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This article investigates how domestic violence and abuse (DVA), its underreporting and its links with alcohol consumption, manifest in and impact the outcome of help-seeking telephone calls to U.K.-based police services. Conversation analysis of call-takers' questions about alcohol found that they either (a) focused only on the perpetrator's drinking, and occurred after informing callers that help was being dispatched, or (b) targeted both victims' and perpetrators' drinking and complicated the decisions to dispatch police assistance. The article helps specify the communicative practices that may constitute victims' negative experiences of disclosing DVA to the police.
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The current state of medical and scientific knowledge on the effects of exposure to electromagnetic fields on workers in the field of clinical magnetic resonance imaging (MRI) is summarized here.A systematic literature search was conducted to analyze the health risks to medical personnel from magnetic fields in MRI. A total of 7273 sources were identified, with 7139 being excluded after screening of the title and abstract. After full-text screening, 34 sources remained and were included in this paper.There are a number of scientific publications on the occurrence of short-term sensory effects such as vertigo, metallic taste, phosphenes as well as on the occurrence of neurocognitive and neurobehavioral effects. For example, short-term exposure to clinical magnetic fields has been reported to result in a 4% reduction in speed and precision and a 16% reduction in visual contrast sensitivity at close range. Both eye-hand precision and coordination speed are affected. The long-term studies concern, among other things, the influence of magnetic fields on sleep quality, which could be linked to an increased risk of accidents. The data on the exposure of healthcare workers to magnetic fields during pregnancy is consistently outdated. However, it has been concluded that there are no particular deviations with regard to the duration of pregnancy, premature births, miscarriages, and birth weight. Epidemiological studies are lacking. With a focus on healthcare personnel, there is a considerable need for high-quality data, particularly on the consequences of long-term exposure to electromagnetic fields from clinical MRI and the effects on pregnancy. · Short-term sensory effects such as vertigo, metallic taste, phosphenes as well as neurocognitive and neurological behavioral effects may occur upon exposure to magnetic fields.. · Long-term effects mainly concern quality of sleep, which can be associated with an increased risk of accidents.. · When pregnant women were exposed to magnetic fields, no particular deviations were found with regard to the duration of pregnancy, premature births, miscarriages, and birth weight.. · König AM, Pöschke A, Mahnken AH. Health risks for medical personnel due to magnetic fields in magnetic resonance imaging. Fortschr Röntgenstr 2024; DOI 10.1055/a-2296-3860.
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PURPOSE: Endovascular treatment has emerged as the gold standard for managing chronic mesenteric ischemia (CMI) resulting from arterial stenosis or occlusion. This study aimed to assess the efficacy and complication rates of continuous interventional radiology treatment for CMI in Germany between 2018 and 2021, comparing these findings with international quality standards. MATERIALS AND METHODS: Data for CMI therapy with stenting and percutaneous transluminal angioplasty (PTA) was obtained from the quality management system of the German Interventional Radiological Society (DeGIR). A total of 3752 endovascular procedures for CMI performed from 2018 to 2021 were documented (PTA: nâ=â675; stenting: nâ=â3077). Data was analyzed for technical and clinical success rates, as well as major complication rates. RESULTS: Overall technical and clinical success rates for PTA and stenting procedures were 92.03â%/85.9â% and 98.76â%/96.62â%, respectively. The most common major complications were: arterial occlusion (PTA: 0.73â%; stenting: 0.63), major bleeding (PTA: 1.05â%; stenting: 0.68â%), aneurysm formation (PTA: 0.29â%; stenting: 0.72â%), stent dislodgment (PTA: 0â%; stenting: 0.06â%), and organ failure (PTA: 0.43â%; stenting: 0.96â%). Technical and clinical success rates were higher, while complication rates were lower than the corresponding threshold recommended by the Society of Interventional Radiology for the percutaneous management of chronic mesenteric ischemia. CONCLUSION: Treatment of CMI performed by interventional radiologists in Germany is safe and effective during daily and on-call shifts with results exceeding internationally accepted standards. KEY POINTS: · Treatment of CMI by interventional radiologists in Germany is effective and safe.. · The interventions are safe and effective regardless of whether they are performed during on-call shifts or the daily routine.. · The clinical and technical success rates favorably surpass the thresholds presented by SIR.. · Different major complications occurred in under 1.1â% of CMI interventions..
