Predictors Of Resolution Research Articles

Longitudinal Outcomes of Malignant Ureteral Obstruction Secondary to Ovarian Cancer: Predictors of Resolution and the Role of Surgical Management

PurposeTo review the management of ovarian cancer (OCa) associated hydronephrosis (HN). Specifically, we aim to identify optimal management of HN in the acute setting, predictors of HN resolution, and the role of surgery (tumor debulking/(+/-)ureterolysis/hysterectomy). Materials/MethodsThe study cohort included OCa patients managed at our institution from 2004-19 that developed OCa-associated HN. Initial HN management was recorded as none, retrograde ureteral stent (RUS) or percutaneous nephrostomy tube (PCN). Primary outcomes included 1) HN management failure 2) HN management complications and 3) HN resolution. Patient, cancer, and treatment predictors of outcomes were assessed using logistic regression and Fine-Gray competing risk models. ResultsOf 2580 OCa patients, 190 (7.4%) developed HN. HN was treated in 121; 90 (74.4%) with RUS, 31 (25.6%) with PCN. Complication rates were similar between PCN and RUS (83% v. 85.1%; p = 0.79; all Clavian Grade I/II). Initial HN treatment failure occurred in 28 patients, predicted by renal atrophy (HR 3.27, p<0.01). HN resolution occurred in only 52 (27%) patients and was predicted by lower FIGO stage (FIGO III/IV HR 0.42 p<0.01) and surgical tumor debulking/ureterolysis (HR 2.83 p = 0.02). ConclusionsResolution of HN associated with malignant obstruction from OCa is rare and is most closely associated with tumor debulking and FIGO stage. Initial endoscopic treatment modality was not significantly associated with complications or resolution, though RUS failures were slightly more commonly. Ureteral reconstruction at time of debulking/ureterolysis is potentially underutilized.

Charlson Comorbidity Index and Frailty as Predictors of Resolution Following Middle Meningeal Artery Embolization for Chronic Subdural Hematoma

Research on variables associated with chronic subdural hematoma (cSDH) resolution following middle meningeal artery embolization (MMAE) is limited. This study investigated the clinical utility of age-adjusted Charlson Comorbidity Index (ACCI) and modified 5-item Frailty Index (mFI-5) for predicting cSDH resolution following MMAE. We identified patients who underwent MMAE at our institution between January 2018, and December 2022, with at least 20 days of follow-up and one radiographic follow-up study. Patient demographics, characteristics, and outcomes were collected. Complete resolution was defined as absence of subdural collections on CT-scan at last follow-up. Non-age adjusted CCI (CCI), ACCI, and mFI-5 scores were calculated. Univariate and multivariable logistic regression analyzed the relationship between cSDH resolution and variables. A receiver operating characteristic (ROC) curve established the utility of ACCI and mFI-5 in predicting hematoma resolution. The study included 85 MMAE procedures. In univariate analysis, patients without resolution were older, had higher CCI, higher ACCI, higher mFI-5, and were more likely to have diabetes mellitus. In multivarible analysis, CCI (OR: 0.66, 95% CI: 0.48, 0.91) was independently associated with resolution controlling for age and antithrombotic resumption. The area under the ROC (AUROC) curve was 0.75 (95% CI: 0.65 - 0.85) for ACCI and 0.64 (95% CI: 0.52 - 0.76) for mFI-5. The optimal cutoffs for predicting resolution were ACCI ≥ 5 (sensitivity = 0.63, specificity = 0.77), and mFI-5 > 0 (sensitivity = 0.84, specificity = 0.43). ACCI and mFI-5 moderately predict MMAE resolution and may aid in medical decision-making.

