Testicular function in males with infantile nephropathic cystinosis

STUDY QUESTION

Do males with the rare lysosomal storage disease infantile nephropathic cystinosis (INC) have a chance of biological fatherhood?

SUMMARY ANSWER

Cryostorage of semen could be an option for approximately 20% of young males with INC, with surgical sperm retrieval from the centre of the testes providing additional opportunities for fatherhood.

WHAT IS KNOWN ALREADY

Biallelic mutations in the cystinosin (CTNS) gene in INC cause dysfunction in cystine transport across lysosomal membranes and cystine accumulation throughout the body. Spontaneous paternity in cystinosis has not been described, despite the availability of cysteamine treatment. Azoospermia has been diagnosed in small case series of males with INC. ART using ICSI requires few spermatozoa, either from semen or extracted surgically from the testes of azoospermic men. However, there is limited evidence to suggest this could be successful in INC.

STUDY DESIGN, SIZE, DURATION

In this prospective cohort study performed between 2018 and 2019, we performed a cross-sectional investigation of 18 male patients with INC to delineate endocrine and spermatogenic testicular function.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Serum hormone levels, semen samples (according to World Health Organization 2010 standards), and testicular ultrasound images were analysed in 18 male patients aged 15.4–40.5 years. Surgical sperm extraction was performed in two, and their testicular biopsies were investigated by light and electron microscopy. Past adherence to cysteamine treatment was assessed from medical record information, using a composite scoring system.

MAIN RESULTS AND THE ROLE OF CHANCE

Adherence to cysteamine treatment was high in most patients. Testicular volumes and testosterone levels were in the normal ranges, with the exception of two and three older patients, respectively. Serum LH levels were above the normal range in all subjects aged ≥20 years. FSH levels were elevated in all but four males: three with spermatozoa in semen and one adolescent. Inhibin B levels were shown to be lower in older men. Testicular ultrasound revealed signs of obstruction in 67% of patients. Reduced fructose and zinc seminal markers were found in 33%, including two patients with azoospermia who underwent successful surgical sperm retrieval. Histology identified fully preserved spermatogenesis in the centre of their testes, but also tubular atrophy and lysosomal overload in Sertoli and Leydig cells of the testicular periphery.

LIMITATIONS, REASONS FOR CAUTION

Limitations of this study are the small number of assessed patients and the heterogeneity of their dysfunction in cystine transport across lysosomal membranes.

WIDER IMPLICATIONS OF THE FINDINGS

This study suggests that testicular degeneration in cystinosis results from the lysosomal overload of Sertoli and Leydig cells of the testicular periphery, and that this can possibly be delayed, but not prevented, by good adherence to cysteamine treatment. Endocrine testicular function in INC may remain compensated until the fourth decade of life; however, azoospermia may occur during adolescence. Cryostorage of semen could be an option for approximately 20% of young males with INC, with surgical sperm retrieval providing additional opportunities for biological fatherhood.

STUDY FUNDING/COMPETING INTEREST(S)

This work was supported by the Cystinosis Foundation Germany. The authors have no competing interests to declare.

TRIAL REGISTRATION NUMBER

n/a.

Establishing an objective biomarker for corneal cystinosis using a threshold-based Spectral domain optical coherence tomography imaging algorithm

PURPOSE

The purpose of the present study was to establish a semi-automated threshold-based image segmentation algorithm to detect and objectively quantify corneal cystine crystal deposition in ocular cystinosis with anterior segment optical coherence tomography (AS-OCT).

METHODS

This prospective, observational, comparative study included 88 eyes of 45 patients from the German Cystinosis Registry Study as well as 68 eyes of 35 healthy control subjects. All eyes were imaged with AS-OCT (Cirrus HD-OCT 5000, Carl Zeiss Meditec AG, Jena, Germany). As an initial step, B-scan images were subjectively analysed for typical changes in morphology in comparison to healthy controls. Based on the experience gained, an objective semi-automated B-scan image segmentation algorithm was developed using a grey scale value-based threshold method to automatically quantify corneal crystals.

