DXS V L S I m m EFLUX (WR) C-IAlC
Wl'lTl
I ~ ~ I C PRESSW
A L
(FA')? B o t t i n i , E.E. B m m Awes,
With this purpose 14 piihents wltli 1uxz.m W R were s t u d i f d witil ur-c
r a h o l c g y . E v a l u a t l q IVP ~ i r n u 1 m - i ~
~ t h d o l ~&
& ~miwlth tliic of appearanoe of VUR: 1) while blackkr f i l h n g ( i n the f i r s t o r
s e c d h a l f ) , 2 ) with t k p r e s e n e of urunhiblted contractions (El, 3)
durirnj voiding, 4) i n t h e p b ~ c t u r i t i o n(PM). It a l s o was qucated i f
t i e W R was i n t e r m i t e n t o r pnnmer~t.Ncrr of t h e p a t l e n t s e v d w t e d hrd.
m u r a j e l u c bladder o r urinary t r a c t & t r u c t i o n . A l l had urinaq t r a c t
l n f e c t l m being t h i s t h e reascn f o r t h e urcdynamic study. A l l t i e
p a t i e n t s were f f n u l e s betmen 2 and 15 years of a c ~ .14 p a t i e n t s , 28
r e n a l units, VUR was detected I n 19 u n i t s : G i n t h e f i r s t Iwlf of bladder
f l l l i r n j , 7 i n the seccnd h a l f , 0 d u r m g UC, 1 while v o l l n q , and 5 I n t h e
IM
' . 7 here prm3ncnt and 12 i n t e n n i m t . Of t h e 12 l n t e r m i t e n t : 6 whlle
f l l l l n g , 1 durlnq m c t u r l b o n , and 5 i n the PM. Of the 7 pfrnwnent: 5 i n
t h e f ~ r s iwlf
t
of bladder filling and 2 i n the s e d h a l f . man the data
[Xescntfd l t i s c l e a r t h d t WR dces not c o r r e l a t e with high bladckr
pressure durlny rmcturition o r LK, sliaring t h a t VUR can
a t my
n m t of U-r x s i c a l cycle. VLn? i s a r a d i o l o g i c siijn of ti^ incmnpetcna:
of t h e v e s l c a r e t e r a l j u n c b o n , ad t h l s i n c q t e n c e m y he 1 s lmre
relato3 t o the rmgrabon of tir wall of the cleietrusor n u c l e of the
bladder during canpliance o r m c t u r i t i o n . From an hydraulic p i n t of
view, u r e t e r a l f l l l l n g during
should deperd on 3 interdepfndent
f a c t o r s : 1) t l e ccqetenoe of the v e s i c o u r e t e r a l junction, 2) the
u r e t e r a l c a r p l l ~ n c e ,3) u r e t e r a l ~ r i s t a l b ca c t i v i t y . With this
c r i t e r l a i f a p i r d r s inconvenient to c l a s i f v VUR accordlnq to the u r e t e r a l
f i l l i n g k w & f t h l s i s nothing n n m thm -the r & o k y ~ c - e v l & n e of Che
i n t e r r e l d b o n of t h ~ s e3 f a c t o r s ur3ulaun by this m t k d o l c x y .
1L
CC13FIEENIW8 FCOD PKGRSl (fXIP) CN 1 F . I NUTRIrTICN S'IRWS
rK INFANTS. tiertr~l;rpf, E . ; Plzarro, F. ; Veqa, V.; Cliddu3,P.
and L l a p m , S . Institute & ~ u t r i c i by T k m l c q i a de l a s Almcntos,
Unlversldad & Q i l l e , C s s i l l a 15138, Santiago 11, Qllle.
