Pédiatrie [News in paediatrics]

Every pediatrician will be confronted with newborns oryoung infants with skin lesions in proximity of the vertebral column. It is important not to miss a spinal dysraphism because of the risk of meningeal infection or of the possible presence of a tethered cord. A practical algorithm is presented. Non-accidental injury in young infants and toddlers is not rare but difficult to detect. Bruises and fractures are highly suspicious for non-accidental injury and should trigger specific investigations. Emergency departments and hospitals are switching from hypotonic to isotonic solutions as maintenance infusions of children. They reduce the risk of hyponatremia without increasing that of hypernatremia, and they should be used preferentially in the majority of pediatric clinical settings

Endoscopic and surgical treatment of vesico-ureteral reflux in children. Comparative long-term follow-up.

PRINCIPLES: This retrospective study analyzes the long-term results of endoscopic and surgical treatment of vesico-ureteral reflux in children. METHODS: A cohort of 130 patients, 67 girls and 63 boys with a mean age of 30 months were treated either by endoscopic subureteral collagen injection (SCIN) in 92 and by Cohen reimplantation surgery in 123 refluxing ureteral units. Mean follow-up was 4.2 years varying from 1 to 8.7 years. Reflux recurrence, urinary tract infection (UTI) and renal function were evaluated. RESULTS: After SCIN reflux was absent in 64% at 6 months. 20% of the initially 92 refluxing ureters were injected twice. After one or two injections reflux was absent in 71%. In 21% recurrent reflux was of grade I or II, not requiring further treatment. UTI was observed in 27%. After Cohen ureteral reimplantation reflux was absent in 96% at 6 months. UTI was observed in 23%. Renal function at diagnosis and follow-up was compared in children with bilateral grade III reflux only. In patients treated with SCIN it was normal in 77% preoperatively and in 90% at follow-up. In patients treated by open surgery it was normal in 47% preoperatively and in 76% at follow-up. CONCLUSION: For high-grade vesico-ureteral reflux re-implantation surgery remains the gold standard. SCIN is indicated for low and medium grade reflux. Recurrent bacteriuria was observed more often after SCIN and pyelonephritis more often after open surgery. The renal function seems to be preserved with both techniques

Conservation of endemic species in the national system of protected areas from Nicaragua

Nicaragua, in the framework of the Convention on Biological Diversity (CBD), agreed to establish a “Representative system of protected areas that adequately conserve biodiversity and terrestrial, marine and inland water ecosystems”. Pursuant to the above, we conducted a Gap Analysis of Biodiversity Conservation for the National System of Protected Areas (SINAP) of Nicaragua, focused on terrestrial and inland water ecosystems as well as on terrestrial species. This paper presents the results of the analysis of the conservation status of the endemic species in the national system of protected areas of Nicaragua. The groups considered for analysis were plants, mollusks, amphibians, reptiles, and mammals. Data presented came from reviewing books, scientific papers, management plans of protected areas and unpublished reports by the authors, and nearly 140 websites. Of the 75 plant species and 31 animal species considered in the analysis, 25 species have some distribution points within the SINAP (ten of them have only one point). There are 80 species apparently absent from the SINAP. Nicaraguan endemic species are severely unprotected.KEY WORDSEndemism, conservation, protected areas, Nicaragua, mollusks, amphibians, reptiles, birds, mammals, plantsNicaragua, en el marco de la Convención de Diversidad Biológica (CDB), se comprometió a establecer un “Sistema representativo de áreas protegidas que conserve de forma adecuada la biodiversidad y los ecosistemas terrestres, marinos y de aguas intercontinentales”. En cumplimiento de lo anterior, se realizó un Análisis de Vacíos de Conservación de la Biodiversidad para el Sistema Nacional de Áreas Protegidas (SINAP), de Nicaragua, enfocado en ecosistemas terrestres y de aguas continentales, así como especies terrestres. En el presente trabajo se presentan los resultados sobre el análisis del estado de conservación de los endemismos en el sistema nacional de áreas protegidas de Nicaragua. Los grupos considerados para el análisis fueron plantas, moluscos, anfibios, reptiles y mamíferos. Los datos presentados procedieron de la revisión de libros, artículos científicos, planes de manejo de áreas protegidas e informes inéditos de los autores, así como unas 140 páginas webs revisadas. De las 75 especies de flora y las 31 especies de fauna consideradas en el análisis, 25 especies tienen alguno de sus puntos de distribución dentro del SINAP (diez de ellas tienen un solo punto). Hay 80 especies aparentemente ausentes dentro del SINAP. Especies endémicas de Nicaragua se encuentran gravemente desprotegidas.PALABRAS CLAVEEndemismos, conservación, áreas protegidas, Nicaragua, moluscos, anfibios, reptiles, aves, mamíferos, planta