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PURPOSE: Endovascular interventional radiological procedures have become the mainstay for the treatment of critical limb ischemia (CLI) due to arterial stenosis or occlusion. Open surgical or endovascular procedures, such as percutaneous transluminal angioplasty (PTA) or stenting can be used as a treatment strategy. The aim is to evaluate the success and major complication rates of interventional radiology treatments for CLI in Germany in 2021, and to compare these results with internationally published data. MATERIALS AND METHODS: Data for PTA and stenting in CLI for 2021 was obtained from the quality management system of the German Society of Interventional Radiology (DeGIR). 16â393 PTA procedures, 701 stenting procedures, and 8110 combined procedures were documented for 2021. Data was analyzed for technical and clinical success rates, as well as major complication rates documented mainly as major bleeding, distal embolization, and aneurysm formation. RESULTS: PTA had technical and clinical success rates of 96.3â% and 92.33â%, respectively. Stenting had technical and clinical success rates of 98.7â% and 96.15â%, respectively. PTA and stenting combined had success rates of 98.71â% and 96.91â%, respectively. The major complications were mainly: major bleeding (PTA: 0.40â%; stenting: 1.28â%; PTA and stenting: 0.54â%), distal embolization (PTA: 0.48â%; stenting: 1â%; PTA and stenting: 0.96â%), and aneurysm formation (PTA: 0.19â%; stenting: 0.43â%; PTA and stenting: 0.19â%). All procedures showed high technical and clinical success rates, while the complication rates were low. CONCLUSION: Interventional radiologists in Germany perform effective and safe treatment for CLI, achieving outcomes that tend to surpass internationally published data. KEY POINTS: · German interventional radiologists provide safe and effective critical limb ischemia treatment.. · Major complications occurred at maximum in 1.28â% of cases.. · Outcomes tend to surpass international data, indicating strong performance..
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PURPOSE: To retrospectively evaluate outcomes of a combined interventional approach to stage 1 (cT1cN0cM0) renal cell carcinomas (RCCs) by transarterial embolization (TAE) followed by percutaneous CT-guided radiofrequency ablation (RFA) in patients ineligible for surgery. MATERIALS AND METHODS: 13 patients (9 male, 4 female, 69.6â±â16.6 y/o) with 14 RCCs (largest diameter: 40.4â±â6.7âmm, cT1a: 4, cT1b: 10) were treated by RFA a median of one day after TAE in a single center. Indications for minimally invasive interventional therapy were bilateral RCCs (nâ=â4), RCCs in a single kidney after nephrectomy (nâ=â3), increased surgical risk due to comorbidities (nâ=â4), and rejection of surgical therapy (nâ=â2). Technical success, effectiveness, safety, ablative margin, cancer-specific survival, overall survival, and tumor characteristics were analyzed. RESULTS: All RCCs were successfully ablated after embolization with a minimum ablative margin of 1.2âmm. The median follow-up was 27 (1-83) months. There was no residual or recurrent tumor in the ablation zone. No patient developed metastasis. Two minor and two major complications occurred. Four patients with severe comorbidities died during follow-up due to causes unrelated to therapy. The 1-year and 5-year overall survival was 74.1â% each. Cancer-specific survival was 100â% after 1 and 5 years. There was no significant decline in mean eGFR directly after therapy (pâ=â0.226). However, the mean eGFR declined from 62.2â±â22.0 to 50.0â±â27.8âml/min during follow-up (pâ<â0.05). CONCLUSION: The combination of TAE and RFA provides an effective minimally invasive therapy to stage 1 RCCs in patients ineligible for surgery. The outcomes compare favorably with data from surgery. KEY POINTS: · Interventional treatment by TAE and ablation is a safe and effective alternative to surgery in stage 1 RCCs.. · Focal therapy of RCCs preserves renal function.. · A small ablative margin appears to be sufficient in the ablation of RCCs.. CITATION FORMAT: · Wessendorf J, König AM, Heers H etâal. Efficacy and Safety of Combined Embolization and Radiofrequency Ablation in Stage 1 Renal Cell Carcinomas. Fortschr Röntgenstr 2022; 194: 1020â-â1025.
