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Dysuria in Children

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461. Bacterial Infections and Pregnancy (Diagnosis)

with microabscesses. Twenty-two percent of perinatal infections result in neonatal death or stillbirth. [ ] Among women who have listeriosis during pregnancy, two thirds of surviving infants develop clinical neonatal listeriosis. Early diagnosis and antimicrobial treatment of infected women during pregnancy can lead to the birth of a healthy child. In neonates, the mortality rate is approximately 50%. Mortality is more likely in early-onset neonatal sepsis. Late-onset listeriosis typically manifests as meningitis (...) collection [ ] If the culture result is positive, the woman should be treated during labor If culture results are unknown at the time of delivery, a risk-based approach can be used, in which patients are deemed at high risk and receive treatment if they meet any of the following criteria: Previously delivered infant with invasive GBS infection GBS bacteriuria during current pregnancy Delivery before 37 weeks' gestation Duration of ruptured membranes longer than 18 hours Intrapartum temperature of more

2014 eMedicine.com

462. Augmentation Cystoplasty (Diagnosis)

for an embryologic urinary defect as a child seek a healthier cosmetic and functional state. In other cases, adults have an acquired condition that is causing bladder dysfunction. Adults may present with symptoms very similar to those of children with congenital abnormalities. Again, surgery is indicated for adults with refractory symptoms and those with risk or progression of upper tract deterioration. Previous Next: Contraindications Patients who are unable or unwilling to perform life-long intermittent (...) pressure and improves continence. Adult patients should have good manual dexterity, proven by performing self-catheterization in front of the physician. In pediatric patients, the parents must be committed to catheterizing the child at least every 4-6 hours. Parents must be taught catheterization before surgery. Intermittent catheterization and anticholinergic management are usually used in combination to accomplish symptom-management goals, to create continence, to eliminate vesicoureteral reflux

2014 eMedicine.com

463. Genital Herpes in Pregnancy (Diagnosis)

of Obstetrics and Gynecologists (Washington, DC) for speaking and teaching; Received honoraria from National Institute of Child Health and Human Development Pediatric and Adolescent Gynecology Research Thi. Chief Editor Ronald M Ramus, MD Professor of Obstetrics and Gynecology, Director, Division of Maternal-Fetal Medicine, Virginia Commonwealth University School of Medicine Ronald M Ramus, MD is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Additional Contributors (...) to herpes simplex virus 2 (HSV-2). Approximately 22% of pregnant women are infected with HSV-2 and 2% of women acquire genital herpes in pregnancy. Approximately 1500-2000 new cases of neonatal HSV infection are diagnosed each year. The incidence of neonatal herpes varies considerably in international studies (about 1:3,200 births in the US and 1:60,000 in the UK). Approximately 80% of infected infants are born to mothers with no reported history of HSV infection. [ ] Untreated neonatal HSV infection

2014 eMedicine.com

464. Epididymal Tuberculosis (Diagnosis)

appearance) with . Severe cases involve the entire bladder wall, where deep layers of muscle are eventually replaced by fibrous tissue, thus producing a thick fibrous bladder. Tubercles are rare in the bladder; if present, they usually appear at the ureteral orifice. Malignancy should be considered with any isolated tubercles away from the ureteral orifices. Epididymal and testicular TB The higher frequency of isolated epididymal TB lesions in children favors the possibility of hematologic spread (...) increased frequency of urination (during the day initially but at night later in the disease course), dysuria, frank pain, suprapubic pain, blood or pus in the urine, and fever. Urinary urgency is relatively uncommon unless the bladder is extensively involved. Patients with GUTB may also present with a painful testicular swelling, perianal sinus, or genital ulcer. Unexplained infertility in both men and women is sometimes attributable to GUTB. [ ] Physicians have also diagnosed endometrial TB while

