11 LeES VESICXJURETERAL (VUR) CCRREIATE WI'Ill INl'RAVESlCAL PRESSUl1E ( IVP)? Bottini, E.E. Bue nos Ai r e s, With this purpose 14 patients wi th krown W R were s tudied wi th urcdynamic rrethcrlolCX]Y and sinultaneous radiolCX]Y. Evaluatin:J IVP sinul taneous ly with tine o f appearance o f VUR: 1) wnile bladder filling (in the fi rs t or secClrl half), 2) with the presence of uninhibited contractioos (OC), 3) duri ng voiding , 4) in the pestmic t uri tien (PM) . It also was quoated if the VUR was i ntennitent or perrranent. . Ncoe o f the patients evaluated had neuroqeni. c blirl:ler or urinary tract chstructien . All had urinary tract i nfectien being this the reascn fa r the urcdynamic study. Al l the patients were ferrules between 2 and 15 ye ars o f age. 14 patients , 28 renal units , VUR was detected in 19 units : 6 in the fi r st half of bladder f illing , 7 in the seccnd half, 0 during OC, 1 wni le vo i ding , and 5 in the PM. 7 wer e pe rmanent and 12 i ntennitent . Of the 12 intennitent: 6 wnile fil ling, 1 during micturition, and 5 in the PM. Of the 7 permanent : 5 i n the first half o f bladder f illing and 2 in the seccnd half . Fran the data presented it i s clear that VUR does not correlate with high bladder pr essure d ur ing micturi tien or OC, shewing that VUR can appear at any m::m=nt o f the vesaca l. cyc le. VUR i s a radio lOJ i c s i gn o f the in=rpetenee of the ve siccureteral junction, and this i ncanpetence may be i s ITOre re lated to the migration of the wall of the detrusor miscte o f the bladder during carpliance or micturitim. Fran an hydraulic po int of v iew, ureteral filling during VUR should depend 00 3 interdependent f a ctors: 1) the crnpetence of the ve s i c ouretera l junction, 2) the ureter a l carpliance, 3) ureteral peristaltic activity. With this c r i teri a i f appears Lnconveni.ent; to clasify VUR accordanq to the ureter al filling because this is nothing ITOre than the radtoloqi.c evidence o f the Interre.latfon of these 3 factors unkno.m by this methodo.loqy , EFFECT CF A NEW INFAm' FOIMJLA TO BE USED IN A NATlOOAL <XM'IEH:Nl'ARY FCDD PRXRl\M (NCFP ) Ctl llO-l WI'RITI Ctl S'TA'JUS IN INFAlfl'S. Hertranpf , E . ; Pizarro, F . ; Veg a , V. ; Q lad ud, P. ard LlaCJlID?, S . Instituto de Nutricion y TecnolOJia de l os Alirrentos , Uniwrsidad de Cnt Ie , casilla 151 38, santiago 11, Chj.Ie , 12 Iren bioavai labi lity fran an infan t f oIlllUla (I PM) (Fe 5rrq/ L; ascorbic acid 50rrq/L) was examined i n 11 adult wcrren us i ng the extrinsic r adicu c tive tag rrethcrl. '!h e geane tric nean absorptioo fran the f onnula was 13%. '!h e effect o f this f onmla on iren nutritim in i nfants was studied i n 43 he althy term infants weaned spootaneous l y before 3 months o f age and who reeei ve d the fonmla until 9 rronths o f age . For control , 55 inf ants received the milk wni c:h is being de live ry thro..>gh the NCFP (whole pa.er, ncn f ortifi ed mi lk) (IP ) and 45 infants were fe d a mi lk f ornula iroo fortified (Fe: 15 nq/l; ascorbic acid: 100 rrq/L) (LF) \J uch has been sho.m to be eff e ctive in prewnting i ron deficie ncy. lielr03 l<..bi n (Hb) , rrean corpuscular vo l urren (H:II) , tzensferr.tn saturation (Fe/IBC), free e rythrocyte prot:qx>q:hyrin (FEP), ard serum fe=iti n (SF) detennined a t 9 rrontlls o f age are sumnarize d beloo : Group Hb (g/ d l) lICM(fl) FEP (ug/dl) Fe/IBC (%) SF' (ug/l ) 72( 3) 99(25 ) 15 (8-27) 14 . 6( 6. 4) NS 0.0 05 NS 0.001 75(6) 88 (30 ) 15.1 (7. 2) 6(2-18) NS P NS 0 .00 01 0 .0005 0. 00 1 IP 11.88(1.15) 69 (6 ) 129 (68) 12.3(7.0) 10 (5- 18) 'Gearetric rrean and a limit o f 1 SO. '!his new forma.La (IPM) inprowd iron nutrition status in infants. '!hi s effect can be increased by adding an extra arro..mt of iron to the fonn ula . LF P IPM 12 . 