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Carcinoma de Células Renais , Ablação por Cateter , Neoplasias Renais , Feminino , Humanos , Masculino , Recidiva Local de Neoplasia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
MAD2L2 (REV7) plays an important role in DNA double-strand break repair. As a member of the shieldin complex, consisting of MAD2L2, SHLD1, SHLD2 and SHLD3, it controls DNA repair pathway choice by counteracting DNA end-resection. Here we investigated the requirements for shieldin complex assembly and activity. Besides a dimerization-surface, HORMA-domain protein MAD2L2 has the extraordinary ability to wrap its C-terminus around SHLD3, likely creating a very stable complex. We show that appropriate function of MAD2L2 within shieldin requires its dimerization, mediated by SHLD2 and accelerating MAD2L2-SHLD3 interaction. Dimerization-defective MAD2L2 impairs shieldin assembly and fails to promote NHEJ. Moreover, MAD2L2 dimerization, along with the presence of SHLD3, allows shieldin to interact with the TRIP13 ATPase, known to drive topological switches in HORMA-domain proteins. We find that appropriate levels of TRIP13 are important for proper shieldin (dis)assembly and activity in DNA repair. Together our data provide important insights in the dependencies for shieldin activity.
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ATPases Associadas a Diversas Atividades Celulares/genética , Proteínas de Ciclo Celular/genética , Reparo do DNA , Proteínas de Ligação a DNA/genética , DNA/genética , Proteínas Mad2/genética , ATPases Associadas a Diversas Atividades Celulares/química , ATPases Associadas a Diversas Atividades Celulares/metabolismo , Animais , Sítios de Ligação , Proteínas de Ciclo Celular/química , Proteínas de Ciclo Celular/metabolismo , Linhagem Celular , Linhagem Celular Tumoral , Cisplatino/farmacologia , DNA/química , DNA/metabolismo , Quebras de DNA de Cadeia Dupla , Proteínas de Ligação a DNA/química , Proteínas de Ligação a DNA/metabolismo , Fibroblastos/citologia , Fibroblastos/efeitos dos fármacos , Fibroblastos/metabolismo , Expressão Gênica , Células HEK293 , Células HeLa , Humanos , Proteínas Mad2/química , Proteínas Mad2/metabolismo , Camundongos , Ftalazinas/farmacologia , Piperazinas/farmacologia , Ligação Proteica , Domínios e Motivos de Interação entre Proteínas , Multimerização Proteica , Proteínas Recombinantes/química , Proteínas Recombinantes/genética , Proteínas Recombinantes/metabolismoRESUMO
ABSTRACT: Carbon dioxide (CO2) gas is an established alternative to iodine contrast during angiography in patients with risk of postcontrast acute kidney injury and in those with history of iodine contrast allergy. Different CO2 delivery systems during angiography are reported in literature, with automated delivery system being the latest. The aim of this study is to evaluate the safety, efficacy, and learning curve of an automated CO2 injection system with controlled pressures in peripheral arterial interventions and also to study the patients' tolerance to the system.From January 2018 to October 2019 peripheral arterial interventions were performed in 40 patients (median age-78âyears, interquartile range: 69-84âyears) using an automated CO2 injection system with customized protocols, with conventional iodine contrast agent used only as a bailout option. The pain and tolerance during the CO2 angiography were evaluated with a visual analog scale at the end of each procedure. The amount of CO2, iodine contrast used, and radiation dose area product for the interventions were also systematically recorded for all procedures. These values were statistically compared in 2 groups, viz first 20 patients where a learning curve was expected vs the rest 20 patients.All procedures were successfully completed without complications. All patients tolerated the CO2 angiography with a median total pain score of 3 (interquartile range: 3-4), with no statistical difference between the groups (Pâ=â.529). The 2 groups were statistically comparable in terms of comorbidities and the type of procedures performed (Pâ=â.807). The amount of iodine contrast agent used (24.60â±â6.44âml vs 32.70â±â8.70âml, Pâ=â.006) and the radiation dose area product associated were significantly lower in the second group (2160.74â±â1181.52âµGym2 vs 1531.62â±â536.47âµGym2, Pâ=â.043).Automated CO2 angiography is technically feasible and safe for peripheral arterial interventions and is well tolerated by the patients. With the interventionalist becoming familiar with the technique, better diagnostic accuracy could be obtained using lower volumes of conventional iodine contrast agents and reduction of the radiation dose involved.
