Home collection of urine specimens - boric acid bottles or Dipslides?

Article Abstract:

Urinary tract infections are frequent occurrences among children, requiring cultures and sensitivity studies to determine the causes. The collection and delivery of an appropriate specimen with which to conduct these studies is not always easily accomplished. Sterile midstream specimens of urine (MSSU) are required. These can be collected into urine collection bottles with added boric acid (final concentration 1.3 percent) or with the use of Dipslides, a commercially available product for the estimation of bacterial counts in urinary infections. The latter was available as a "dip" into the collected urine, or as a "stream " sample, which is held in the stream of urine being passed, the excess shaken off, and then sent in. The study tried to establish which of the three methods would provide the most accurate results when used at home compared to specimens collected in the hospital with careful supervision. One hundred seven patients in the outpatient renal clinic participated in the program, and sterile MSSU were collected in the clinic and stored in the refrigerator. Parents were instructed in collection and delivery procedures for the home-collected specimens. One hundred patients provided MSSU and Dipslide specimens; the remainder did not comply and were excluded from further participation. Sixteen others were excluded because the initial MSSU were contaminated. The study group eventually involved both appropriate specimens from 84 children. Delivery times by mail varied from one to seven days. Seventeen Dipslides were received with one or both of the media detached. Others (36) were either unsterile or otherwise unacceptable. The positive rate with the Dipslides was frequently equivocal, with bacterial counts bordering the limit of infection, 105 cells per ml of urine. Neither method was totally satisfactory in identifying or excluding significant urinary tract infection. The method to be used must be determined by the circumstances for each patient. (Consumer Summary produced by Reliance Medical Information, Inc.)

Analysis, Product/Service Evaluation, Medical examination, Collections and collecting, Diagnostic specimens, Urine, Urinalysis, Dipslides (Medical test kit)

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Serial 99m Tc dimercaptosuccinic acid (DMSA) scans after urinary infections presenting before the age of 5 years

Article Abstract:

A DMSA scan is an imaging technique used to observe scarring and other damage to the urinary tract. These scans were used to trace the course of urinary tract infections in a group of children under the age of five. Urinary tract infections can frequently lead to scarring and eventual dysfunction of the kidneys. DMSA scans were performed on 49 kidneys in 40 children with confirmed, symptomatic urinary tract infections. A follow-up scan was performed on each of the children to monitor the changes in the damaged tissues. The children studied showed varying degrees of reflux, a backwards flowing of urine into the bladder and kidneys, ranging from Grade 1 to Grade 3. Grade 3 is a serious reflux that causes distension of the tissues. Based on the results of the second DMSA scan, it was noted that 80 percent of the defects noted on the first scan were still present. The authors conclude that where scarring is caused by an early infection, the damage to the tissues is frequently permanent. There was no significant correlation between the degree of reflux and the changes in the condition of the urinary tract, nor was there any correlation between the incidence of new infection and changes in the condition at the second scan. One patient who had a Grade 3 reflux with a new infection showed a deteriorated condition. The study revealed that the degree of DMSA uptake on the initial scan was a useful predictor of the future course of deterioration when only one kidney was damaged. No kidney with a relative uptake of less than 35 percent recovered. Where there was uptake in the normal range (43 to 57 percent), however, it was unclear whether the damage would be temporary or permanent. DMSA may be a useful tool in studying urinary tract infections. (Consumer Summary produced by Reliance Medical Information, Inc.)

Kidney diseases, Medical imaging equipment

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5-HT3 antagonist ondansetron - an effective outpatient antiemetic in cancer treatment

Article Abstract:

Administration of cancer chemotherapy or antineoplastic agents is usually associated with nausea and vomiting. Severe vomiting is often a dose-limiting factor and may influence compliance with the treatment regimen. Most effective antiemetics, drugs used to prevent nausea and vomiting, are given intravenously. There are few effective oral antiemetics; however, researchers continue to search for new drugs. The effectiveness of one new drug, ondansetron, a so-called 5-HT3 antagonist, has been studied in adults and animals. A study was conducted in children with solid tumors to determine its efficacy when given with a variety of chemotherapy regimens. Thirty children ranging from 2 to 16 years were studied. Eleven of 12 children who received the antineoplastic agent carboplatin had a complete or major response to the antiemetic. Among children who received other chemotherapeutic agents, seven of eight who received adriamycin with cyclophosphamide, three of six who received cisplatin, and four of five who received ifosfamide had a complete or major response. The antiemetic efficacy was maintained in the children who received cyclophosphamide and adriamycin, or carboplatin, but not in those receiving cisplatin or ifosfamide. Overall, a total of 27 children, or 87 percent, obtained a beneficial effect on the first day of antiemetic therapy. One concern with the use of ondansetron is the development of transient rise in liver enzymes. This side effect occurred in three patients but was transient. The results of this study are encouraging, particularly since the effects of the antiemetic were present on the first day. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Antineoplastic agents, Cancer, Chemotherapy, Antiemetics, Ondansetron

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