Clinical Evolution of Acute Vestibular Syndrome: Longitudinal Retrospective Analysis of Epidemiological Data and Prognostic Factors for Recovery

We evaluated the clinical features of patients admitted to the ED with acute vertigo, verifying symptoms after one month and one year to establish epidemiological factors and predictors of resolution. We reviewed 233 records of patients admitted to ED for acute vertigo (125 F and 85 M, mean age 56.12 years). We analyzed the correlation between time of resolution (at one month and one year) and symptoms duration (subjective and/or objective vertigo, instability, cervical pain, audiological, neurological, and neurovegetative symptoms), comorbidities, and therapies, the result of the clinical and instrumental vestibular examination. Resolution of acute vertigo occurred in 81.1%, while persistence of vertigo one year after ED access was reported in 18.8%. There were 135 patients who recovered in one month. The presence of instability, auditory and neurovegetative symptoms, and neck pain represents a significant factor for recovery within one year. Age over 65 and a history of hypertension are associated with a worst recovery. Patients with spontaneous Nystagmus or positive HIT showed a significant difference in symptoms recovery within one month and one year. Presence of positional Nystagmus represents a positive prognostic factor. Our findings emphasize the importance of clinical evaluation of the acute vertigo, helping the clinicians to define central or peripheral diagnosis and predict the resolution of vertigo.

Outcomes and predictors of response to endotherapy in pancreatic ductal disruptions with refractory internal and high-output external fistulae.

Endoscopic retrograde cholangiopancreatography (ERCP) remains the primary treatment for a subset of patients with pancreatic fistulae. The objective of this study was reporting outcomes of ERCP and predictors of resolution in patients with pancreatic fistulae refractory to conservative therapy. Retrospective review of patients who underwent ERCP and pancreatic stent placement for pancreatic fistula not responding to medical therapy was performed. Clinical features, laboratory parameters, radiological features and pancreatogram findings were noted. Clinical resolution of fistula was the primary outcome measure. Sixty-eight patients underwent ERCP for high-output pancreatic fistula (Mean age 34.1 years, 91.1% males, 35/68 chronic pancreatitis, 52.9% alcohol etiology). Internal fistulae (pancreatic ascites, pleural effusion, or pericardial effusion) were seen in 55 (80.9%) patients and external fistula in 13 (19.1%) patients. Technical success for ERCP was 92.6% (63/68). Leak was seen in 98.4% (62/63). The most common leak site was body (69.8%). Multiple leak sites were seen in 23.1%. Pancreatic stricture was found in 36.5%. In 44 (69.4%) patients, stent was placed beyond the site of the leak. Resolution at six weeks was achieved in 76.4% (52/68). On univariate and multivariate analyses, placement of stent beyond site of leak was significantly associated with resolution of high-output fistulae (3/41 [7.3%] vs. 5/19 [26.3%], p = 0.03; odds ratio: 6.5, 95% confidence interval: 1.211-34.94). In our experience, ERCP was successful in 76% of patients with pancreatic fistulae refractory to conservative therapy. Stent placement beyond the site of leak was associated with higher resolution of fistulae.

0999 Predictors Of Natural Resolution Of Behavioral Sleep Problems In Early Childhood

Abstract Introduction Primary care providers are often unsure which patients require treatment for behavioral sleep problems of early childhood vs. which are likely to improve without intervention. Given limited treatment resources as well as the time and cost burden that intervention can pose for families, it may be helpful to identify the predictors of children whose behavioral sleep problems are likely to resolve -- and stay resolved -- without active intervention. Methods Here, we use the control arm of a randomized trial of 2.5 to 5 year-old community-recruited children with behavioral sleep problems to examine the natural history of behavioral sleep problems and the predictors of resolution. Of 217 families in the control arm, 146 had inadequate mean sleep duration at baseline (&amp;lt; 10.5 hours/night per diary) and were eligible for inclusion in the analysis. Data were drawn from sleep diaries and parent report surveys conducted at baseline, 3 and 12 months. Improvement was defined as increased duration by either at least 60 min from baseline or by 30 min to at least 10.5 hours/night. We conducted an exploratory logistic regression to identify predictors of natural resolution. Results Of the 146 eligible families, 130 had follow-up data at both 3 and 12 months and were included in this analysis. Of those 130, only 22 (17%) had substantially improved sleep by 3 months follow-up, and 10 of these continued to have improved sleep duration at 12 months. The strongest predictors of natural improvement both at 3 and 12 months were female child sex, having either infant or school-aged siblings, CBQ low-intensity pleasure score (i.e., children who tend to respond positively to cuddling, reading, and other gentle activities), mean duration of sleep onset latency per diary, parent-reported parasomnias on the CSHQ, and age under 4 years. Conclusion These findings suggest that contrary to common beliefs of both primary care providers and parents, relatively few children will experience a clinically meaningful improvement in sleep duration without intervention. Support This work is supported by a grant from the National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health &amp; Human Development (NICHD): 5R01HD071937.

