Vesicoureteral Reflux and Renal Scar

PURPOSE: Vesicoureteral reflux(VUR) is the major risk factor of urinary tract infection(UTI) in children and may result in serious complications such as renal scarring and chronic renal failure. The purpose of this study was to evaluate the relationship between VUR and renal scar formation, the usefulness and correlation of various imaging studies in reflux nephropathy, and the spontaneous resolution of VUR. METHODS: We retrospectively reviewed 106 patients with VUR with no accompanying urogenital anomalies in the Department of Pediatrics, Bundang CHA Hospital during the period from Jan. 1996 to Mar. 2005. Ultrasonography and 99mTc-dimercaptosuccinic acid(DMSA) scan were performed in the acute period of UTI. Voiding cystourethrography(VCUG) was performed 1 to 3 weeks after treatment with UTI. Follow-up DMSA scan was performed 4 to 6 months after treatment and a follow-up VCUG was performed every 12 months. RESULTS: The mean age at detection of VUR was 13.8+/-22.2 months and the male to female ratio was 2:1. The incidence of renal scarring showed a tendency of direct correlation between severity of VUR(P<0.001) and abnormal findings of renal ultrasonography(P<0.01). 63.2%(24 of 38 renal units) of renal parenchymal defects present in the first DMSA scan disappeared on follow-up DMSA scans. Follow-up DMSA scans detected renal scars in 7(14%) of 50 renal units with ultrasonographically normal kidneys. Meanwhile, ultrasonography did not show parenchymal defects in 7(36.8%) of 19 renal units where renal scarring was demonstrated on a follow-up DMSA scan. The spontaneous resolution rate of VUR was higher(75%) in cases with low grade(I to III) VUR(P<0.01). CONCLUSIONS: The presence and severity of VUR and abnormal findings of renal ultrasonography significantly correlated with renal scar formation. DMSA scan was useful in the diagnosis of renal defects. Meanwhile renal ultrasonography was an inadequate method for evaluating renal parenchymal damage. Therefore, follow-up DMSA scans should be performed to detect renal scars even in children with low-grade VUR and normal renal ultrasonography.

Clinical Consideration of Premature Twins Conceived by in Vitro Fertilization and those of Naturally Conceived / 대한주산의학회잡지

OBJECTIVE: The aim of this study was to evaluate and compare neonatal outcome of premature twins conceived by in vitro fertilization (IVF) to those of naturally conceived. METHODS: We retrospectively analyzed neonatal outcome of sixty pairs of premature twins conceived by IVF (IVF twin group) and 34 pairs that naturally conceived (natural twin group). Maternal and obstetric characteristics were also compared. All were born before 35 weeks of gestation between January 2000 and December 2004 at Pochon-Cha Hospital and admitted to neonatal intensive care unit. Student t-test and chi-square test were used for statistical analysis. RESULTS: For obstetrical characteristics, maternal age and rates of nulliparous were sibnificanty twin group. But, other parameters (preterm labor, premature rupture of membranes, pregnancy-induced hypertension, gestational diabetes mellitus) were similar between two groups. For neonatal outcome, gestational age, duration of hospital stay, Apgar score, neonatal mortality and morbidity were reviewed. All parameters were no significant differences in IVF twin group compare to natural twin group CONCLUSIONS: In our study, IVF twin group had no significant differences in obstetric characteristics (except for maternal age and parity) and neonatal outcome compare to natural twin group.

A Case of Unilateral Pleural Effusion Due to Percutaneously Inserted Central Venous Catheterization

Percutaneously inserted central venous catheterization (PICC) is commonly used for the management of preterm infants and surgical newborn babies to provide intravenous access for prolonged therapy and parenteral nutrition. Insertion of PICC in neonate has been associated with both immediate and late complications. The immediate complications include catheter malposition, pneumothorax and hemothorax usually secondary to the insertion procedure. Late complications are sepsis, thrombosis, catheter tip migration, vessel perforation, cardiac tamponade, pericardial effusion, pleural effusion and chemical pneumonitis. It is recognized that catheter tip migration can occur at any time with potentially fatal outcome. We report here a newborn infant that successful PICC placement was followed a few days later by the development of a unilateral pleural effusion due to migration of the cathter tip, with a brief review of the literatures.

Puberty and Gender Differences of Plasma Leptin, Adiponectin Levels, and Leptin/Adiponectin Ratio / 대한소아내분비학회지

PURPOSE: Leptin and adiponectin levels show gender differences in adults, both of which are higher in women. We aimed to describe the gender differences in leptin and adiponectin levels according to pubertal development, and relationships of leptin, adiponectin, and leptin/adiponectin ratio (L/A) with sex steroids. METHODS: Seventy-seven healthy children (36 boys and 41 girls) were enrolled, and were divided into prepuberty, early puberty (Tanner stage 2 or 3), and late puberty (Tanner stage 4 or 5). Fasting plasma levels of leptin, adiponectin, testosterone, estradiol, and sex-hormone binding globulin (SHBG) were measured. RESULTS: 1) There was no gender difference in leptin and adiponectin in prepuberty. In early puberty, leptin was higher in girls, and in late puberty, both leptin and adiponectin were higher in girls than in boys. The L/A did not show any gender difference in our participants. 2) Leptin correlated with percent weight for height (%WFH) in both genders, and also with Tanner stage, estradiol, and FAI in girls. Adiponectin correlated inversely with %WFH, Tanner stage and FAI in boys. The L/A showed positive relationships with %WFH, Tanner stage and free androgen index (FAI) in both genders, and also with estradiol in girls. 3) In multiple regressions, age, %WFH, estradiol, and FAI were independently related to Ln (leptin) (R2=0.603). FAI was independently related with Ln (adiponectin) (R2=0.063), and the %WFH and estradiol with Ln (L/A) (R2=0.434). CONCLUSION: Gender differences of leptin and adiponectin become apparent with the progression of puberty. Estrogen is independently related to leptin levels, and androgen is related to both leptin and adiponectin.