Self-reported health-related quality of life in children and adolescents with myelomeningocele.

The aim of the study was to investigate self-reported health-related quality of life (HRQOL) in children and adolescents with myelomeningocele (MMC) and to examine the impact of clinical impairments and limitations in activities of daily living (ADL). Fifty patients (28 females, 22 males) between 8 and 16 years of age (mean age 12y 1mo [SD 2y 4mo]) with MMC from three German paediatric centres and their mothers completed standardized measures on HRQOL (KINDL-R) and limitations in ADL (Childhood Health Assessment Questionnaire). Lesion level was thoracic in nine, sacral in 25, and lumbosacral in 11 patients. Twenty-one patients were community walkers, 17 were able to walk in the home, and seven used a wheelchair. Two-thirds had health problems related to the central nervous system causing current difficulties (eight patients had a shunt, six had hydrocephalus, and 10 had a tethered cord). Patients in the study group reported diminished overall HRQOL compared with norm data, specifically in the dimensions of emotional well-being, self-esteem, and peer relations. Adolescents reported diminished HRQOL in the dimension of peer relations. Most medical parameters as well as limitations in ADL were not significantly associated with HRQOL. Our findings confirm the results of studies which dispute a linear inverse association between condition severity and HRQOL and emphasize the importance of peer relations in young patients with MMC.

[Familial vesico-ureteral reflux and familial urinary tract infection (author's transl)]. / Familiärer vesico-ureteraler Reflux und familiäre Infektanfälligkeit

In 6 families several members had vesico-ureteral reflux and/or recurrent urinary tract infections. From the analysis of the case reports the following tentative conclusions could be drawn: Familial reflux may be caused. 1. by primary insufficiency of the vesico-ureteral junction. 2. possibly by secondary changes consequent to a familial tendency to recurrent urinary tract infections.

[Potentially uropathogenic enterobacteria on the periurethral mucosa of urologically normal individuals (author's transl)]. / Untersuchungen über die Besiedelung der periurethralen Schleimhäute mit potentiell uropathogenen Keimen (Darmbakterien) bei urologisch gesunden Probanden

Swabs from the periurethra from 160 urologically normal individuals, male and female, of various age groups were examined for potentially uropathogenic enterobacteria. Children from 0--3 years constantly showed (100%) high numbers of different enterobacteria. The frequency of identification and the number of these bacteria diminished abruptly with advancing age. In adult women we found a prevalence of 15%. The periurethral flora with regard to enterobacteria is probably the result of a dynamic equilibrium between contamination and elimination. The important role of contamination is documented by the massive seeding in the 0--3 years age group and the abrupt diminuition after successful bowel training. The mechanism of elimination is unknown. Personal hygiene, the pH of the periurethral mucosa, a special antibacterial substance and the ecological equilibrium of the periurethral flora are discussed as possible factors.

[Localization of urinary infection after antireflux surgery (author's transl)]. / Rezidivierende Harnwegsinfekte nach erfolgreicher Antirefluxplastik: ihre Lokalisation mit dem Blasenauswaschtest

Bladder wash-out tests were performed in a series of patients after successful antireflux surgery. The majority (65.5%) of infections were localized in the bladder, even if the IVP demonstrated signs of pyelonephritis (renal scarring and calcieal clubbing). 21.3% of the tests demonstrated a participation of the upper urinary tract. The bladder bacteriurias were interpreted as reinfections, and also some of the supravesical bacteriurias. In other cases, this differentiation could not be made.