Unilateral ureteropelvic junction obstruction in children: long-term followup after unilateral pyeloplasty.

PURPOSE: The benefit of surgery on renal function in unilateral ureteropelvic junction stenosis (UPJS) is still debated. We evaluated renal function outcome after unilateral pyeloplasty in 53 children. MATERIALS AND METHODS: We retrospectively reviewed 123I-hippuran renography performed at diagnosis and 5 to 15 years (mean +/- SD 7 +/- 3 years) after successful pyeloplasty. UPJS was prenatally detected in 26 children because of urinary tract infection in 17 and miscellaneous reasons in 10. Relative function (RF) and absolute function were measured on background corrected renograms. Absolute function of the affected and contralateral kidneys was determined by an accumulation index (AI), representing the percent injected dose extracted by each kidney 30 to 90 seconds after the heart peak. RESULTS: Preoperatively 33 of the 53 UPJS kidneys had a decreased AI but only 8 had a RF of less than 40%, which was improved in 7 at followup. In addition, the AI improved in 29 kidneys, of which 19 (36%) normalized. Of the UPJS kidneys 14 had an initially decreased AI that remained abnormal at followup. In these kidneys preoperative RF was less than 40% in all. At followup RF was greater than 40% in 4 children, in whom the AI of the UPJS kidney did not improve but the AI of the contralateral one decreased from supranormal to normal. Seven contralateral kidneys had a supranormal AI, whereas the AI remained normal in 3, of which the RF in the UPJS kidney remained at less than 40%. The AI and RF were normal in 20 UPJS kidneys and remained normal. CONCLUSIONS: When normal, the AI and RF reflected renal function outcome similarly. The AI added relevant information in UPJS kidneys with impaired function, showing compensation of the contralateral kidney

F+0 renography in neonates and infants younger than 6 months: an accurate method to diagnose severe obstructive uropathy.

We studied the response to F+0 renography and the relative and absolute individual kidney function in neonates and < 6-mo-old infants before and after surgery for unilateral ureteropelvic junction obstruction (UJO). METHODS: The results obtained at diagnosis and after pyeloplasty for 9 children (8 boys, 1 girl; age range, 0.8-5.9 mo; mean age +/- SD, 2.4 +/- 1.5 mo) with proven unilateral UJO (i.e., affected kidney [AK]) and an unremarkable contralateral kidney (i.e., normal kidney [NK]) were evaluated and compared with a control group of 10 children (6 boys, 4 girls; age range, 0.8-2.8 mo; mean age, 1.5 +/- 0.7 mo) selected because of symmetric renal function, absence of vesicoureteral reflux or infection, and an initially dilated but not obstructed renal pelvis as proven by follow-up. Renography was performed for 20 min after injection of (123)I-hippuran (OIH) (0.5-1.0 MBq/kg) immediately followed by furosemide (1 mg/kg). The relative and absolute renal functions and the response to furosemide were measured on background-subtracted and depth-corrected renograms. The response to furosemide was quantified by an elimination index (EI), defined as the ratio of the 3- to 20-min activities: An EI > or = 3 was considered definitively normal and an EI < or = 1 definitively abnormal. If EI was equivocal (1 < EI < 3), the response to gravity-assisted drainage was used to differentiate AKs from NKs. Absolute separate renal function was measured by an accumulation index (AI), defined as the percentage of (123)I-OIH (%ID) extracted by the kidney 30-90 s after maximal cardiac activity. RESULTS: All AKs had definitively abnormal EIs at diagnosis (mean, 0.56 +/- 0.12) and were significantly lower than the EIs of the NKs (mean, 3.24 +/- 1.88) and of the 20 control kidneys (mean, 3.81 +/- 1.97; P < 0.001). The EIs of the AKs significantly improved (mean, 2.81 +/- 0.64; P < 0.05) after pyeloplasty. At diagnosis, the AIs of the AKs were significantly lower (mean, 6.31 +/- 2.33 %ID) than the AIs of the NKs (mean, 9.43 +/- 1.12 %ID) and of the control kidneys (mean, 9.05 +/- 1.17 %ID; P < 0.05). The AIs of the AKs increased at follow-up (mean, 7.81 +/- 2.23 %ID) but remained lower than those of the NKs (mean, 10.75 +/- 1.35 %ID; P < 0.05). CONCLUSION: In neonates and infants younger than 6 mo, (123)I-OIH renography with early furosemide injection (F+0) allowed us to reliably diagnose AKs and to determine if parenchymal function was normal or impaired and if it improved after surgery