64 (0.85) 0 . 05 12. 23 (1. 09) NlJI'RITICNAL CUALITY OF A NEW INFANT FORMJIA (IPM) FOR '!l IE NATICtlAL CXMPIHENTARY FCX:D PRXRl\M (PNAC) IN OllIE: METABOLIC ·SWDIES. Barrera G. ; Catillo C.; Jarpa, S. ; Ruimallo, J . llm'I . U. o f QUle. 14 de Ol ile. A milk based infant f ood was fo mulated for 0- 12 m:nths o ld i nfants to repl ace p<J\'odered COr/' s milk wnich i s distributed by National Pr ogram of Q:npIerrentary Feeding of the Ministery of Health. '!h e Program SlWlies 2 k g/m:nth o f whole p<J\'odered mi lk to this pcpulatien o f infants and this neans that in sane cases the protein p rovided is higher than 200% o f the reccmrended daily dietary a llooanoes wni le in other cases the energy supply reaches enly 50-60% of the RIlA . '!his fact led us to de ve lq:> a new ITOre balanced f ormrka b ut wi th a similar CXlSt o f whole p<J\'odered mi lk for this age group. The new f ormula has the f ollewing nu tri tianal characteristics : casein,!whey protein: 40/ 60; highly dige stible f ats, an cp tim.m l evel of essential f atty acids ; carbc:hydrates with excellent dige stibility; vi tamins and minerals ; the protein ard caloric supply can be easily m:xlulated between 1.5- 2 .25 g/lOO oc end 50-75 Kcal/lOO c c r e s pectively; adequate renal sol u te l oad (105- 106 rrOsrn/l t) . A s t udy of the technical and e conani.cal fe asibility was done in order to assure t ha t a ll the previous character i s tics '<Iere present wi thin the CXlSt i ni tially set as objective. '!his was confi rrred when the Ministery o f Hea l th called for a p ub lic prcposal to pr oduce 40 Ton of this infant fo rma.La to use it i n a field study (about 3000 i nfan ts). '!his prcposal was won by an inportant local milk industry and the CXlSt of the product was 80% o f the cost of whole milk. A shelf-life was carried out with this infant fomul a to determine its optimun s tabi lit y . GLUCCCORTlCOIOS NID ADREWIL ANOKGEN FUlCfICN IN PEDIATRIC PATIllITS WI'Ill END STAGE REWIL DISEASE (ESRD) . Fer r ari s , J . R.; RamIrez ,J. A.; Goldberg, V. ; Ri varola,M. Dto. Pediatri aHospi tal Italiano-Buenos Ai res, Argentina . 15 Delaye d gonadal and/or adrenal puberty in children with ESlID diminishes patient self-esteem and hanpcr rehabilitaticn. Data detailing adrenal puberty in patients with ESlID are no t available. Fo r that reason 2.6 patients (16 male; 10 female) who were between 6.5 and 22 .5 years o f age (rrean: 14. 5) were s tudied . Ten patien ts were pre-pubertal, 8 p ube rtal and 8 post-pube rtal. All of them were on chronic hemJdialysis. '!h e Tanner stages (pubic hair dew lcprent) were delayed in 56 % o f patients . serum co rtisol (C) was increased in a ll, but 2 patients. serun L14andros tenedione (tl 4) was no nnal i n a ll b ut 2 patients. serum dehydroepiandrosterone sulfate (OS) was increased in 6 ou t of 11 prepube rtal and p ube rtal males. Bone age sho..ed a posrtave correlation wi th OS (r- 0 . 53 ; p < 0. 00 5 ). serun ACI'Il was normal. A reductioo o f 50% in C and 78% in OS was f ound after dexane thasone suppression (OX) ; bu t L14 did no t s upp ress pest OX. ACI'Il s timulatioo test increased C by 50% and tl 4 by 80%, but no stimulatien was observed in OS . a:NCl.USIGlS: In pe dia tric patients and young adults with ESRD, we found : 1) Increased C leve ls and partial OX resistance of pit ui tary-adrenocortical axis, s imilar to tha t f ound in Cushing's disease or in s tress ; 2) Delayed de wlcprent o f the androgen prcrlucing zona reticulari s, s ugg e s ted by the Lack o f res ponse of OS to l\CTIl; 3) The dissociation between C and adrenal androgens observed i s consistent with the existence of different rrec:hanisms of control f or these tlNO adrenal functions. 