High sensitive C-reactive protein: a new marker for urinary tract infection, VUR and renal scar.

BACKGROUND: Accurate diagnosis and early treatment of urinary tract infections (UTI) are important because of its association with renal scarring (RS). AIMS: To investigate the serum levels of fibronectin, high sensitive CRP (Hs-CRP), urinary fibronectin, and beta-2 microglobulin (beta2MG) levels in patients with UTI and relationship of these parameters with VUR (vesicoureteral reflex) and RS. PATIENTS AND METHODS: 72 patients were included in study and divided into three groups: Group I (20 patients with first UTI); Group II (16 patients with recurrent UTI with VUR); Group III (16 patients without UTI with VUR). RESULTS: Serum and urine fibronectin levels were similar in all study groups and controls. Urinary beta2MG levels were higher in Group II (302±179 ng/ml) than in the Group I (134±90 ng/ml) (p < 0.001). Moreover, beta2MG levels were similar in Group II (302±179 ng/ml) and group III (218±147 ng/ml). By contrast, beta2MG levels were higher in Group III (218±147 ng/ml) than in the controls (64±32 ng/ml) (p < 0.001). Hs-CRP levels were higher in Group I (1.8±2.7 mg/L), Group II (23.1±32 mg/L), and III (0.4±0.1 mg/L) than the controls (0.2±0.08 mg/L) (p < 0.001). Hs-CRP levels were higher in Group II (23.1±31.9 mg/L) than in the Group I (1.8±2.7 mg/L) (p < 0.001). Hs-CRP levels were higher in Group I (1.8±2.7 mg/L) and Group II (23.1±31.9 mg/L) than in the Group III (0.4±0.1 mg/L) (p < 0.001). Hs-CRP levels were higher in group III (0.37±0.17 mg/L) than in the controls (0.2±0.08 mg/L) (p < 0.001). Hs-CRP (18.8±25 mg/L) and beta2MG levels (349.4±128.5 ng/ml) were different in UTI with RS from the controls (0.2±0.08 mg/L and 64±32 ng/ml respectively, p < 0.001). Fibronectin levels were similar in patients with and without RS. CONCLUSIONS: Increased urinary beta2MG and Hs-CRP were observed in initial UTI and recurrent UTI with VUR. Fibronectin levels were not useful for detection of first and recurrent UTI with VUR and RS. Elevated Hs-CRP levels can help us predetermine the patients with VUR prone to proceed to clinical chronic renal failure.

Triplets with growth failure, microcephaly, mental retardation, nail hypoplasia and corpus callosum agenesis: is it a variant of Coffin-Siris or a new syndrome?

We report eight-year-old triplet girls whose clinical features included microcephaly, severe mental retardation, hypoplasia of distal phalanges of both fifth and second fingers and nail hypoplasia on second fingers, dysmorphic facial features, and partial corpus callosum agenesis. During infancy, a Pavlik harness was used for congenital hip dislocation, and they had difficulty in feeding. One had been operated for patent ductus arteriosus. To our knowledge, this rare combination has not been previously reported in triplets whose clinical features closely resemble those of Coffin-Siris syndrome. The other diagnostic possibilities are also reviewed.

Renal function in children with hypercalciuria.

Hypercalciuria is a common problem causing symptoms such as abdominal pain, hematuria and enuresis, and leading to stone formation. It results from a renal tubular calcium "leak" or intestinal hyper-reabsorption of calcium. This study was performed to determine whether renal functional impairment was present in children with hypercalciuria. The study group comprised 298 children who were screened for hypercalciuria by means of urinary calcium/creatinine (UCa/UCr) ratio. The renal functions of 18 children (6.4%) detected as having hypercalciuria with Ca/Cr ratios of greater than 0.18 in their spot urines were evaluated. Results were compared with those of the healthy control group. The rate of hypercalciuria did not very significantly between the boys and girls (p > 0.05). The mean value of daily calcium excretion was 6.42 + 3.93 mg/kg/day in the children with hypercalciuria, which was significantly different from that of the control group (p < 0.01). When the values of creatinine, osmolar and free water clearances, fractional excretion of sodium and tubular reabsorption of phosphorus were compared between the patient and control groups, the difference was not significant (p > 0.05). Urinary N-acetyl-beta-D-glucosaminidase (NAG) excretion, which was described as the creatinine ratio, was significantly higher in the children with hypercalciuria. These findings suggest that in the presence of normal renal functional studies in children with hypercalciuria, tubular injury can be detected by NAG, which is a more sensitive marker of renal tubular injury.

Diabetes insipidus in a pediatric patient with systemic lupus erythematosus. A case report.

In systemic lupus erythematosus (SLE), the central nervous system (CNS) produces numerous and varying clinical disorders. A 14-year-old girl with the features of cerebral involvement in SLE is presented. The development of diabetes insipidus (DI), which responded to desmopressin, was an interesting finding in this case. Therapy consisting of high-dose methylprednisolone combined with cyclophosphamide was effective in improving the symptoms as well as the DI.

