstruction (n = 26) being the most common. Obstructive pyelitis, malignancy, stone, renal cystic disease, trauma, and neurogenic bladder disturbance were also indications. No complications such as loss of the kidney, serious infection, or hemorrhage of clinical importance were observed. Obstruction was successfully relieved in all patients, but 12 kidneys and five hemikidneys did not recover function and were eventually removed. CONCLUSION: The percutaneous nephrostomy procedure is a safe technique that can be used successfully for short- and longterm drainage in all children, even in small infants and those with solitary kidneys, and is a valuable adjunct to surgery.

BRCA1-positive patients are small for gestational age compared with their unaffected relatives.

The BRCA1 gene is thought to exert its main function early in life. We, therefore, studied the effects of BRCA1 mutations on birth weight and birth length. This was carried out by comparing 33 women with and without mutations. Birth weight and length were obtained from a self-administered questionnaire. BRCA1 mutations carriers had a significantly lower birth weight (P = 0.0041) compared with non-carriers, after adjustment for gestational age. They were also significantly shorter at birth compared with their unaffected relatives (P = 0.0060), after adjustment for gestational age. The BRCA1 gene thus seems to influence the carriers in utero. The findings could imply that humans heterozygotic for the BRCA1 mutations may be influenced by the mutations during development in utero.

Morphometric study of mesenteric and renal arteries in spontaneously hypertensive rats.

Arteries from spontaneously hypertensive rats (SHR), stroke-prone spontaneously hypertensive rats (SHRSP) and Wistar-Kyoto controls (WKY) were fixed by immersion and plastic embedded. The media cross-sectional area and the length of the internal elastic membrane were measured. The ratio between media thickness and internal radius was then calculated for a standardized condition, implying a perfectly smooth and circular internal elastic membrane. An increase of the media to radius ratio was already demonstrable in visceral arterial branches of SHR and SHRSP by 15 days of age, indicating that changes of arterial structure could be of pathogenetic importance in early hypertension. At seven months of age the ratio was significantly increased in mesenteric arterial branches of SHR and SHRSP and in renal arterial branches of SHRSP. The media to radius ratio was markedly increased in the renal and superior mesenteric arterial trunks of adult SHR (P less than 0.001 in both) and SHRSP (P less than 0.001 and P less than 0.01). This was due to a greater media cross-sectional area in the former vessels and to a combination of greater media and reduced radius in the latter.

A method for testicular denervation in rats.

A successful method for microsurgical denervation of the testes in rats is described. Testes were unilaterally denervated in 15 animals. Thirteen untreated and two sham-operated rats served as controls. With the animal under ether anesthesia, the spermatic vessels on either side were exposed with the aid of microsurgical technique and an operating microscope. The area was then dyed with two to three drops of 1% Toluidine blue. With utmost precaution the nerves were separated from the vessels and resected. A biopsy specimen from the epididymal fat pad of each side was removed and assayed for norepinephrine content. The denervation procedure was considered successful if the norepinephrine content of the denervated fat pad was less than 11% of that of the contralateral fat pad. The denervation procedure was successful in 13 of 15 animals. No recognizable side effects from the use of Toluidine blue were observed.