ABSTRACT
OBJETIVO: Determinar predictores independientes prenatales y postnatales de una mala evolución de la función renal, de la resolución espontanea o de la necesidad de cirugía en la hidronefrosis prenatal. MÉTODOS: Estudio retrospectivo en pacientes con hidronefrosis prenatal. Analizamos diferentes variables clínicas prenatales y postnatales, así como, el DAP (diámetro anteroposterior) de la pelvis renal en la ecografía prenatal del tercer trimestre, y en la primera y segunda ecografía postnatal. Las analizamos mediante t de Student, chi-cuadrado, análisis de supervivencia, y curvas de COR. RESULTADOS: Se incluyeron 218 pacientes con 293 UR (unidades renales). Operadas 147/293 (50,2%) UR, resolución espontánea 76/293 (25,9%) UR, y 76/293 (25,9%) UR presentaron mala evolución. Encontramos como factores de riesgo para la cirugía el bajo peso al nacer (OR 3,84; IC 95% 1,24-11,84), la prematuridad (OR; 4,17 IC 95% 1,35-12,88), la duplicidad (OR 4,99; IC 95% 2,21-11,23) y la presencia de patología nefrourológica subyacente (OR 53,54; IC 95% 26,23-109,27). Para la no resolución espontánea se encontraron las alteraciones en el volumen del líquido amniótico (RR 1,46; IC 95% 1,33-1,60) así como la patología nefrourológica subyacente y la duplicidad. Para la mala evolución la alteración del volumen del líquido amniótico (OR 11,99; IC 95% 2,70-53,21), la presencia de patología nefrourológica subyacente (OR 4,81 IC 95% 2,60-8,89) y la cirugía (OR 4,23 IC 95% 2,35-7,60). El DAP en las tres ecografías es fiable para la predicción de cirugía (área bajo la curva 0,65; 0,82; 0,71), para resolución espontánea (área bajo la curva 0,80; 0,91; 0,80) y solo el DAP de la primera ecografía postnatal para mala evolución (área bajo la curva 0,73). Los DAP con mayor sensibilidad y especificidad son los de la primera ecografía postnatal; 14,60mm para cirugía; 11,35mm para resolución espontánea; y 15,50 mm para mala evolución. CONCLUSIÓN: A mayor DAP en la pelvis renal en cualquiera de las tres ecografías las probabilidades de cirugía y de no resolución espontanea son mayores. La primera ecografía es la más fiable para predecir la evolución en la hidronefrosis prenatal. Existen otros factores a tomar en cuenta para predecir la evolución de los pacientes con HN prenatal
OBJECTIVES: To determine prenatal and postnatal independent predictors of poor outcome, spontaneous resolution, or the need for surgery in patients with prenatal hydronephrosis. METHODS: We performed a retrospective study of patients with prenatal hydronephrosis. The renal pelvis APD was measured in the third prenatal trimester ultrasound, as well as in the first and second postnatal ultrasound. Other variables were taken into account, both prenatal and postnatal. For statistical analysis we used Student t-test, chi-square test, survival analysis, logrank test, and ROC curves. RESULTS: We included 218 patients with 293 renal units (RU). Of these, 147/293 (50.2%) RU were operated. 76/293 (25.9%) RU had spontaneous resolution and other 76/293 (25.9%) RU had poor outcome. As risk factors for surgery we found low birth weight (OR 3.84; 95% CI 1.24-11.84), prematurity (OR 4.17; 95% CI 1.35-12.88), duplication (OR 4.99; 95% CI 2.21- 11.23) and the presence of nephrourological underlying pathology (OR 53.54; 95% CI 26.23-109.27). For the non-spontaneous resolution, we found as risk factors the alterations of amniotic fluid volume (RR 1.46; 95% CI 1.33-1.60) as well as the underlying nephrourological pathology and duplication. In the poor outcome, we found as risk factors the alterations of amniotic fluid volume (OR 4.54; 95% CI 1.31-15.62), the presence of nephrourological pathology (OR 4.81 95% CI 2.60-8.89) and RU that was operated (OR 4.23, 95% CI 2.35-7.60). The APD of the renal pelvis in all three ultrasounds were reliable for surgery prediction (area under the curve 0.65; 0.82; 0.71) or spontaneous resolution (area under the curve 0.80; 0.91; 0.80), only the first postnatal ultrasound has predictive value in the poor outcome (area under the curve 0.73). The higher sensitivity and specificity of the APD as predictor value was on the first postnatal ultrasound, 14.60 mm for surgery; 11.35 mm for spontaneous resolution and 15.50 mm for poor outcome. CONCLUSION: The higher APD in the renal pelvis in any of the three ultrasounds, the greater the chances of surgery and failure of spontaneous resolution. The first postnatal ultrasound is the most reliable in predicting outcome of prenatal hydronephrosis. There are other factors to take into account to predict the outcomes of these patients
