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Journal of Emergencies, Trauma, and... 2017Renal trauma in the pediatric population is predominately due to blunt mechanism of injury. Our purpose was to determine the associated injuries, features, incidence,...
BACKGROUND
Renal trauma in the pediatric population is predominately due to blunt mechanism of injury. Our purpose was to determine the associated injuries, features, incidence, management, and outcomes of kidney injuries resulting from blunt trauma in the pediatric population in a single level I trauma center.
METHODS
This was a retrospective chart and trauma registry review of all pediatric blunt renal injuries at a regional level I trauma center that provides care to injured adults and children. The inclusion dates were January 2001-June 2014.
RESULTS
Of 5790 pediatric blunt trauma admissions, 68 children sustained renal trauma (incidence: 1.2%). Only two had nephrectomies (2.9%). Five renal angiograms were performed, only one required angioembolization. Macroscopic hematuria rate was significantly higher in the high-grade injury group (47% vs. 16%; = 0.031). Over half of the patients had other intra-abdominal injuries. The liver and spleen were the most frequently injured abdominal organs.
CONCLUSION
Blunt renal trauma is uncommon in children and is typically of low American Association for the Surgery of Trauma injury grade. It is commonly associated with other intra-abdominal injuries, especially the liver and the spleen. The nephrectomy rate in pediatric trauma is lower compared to adult trauma. Most pediatric blunt renal injury can be managed conservatively by adult trauma surgeons.
PubMed: 28855777
DOI: 10.4103/JETS.JETS_93_16 -
SA Journal of Radiology 2020The relevance of clinical data included in blunt trauma referrals for abdominal computed tomography (CT) is not known.
BACKGROUND
The relevance of clinical data included in blunt trauma referrals for abdominal computed tomography (CT) is not known.
OBJECTIVES
To analyse the clinical details provided on free-text request forms for abdominal CT following blunt trauma and assess their association with imaging evidence of intra-abdominal injury.
METHOD
A single-institution, retrospective study of abdominal CT scans was performed for blunt trauma between 01 January and 31 March 2018. Computed tomography request forms were reviewed with their corresponding CT images. Clinical details provided and scan findings were captured systematically. The relationship between individual clinical features and CT evidence of abdominal injury was tested using one-way cross tabulation and Fisher's exact test.
RESULTS
One hundred thirty-nine studies met inclusion criteria. A wide range of clinical details was communicated. Only clinical abdominal examination findings ( = 0.05), macroscopic haematuria ( < 0.01), pelvic fracture or hip dislocation ( = 0.04) and positive focused assessment with sonography in trauma ( < 0.01) demonstrated an associated trend with abdominal injury.
CONCLUSION
Key abdominal examination and basic imaging findings remain essential clinical details for the appropriate evaluation of CT abdomen requests in the setting of blunt trauma. Methods to improve consistent communication of relevant clinical details are likely to be of value.
PubMed: 32391180
DOI: 10.4102/sajr.v24i1.1837 -
International Braz J Urol : Official... 2016Bladder tumors are rare in children and adolescents. For this reason, the diagnosis is sometimes delayed in pediatric patients. We aimed to describe the diagnosis,...
PURPOSE
Bladder tumors are rare in children and adolescents. For this reason, the diagnosis is sometimes delayed in pediatric patients. We aimed to describe the diagnosis, treatment, and follow-up methods of bladder urothelial neoplasms in children and adolescents.
MATERIALS AND METHODS
We carried out a retrospective multicenter study involving patients who were treated between 2008 and 2014. Eleven patients aged younger than 18 years were enrolled in the study. In all the patients, a bladder tumor was diagnosed using ultrasonography and was treated through transurethral resection of the bladder (TURBT).
RESULTS
Nine of the 11 patients (82%) were admitted with gross hematuria. The average delay in diagnosis was 3 months (range, 0-16 months) until the ultrasonographic diagnosis was performed from the first episodes of macroscopic hematuria. A single exophytic tumor (1-4cm) was present in each patient. The pathology of all patients was reported as superficial urothelial neoplasm: two with papilloma, one with papillary urothelial neoplasm of low malignant potential (PUNLMP), four with low grade pTa, and four with low grade pT1. No recurrence was observed during regular cystoscopic and ultrasonographic follow-up.
