Partial ureteric obstruction in weanling rats. II. Long-term effects on renal function and arterial blood pressure.

A partial obstruction of the left ureter was created in weanling (3-week-old) rats. Renal function was studied after 7-9 weeks and compared to that in age-matched controls. Arterial blood pressure was found substantially increased. During normal hydration, the hydronephrotic kidney had low excretions of urine, potassium, osmoles and, especially, sodium. The contralateral, intact side showed no compensatory traits. On volume expansion, the hydronephrotic kidney demonstrated an unimpaired reacting capacity, leading to normalization of urine, sodium and osmole excretions and even to supernormal renal blood flow, glomerular filtration and potassium excretion. On the intact side, the excretion of potassium was increased like that on the hydronephrotic one, while excretions of urine, sodium and osmoles were increased even more. The fact that the intact kidney handled most of the urine excretion was interpreted as the result of a mechanism protecting the obstructed kidney from additional pressure insults while homeostasis was maintained. The arterial hypertension may result from the combination of retention of fluid and sodium by the hydronephrotic kidney and the absence of compensation by the intact kidney during normal hydration--like that in everyday life. The functional changes during normal hydration were generally more severe than those we found after obstruction in neonatal and adult rats, in which arterial hypertension was never observed. The clinical implication would be that the kidney may be less tolerant to pressure rises during the infant year. Changes due to obstruction are known to occur rapidly, but after that neither progress nor reverse.(ABSTRACT TRUNCATED AT 250 WORDS)

Avoiding splenectomy in the treatment of children with splenic injury.

Ninety-two consecutive patients with traumatic rupture of the spleen were studied. Of the first 46 children (group A), 44 underwent splenectomy. In the subsequent group (group B) non-operative management was successful in 40 of 46 patients, five patients were operated with splenic repair, and one had the spleen removed. All the ruptures were caused by blunt trauma and the severity of the splenic injury was roughly the same in the two groups of patients. A third of the patients in each group had associated injuries, renal injury being the most common intraabdominal lesion. The median hospital stay was 8.0 days (range 5 to 28) in group A and 12.5 days (range 7 to 18) in group B. Among the 40 patients who were treated conservatively, a biphasic course was seen in 23: one or two days after the accident a period of increased pulse rate, fever and increased abdominal tenderness and pain followed, but no evidence for a delayed rupture was found. Our results of conservative treatment of splenic rupture are encouraging and show that non-operative management should be considered in most cases.

Scintigraphic evaluation of traumatic splenic lesions in children.

Ninety-eight children with recent blunt abdominal trauma which initially evoked clinical suspicion of splenic injury were examined with colloid scintigraphy of the spleen and the liver using multiple imaging views and with abdominal survey. Nineteen children were, in addition, examined with tomographic scintigraphy. The clinical findings and the course of the disorder were reanalyzed. Scintigraphy indicated splenic injury in 56 children and hepatic injury in another 5 children. The left lateral and the left oblique were the optimum imaging views for detecting splenic ruptures. Tomographic scintigraphy did not improve the diagnostic yield. Abdominal survey failed to indicate almost every second case of splenic rupture and provided no additional information of significance. The clinical review agreed with the scintigraphic diagnosis of splenic lesions but, in addition, it suggested possible splenic lesions in another 10 children with normal scintigraphy. This discrepancy cannot be explained as surgery was not employed; the occurrence of splenic lesions too small to become detectable at scintigraphy or to provoke clinically evident symptoms may be supposed.

Partial ureteric obstruction in the pubescent rat. I. Long-term effects on renal function.

A partial obstruction of the left ureter was created in six-week-old rats. The effects on renal function were studied after three, nine and 15 weeks, first in normal hydration, and then after extracellular volume expansion. Moderate hydronephrosis without parenchymal weight reduction developed within three weeks. The hydronephrotic kidney i) excreted during normal hydration less urine and sodium than the intact one, because of increased reabsorption, ii) was capable of reacting fully on volume expansion and iii) had, after volume expansion, a higher renal blood flow and GFR but also a higher reabsorption of water, sodium, potassium and osmoles, resulting in excretions similar to those on the intact side. The differences noted were small (less than 20%) except for sodium excretion. The hydronephrotic kidney seemed to tolerate an increase in ureteral resistance better than the intact one would do. There were no significant differences between the three, nine and 15-week groups, with regard to the effects on the hydronephrotic kidney. Thus, except for a tendency to sodium retention, the effects of partial ureteric obstruction in young rats seem to be relatively harmless and do not increase with time.

IgG and IgM antibody responses to pneumococcal vaccination in splenectomized children and in children who had non-operative management of splenic rupture.

