Abnormalities of the thyroid in survivors of childhood Hodgkin's disease.

AIM: The progress made in the treatment of Hodgkin's disease (HD) has resulted in long-term survival rates >90%, therefore late sequelae of treatment, especially endocrine diseases, have become more important. Hypothyroidism is the most frequent thyroid disease but hyperthyroidism, thyroid nodules and cancer are also frequent. Thyroid cancer begins to appear 5-10 years after neck irradiation and risk persists for decades. Therefore it is important a careful and long-term follow-up of these patients. METHODS: This report analyzed the thyroid function of thirteen patients successfully treated for childhood HD according to three different protocols of therapy. Treatment modalities were correlated to the occurrence of thyroid dysfunction. RESULTS: After a median follow-up of 8.3 years, nine out of thirteen patients were found to have thyroid abnormalities. Six patients developed hypothyroidism, one patient developed hyperthyroidism, two patients showed only ultrasound abnormalities. CONCLUSIONS: The patients treated with lower radiotherapy (RT) doses and restricted RT extension showed a lower incidence of thyroid abnormalities compared to patients treated with higher RT dose and extended RT field. This study, even though performed in a small cohort of patients, confirms the high incidence of thyroid abnormalities in patients treated for HD and strengthens the importance of a long-term follow-up.

[Urinary infection in adolescents] / Infecção urinária na adolescência.

OBJECTIVE: Urinary tract infections are caused by various gram-negative bacteria. Escherichia coli is the most common causative agent in all groups of patients. Staphylococcus saprophyticus is now recognized as a common cause of urinary tract infection in adolescents and young adult women. METHODS: Review of literature and clinical experience with urinary tract infections in adolescents at the Pediatric Nephrology Department of Hospital Santa Casa de São Paulo. RESULTS: Lower urinary tract infection, hematuria and dysuria were the most frequent symptoms observed in infections caused by Staphylococcus saprophyticus. Some asymptomatic cases were observed. The infection may be associated with adverse effects of maternal and fetal health during pregnancy. CONCLUSIONS: This article reviews the diagnosis, etiology, treatment, and complications associated with urinary tract infections in adolescents.

[Echotomography and hyperechoic angiomas of the liver. The structural aspects in 297 cases]. / Ecotomografia e angiomi iperecogeni del fegato. Aspetti strutturali in 297 casi.

Two-hundred-seventy-nine hyperechoic liver hemangiomas were studied with sonography (US) in order to define their structural patterns and the incidence of the different signs that could be used for diagnostic purpose. For each hemangioma the following parameters were considered: hypoechoic areas inside the mass, posterior acoustic enhancement, hypoechoic halo surrounding the lesion, posterior attenuation, and calcifications. Hemangiomas were equally frequent in both sexes (1:1.1), and many patients presented with multiple lesions (44.7%). Hypoechoic areas were present in 70% of the hemangiomas, and acoustic enhancement in 29%. Other signs had a lower incidence: hypoechoic halo 2.86%, posterior attenuation 2.15%, and calcifications 1.1%. The authors believe that, in non-neoplastic patients, a hyperechoic hepatic lesion presenting with hypoechoic areas and acoustic enhancement, with no surrounding hypoechoic halo, can be confidently diagnosed as a hemangioma by US alone.

[Renal scintigraphy using technetium dimercaptosuccinic acid in the diagnosis of pyelonephritis in children: study of 17 cases] / Cintilografia renal com ácido dimercaptossuccínico marcado com tecnécio no diagnóstico da pielonefrite na infância: estudo de 17 casos.

OBJECTIVE: To determine whether the presence of abnormal results in DMSA renal scintigraphy indicates pyelonephritis. METHODS: We performed the washout test in 17 children with urinary tract infection, as a criterion standard, to locate the infection site. All the children underwent DMSA renal scintigraphy in the acute phase of the disease. The results were analyzed by the chi-square test or Fisher test. RESULTS: DMSA renal scintigraphy revealed changes in all five cases of pyelonephritis, suggesting acute kidney involvement. On the other hand, only one child with cystitis (total = 12 cases) had abnormal results in renal scintigraphy. Sensitivity and specificity were 100% and 92%, respectively. CONCLUSION: DMSA renal scintigraphy is a sensitive method for the diagnosis of pyelonephritis in children.