RESULTS

On AS-OCT B-scans, corneal crystals appeared as hyperreflective deposits within the corneal stroma. The crystals were distributed either in all stromal layers (43 eyes, 49%) or confined to the anterior (23 eyes, 26%) or posterior stroma (22 eyes, 25%), respectively. The novel automatic B-scan image segmentation algorithm was most efficient in delineating corneal crystals at higher grey scale thresholds (e.g. 226 of a maximum of 255). Significant differences in suprathreshold grey scale pixels were observable between cystinosis patients and healthy controls (p < 0.001). In addition, the algorithm was able to detect an age-dependent depth distribution profile of crystal deposition.

CONCLUSION

Objective quantification of corneal cystine crystal deposition is feasible with AS-OCT and can serve as a novel biomarker for ocular disease control and topical treatment monitoring.

Accuracy of blood glucose meters for self-monitoring affects glucose control and hypoglycemia rate in children and adolescents with type 1 diabetes

AIMS/HYPOTHESIS

This study investigated the accuracy of blood glucose meters for self-monitoring and its influence on glycated hemoglobin (HbA1c) levels and the frequency of hypoglycemic coma.

MATERIALS AND METHODS

Self-measured and simultaneously obtained laboratory blood glucose values from 9,163 patients with type 1 diabetes <18 years of age in the German/Austrian Diabetes Prospective Documentation Initiative registry were analyzed by investigating their compliance with the International Organization for Standardization (ISO) criteria (versions 2003 and 2013) and by error grid analyses. Regression models elucidated effects on glucose control and hypoglycemia rates.

RESULTS

Depending on the respective subgroup (defined by sex, age, duration of diabetes, mode of insulin therapy), 78.7-94.7% of the self-monitoring of blood glucose (SMBG) values met the old and 79.7-88.6% met the new ISO criteria. In Clarke and Parkes error grid analyses, the percentages of SMBG values in Zone A ranged between 92.8% and 94.6% (Clarke) and between 92.2% and 95.0% (Parkes). The patient group with SMBG devices measuring "far too low" (compared with the laboratory-obtained glucose levels) presented with a higher HbA1c level than those measuring "far too high," "too high," "identical/almost identical," or "too low" (based on quintiles of deviation). Performing "far too high" was associated with the highest rate of hypoglycemic coma in comparison with the other deviation quintiles.

CONCLUSIONS

This study showed that current SMBG devices fulfilled neither the previous nor the new ISO criteria. Large deviations of the SMBG values from the "true" glucose levels resulted in higher HbA1c levels and markedly increased rates of hypoglycemic events.

Body-surface-area related renal volume: a common normal range from birth to adulthood

Renal volume is an important parameter of renal development. Deviations from normal volume may indicate pathologic conditions. Thus, during childhood, the ever changing renal volumes require the continuous referral to normal volume charts in order to classify actual volumes, which is rather inconvenient. In daily practice this is frequently disregarded and kidneys are evaluated by their appearance only. Therefore, we tested the hypothesis that body surface area (BSA) and renal volume grow proportionally from birth to adulthood. We divided the renal volume of a child by its BSA to get the BSA-related renal volume (BSARV) and found no differences between left and right kidneys and a normal distribution for all kidneys regardless of the patient's age. BSARV has a common normal range for all age groups with the 10th percentile of 45 and the 90th percentile of 85 mL/m(2). 80% of all kidneys do not exceed the volume of their counterparts by more than 20%. BSARV alleviates the correct evaluation of a child's renal volume regardless of age and reveals pathological influences by the simple observation that a kidney deviates from a former percentile or z-value. This is especially valuable in the followup of kidneys with chronic diseases.