Renal involvement in the Laurence-Moon-Bardet-Biedl syndrome: report of five cases.

We report five patients with Laurence-Moon-Bardet-Biedl syndrome (LMBBS) who had renal involvement. Intravenous pyelography showed bilateral or unilateral calyceal clubbing and blunting in all patients. In addition, one patient had a parapelvic cyst in the left kidney and another had bilateral lobulated renal outlines of the fetal type. One patient had a urinary concentrating defect and two patients showed increased fractional sodium excretion. Estimated tubular phosphate reabsorption values were in normal limits in all of five patients. No patient had a urine acidification defect, proteinuria, glycosuria, or hyperaminoaciduria. One patient died from end-stage renal failure. The remaining four patients had normal serum creatinine values and estimated creatinine clearances. 99mTechnetium-diethylenetriamine pentaacetate renal scanning showed prolonged and delayed concentration and delayed excretion in three of the four patients who survived. A focal scar was determined on the left kidney of one of four patients by 99mtechnetium-dimercaptosuccinic acid renal scanning. All LMBBS cases with or without renal symptoms should be routinely evaluated for renal abnormalities. Renal scanning is a valuable method, especially for determining the renal involvement in the early stage of disease.

N-acetyl-beta-D-glucosaminidase excretion in patients with unilateral renal agenesis or nephrectomy in childhood.

Renal functional impairment due to the damaging effect of hyperfiltration of the remnant kidney was evaluated in patients who had been uninephrectomized in childhood or had unilateral agenesis. Sixteen patients (8 male, 8 female) a mean of 7.1 years (1-26 years) postnephrectomy were evaluated. Blood pressure values, clearances of creatinine (Ccr) and phosphorus (Cp), urine osmolality, total protein excretion and NAG (N-acetyl-beta-d-glucosaminidase) excretion were determined. Ccr values were slightly but not significantly lower (90.390 +/- 11.223 ml/min) than those of control subjects (110.818 +/- 7.755 ml/min). Daily urinary protein excretion adjusted for body surface was significantly higher in the study group (p < 0.05). Urinary NAG excretion measured with a spectrophotometric method and described as the Cr ratio was significantly higher in the patients than the control subjects (p < 0.05). It was concluded that the damaging effects of hyperperfusion not only involve the glomerulus but also the proximal and distal tubulus.

Diagnostic value of renal arteriography in polyarteritis nodosa.

Polyarteritis Nodosa (PAN) is a rare disease in childhood. No single pattern of clinical presentation characterizes this disease, but abdominal pain, central or peripheral nervous system disease, arthritis, myalgia and skin lesions occur at some time during the course of the illness. In this case a 16-year-old boy who presented with abdominal pain, elevated sedimentation rate associated with hypertension, and a high level of renin, all of which were detected during his hospitalization, suggested the diagnosis of PAN, and renal angiography was performed. Characteristic renal aneurysms were visualized and the diagnosis was confirmed.

Effect of vasoactive intestinal peptide and naloxone combination on urinary N-acetyl-beta-D-glucosaminidase level and kidney histology of rats exposed to severe hemorrhage.

Renal hypoperfusion which occurs in hemorrhagic shock creates an environment in which cellular injury and organ dysfunction can occur during the episode of shock as well as reoxygenation and reperfusion. At the same time, mast cell degranulation which is observed during hemorrhage may have an additional deleterious effect on the kidney. Twenty-two (Mus norvegicus albinos) rats (200-250 g) of either sex were used. The animals were divided into three groups. Group 1, the control group, was exposed to a 40% hemorrhage. Group 2 was exposed to 40% hemorrhage and then shed blood reperfused. Group 3 was exposed to 40% hemorrhage, and in addition to shed blood reperfusion 25 ng kg-1 vasoactive intestinal peptide (VIP) + 5 mg kg-1 naloxone (NLX) were given. At the end of the experiment the kidneys were evaluated either histologically or by measurement of the urinary N-acetyl-beta-D-glucosaminidase (NAG) activity. Shed blood reperfusion caused continuation of ischemic tissue damage and elevation of urinary NAG activity. Addition of VIP and NLX to the blood reperfusion caused a decrease in urinary NAG excretion, and the histology of renal tissue was almost normal.

Meckel syndrome in twins.

Meckel syndrome in twins is presented. Although several families have been reported as having this syndrome in more than one member, this is the first instance that twins having this disorder have been reported. We wish to emphasize the importance of genetic counselling in such a case in which prenatal diagnosis is possible.

Complement activation and serum beta-glucuronidase level during hemodialysis.

Peripheral white blood cell counts, complement and serum beta-glucuronidase activity were examined in 15 chronic hemodialysis patients, ranging in age from 8 to 10 years, precisely at initiation of dialysis, at 15 min after the initiation and at the end of the dialysis. At the initiation of dialysis, a rapid decline of neutrophils from the predialysis value was observed. The complement C3 level fell simultaneously but C4 was not changed. We have observed that the complement activation which follows hemodialysis is accompanied by a rise in the activities of plasma beta-glucuronidase. A rise in the serum beta-glucuronidase level was considered to be the result of complement activation and leukopenia. Granulocytopenia significantly increased the risk of infection of hemodialysis.

