RESUMO
OBJECTIVE: To evaluate possible predictive factors of involution on ultrasonography (US) or disappearance of a prenatally detected multicystic dysplastic kidney (MCDK). PATIENTS AND METHODS: Forty-five children with unilateral MCDK detected by prenatal ultrasonography between 1989 and 2002 were analysed. All patients except one had (99m)Tc isotopic scintigraphy to confirm the absence of renal function in the MCDK. All children were managed conservatively with follow-up visits every 6 months, with US 6-monthly during the first 2 years of life and yearly thereafter. Survival was analysed using the Kaplan-Meier method to evaluate the involution of the MCDK, with differences between subgroups assessed using the two-sided log-rank test. Cox's regression model was applied for the multivariate analysis. RESULTS: The mean (range) follow-up was 50 (12-167) months; in all, 279 ultrasonograms were taken, the mean (range) number per patient being 6 (3-10). US showed partial involution of the MCDK in 30 (67%) cases and complete involution in nine (20%). The absolute MCDK length remained almost unchanged in six children (13%). Univariate analysis showed that four variables were possibly associated with complete involution of the MCDK (gender, impalpable kidney, renal length at admission using two thresholds, 62 and 78 mm). After adjusting by Cox's model only a renal length at diagnosis of <62 mm remained associated with complete involution (relative risk 8, 95% confidence interval 0.98-68; P = 0.05). CONCLUSION: These results suggest that only a renal length of <62 mm on initial US was predictive of complete involution of the MCDK during the follow-up.
Assuntos
Doenças Fetais/diagnóstico por imagem , Rim Displásico Multicístico/diagnóstico por imagem , Ultrassonografia Pré-Natal/normas , Feminino , Seguimentos , Humanos , Hidronefrose/diagnóstico por imagem , Masculino , Rim Displásico Multicístico/terapia , Valor Preditivo dos Testes , Gravidez , Cintilografia , Sensibilidade e EspecificidadeRESUMO
We report the long-term clinical results of conservative management of children with unilateral multicystic dysplastic kidneys (MCDK). Between 1989 and 2002, 43 children with MCDK detected by prenatal ultrasonography were prospectively followed. At birth, ultrasonography confirmed the prenatal findings in all cases. Patients underwent a radioisotope scan and micturating cystogram in order to confirm the diagnosis and to exclude other uropathies. Follow-up ultrasound (US) examinations were performed at 6-month intervals during the first 2 years of life and yearly thereafter. The mean follow-up time was 42 months (range 12-156 months). Two children developed hypertension during follow-up. In total 257 US scans were performed. The mean number of US scans per patient was 6 (range 3-10). US scans demonstrated partial involution of the MCDK in 30 (70%) cases and complete involution in 8 (19%). The absolute MCDK length remained almost unchanged in 5 children (11%). The estimated median time of complete involution of the MCDK was 122 months [95% confidence interval (CI)=86-158 months]. A total of 33 (76.7%) contralateral kidneys underwent compensatory hypertrophy, reaching a renal length above the 95th percentile during follow-up. The estimated median time for the occurrence of compensatory hypertrophy was 30 months (95% CI=15-45 months). In conclusion, the natural history of MCDK is usually benign but patients must have long-term follow-up with US scans and blood pressure measurements.
Assuntos
Rim Displásico Multicístico/fisiopatologia , Progressão da Doença , Feminino , Humanos , Hipertensão/etiologia , Lactente , Recém-Nascido , Masculino , Rim Displásico Multicístico/complicações , Rim Displásico Multicístico/diagnóstico por imagem , Gravidez , Estudos Prospectivos , Remissão Espontânea , Ultrassonografia Pré-NatalRESUMO
Säo apresentados três pacientes com fístula traqueo-esofágica isolada (tipo H) operados com sucesso. O quadro clínico é representado por distensäo gástrica, tosse e cianose à alimentaçäo, e pneumonias recorrentes. A traqueoscopia é o método de diagnóstico mais importante e a cervicotomia direita é a melhor via de acesso cirúrgico para tratamento das fístulas traqueo-esofágica cervicais.
Assuntos
Recém-Nascido , Lactente , Criança , Humanos , Masculino , Feminino , Traqueia/anormalidades , Fístula , Doenças da Traqueia , Esôfago/anormalidades , Fístula Traqueoesofágica/cirurgia , Fístula Traqueoesofágica/diagnóstico , Traqueia/anormalidades , Brasil , Atresia Esofágica , Esôfago/anormalidadesRESUMO
Os autores apresentam criança de seis anos, feminina, com ascite volumosa e obstruçäo intestinal. Foi submetida a extensa propedêutica culminando com laparotomia exploradora que mostrou intensa fibrose do peritôneo visceral e parietal. O intestino delgado apresentava-se comprimido pelo peritôneo fibrosado, sendo a causa da obstruçäo intestinal. Cirurgicamente, nenhum tratamento foi feito. Houve resoluçäo do quadro de obstruçäo intestinal com terapêutica conservadora, representda por aspiraçäo gástrica contínua e nutriçäo parental prolongada. Apresenta-se revisäo de literatura