Genital Prolapse Causing Urinary Obstruction and Hydronephrosis in a Neonate: A Case and Review of the Literature

Neonatal genital prolapse is a rare condition seen early in life, often in conjunction with spinal cord anomalies. We present a case of a 38-week gestational age female in whom urinary obstruction and bilateral hydronephrosis resulted from genital prolapse. We suggest that although a serious urologic outcome can potentially result from this condition, cure for both can be achieved swiftly and without major complications

Intravesical Botulinum Toxin for Persistent Autonomic Dysreflexia in a Pediatric Patient

Introduction. We present a novel case of persistent autonomic dysreflexia in a pediatric spinal cord injury patient treated successfully with intravesical botulinum toxin. Study Design. A retrospective chart review of one patient seen at the Children’s Hospital of Wisconsin from 2006 to 2012 was performed. Results. A pediatric spinal cord injury patient with known neurogenic bladder presented with severe hypertension consistent with autonomic dysreflexia. His symptoms and hypertension did not improve with conservative measures, and he necessitated ICU admission and antihypertensive drips. He was taken to the operating room for intravesical botulinum toxin for refractory bladder spasms. Following this, his symptoms abated, and he was weaned off IV antihypertensives and returned to his baseline state. His symptoms were improved for greater than six months. Conclusions. There are few treatment options for the management of refractory autonomic dysreflexia. Intravesical botulinum toxin has never been reported for this use. Dedicated research is warranted to assess its efficacy, as it was used successfully to abort autonomic dysreflexia in this patient

Perspectives of Cancer Survivors with Low Income: A Content Analysis Exploring Concerns, Positive Experiences, and Suggestions for Improvement in Survivorship Care

The number of cancer survivors in Canada has reached 1.5 million and is expected to grow. It is important to understand cancer survivors’ perspectives about the challenges they face after treatment is completed. Many factors create barriers to accessing assistance, and limited income may be a significant one. This study is a secondary analysis of data from a publicly available databank (Cancer Survivor Transitions Study) regarding the experiences of Canadian cancer survivors. The goal was to explore major challenges, positive experiences, and suggestions for improvement in survivorship care for low-income Canadian cancer survivors one to three years following treatment. A total of 1708 survey respondents indicated a low annual household income (<$25,000 CD). A content analysis was performed utilizing written comments to open-ended questions. The major challenges respondents described focused on physical capacity limits and treatment side effects; positive experiences emphasized support and attentive care; and suggestions for improvements highlighted the need for better support, information about self-care and side effect management, and timely follow-up care. The relationships between household income and the management of survivors’ physical, emotional, and practical concerns require consideration. The design of follow-up care plans, programs, services, and financial assessments of patients may prepare survivors for predictable issues and costs in their transition to survivorship

Cancer Survivors Living in Rural Settings: A Qualitative Exploration of Concerns, Positive Experiences and Suggestions for Improvements in Survivorship Care

In Canada, the number of cancer survivors continues to increase. It is important to understand what continues to present difficulties after the completion of treatment from their perspectives. Various factors may present barriers to accessing help for the challenges they experience following treatment. Living rurally may be one such factor. This study was undertaken to explore the major challenges, positive experiences and suggestions for improvement in survivorship care from rural-dwelling Canadian cancer survivors one to three years following treatment. A qualitative descriptive analysis was conducted on written responses to open-ended questions from a national cross-sectional survey. A total of 4646 individuals living in rural areas responded to the survey. Fifty percent (2327) were male, and 2296 (49.4%) were female; 69 respondents were 18 to 29 years (1.5%); 1638 (35.3%) were 30 to 64 years; and 2926 (63.0%) were 65 years or older. The most frequently identified major challenges (n = 5448) were reduced physical capacity and the effects of treatment. Positive experiences included family and friend support and positive self-care practices. The suggestions for improvements focused on the need for better communication and information about self-care, side effect management, and programs and services, with more programs available locally for practical and emotional support

Adolescent and young adult perspectives on challenges and improvements to cancer survivorship care: How are we doing?

Purpose: The purpose was to review main challenges experienced by adolescent and young adult (AYA) cancer survivors (18-34 years) during transition to survivorship and their suggestions regarding improvements needed in care. Methods: A national survey was conducted to identify experiences with follow-up care 1-3 years after cancer treatment. The survey included open-ended questions for respondents to add topics of importance and details for deeper insight. This study presents analysis of open-ended questions about main challenge faced by AYA respondents and their suggestions for improvements in care. Results: Of 575 AYA survey respondents, 497 (86.4%) commented regarding main challenges. Twenty-one indicated that they had no challenges. Of those reporting challenges, 209 (43.9%) named one challenge, 267 (56.1%) identified more than one. In total, 955 challenges were identified with the most frequently cited being physical (n = 462, 48.4%) and psychological (n = 234, 24.5%). A total of 391 survivors wrote 679 suggestions about improvements in care with the majority (n = 248, 69.4%) offering more than one. The most frequently cited suggestions included information/communication (n = 191, 29.8%), naming a range of topics for which information was desired, and access to post-treatment therapies/services (n = 164, 25.5%) such as counseling, physiotherapy, and occupational therapy. The overarching theme was, "I need follow-up care that fits me." Conclusions: AYA cancer survivors are diverse and face unique challenges following treatment, which can have life-long implications and impede their recovery. Personalized follow-up care is highly recommended by these survivors.<br/

Variability in Size Measurement of Renal Masses Smaller Than 4 cm on Computerized Tomography

We assessed the degree of interobserver and intra-observer variability in the size measurement of small renal tumors with computerized tomography. A total of 29 renal masses from 21 patients were reviewed independently by 3 radiologists on computerized tomography performed with 5 mm collimation and a reconstruction interval of 2.5 mm. Measurements were made of the largest axial dimension (X), perpendicular axial dimension (Y) and slice direction (Z) with double reads performed in a subset of patients. The predicted 95% CI was calculated for each measure, assuming different readers and the same reader. The predicted error bounds for a single renal mass measurement in the X axis were ±3.1 mm when considering multiple readers and ±2.3 mm for a single reader. In the X axis 78 of the 87 measurements (90%) were within 2 mm of the average measure. Smaller variances in measurements were seen with single reader repeat measurements than with multiple readers. Highest variances were seen in the Z axis. Measurements of volume and cross-sectional area showed a higher degree of variance. When comparing independent computerized tomography readings done with 5 mm collimation and a 2.5 mm reconstruction interval, a size change in the largest axial dimension of a renal mass of less than 3.1 mm between different radiologists and less than 2.3 mm for the same radiologist should be viewed with caution because it is within the range of measurement variability