Long-term Follow-up Of Children Research Articles

760: Longterm Follow-up of Children with Antireflux Surgery: Is Routine Urinalysis Necessary?

You have accessJournal of UrologyDiscussed Poster, Monday, May 22, 2006, 1:00 - 4:00 pm1 Apr 2006760: Longterm Follow-up of Children with Antireflux Surgery: Is Routine Urinalysis Necessary? Izumi Kanemitsu, Mari Suzuki, and Yuichiro Yamazaki Izumi KanemitsuIzumi Kanemitsu More articles by this author , Mari SuzukiMari Suzuki More articles by this author , and Yuichiro YamazakiYuichiro Yamazaki More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)32996-3AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "760: Longterm Follow-up of Children with Antireflux Surgery: Is Routine Urinalysis Necessary?." The Journal of Urology, 175(4S), p. 247 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 175Issue 4SApril 2006Page: 247 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Izumi Kanemitsu More articles by this author Mari Suzuki More articles by this author Yuichiro Yamazaki More articles by this author Expand All Advertisement PDF downloadLoading ...

774: Long-Term Follow-Up of Children with Continent Cutaneous Urinary Diversion

774: Long-Term Follow-Up of Children with Continent Cutaneous Urinary Diversion

A study on glucose metabolism in a small cohort of children and adolescents with kidney transplant

Post-transplant diabetes mellitus (PTDM) and impaired glucose tolerance are now considered among the major adverse events following organ transplantation. The present study was aimed at investigating the regulation of glucose metabolism in pediatric recipients of a kidney transplant (KT), receiving tacrolimus or cyclosporine A-based immunosuppression. Twelve subjects, eight males and four females, aged 12.1+/-3.8 yr, and with a mean time from KT of 45.6 months were enrolled in the study. All patients had a basal evaluation of fasting glucose (GF), fasting insulin (IF), C-peptide and glycated hemoglobin (HbA1c) levels. They then underwent oral glucose tolerance test (OGTT), with measurement of blood glucose and insulin concentration. Two children had impaired GF, associated with supernormal HbA1c levels, one patient showed impaired glucose tolerance, none had PTDM. Peripheral insulin resistance, as measured by quantitative insulin sensitivity check index (QUICKI) and homeostasis model assessment estimate of insulin sensitivity (HOMA-IR) index, was enhanced in 3 patients. Subsequently, GF significantly increased with time from transplant (p=0.01), while fasting C-peptide and the area under the curve of insulin correlated with creatinine clearance. In conclusion, our results, although generated in a small sample size, would suggest that long-term follow-up of children receiving a KT should extend to explore the response to oral glucose load and at least the basal measure of insulin response.

Normal Glomerular Filtration Rate in Long-Term Follow-up of Children after Orthotopic Liver Transplantation

Cyclosporine A (CyA) and tacrolimus are the principal immunosuppressive agents used for OLT in children. However, progressive deterioration of renal function from calcineurin inhibitor toxicity after OLT has been widely reported. The aim of this study was to assess long-term renal function in children after OLT. We reviewed all OLT patients surviving >1 year at Sainte Justine Hospital from 1987 to 2003. The GFR (ml/min/1.73 m) was measured yearly by the Tc-99m DTPA single injection technique In all, 101 OLT patients (27 tyrosinemia, 33 biliary atresia, 5 fulminant hepatic failure, 36 miscellaneous) were studied. Median age at OLT was 35 months (range 6-178 months) in tyrosinemia group and 58 months (range 1-226 months) in the "Others" (P = NS), median pediatric end-stage liver disease score was respectively 3 (range -9 to 21) and 15 (-9 to 35), (P=0.001), and median follow-up was 6 (range 1-14) and 6 (range 1-17) (P = NS) years, respectively. Median annual GFR values in tyrosinemia fluctuated between 61 and 104 ml/min/1.73 m, with an improving tendency, and 94-121 ml/min/1.73 m in the Others. GFR did not differ on CyA vs. tacrolimus treatment. The median duration of therapy with calcium-channel blocker in the tyrosinemia group was 5 (1-13) vs. 2 (1-13) years in the Others. Median GFR remained normal in most nontyrosinemia patients (Others). Tyrosinemia patients remained stable at a lower GFR. CyA administration in three daily doses and prolonged calcium-channel blocker therapy may have contributed to this stability. Impairment of kidney function was associated with congenital kidney disease, toxic kidney injury, and portal hypertension.