2014 eMedicine.com

465. Hematopoietic Stem Cell Transplantation (Diagnosis)

hampered by small numbers. [ ] Patients treated with chemotherapy alone have achieved remission, but overall survival has been poor. [ , ] In a comparison allogeneic transplant versus chemotherapy in children with Phl + ALL (UK Medical Research Council trial for childhood ALL [MRC ALL 97] program from 1997-2002), 3-year survival was reported as 60% compared with 36%, respectively. [ ] Children with induction failure (M2 or M3 bone marrow status at the end of 1 mo of therapy) were found to have very (...) Leukocyte adhesion deficiency Indications for HSCT in specific diseases Acute myeloid leukemia Allogeneic HSCT is the treatment of choice for all children with acute myeloid leukemia (AML) with a human leukocyte antigen (HLA) ̶ matched sibling in their first complete remission (CR1). In adults, this is reserved for those with high-risk features in their CR1. In adults with standard or good risk features, stem cell transplantation is reserved for their second complete remission (CR2). HSCT is the only

2014 eMedicine.com

466. Gonococcus (Diagnosis)

partners frequently enough to sustain the infection in a community are defined as core transmitters. Neonatal and pediatric gonococcal infection Neonatal gonococcal infection may follow conjunctival infection, which is obtained during passage through the birth canal. In addition, direct infection may occur through the scalp at the sites of fetal monitoring electrodes. In children, infection may occur from sexual abuse by an infected individual or possibly nonsexual contact in the child's household (...) of reported gonorrhea cases by age group and sex, United States, 2016. Courtesy of the Centers for Disease Control and Prevention (CDC). Infection in children is a marker for child sexual abuse and should be reported as such, although a 2007 review provided some support for nonsexual transmission between children and for transmission from adults to children related to poor hand hygiene. [ , ] Gonococcemia remains an important disease in the adolescent and young adult population, with a peak incidence

2014 eMedicine.com

467. Gonococcemia (Diagnosis)

partners frequently enough to sustain the infection in a community are defined as core transmitters. Neonatal and pediatric gonococcal infection Neonatal gonococcal infection may follow conjunctival infection, which is obtained during passage through the birth canal. In addition, direct infection may occur through the scalp at the sites of fetal monitoring electrodes. In children, infection may occur from sexual abuse by an infected individual or possibly nonsexual contact in the child's household (...) of reported gonorrhea cases by age group and sex, United States, 2016. Courtesy of the Centers for Disease Control and Prevention (CDC). Infection in children is a marker for child sexual abuse and should be reported as such, although a 2007 review provided some support for nonsexual transmission between children and for transmission from adults to children related to poor hand hygiene. [ , ] Gonococcemia remains an important disease in the adolescent and young adult population, with a peak incidence

2014 eMedicine.com

468. Gonococcal Infections (Diagnosis)

unprotected intercourse with new partners frequently enough to sustain the infection in a community are defined as core transmitters. Neonatal and pediatric gonococcal infection Neonatal gonococcal infection may follow conjunctival infection, which is obtained during passage through the birth canal. In addition, direct infection may occur through the scalp at the sites of fetal monitoring electrodes. In children, infection may occur from sexual abuse by an infected individual or possibly nonsexual contact (...) contraceptives Rates of reported gonorrhea cases by age group and sex, United States, 2016. Courtesy of the Centers for Disease Control and Prevention (CDC). Infection in children is a marker for child sexual abuse and should be reported as such, although a 2007 review provided some support for nonsexual transmission between children and for transmission from adults to children related to poor hand hygiene. [ , ] Gonococcemia remains an important disease in the adolescent and young adult population

2014 eMedicine.com

469. Epididymitis (Diagnosis)

demonstrates increased blood flow in the epididymis resulting from the active inflammation. Signs and symptoms The following history findings are associated with acute epididymitis and orchitis: Gradual onset of scrotal pain and swelling, usually unilateral, often developing over several days (as opposed to hours for testicular torsion) Dysuria, frequency, or urgency Fever and chills (in only 25% of adults with acute epididymitis but in up to 71% of children with the condition) Usually, no nausea (...) resection of the ejaculatory ducts, resulting in epididymitis. It can also be a result of heavy physical activity such as weight lifting. In children, infection is less common an etiology. One study of a pediatric emergency department found only 4 (4.1%) of 97 children diagnosed with epididymitis had a positive urine culture. [ ] Children may have various congenital abnormalities or functional voiding problems that increase the risk of reflux into the ejaculatory ducts. For example, epididymitis may

