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Biomedical subjects

F B Stapleton

Publications and source records attributed to F B Stapleton.

At least 19 recordsLinked to original sources
PubMed1998

Limited evaluation of microscopic hematuria in pediatrics.

OBJECTIVE: The purpose was to determine the value of the standard laboratory and radiologic evaluation of microscopic hematuria in children, and to determine the prevalence of idiopathic hypercalciuria in those children referred for evaluation of unexplained microscopic hematuria. METHODS: This was a retrospective study of 325 children referred from 1985 to 1994 for the evaluation of asymptomatic microscopic hematuria. The diagnostic studies reviewed included serum creatinine, blood urea nitrogen, serum electrolyte studies, serum complement concentration, antinuclear antibody, urinalysis, urine calcium to creatinine ratios, urinary protein to creatinine ratio and/or 24-hour urinary protein excretion, renal ultrasounds, intravenous pyelograms, voiding cystourethrograms, and historical information. RESULTS: All creatinine and electrolyte values were normal for age, and none of the biochemical tests obtained in the children with hypercalciuria was abnormal. Of the 325 patients with idiopathic microscopic hematuria, only 18 had abnormal renal ultrasound examinations and 9 voiding cystourethrograms showed low-grade reflux. Hypercalciuria was found in 29 patients. The family history was positive for urolithiasis in 16% of patients without hypercalciuria compared with 14% of patients with hypercalciuria. A positive family history of hematuria was reported in 25% of patients; 62 patients did not have hypercalciuria and 4 of the patients had hypercalciuria. Microscopic hematuria in children is a benign finding in the vast majority of children. CONCLUSIONS: Our data demonstrate that a renal ultrasound, voiding cystourethrogram, cystoscopy, and renal biopsy are not indicated in the work-up of microscopic hematuria, and microhematuria in the otherwise healthy child is a minimal health threat, rarely indicative of serious illness.

Adolescent↗
PubMed1996

Content analysis of prime-time television medical news. A pediatric perspective.

OBJECTIVES: To assess child health news broadcasts by a major regional television station and to evaluate the attitudes of parents and pediatricians about the context and value of television news reports. DESIGN: Videotaping 6 months of consecutive evening news telecasts (Monday and Friday). Self-administered surveys given to a convenience sample of parents and mailed to community pediatricians. SETTING: Local and national newscasts of prime-time coverage by a major metropolitan television station. PARTICIPANTS: One hundred forty-four members of the Buffalo (NY) Pediatric Society and 87 parents of children in the outpatient or inpatient departments of The Children's Hospital, Buffalo. RESULTS: Pediatric issues were presented in 15% of local and 21% of national medical news stories. Adult-specific issues were addressed in 48% of local and 33% of national medical news reports. Local pediatric news reports focused on behavior (22%) and major illnesses (22%); national pediatric news concentrated on nutrition (30%), allergy (21%), and major illnesses (21%). Seventy percent of local and 85% of national pediatric news reports referenced an informative source. Fifty-one (59%) of the 87 parents and 69 (48%) of the 144 pediatricians consider television news to be an effective means of increasing awareness of child health issues. Parents and physicians recommended pediatric emergencies, safety, disease prevention, and adolescent issues as important areas of emphasis for television news. Fifty-one percent of the parents (44) and 48% of the pediatricians (69) believed that television reports increase knowledge of how to access local health resources. CONCLUSIONS: Television news reports are important sources of child health information. Pediatric topics on local and national news programs often do not focus on topics considered of highest priority by parents and pediatricians. Greater awareness by pediatricians of the potential value of television news as a tool for public health education is warranted.

Adult↗
PubMed1996

Oral calcium loading test and response to diuretics in normal Taiwanese school children.

To investigate possible mechanisms of increased urinary calcium excretion and increased prevalence of urolithiasis in 16- to 20-year-old children, oral calcium loading and diuretic tests were performed in 120 normal children in three age groups (7-8, 12-13, and 17-18 years of age). Urinary calcium/creatinine ratios and 24-h urinary calcium excretion were significantly increased following the oral calcium loading test in 17- to 18-year-olds compared with the two younger age groups. Oral furosemide resulted in increased urinary calcium excretion in the 17- to 18-year age group, while hydrochlorothiazide was less effective in reducing urinary calcium excretion in this age group. These results suggest that increased intestinal calcium absorption and decreased renal tubular reabsorption of calcium in 17- to 18-year-olds may be contributing factors in the increased prevalence of nephrolithiasis in older Taiwanese children.

Acetazolamide↗
PubMed1996

Clinical approach to children with urolithiasis.

Urinary stones are being recognized more frequently in children. As a result of major advancements in the urological therapies available to children with obstructed uropathy, infection-related stones no longer dominate the clinical manifestations of pediatric urolithiasis. Clinical manifestations of urolithiasis in children differ somewhat from adults and change during childhood. Causes of urolithiasis in children are remarkably similar to those of adults, although diagnostic criteria frequently vary throughout childhood. Hypercalciuria is the most common metabolic cause of pediatric urolithiasis. This article presents a general overview of urolithiasis in children and a practical approach to the medical evaluation of such children.