Management of leak after sleeve gastrectomy: outcomes of 73 cases, treatment algorithm and predictors of resolution.

IntroductionGastric leak post laparoscopic sleeve gastrectomy (LSG) is a severe complication that has been reported in 1.5–3% of cases. Management algorithms of leak exist; however, no known factors predict the time to resolution. This study aims to share outcomes of our management algorithm of post LSG leak, including the rate of resolution, complications, admission to the intensive care unit, conversion to other techniques, and mortality. To determine if any factors can predict the resolution time.MethodsA retrospective analysis of patients who had LSG leaks and was managed in the main tertiary center in Qatar (January 2012–December 2017).ResultsA total of seventy-three patients had post LSG leaks. Fifty-six (76.7%) underwent LSG outside our center. Thirteen leaks (17.8%) were after revisional LSG. Laparoscopic exploration was performed in twenty patients (27.4%) and feeding jejunostomy in nine patients (12.3%). Patients were followed up for 12 months. All healed within 8.8 ± 0.72 weeks. The resolution rate was (97.1%) without surgical conversion, while two patients required fistulo-jejunostomy. No patient died. Complications occurred; re-leak (14.9%) and splenic abscess (2.9%). Patients on jejunal feeding had shorter resolution time (HR = 2.7, P = 0.018), while patients on total parenteral nutrition and post-endoscopic dilatation had 66% and 50% increases in the resolution time; (HR = 0.34, P = 0.026) and (HR = 0.5, P = 0.047), respectively.ConclusionManagement of post-LSG leak is multimodal. Our clinical experience demonstrated less urge to perform extensive surgical interventions. Patients on enteral feeding had shorter resolution time while patients with sleeve stricture had a longer time to resolution.

Nonalcoholic Fatty Liver Disease (NAFLD) Outcome Post–Bariatric Surgery in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Consortium