2014 eMedicine.com

470. Congenital Adrenal Hyperplasia (Follow-up)

. Complications of excessive administration of glucocorticoids include growth failure, obesity, striae, hypertension, hyperglycemia, and cataracts. The complications of excess mineralocorticoid administration include hypertension and hypokalemia. A study by Maccabee-Ryaboy et al of 180 pediatric patients indicated that children with CAH are more likely to experience hypertension than are children in the general population, with the incidence of hypertension varying according to sex and the type of CAH (...) MA, Prakash D, et al. Spontaneous adrenal hemorrhage associated with transient antiphospholipid antibody in a child. Clin Pediatr (Phila) . 2001 Jun. 40(6):347-50. . Speiser PW, Azziz R, Baskin LS, Ghizzoni L, Hensle TW, Merke DP. Congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab . 2010 Sep. 95(9):4133-60. . Poppas DP. Clitoroplasty in congenital adrenal hyperplasia: description of technique. Adv Exp

2014 eMedicine Pediatrics

471. Menstruation Disorders (Overview)

, Roche AF, Kulin HE, Lee PA, Himes JH, et al. Age at menarche and racial comparisons in US girls. Pediatrics . 2003 Jan. 111(1):110-3. . Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child . 1969 Jun. 44(235):291-303. . . World Health Organization multicenter study on menstrual and ovulatory patterns in adolescent girls. II. Longitudinal study of menstrual patterns in the early postmenarcheal period, duration of bleeding episodes and menstrual cycles. World (...) of inherited bleeding disorders in women with menorrhagia. Lancet . 1998 Feb 14. 351(9101):485-9. . Ragni MV, Bontempo FA, Hassett AC. von Willebrand disease and bleeding in women. Haemophilia . 1999 Sep. 5(5):313-7. . Werner EJ, Broxson EH, Tucker EL, Giroux DS, Shults J, Abshire TC. Prevalence of von Willebrand disease in children: a multiethnic study. J Pediatr . 1993 Dec. 123(6):893-8. . Shankar M, Lee CA, Sabin CA, Economides DL, Kadir RA. von Willebrand disease in women with menorrhagia: a systematic

2014 eMedicine Pediatrics

472. Meatal Stenosis (Overview)

. [ ] Meatal stenosis is typically characterized by an upward-deflected, difficult-to-aim urinary stream and, rarely, by dysuria and urgent, frequent, and prolonged urination. Surgical meatotomy or meatoplasty is normally curative. For patient education resources, see the , as well as and . Next: Pathophysiology After circumcision, a child who is not toilet-trained persistently exposes the meatus to urine, which results in inflammation (ammoniac dermatitis) and mechanical trauma as the meatus rubs against (...) of meatal stenosis may not alleviate them. Previous References Van Howe RS. Incidence of meatal stenosis following neonatal circumcision in a primary care setting. Clin Pediatr (Phila) . 2006 Jan-Feb. 45 (1):49-54. . Joudi M, Fathi M, Hiradfar M. Incidence of asymptomatic meatal stenosis in children following neonatal circumcision. J Pediatr Urol . 2011 Oct. 7 (5):526-8. . Frisch M, Simonsen J. Cultural background, non-therapeutic circumcision and the risk of meatal stenosis and other urethral stricture

2014 eMedicine Pediatrics

473. Arthritis, Conjunctivitis, Urethritis Syndrome (Treatment)

). Rheumatol Int . 2009 Jul. 29(9):1097-9. . Rueda JC, Crepy MF, Mantilla RD. Clinical features of Poncet's disease. From the description of 198 cases found in the literature. Clin Rheumatol . 2013 Jul. 32(7):929-35. . Prati C, Bertolini E, Toussirot E, Wendling D. Reactive arthritis due to Clostridium difficile. Joint Bone Spine . 2010 Mar. 77(2):190-2. . Durand CL, Miller PF. Severe Clostridium difficile colitis and reactive arthritis in a ten-year-old child. Pediatr Infect Dis J . 2009 Aug. 28(8):750-1 (...) findings of enthesitis in reactive arthritis. Clin Nucl Med . 2011 Feb. 36(2):121-3. . Simonini G, Taddio A, Cimaz R. No evidence yet to change American Heart Association recommendations for poststreptococcal reactive arthritis: comment on the article by van Bemmel et al. Arthritis Rheum . 2009 Nov. 60(11):3516-8; author reply 3518-9. . Moorthy LN, Gaur S, Peterson MG, Landa YF, Tandon M, Lehman TJ. Poststreptococcal reactive arthritis in children: a retrospective study. Clin Pediatr (Phila) . 2009 Mar