Initial insulin therapy in children and adolescents with type 1 diabetes mellitus

OBJECTIVE

The aim of the study was to define parameters that influence the initial insulin dosage in young subjects with type 1 diabetes regarding the amount of daily insulin, the ratios of basal and prandial insulin, and the insulin/carbohydrate ratios.

STUDY DESIGN

We used a computer-based registry (with prospectively collected data) in Germany and Austria, a software for the management and data documentation of diabetic patients (DPV), to analyze the initial insulin therapy in 2247 children with newly diagnosed type 1 diabetes to identify factors that influence diabetes therapy within the first 10 d.

RESULTS

For both genders, glucosylated hemoglobin A1c (HbA1c), blood pH at diabetes onset, and pubertal status are the major factors determining the initial insulin dosage calculated as the amount of daily insulin per kilogram body weight (kg), the basal and prandial insulin dose per kilogram, and day and the insulin/carbohydrate ratios for meals. The frequency of hypoglycemia correlated with increasing quotient of applied to calculated insulin dosage.

CONCLUSION

The predictive factors of insulin requirement may exert beneficial effects on the assessment and adjustment of insulin therapy in young diabetic subjects at disease onset. On the basis of a multiple, linear regression, we suggest a formula to calculate the initial insulin therapy.

Prevailing therapeutic regimes and predictive factors for prandial insulin substitution in 26 687 children and adolescents with Type 1 diabetes in Germany and Austria

AIMS

To analyse current therapeutic strategies for prandial insulin substitution in a large number of children and adolescents with Type 1 diabetes in Germany and Austria, along with changes in therapeutic habits and outcome.

METHODS

We classified the data of 26 687 patients, treated from 1995 to 2005 in 152 paediatric clinics, using a database established for quality control and scientific surveys in paediatric diabetology (DPV).

RESULTS

Seventy-three per cent of all patients (mean age 13.6 years., mean duration of diabetes 5.4 years.) were treated with > or = 4 daily injections (intensified conventional treatment; ICT), 14% with continuous subcutaneous insulin infusion (CSII), 13% with 1-3 injections per day (conventional treatment). Frequency of daily injections increased with age, duration of diabetes and insulin dose. The insulin dose at breakfast was higher than for the evening meal or lunch, from diagnosis onwards. Individuals using insulin analogues received up to 11% higher insulin doses per day compared with patients treated with human insulin. The time of day, age, duration of diabetes, female gender, insulin analogues and ICT all had a significant influence on prandial insulin doses. Although the number of patients treated with ICT or CSII increased over the period of observation, mean glycated haemoglobin (HbA(1c)) was approximately 8.0% each year, and decreased by only 0.01%.

CONCLUSIONS

Eighty-seven per cent of patients were treated with ICT or CSII. However, while this percentage increased over the observation period, mean HbA(1c) was almost constant. Longer duration of diabetes, increasing age, female gender, insulin analogues and ICT were associated with higher prandial insulin doses.

Development of nephrocalcinosis in very low birth weight infants

Premature infants undergo intensive growth during the postnatal period. Adequate mineralization is dependent on sufficient intake of calcium (Ca) and phosphorus (P). However, Ca and P supplementation can be associated with some risks, for example development of nephrocalcinosis. We investigated pathophysiological risk factors in premature very low birth weight (VLBW) infants associated with the development of nephrocalcinosis. From June 1994 to September 1995 all preterm neonates with a birth weight below 1,500 g were screened prospectively. At regular intervals of 2 weeks, ultrasonography (US) of the kidneys was performed and parameters of mineral metabolism were assessed in blood and spot urine samples. For analysis, premature infants with nephrocalcinosis (group N) were compared with infants without nephrocalcinosis (group R) and with a retrospectively pair-matched subgroup of premature infants without nephrocalcinosis (control group C) taken from the same study. Nephrocalcinosis was detected in 20 of 114 preterm neonates (group N, 17.5%). Of these 20 infants with nephrocalcinosis, 16 presented with a tendency towards systemic acidosis (pH<7.25) on day 2-7, compared with only 4 of 20 premature infants of the control group. Premature infants of group N had a lower serum P at 2 weeks of life and 5 (versus 0 patients of the control group C) had transient hypophosphatemia (serum P<1.6 mmol/l). Moreover, the Ca/creatinine ratio in spot urine specimens tended to be higher (P<0.1) in patients developing nephrocalcinosis. There were no significant differences in the duration of ventilation, the length of stay in the intensive care unit, and duration and frequency of furosemide and steroid treatment between the groups N and C. VLBW premature infants developing nephrocalcinosis frequently presented with slightly impaired acid-base homoeostasis within the 1st week, followed by signs of impaired mineralization (and immature or impaired renal function) within 2 weeks. In VLBW premature infants, close observation of acid-base status and regular analysis of spot urine specimens (Ca, P, creatinine) during the first weeks of life may help to identify those premature infants at risk for nephrocalcinosis.