Teen-LABS is a multicenter, prospective observational study of adolescents undergoing bariatric surgery. Predictors of resolution of NAFLD post-surgery are unclear. We evaluated changes in serum ALT levels, an acceptable surrogate when liver biopsy is not feasible, in 219 Teen-LABS subjects 3 years post gastric bypass or vertical sleeve gastrectomy. Three years post-surgery, median BMI declined to 38.4 from 52.6 kg/m2 at baseline (p&amp;lt;0.01). Median ALT (IU/L) decreased between baseline (36.5 ± 2.6 [95% CI: 31.4, 41.7]) and 6 months after surgery (28.9 ± 2.5 [95% CI: 24.4, 33.9]), and remained stable at 1, 2 and 3 years, all p&amp;lt;0.01 vs. baseline. 58% had abnormal ALT at baseline, which decreased to 10% at 3 years. After adjustment by logistic regression, 6 month improvement in BMI, fasting glucose, HOMA-IR, triglycerides, TG/HDL, and HDL were independently associated with reduced ALT. Improvement in metabolic indices remained significantly associated with decline in ALT, after adjusting for BMI (Table). In conclusion, while weight loss was associated with decreased ALT by 6 months post-surgery, improved fasting glycemia, insulin resistance and dyslipidemia indices were also independently associated with ALT decline. Association between change in predictor variables and decline in ALT from baseline to 6 months.Change in predictor variables over 6 monthsEstimate (SE) adjusted for age, race, sexp-valueEstimate (SE) adjusted for age, race, sex, change in BMIp-valueDecline in BMI0.64 (0.13)&amp;lt;0.01Decline in fasting glucose0.40 (0.07)&amp;lt;0.010.28 (0.08)0.01Decline in HbA1C4.59 (2.28)0.041.57 (2.32)0.50Decline in HOMA-IR1.11 (0.22)&amp;lt;0.010.82 (0.27)&amp;lt;0.01Decline in Triglycerides0.17 (0.02)&amp;lt;0.010.15 (0.02)&amp;lt;0.01Increase in HDL-0.75 (0.15)&amp;lt;0.01-0.52 (0.16)&amp;lt;0.01Decline in TG/HDL ratio5.11 (0.56)&amp;lt;0.014.85 (0.66)&amp;lt;0.01 Disclosure F. Bacha: Research Support; Self; AstraZeneca, JAEB Center For Health Research, National Institutes of Health, Pediatric Diabetes Consortium. R. Gupta: None. T.M. Jenkins: None. M. Brandt: None. T.H. Inge: Consultant; Self; Standard Bariatrics, Independent Medical Expert Consulting Services, UpToDate. D. Kleiner: None. S. Xanthakos: None.

Sustained efficacy following resolution of frequent heartburn with an over-the-counter regimen of esomeprazole 20\xa0mg or placebo for 14\xa0days: two randomized trials

BackgroundA two-week course of therapy with an over-the-counter proton-pump inhibitor (PPI) is recommended for frequent heartburn. Limited research has been conducted on the sustained efficacy of short-term PPI therapy after treatment cessation. Esomeprazole 20 mg was evaluated in the seven-day follow-up period after the two-week treatment period using pooled data from two identical randomized, double-blind, placebo-controlled studies.MethodsAdults without confirmed diagnoses of gastroesophageal reflux disease experiencing heartburn at least two days/week in the past four weeks were eligible. Subjects received treatment with esomeprazole 20 mg or placebo once daily for 14 days. Heartburn episodes were documented using daily diaries. Missing data during the two-week treatment period were assumed to be days with heartburn. The proportion of subjects with heartburn resolution while on treatment and during the seven days of follow-up was assessed. Predictors of resolution during this post-treatment period were evaluated using a stepwise logistic regression model.ResultsAll subjects in the pooled analysis set who reported diary data for at least three follow-up days were analyzed (N = 584). This cut-off was used to ensure that sufficient data were collected for these analyses. Greater run-in heartburn frequency was a significant negative predictor of heartburn resolution during follow-up (P < 0.001). Among the on-treatment efficacy variables, the best predictor of resolution during follow-up was resolution during the last seven days of treatment (odds ratio: 3.81 [95% confidence interval: 2.40, 6.05; P < 0.0001]).ConclusionsLower baseline heartburn frequency and heartburn resolution during the last seven days of treatment were associated with a greater likelihood of heartburn resolution during the seven-day follow-up.Trial registrationRegistered at ClinicalTrials.gov June 11, 2011: NCT01370525; NCT01370538.

Fetal megacystis: prediction of spontaneous resolution and outcome.