1rcn b i c a v a h b i l i t y f r a n an l n f a n t formula (LPM) (I+ 5 q / L ; ascorbic
a c i d 50nrjfiG was e x m n e d l n 11 a d u l t wcnen u s i q the extrinsic
r a d i c n c h x tag m t h c d . The g e m t r i c m a n absorption f r a n t h e fomiula
was 13%. The e f f e c t of t h i s formula on i r o n n u t r i t i o n i n l n f a n t s was
s t u d i e d i n 43 healthy t e r n i n f a n t s w e a d s
p
~
l k f yo r e 3 nontiis
of age ad who r e e l v e d the formula u n t l l 9 rmnths of n i p . For c o n t r o l ,
55 m i a n t s r e c a v e d the milk wiu& is k i n g & l i v e r y through t k NQ1'
(whole p e r , non f o A f l e d m l k ) ( I P ) and 45 i n f a n t s were f e d a nuLk
fornula lrrm f o r t i f i e d (Fe: 15 q / l ; ascoi+nc a c i d : 100 rrrj/L) (LT)d l l c h
has k e n shuvn to be effective i n p r e E n t i n q l r o n ckflclency. llenrxjlcbln
(Ibj, m a n corpuscular volunrn ( D )t,r a m f e r r i n s a t u r a t i o n (Fe/lL3C),
frrul e r y t h r c q t E p r o t o p o q h y r l n (FIIP), and serum f e r r i t i n (SF) d e t e m r r d
a t 9 rrnnths of age are m m a r l z e d k l w :
Ib (rj/dlj
VCM(f1) FEP (uq/dl)
F e / K (a)
SF* (ug/l)
Group
12.64(0.85)
72(3)
99(25)
14.616,4,
15(8-27)
0.05
0.005
NS
NS
0 .001
ILM
'
12.23(1.09)
75(6)
88(30)
15,1(7,2)
6(2-lU)
p
NS
0.0001
0.0005
NS
0.001
U
11.88(1.15)
69(6)
129(68)
(5-18j
12,3(7,0j
*Gfurctrlc rre~mand a Limit of 1 SD.
ms rrw f o m l a IIPM) improved l r o n nutrition s t a t u s i n i n f a n t s . Tnis
e f f e c t can te Increased hy a&ng an e x t r a a n m t of I r o n to the formula.
U.'
p
13
m r u l l 6 , J.
NATIW
C
C
M
F PWO~ p~
m (PW) IN auu:
MEJABoLIC SIVDILS. Barrera G.; C a b l l o C.; Jarpa, S . ;
m. U.
of h l e .
Nltrajcn, f a t Jnd c a l o r i c retention w e r e rrraured lri 10 male infants
r e w v e r m g f r a n rrarasmic m l n u t r i t i o n when fed e l t h e r LP o r LPM. Subjects
e r e 6 . 8 mtk o l d on average and had a WA
/ r a b o of 72% and. d W / i l r a t l o
of 95% of the NolS stardard.lhcy went through two consecutive h l a n o c
pcriods of 6 days each ( 3 days f o r a d a p t a h o n and 3 days f o r urlircl a r i i
feces c o l l e c t i m ) . Caloric denslty of both formulas was 85 Kca1/100 ml
wlth 13%of c a l o r i e s f r m p r o t e l n i n IP ard 11%
I n LPM. Calorlc intake,
a b s o q ~ t i o nand r e l a u v e r e t m b o n was s h @ t l y and not s i q u f i w n t l y
g r e a t e r m t h LPM than LP. Fat lntake was q r e a t e r with IPM (5.4 gr/kg/d;iy)
tha? with IP (4.2 qr/kg/dia) ( ~ ~ 0 . 0 2 5 Tnls
)
resulted l n siyruficabve
d i f f e r e n c e s i n f a t absorption (LPM: 4.3 gr/kg/day; LPM: 3 gr/kg day,
p c 0 . 0 0 2 5 ) . N i t r q e n intakf was s i i j r u f i c a n t l y l e s s with IPM 1487 q/kij/
day) than with IZ (571nq/kg/day) (p (0.0025) w i t h a g r e a t e r urinary
nitrorjen excretion f o r LP (417 mg/ky/day) than f o r LPM (304 q b q / d a y )
(1' <0.001) . m n t nitr-n
r e m t l o n f o r IR4 was on average 115 ty/kg/
&y a d f o r LP m l y 68 mg/kg/day. lhis h f f e r e n o e was not s l p f i - t i v e
Ircaus wick individual v a n a t i o n . h r the s h o r t period of the sturiy no
difference was detected I n biochemical o r a n t h u q x m t r i c i d c d t o r s of
n u t r l t l o n a l r e l a t e d t o the f e f l n g of I2 o r LPM.