Melatonin and sleep in children with neurodevelopmental disabilities and sleep disorders

<h2>Summary</h2> Sleep disorders impair the quality of life for children with neurodevelopmental disabilities and their families. Melatonin, a natural regulator of sleep, may be an effective therapy in this area. Numerous studies in children report that melatonin may be beneficial for sleep. Studies differ widely from each other with respect to the dosage and time of administration. The effectiveness of melatonin depends on a number of factors, including dose, the individual sensitivity of the patient and the time of administration. Few acute adverse effects have been reported. Long-term adverse effects have not been systematically studied. Well-designed, randomised, controlled studies with long-term follow-up in children are needed.

Is Nocturia Equally Common Among Men and Women? A Population Based Study in Finland

We assessed the prevalence of nocturia and its association with sociodemographic factors. Information was collected with a questionnaire mailed to a random sample of 6,000 subjects 18 to 79 years old, identified from the Finnish Population Register Centre. Nocturia was defined as 1 or more, or 2 or more voids per night. Information was collected using the DAN-PSS questionnaire with an additional question from the AUA-SI questionnaire. Age standardized prevalence was calculated using the European standard population. Logistic regression was used for multivariate analysis. Of the 6,000 subjects 62.4% responded and 97.9% of the participants provided information on all nocturia questions. The age standardized prevalence of nocturia (1 or more voids per night) was 37% (95% CI 34%-40%) among men and 43% (95% CI 40%-46%) among women. With criterion of 2 or more voids per night prevalence was 12% (95% CI 10%-14%) for men and 13% (95% CI 11%-14%) for women. Women 18 to 49 years old had more nocturia than men. At 50 to 59 years old half of men and women reported nocturia. In older age groups nocturia was more frequent among men than women. The prevalence of nocturia increased at a constant rate with age. It increased twice as rapidly in men as among women (increase in OR 7.3% [95% CI 6.5%-8.2%] and 3.5% [95% CI 2.9%-4.1%] per year among men and women, respectively). The age standardized prevalence of nocturia (1 or more voids per night) was approximately 40% for both genders. In men the prevalence of nocturia increases more rapidly with age than in women. Nocturia is more common among women at a younger age but the differences disappear by middle age. In the elderly nocturia is more frequent among men.

Bone Mineral Density and Alterations of Bone Metabolism in Children and Adolescents with Type 1 Diabetes Mellitus

To analysis bone mineral density (BMD) and bone turnover markers in children and adolescents with type 1 diabetes mellitus (DM1) and to establish possible correlations with duration of the disease and degree of metabolic control. Fifty-eight (26 prepubertal, 32 pubertal) children (29 boys) with DM1 (age: 11.7 +/- 3.1 years) and 44 (20 prepubertal, 24 pubertal) healthy children (21 boys) as controls (age: 10.8 +/- 3.2 years) were included in the study. BMD was measured by dual energy X-ray absorptiometry (DEXA). Scans of the lumbar spine (LS2-4) and femoral neck (FN) were carried out. Serum levels of osteocalcin, amino-terminal propeptide of type I procollagen (PINP), and alkaline phosphatase, as markers of bone formation, and urinary calcium/creatinine (Ca/Cr) ratio and levels of N-telopeptide (Ntx), as markers of bone resorption, were assessed. Anthropometrics, duration of DM1, presence of complications, insulin dose, and degree of metabolic control were obtained from the patients' records. In children with DM1 and controls, the mean measurements of LS2-4 BMD were 0.698 +/- 0.178 g/cm2 and 0.669 +/- 0.192 g/cm2, respectively (p >0.05), and FN-BMD measurements were 0.743 +/- 0.147 g/cm2 and 0.744 +/- 0.170 g/cm2, respectively (p >0.05). Children with DM1 had lower serum levels of calcium, intact parathyroid hormone, osteocalcin and PINP, and higher serum levels of 25-hydroxyvitamin D and urinary Ca/Cr (p <0.05). BMD was not related to any of the markers of bone resorption or formation, duration of the disease, or degree of metabolic control. Although we did not establish decreased LS2-4 and FN-BMD measurements in patients with DM1, we found reduced bone formation and increased bone resorption markers in children with DM1. Measurements of serum osteocalcin, PINP, urinary Ntx and Ca/Cr might be useful for long-term follow-up in children and adolescents with DM1.

Attitudes of pediatric urologists regarding sports participation by children with a solitary kidney.

