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2014 | 14 | 58 | 258-272
Article title

Ultrasonografia w diagnostyce krwotocznego zapalenia pęcherza moczowego po przeszczepach szpiku kostnego u dzieci

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EN
Ultrasonography in the diagnosis of hemorrhagic cystitis – a complication of bone marrow transplantation in pediatric oncology patients
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Abstracts
EN
Objective: The aim of this study was to evaluate the usefulness of ultrasonography in the diagnosis of hemorrhagic cystitis following bone marrow transplantation in children. Material and methods: The study involved an analysis of clinical material and the results of imaging tests performed in 334 patients who underwent hematopoietic cell transplantation. Ultrasonographic findings in 42 patients with hemorrhagic cystitis were analyzed in detail. The ultrasound images served to assess the severity of hemorrhagic cystitis and the results were compared with the clinical assessment of the disease on the Droller scale, as well as the laboratory and endoscopic tests. Results: In the studied group of patients hemorrhagic cystitis following allogeneic transplantation was diagnosed in 12.5% cases. 73.8% patients received transplants from unrelated donors, 26.2% – from compatible siblings. The study revealed a higher incidence of hemorrhagic cystitis in children above 10 years of age. Grade 3 according to the Droller was diagnosed in 42.9%, grade 2 – in 30.9%, grade 4 – in 14.3%, and grade 1 – in 11.9% patients. The number of ultrasound examinations depended on the clinical symptoms, severity, duration and co-occurrence of other complications following the transplantation and was within the 1–15 range (average: 4.6). Grades 3 and 4 were related to the poor clinical condition of the patients and to their longer hospitalization. During this period there was an increased risk of renal malfunction and acute renal failure, post-inflammatory narrowing of the ureters, hydronephrosis, and in grade 4 the fibrosis of the bladder with reduced bladder capacity. Analyses demonstrated a significant correlation between the ultrasound image of the bladder wall and the clinical severity. Conclusions: Ultrasound with Doppler options remains the primary diagnostic tool in the evaluation of hemorrhagic cystitis, and is useful in terms of its diagnosis, determination of the severity, and monitoring of the treatment.
PL
Cel: Celem pracy była ocena przydatności ultrasonografii w diagnostyce krwotocznego zapalenia pęcherza moczowego, dość częstego powikłania po przeszczepach szpiku kostnego u dzieci. Materiał i metoda: W pracy przeanalizowano materiał kliniczny i wyniki badań obrazowych 334 pacjentów po transplantacji komórek hematopoetycznych. Analizie poddano wyniki badań ultrasonograficznych wykonanych u 42 dzieci z krwotocznym zapaleniem pęcherza moczowego. Na podstawie USG oceniano stopień zaawansowania krwotocznego zapalenia pęcherza moczowego, a wyniki porównywano z oceną kliniczną procesu w skali Drollera, badaniami laboratoryjnymi i endoskopowymi. Wyniki: W analizowanej grupie dzieci krwotoczne zapalenie pęcherza moczowego rozpoznano po transplantacjach allogenicznych u 12,5% badanych, u 73,8% był to przeszczep od dawcy niespokrewnionego, u 26,2% – od zgodnego rodzeństwa. Wykazano częstsze występowanie krwotocznego zapalenia pęcherza moczowego u dzieci starszych, powyżej 10. roku życia. Stopień 3. w skali Drollera stwierdzono u 42,9% dzieci, stopień 2. – u 30,9%, stopień 4. – u 14,3%, a stopień 1. – u 11,9% dzieci. Liczba badań ultrasonograficznych i rozpoznanie zależały od objawów klinicznych, stopnia zaawansowania, czasu trwania oraz współwystępowania innych powikłań po transplantacji i wynosiła 1–15 (średnio 4,6). Trzeci i czwarty stopień wiązały się ze złym stanem klinicznym chorych, a także wydłużeniem czasu hospitalizacji. W okresie tym wzrastało ryzyko uszkodzenia czynności nerek i ostrej niewydolności nerek, pozapalnego zwężenia moczowodów, wodonercza, a w końcowym stadium zwłóknienia pęcherza moczowego. Stwierdzono istotną zależność obrazu ultrasonograficznego zmienionej w przebiegu zapalenia ściany pęcherza moczowego, ze stopniem klinicznego zaawansowania. Wnioski: Badanie ultrasonograficzne z opcjami dopplerowskimi pozostaje podstawowym badaniem diagnostycznym w ocenie krwotocznego zapalenia pęcherza moczowego, jest przydatne w rozpoznawaniu, określaniu stopnia zaawansowania choroby i monitorowaniu leczenia.
Discipline
Publisher

Year
Volume
14
Issue
58
Pages
258-272
Physical description
Contributors
  • Division of General and Pediatric Radiology, Department of Radiology, Wrocław Medical University, Curie-Skłodowskiej 68, 50-369 Wrocław, Poland, tel.: +48 71 784 26 51, ulador@rad.am.wroc.pl
author
  • Division of General and Pediatric Radiology, Department of Radiology, Wrocław Medical University, Wrocław, Poland
  • Division of General and Pediatric Radiology, Department of Radiology, Wrocław Medical University, Wrocław, Poland
  • Division of General and Pediatric Radiology, Department of Radiology, Wrocław Medical University, Wrocław, Poland
  • Division of General and Pediatric Radiology, Department of Radiology, Wrocław Medical University, Wrocław, Poland
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article
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YADDA identifier
bwmeta1.element.psjd-993eb271-e592-4107-aaf7-e8a82771d32b
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