To investigate the natural history of fetal megacystis from diagnosis in utero to postnatal outcome, and to identify prognostic indicators of spontaneous resolution and postnatal outcome after resolution. This was a national retrospective cohort study. Fetal megacystis was defined in the first trimester as a longitudinal bladder diameter (LBD) ≥ 7 mm, and in the second and third trimesters as an enlarged bladder failing to empty during the entire extended ultrasound examination. LBD and gestational age (GA) at resolution were investigated with respect to likelihood of resolution and postnatal outcome, respectively. Sensitivity, specificity and area under the receiver-operating characteristics curve (AUC) were calculated. In total, 284 cases of fetal megacystis (93 early megacystis, identified before the 18th week, and 191 late megacystis, identified at or after the 18th week) were available for analysis. Spontaneous resolution occurred before birth in 58 (20%) cases. In cases with early megacystis, LBD was predictive of the likelihood of spontaneous resolution (sensitivity, 80%; specificity, 79%; AUC, 0.84), and, in the whole population, GA at regression was predictive of postnatal outcome, with an optimal cut-off at 23 weeks (sensitivity, 100%; specificity, 82%; AUC, 0.91). In the group with early megacystis, the outcome was invariably good when resolution occurred before the 23rd week of gestation, whereas urological sequelae requiring postnatal surgery were diagnosed in 3/8 (38%) cases with resolution after 23 weeks. In the group with late megacystis, spontaneous resolution was associated with urological complications after birth, ranging from mild postnatal hydronephrosis in infants with resolution before 23 weeks, to more severe urological anomalies requiring postnatal surgery in those with resolution later in pregnancy. This supports the hypothesis that an early resolution of megacystis is often related to a paraphysiological bladder enlargement that resolves early in pregnancy without consequences, while antenatal resolution occurring later in pregnancy (after the 23rd week of gestation) should suggest a pathological condition with urological sequelae. In fetal megacystis, LBD and GA at regression can be used as predictors of resolution and outcome, respectively. These parameters could help in fine-tuning the prognosis and optimizing the frequency of follow-up scans. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Natural History of Peanut Allergy and Predictors of Resolution in the First 4 Years of Life: A Population-Based Assessment

R Peters, K Allen, S Dharmage. J Allergy Clin Immunol. 2015;135(5):1257–1266 Using prospectively collected data, this study sought to describe the natural history of peanut allergy in childhood and to provide thresholds for skin prick test (SPT) results and specific immunoglobulin E (sIgE) levels that predict probability of tolerance or persistence of peanut allergy. This study included 1-year old infants with peanut allergy from the population-based, longitudinal HealthNuts study conducted in Australia. Infants with challenge-confirmed peanut allergy ( n = 156) were enrolled at …

Natural history of peanut allergy and predictors of resolution in the first 4 years of life: A population-based assessment

There are no prospectively collected data available on the natural history of peanut allergy in early childhood. Previous studies of predictors of tolerance development have been biased by failure to challenge high-risk children when IgE antibody levels are high, therefore potentially introducing bias to persistent allergy. We sought to describe the natural history of peanut allergy between 1 and 4 years of age and develop thresholds for skin prick test (SPT) results and specific IgE (sIgE) levels measured at age 1 and 4 years that have 95% positive predictive value (PPV) or negative predictive value for the persistence or resolution of peanut allergy. One-year-old infants with challenge-confirmed peanut allergy (n = 156) from the population-based, longitudinal HealthNuts Study (n = 5276) were followed up at 4 years of age with repeat oral food challenges, SPTs, and sIgE measurements (n = 103). Challenges were undertaken in all peanut-sensitized children at 1 and 4 years of age, irrespective of risk profile. Peanut allergy resolved in 22% (95% CI, 14% to 31%) of children by age 4 years. Decreasing wheal size predicted tolerance, and increasing wheal size was associated with persistence. Thresholds for SPT responses and sIgE levels at age 1 year with a 95% PPV for persistent peanut allergy are an SPT-induced response of 13 mm or greater and an sIgE level of 5.0 kU/L or greater. Thresholds for SPT and sIgE results at age 4 years with a 95% PPV for persistent peanut allergy are an SPT response of 8 mm or greater and an sIgE level of 2.1 kU/L or greater. Ara h 2, tree nut, and house dust mite sensitization; coexisting food allergies; eczema; and asthma were not predictive of persistent peanut allergy. These thresholds are the first to be generated from a unique data set in which all participants underwent oral food challenges at both diagnosis and follow-up, irrespective of SPT and sIgE results.