[Congenital, solitary hepatic cyst: Observation of the development from birth upon the intervention in the 5th year of life]

BACKGROUND

Sonographic screening helps to discover pathological findings in asymptomatic patients. In these cases the decision about diagnostic and therapeutic consequences is difficult.

CASE REPORT

We describe a girl with a congenital small solitary hepatic cyst with rapidly increasing size after the second year, which was interventionally sclerosed at the age of five years.

CONCLUSION

Even in cases of small cysts long term follow up investigations are necessary, because the growth rate of the cyst can change.

[Ultrasound screening of the infant hip]

The sonographic screening of the hip has led to a marked decrease in treatment of children with developmental dysplasia of the hip (ddh) as inpatients. The prognosis for this disorder has greatly improved in the past few years due to early diagnosis and correspondingly early beginning of therapy, in many cases by using simple therapeutic methods. This undisputed success has been achieved with a high treatment rate in comparison with international practice (6.4%). The expectancy of reducing the number of checks, and thus costs, by deciding on the 4th to 6th week of life as the time for screening has not been met.

[Peutz-Jeghers syndrome--new possibilities of noninvasive diagnosis]

The ultrasonographic findings on Peutz-Jeghers syndrome are demonstrated on two cases. As a non-invasive method the digitalized computered sonography may give the opportunity to detect even small polyps. The sensitivity of this method is comparable with the MRI and gives new perspectives in the follow up of Peutz-Jeghers syndrome.

[Prevalence of gallstones in the neonatal period]

AIM

To assess the prevalence of gallstones in normal neonates.

METHOD

We used sonography to assess the gallbladder in 3500 unselected infants between 1993 and 1995. Examination was performed during the first four days of life as part of a prospective neonatal screening study evaluating hip and renal abnormalities.

RESULTS

We found sludge or gallstones in 19 children (0.5%). In 4 of 11 patients followed for up to 18 months, the gallstones persisted. In 3 of the cases, there was a family history of gallstones. None of the children had signs of cholestasis. Three were treated with ursodesoxycholic acid 15-20 mg/kg (per day): only one responded.

CONCLUSION

About 0.5% of neonates have gallstones or gall bladder sludge; this is a higher percentage than previously thought. In one-third of the patients who were followed, the gallstones remained. Persistence was more likely in those with a positive family history for gallstones.

[Comparative studies of the use of linear array, curved array and sector technique in sonography of the infant hip]

In an experimental study, the sonographic speed in the hyaline cartilage of the hip of the newborn is measured. With 1549 m/s it lies in the intermediate range of the equipment's pre-set calculation basis. By comparing large groups the study shows that the accuracy of the measurements of the angle alpha is independent of the technology used in the production of the hip sonogram. On the other hand, the image scale has a clear influence. The image scale of 1:1 is inadequate for a reliable repeated cross-sectional presentation and for measurements. The study shows that there are no statistically demonstrable differences when measuring hip sonograms regardless of whether they have been produced using linear array or sector scanning. This is shown both by repeated presentation of the respective cross-section by one and the same researcher and by measurement of identical sonograms by different researchers.

