Initial management of meningomyelocele children
Jacques Corcos, David Ginsberg, Gilles Karsenty in Textbook of the Neurogenic Bladder, 2015
Initial management is dictated by the findings on urodynamic assessment irrespective of the upper urinary tract appearance on x-ray imaging (Table 56.3).17,30–33 No intervention is necessary in the child with a synergic sphincter, who voids to completion with normal pressure. Similarly, no specific treatment is needed in the child with complete denervation, a low leak-point pressure, and sporadic but complete emptying. However, intervention employing CIC is considered mandatory in the child with DSD because experience has shown expectant therapy alone often leads to a decompensated bladder with poor compliance, hydroureteronephrosis, and vesicoureteral reflux (VUR), all of which may not be reversible with aggressive subsequent management (Figure 56.2). Besides, it has been noted augmentation cystoplasty is needed more often if the bladder is allowed to progress to inelasticity from the continued high bladder outlet resistance associated with DSD.20,26 Dimercaptosuccinic acid (DMSA) renal scanning has provided another more paramount reason for intervening early, due to irreversibility of any renal injury that occurs from high pressure reflux and urinary infection.34
Urinary tract infections
Prem Puri in Newborn Surgery, 2017
A dimercaptosuccinic acid (DMSA) scan at the time of presentation is the hallmark of the top–down approach. Some authors advocate that 50% of children will have a positive DMSA during the acute phase. Out of those children, 30%–40% will demonstrate reflux. Conversely, 90% of children with VUR will have had a positive DMSA scan. If VCUG is deferred for those children with febrile UTI and a positive acute DMSA scan, presence of hydronephrosis, or a dilated ureter, one would miss 10% of children with VUR, the majority of these being children with low-grade VUR, low risk for UTI, and late renal scarring.27 Small studies looking into early DMSA scanning in neonates, mainly females and uncircumcised males, agree that DMSA is helpful in ruling out later development of permanent renal damage but was not predictive of the absence of dilating VUR. Therefore, if dilating VUR is to be ruled out, a VCUG needs to be performed even in the presence of a normal DMSA scan.29 Neonatal reflux, even high grade, is more likely to resolve than VUR detected after UTI at a later age. Prospective data on the follow-up of infants with prenatal hydronephrosis diagnosed with grade III, IV, or V showed resolution rates of 53%, 28%, and 40%, respectively, at 4 years.
Skin manifestations of poisoning
Biju Vasudevan, Rajesh Verma in Dermatological Emergencies, 2019
Avoidance of the source of exposure is of utmost importance. Chelation therapy is indicated even in asymptomatic children with blood lead level >45 μg/dL. Dimercaprol or BAL, calcium disodium ethylene diamine tetra-acetic acid (CaNa2EDTA), D-penicillamine, and Meso-2,3-dimercaptosuccinic acid (DMSA), named succimer, are approved for the treatment of acute and chronic lead poisoning [67]. Thiamine in combination with CaNa2 EDTA, vitamins C and E, and garlic all have shown some efficacy in reducing lead-induced oxidative stress [68–70].
Fixed drug eruption due To 2,3-dimercapto-1-propanesulfonic acid (DMPS) treatment for mercury poisoning: a rare adverse effect
Published in Acta Clinica Belgica, 2019
Fatma Erden, Erol Rauf Agis, Meside Gunduzoz, Omer Hinc Yilmaz
Mercury is a highly toxic metal for human body and has a very wide range of uses in many fields such as agriculture, medicine, and industry. In order to prevent some diseases that may develop in various industrial branches associated with this toxic agent, employees are monitored in Ankara Occupational and Environmental Diseases Hospital in certain periods. During visits, appropiate antidotal therapy are given to patients with rising heavy metal levels. Throughout the world, Dimercaptosuccinic acid (DMSA), dimercaprol (BAL), and 2,3-dimercaptopropane-1-sulfonate (DMPS) are the agents used in chelation treatment in patients with high mercury levels [8,9]. Among the first choices for antidotal treatment in mercury exposure, DMPS (Dimaval®) is generally a drug with a low incidence of side effects and containing sulfon group. The most common unexpected effects are allergic skin reactions. It may cause variable skin lesions ranging from mild pruritus, erythematous lesion to erythema multiforme and Steven–Johnson syndrome [5]. FDE due to DMPS was not detected in our literature review. But, DMPS is a drug containing a sulfon group like dapsone and there are FDE cases associated with dapsone [10]. In this clinical presentation, it is possible to think this occured with a mechanism similar to dapsone [10].
An adolescent girl with obstructive uropathy requiring nephro-ureterectomy was subsequently diagnosed with renal tuberculosis: case report
Published in Paediatrics and International Child Health, 2021
Özge Kaba, Manolya Kara, Zuhal Bayramoğlu, Emine Çalışkan, Bilal Çetin, Elnur Karimov, Ünsal Özkuvancı, Yasemin Özlük, Selda Hançerli Torun, Zeynep Nagehan Yürük Yıldırım, Hasan Orhan Ziylan, Ayper Somer
Three fasting gastric lavage specimens were negative on acid-fast bacilli stain. Contrast-enhanced abdominal magnetic resonance imaging (MRI) demonstrated left renal calyx dilation and blunting together with a hypo-intense signal and thickening throughout the ureter (Figure 3). Dimercaptosuccinic acid (DMSA) scintigraphy demonstrated a normal right kidney and impaired left kidney function (10%). The patient was commenced on anti-tuberculous therapy (ATT): isoniazid, rifampicin, pyrazinamide and ethambutol. One month later, cystoscopy and stent placement into the left ureter were planned. However, the ureteric stent could not be inserted owing to bullous oedema and erythematous bladder mucosa. Methylprednisolone (2 mg/kg/day, max 60 mg for 4 weeks, and then in decreasing doses) was added. After 8 weeks of corticosteroid therapy, another left ureteric stent was attempted but also failed. In the 12th week of ATT, she underwent percutaneous nephrostomy. Despite these interventions, repeat DMSA scintigraphy demonstrated diminished left kidney function (7%) and persisting hydronephrosis on ultrasound. Left nephro-ureterectomy was performed in the 28th week of treatment. Histology demonstrated focal necrotising granulomatous pyelonephritis (Figure 4). On follow-up, there were no complications in the right kidney and renal function remains normal.
The comparison of the resistivity index values in the ultrasonographic evaluation of a unilateral atrophic/hypoplastic kidney
Published in Renal Failure, 2020
Tahir Dalkiran, Yasar Kandur, Besra Dagoglu, Hatice Saki, Sukru Gungor, Sevcan Ipek
The great value of dimercaptosuccinic acid (DMSA) scintigraphy in distinguishing pyelonephritis/atrophy/scars/hypoplastic kidneys has been previously recognized [6]. However, scintigraphy is an expensive examination that is not readily available in all centers, and it also exposes a patient to radiation. On the other hand, renal Doppler investigation is a rapid, noninvasive, painless, safe, and radiation-free technique, which may substantiate subtle renal blood flow changes by using intrarenal resistive index (RI) and allow differentiation of various renal pathophysiological conditions [7–9]. The differentiation of atrophic and hypoplastic kidneys is of clinical importance due to the likelihood of the former to progress. We hypothesized that RI might be a useful marker to differentiate hypoplastic and atrophic kidneys.
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