DIAGNOSTIC VALUE OF URETHRAL PROFILOMETRY IN CHILDREN: RECOMMENDATIONS FOR PRACTICAL USE

In pediatric neuro-urology, the method of urodynamic studies – urethra profirometry (UP) – is one of the main ones, but still inferior in frequency to cystometry and uropometry. The main indications for use of the UP method are stress urinary incontinence and a comprehensive examination of neurological patients. The long-term focus of the UP results has been on decreasing the closure function of the urethral sphincter. The article summarizes the material on the application of the UP method in children, describes the techniques, indications and possible results of the research on the practical significance of the reduction of intraurethral pressure, its high rates and instability.

Evaluation of Velopharyngeal Closure Function With 4-Dimensional Computed Tomography and Assessment of Radiation Exposure in Pediatric Patients: A Cross-Sectional Study

Objective: Some patients with cleft palate (CP) need secondary surgery to improve functionality. Although 4-dimensional assessment of velopharyngeal closure function (VPF) in patients with CP using computed tomography (CT) has been existed, the knowledge about quantitative evaluation and radiation exposure dose is limited. We performed a qualitative and quantitative assessment of VPF using CT and estimated the exposure doses. Design: Cross-sectional. Setting: Computed tomography images from 5 preoperative patients with submucous CP (SMCP) and 10 postoperative patients with a history of CP (8 boys and 7 girls, aged 4-7 years) were evaluated. Patients: Five patients had undergone primary surgery for SMCP; 10 received secondary surgery for hypernasality. Main Outcome Measures: The presence of velopharyngeal insufficiency (VPI), patterns of velopharyngeal closure (VPC), and cross-sectional area (CSA) of VPI was evaluated via CT findings. Organ-absorbed radiation doses were estimated in 5 of 15 patients. The differences between cleft type and VPI, VPC patterns, and CSA of VPI were evaluated. Results: All patients had VPI. The VPC patterns (SMCP/CP) were evaluated as coronal (1/4), sagittal (0/1), circular (1/2), and circular with Passavant’s ridge (2/2); 2 patients (1/1) were unevaluable because of poor VPF. The CSA of VPI was statistically larger in the SMCP group ( P = .0027). The organ-absorbed radiation doses were relatively lower than those previously reported. Conclusions: Four-dimensional CT can provide the detailed findings of VPF that are not possible with conventional CT, and the exposure dose was considered medically acceptable.

Early experience with four-dimensional computed tomography for observing velopharyngeal closure function in pediatric patients and the evaluation of the exposure dose

Background The aims of this study were to perform a four-dimensional assessment of velopharyngeal closure function in pediatric patients with cleft palate using 320-row area detector computed tomography (CT), and to estimate the organ-absorbed doses using Monte Carlo simulation. Methods We evaluated CT image data obtained between July 2018 and August 2019 from five pediatric patients with cleft palate (four boys and one girl; age range, 4–7 years) at Fujita Health University Hospital. The presence of velopharyngeal insufficiency (VPI), patterns of velopharyngeal closure (VPC), and cross-sectional area of VPI were evaluated. In addition, organ-absorbed doses were assumed in the Monte Carlo simulation. However, we did not perform statistical analysis because of the insufficient number of patients enrolled in this study. Results The existence of VPI and hypernasality were completely concordant. The VPC patterns were circular (two patients), circular with Passavant’s ridge (one patient), and unevaluable (two patients). The organ-absorbed doses were relatively lower than those in past reports. Conclusions Our method could be an alternative for patients who refuse the conventional nasopharyngoscopic evaluation.

Treatment of patients with a duodenal ulcer with disorders of the motor evacuator function of the stomach and duodenal

Aim. The study of disorders of the motor-evacuation function of the stomach and duodenum (duodenum) in patients with duodenal ulcer and their use in choosing effective therapy.Materials and methods. The study included 107 patients with ulcerous duodenal ulcer with the presence of motor-evacuation disorders of the gastroduodenal zone — group I and 99 patients with ulcerous duodenal ulcer without a violation of motor-evacuation function of the stomach and duodenum — group II. Anamnestic and physical data, results of X-ray and endoscopic examinations were used in verification of the ulcer. Assessment of the motor function of the stomach and duodenum was carried out using the gastroenteromonitor GEM-01 “Gastroskan-GEM”. Depending on the treatment method, patients with ulcerous duodenal ulcer of group I were divided into 2 groups: observation group — 52 patients with ulcerous duodenal ulcer of the duodenal ulcer received 50 mg 3 times a day prokinetic itopride hydrochloride as a part of complex anti-ulcer therapy and a comparison group — 55 patients with ulcerous duodenal ulcer underwent standard antiulcer therapy.Results. In the observation group after treatment, pain disappeared in 90.0% of patients, decreased in 10.0%. In the comparison group, pain completely disappeared in 18.8% of patients, decreased in 76.6%, remained unchanged in 4.7%. Against the background of treatment in patients of the observation group, the frequency and amplitude of the stomach and duodenum corresponded to the normokinetic type of curve. When using itopride hydrochloride in the treatment of patients of the observation group, restoration of the closure function of the pylorus was revealed. After the treatment, the ulcer healed in the observation group in 97.8% of patients (in 88.2% of cases at the stage of a high-quality “white” scar); in the comparison group, ulcer healing occurred in 94.5% of cases, of which in 67.1% — in the stage of poor-quality “red” scar).Conclusion. The use of the prokinetics of itopride hydrochloride as part of complex therapy increases the effectiveness of the treatment of ulcerative duodenal ulcer by restoring the motor-evacuation function of the stomach and duodenum.