2014 eMedicine Pediatrics

474. Hematuria (Overview)

Nephrol . 2009 Oct. 24(10):1951-8. . Expert Panel on Pediatric Imaging:., Dillman JR, Rigsby CK, Iyer RS, Alazraki AL, Anupindi SA, et al. ACR Appropriateness Criteria ® Hematuria-Child. J Am Coll Radiol . 2018 May. 15 (5S):S91-S103. . Diven SC, Travis LB. A practical primary care approach to hematuria in children. Pediatr Nephrol . 2000 Jan. 14(1):65-72. . Dodge WF, West EF, Smith EH, Bruce Harvey 3rd. Proteinuria and hematuria in schoolchildren: epidemiology and early natural history. J Pediatr (...) . . Kalia A, Travis LB, Brouhard BH. The association of idiopathic hypercalciuria and asymptomatic gross hematuria in children. J Pediatr . 1981 Nov. 99(5):716-9. . Kincaid-Smith P, Fairley K. The investigation of hematuria. Semin Nephrol . 2005 May. 25(3):127-35. . Krieger I, Sargent DA. A postural sign in the sensory deprivation syndrome in infants. J Pediatr . 1967 Mar. 70(3):332-9. . Loo RK, Lieberman SF, Slezak JM, Landa HM, Mariani AJ, Nicolaisen G, et al. Stratifying risk of urinary tract

2014 eMedicine Pediatrics

475. Hemorrhagic Cystitis (Overview)

stem cell transplantation. Biol Blood Marrow Transplant . 2011 Oct. 17(10):1512-9. . Hatakeyama N, Suzuki N, Yamamoto M, Kuroiwa Y, Hori T, Mizue N, et al. Detection of BK virus and adenovirus in the urine from children after allogeneic stem cell transplantation. Pediatr Infect Dis J . 2006 Jan. 25(1):84-5. . Hoffman JA, Shah AJ, Ross LA, Kapoor N. Adenoviral infections and a prospective trial of cidofovir in pediatric hematopoietic stem cell transplantation. Biol Blood Marrow Transplant . 2001. 7 (...) , Choi Y, et al. Isolation of adenovirus type 7 from the urine of children with acute hemorrhagic cystitis. Pediatr Infect Dis J . 1996 Jul. 15(7):633-4. . Mori T, Aisa Y, Shimizu T, Ikeda Y, Okamoto S, Okada K, et al. Hemorrhagic cystitis caused by adenovirus type 34 after allogeneic bone marrow transplantation. Transplantation . 2005 Mar 15. 79(5):624. . Umekawa T, Kurita T. Acute hemorrhagic cystitis by adenovirus type 11 with and without type 37 after kidney transplantation. Urol Int . 1996. 56(2

2014 eMedicine Pediatrics

476. Gonorrhea (Overview)

partners frequently enough to sustain the infection in a community are defined as core transmitters. Neonatal and pediatric gonococcal infection Neonatal gonococcal infection may follow conjunctival infection, which is obtained during passage through the birth canal. In addition, direct infection may occur through the scalp at the sites of fetal monitoring electrodes. In children, infection may occur from sexual abuse by an infected individual or possibly nonsexual contact in the child's household (...) of reported gonorrhea cases by age group and sex, United States, 2016. Courtesy of the Centers for Disease Control and Prevention (CDC). Infection in children is a marker for child sexual abuse and should be reported as such, although a 2007 review provided some support for nonsexual transmission between children and for transmission from adults to children related to poor hand hygiene. [ , ] Gonococcemia remains an important disease in the adolescent and young adult population, with a peak incidence