CONCLUSIONS
Regardless of the presence of hematuria, bladder tumors in children are usually not considered because urothelial carcinoma in this population is extremely rare, which causes a delay in diagnosis. Fortunately, the disease has a good prognosis and recurrences are infrequent. Cystoscopy may be unnecessary in the follow-up of children with bladder tumors. We believe that ultrasonography is sufficient in follow-up.
Topics: Adolescent; Age Factors; Carcinoma, Papillary; Carcinoma, Renal Cell; Child; Cystoscopy; Delayed Diagnosis; Female; Follow-Up Studies; Hematuria; Humans; Male; Rare Diseases; Retrospective Studies; Time Factors; Treatment Outcome; Ultrasonography; Urinary Bladder Neoplasms; Urothelium
PubMed: 27256177
DOI: 10.1590/S1677-5538.IBJU.2015.0200 -
Translational Andrology and Urology Dec 2017Despite advances in the surgical and medical treatment of bladder cancer, there have only been minor improvements in mortality and morbidity rates over the past decades.... (Review)
Review
Despite advances in the surgical and medical treatment of bladder cancer, there have only been minor improvements in mortality and morbidity rates over the past decades. Urine-based markers help to improve diagnosing bladder cancer with the aim of complementing or probably in future replacing cystoscopy. Biomarkers may allow individualized risk stratification and support decision-making regarding therapy and follow-up. This review summarizes the existing urine-based biomarkers in bladder cancer. We conducted a comprehensive review of the literature. We conducted a PubMed/Medline based research on English language articles and selected original articles and review articles that provided both description and assessment of urinary markers at time of screening, initial diagnosis, monitoring and prognostic evaluation of urothelial bladder cancer. Our research covered studies published between 2000 and 2017. The aim of this study was to give clinicians keys to understand the existing or promising urinary markers that may become alternatives to cytology/cystoscopy pair in the near future. Many urinary markers are now available, often with superior sensitivity to cytology. Their uses have been evaluated in numerous clinical situations in addition to the time of initial diagnosis and surveillance such as cases of isolated macroscopic hematuria or atypical cytology discordant with the rest of the explorations. However, their superiority over the cytology/cystoscopy association is not demonstrated. These new markers are lacking for the most part of standardization and simplicity making their use in common practice difficult. the types and forms of these new markers are very heterogeneous among themselves and between the studies that evaluate them. Well-designed protocols and prospective, controlled trials are needed to provide the basis to determine whether integration of urine- and blood-based biomarkers into clinical decision-making will be of value for bladder cancer detection and screening in the future.
PubMed: 29354490
DOI: 10.21037/tau.2017.11.29 -
Journal of Clinical Medicine Aug 2018The purpose of this study was to evaluate the clinical characteristics of 44 pediatric patients who were diagnosed as having nutcracker syndrome (NCS). We also...
The purpose of this study was to evaluate the clinical characteristics of 44 pediatric patients who were diagnosed as having nutcracker syndrome (NCS). We also investigated the left renal vein Doppler ultrasonography (DUS) results, to determine whether or not there was an association between clinical symptoms and DUS findings among these patients. The clinical data from 44 pediatric patients who were diagnosed as having NCS from January 2008 to December 2015 were retrospectively reviewed. We grouped the patients according to the presenting symptoms as symptomatic (loin pain; macroscopic hematuria or both) and non-symptomatic (microscopic hematuria and proteinuria were detected incidentally) and evaluated the left renal vein DUS indices in these two groups separately. Asymptomatic NCS was found in 27 (61.4%) patients; 21 (47.7%) of whom were admitted for the evaluation of proteinuria. The most frequent presenting symptoms were left flank pain (20.5%) and macroscopic hematuria (13.6%); and 2 (4.5%) patients presented with a combination of left flank pain and macroscopic hematuria. The mean ratio of the diameter of the hilar portion of the left renal vein (LRV) to that of the aortomesenteric portion was 4.36 ± 1.55. The mean ratio of the peak velocity (PV) between the two sites of the LRV was 7.32 ± 2.68 (3.1⁻15.6). The differences in the ratio of the diameters were statistically significant between the two groups and significantly higher in children with asymptomatic NCS ( = 0.025). The PV ratios of the LRV ( = 0.035) were significantly higher in asymptomatic children with NCS than in the symptomatic group. Our study identifies that increased compression ratio of the LRV entrapment is most observed in orthostatic proteinuria and microscopic hematuria.
