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Long-term urologic and gynecologic follow-up in anorectal anomalies: The keys to success
Published in Alejandra Vilanova-Sánchez, Marc A. Levitt, Pediatric Colorectal and Pelvic Reconstructive Surgery, 2020
Geri Hewitt, Daniel G. DaJusta, Christina B. Ching
A 5-year-old female with a history of cloaca consisting of a 2 cm common channel and 1 cm urethra presents for evaluation of urinary incontinence. As an infant she underwent posterior sagittal anorectovaginourethroplasty (PSARVUP) with separation of her vagina from her urethra (urogenital separation) and interposition of bowel (left colon) from her native vagina to her perineum. She is interested in toilet training and shows the ability to generate a stream and urinate on command. She will, however, have dribbling between volitional voiding. She has not had any urinary tract infections. A renal ultrasound is normal. An MRI of her spine is normal. She underwent video urodynamics that show a large capacity, compliant bladder without overactivity. The video portion, however, shows significant pooling of urine in the vagina with voiding (Figure 7.1). Cystoscopy shows an urethrovaginal fistula in her mid-urethra distal to her bladder neck.
Pediatrie genitourinary oncology
Published in J Kellogg Parsons, E James Wright, The Brady Urology Manual, 2019
Jennifer Miles-Thomas, Matthew E Nielsen, Caleb P Nelson
Renal ultrasound: Screening test to assess IVC, establish tissue of origin, and discriminate solid vs cystic mass.
Introduction to specialist investigations and procedures
Published in Louisa Baxter, Neel Sharma, Ian Mann, The Junior Doctor’s Guide to Gastroenterology, 2018
Louisa Baxter, Neel Sharma, Ian Mann, Ian Sanderson
When the liver, gallbladder, spleen and pancreas are being imaged, the patient should be nil by mouth for 8-12 hours before the procedure. For renal ultrasound, the patient should be nil by mouth for 8-12 hours before the procedure, and about an hour before the test they will be required to drink four to six glasses of liquid to ensure that their bladder is full.
Maryland ACP Winners from Mulholland Mohler Residents meeting 2021
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Case presentation: A 59-year-old man presented to the emergency department with bilateral lower extremity weakness, dry mouth and nausea for one month and decreased urine output for a week. He had a history of coronary artery disease, atrial fibrillation, type 2 diabetes mellitus, stage 3a chronic kidney disease, and laparoscopic sleeve gastrectomy. Examination revealed urinary retention requiring indwelling catheterization. Labs showed hyperkalemia (6.6mEq/L), AKI with BUN 105 mg/dL, creatinine 7.86 mg/dL (baseline creatinine 1.24 one month prior), normal anion gap metabolic acidosis, microscopic hematuria, and proteinuria. Further, labs showed low complement C3 (82 mg/dL), normal C4, negative hepatitis panel, ANA, ANCA, protein electrophoresis, anti-glomerular basement membrane antibody. Renal ultrasound is unremarkable. Differentials for AKI included bladder outlet obstruction, post-infectious glomerulonephritis (dental infection 5 weeks prior), acute tubular necrosis (ATN) or acute interstitial nephritis due to amoxicillin (prescribed after dental infection). Due to worsening renal failure and uremic symptoms despite supportive treatment, kidney biopsy was performed, and patient started on HD. Biopsy results revealed ATN and intra-tubular oxalate concretions consistent with oxalate nephropathy. Subsequent dietary history revealed that after dental infection, patient drank about 2 liters of iced tea daily. He was advised to stop iced tea and required outpatient HD, with eventual return of renal function after 8 weeks allowing liberation from dialysis with a residual serum creatinine of 1.9 mg/dL.
A case of ocular cystinosis associated with two potentially severe CTNS mutations
Published in Ophthalmic Genetics, 2019
Andrew C. Browning, Gustavo S Figueiredo, Oliver Baylis, Emma Montgomery, Clare Beesley, Elisa Molinari, Francisco C. Figueiredo, John A. Sayer
Systemic physical examination was unremarkable and tests of renal function including serum electrolytes, urea, creatinine and urinary protein/creatinine ratio were all normal. Serum immunoglobulin levels were within normal limits and no paraprotein band was found on serum electrophoresis. Her serum uric acid level was 0.25 µmol/l (normal range 0.14–0.36). Random mid-stream urine dipstick testing was negative for protein, blood and glucose and a renal ultrasound scan was also normal. The patient’s blood leucocyte cystine level was 1.3 nmol/cystine/mg protein (normal range less than 0.2). In vivo confocal microscopy of the cornea and bulbar conjunctiva using Heidelberg HRT3 laser scanning technology with the Rostock Corneal Module (Heidelberg Engineering Inc., Massachusetts, USA) demonstrated rod shaped crystals within the anterior corneal and conjunctival stroma (Figure 1b-f).
A 2-year-old boy with circulatory failure owing to streptococcal toxic shock syndrome: case report
Published in Paediatrics and International Child Health, 2018
Werner Keenswijk, Johan Vande Walle
Urinalysis showed leukocytes 62/μL (0–25) and erythrocytes 240 μL (0–25) but no proteinuria or other abnormalities. Chest radiograph was normal and echocardiography demonstrated moderately reduced myocardial contractility but no signs of right-sided heart failure. Renal ultrasound was normal. Septic shock with AKI and disseminated intravascular coagulation (DIC) was suspected, and he immediately received intravenous fluid resuscitation and antibiotics (ciprofloxacin and amikacin, later changed to cefotaxime) but developed a decreased level of consciousness and was placed on mechanical ventilation with the addition of inotropes (maximum dosages: epinephrin 0.12 μg/kg/min, norepinephrin 1.5 μg/kg/min, dobutamin 15 μg/kg/min). He received repeated platelet and packed cells infusions and continuous IV fluid therapy (0.9% saline, glucose 5%/sodium chloride 0.45%, albumin 5% solution) to restore his circulation. Corticosteroids (hydrocortisone 4 mg/kg/day) were also added for the persistent hypotension and continued for the first 48 h of admission.