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Angiografia/métodos , Dióxido de Carbono/administração & dosagem , Procedimentos Endovasculares/métodos , Doença Arterial Periférica/cirurgia , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Estudos de Viabilidade , Feminino , Humanos , Compostos de Iodo , Masculino , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: The increasing number of minimally invasive fluoroscopy-guided interventions is likely to result in higher radiation exposure for interventional radiologists and medical staff. Not only the number of procedures but also the complexity of these procedures and therefore the exposure time as well are growing. There are various radiation protection means for protecting medical staff against scatter radiation. This article will provide an overview of the different protection devices, their efficacy in terms of radiation protection and the corresponding dosimetry. METHOD: The following key words were used to search the literature: radiation protection, eye lens dose, radiation exposure in interventional radiology, cataract, cancer risk, dosimetry in interventional radiology, radiation dosimetry. RESULTS AND CONCLUSION: Optimal radiation protection always requires a combination of different radiation protection devices. Radiation protection and monitoring of the head and neck, especially of the eye lenses, is not yet sufficiently accepted and further development is needed in this field. To reduce the risk of cataract, new protection glasses with an integrated dosimeter are to be introduced in clinical routine practice. KEY POINTS: · A combination of personal radiation protection devices and optimized dosimetry improves the safety of medical staff.. CITATION FORMAT: · König AM, Etzel R, Thomas RP etâal. Personal Radiation Protection and Corresponding Dosimetry in Interventional Radiology: An Overview and Future Developments. Fortschr Röntgenstr 2019; 191: 512â-â521.
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Lesões por Radiação/prevenção & controle , Proteção Radiológica/métodos , Radiologia Intervencionista , Radiometria/métodos , Fluoroscopia/tendências , Previsões , Alemanha , Humanos , Lesões por Radiação/etiologia , Radiologia Intervencionista/tendências , Radiometria/tendências , Espalhamento de RadiaçãoRESUMO
One of the most commonly made diagnoses in secondary care memory services is functional memory disorder (FMD). FMD is non-progressive and characterised by persistent worries about memory failures without objective evidence of cognitive impairment. This study explores how patients with FMD present their memory concerns. Utilizing video recordings of consultations between patients and neurologists in a memory clinic, we show that FMD patients account for their memory deficits as significant disruptions to their daily lives. Resonating with research which identified a dissonance between self-reports of memory functioning by FMD patients and the outcome of neuropsychological assessments, we demonstrate that, in giving a detailed account of their perceived memory problems, patients provide objective conversational evidence of their cognitive and memory capacity, implicitly undermining the claim of an objective problem. Using conversation analysis, we examine three of the more prominent interactional practices FMD patients draw on when attempting to communicate memory deficits to the doctor - they are (i) contrasts with a standard of 'normal'; (ii) third-party observations; and (iii) direct reported speech. These interactional features are recurrent devices for displaying memory concerns as legitimate problems, embedded within patients' accounts of their day-to-day lives.
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Disfunção Cognitiva/psicologia , Neurologistas , Relações Médico-Paciente , Encaminhamento e Consulta , Feminino , Humanos , Masculino , Anamnese/métodos , Testes Neuropsicológicos/normas , Reino Unido , Gravação em VídeoRESUMO
PURPOSE: Local ablative therapies have become an established treatment option in interventional oncology. Radiofrequency ablation (RFA) and microwave ablation (MWA) are a standard of care in the treatment of hepatocellular carcinoma (HCC). Currently, there is an increasing interest in cryotherapy, one of the oldest ablation techniques. It has some unique characteristics with regard to technology and mechanism of action. MATERIALS AND METHODS: A systematic literature search using the terms cryotherapy, cryosurgery and cryoablation was performed. Selected studies are presented dealing with the mechanism of action, cryobiology and clinical use of percutaneous, image-guided cryoablation. Recent developments and perspectives are presented. RESULTS: Cryotherapy is increasingly used and has been included in guidelines for selected tumor entities such as renal cell carcinoma. Cryo-immunotherapy and combination treatments are future areas of interest. CONCLUSION: Cryoabalation may be used in many indications. Its major advantages are its unique visualization and the anesthesiologic effects of cold. While there are only a few prospectively randomized trials, the existing data on the use of cryoablation is promising. Its use appears to be justified in selected tumors, oligometastatic patients and for palliative indications. KEY POINTS: · Interventionalists need to know about the unique characteristics and advantages of cryoablation.. · Proper patient selection and optimal image guidance are essential for successful cryotherapy.. · Cryoablation offers unique advantages such as anesthesiologic effects and characteristic imaging features.. · The lack of prospective randomized trials is a key disadvantage of cryoablation.. CITATION FORMAT: · Mahnken AH, König AM, Figiel JH. Current Technique and Application of Percutaneous Cryotherapy. Fortschr Röntgenstr 2018; 190: 836â-â846.
