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BMJ No 7113 Volume 315 Papers - Abstracts Saturday 11 October 1997
New renal scarring in children who at age 3 and 4 years had had
normal scans with dimercaptosuccinic acid: follow up study
New renal scarring in children who at age 3 and 4 years had had normal scans with dimercaptosuccinic acid: follow up studySue J Vernon, Malcolm G Coulthard, Heather J Lambert, Michael J Keir, John N S Matthews
AbstractObjective: To determine up to what age children remain at risk of developing a new renal scar from a urinary tract infection.Design: Follow up study. Families of children who had normal ultrasound scans and scanning with dimercaptosuccinic acid (DMSA) after referral with a urinary tract infection when aged 3 (209) or 4 (220) were invited to bring the children for repeat scans 2-11 years later. A history of infections since the original scan was obtained for children not having a repeat scan. Setting: Teaching hospital. Subjects: Children from three health districts in whom a normal scan had been obtained at age 3-4 years in 1985-1992 because of a urinary tract infection. Main outcome measure: Frequency of new renal scars in each age group. Results: In each group, about 97% of children either had repeat scanning (over 80%) or were confidently believed by their general practitioner or parent not to have had another urinary infection. The rate of further infections since the original scan was similar in the 3 and 4 year old groups (48/176 (27%) and 55/179 (31%)). Few children in either group known to have had further urinary infections did not have repeat scanning (3/209 (1.4%) and 4/220 (1.8%)). In the 3 year old group, 2.4% (5/209) had one or more new kidney scars at repeat scanning (one sided 95% confidence interval up to 5.0%), whereas none of the 4 year olds did (one sided 95% confidence interval up to 1.4%). The children who developed scars were all aged under 3.4 years when scanned originally. Conclusions: Children with a urinary tract infection but unscarred kidneys after the third birthday have about a 1 in 40 risk of developing a scar subsequently, but after the fourth birthday the risk is either very low or zero. Thus the need for urinary surveillance is much reduced in a large number of children.
Department of
Child Health, Department of Medical Physics, Department of Statistics,
Correspondence to: Dr Coulthard Intraoperative intravascular volume optimisation and length of hospital stay after repair of proximal femoral fracture: randomised controlled trialSusan Sinclair, Sally James, Mervyn Singer See Editorial by Gan and Arrowsmith, p 893
AbstractObjectives: To assess whether intraoperative intravascular volume optimisation improves outcome and shortens hospital stay after repair of proximal femoral fracture.Design: Prospective, randomised controlled trial comparing conventional intraoperative fluid management with repeated colloid fluid challenges monitored by oesophageal Doppler ultrasonography to maintain maximal stroke volume throughout the operative period. Setting: Teaching hospital, London. Subjects: 40 patients undergoing repair of proximal femoral fracture under general anaesthesia. Interventions: Patients were randomly assigned to receive either conventional intraoperative fluid management (control patients) or additional repeated colloid fluid challenges with oesophageal Doppler ultrasonography used to maintain maximal stroke volume throughout the operative period (protocol patients). Main outcome measures: Time declared medically fit for hospital discharge, duration of hospital stay (in acute bed; in acute plus long stay bed), mortality, perioperative haemodynamic changes. Results: Intraoperative intravascular fluid loading produced significantly greater changes in stroke volume (median 15 ml (95% confidence interval 10 to 21 ml)) and cardiac output (1.2 l/min (0.1 to 2.3 l/min)) than in the conventionally managed group (-5 ml (-10 to 1 ml) and -0.4 l/min (-1.0 to 0.2 l/min)) (P<0.001 and P<0.05, respectively). One protocol patient and two control patients died in hospital. In the survivors, postoperative recovery was significantly faster in the protocol patients, with shorter times to being declared medically fit for discharge (median 10 (9 to 15) days v 15 (11 to 40) days, P<0.05) and a 39% reduction in hospital stay (12 (8 to 13) days v 20 (10 to 61) days, P<0.05). Conclusions: Proximal femoral fracture repair constitutes surgery in a high risk population. Intraoperative intravascular volume loading to optimal stroke volume resulted in a more rapid postoperative recovery and a significantly reduced hospital stay. Bloomsbury Institute of Intensive Care
Medicine, Department of
Orthopaedics,
Correspondence to: Dr M Singer
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