Bladder augmentation with small intestinal submucosa leads to unsatisfactory long-term results.

PURPOSE: To evaluate the use of small intestinal submucosa (SIS) for bladder augmentation in a series of select patients. MATERIAL AND METHODS: Six patients (age 6.5-15.4, mean 9.8 years) underwent bladder augmentation with SIS: one after a cloacal exstrophy repair, one after multiple surgery of the bladder because of vesicoureteral reflux, two with spina bifida, two after bladder exstrophy repair. All suffered from a microbladder with a mean volume of 61.5 ml (range 15-120, 7-36% of expected bladder capacity for age). Preoperative bladder compliance ranged from 1.0 to 3.3 (mean 1.3) ml/cmH2O. RESULTS: Follow-up time ranged from 4.6 to 33.5 (mean 24.4) months. An increase of bladder volume was achieved in four patients (53-370 ml, 16-95% of expected bladder capacity for age). Bladder compliance postoperatively ranged from 0.9 to 5.6 (mean 3.0) ml/cmH2O. Histological examinations showed a complete conversion of SIS, leaving irregular urothelial lining and bladder wall containing muscular, vascular and relatively thick connective tissue in four patients and regular urothelium in two patients. Major complications were bladder stones in two patients and a bladder rupture in one patient. CONCLUSION: Bladder augmentation with SIS in humans failed to fulfill the hopes raised by animal studies. Due to the insufficient increase in bladder compliance and therefore failure to accomplish sufficient protection of the upper urinary tract, bladder augmentation with SIS cannot be recommended as a substitute for enterocystoplasty.

Assay of antibodies to hepatitis C virus protein C100-3 in blood donors from northern Germany.

The prevalence of anti-C100-3 increases with age from 0.41% to 1.26%. It is more frequent in donors with elevated ALT (4.5%). Most ALT elevations, however, are not related to anti-C100-3. Low EIA signals (< 3 x cutoff) are often non-specific. The cutoff value should be 2.5 times higher. High EIA signals correlate with ALT elevations.

Thermal denaturation of whey proteins and its effect in dairy technology.

The irreversible denaturation of the most important whey protein fractions, namely beta-lactoglobulin A and B and alpha-lactalbumin were studied. The orders of the reactions, the rate constants and the activation energies were determined. The experiments were extended to include whey protein solutions of different concentrations and mixtures of whey proteins and caseins in different proportions. The kinetic data found by experiment make it possible to calculate in advance the precise degree of irreversible denaturation. It was found that the denaturation of beta-lactoglobulin was a good test parameter in technological studies and that there was a close correlation between the degree of denaturation and the results of important dairy processes.

Unsatisfactory specificities and sensitivities of six enzyme immunoassays for antibodies to hepatitis B core antigen.

To examine the consistency and comparability of anti-hepatitis B core antigen (anti-HBcAg) assays, four blood donation centers of the Red Cross in the Federal Republic of Germany tested 4,080 unselected blood donors with six different tests in parallel. Confirmation testing of reactive samples was done in the National Reference Center for Viral Hepatitis. Depending on the test kit used, 4.1 to 9.9% of serum samples were initially positive and 2.9 to 7.5% were repeatedly positive. Sixteen percent of serum samples were positive in at least one test but only three percent were positive in all six tests. Statistical analysis of frequency distribution of optical densities for each test suggested that there should be a correction of the cutoff values. This reduced the number of false-positive results by half, but a significant proportion of discrepant results could not be resolved. The lack of specificity and consistency requires cautious interpretation of isolated anti-HBcAg results in clinical specimens. Screening of predominantly anti-HBcAg-negative populations (e.g., blood donors) by the current anti-HBcAg test kits will almost necessarily give unsatisfactory results.

Value of ultrasound in the treatment of solitary kidneys in infancy and childhood.

Every second patient with a solitary kidney suffers from renal disease. This accumulation of renal diseases of varying origin makes special care for these children necessary. The quality of diagnostic methods is decisive for the choice of therapy. The advantages of primary ultrasound diagnosis and sonographical function tests are described. Sonographical differentiation of disturbances of the urinary transport is possible by means of forced-diuresis ultrasonography, whereas a vesico-ureteral reflux can be detected by means of voiding sonocystography. The value of ultrasound for primary diagnosis, assessment of therapeutic course and postoperative long-term follow-up is discussed.

[Diagnostic value of sonography in vesico-ureteral reflux in infancy and childhood]. / Der diagnostische Stellenwert der Sonografie beim vesiko-ureteralen Reflux im Säuglings- und Kindesalter.

The direct demonstration of reflux by filling of the urinary bladder using real time sonography is a new method avoiding radiation exposure. Since 1979 we use this technique (Miktions-Cysto-Sonographie, MCS) as routine procedure. In 117 cases with 163 radiologically diagnosed refluxes we could demonstrate, that refluxes of grad II or higher gave a positive sonogram. As a consequence it is proposed, that for children with urinary tract infections the first examinations should be the sonography of kidneys and the sonographic evaluation of reflux. In the cases of conservatively treated refluxes the check-up of the reflux is carried out only sonographically. The same is valid for the control after antireflux surgery. Thus radiological examinations are necessary only for sonographically suspicious findings. The urinary tract obstruction after antireflux operations is detected sonographically, too. In 99 cases of antireflux operations it could be shown, that the urinary flow came back to the normal state within 3 months post operation.

[The micturition sonourogram: a new possibility for determining vesicorenal reflux in children]. / Das Miktionssonourogramm: Eine neue Möglichkeit der Erfassung des vesikorenalen Refluxes im Kindesalter.

Real time sonography enables sonographic imaging of vesicorenal reflux in childhood. Examination procedure is fundamentally like micturition cystourethrography and is called micturition sonourography (MSU). 117 children with radiologically diagnosed vesicorenal reflux were examined by this new method. The sonographically determined ascension of the bladder content into the renal pelvis is called "positive MSU". All vesicorenal refluxes of the third to fifth grade were also confirmed by sonography. Second-degree reflux can be confirmed in up to 95% of the cases if technique and experience are sufficiently advanced. The article discusses the technical procedure, diagnostic relevance and importance of the method.

[Sonographic evaluation of drainage relations following antireflux operations in childhood]. / Sonografische Beurteilung der Abflussverhältnisse nach Antirefluxoperationen im Kindesalter.

The judgment of the passage conditions after operations on the ureter and the kidney is of great importance. The sonography as "diagnostics of choice" allows an exact, non-invasive continuous control of the passage of urine in the early postoperative phase and in the kidney dispensary. On a larger number of patients is examined, which value this method obtains in the postoperative diagnostics. With the help of a subdivision of the disturbances of the transport of urine according to sonographic criteria an exact judgment is possible and restricts the use of radiological methods to cases with pathological sonographic findings.