[Sonographic visualization and size determination of the abdominal organs in healthy newborn infants]

The determination of organ size is another important criterium in ultrasound examination. There are only few investigations in the neonatal group. Therefore in a prospective study the abdominal organs of 85 neonates were examined with a 7.5 MHz small part scanner. These organs were measured in standardized sections in order to establish normal values]

Clinical heterogeneity in infantile galactosialidosis

A new case of infantile galactosialidosis is presented. The condition was diagnosed when the patient was 4 months of age and she died at 20 months. She exhibited some of the symptoms of classical infantile galactosialidosis but no corneal clouding, cherry-red macular spot or limitation of joint mobility. Sonographic examination showed large kidneys and thickened cardiac septa, two symptoms as yet undescribed in this disorder. Urinary oligosaccharide analysis gave grossly pathological results and subsequent fibroblast enzyme analysis showed a deficiency of alpha-neuraminidase and beta-galactosidase. The patient's clinical features are compared with the few cases so far described in the literature.

Sonographic biometry in obstructive uropathy of children: preoperative diagnosis and postoperative monitoring

Renal sonography was performed in 92 children with obstructive uropathy or vesicoureteral reflux preoperatively and at follow-up. Renal volume and the anteroposterior diameter of the renal pelvis proved to be the most reliable morphometric criteria for objective sonographic staging and follow-up of urinary tract obstruction. If transient obstruction occurred after uncomplicated antireflux ureterovesico-plasties (n = 41), it lasted at most 4 weeks. Kidneys with transient postoperative ureterovesical junction obstruction (n = 21) reverted to normal sonographic pattern within 4 weeks following ureteral reimplantation. In cases of ureteropelvic junction obstruction (n = 30), it took up to 6 months for the majority of kidneys to present almost normal sonographic findings. Sonographic biometry and the knowledge about the uncomplicated postoperative course render postsurgical monitoring easier and more reliable.

[Sonographic screening of newborn infants]

527 consecutive births were screened by real time ultrasound for detecting malformations of the brain, the heart, kidneys, hips and abdominal organs. Sonography was performed during the first day of life together with the clinical examination. 18 major malformations were found. In 8 of these patients (45%), the malformation could not be diagnosed by clinical examination alone. Only 2 of those neonates were assumed to develop clinical symptoms the following days. The rate of incidence of renal malformations proven by this single ultrasound examination was 7 times higher than normally detected by the preventive clinical screening programme within the first four years.

Prenatal diagnosis of neuroblastoma by sonography

Background

Zoledronic acid is the most potent osteoclast inhibitor and is widely used for advanced cancer patients with bone metastasis, but its role on cancer stem cells (CSCs) remains unclear. In the present study, we aimed to identify the stemness phenotypic characteristics of CSCs derived from cervical cancer cells and explore the anti-cancer efficiency of zoledronic acid on these cells, as well as the possible molecular mechanisms.

Methods

Stemness phenotypic identification of cervical cancer cells derived CSCs was performed via sphere formation efficiency (SFE), tumorigenesis, immunofluorescence staining, Transwell assay, and western blot. Anti-cancer efficiency of zoledronic acid on these cells (including proliferation, stemness phenotype, apoptosis, and cell cycle) was carried out through MTT assay, SFE, transwell, DAPI staining, flow cytometry, immunofluorescence, TUNEL staining, and western blot, both in vitro and in vivo.