PubMed: 30104539
DOI: 10.3390/jcm7080214 -
Nihon Hinyokika Gakkai Zasshi. the... 2020(Objectives) We examined the treatment outcomes in cases of chronic unilateral hematuria treated using flexible ureteroscope for observation and hemostasis. (Methods)...
(Objectives) We examined the treatment outcomes in cases of chronic unilateral hematuria treated using flexible ureteroscope for observation and hemostasis. (Methods) The study included 14 patients (7 men and 7 women) with a median age of 56.5 years who underwent ureteroscopy using a digital flexible ureteroscope for chronic unilateral hematuria between March 2014 and August 2019. All the patients presented with macroscopic hematuria as a clinical symptom, but in one patient, the hematuria was accompanied by anemia and required a blood transfusion. In addition, bleeding occurred on the left side in 8 patients and on the right side in 3 patients; however, for the remaining 3 patients, the affected side could not be identified. Fourteen patients were examined on the basis of the ureteroscopic findings, number of bleeding sites, hemostatic intervention, treatment effect, and presence or absence of recurrences. (Results) The ureteroscopic findings showed a hemangioma in 7 patients and minute venous rupture in 3, but the remaining 4 patients showed no clear findings. The site of the findings was in the superior calyces in 8 cases, middle calyces in 4 cases, inferior calyces in 4 cases, and renal pelvic wall in 1 case. In addition, the findings were located at multiple sites in 6 cases, including all renal calyces in 2 cases. Ten patients with findings underwent hemostatic interventions (electrocoagulation and laser treatment). The median postoperative follow-up period was 32.4 months (range, 6.4-65.4 months). In all the cases, the hematuria disappeared after treatment. One of the 2 patients with findings in all renal calyces showed recurrence of macroscopic hematuria at 1 year and 6 months, which disappeared after conservative treatment. (Conclusions) In this study, observation using digital flexible ureteroscope was useful in the treatment of chronic unilateral hematuria, and the hemostatic interventions performed on the bleeding sites in the renal pelvis were effective.
Topics: Adult; Aged; Aged, 80 and over; Chronic Disease; Female; Hematuria; Hemostasis, Endoscopic; Humans; Kidney; Male; Middle Aged; Pliability; Retrospective Studies; Surgery, Computer-Assisted; Treatment Outcome; Ureteroscopes; Ureteroscopy; Young Adult
PubMed: 33473090
DOI: 10.5980/jpnjurol.111.16 -
Cureus Oct 2021Metastatic breast cancer among young women represents a serious public health issue. The most frequent sites of dissemination are bone, liver, lung, lymph nodes and...
Metastatic breast cancer among young women represents a serious public health issue. The most frequent sites of dissemination are bone, liver, lung, lymph nodes and brain. Bladder location is extremely unusual. We present the case of a 33-year-old female who was receiving palliative chemotherapy for bilateral metastatic invasive lobular cancer. Following episodes of macroscopic hematuria, a CT scan was performed, which revealed a thickening of the bladder wall. After an endoscopic resection with immunohistological analysis, the diagnosis was confirmed. Voiding symptoms in a woman with a history of breast cancer should be evaluated to rule out a secondary urinary tract lesion. As soon as the diagnosis is determined, appropriate therapy should be initiated.
PubMed: 34796050
DOI: 10.7759/cureus.18737 -
BMC Urology Apr 2022To evaluate the diagnostic accuracy of computed tomography-urography (CTU) to rule out urinary bladder cancer (UBC) and whether patients thereby could omit cystoscopy.
BACKGROUND
To evaluate the diagnostic accuracy of computed tomography-urography (CTU) to rule out urinary bladder cancer (UBC) and whether patients thereby could omit cystoscopy.
METHODS
All patients evaluated for macroscopic hematuria with CTU with cortico-medullary phase (CMP) and cystoscopy at our institute between 1 November 2016 and 31 December 2019 were included. From this study cohort a study group consisting of all UBC patients and a control group of 113 patients randomly selected from all patients in the study cohort without UBC. Two radiologists blinded to all clinical data reviewed the CTUs independently. CTUs were categorized as positive, negative or indeterminate. Diagnostic accuracy and proportion of potential omittable cystoscopies were calculated for the study cohort by generalizing the results from the study group.