Subject(s)
Humans , Male , Female , Child , Hydronephrosis/metabolism , Hydronephrosis/pathology , Prenatal Care/methods , Retrospective Studies , Pediatrics/methods , Kidney Pelvis/pathology , Ultrasonography, Prenatal/methods , Constriction, Pathologic/diagnosis , Congenital Abnormalities/genetics , Hydronephrosis/complications , Hydronephrosis/diagnosis , Prenatal Care/classification , Pediatrics/standards , Kidney Pelvis/metabolism , Ultrasonography, Prenatal/instrumentation , Constriction, Pathologic/complications , Congenital Abnormalities/embryologyABSTRACT
OBJECTIVES: To determine prenatal and postnatal independent predictors of poor outcome, spontaneous resolution, or the need for surgery in patients with prenatal hydronephrosis. METHODS: We performed a retrospective study of patients with prenatal hydronephrosis. The renal pelvis APD was measured in the third prenatal trimester ultrasound, as well as in the first and second postnatal ultrasound. Other variables were taken into account, both prenatal and postnatal. For statistical analysis we used Student t-test, chi-square test, survival analysis, logrank test, and ROC curves. RESULTS: We included 218 patients with 293 renal units (RU). Of these, 147/293 (50.2%) RU were operated. 76/293 (25.9%) RU had spontaneous resolution and other 76/293 (25.9%) RU had poor outcome. As risk factors for surgery we found low birth weight (OR 3.84; 95% CI 1.24-11.84), prematurity (OR 4.17; 95% CI 1.35-12.88), duplication (OR 4.99; 95% CI 2.21-11.23) and the presence of nephrourological underlying pathology (OR 53.54; 95% CI 26.23-109.27). For the non-spontaneous resolution, we found as risk factors the alterations of amniotic fluid volume (RR 1.46; 95% CI 1.33-1.60) as well as the underlying nephrourological pathology and duplication. In the poor outcome, we found as risk factors the alterations of amniotic fluid volume (OR 4.54; 95% CI 1.31-15.62), the presence of nephrourological pathology (OR 4.81 95% CI 2.60-8.89) and RU that was operated (OR 4.23, 95% CI 2.35-7.60). The APD of the renal pelvis in all three ultrasounds were reliable for surgery prediction (area under the curve 0.65; 0.82; 0.71) or spontaneous resolution (area under the curve 0.80; 0.91; 0.80), only the first postnatal ultrasound has predictive value in the poor outcome (area under the curve 0.73). The higher sensitivity and specificity of the APD as predictor value was on the first postnatal ultrasound, 14.60 mm for surgery; 11.35 mm for spontaneous resolution and 15.50 mm for poor outcome. CONCLUSION: The higher APD in the renal pelvis in any of the three ultrasounds, the greater the chances of surgery and failure of spontaneous resolution. The first postnatal ultrasound is the most reliable in predicting outcome of prenatal hydronephrosis. There are other factors to take into account to predict the outcomes of these patients.
Subject(s)
Hydronephrosis/congenital , Hydronephrosis/therapy , Child , Child, Preschool , Female , Humans , Hydronephrosis/diagnostic imaging , Infant , Infant, Newborn , Male , Prognosis , Retrospective Studies , Treatment Outcome , Ultrasonography, PrenatalABSTRACT
Pancreatic tumors are very rare in children. Until now, approximately 150 cases have been reported in the English-language medical literature. Only 4 of them represented serous cystadenoma. Although the tumor is not potentially malignant, all patients required partial pancreatic resection. The authors present a 4-year-old girl with a short history of abdominal pain and vomiting. Sonography and computed tomography showed a pancreatic mass. The mass was proved to be a serous cystadenoma, and resection of the tumor was performed. Clinical discussion with review of the literature is presented.
