Imaging Studies after a First Urinary Tract Infection in Children

Renal imaging is recommended for children after a first documented urinary tract infection. In this prospective study, 309 children between the ages of one month and two years underwent renal imaging studies (technetium-99m–labeled dimercaptosuccinic acid scanning and renal ultrasonography) within 72 hours after the diagnosis of urinary tract infection, voiding cystourethrography one month later, and repeated scanning six months later. Management was not changed by the finding of ultrasonographic abnormalities (in 12 percent of the children). Monitoring with urinalysis and culture appears to be as effective as imaging studies.

The routine performance of imaging studies in young children after a first urinary tract infection appears to be of little clinical value.

Related Editorial

Intratumoral T Cells, Recurrence, and Survival in Epithelial Ovarian Cancer

The outcome of treatment in advanced ovarian cancer can vary considerably among patients with similar clinical and pathological findings. In this immunohistochemical study of tumors from 186 patients, the presence of T cells within the tumor was strongly associated with a good outcome, whereas the absence of T cells correlated with a poor outcome.

These results constitute strong, indirect evidence that an antitumor immune response has a potent influence on the outcome of advanced ovarian cancer. Similar results in studies of other neoplasms support the thesis that the immune system participates in the defense against cancer.

Related Editorial

Outbreaks of P. aeruginosa Associated with Defective Bronchoscopes

Two reports in this issue describe outbreaks of Pseudomonas aeruginosa infections in hospitals. In both cases an increase in the frequency of pseudomonas infections was associated with bronchoscopy. In one study, isolates from the patients were genetically related to isolates from bronchoscopes that had loose caps on their biopsy ports.

Endoscopes are the devices most commonly associated with nosocomial outbreaks of infection. The outbreaks described in both studies involved bronchoscopes with defects that rendered disinfection procedures ineffective. This experience emphasizes the need for close surveillance for such infections and for better methods of recalling defective medical devices.

Related Perspective

Patient Safety: Retained Sponges and Instruments
This study compared characteristics of patients with retained sponges or instruments after surgery, identified through a large malpractice insurer, and control patients who underwent the same types of surgery but did not have retained foreign objects. Independent predictors of the retention of a foreign body included emergency surgery, an unplanned change in procedure, and higher body-mass index. Counts of instruments and sponges were less likely to have been performed for patients with retained foreign bodies than for controls, although in the majority of cases, such counts were performed and were recorded as being correct.

The implication of these findings is that specific characteristics of both patients and their surgical procedures are associated with an increased risk of retention of a sponge or instrument. This type of analytic approach may be useful in elucidating other medical errors and suggesting strategies for their prevention.

Suspected Appendicitis
An otherwise healthy 22-year-old woman comes to the emergency department with acute abdominal pain of 18 hours' duration in the right lower quadrant. On physical examination, she is afebrile, with tenderness on deep palpation in the right lower quadrant, and has no peritoneal signs. Pelvic examination reveals tenderness in the right adnexa without a mass. How should this patient be further evaluated?

HOME  |  SUBSCRIBE  |  SEARCH  |  CURRENT ISSUE  |  PAST ISSUES  |  COLLECTIONS  |  PRIVACY  |  TERMS OF USE  |  HELP  |  beta.nejm.org

Comments and questions? Please contact us.

The New England Journal of Medicine is owned, published, and copyrighted © 2009 Massachusetts Medical Society. All rights reserved.