1,720,972 research outputs found
Ektopic ureter - a not considered cause of persisting enuresis in girls
No full textBackground: Ectopic ureter - especially in a duplicated collecting renal system - is a specific cause of incontinence in young girls. Although the symptom of continuous dribbling of urine is characteristic for this malformation, diagnosis is often delayed, as the possibility of ectopic ureters is not considered in treating girls with delayed toilet training. Case report: We present the case of a young girl with a variety of unnecessary invasive diagnostic and therapeutic procedures due to a misunderstood "enuresis", before incontinence was cured by upper pole heminephrectomy. Conclusions: Girls, who never have been dry and who loose urine all the time do have an ectopic ureter, unless evidence to the contrary has been put forward. Only considering the possibility of ectopic ureters will avoid unnecessary diagnostic and therapeutic procedures in these girls
Dextranomer microspheres (Deflux) in the endoscopic treatment of childhood vesicoureteric reflux
No full textPurpose. Substances currently used for endoscopic correction of vesicoureteric reflux like Teflon, silicone or bovine collagen are critical with regard to biocompatibility. We investigated dextranomer microspheres (Deflux) in the endoscopic therapy of vesicoureteric reflux. Methods and Patients. Deflux was used in 29 children aged 20 months to 13,5 years (40 vesicoureteric units). Effectiveness of treatment was controlled by voiding cystourethrography 3 to 6 months afterwards. Results. Overall,the endoscopic treatment with Deflux was successful in 17 children and 23 vesicoureteric units. Infection associated reflux I degrees -III degrees was treated successfully in 17 of 19 children (=89,5%). In contrast, endoscopic therapy was not effective in children with reflux IV degrees and V degrees and in children with neurogenic bladder dysfunction. Conclusion. Deflux is an attractive alternative in the endoscopic treatment of vesicoureteric reflux in children. Especially, children with infection associated low-grad reflux may profit from this minimally invasive therapy
Effective aromatase inhibition by anastrozole in a patient with gonadotropin-independent precocious puberty in McCune-Albright syndrome
No full textTestolactone is used to treat conditions with excessive estrogen synthesis, e.g. gonadotropin-independent precocious puberty in McCune-Albright syndrome (MAS). Unfortunately, daily treatment with testolactone requires 3 to 4 doses (10-20 tablets) and even at these doses it is sometimes ineffective. We treated a patient with MAS (cafe-au-lait spots; thelarche at age 2-(6)/(12) yr; menarche at 5-(5)/(12) yr; accelerated bone age [BA 10 yr]) with the highly selective aromatase inhibitor anastrozolle (1 mg once per day). Tamoxifen 1 mg/kg per day was added for 1 year but was discontinued when an ovarian cyst developed with markedly elevated estradiol levels. Estradiol levels returned to normal after resuming anastrozole-only treatment and accelerated BA progressed only 6 months during 21/2 years of treatment. The potent estrogen suppressive action and simple dosage regimen of anastrozole suggest it may be advantageous compared to other aromatase inhibitors such as testolactone or anti-estrogens
Effective aromatase inhibition by anastrozole in a patient with gonadotropin-independent precocious puberty in McCune-Albright syndrome
No full textTestolactone is used to treat conditions with excessive estrogen synthesis, e.g. gonadotropin-independent precocious puberty in McCune-Albright syndrome (MAS). Unfortunately, daily treatment with testolactone requires 3 to 4 doses (10-20 tablets) and even at these doses it is sometimes ineffective. We treated a patient with MAS (cafe-au-lait spots; thelarche at age 2-(6)/(12) yr; menarche at 5-(5)/(12) yr; accelerated bone age [BA 10 yr]) with the highly selective aromatase inhibitor anastrozolle (1 mg once per day). Tamoxifen 1 mg/kg per day was added for 1 year but was discontinued when an ovarian cyst developed with markedly elevated estradiol levels. Estradiol levels returned to normal after resuming anastrozole-only treatment and accelerated BA progressed only 6 months during 21/2 years of treatment. The potent estrogen suppressive action and simple dosage regimen of anastrozole suggest it may be advantageous compared to other aromatase inhibitors such as testolactone or anti-estrogens