Age of Onset↗
PubMed1996

Prolonged hypocomplementemia in poststreptococcal acute glomerulonephritis.

Complement levels conventionally return to normal in eight weeks in patients with poststreptococcal acute glomerulonephritis (PSAGN). The objective of this study was to determine the significance of prolonged hypocomplementemia (> 8 weeks) in this group of patients. Between April 1993 and January 1995, 20 patients were followed prospectively for a mean of 6 months (range 3-20 months after the episode of PSAGN. Serum C3 concentrations were measured at diagnosis and at regular intervals. Five patients (26%) had prolonged hypocomplementemia. Percutaneous renal biopsies were performed in three patients which revealed findings consistent with the clinical diagnosis of PSAGN. All of these patients showed gradual improvement of their symptoms; some have persistent microscopic hematuria without proteinuria. Kidney function is normal in all despite hypocomplementemia. We conclude that hypocomplementemia (> 8 weeks) with resolving features of acute glomerulonephritis does not exclude the diagnosis of PSAGN, and a renal biopsy may be deferred if there is clinical improvement.

Acute Disease↗
PubMed1995

Integration of community pediatricians into an academic department.

A process of enhanced participation by community pediatricians in the programs and administration of an academic department is described. We realize that many departments incorporate volunteer faculty into their academic programs without creating a specific structure, such as our divisional classification. The customary paradigm of providing "ad hoc" opportunities and responsibilities for volunteer faculty is somewhat analogous to the traditional "quality assurance" model of management, which is responsive in nature and places the participants in a dependent relationship to the academic leadership. Creating academic division structure allows the volunteer faculty to initiate projects, create interdivisional work teams, and evaluate the results of their involvement and is more reflective of the new "continuous quality improvement" model. This system elevates the volunteer faculty into a partnership relationship with the academic faculty. The sense of ownership and opportunity for personal growth appear to be important drives for sustained community involvement. Although the benefits of our program appear promising, committed leadership within the academy and community will be required for long-term success. Re-analysis of the intramural dynamics and activities following systemic restructuring of the health care system will be of interest.

Community-Institutional Relations↗
PubMed1994

Urinary mineral excretion among normal Taiwanese children.

Prompted by a large population of children with renal stones seen in 20 of our country's teaching hospitals over the past 10 years, this study of urinary mineral excretion in normal children was performed. Fasting urine from 1,072 normal Taiwanese school children and 24-h urine collections from 125 children separated into three age groups were analysed for calcium (Ca), phosphate, magnesium (Mg), uric acid, sodium (Na) and creatinine (Cr). Fasting Ca/Cr ratios were not different between the sexes. Ca/Cr ratios were higher in the 17- to 18-year age group as were 24-h urinary Ca excretions. Urinary Mg/Cr ratios were higher in girls than boys and 24-h urinary Mg excretion was highest in the younger age groups. Urinary Mg excretion in Taiwanese children is 54%-86% lower than previously reported in Caucasian children. Both uric acid/Cr ratios and 24-h urinary uric acid excretion were highest in the youngest children. Urinary Na/Cr ratios and 24-h urinary Na excretion were higher in the two younger age groups. There was no correlation between 24-h urinary Ca and Na excretion.

Adolescent↗
PubMed1994

Applying decision analysis to management of adolescent idiopathic nephrotic syndrome.

Due to the concern that adolescents presenting with nephrotic syndrome are less likely to have minimal change disease than younger children, pediatric nephrologists have tended toward renal biopsy-tailored treatment rather than corticosteroid use in this population. The need for biopsy prior to treatment of nephrotic syndrome in adults has been challenged. A similar challenge to the clinical need for this procedure in adolescents with idiopathic nephrotic syndrome is raised here. The principles of medical decision analysis were applied and calculations were made with the Decision Maker computer program. The life expectancy of an adolescent who receives biopsy-tailored treatment was found to be no different from that of an adolescent who receives empiric corticosteroid treatment. We conclude that renal biopsy is not mandatory for the clinical management of adolescents with idiopathic nephrotic syndrome. Prognostically, a response, or lack thereof, to empiric corticosteroid therapy may be just as informative as a histological diagnosis.

Adolescent↗
PubMed1994

Hematuria associated with hypercalciuria and hyperuricosuria: a practical approach.

Hematuria is one of the most common urinary abnormalities found in children. When hypercalciuria was identified as a potential etiology of painless hematuria, many questions arose concerning the general importance of this observation. Subsequently, increased uric acid excretion also has been purported to cause hematuria in children. This review traces the history of these observations and describes the clinical characteristics of the clinical syndrome of hematuria associated with hypercalciuria and hyperuricosuria. Diagnostic criteria of excessive urinary excretion of calcium and uric acid are reviewed; differences in urinary calcium and uric acid excretion between infants and older children are emphasized. Aside from urolithiasis, few long-term consequences from hypercalciuria or hyperuricosuria have been identified, although some debate exists concerning the effect of chronic hypercalciuria upon bone mineralization.

Calcium↗