Little data are available regarding sports participation and appropriate long-term followup of children with a solitary kidney. We determine the current practice patterns and recommendations among pediatric urologists regarding sports participation and followup of these patients. A survey was mailed to the 231 active members of the American Academy of Pediatrics, Section on Urology. The survey included questions regarding counseling of patients with a solitary kidney and physician estimates of long-term risk to overall renal function. Of the 231 surveys 182 were returned for an overall response rate of 79%. Of the respondents 68% recommend that patients with a solitary kidney avoid contact sports. Recommendations in regard to participation in contact sports were further stratified as strongly against participation (27%), against participation with rare exceptions (30%), no recommendation either way (14%), allow participation (25%) and no restrictions be made (4%). Of the respondents 88% agreed that the estimated risk of renal loss from a child participating regularly in contact sports is less than 1% and 60% recommended special medical followup. Despite the consensus that the risk of renal injury in contact sports is low, a significant number of pediatric urologists advise avoidance. There appears to be a lack of consensus regarding long-term medical surveillance of these patients. Studies designed to obtain accurate clinical data regarding these issues are warranted to establish evidence based guidelines for the long-term treatment of children with a solitary kidney.

Authors' response to ‘HIV and infant feeding: a complex issue in resource-limited settings’ by Becquet and Leroy, to the letter to the editors by Coutsoudis et al., and to ‘Increased risk of infant HIV infection with early mixed feeding’ by Piwoz and Humphrey

Authors' response to ‘HIV and infant feeding: a complex issue in resource-limited settings’ by Becquet and Leroy, to the letter to the editors by Coutsoudis et al., and to ‘Increased risk of infant HIV infection with early mixed feeding’ by Piwoz and Humphrey

535 Long-term follow-up of children with HBV infection treated with interferon α

535 Long-term follow-up of children with HBV infection treated with interferon α

Blood pressure in the long-term follow-up of children with haemolytic uremic syndrome

formula) >80 ml/min/1.73 m 2 and proteinuria 2 SD above the normal mean. The glomerular filtration rate was estimated from the plasma clearance of chromium-51 EDTA [4]: mean GFR (SD) in the HUS children was 95.1 (22.7) ml/min/1.73 m 2 SA and was less than 80 ml/min/1.73 m 2 SA in 16 (18%) of them. There were significant negative correlations between GFR and SBPSDS (r=�0.48, P <0.0001) and Ualb/creat (r=�0.41, P<0.0001), and between Ualb/creat and SBPSDS (r=0.25, P =0.02). Such correlations are more informative than the absolute values of the individual variables as they are not bedevilled by the uncertainty of the normal ranges; they indicate considerable residual nephropathy in this group of patients. The challenge to paediatric nephrologists is to maintain the follow-up of such cohorts well into adult life to get the full picture of the legacy of an acute attack of D+ HUS.

Long-term follow-up in children with functional hemispherectomy for Rasmussen’s encephalitis

Cerebral hemispherectomy has been performed for over 60 years. Multiple variations of functional hemispherectomy have been performed since its inception by Rasmussen. Long-term follow-up for these variations is lacking in the medical literature. We review the long-term follow-up for five children with Rasmussen's encephalitis who underwent a modification of functional hemispherectomy. The length of follow-up for this cohort ranged from 13 to 23 years (mean 15.6 years). All patients experienced immediate and complete elimination of seizures. Only one patient underwent ventriculoperitoneal shunt placement. All patients are capable of ambulating on their own. Many years following their procedures, this cohort of patients remains seizure free.

Long-term follow-up of children with vesicoureteral reflux with and without antibiotic prophylaxis

The aim of the present study was to obtain data on the outcome of children with persistent vesicoureteral reflux (VUR) after cessation of antibiotic prophylaxis. Children with VUR who had been on antibiotic prophylaxis for at least 2 y and were free of urinary tract infections (UTI), had normal voiding patterns, and no hydronephrosis or new kidney scarring, had antibiotic prophylaxis discontinued, were followed up prospectively with urine cultures, voiding cystourethrography, and technecium-99m dimercaptosuccinate renal scintigraphy. The findings were compared with those of the same patients while they were on antibiotic prophylaxis. In 54 children (39 girls and 15 boys), antibiotic prophylaxis was discontinued. The mean follow-up time on and off antibiotic prophylaxis was 4.4+/-2.1 and 4.4+/-2.2 y, respectively. Nine UTI episodes occurred during the on- and 8 during the off-prophylaxis period. In 80 of 96 and in 68 of 74 ureters the reflux resolved or downgraded during the on- and off-prophylaxis periods, respectively. No new scar lesions were detected in any of the children. In conclusion, in children with persistent VUR and certain characteristics, antibiotic prophylaxis can be safely discontinued.