.
FORKlIATICN CE AN I N F m FCOD FOR l1E NATIONAL PKCGIOlM OF
~ ~ F E u ) M G . K ~ ~ ~ , J . ; ~ ~ P s
m a , F. I n s t l t u t o c!e W u t r i c i k y E c . dc l o s I \ l i n ~ n U~. ,
14
ck Qllle.
A milk bjsed l n f a n t food was f o m l a M f o r 0-12 m t h s o l d i n f a n t s to
replaoc @red
a ' s milk wtuch 1s h s t r i b u t e d by
NaUonal Frogran
of Carplcnmtary Feeding of t h e Mlnistery of Health. Tne Prorjrm supplies
2 krj/month of whole @red
m i l k to *s
papulatlon of i n f a n t s a d t h l s
mans. tllat i n sonr cases the p r o t e l n providtci i s higher than 200'6 of t l ~
reamnmckd d a l y d i e t a r y a l l c w ~ n c e sbile in o t h e r cdsfs t h e ererTy
supply reaches m l y 50-608 of t i e RDA. lhis f a c t l e d us to dfvelop a
rmre balanced fornula but with a similar c o s t of whole W r c d
rw
milk f o r this age group. The rw f o m l a has t h e f o l l m l n q n u t r i t l m l
c h a r a c t e r ~ s b c s :casein/wtey p r o t e i n : 40/60; h q h l y d i g e s t i b l e f a t s , an
wlth excfllemt
c p t i m m l e v e l of e s s e n u a l f d t t y aclds; ca&&ydrates
d i g e s u i l i t y ; vltarruns ard minerals; the p r o t c i n and c a l o r i c s q 2 l y c m
be e a s i l y M u l a t e d betkeen 1.5- 2.25 g/100 cc and 50-75 Kw1/100 c c
res[iectlvely; x k q u t e r e n a l s o l u t e lcad (105-106 nl)snl/lt). A st*
of
t i e t e c h m c a l and ecananical f e a s i b i l i t y was dorr i n o r k r to assure tiiat
a l l the previous c h n r a c t e r i s u c s wre present within the mt l m t l a l l y
set as o b ~ e c t l v e .l h l s was confitnrd when the m n i s t e r y of llealtll ailed
f o r d public proposal to produrn 40 Ton of t i u s i n f a n t f o m l d to use ~t
l n a f i e l d st*
( h u t 3000 ~ n f a n t s ) .'This pr-al
was *rsn by an
inporLmt l o c a l milk industry and the ccst of t h e p r d u c t was 80% of Uie
c o s t of whole m i l k . A s h e l f - l l f e was carried. c u t wlth t h i s i n f a t f o m l a
t o dt.terrmne Its optunun S t d b l L l t ~ .
GUCCOFTICOIDS TIC13 ADRENAL ANDIb3CJ;TJ FUNCTICN IN PEDIATRIC
PATENTS WInt LWD dSiXE HENAL DISXiE (ESIUI) . F c r r a r i s J.
R. ; R a m i r c z , ~ . ~
; .Goldkrij, V. ; Rivarola,M. Dto. ~i&a&;aHospital Itallanc-BwnOs Aires, Argentina.
15
Cclayed gon&l and/or adrenal p u l r r t y i n d u l d r e n with ESFC ~ s t l c s
p a t l e n t self-estrem and h a r r p r r c h a b l h t a U o n . Data d e t a l i r n j &ml
puberty l n p a U e n t s wlth ESFC are n o t a v a l d b l e . For t h a t redson 26
p a b e n t s (16 m l e ; 10 fennle) who were tetkeen 6.5 and 22.5 years of age
(rrean: 14.5) were s t u h e d . E n p a b e n t s were pre-puberul, 8 pubertal and
8 post-puber-1.
