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ABSTRACT: Hemolytic uremic syndrome (HUS) is an uncommon cause of acute renal failure in children. In contrast to Western countries, most HUSs in Taiwan are caused by Streptococcus pneumoniae. In this article, we demonstrate the clinical courses of children with HUS in Taiwan and try to explain the pathophysiology of complications.
We retrospectively reviewed the medical records of children with HUS who were admitted to the Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan, between January 1997 and February 2008. The clinical courses, laboratory data, complications, and prognosis were recorded. We divided the patients into dialysis group and non-dialysis group. The laboratory data for the two groups were expressed as mean, standard deviation, and range.
Nine patients were enrolled in the study, and all were diagnosed with S pneumoniae-associated HUS. One patient had meningitis, and the others had pneumonia. The mean durations of anemia and thrombocytopenia were 19.2 days and 10.2 days, respectively. Five patients received renal replacement therapy because of oligouria. The average of the peak total bilirubin levels of patients in the dialysis and non-dialysis groups were 24.6 ± 20.7mg/dL and 3.8 ± 1.9mg/dL, respectively. In addition to one patient who had meningitis, four other patients experienced central nervous system (CNS) complications. The mean durations of hypertension in five patients with CNS manifestations and four patients without CNS manifestations were 16.8 ± 7.8 days and 4.8 ± 6.6 days, respectively. Two patients died in acute stage, and most of the others had regained normal renal function at discharge or during follow-up.
(1) Streptococcus pneumoniae is the most common causative pathogen of HUS in Taiwan; (2) the mean duration of hypertension in patients with CNS manifestations was much longer than that in patients without CNS manifestations; and (3) the average of the peak total bilirubin levels of patients in the dialysis group was much higher than that in the patients of the non-dialysis group.
Pediatrics & Neonatology 04/2011; 52(2):73-7. · 0.75 Impact Factor
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ABSTRACT: Cases of nonobstructive dilation of the upper urinary tract subsequently becoming obstructive are rare. We report a case involving a male child approximately 2.5 years old (29 months) who presented with an obstruction of the ureterovesical junction, which had been diagnosed and treated for nonobstructive dilation at another hospital 15 months earlier. At our hospital, we found no ureteral orifice by cystoscopic examination. Exploratory surgery was performed and complete obstruction of the ureterovesical junction was observed. We resected the segment involved in the obstruction and performed an ureteroneocystostomy. Patients found to have nonobstructive dilation of the urinary tract, a common and often innocuous finding, need careful follow-up to ensure that obstructions that may develop later can be treated in a timely manner.
Pediatrics & Neonatology 12/2010; 51(6):353-5. · 0.75 Impact Factor
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ABSTRACT: De novo urothelial carcinoma is relatively rare among post-transplant malignancies and never reported in pediatric kidney transplant recipients. In this paper, we reported one 12-yr-old male case with painless gross hematuria as the initial manifestation of de novo urothelial carcinoma in living donor graft pelvis. We emphasize the importance that cystoscopy and retrograde pyelography of native and transplant kidneys should be performed in all kidney transplant recipients with painless gross hematuria.
Pediatric Transplantation 12/2007; 11(7):811-3. · 1.48 Impact Factor
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ABSTRACT: The aim of this study was to carry out a preliminary analysis of the impact of a government-sponsored disease management programme for paediatric asthma on economic outcomes and patient satisfaction.
Of the 398 patients who participated in the programme, 249 (62.56%) who had at least two medical care encounters with an ICD-9 code of 493 were classified as 'already diagnosed cases'; and 129 (34.12%) who had a single or no medical care encounter with an ICD-9 code of 493 were classified as 'newly diagnosed cases'. A retrospective 1:4 (intervention vs. control group) matched cohort study design was conducted, with the control group randomly drawn from 236 637 paediatric asthmatics who were not enrolled the programme. Questionnaires were collected from 105 (26.3%) of the patients.
Comparison results of 1 year pre/post tests of utilisation of health care resources indicated that the intervention group of already diagnosed cases had 77.97% fewer emergency department visits, 80.77% fewer inpatient visits, and 75.65% fewer stays of significant length. For the newly diagnosed group, the intervention group had 35.11% fewer emergency department visits than the control group. The majority of the patients had substantial adherence to physicians' suggestions, more accurate knowledge and better self-care skills concerning asthma.
A nurse-led management programme has proved useful in managing paediatric asthma in Taiwan. Simplification of paperwork, some reorganisation of the practitioner's daily responsibilities and provision of a fail-safe information system may make the programme even more beneficial.
Journal of Paediatrics and Child Health 04/2007; 43(3):134-8. · 1.28 Impact Factor
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ABSTRACT: Vancomycin-related nephrotoxicity typically manifests as acute tubulointerstitial nephritis. The drug does appear, however, to increase the nephrotoxicity of concurrently administered aminoglycosides. The extent of direct tubular toxicity attributable to vancomycin, especially in the absence of aminoglycoside treatment, does not appear to have been previously described. We report a case of biopsy-proven acute tubular necrosis secondary to vancomycin toxicity in a 13-year-old boy where there was no likely alternate explanation for toxic or ischemic injury. No hemodialysis was required, and the patient made a full recovery with subsequently regained renal function.
Renal Failure 02/2007; 29(8):1059-61. · 0.82 Impact Factor
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ABSTRACT: Fibroepithelial polyps causing ureteropelvic junction obstruction are rarely reported in the pediatric age group. We report a 9-year-old boy who had ureteropelvic junction obstruction that proved to be owing to benign fibroepithelial polyps. Intravenous pyelography showed hydronephrosis with filling defects at the left ureteropelvic junction. Operative exploration revealed several finger-like polypoid neoplasms obstructing the lumen. The involved segment was resected and a dismembered pyeloplasty was performed. Fibroepithelial polyps were diagnosed by histology. The clinical imaging findings, features and methods of surgical treatment of this rare lesion are discussed.
Acta paediatrica Taiwanica = Taiwan er ke yi xue hui za zhi 47(5):249-51.
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ABSTRACT: Necrotizing pneumonia (NP) is a rare but complex complication of lobar pneumonia in children. It is characterized by massive necrosis and liquification of lung tissues by the presence of multiple cavities rather than a solitary one. To evaluate the clinical features of NP, we enrolled 17 patients at Chang-Gung Memorial Hospital (Kaohsiung) from November 1999 to December 2002. The diagnosis of NP was based upon findings of chest computed tomography. There were six boys and 11 girls, ages ranging from 47 days to seven years. Streptococcus pneumoniae was the most common pathogen responsible for 9 cases in our study. Our patients remained febrile, even with the appropriate antibiotics administered, for a mean of 12.1 +/- 5.2 days and hospitalized for a mean of 22.7 +/- 7.0 days. The right lung was affected more than the left (12:7). On admission, laboratory data showed either leukocytosis, or normal leukocyte count, or leukopenia, but C-reactive protein was abnormally high (mean = 304.8 +/- 96.3 mg/L). Anemia and significant platelet count elevation developed at a mean period of 8.5 +/- 3.5 and 10.9 +/- 4.7 days after their hospitalization, respectively. Surgical intervention was performed in one case only in our series. Chest roentgenography took a mean of 60.3 +/- 15.6 days to resolve completely. Although the clinical course was prolonged, all patients with NP eventually recovered completely with no sequela.
Acta paediatrica Taiwanica = Taiwan er ke yi xue hui za zhi 44(6):343-8.