Predictors of Resolution of Urgency Urinary Incontinence (UUI) after Anti-incontinence Procedures Performed for Mixed Urinary Incontinence

Predictors of Resolution of Urgency Urinary Incontinence (UUI) after Anti-incontinence Procedures Performed for Mixed Urinary Incontinence

Enteral nutrition and total parenteral nutrition components in the course of total parenteral nutrition–associated cholestasis in neonatal necrotizing enterocolitis

Newborns with necrotizing enterocolitis (NEC) are at high risk for the development of total parenteral nutritional-associated cholestasis (TPNAC). Patients with NEC were evaluated to determine risk factors for development of TPNAC and predictors of resolution. We hypothesized that there are additional factors relating to the timing of enteral nutrition or TPN components that effect development and persistence of TPNAC in patients with NEC that may be altered to decrease the chance of progression to liver failure. This was a retrospective chart review of NEC patients from 2001 to 2010. TPNAC was defined as direct bilirubin ≥2mg/dL, the level used for cholestasis in neonatal studies relating to TPNAC. Of 178 patients with NEC, 96 developed TPNAC, and in 27 TPNAC had resolved by discharge. Days of TPN did not affect TPNAC resolution by discharge (P=1.0). TPNAC was less likely to occur in patients with body weights >1,500g, enteral nutrition within the first week of life, no infection, fewer TPN days, and lesser hospital stay (P<.01). There were many factors affecting resolution of cholestasis. Enteral nutrition within 6days of birth decreased development of TPNAC (P<.01), and resumption of enteral nutrition within 3weeks after NEC diagnosis increased the resolution of cholestasis (P<.01). No component of TPN was important for the development or resolution of cholestasis. Of the factors that effect development and resolution of TPNAC in NEC, the ones that we can alter include early enteral feeds and surveillance for infection.

Mo1375 EUS Guided Pancreatic Pseudocyst Drainage: What Are the Predictors for Resolution?

Placement of double pigtail plastic stents, with limited lumen size, for endoscopic pancreatic pseudocyst (PP) drainage requires repeat wire access of the cystenterostomy after initial stent deployment. Conventional covered self-expanding metal stents (CSEMS) are larger in diameter and permit single-step insertion but carry a risk for stent migration. Our objective was to compare metal vs plastic in PP drainage in terms of outcomes, success rate and number of sessions.

Predictors of depression and anxiety in community dwelling stroke survivors: a cohort study

Purpose: Few longitudinal studies explore post-stroke patterns of psychological morbidity and factors contributing to their change over time. We aimed to explore predictors of post-stroke depression (PSD) and post-stroke anxiety over a 12-month period. Methods: A prospective cohort study. Consecutively recruited stroke patients (n = 134) participated in face-to-face interviews at baseline, 3, 6, 9, and 12 months. Primary outcome measures were depression and anxiety (measured via Hospital Anxiety and Depression Scale). Independent variables included disability (Modified Rankin Scale), Quality-of-life (Assessment Quality-of-life), social support (Multi-dimensional Scale Perceived Social Support) and community participation (Adelaide Activities Profile (AAP)). Secondary outcomes were predictors of resolution and development of PSD and anxiety. Results: Anxiety (47%) was more common than depression (22%) at baseline. Anxiety (but not depression) scores improved over time. Anxiety post-stroke was positively associated with baseline PSD (p < 0.0001), baseline anxiety (p < 0.0001) and less disability (p = 0.042). PSD was associated with baseline anxiety (p < 0.0001), baseline depression (p = 0.0057), low social support (p = 0.0161) and low community participation (p < 0.0001). The only baseline factor predicting the resolution of PSD (if depressed at baseline) was increased social support (p = 0.0421). Factors that predicted the onset of depression (if not depressed at baseline) were low community participation (p = 0.0015) and higher disability (p = 0.0057). Conclusion: While more common than depression immediately post-stroke, anxiety attenuates while the burden of depression persists over 12 months. Clinical programs should assess anxiety and depression, provide treatment pathways for those identified, and address modifiable risk factors, especially social support and social engagement.Implications for RehabilitationPsychological distress post stroke is persisting.Multi-disciplinary teams that establish goals with patients promoting social and community engagement could assist in managing psychological morbidity.A shift towards promoting longer-term monitoring and management of stroke survivors must be undertaken, and should consider the factors that support and hinder psychological morbidity.