The IgG and IgM type specific anticapsular pneumococcal antibody titres were studied with ELISA during one year following vaccination with a 14-valent pneumococcal polysaccharide vaccine in four different patient groups: 41 children splenectomized after a traumatic rupture, 16 splenectomized because of disease, 15 non-surgically managed after splenic rupture, and 19 healthy controls. Serum samples were obtained before vaccination and after 14, 60, 180, and 360 days. The IgG antibody responses were equally good in all of the patient groups, while the IgM antibody responses were less pronounced in the splenectomized. In the non-surgically managed patients, the IgM antibody titres after vaccination, as well as antibody responses per se, were significantly higher for all 12 pneumococcal types studied than in the patients who were splenectomized. Both the IgG and the IgM antibody titres were highest at 14 days after vaccination. However, while the IgG titres for most pneumococcal types remained elevated at 360 days, the IgM titres soon fell to prevaccination levels. The antibody response was less good for the types 3 and 6 A. The results indicate that the IgG antibody response to pneumococcal polysaccharide vaccination is unaffected in splenectomized individuals, but the IgM antibody response is decreased. In patients with a healed traumatically damaged spleen, both the IgG and IgM responses seem to be normal.

Oral absorption of flucloxacillin in infants and young children.

The bioavailability of flucloxacillin (Heracillin) following oral administration was determined in infants and children. After a dose of 12.5 mg/kg, peak concentrations were achieved at 60 min. which declined rapidly and were low in older children only 4 hours afterwards. Infants below 6 months of age showed a better absorption when given the mixture than older children. Older children achieved higher plasma concentrations when given tablets than when given equal doses of the mixture. There was no difference in the concentration when the dose was given to the subject when fasting, or with breakfast.

Lung function after repair of congenital diaphragmatic hernia.

To study lung development after repair of congenital diaphragmatic hernia 20 patients operated on between 1960 and 1976 were followed-up at 6-22 years of age. All had had an uneventful postoperative course, had no concomitant disease and were subjectively well with an ordinary physiological performance. The investigation showed a mean increase of residual volume by one third of predicted normal values. Fractional perfusion and ventilation were reduced by 20% on the hernia side compared with the contralateral side. Functional impairment owing to pulmonary hypoplasia was ruled out by the existence of a normal working capacity and maintenance of a normal alveolar gas exchange during exercise on a high work load.

Renal function in dogs with chronic moderate unilateral ureteral obstruction.

Partial obstruction of the left ureter was created in seven dogs. Renal function was studied 3 weeks later. Total renal blood flow (RBF) and intrarenal blood flow distribution were studied using the microsphere technique. Glomerular filtration rate (GFR), effective renal plasma flow (CPAH) and the excretion of sodium and osmolar substances were determined using the clearance technique. RBF, GFR and CPAH in the hydronephrotic kidney were reduced to approximately 30% of the same parameters in the contralateral kidney. Urinary sodium excretion was consistently lower in the hydronephrotic than in the contralateral kidney. Volume expansion with isotonic saline solution revealed that this reduction of sodium excretion from the hydronephrotic kidney was out of proportion to the extent of GFR reduction. The contralateral unobstructed kidney did not compensate for this salt retention by increasing its sodium excretion.

Results of surgical treatment of lung metastases in children.

Between 1970 and 1979, 14 patients were operated on for pulmonary metastases. In 9 of these the primary tumour was a Wilms' nephroblastoma. Five out of the 14 patients are presently alive and free from disease (3 to 10 years after pulmonary resection). Primary tumours of the survivors were Wilms' tumour in 3 cases, an ovarian teratoma in one patient and a Ewing's sarcoma in one patient. Two of survivors had bilateral involvement and one had multiple metastases of one lung with pleural exudation. The disease-free interval was the same among the survivors and the non-survivors. It is apparent from the present material that some patients with a very poor prognosis as predicted from different prognostic factors can be cured after surgical excision of the metastases. The surgical procedure in children involves a very small risk and only moderate discomfort. An active surgical approach is therefore recommended.

Postoperative causes of death in pediatric surgery: analysis and conclusions for the therapy.

The mortality of children with posterolateral diaphragmatic hernia (PDH) is mainly dependent upon the degree of lung hypoplasia. Other less significant factors are dysmaturity, associated anomalies, infection and haemorrhages. Children with grave cyanosis from PDH immediately after birth have a poor prognosis due to persistent foetal circulation with pulmonary vascular hypertension and right-left shunting. A better understanding and treatment of this persistent foetal circulation may considerably improve the surgical mortality, though in some cases the lung hypoplasia may be too far advanced.

Posterolateral diaphragmatic hernia--long-term results.

During the years 1965--1974, 125 cases of posterolateral diaphragmatic hernia have been operated at five departments of pediatric surgery in Sweden. The overall operative mortality was 50%. A follow-up investigation included 19 cases, where in 12 cases spirometry and in 11 cases studies of the mobility of the diaphragm were included. Physical examination revealed excellent results in most cases. Lung function studies, however, show a moderate (20--30%) reduction, which is not surprising with regard to lung hypoplasia and impaired movement of the diaphragm on the operated side. In adolescence and younger age, these patients are mostly in excellent condition; but later, when lung function is also reduced by the age factor, their neonatal condition may be of importance.