ABSTRACT
Intravesical instillation of bacille Calmette-Guérin (BCG), an attenuated strain of Mycobacterium bovis, is the treatment of choice for many patients with bladder cancer. In a small percentage, this therapy is associated with systemic side effects including pneumonitis. It is uncertain whether these systemic manifestations are due to dissemination of infection or due to hypersensitivity, an etiologic distinction that has important therapeutic implications. We report the first case in which miliary M. bovis was proven to be the responsible mechanism, by culture of M. bovis biovar BCG from a transbronchial lung biopsy and complete resolution on anti-tuberculous chemotherapy.
Subject(s)
BCG Vaccine/adverse effects , Carcinoma, Transitional Cell/drug therapy , Mycobacterium bovis , Tuberculosis, Miliary/chemically induced , Urinary Bladder Neoplasms/drug therapy , Administration, Intravesical , Aged , Antitubercular Agents/administration & dosage , Antitubercular Agents/therapeutic use , BCG Vaccine/administration & dosage , Biopsy , Humans , Male , Radiography , Tuberculosis, Miliary/diagnostic imaging , Tuberculosis, Miliary/drug therapyABSTRACT
In a subgroup of children with myelomeningocele, urinary incontinence cannot be managed by clean intermittent catheterization and anticholinergic medication. The authors report on 24 such children who required bladder-outlet reconstruction. Twelve boys underwent the Young-Dees/Leadbetter procedure, 8 girls underwent the Burch procedure and the remaining 4 had a combination of the two. Augmentation cystoplasty was also carried out in seven girls and one boy. Results were most favourable in the girls, with improvement in 92%, in contrast to the boys in whom only 58% were improved. Artificial sphincter placement may be a more beneficial alternative for boys.
Subject(s)
Meningomyelocele/complications , Urinary Bladder, Neurogenic/surgery , Urinary Bladder/surgery , Adolescent , Child , Child, Preschool , Female , Humans , Male , Methods , Urinary Incontinence/surgeryABSTRACT
We report 4 cases of mixed gonadal dysgenesis with a karyotype containing a dicentric Y chromosome. All cases were mosaic with 45X and 46X, dic(Y) cell lines. Of the patients 1 had ambiguous genitalia and some features of Turner's syndrome, 2 had classical features of Turner's syndrome with normal female external genitalia and 1 had no features of Turner's syndrome but he presented with penoscrotal hypospadias, inguinal hernia and cryptorchidism. Female gender assignment and early total gonadectomy should be considered when a dicentric Y chromosome is present in cases of mixed gonadal dysgenesis.
Subject(s)
Gonadal Dysgenesis, Mixed/genetics , Gonadal Dysgenesis/genetics , Y Chromosome/ultrastructure , Child, Preschool , Cryptorchidism/genetics , Female , Hernia, Inguinal/genetics , Humans , Hypospadias/genetics , Infant , Infant, Newborn , Karyotyping , Male , Sex Chromosome Aberrations/genetics , Sex Determination Analysis , Turner Syndrome/geneticsABSTRACT
A retrospective clinical review was done to study the value of ultrasound and renography in the investigation of 100 neonates with renomegaly. Abnormalities in 73 patients were detected antenatally with ultrasonography. Of the neonates 47 had lower urinary tract pathological conditions and ultrasound was more than 90 per cent accurate in identifying the accompanying ureteral dilatation. A total of 53 neonates had upper tract anomalies (ureteropelvic junction obstruction or cystic dysplasia). With ultrasonography the degree of pyelocaliectasis in patients with ureteropelvic junction obstruction was classified as mild (22 units), moderate (13) or severe (7). Initial treatment and followup were reviewed to study the clinical course of neonates with mild to moderate degrees of pyelocaliectasis followed nonoperatively, and to determine whether the diuretic renogram had a predictive role in identifying which kidneys were most likely to deteriorate.