Long-term follow-up of children exposed in utero to nifedipine or ritodrine in the management of preterm labor

Long-term follow-up of children exposed in utero to nifedipine or ritodrine in the management of preterm labor

Incorporation of a Comprehensive Pediatric Thrombosis Program into the Multidisciplinary Care Team for Children with Congenital Heart Disease: A Prospective Cohort Study.

BACKGROUND: Over the last 10 years, children with congenital heart disease (CHD) have been experiencing increased survival due to diagnostic and surgical techniques. However, associated with this is a requirement for prolonged central venous access which has serious associated sequelae, of which thrombosis is one of the most important. In a busy comprehensive cardiovascular program, the diagnosis, treatment and management of children with or at risk for thrombosis is extremely demanding and constantly changing based on current evidence based recommendations. The Stollery Children's Hospital, a member of the Western Canadian Children's Heart Network (WCCHN), is the cardiovascular surgical centre for children with CHD from British Columbia, Manitoba, Alberta, and Saskatchewan An expert Pediatric Thrombosis Team has been incorporated into the multi disciplinary management of children with CHD. This team is dedicated entirely to the diagnosis, management and long term followup of children requiring anticoagulation.MATERIALS/METHODS: A standard approach to the diagnosis, management and long term followup of children with CHD with or at risk for thrombosis was initiated. The Pendragon data base was custom designed to prospectively collect the following data on all children: demographics, treatment and long term outcome.RESULTS: Since the inception of the Thrombosis service (Oct 2003) there have been 325 children who required cardiac surgery with 40% (n=129) of these children requiring Thrombosis consultation. The 4 most common causes for Thrombosis referral have been primary prophylaxis post CHD surgery including mechanical valves, Blalock Taussig shunts, and Fontan procedures, 51% (n=66), suspected CVL related thrombosis 26% (n=33), arterial catheter related thrombosis (catheterization or monitoring) 16% (n=19), and extracorporeal membranous oxygenation 9% (n=11). By Oct 2004, it is anticipated that 300 children will have been consulted on.CONCLUSIONS: The 1st year results of the data collected on this prospective cohort will be presented including demographics, reason for anticoagulation, diagnosis, and long term outcome.

Prediction of IQ and Achievement at Age 8 Years From Neurodevelopmental Status at Age 1 Year in Children With D-Transposition of the Great Arteries

Studies of developmental outcomes in children with congenital heart disease (CHD) frequently use assessments conducted in infancy as primary endpoints. Whether test scores of CHD patients in infancy are predictive of status at school age has not been evaluated, however. In the Boston Circulatory Arrest Study, 135 children with D-transposition of the great arteries repaired by arterial switch operation were administered the Bayley Scales of Infant Development and the Fagan Test of Infant Intelligence at 1 year of age and the Wechsler Intelligence Scale for Children, Third Edition and the Wechsler Individual Achievement Test at 8 years. Although most 1-year test scores were significantly associated with 8-year test scores, the amounts of shared variance were modest (<10%). All 1-year test scores had poor sensitivity (16%-32%) and poor positive predictive value (35%-42%) but good specificity (80%-93%) and negative predictive value (78%-79%). More than half of the children with low scores at 8 years (< or =85) had had scores >84 at 1 year. This pattern suggests that although test scores at 1 year are modestly associated with test scores at 8 years, many children who are at risk for poor late outcomes will not be identified on the basis of 1-year test scores. Long-term follow-up of children with CHD is necessary to draw inferences about the developmental sequelae of preoperative, intraoperative, and postoperative factors.

Blood pressure in the long-term follow-up of children with hemolytic uremic syndrome.

The hemolytic uremic syndrome (HUS) is the most common cause of acute renal failure (ARF) in young children. Most patients recover from the acute phase of the illness but they may develop arterial hypertension(AH) after many years, even in the absence of signs of renal impairment during short-term follow-up. In this study, we performed casual blood pressure (BP) measurement, 24-h blood pressure monitoring (ABPM), and a Bruce walking treadmill study (ET) in 24 children (aged 5-15 years, 13 males, 11 females) with a history of HUS and normal renal function during follow-up (median 5.8 years, range 1.8-12.4 years). There were 22 children(91%) with prodromal diarrhea associated with HUS and 20 (83%) underwent dialysis during the acute illness. All children had normal casual BP measurement. Of 13 children (54%) with normal ABPM, 5 patients (38%) had an abnormal BP response during the ET study. There were 4 (58%) of the 7 patients with AH by ABPM (29%)and an abnormal BP response during ET. These findings suggest that ET could be a useful means of identifying children with a history of HUS that could be at risk of future AH even if they had normal renal function, casual BP, and ABPM during long-term follow-up. These results should be confirmed with a large prospective clinical study.