16 13 Ni trOjen, f at and calor ic re ten tion were rreasured in 10 male i n f ants recover ing fran marasmic malnutritien when fed either IP o r ll'M. Subjects "-Cre 6 .8 rronths o ld on awrage ard had a W/A ratio o f 72% and a W/I! r a tio o f 95 % o f the tOlS s tandard.They went through tlNO consecutiw balance peraods o f 6 da ys each (3 days for adaptation and 3 days for urine and fe ces col lectioo ). Caloric dens i ty o f bo th fontL1las was 85 Kcal/ lOO ml with 13% of calories fran protein in IP and 11% in IPM . Cal oric intake, ubso rptioo and relative retention was s light ly and not signi fi cantly g reate r with IPM than IP. Fa t i n take was greater with IPM (5 .4 gr!kg/day) than wi th IP (4.2 gr!kg/ dia) (p <0 .025 ) . '!his resulted in signi f icative differences i n f a t ab sorption (!P M : 4. 3 gr!kg/day ; IPM: 3 q rvkq day , P < 0 .0 025 ). Ni trOjen intake was s i gni ficantly less with ll'M (487 rrq!kg/ day) than with IP (571 rrq!kg/ da y ) (I' < 0 . 0025) with a greater urinary nitrO]en excre tion f or IP (417 rrq!k g/day) than f or IPM (30 4 rrq!kg/day) (1' < 0 . 001). !'parent nitrogen retentioo f or IPM was on average 115 rrq!kg/ da y ard f or ll' only 68 nq!kg/ day . '!his difference was no t s ignificctivc because wide individual variatioo . Over the short period o f the s t udy no di fference was detected in biochemical o r anthrcparetric indicators o f nutritional related to the feedi ng o f IP o r IPM. FrnMJIJITICtl OF AN INFAm' FCX:D FOR TIlE NATIOOAL PRXRl\M OF King, J. ; de Pablo, S .; Monte s de <XM'IEH:Nl'ARY Dca , F . Instituto de Nutricioo y Tee. de l os AlillI:mtos, U. HEl-OLYTIC UREMIC stNDlOlE : EARLY REWIL lE SICNS AND L\ 'IE P= I S . Martini , R.J . ; Gall o, G. llQSPlTAL DE NIf1CS DE CXJRlXBA y . " RICI\I1DO Aires, Argentina. 'lh e histol og i cal s tudies and clinical h i stories of 60 patie n ts with Hem:>l ytic Uremi c Syndrane (HUS) follooed up at the QUldren' s Hosp i ta l o f CorddJa City (Argentine ) between 1965-1982 were reviewed. Ili s tolOj i cal studies were perforrred with b i opsy spe cirrens in 54 cases and wi th necrcpsy spec .inens in the other 6 . In a ll cases the s t udies were pe r formed d uring the first four week s o f the disease. In 47 cases (78 , 3%) typical thrarbotic microangicpatic les i ons (MATR) .ere f ound, ""' ile in the anothe r 13 cases (21 , 6%) the les ions were inespecific. '!he les ions were class ifi ed into threee groups : 'lYPE I: those cases wi th focal MATR o r ines pe cifi c lesions (41 , 7%) ; 'lYPE II: those cases with di f us se MATR ( 36, 6 %) and'lYPE III : those cases with difusse MA1R oarplicated wi th cortical ne crosis or vascu lar damage (21 ,6%) . Fourty three patien ts were re-examined with c linical ard labor attories tests during 19 83 . 'l'Nenty three of them were cured wnile the another twe nty shooed sore renal secuelae . 'lhirteen had proteinuria , tlNO arterial hypertensioo and fi ve chronic renal failure. Ilealing was observed in 65% o f the patients wi th l e sions TYPE I, in 34 , 7 o f the patie nts with lesions TYPE II and in 0% o f the patients with les ions TYPE III. '!h e patients with les i ons type I or II only shooed proteinuria as renal secuelae, but those with lesions type III developed proteinuria, arterial hypertension and or chronic rena l failure. we ccncll.rle that the present hist:q>atolOjical classificatien of the e arl y renal lesions are useful ir order to predict rena l damage in late pericrl o f the disease. Olronic renal f ailure de pends on the presence of cortical necrosis o r vascular damage . 370