Results

Enhanced self-renewal ability, including SFE and tumorigenesis, was verified in cervical cancer cells derived CSCs compared to parental cervical cancer cells. Specifically, the expression of ALDH1, Sox2, CD49f, Nanog, and Oct4 was significantly up-regulated in cervical cancer cells derived CSCs. Furthermore, enhanced migratory ability was observed in these cells along with up-regulated N-cadherin and Vimentin and down-regulated E-cadherin. Zoledronic acid inhibited cervical cancer cells derived CSCs proliferation in vitro and in vivo. The stemness phenotype of these CSCs including tumor sphere formation, migration, as well as the expression of the aforementioned associated markers was also suppressed. In addition, zoledronic acid significantly induced apoptosis and cell cycle arrest of cervical cancer cells derived CSCs in a dose-dependent manner. Mechanistically, the expression of phosphorylated Erk1/2 and Akt was significantly increased in cervical cancer cells derived CSCs compared to parental cervical cancer cells. Zoledronic acid inhibited phosphorylated Erk1/2 and Akt in cervical cancer cells derived CSCs. IGF-1, a potent stimulator for Erk1/2 and PI3K/Akt, attenuated the aforementioned anti-cancer effect of zoledronic acid.

Conclusions

Zoledronic acid inhibited the growth of cervical cancer cells derived CSCs through attenuating their stemness phenotype, inducing apoptosis, and arresting cell cycle. The suppression of phosphorylated Erk1/2 and Akt was involved in this process.

Electronic supplementary material

The online version of this article (10.1186/s13046-019-1109-z) contains supplementary material, which is available to authorized users.

Prenatal diagnosis of neuroblastoma by sonography

Herein we report the first case in the literature in which a neuroblastoma in a fetus was recognized before birth and its growth could be observed. The diagnosis was made by ultrasonography. Other helpful diagnostic procedures in prenatal diagnosis are: determination of catecholamines, sonographic examination of the placenta, and search for metastases. As more and more centers perform ultrasound examinations routinely in pregnancy, similar findings such as fetal tumors or congenital malformations are to be expected more frequently.

[Pediatric sonography]

Sonography has become the most important basic imaging method in pediatrics. It mainly differs from sonography in adults in having more unspecific causes for examination, other facets of application, and a wider range of applicability including newborns and infants. Sonography should precede x-ray examination, since its findings must determine the need for and the timing and type of x-ray examinations. The wide range of application justifies a distinction between general and special pediatric sonography. This distinction seems to be particularly relevant with regard to the requirements for optimal technical equipment.

Sonographic diagnosis of intussusception in childhood

The diagnosis of intussusception was established in 26 children by sonography alone. In 23 cases barium enema confirmed the diagnosis; two cases because of longstanding intussusception and one case after intestinal anastomosis were confirmed by surgery alone; in two additional cases barium enema ruled out the sonographically suspected intussusception. No positive finding was missed by sonography, which proved to be an accurate method for the diagnosis of intussusception. The sonographic findings of idiopathic intussusception and intussusception caused by lymphosarcoma are presented.

Sonographic biometry of liver and spleen size in childhood

In 194 healthy children of all ages, sonographic measurements of the liver and spleen were performed on standardized section planes and normal values established. These measurement values showed an approximately linear increase in the course of development and correlated best with the body length. For a rapid orientational evaluation of the liver size, sonographic nomograms of the individual measurements were developed. The spleen size was determined by volume calculation. On the basis of an index of liver size, which was calculated from the individual measurements, a diagram for simultaneous determination of liver and spleen size could be developed. These nomograms permit objective morphometry of size changes in the two organs.

[Accessory pancreatic cyst located in the mesocolon in a child (author's transl)]

Case reports of a 1.5-year-old child who had a cyst in the mesocolon ascendens arising from ectopic pancreatic tissue. It is the third case of an accessory pancreatic cyst and at the same time, the first case in which the cyst in the mesocolon ascends has been found in early childhood. Pathogenesis, diagnosis and symptomatology are discussed.

