Cerebrospinal fluid (CSF) markers of brain damage are potentially capable of providing quantitative information about the extent of certain neurological injury. The presence of such markers in CSF after brain damage is transient and it is essential to understand their kinetics if they are to be used in clinical practice. In the present study, the CSF concentrations of two neurospecific proteins. S-100 protein and neuron-specific enolase (NSE), were determined in rats before and repeatedly after one of two types of experimental brain damage: traumatic cortical injury and focal cerebral ischemia induced by middle cerebral artery (MCA) occlusion. The two types of experimental brain damage resulted in significant differences in the kinetics of S-100 and NSE concentrations in CSF. Cortical contusion was followed by a rapid increase in both S-100 and NSE and a peak occurred in both after about 7 1/2 hours, at which time the values declined toward normal. A second, smaller peak was seen after about 1 1/2 days. The increase and decrease in S-100 and NSE levels in CSF was slower after MCA occlusion; a peak was seen after 2 to 4 days. Furthermore, S-100 was generally higher than NSE after trauma, whereas after MCA occlusion the NSE concentration was slightly higher than the S-100 value. These results support the use of CSF markers for estimation of the extent of brain damage in experimental models and forms a basis for the understanding of their kinetics, which is important for their use in clinical practice.

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The functional damage caused by vesicoureteral reflux (VUR) has been examined by unilateral clearance studies in 22 children with recurrent urinary tract infection (UTI) and representing 23 kidneys with large VUR. 7 kidneys with small to moderate VUR and 14 kidneys without VUR. Inulin clearance, Na+ excretion and glucose reabsorption were determined. In kidneys without or with small and moderate VUR, UTI had no effect on renal function if treated. In kidneys with large VUR extending into the pelvis and dilating the ureter, there was a gradual deterioration of glomerular filtration rate (GFR) that was accelerated after the age of 6 yr. Before puberty more than 50% of renal function was lost despite strict medical care of the UTI. If this functional loss was unilateral, hyperfunction of the contralateral kidney was generally observed. Maximal glucose reabsorption was depressed in proportion to GFR. In kidneys with unilaterally low GFR, the fractional Na+ excretion was consistently increased as compared to the contralateral kidney with normal GFR. This adaptive increase in Na+ excretion must therefore be of intrarenal origin.

Summary From clinical observations and studies of the renal function in six male infants and children with obstructive uropathy, the following conclusions may be summarized: La fonction rénale dans les obstructions de l'appareil urinaire chez l'enfant. De l'observation clinique et de l'étude de la fonction rénale chez six nourrissons et enfants masculins présentant une obstruction de l'appareil urinaire on peut conclure brièvement comme suit: Les premiers symptómes de la maladie peuvent être une augmentation lente du poids, de l'anorexie, des vomissements et de la diarrhée, qui sont souvent en relation avec une déshydratation. Ces symptômes peuvent être plus localisés comme une infection urinaire ou une masse abdominale attirant l'attention sur la malformation. Il peut exister une obstruction importante, malgré une miction normale, due à des formations valvulaires urétrales. Une atteinte de la fonction tubulaire rénale peut se développer précocement dans l'évolution de la maladie, longtemps avant que n'existent des symptômes de lésion glomérulaire, ainsi que le montre le taux élevé de l'azote non protéique. Quatre patients présentainet une acidose modérée due à une capacité réduite de conserver les bases fixées. Chez un enfant on a pu mettre en évidence une polyurie résistante à la pitressine avec une hyposthenurie, tandis qu'un autre patient souffrant d'une obstruction urétérale unilatérale présentait une diminution de la réabsorption d'eau au niveau d'un rein hydronéphrotique. Après l'opération la dilatation par hydronéphrose avait considérablement diminué et la capacité d'excrétion, ainsi qu'il a été découvert par l'examen radiologique, s'était améliorée. Quoiqu'on ait trouvé après opération des signes d'une amélioration de la fonction rénale tubulaire, la polyurie et l'acidose persistaient, obligeant à recourrir à vin traitement alcalinisant chez certains pendant la période d'observation. La rapidité avec laquelle l'insuffisance rénale se développe, démontre la nécessité d'un diagnostic et d'un traitement chirurgical précoce afin de prévenir une progression ultérieure et des lésions rénales irréversibles. Die Nierenfunktion bei kindlicher obstruktiver Uropathie. Aus klinischen Beobachtungen und Untersuchungen der Nierenfunktion bei sechs männlichen Säuglingen und Kindern mit obstruktiver Uropathie kÖnnen folgende Ergebnisse zusammengefasst werden: Die initialen SymptÖme der Erkrankung kÖnnen sein: träge Gewichtszunahme, Appetitlosigkeit, Erbreehen und Durehfall, oft in Verbindung mit Dehydration, oder sie kÖnnen mehr lokalisiert sein wie eine Infektion der Harnwege oder ein Tumor im Abdomen, der die Aufmerksamkeit auf die Missbildung lenkt. Selbst bei normaler Miktion kann eine ausgesprochene Obstruktion als Folge von Urethralklappen vorkommen. Eine Beeinträchtigung der tubulären Nierenfunktion kann sich im Laufe dieser Erkrankung frühzeitig entwickeln, lange bevor irgendwelche Symptome eines glomerulären Schadens, angezeigt durch einen erhÖhten Reststickstoffwert, vorhanden sind. Bei vier der Patienten besta...

Urodynamics were studied in one group of boys with definite infravesical obstruction and in another group with various other disorders of the lower urinary tract. They were compared with a group of normal cases and a control group without infravesical obstruction. In the group with a priori definite infravesical obstruction, opening pressure, maximum voiding pressure and peak-flow pressure relatively often fell outside the 2 standard deviations of the control group. As regards other pressure variables, there was a high degree of overlap between normal and abnormal micturition. In individual patients combinations of normal pressure/ decreased flow were observed. Bladder pressure measurement alone provides only a limited basis for evaluation. Boys with lesions of the lower urinary tract use abdominal straining to a much greater extent than normal boys, but apparently with little improvement in bladder emptying. Maximum flow in all patients with a priori definite infravesical obstruction fell outside the lower normal limit. All these cases had increased minimum urethral resistance. In a number of patients with a priori doubtful infravesical obstruction normal maximum flow was combined with slightly increased intravesical pressure. Estimation of maximum flow and evaluation of the flow curve would appear to constitute a suitable method for urodynamic screening. The various micturition patterns in different diagnostic groups are exemplified. The method employed provides valuable diagnostic inforrnation. METHODThe method employed has already been reported and the influence of various sources of error discussed Scand J Urol Nephrol5Scand J Urol Nephrol Downloaded from informahealthcare.com by University of Auckland on 12/12/14For personal use only.