A dilatant, two-layer debris flow model validated by flow density measurements at the Swiss illgraben test site

We propose a dilatant, two-layer debris flow model validated by full-scale density/saturation measurements obtained from the Swiss Illgraben test site. Like many existing models, we suppose the debris flow consists of a matrix of solid particles (rocks and boulders) that is surrounded by muddy fluid. However, we split the muddy fluid into two fractions. One part, the inter-granular fluid, is bonded to the solid matrix and fills the void space between the solid particles. The combination of solid material and inter-granular fluid forms the first layer of the debris flow. The second part of the muddy fluid is not bonded to the solid matrix and can move independently from the first layer. This free fluid forms the second layer of the debris flow. During flow the rocky particulate material is sheared which induces dilatant motions that change the location of the center-of-mass of the solid. The degree of solid shearing, as well as the amount of muddy fluid and of solid particles, leads to different flow compositions including debris flow fronts consisting of predominantly solid material, or watery debris flow tails. De-watering and the formation of muddy fluid washes can occur when the solid material deposits in the runout zone. After validating the model on two theoretical case studies, we show that the proposed model is able to capture the streamwise evolution of debris flow density in time and space for real debris flow events.ISSN:1612-510

Urinary albumin excretion and chronic kidney disease in children with vesicoureteral reflux.

Albuminuria is a potential biomarker of chronic kidney disease (CKD) in various glomerular diseases. Vesicoureteral reflux (VUR) often progresses to CKD, and study is required of use of albuminuria as a biomarker for this condition. The aim of this study was to evaluate the association between albuminuria and glomerular filtration rate (GFR) or filtration fraction (FF) in children with VUR. In this retrospective study, renal parameters of 141 children with VUR were investigated, using inulin clearance, FF, and albuminuria. The association between urinary albumin to creatinine ratio (ACR), GFR, and FF was analyzed in a continuous manner by calculating the β coefficient, and also in a binary manner by calculating the OR. Using both continuous and binary analyses, ACR values were negatively and significantly associated to GFR values in patients with low, normal, or high FF values (Table). It was also positively and significantly associated with FF values in patients with low, normal or high GFR values (Table). No association was found between ACR and gender, VUR stages or laterality, number of urinary tract infection, presence of a single functional kidney, history of reflux surgery, or renal scars or hypertension. ACR is associated with CKD in patients with VUR. In addition, increased urinary albumin excretion cannot be completely and solely explained by decreased GFR and/or increased FF values. The two main limitations of this study are the crude assessment of renal scarring, which prevented finer analysis between albuminuria and renal scarring surface area, and that the study cohort may not be representative of the true VUR population. This study shows that albuminuria is associated with decreased renal function in patients with VUR and that it could be used to monitor renal function in this condition