RESULTS
The study cohort consisted of 2195 patients, 297 of which were in the study group (UBC group, n = 207 and control group, n = 90). Inter-rater reliability was high (κ 0.84). Evaluation of CTUs showed that 174 patients were assesessed as positive (showing UBC), 46 patients as indeterminate (not showing UBC but with limited quality of CTU), and 77 patients as negative (not showing UBC with good quality of CTU). False negative rate was 0.07 (95%, CI 0.04-0.12), false positive rate was 0.01 (95% CI 0.0-0.07) and negative predictive value was 0.99 (95% CI 0.92-1.0). The area under the curve was 0.93 (95% CI 0.90-0.96). Only 2.9% (3/102) with high-risk tumors and 11% (12/105) with low- or intermediate-risk tumors had a false negative CTU. Cystoscopy could potentially have been omitted in 57% (1260/2195) of all evaluations.
CONCLUSIONS
CTU with CMP can exclude UBC with high accuracy. In case of negative CTU, it might be reasonable to omit cystoscopy, but future confirmative studies with possibly refined technique are needed.
Topics: Humans; Cystoscopy; Hematuria; Reproducibility of Results; Tomography, X-Ray Computed; Urinary Bladder Neoplasms; Urography
PubMed: 35413901
DOI: 10.1186/s12894-022-01009-4 -
Sudanese Journal of Paediatrics 2022Khalawi are one of the most ancient non-governmental educational institutions that are commonly found all over Sudan playing a major role in the Sudanese society. The...
Khalawi are one of the most ancient non-governmental educational institutions that are commonly found all over Sudan playing a major role in the Sudanese society. The majority of Khalwa students are children. This study was part of a mixed methods project, conducted by Khartoum Medical Students' Association, aiming to investigate the health status of Khalwa students. It is a cross-sectional study carried out in Mustafa Alfadni Khalwa, Sharg Al-Neel suburb in Khartoum State. The participants were clinically assessed by a doctor and data were collected by using a data entry tool made specially to screen for major infectious diseases among students. The results showed a mean age of 13.7 years. Most of the students (47.7%) were originally from Darfur, and 27.5% of them had only Khalwa education. Respiratory clinic results revealed that 10% were complaining of cough, and 3.4% were diagnosed with pneumonia. Additionally, 44.6% of the students had tinea capitis and 21% had scabies. On examination, 2.3% and 1.1% had mild splenomegaly and hepatomegaly, respectively. Infectious conjunctivitis and trachoma were reported among 11.7% and 10.9%, respectively. Blood films for malaria were positive in 51.3%. Macroscopic and microscopic haematuria was evident among 13.4% and 10.8% of the participants, respectively. Stool examination results showed that 1.4% of the students had worms, 1.5% had ova and 18.8% had red blood cells in stools. Infectious diseases are very common among Khalwa students and their living environment is facilitating the transmission of these diseases. Agent control and sanitation improvement are crucial to decrease such infectious diseases.
PubMed: 35958082
DOI: 10.24911/SJP.106-1611150286 -
BMJ Case Reports Apr 2021We describe a case of a 17-year-old man admitted in the emergency room with a 2-month history of intermittent macroscopic haematuria and left lumbar pain. Physical...
We describe a case of a 17-year-old man admitted in the emergency room with a 2-month history of intermittent macroscopic haematuria and left lumbar pain. Physical examination and vital signs were normal. Investigation indicated a recurrent non-glomerular haematuria. The Doppler ultrasound revealed a compression of the left renal vein with upstream dilatation which was subsequently confirmed by CT angiography. These findings are in keeping with a case of nutcracker syndrome (NutS). Although asymptomatic in most cases, it can be a rare cause of haematuria. The teenager was referred to paediatric nephrology and was treated conservatively with spontaneous resolution of macroscopic haematuria. With this case, we would like to highlight that in children or adolescents with haematuria without an apparent cause, a high level of suspicion and appropriate imaging are necessary for the diagnosis of NutS.
Topics: Adolescent; Hematuria; Humans; Male; Renal Nutcracker Syndrome
PubMed: 33863767
DOI: 10.1136/bcr-2020-240228