Leishmaniasis - Oral treatment with hexadecylphosphocholine
No full textHexadecylphosphocholine (HDPC, Miltefosine, Impavido(R)) was synthesized at the Max-Planck-Institut fir Biophysikalische Chemie in Gottingen, Germany and successfully used for the therapy of cancer metastases [7, 8]. At the Institute of General and Tropical Hygiene of Gottingen University the antiparasitic efficacy - earlier mentioned by Croft et al. (1987) [6] - could be established for the first time in animals after oral administration [14]. In India Impavido(R) has been recently registered for the treatment of visceral leishmaniasis as the first oral medication in this indication. Clinical studies in India [13,17-19] - actually a phase IV study is running and Columbia (cutaneous leishmaniosis [15]) demonstrated the excellent efficacy of this oral treatment also in patients with Antimon resistance [9-11]. The cure rates are above 90% with low side effects (Impavido(R) twice 50 mg capsules daily over 28 days)
Long-term experience with Cohen ureteral reimplantation in bilateral VUR in childhood
No full textIntroduction. In bilateral VUR, Cohen crosstrigonal ureteric reimplantation is a popular but also controversial surgical approach. We present our own experience in a retrospective analysis. Patients and methods. Between 1990 and 2005,41 children (26 girls, 15 boys) with bilateral reflux [92 renal units (RU)] underwent ureteric rei m plantation. The mean age was 4.5 (0.3-12) years. Eight patients had ureteral duplication (six unilateral, two bilateral); 12 of 41 patients had no intraoperative ureteral stenting. Seven patients had prior surgery for VUR. A successful result was defined as absence of VUR, significant UVJ obstruction, or voiding dysfunction throughout the follow-up. Results. The mean follow-up was 7.8 (0.515) years. Eight patients (19.5%) had 13 complications. One patient had an intraoperative small bowel lesion (2%). Six patients (14.6%) had UTI. Four patients (9.8%) showed transient UVJ obstruction. Three required a temporary percutaneous nephrostomy. Two of these patients had no intraoperative ureteral stenting. Recurrence of VUR was found in 2 patients (4.8%) and 2/92 RU (2.2%), respectively. Complications were more frequent in high-grade VUR, ureter duplex, or unstented ureteral reimplantation. Prior surgery for VUR did not influence the postoperative outcome. Postoperative voiding disorders were not observed. Conclusions. Two unilateral recurrences of VUR were observed, requiring a reoperation in one patient. A reoperation for UVJ obstruction was not necessary. Related to 92 RU the surgical success rate was 97.8%. Intraoperative ureteral stenting has to be considered with respect to the current discussion of shortening inpatient procedures. In our experience, the perioperative risk was elevated in patients with high-grade VUR or ureteral duplication
Neonatal-onset multisystem inflammatory disease (NOMID) due to a novel S331R mutation of the CIAS1 gene and response to interleukin-1 receptor antagonist treatment
No full textNeonatal-onset multisystem inflammatory disease (NOMID) is due to mutations in the CIAS1 gene. We describe the case of a 5-year-old boy with neonatal onset of urticaria-like rash, chronic fever, laboratory findings of systemic inflammation, hepatosplenomegaly, and chronic CNS inflammation associated with sensorineural deafness. Sequence analysis of exon 3 of the CIAS1 gene revealed a novel C1754A/S33IR Mutation. Since experimental evidence Suggests that patients with cryopyrin-associated periodic syndromes (CAPS) could respond to inhibition of binding of interleukin IL-1 alpha and IL-1 beta to the IL-1 receptor type 1, we treated the child with the IL-1 receptor antagonist anakinra. A remarkable clinical and serological response to therapy was observed, suggesting that pharmacological inhibition of the IL-1 signaling pathway offers an important new treatment option for patients with NOMID. (c) 2006 Wiley-Liss, Inc
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