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Criocirurgia/métodos , Crioterapia/métodos , Neoplasias/cirurgia , Neoplasias Ósseas/patologia , Neoplasias Ósseas/cirurgia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/cirurgia , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Criocirurgia/instrumentação , Crioterapia/instrumentação , Desenho de Equipamento , Seguimentos , Humanos , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Masculino , Estadiamento de Neoplasias , Neoplasias/patologia , Seleção de Pacientes , Complicações Pós-Operatórias/etiologia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Neoplasias de Tecidos Moles/patologia , Neoplasias de Tecidos Moles/cirurgia , Cirurgia Assistida por Computador/instrumentação , Cirurgia Assistida por Computador/métodosRESUMO
INTRODUCTION: In this in-vitro study, we aimed to investigate the predictability of the expected amount of stripping using 3 common stripping devices on premolars. METHODS: One hundred eighty extracted premolars were mounted and aligned in silicone. Tooth mobility was tested with Periotest (Medizintechnik Gulden, Modautal, Germany) (8.3 ± 2.8 units). The selected methods for interproximal enamel reduction were hand-pulled strips (Horico, Hapf Ringleb & Company, Berlin, Germany), oscillating segmental disks (O-drive-OD 30; KaVo Dental, Biberach, Germany), and motor-driven abrasive strips (Orthofile; SDC Switzerland, Lugano-Grancia, Switzerland). With each device, the operator intended to strip 0.1, 0.2, 0.3, or 0.4 mm on the mesial side of 15 teeth. The teeth were scanned before and after stripping with a 3-dimensional laser scanner. Superposition and measurement of stripped enamel on the most mesial point of the tooth were conducted with Viewbox software (dHal Software, Kifissia, Greece). The Wilcoxon signed rank test and the Kruskal-Wallis test were applied; statistical significance was set at alpha ≤ 0.05. RESULTS: Large variations between the intended and the actual amounts of stripped enamel, and between stripping procedures, were observed. Significant differences were found at 0.1 mm of intended stripping (P ≤ 0.05) for the hand-pulled method and at 0.4 mm of intended stripping (P ≤ 0.001 to P = 0.05) for all methods. For all scenarios of enamel reduction, the actual amount of stripping was less than the predetermined and expected amount of stripping. The Kruskal-Wallis analysis showed no significant differences between the 3 methods. CONCLUSIONS: There were variations in the stripped amounts of enamel, and the stripping technique did not appear to be a significant predictor of the actual amount of enamel reduction. In most cases, actual stripping was less than the intended amount of enamel reduction.
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Dente Pré-Molar/cirurgia , Esmalte Dentário/cirurgia , Instrumentos Odontológicos , Má Oclusão/cirurgia , Procedimentos Cirúrgicos Bucais/instrumentação , Abrasão Dental por Ar/instrumentação , Precisão da Medição Dimensional , Humanos , Odontometria , Procedimentos Cirúrgicos Bucais/métodos , Estatísticas não ParamétricasRESUMO
OBJECTIVE: To track the clinical evolution of febrile urinary tract infection (UTI) diagnosed in 0- to 3-month-old infants and characterize uropathogen frequencies, antimicrobial resistance rates, renal abnormalities, and differences in the sexes in this age group. STUDY DESIGN: We observed prospectively 46 infants identified in a cohort of 209 children with first UTI diagnosed between July 2006 and July 2008 at the age of 0 to 3 months. Renal ultrasound scanning and voiding cystourethrography examinations were performed in all infants. RESULTS: Infants < 3 months old represented 21% of all children with first UTI. Of these children, 26% were female and 74% were male. Escherichia coli was isolated in 88% of cases and had a high rate of resistance to ampicillin (71%) and to trimethoprim/sulfamethoxazole (47%); 21% of children had vesicoureteral reflux, which was of low-grade in 67% of cases, with spontaneous resolution before 2 years in all cases. In infants with normal ultrasound scanning results, a low-grade vesicoureteral reflux was subsequently found in 10% of cases. CONCLUSION: Infants aged 0 to 3 months represent 21% of children treated for febrile UTI. Boys represent 74% of these cases. E coli is responsible for 88% of UTIs, with a high rate of resistance to antibiotics. When ultrasound scanning examination results are normal, the risk of missing a significant renal abnormality is expected to be extremely low.