Ovarian Cysts in the Adolescent Patient Population. Determining Expectant vs. Surgical Management: A Retrospective Analysis

Although laparoscopy for surgical intervention of ovarian cysts in adolescents has been well studied and is the preferred surgical approach, indications for management of ovarian cysts in this age group are not well defined. The aim of this study was to determine the rate of spontaneous resolution of ovarian cysts in adolescents as well as determine the predictive characteristics that would aid in safe observation and expectant management versus surgical intervention. Additionally, we seek to determine the pathology consistent with the characteristics requiring surgical management. With approval of the Institutional Review Board, all charts of adolescent females thirteen to eighteen years who were given a diagnostic ICD-9 code consistent with ovarian cyst or mass were reviewed. Subjects without documented resolution or documented surgical intervention for non-resolution were excluded. In addition, patient age, race, cyst size, laterality, and level of cyst complexity were recorded. Histopathology typing was included if surgical excision was performed. A multiple logistic regression analysis was conducted to determine clinical, as well as demographic characteristics of ovarian cyst resolution. Of the 342 charts reviewed, 151 met all inclusion criteria. 91 (60.3%) achieved resolution of their cysts, 60 (39.7%) did not. Only cyst side (right) and right cyst largest diameter (<7cm) were predictors of resolution. Neither cyst type nor levels of complexity were predictors of spontaneous resolution. The most common histopathology found at surgical excision for non resolution was serous cystadenoma. No malignancies were diagnosed. The majority of ovarian cysts in the adolescent population resolves or persists with no definitive characteristic associated with either outcome. A conservative approach to the treatment of such cysts in the form of clinical observation is recommended when the clinical scenario allows.

Hypertension in children with poorly functioning unilateral kidneys: predictors of resolution after nephrectomy

To identify the outcome of nephrectomy and predictors of hypertension (HTN) resolution in children with poorly functioning unilateral kidneys (differential renal function, DRF of < 15%), as concurrent HTN is often an indication for nephrectomy. Over a 7.5-year period, a single centre retrospective analysis of 89 children with unilateral nonfunctioning/poorly functioning kidney who underwent nephrectomy was conducted. Preoperative HTN was present in 18 children (20.2%). The childrens' characteristics (age, sex, body mass index, pathology, side), cause of nonfunction, diagnostics including preoperative proteinuria (dipstick) and DRF (nuclear scan), pathological features of specimen and follow-up were recorded. The mean (median; range) age at nephrectomy was 6.8 (5; 0.333-14) years with a mean (median; range) follow-up of 2.4 (3; 0.083-5.5) years. The mean (median; range) DRF was 6.5 (1; 0-15)%. Twelve of 18 children (67%) resolved their HTN. Age at nephrectomy, sex, side of nonfunctioning kidney and surgical approach (78% laparoscopic nephrectomy) did not correlate with HTN resolution. Persistence of HTN seemed to correlate with residual function of more than a DRF threshold of 5% (P = 0.05), the presence of preoperative qualitative proteinuria by dipstick (P = 0.03) and inflammation on pathology. HTN resolved after nephrectomy for poorly functioning unilateral kidney in most of the children. Persistence of HTN is probably multifactorial. Ipsilateral residual function before nephrectomy, preoperative proteinuria and pathological features of nephrectomy specimen may serve as clinically useful markers for outcome prediction.