[Value of neuraminic acid as a clinical parameter in 42 patients with small-cell bronchial cancer]. / Der Wert der Neuraminsäure als klinischer Parameter bei 42 Patienten mit kleinzelligem Bronchialkarzinom.

The serum concentrations of neuraminic acid, CEA, gamma-Gt, 5-nucleotidase, haptoglobin, and alkaline phosphatase were determined before therapy and three and six months after the initiation of therapy in 42 patients with small cell bronchial carcinomas. Before therapy, a significantly increased serum concentration as compared to normal values was found for neuraminic acid in 97% of patients (43/44), for CEA in 54.7% (23/42), for gamma-Gt in 19% (8/42), for 5-nucleotidase in 11.9% (5/42), for haptoglobin in 36.3% (14/44), and for alkaline phosphatase in 9.5% of all patients (4/42). Three and six months later, these laboratory investigations did not give any valuable hint with respect to therapy results, with the exception of neuraminic acid (p less than 0.05). Prior to therapy, the concentrations of neuraminic acid were considerably increased in patients (mean = 3.16 +/- 0.47 mumol/ml) with regard to normal values (mean = 1.90 +/- 0.14 mumol/ml). Within the total group of 42 patients suffering from small cell bronchial carcinomas, there was no significant difference between the serum concentrations of neuraminic acid of eleven patients with localized tumors (mean = 3.12 +/- 0.53) and those of 31 advanced tumor patients (mean = 3.16 +/- 0.45) (p less than 0.05). During the six months' treatment period, the concentration of neuraminic acid was valuable as clinical parameter in 36 patients, i.e. 85% of all cases (0.001 less than p less than 0.01). It was shown that the serum concentration of neuraminic acid indicated a regression of the disease in 23 patients (p less than 0.001), a progression in 8 patients (0.02 less than p less than 0.05), and a regression with subsequent progression of the tumor in 5 patients (0.001 less than p less than 0.01).

[Electron irradiation of cervix cancer using a new transvaginal tube system attached to the betatron]. / Elektronenbestrahlung des Kollumkarzinoms mit einem neuen transvaginalen Tubussystem, das am Betatron angesetzt wird.

A new tube system for the betatron, which normally is only applied in percutaneous electron therapy, was developed at the Radiotherapeutic Department of the Medical Faculty of Istanbul. The new system allows to use the betatron also in transvaginal irradiation of the uterine cervix cancer. The authors describe the technical features of this system, its clinical application, and the results achieved. In great tumor centres where every type of malignant disease is treated, it is indispensable to dispose of the equipment necessary for certain very special cases, even if this equipment is not used frequently. In recent years, applicators for cavitary therapy and high voltage units for percutaneous therapy have been gradually substituted for the tube system employed in former times with orthovolt therapy units in intravaginal irradiation of cervical and vaginal carcinomas. There are cases, however, where the therapy techniques used nowadays are not sufficient or where a cavitary therapy should be used. Furthermore electrons which today can easily be produced for percutaneous surface therapy with linear accelerators can also be used for transvaginal therapy. We, too, have developed a new tube system which was attached to the betatron and used in intravaginal irradiation. This study describes the tube system, its clinical application, and the results achieved.

[Neuraminic acid (NANA) in the serum as an indicator in breast cancer]. / Neuraminsäure (NANA) im Serum als Indikator beim Mammakarzinom.

The serum concentration of neuraminic acid and the carcino-embryonic antigen (CEA) were measured in 178 patients with diagnosed mammary carcinoma and 114 control patients. Among these 178 patients, 16 showed a local recurrence, 68 were tumor-free, and 94 had distant metastases. Only 42 out of these 94 patients kept the check-up appointments. During six months, they were regularly examined and treated with cytostatic drugs. The neuraminic acid levels corresponded mostly to the clinical state and the response to chemotherapy of these patients. All of the 94 patients with generalized mammary carcinoma had a significantly increased neuraminic acid concentration in the serum (p less than 0.001). The serum levels were not modified in 16 patients with local recurrences and in 68 tumor-free patients. The CEA values did not correspond to the serum neuraminic acid levels and the clinical state of the patients. The increase of the neuraminic acid concentration in the serum of these 42 patients with metastatic mammary carcinomas show that this parameter is a valuable indicator for the progression of this disease.

[Results of radiotherapy and chemotherapy in small-cell bronchial carcinoma]. / Die Ergebnisse der Strahlentherapie und Chemotherapie beim kleinzelligen Bronchialkarzinom.

At the Radiotherapeutic Department of the Faculty of Medicine in Istanbul, 35 masculine patients with microcellular bronchial carcinoma, limited disease, were treated for two years, i.e. between 1980 and 1981, with a combination of radiotherapy and chemotherapy. Nine out of these patients are tumor-free after at least 46 months, i.e. about four years. This corresponds to a tumor-free survival rate of 25.7%.