A l l of them here wi c h r o m c M a l y s l s . The Tanner
stages (pubic h r &velqment) were delayed i n 56% of p d t l e n t s . Serum
cortisol (C) was l n a r a s e d m a l l , b u t 2 p a h e n t s . Serum n 4 a n d r o s t e d o w ((04) was n o m l I n a l l b u t 2 p a t l e n t s . Scrum
&hydroeplandrosterone s u l f a t e (DS) was mcreased ~ _ n6 o u t of 11 prepubertal and p u b e r t a l m h s .
age s h o ~ da p s l t l v e m r r e l a t l o n wlth
DS (r-0.53; p < 0 . 0 0 5 ) . Serum Am1 was normal. A r e d u c U m of 50% I n C
a d 78% I n DS was found a f t e r ckxarethasm suppression (DX) , but A4 h d
not suppress p s t DX. PCIII s t u n u l a b m t e s t mcreased C by 50% and A 4 by
80%, b u t no stLmulaUm wds observed i n DS. CCNCWSICNS rn r e h a t r l c
p a b e n t s and young a d u l t s with ESRD, wf f o w d : 1) Increased
l e v e l s and
p a r t i a l DX resistance of p l t u t ; u y - a d r e m r t i c a l a x i s , s l r m l a r to t h a t
f
d i n C b h i n g ' s &sea=
o r m s t r e s s ; 2) Wlayed d e ~ l q r r c n of
t the
androgen prcduclnq zcna r e t l c u l a r i s , suggested by the lack of r e s p n s e of
DS t o ACTII; 3) Ihe d i s s o c i a t i o n k e m n C and a d ~ n a ancbqens
l
obsemd
1s m n s l s t e n t with the e x i s t e m of & f i e r e n t rrecfianisms of c o n t r o l f o r
C
functions'
~
~
I
UREMIC
?
C SYNDR3E: EARLY
HENAL LESICNS AND LYIE
The h l s t o l c r j l c a l s t u d i e s and c l m c a l h i s t o r i e s of 60 p a t i e n t s with
l l m l y t l c Urcrmc Syndrorre (HUS) f o l l m d up a t the Q l i l d r e n ' s l l o s p ~ u lo i
Corddx City IArgenbne) bebeen 1965-1982 were reviewed. Hlstologlcal
s t u h e s were p r f o d with b i q s y specinens l n 54 cases and with
necrcpsy spcim?ns 111 the o t h c r 6 . I n a l l cases the s t u h e s *re
p e r i o d during t h e f i r s t four d
s of the h s e a s e . I n 47 cases (78.3%)
t y p c a l thranbotlc m i c r m g i c p ; i U c l e s l a n s (MATR) were f o d ,
wiilk I n
t h e another 13 cases (21,6%) the l e s i m wfre w s ~ e c l f i c .I h e leslons
were e l a s s i f l e d i n t o threee g r q s : W E I : those cases wltll Eccal Enn'rR
o r i n e s p e c i f l c l e s i o n s ( 4 1 , 7 % ) ;W E 11: those cases with h f u s s e MATR
(36,641 and TYPE 111: thase cases with d i f u s s e MATR m n p l i c a t e d wlth
m r t i w l necrosis o r vascular damge (21,681. Fourty three p a t i e n t s here
r e - e d r r d with c k n i c a l and l a b o r a t t o r l e s t e s t s during 1983. l w n t y
three of Urem here cured wlnle the another M n t y shohed sm r e n a l
s e w l a ? . Ihi-n
had p r o t e l n u r i a , b m a r t e r i a l h y p r t e n s i o n and f l v e
d u o r u c r e n a l f a i l u r e . Heallng was observed i n 658 of the p a b e n t s wlth
lesions ' W E I , l n 34,7 of the p a t i e n t s with l e s i o n s TYPE I 1 and i n 0%
of t h e p a t l e n t s with l e s l o n s TYPE 111. Ihe p a t l e n t s with l e s i o n s t y l x I
o r I 1 only s h m d p r o t e i n u r i a a s r e n a l secllelae, b u t those wlth lesions
type I11 developed p r o t e i n u r i a , a r t e r i a l hypertension and o r c h r m c
r e n a l f a l u r e . We mnclude thdt the p r e s e n t h i s t c p a t o l o g i c a l
c l a s s i f i c a t i o n of the e a r l y r e n a l l e s i o n s are u s e f u l l r or&r to pre&ct
r e n a l h g e i n l a t e p e r l c d of the disease. a r m c r e m l f a l u r e d e p n c k
M the presenoe of m r t i c a l l r c r o s i s o r vascular dam-.
~
~
,
s