Incidence of new onset metabolic acidosis following enteroplasty for myelomeningocele

245Urological Surveyresults demonstrated that male gender, age less than one year at diagnosis, lower grade of reflux at presentation and unilateral reflux were all predictors of spontaneous resolution, which is consistent with previous studies. In addition, they were able to demonstrate that reflux improvement on imaging one year after diagnosis, as well as improvement in reflux grade from the previous year at any point during follow-up, were both independent predictors of resolution. This study has important clinical implications when counseling with parents over the decision to con-tinue waiting for spontaneous resolution versus pursuing surgical correction of reflux. Though many of us have assumed that improvement in the grade of reflux is a positive indicator of a greater likelihood for spontaneous resolution, we now have data to back up our assumptions.

Spontaneous resolution rates of vesicoureteral reflux in Brazilian children: a 30-year experience

We evaluated clinical characteristics of primary vesicoureteral reflux (VUR) in infants in a 30-year period in Brazil with special reference to the relation of renal parenchymal damage to urinary tract infection and gender. From 1975 through 2005, 417 girls (81.6%) and 94 boys (18.4%) with all grades of reflux were retrospectively reviewed. Patients were categorized by the worst grade of reflux, maintained on antibiotic prophylaxis and underwent yearly voiding cystourethrography until the reflux was resolved. VUR was considered resolved when a follow-up cystogram demonstrated no reflux. Surgical correction was recommended for those who fail medical therapy, severe renal scarring or persistent VUR. Grades I to V VUR resolved in 87.5%, 77.6%, 52.8%, 12.2% and 4.3%, respectively. Renal scars were present at presentation in 98 patients (19.2%). Neither gender nor bilaterality versus unilaterality was a helpful predictor of resolution. The significant difference was found among the curves using the log rank (p<0.001) or Wilcoxon (p<0.001) test. Despite the current use of screening prenatal ultrasound, many infants are still diagnosed as having vesicoureteral reflux only after the occurrence of urinary tract infection in our country. Scarring may be associated to any reflux grade and it may be initially diagnosed at any age but half of the scars are noted with higher grades of reflux (IV and V). The incidence of reflux related morbidity in children has significantly diminished over the last three decades.

Do We need ureteric re-implantation during augmentation cystoplasty? a videourodinamic evaluation

Purpose We evaluated the pre and postoperative videourodynamic(VUD) results of children with high pressure low compliant bladders and vesicoureteral reflux (VUR) who underwent augmentation cystoplasty without antireflux surgery. We hypothesized that not always bad preoperative bladder dynamics are to blame for the associated VUR. VUR persists despite successful augmentation in some. We tried to find objective urodynamic criteria where antireflux surgery might potentially be necessary to avoid persisting VUR. Material and methods 19 meningomyelocele patients with hypocompliant overactive bladder and associated high gradeVUR with a mean age of 11.4 years(5-21) underwent ileocystoplasty alone. Bladder outlet procedures, previous operation and persitent night-time drainage were excluded. Bladders were assessed preoperatively and sixth months postoperatively by multicycleVUDs Results VUR persisted in 9 patients despite a low pressure, compliant bladder being achieved. In these, VUR started at lower volumes with a mean of 29.6ml;(19-52ml) and lower pressures with a mean of 14.6cm-H20(9.6-25). Whereas in patients with no persistent VUR, it started at higher pressures (mean 49 cm-H20)(33-68). When preoperative VUD findings were retrospectively analysed, VUR started at lower volumes (mean14.8ml; 8-33) and intravesical pressures (mean7.8 cm-H20; 4 -17) in these 9 patients when compared to cases with resolved VUR Conclusions Preoperative VUD findings might be a predictor for resolution of VUR after augmentation. If VUR starts at low pressures, it is very likely to persist after augmentation. In these patients VUR should be corrected during augmentation. Further urodynamic cut off values for reimplantation would be useful to predict the outcome and thus the approach to VUR during augmentation.