Clinical signs and symptoms of urinary tract infection (UTO) are often nonspecific and misleading in pediatric patients, especially in infants. Technetium 99-m-dimercaptosuccinic acid (Tc99m DMSA) scintigraphy is considered the most sensitive technique for the identification of renal parenchymal change in acute pyelonephritis (APN) and renal scarring. But there is no accurate prevalence of APN in children with first febrile UTI. Our study is to investigate the prevalence of APN and renal scarring by means of DMSA renal SPECT image and the role of vesicoureteric reflux (VUR) in APN and renal scar formation for Children with febrile UTI. Form Nov. 1996 to Dec. 199,216 patients (132 boys and 84 girls) were enrolled into our study. Inclusion criteria for febrile UTI included fever with body temperature＞ 38oC and positive urine culture. Recurrent UTI history and obstructive or congenital abnormalities of genitourinary tract, except VUR, were excluded. Scintigraphy was firstly performed within seven days of admission and scintigraphy was followed up at least 3 months later after the acute episode. Children were grouped by the different age as Gr. I: ＜ 1 yr (M/F: 113/36); Gr. II 1~5 yr (M/F: 11/22); and Gr. III: ＞ 5`17yr (M/F: 8/26). The overall prevalence of APN in febrile UTI was 70%(male: 66%, female: 76%, P = 0.110). Different age group with APN have significant difference (I:63%, II: 86%; III:84%, Gr. I vs II & vs III P＜0.05). During the follow-up period, 61 (46%) of 133 APN patients received secondary scintigraphy, and 35 (57%) patients showed renal scar formation. Totally, 106(M/F: 59/47) patients with febrile UTI received VCUS, and the prevalence of VUR in each age group were I: 22%; II: 68%, and III: 44% (Gr. I vs II, P ＜ 0.05). However, there were no significant different in gender. APN associated with VUR was 31% (24/78), and renal scar associated with VUR was 58% (14/24). By comparison of grading in VUR, we confirmed that high-graded (3-5) VUR was more susceptible to renal scar formation (P＜0.05) To conclude, our study revealed children with febrile UTI seem to have higher prevalence of APN than of infant (≤ 1 yr). There was significant difference of VUR in different age, esp. in children with febrile UTI. Low-graded VUR is not the risk for APN or renal scar formation, and the role of prophylactic antibiotics for low-graded VUR should be reevaluated.
Central diabetes insipidus (CDI) is an uncommon disease caused by the deficiency of antidiuretic hormone (ADH), i.e. vasopressin. Deficiency of ADH leads to a failure to conserve water and results in polyuria and polydipsia. Desmopressin (1-desamino-8-Darginine vasopressin, dDAVP), a synthetic analogue of vasopressin, has been utilized for over 20 years, it is the most effective drug for the management of CDI and is adminosered typically by intranasal route one to three times daily. Recently, dDAVP was proven to be effective when given orally. The experience of treating CDI with oral dDAVP is limited in Taiwan. We hereby reported two cases of CDI, one was caused by metastatic lung cancer and the other was idiopathic. These two cases responded to administration of oral dDAVP without notable side-effects. In this report, we shared our experience in dosage adjustment of dDAVP that was critical for successful treatment. The pharmacokinetic characteristics of oral dDAVP were also discussed in this report.
Systemic lupus erythematosus (SLE) is characterized by the production of pathogenic autoantibodies and the deposition of immune complexes in various organs, whereas minimal change disease (MCD) is characterized by normal or only mild mesangial cell proliferation without deposition of immune complexes. Although these two diseases are so different, they all share the same characteristics of dysregulation of T-lymphocyte and the appearance of low T4/T8 ratio. In this report, we present two cases who had (suspected) SLE developed minimal change NS (MCNS). Case 1 was diagnosed to have SLE, which fulfilled 5 revised SLE criteria of American College of Rheumatology (ACR), but MCD was shown in renal biopsy. Transient renal insufficiency was also noted. Case 2 had NS as well. Renal pathology revealed MCD and tubuloreticular inclusion. High titer of ANA developed later, and the diagnosis of SLE was highly suspected. Both cases got remission from NS after receiving steroid therapy. Since evidence supports that MCNS might be associated or related with SLE, the therapeutic strategy (corticosteroid) is suggested to treat as primary MCNS. Proper recognition of this entity by renal biopsy should be taken into consideration in SLE patient with NS.
We report 2 cases of gas-forming vertebral osteomyelitis in diabetic patients. Both were caused by gram-negative bacilli, Escherichia coli and Klebsiella pneumoniae respectively. Both ran a fulminant course to death despite appropriate parenteral antibiotics. We suggest that early surgical intervention may be needed in cases with gas-forming vertebral osteomyelitis.
Narrow-band imaging (NBI) is a novel endoscopic imaging technology that improves the visibility of capillaries. The aim of this study was to evaluate the efficacy of NBI hysteroscopic excision in symptomatic post-cesarean scar diverticulum (PCSD) patients compared to conventional white light (WL) hysteroscopy.
Background: Detection of digital volume pulse (DVP) using photoplethysinography has been employed to evaluate the pulse wave velocity (PWV) and arterial stiffness. The aims oft/ifs study were to introduce a novel method in measuring global arterial stiffness by dual-channel DVP and compared with standard applanation tonometry (AT) in chronic kidney disease (CKD) patients, and to analyze the relationship between PWV-DVP and cardiovascular risk factors. Methods: Arterial stiffness was measured by PWV-AT and PWV-DVP in 70 CKD patients. Correlations between PWV-AT and PWV-DVP as well as relationship between PWV-DVP and cardiovascular risk factors were analyzed. Results: There was a significant correlation between overall PWV-AT and PWV-DVP (r=0.6468, P＜0.0001). Further analysis revealed significant correlation between PWV-AT and PWV-DVP in CKD Stages 1 to 2 and in Stages 3 to 4, but not in CKD Stage 5. Multivariate regression analysis revealed that systolic BP was the only independent factor associated with PWV-DVP. Conclusions: PWV-DVP is correlated with standard PWV-AT in CKD Stage 1 to 4 but not in CKD Stage 5. Because of the difference between PWV-DVP and PWV-AT which represented global arterial stiffness and aortic stiffness, respectively the predictive powers of two arterial stiffness methods in cardiovascular outcome of CKD patients deserved further evaluation, Moreover; considering the traditional cardiovascular risk factors, systolic BP is an independent factor associated with PWV-DVP.
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