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Febre , Infecções Urinárias , Feminino , Febre/etiologia , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Infecções Urinárias/complicações , Infecções Urinárias/diagnóstico , Infecções Urinárias/microbiologia , Infecções Urinárias/terapiaRESUMO
We designed a growth factor release system to potentially stabilize neovascularization in the treatment of ischemic tissue. In this study, the release of PDGF-BB and TGF-ß1 was controlled with distinct kinetics from injectable PEGylated fibrin gels. Growth factors can be loaded into PEGylated fibrin gels via 3 mechanisms: entrapment, conjugation through a homobifunctional amine reactive PEG linker, and physical affinity with the fibrin matrix. PDGF-BB was entrapped during thrombin-mediated crosslinking leading to a diffusion-controlled release over 2days. TGF-ß1 was both conjugated through the PEG linker and bound to the matrix via physical affinity, delaying the release rate of TGF-ß1 up to 10days. Further, the release rate was highly correlated to gel degradation rate indicating that TGF-ß1 release is degradation-controlled. Therefore, by modulating the molar ratio of PEG to fibrinogen, we were able to control the release rate of TGF-ß1 without altering the release kinetics of PDGF-BB. The bioactivity of loaded TGF-ß1 was maintained upon release as evidenced by the inhibition of cell proliferation. This system could be expanded to incorporate growth factors loaded via 3 schemes with differing release rates from an injectable system allowing for a high degree of flexibility in other combinational drug delivery and tissue engineering systems.
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Portadores de Fármacos/química , Fibrina/química , Fator de Crescimento Derivado de Plaquetas/administração & dosagem , Polietilenoglicóis/química , Engenharia Tecidual/métodos , Fator de Crescimento Transformador beta1/administração & dosagem , Animais , Becaplermina , Linhagem Celular , Proliferação de Células/efeitos dos fármacos , Reagentes de Ligações Cruzadas/química , Preparações de Ação Retardada , Combinação de Medicamentos , Composição de Medicamentos , Estabilidade de Medicamentos , Células Epiteliais/efeitos dos fármacos , Células Epiteliais/metabolismo , Fibrinogênio/química , Hidrogéis/química , Cinética , Vison , Neovascularização Fisiológica/efeitos dos fármacos , Fator de Crescimento Derivado de Plaquetas/química , Fator de Crescimento Derivado de Plaquetas/farmacologia , Estabilidade Proteica , Proteínas Proto-Oncogênicas c-sis , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/química , Solubilidade , Fator de Crescimento Transformador beta1/química , Fator de Crescimento Transformador beta1/farmacologiaRESUMO
Fetal renal pelvis dilatation is a frequent abnormality that has been observed in 4.5% of pregnancies. The majority of these cases have a tendency to resolve during infancy. Nevertheless, fetal renal pelvis dilatation may be due to significant structural abnormalities such as pelvi-ureteric junction stenosis or vesico-ureteral reflux that may adversely affect renal function or cause urinary infection or sepsis. This review article aims to summarize the data regarding fetal renal pelvis dilatation and to analyze controversial attitudes in the light of the various lines of practice, and to present rational antenatal and postnatal investigation strategy.
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Doenças Fetais/patologia , Dilatação Patológica , Feminino , Doenças Fetais/diagnóstico , Doenças Fetais/fisiopatologia , Humanos , Recém-Nascido , Pelve Renal/patologia , Pelve Renal/fisiopatologia , Gravidez , Diagnóstico Pré-NatalRESUMO
OBJECTIVES: To determine if two successive ultrasound examinations could rule out the presence of clinically significant contralateral anomalies in neonates with multicystic dysplastic kidney (MCDK), thereby avoiding unnecessary voiding cystourethrography (VCUG). STUDY DESIGN: We followed 76 newborn infants with antenatally discovered MCDK. Two successive neonatal renal ultrasound examinations were performed, one within the first week and one at around 1 month of life. VCUG and isotopic studies were performed in all infants. RESULTS: Urologic anomalies of the contralateral kidney were present in 19 of 76 children (25%): vesicoureteral reflux (VUR) in 16 (21%), ureteropelvic junction obstruction in 2 (3%), and renal duplex kidney in 1 (1%). Sixty-one infants (80% of total) had normal contralateral urinary tract on the 2 successive neonatal renal ultrasound scans. Among them, 4 of 61 (7%) infants presented with low-grade VUR on VCUG that had resolved spontaneously before 2 years of age. The sensitivity, specificity, positive predictive value, and negative predictive value of two successive ultrasound scans in the neonatal period to predict contralateral urological anomalies on VCUG were 75%, 95%, 80%, and 93%, respectively. CONCLUSIONS: In infants with antenatally diagnosed MCDK, two successive normal neonatal renal ultrasound scans will rule out clinically significant contralateral anomalies, thereby rendering the need for a neonatal VCUG unnecessary.