[Diagnosis of pancreatic insufficiency with fluorescein dilaurate in patients with cystic fibrosis (author's transl)]

The tubeless pancreas-function test with fluorescein dilaurate, which is based on the saponification of the test substance by pancreas-specific arylesterases, and which has proved itself in adults, was given to children for the first time. After reduction of the size of the test dose and the amount of liquid to be drunk, there were no difficulties in carrying out the test. Elimination of the fluorescein released from the flourescein dilaurate and excreted via the kidneys was clearly less in patients with cystic fibrosis than in normal subjects. Thus, the test in its modified form for children can provide adequate differentiation between normal and pathological pancreas function.

[Ultrasonic examinations of Wilms' tumors stage II-V during preoperative therapy (author's transl)]

Ultrasonic examinations were performed at weekly intervals in 8 patients with Wilms tumors Stage II-V during the period of preoperative therapy. Measurements of the maximum expansion of the tumors were made and expressed in an ellipsoid formula. The tumor volume was thus calculated. A description of the compactness of the tumor as well as the bordering of the tumor were done. This was followed by a photographic documentation. The mean value of the initial tumor volume in the 8 patients was 551 ml. At the end of the preoperative therapy, an average volume of 305,1 ml was recorded. One week after beginning the therapy, 25-40% diminution of the initial tumor volume was noted in 5 patients. The diminution in volume till tumor extirpation was in all 49%. In 3 patients, the reduction of tumor mass through therapy was only 27,8%. The histological examinations revealed a fetal rhabdomyomatic nephroblastoma in one case. The second case was massive tumor haemorrhage and in the third case a considerable formation of cysts.

Use-effectiveness and client satisfaction in six centers teaching the Billings Ovulation Method

Use-effectiveness of the Billings Ovulation Method (OM) is reported for 1139 clients from six centers who were followed for at least 24 months. Method failure rates were 1% when calculated by either Pearl formula or life table analysis. Combined method and user failure rates were 20% when calculated with the Pearl formula, and 16% at 12 months and 23% at 24 months by life table analysis. Pregnancy rates were higher for couples using OM alone, than for couples using OM in combination with additional fertility awareness methods or together with barrier methods. The difference was significant when estimated by the Pearl formula but not when analyzed by the life table. The emotional implications underlying the apparent contradiction between a desire to avoid pregnancy and the deliberate coital use of fertile days are reflected in the differences between method and user failure rates, the high client satisfaction levels reported with "user failure," and 56% continuation rate at 24 months. The will require in-depth exploration.

[Diagnosis and differential diagnosis of acute hematogenous osteomyelitis in infants (author's transl)]

Clinical and laboratory data are frequently unspecific in acute hematogenous osteomyelitis of infants. As prognosis is dependent on early treatment, a timely radiologic diagnosis is mandatory. Because of specialties in the vascular supply, the roentgenmorphologic alterations of acute hematogenous osteomyelitis in infants differ from the appearance of the disease in other age groups. The acute osteomyelitis in infants frequently leads to destruction of the epiphysis and purulent joint effusion. A subtle analysis of soft tissue lesions will already rise suspicion for acute hematogenous osteomyelitis before destructive or reactive osseous alterations prove the diagnosis by roentgenology. Nuclear medicine examinations of the bone have contributed significantly to radiologic diagnosis of acute hematogenous osteomyelitis in infants despite of few negative results. Osseous trauma and other diseases should be included in differential diagnosis. Especially in neonatals and premature infants, variations in the typical course and appearance of the disease may occur.

[Acute anuria due to renal candidiasis in infants (author's transl)]

There are reports here on three cases of renal candidiasis in infancy which after predisposing factors suddenly led to a deterioration in the general state, to a considerable enlargement of the kidneys and to the occurrence of an anuria. The pecularities of the course as well as a conservative treatment success using 5 fluorcytosin are reported on. The pathogenesis of the illness is discussed.

[Renal sonography--errors, pitfalls, and their sources (author's transl)]

Retrospective evaluation of sonographic diagnoses showed 14 false interpretations, proven by operation or renal angiogram. A classification of errors and pitfalls in renal sonography is attempted and the place of this method in the diagnostic plan in kidney diseases is discussed.