2014 eMedicine Pediatrics

477. Meatal Stenosis (Treatment)

of up to 8 weeks. In a survey of office pediatric urologic procedures, which included meatotomy, lysis of labial adhesions, and newborn circumcision, Smith and Smith found that 95 of 99 parents stated that they were satisfied with their decision to have these procedures performed in the office, and 95% reported good outcomes (only one patient had recurrent meatal stenosis). [ ] Mild dysuria may be present for 1-2 days after meatotomy. If dysuria results in urinary retention, placing the child (...) and noted good patient tolerance when a caring approach is used to reassure the child before and during the procedure. In this series, parents were encouraged to remain with the children during the operation; their presence seemed to have a calming effect. In a retrospective study of 55 boys who underwent clinic meatotomy (CM) under topical lidocaine and prilocaine (EMLA) anesthesia, Fronczak et al found that although their success rate was lower than that reported in earlier studies and the incidence

2014 eMedicine Pediatrics

478. Hypercalciuria (Follow-up)

al. Prevalence and spot urine risk factors for renal stones in children taking topiramate. J Pediatr Urol . 2013 Jan 31. . . Vachvanichsanong P, Malagon M, Moore ES. Recurrent abdominal and flank pain in children with idiopathic hypercalciuria. Acta Paediatr . 2001 Jun. 90(6):643-8. . Alon US, Berenbom A. Idiopathic hypercalciuria of childhood: 4- to 11-year outcome. Pediatr Nephrol . 2000 Sep. 14(10-11):1011-5. . Escribano J, Balaguer A, Martin R, Feliu A, Espax R. Childhood idiopathic (...) degree of hematuria and back or abdominal pain and is also sometimes associated with voiding symptoms. Microcrystallization of calcium with urinary anions has been suggested to lead to injury of the uroepithelium in children with hypercalciuria. Consequently, when taking the history of the illness, attempt to identify symptoms relating to the urinary tract, paying special attention to the following signs and symptoms: Dysuria Abdominal pain Irritability (infants) Urinary frequency Urinary urgency

2014 eMedicine Pediatrics

479. Meatal Stenosis (Follow-up)

of up to 8 weeks. In a survey of office pediatric urologic procedures, which included meatotomy, lysis of labial adhesions, and newborn circumcision, Smith and Smith found that 95 of 99 parents stated that they were satisfied with their decision to have these procedures performed in the office, and 95% reported good outcomes (only one patient had recurrent meatal stenosis). [ ] Mild dysuria may be present for 1-2 days after meatotomy. If dysuria results in urinary retention, placing the child (...) and noted good patient tolerance when a caring approach is used to reassure the child before and during the procedure. In this series, parents were encouraged to remain with the children during the operation; their presence seemed to have a calming effect. In a retrospective study of 55 boys who underwent clinic meatotomy (CM) under topical lidocaine and prilocaine (EMLA) anesthesia, Fronczak et al found that although their success rate was lower than that reported in earlier studies and the incidence

2014 eMedicine Pediatrics

480. Hematopoietic Stem Cell Transplantation (Follow-up)

hampered by small numbers. [ ] Patients treated with chemotherapy alone have achieved remission, but overall survival has been poor. [ , ] In a comparison allogeneic transplant versus chemotherapy in children with Phl + ALL (UK Medical Research Council trial for childhood ALL [MRC ALL 97] program from 1997-2002), 3-year survival was reported as 60% compared with 36%, respectively. [ ] Children with induction failure (M2 or M3 bone marrow status at the end of 1 mo of therapy) were found to have very (...) Leukocyte adhesion deficiency Indications for HSCT in specific diseases Acute myeloid leukemia Allogeneic HSCT is the treatment of choice for all children with acute myeloid leukemia (AML) with a human leukocyte antigen (HLA) ̶ matched sibling in their first complete remission (CR1). In adults, this is reserved for those with high-risk features in their CR1. In adults with standard or good risk features, stem cell transplantation is reserved for their second complete remission (CR2). HSCT is the only

2014 eMedicine Pediatrics

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