We performed 99mTc dimercaptosuccinic acid (DMSA) scan and ultrasonography in 146 children during the acute phase of a proven urinary tract infection (UTI). In 99 a micturating cysto-urethrography and in 83 an intravenous urography was also done. The occurrence of fever and increased WBC count, CRP and ESR were also studied. It appeared from this retrospective study that 47% of the kidneys had a cortical or patchy pattern of decreased uptake of 99mTc DMSA, as compared to 23% with abnormal findings on US. Vesico-ureteral reflux was present in 38% of the kidneys with parenchymal involvement on 99mTc DMSA scan. Although fever, leucocytosis and elevated CRP and ESR were significantly correlated with abnormal 99mTc DMSA scan, they were also observed in children without renal parenchymal involvement. Our results suggest that 99mTc DMSA scan is a sensitive method for the detection of parenchymal involvement during acute UTI. The exact nature of these lesions and their relation with scars need, however, to be defined.

We describe 2 sibs with multiple congenital anomalies. The main manifestations include hypoplasia of the corpus callosum and/or cerebellar hypoplasia, Robin sequence, pharyngeal and laryngeal hypoplasia, abnormal ears, excessive neck skin, cardiac defect, and Hirschsprung disease. The presence in 2 sibs born to healthy, consanguineous parents suggests autosomal recessive inheritance. These anomalies must have arisen during blastogenesis; the syndrome resembles most the condition described in 1988 by Toriello and Carey.

alpha 2- and beta-adrenergic receptors in human placental membranes have been investigated using the radioligands [3H]-RX 821002 and [3H]-dihydroalprenolol, respectively. The specific binding of the alpha 2-adrenoceptor antagonist RX 821002 confirms the presence of an alpha 2-adrenoceptor in the human placenta, which has been characterized previously with [3H]-rauwolscine. The major finding presented here is a correlation between the alpha 2- and beta-adrenergic receptor concentrations (r = 0.765) in the human placenta at term. It is suggested that the alpha 2/beta adrenoceptor balance may play an important role in regulation of the vascular bed of the placenta. Determination of the alpha 2/beta ratio may help towards an understanding of the contractility of the placental vascular muscles.

99Tcm-DMSA planar images of 49 randomly selected patients (10 adults, 39 children) were sent to 15 physicians at various centres in Belgium. They were asked to calculate, using their own routine program, the relative uptake (expressed as a percentage) of each kidney. The data were sent on disks formatted so that they could be read by all participants, using their own computer systems. For each scan, the inter-observer variability was expressed using the maximum difference and the standard deviation of left renal uptake. Left renal uptake measured by the 15 observers in the 49 patients was 29.0-72.0% (mean +/- s = 49.8 +/- 6.4%). The maximum differences in left renal uptake ranged between 1.7% and 12.0% (4.5 +/- 2.6%); however, the maximum difference did not exceed 8% in about 90% of the patients. The standard deviations of the individual left renal uptake were between 0.6 and 3.9 (1.3 +/- 0.8). The standard deviations were significantly higher in adults (mean standard deviation = 2.05) than in children (mean standard deviation = 1.12) (P < 0.001); this was probably related to the high background observed in three adults with severe renal impairment. Indeed there was a significant correlation (P < 0.001) between the standard deviation and both the signal-to-noise ratio and the degree of asymmetry between the right and left kidneys. The differences between right and left kidney uptake were systematically lower for some observers, suggesting an influence of the calculation programs.

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