Seventy six children, 18 boys and 58 girls, aged 0-15 9 (median 1.0) years, with acute pyelonephritis were prospectively studied with a technetium-99m dimercaptosuccinic acid (DMSA) scan during infection and two months later. Fifty nine of these children were also studied two years after the infection. Seventeen Previous studies have shown that renal scarring was almost always associated with vesicoureteric reflux (VUR).9 Later studies using the DMSA scan, however, have suggested that scarring may often occur in the absence of VUR,5 and it has been claimed that renal scarring may be independent of the presence or absence of VUR.10 We therefore need to reassess our knowledge in this field on the basis of studies in which acute pyelonephritis has been diagnosed and followed up with DMSA scans.The aim of this prospective clinical study was to determine the incidence of renal scarring after acute pyelonephritis and how this correlated with previously well known risk factors such as VUR, age, delay in starting treatment, and recurrent urinary tract infections. Patients and methodsSeventy six patients (152 kidneys), 18 boys and 58 girls, aged 0-15-9 (median 1 0) years, consecutively admitted to our hospital with the clinical diagnosis of acute pyelonephritis were studied with a DMSA scan within five days of admission and about two months later. Figure 1 gives the age and sex distributions of the children. Acute pyelonephritis was defined as fever :38 5°C, C reactive protein >20 mg/l, or erythrocyte sedimentation rate >20 mm/hour, and a positive urinary culture. The laboratory data during acute pyelonephritis in most of these children have been published previously.5 All the children were available for long term follow up and a DMSA scan was performed in 59 (78%) of them after two years. The remaining 17 (22%) children had a normal DMSA scan at two months and 11 (65%) of these also had a normal DMSA scan during infection. After the initial treatment, all children received prophylactic antibiotics until the second investigation at two months, and none had a breakthrough infection during that time.

Background: Mild cognitive impairment (MCI) was recently described as a heterogeneous group with a variety of clinical outcomes and high risk to develop Alzheimer's disease (AD). Regional cerebral blood flow (rCBF) as measured by single photon emission computed tomography (SPECT) was used to study the heterogeneity of MCI and to look for predictors of future development of AD.

Seventy-two children, 59 girls and 13 boys, 0.1-15.9 (median 1.1) years of age, with acute pyelonephritis (APN) were investigated with the aid of a dimercaptosuccinic acid (DMSA) scan, renal ultrasonography (US) and a desmopressin test within 5 days of admission. Sixty-two children were reinvestigated approximately 2 months later when intravenous urography (IVU) and micturition cysto-urethrography were also performed. During infection, 92% of the children showed changes in the DMSA scan with 69% by US, and the two investigations agreed in 58% of the kidneys. At follow-up, 68% showed changes in the DMSA scan, 47% by US and 48% by IVU. The DMSA scan and IVU agreed in 60% of the kidneys. Twenty-nine percent of the children had vesico-ureteric reflux (VUR). The presence of grade greater than or equal to 3 VUR was associated with greater defects on the DMSA scan during infection, and at follow-up with a higher frequency of persistent changes compared with no VUR (P less than 0.02 and 0.01, respectively). During infection the size of the defect on the DMSA scan correlated with renal volume and C-reactive protein and inversely with the glomerular filtration rate, and at follow-up it correlated inversely with the renal concentration capacity. The DMSA scan is a sensitive method for diagnosing and localizing APN in children, and findings on DMSA scan show a weak but significant correlation with routine clinical and radiological parameters. It is suggested that persistent renal damage after APN in children without VUR may be more common than previously assumed.

The a-adrenergic agonist oxymetazoline increased Na+,K+-ATPase activity of single proximal convoluted tubules dissected from rat kidney. Activation of the enzyme by oxymetazoline was prevented by either the a1-adrenergic antagonist prazosin or the a2-adrenergic antagoit yohimbine and was mimicked by the calcium ionophore A23187. The effect of oxymetazoline on Na+,K+-ATPase activity was prevented by a specific peptide inhibitor of calcineurin, as wed as by FK 506, an immunosuppressant agent known to inhibit calcineurin; these results indicate that the action of oxymetazoline is mediated via activation of calcineurin (a calcium/caimodulindependent protein phosphatase). Activation of the Na+,K+-ATPase by either oxymetazoline or A23187 was aocited with a >2-fold increase in its affinity for Na+. The results provide a biochemical me s by which norepinephrine, released from renal nerve terminals, stimulates Na+ retention.Regulation of sodium excretion by renal sympathetic nerve activity plays a major role in the maintenance of Na+ homeostasis (1). However, little is known about the mechanism by which this regulation occurs. Norepinephrine promotes Na+ retention by a mechanism involving a-adrenergic, but not 3-adrenergic (2-4), receptor activation. Activation of a-adrenergic receptors is associated with increased cytosolic calcium in many cell types (5, 6). Here we present evidence that norepinephrine, acting on a-adrenergic receptors, increases Na+,K+-ATPase activity in permeabilized cells of the proximal convoluted tubule of rat kidney. Moreover, norepinephrine appears to increase this activity through a mechanism involving activation of the calcium/calmodulindependent protein phosphatase, calcineurin.MATERIALS AND METHODS Segments from 'the proximal convoluted tubule were dissected from the cortex ofcollagenase-perfused rat kidneys, in a physiological buffer containing 137 mM NaCl, 5 mM KCl, 0.8 mM MgSO4, 0.33 mM Na2HPO4, 0.44 mM KH2PO4, 0.25 mM CaCl2, 1 mM MgCl2, 10 mM Tris HCl, pH 7.4 at 40C. After dissection was completed, the tubule segments were incubated for 30 min at room temperature in the physiological buffer; in most protocols the NaCl concentration was reduced to 20 mM, and isoosmolality was maintained by the addition of 117 mM choline chloride. Oxymetazoline, prazosin, and yohimbine were obtained from Sigma, the Ca2+ ionophore A23187 from Calbiochem, and FK 506 and rapamycin were from Abbott. Test substances were added to the modified physiological buffer. To allow the peptides to enter the cell, the tubule segments were permeabilized with rapid freezing and thawed. This procedure, which allowed dextran molecules of Mr 4000 to enter the cell, was done during inspection in a stereo microscope.Measurement of Na+,K+-ATPase Activity. Segments were subjected to hypotonic shock to permeabilize the tubule cells. Na+,K+-ATPase activity was' measured as described (7) (GFSPPHRITSFEEAKG), which overlaps the first peptide, spans residues 460-475. Its amino terminus coincides with the first cleavage site of c...

Eccentric training resulted in decreased tendon volume and intratendinous signal and was correlated with an improved clinical outcome. Magnetic resonance imaging techniques can be used as an adjunct to clinical evaluation by monitoring morphologic effects in clinical treatment studies of Achilles tendinopathy.

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We found decreased pain, improved performance and decreased intratendinous signal both compared to index examination and immediately after the 3 months training regimen in a 4.2-year clinical and MRI follow up, in a group of patients treated with heavy loaded eccentric calf-muscle training for chronic Achilles tendinopathy. The improvements were greater at 4.2-year follow up, despite no further active treatment, than immediately after the treatment. This may indicate a good long-term prognosis for Achilles tendinosis patients.