A Case of Neonatal Urinary Ascites due to Bladder Perforation Treated with Urinary Drainage

Urinary ascites in newborns is a rare event that usually is associated with posterior urethral valves and other obstructing anomalies of the genitourinary tract. A case of neonatal urinary ascites without genitourinary tract abnormalities is reported. This premature male neonate was treated by artificial ventilation due to respiratory distress syndrome. The umbilical artery catheter was placed without difficulties and functioned well until removal. Periumbilical leak of urine was not observed. He showed abdominal distension and oliguria on second postnatal day. He was found to have ascites, hyponatremia and elevation of BUN content disproportionate to the mild elevated serum creatinine value. Radiological examination revealed normal genitourinary tract except intraperitoneal extravasation of contrast material from the bladder. Conservative management resulted in complete resolution of the lesion in this patient.

Screening for Asymptomatic Bacteriuria in Korean Preschool Children / 대한비뇨기과학회지

PURPOSE: To determine the incidence of asymptomatic bacteriuria in Korean preschool children, we performed national survey. MATERIALS AND METHODS: We surveyed kindergardens in seven representative cities of Korea. Before performing urine culture, we selected children by urine dipstick screening method(leukocyte esterase and nitrite test). And we analysed the incidence according to sex, age and socioeconomic status. RESULTS: Total registered population was 2,239 children and male to female ratio was 1.16. Overall, asymptomatic bacteriuria was found in 1.03%(23 children). In the male the incidence was 0.3%(3 children) and in the female it was 2.0%(19 children). Less than 4 years old children showed higher incidence (2.9%) than those of any other age groups, such as, 0.5% in 4, 1.1% in 5 and 1.3% in 6 years old. High, middle and low socioeconomic status groups showed the incidence as 0%, 0.9% and 1.4%, respectively The number of leukocyte esterase positive children was 184(8.2%) and that of nitrite positive children was 115(5.1%). Among them urine culture was performed in 175children and 23 children showed significant bacteriuria(colony count> 100,000/ml), so predictability of asymptomatic bacteriuria by dipstick test was 13.1% Radiologic study was performed in 9 children who had bacteriuria, but none of them showed urological abnormalities. CONCLUSIONS: From the above data, we found that asymptomatic bacteriuria is more common in female, younger age and lower socioeconomic status among the Korean preschool children. Considering cost-benefit aspects of the screening for asymptomatic bacteriuria, however, we should re-evaluate the necessity of our study on these particular age groups.

The Study of Urinary Hydroxypyridinium Crosslinks Concentrations in Patients with RA or OA , and Its Clinical Significance / 대한내과학회지

OBJECTIVES: To evaluate the urinary concentrations of hydroxyridinium crosslinks of collagen in patients with osteoarthritis(OA) or rheumatoid arthritis(RA), and to compare its clinical correlation with the classic indices of the disease activity of RA. METHODS: Concentrations of urinary pyridinoline (Pyd) and deoxypyridinoline(Dpd) were measured in urinary samples collected from 18 control patients, 35 patients with OA, 45 patients with RA by competitive enzyme immunoassay using microplate coated with monoclonal antibody. RESULTS: 1) Mean urinary concentrations of Pyd in OA patients were 33.5nmol/mmol creatinine, in RA patients were 50.0nmol/mmol creatinine which were higher than the values in controls (25.1 nmol/mmol creatinine). Also, mean concentrations of Dpd in OA patients were 9.2nmol/mmol creatinine, in RA patients were 10.1nmol/mmol creatinine which were higher than the values in controls(5.6nmol/mmol creatinine)(p<0.01). 2) Mean urinary concentration of Pyd was 50.0 nmol/mmol creatinine in RA patients, which was significantly higher than the values in OA(33.5 nnmol/mmol creatinine)(p<0.05), but the mean Dpd concentratians were not significantly different between the two groups. 3) The concentrations of urinary Pyd in RA patients was significantly correlated with the biologic markers indicating inflammatory activity such as ESR(r=0.68, p<0.001), CRP(r=0.72, p<0.001) and the number of tender joint(r=0.66, p<0.01) CONCLUSION: Urinary concentrations of Pyd and Dpd were significantly higher in OA and RA patients than in controls, Especially urinary Pyd concentrations were significantly increased in RA patients than in OA patients, and strongly correlated with disease activity index of rheumatoid arthritis. The mean Dpd concentration, bone specific analogue, in RA patients was not significantly different from that of OA patients and it was not correlated with disease activity index Thus measurement of urinary Pyd might provide a sensitive, noninvasive biochemical marker for studying activity of RA.

A Case of Angiosarcoma Presenting Pleural Effusion / 결핵

Angiosarcoma is a very rare malignant tumor of endothelial cell origin. We experienced a case of angiosarcoma presented with massive pleural effusion, which was considered as a metastasis from right kidney. A 44-year-old male patient was admitted due to dyspnea for one month. He had a history of transient hematuria 3 months before admission, which disappeared spontaneously Chest roentgenography showed total haziness in left hemithorax with multiple nodular shadows in right lung. Abdominal ultrasonogram showed a single heterogeneous hyperechoic mass, measuring about 7.3×7.1×6.5cm in size in the upper and mid-pole of the right kidney, involving. renal sinus. Computed tomography of the chest revealed highly enhanced multiple pulmonary and subpleural nodules with loculated pleurisy. In bronchoscopic finding, a fungating, hypervascular tumor mass was noticed at the orifice of anterior basal segment of left lower lung after removal of tenaceous mucus Pleural and bronchoscopic biopsies showed findings of angiosarcoma confirmed by immunochemical stains with factor VIII related antigen(+), laminin(+) and vimentin(+), and by characteristic electronmicroscopic findings. Massive pleural effusion was controlled with several times of pleurodesis in both pleural spaces.

Bilateral torsion of the testes in a newborn infant

We report one case of bilateral testicular torsion. A 400 gm male infant, born by cesarean section due to induction failure at 42 weeks gestation, was hospitalized at 9 days of age secondary to bilateral testicular mass. Physical examination revealed an healthy baby with enlarged, firm, nontender mass on both sides of the scrotum. Transillumination of the mass showed no transmission of light. Laboratory data included a normal CBC and a urinalysis. Ultrasonogrophy showed well encapsulated 0.9 x 0.9 x 1.0 cm sized and 1.5 x 1.3 x 1.3 cm sized homogenous hypoechoic solid mass in left and right testicles respectively, remainder testicular parenchyme showed normal structure. Exploration of the testes was performed at 25-days old under general anesthesia. Exploration revealed a infarction of the right testes secondary to spermatic cord torsion, evidenced by clockwise turns outside the tunica vaginalis of 270 degrees. Left testes was infarcted but a quarter of them seemed normal. Orchiectomy on right and fixation on left testes were performed respectively. Left spermatic cord seemed to be detorted spontaneously. Postoperatively the infant did well and discharged 5 days after operation. Follow up examination during the next 3 months have shown appropriated sized testicle with normal colorization and arterial pulse. Testicular scan performed at age 39 days showed good perfusion of left testes.