Hematopoietic cell transplantation in inborn errors of metabolism

Purpose of review Hematopoietic stem cell transplantation for inborn errors of metabolism is gaining increasing recognition both by transplant physicians and metabolic disorder specialists worldwide. This review discusses the basic concepts underlying hematopoietic cell therapy for lysosomal storage disorders and updates the most recent clinical developments in the field. Recent findings It has recently been described that macrophages secrete lysosomal enzymes without a mannose 6-phosphate recognition site, thus prohibiting uptake by enzyme-deficient cells. These data question our current model of enzyme replacement within the central nervous system by macrophages crossing the blood–brain barrier and secreting enzymes into the extracellular space. Several experimental disease models for lysosomal storage disorders have been developed and are discussed. Recent clinical observations include an increased risk for pulmonary hemorrhage and long-term cardiac improvement in Hurler patients, new data on neurocognitive outcome in X-linked adrenoleukodystrophy, and regression of symptoms in Farber patients without central nervous system involvement after stem cell transplantation. Summary Although certain inborn errors improve after stem cell transplantation, the mechanisms by which these beneficial effects are mediated, particularly in central nervous system disease, need further investigation. Long-term follow-up in children with metabolic disorders is essential to define the role of stem cell transplantation in the different diseases, and to identify novel and thus far unknown long-term consequences of the respective errors of metabolism.

Que conseiller pour les épreuves fonctionnelles respiratoires de l’enfant d’âge préscolaire en ville ?

Lung function testing provides objective criteria for diagnosis, assessment of bronchodilator response and long term follow-up of children with suspected or proven asthma. Technological progress in the past few years allows reproducible and validated lung function measurements in preschool children. Measurements can now be done in ambulatory private practice. Time, patience and precision are required. The results can demonstrate basal and provoked bronchial obstruction and its reversibility with bronchodilators. With animated incentive devices, forced expiratory measurements can be obtained in almost 60% of preschool children. Resistance measurements require less cooperation and are easily performed in the majority of young children; different techniques, including plethysmographic assessment for specific airway resistance and forced oscillation or flow interruption techniques for respiratory resistance, can be used. Reference values for these techniques are now available for this population. The choice of the technique to be used will be based on the cost and size of the equipment and on the operator’s experience.

Long-term follow-up in children treated for retroperitoneal malignant tumours.

Thirty-two long-term survivors after treatment with surgery, radiotherapy and chemotherapy for neuroblastoma (NRB) and Wilms' tumour (WT) were re-evaluated after a period of more than 10 years (mean 16 yr 1 mo, range 27 yr 2 mo/10 yr 5 mo). In addition to routine clinical and laboratory studies, all patients underwent auxometry, echocardiography, spinal X-ray, abdominal US and kidney radionuclide scans. Neither obvious physical signs nor cutaneous toxicity were noted at inspection. No dysmenorrhoea or sexual disorders were mentioned. Haematological data turned out to be all in the normal range, except for TIBC/UIBC ratio (out of range in 70 % of cases); gammaGt (62.5 %); A/G ratio (12.5 %); ALT (37.5 %). Auxometrical data were all in the normal range; in particular, results of mean weight and height were just slightly over the 50 degrees centile. Spinal X-rays revealed mild kyphotic deformities (68.9 %), pelvic obliquity and tilting (62.5 %), rotation of the vertebral bodies (34.3 %) and compensatory curves of the spine (21.8 %). No impairment of cardiac functions was noted at echocardiography. No alteration of the hepatic structure was detectable at US scans. Marked impairment of the renal function (20 % and 1.5 % residual function) was detected at radionuclide imaging in 2 NRB patients who had not undergone nephrectomy, with the kidney having almost disappeared in one. In conclusion, the study emphasises the need for careful and prolonged follow-up for the detection of sequelae than can appear even many years after the initial treatment, and the wisdom and the need for a continued search for less aggressive protocols; as long as the cure rate is not compromised, less aggressive protocols should aim for a satisfactory overall survival with a reduced incidence of sequelae and hence a better quality of life.