Biomedical subjects

Eleonora M Lima

Publications and source records attributed to Eleonora M Lima.

3 recordsLinked to original sources

PubMed2003

Bone density measurements in pediatric patients with renal osteodystrophy.

Peripheral quantitative computed tomography (pQCT) can selectively measure the densities of cortical and trabecular bone, but there is limited information about its use in patients with renal osteodystrophy. Thus pQCT (Norland XCT-2000, Stratec, Pforzheim, Germany) was performed at the ultradistal radius in 21 patients aged 16+/-3.6 (SD) years on continuous cycling peritoneal dialysis. Trabecular bone density (TBD) was higher in patients, 206+/-16 mg/cm(3), than in controls, 182.7+/-24.8 mg/cm(3) ( P<0.0001), whereas cortical bone density (CBD) was lower in patients, 946.5+/-147.5 mg/cm(3), than in controls, 1,153+/-25.4 mg/cm(3) ( P<0.001). TBD was inversely correlated with age ( r=-0.59, P=0.05), height ( r=-0.59, P<0.01), and weight ( r=-0.51, P<0.05). In contrast, CBD was positively correlated with age ( r=0.53, P<0.05), height ( r=0.56, P<0.05), and weight ( r=0.53, P<0.05). CBD was inversely related to serum alkaline phosphatase ( r=-0.71, P<0.001) and parathyroid hormone levels ( r=-0.50, P<0.05). In patients with adynamic bone, TBD was less, 192+/-9 mg/cm(3), than in those with high-turnover lesions, 215+/-13 mg/cm(3), P<0.001. CBD, however, was lower in patients with high-turnover lesions, 900+/-151 mg/cm(3), than in those with low turnover, 1,022+/-111 mg/cm(3), P<0.05. Compared with controls, in patients with high-turnover lesions, CBD was lower ( P<0.0001) and TBD higher ( P<0.0001). These findings suggest that pQCT may be an additional tool in the assessment of renal osteodystrophy.

Adolescent↗

PubMed2003

Bladder dysfunction: diagnosis with dynamic US.

PURPOSE: To evaluate the role of dynamic ultrasonography (US) in the diagnosis of bladder dysfunction and to compare dynamic US with urodynamic study, which is considered to be the standard in the diagnosis of bladder dysfunction. MATERIALS AND METHODS: Images from 71 pairs of examinations in 63 patients (median age, 7.9 years; range 1.0-17.4 years) were included in the study. After the child consumed adequate fluids in an appropriate environment, natural filling of the bladder occurred, and dynamic US was used to evaluate detrusor activity, determine capacity of the bladder, and estimate residual urine volume. A urodynamic study was performed in every patient within 6 months of dynamic US and under the same treatment conditions. The paired Student t test was used to compare the maximal cystometric capacity values obtained with the two examinations. Analysis of validity was performed with the calculation of sensitivity, specificity, positive and negative predictive values, and their respective 95% confidence limits. RESULTS: The bladder capacity was not significantly different between dynamic US and urodynamic study (P =.12). Analysis of validity for the determination of the presence of clinically substantial residual urine showed 97.7% sensitivity and 100% specificity for dynamic US. The sensitivity and specificity of dynamic US in the detection of involuntary detrusor contraction were 93.0% and 88.9%, respectively. In the analysis of involuntary detrusor contraction with urine leakage, dynamic US showed sensitivity of 100% and specificity of 97.8%. CONCLUSION: Dynamic US is a sensitive method for the diagnosis of bladder dysfunction.

Adolescent↗

PubMed2003

Predictive factors of progression of chronic renal insufficiency: a multivariate analysis.

The purpose of this study was to identify clinical, nutritional, and laboratory factors associated with the rate of progression of chronic renal insufficiency among children and adolescents admitted to a pre-end-stage renal failure (ESRF) interdisciplinary program. Sixty-two children and adolescents aged 2 months to 19 years with chronic renal failure on conservative management were prospectively followed from 1990 to 1999. The following variables were analyzed: age at admission, sex, race, blood pressure, primary renal disease, Z scores for weight and height, glomerular filtration rate (GFR), urea, and presence and degree of proteinuria. Progression to ESRF was assigned as a dependent variable. The analysis was conducted in two steps. In a univariate analysis, variables associated with ESRF outcome were identified by the log-rank test. Then, the variables that were significantly associated with adverse outcome were included in a multivariate analysis. This analysis, using the Cox proportional hazards model, was performed to identify variables that were independently associated with a worse prognosis. Only variables that remained independently associated with adverse outcome were included in the final model. Twenty-one (34%) patients evolved to ESRF during a median follow-up of 43 months. Two variables were identified as independent predictors of progression to ESRF: GFR under 30 ml/min (RR=3, 95% CI=1.7-5.3, P=0.0001) and severe proteinuria (RR=3.1, 95% CI=1.2-7.6, P=0.01). The combination of two factors-GFR lower than 30 ml/min and presence of severe proteinuria on admission-was an independent indicator of adverse outcome in children and adolescents with chronic renal insufficiency who were conservatively managed.

Adolescent↗