Urethral Duplications in Children - A Case Series

Background: Urethral duplications are rare congenital anomalies with multiple anatomical variants. They mostly occur in the sagittal plane and can be associated with other congenital urogenital malformations. According to Effmann urethral duplications are classified into incomplete (type I), complete (type II), and complete associated with caudal duplication (type III). Methods: We hereby describe three cases of urethral duplications and their respective treatment. Results: Two cases were type I duplications. One patient was treated by complete resection of the blind ending secondary urethra, whereas no treatment was performed in the second patient. The third case was a IIA-2 Y-subtype duplication that needed complex reconstruction. Conclusions: There is no need for surgical management in asymptomatic patients with type I urethral duplications. Type IIA-2 Y-subtype duplications are extremely rare, and their treatment must be individualized according to anatomical and physiological features. Keywords: Urethral duplication; Y-duplication; Urethral anomal

Changes in plasma phenylalanine, isoleucine, leucine, and valine are associated with significant changes in intracranial pressure and jugular venous oxygen saturation in patients with severe traumatic brain injury

Changes in plasma aromatic amino acids (AAA = phenylalanine, tryptophan, tyrosine) and branched chain amino acids (BCAA = isoleucine, leucine, valine) levels possibly influencing intracranial pressure (ICP) and cerebral oxygen consumption (SjvO(2)) were investigated in 19 sedated patients up to 14 days following severe traumatic brain injury (TBI). Compared to 44 healthy volunteers, jugular venous plasma BCAA were significantly decreased by 35% (p < 0.001) while AAA were markedly increased in TBI patients by 19% (p < 0.001). The BCAA to AAA ratio was significantly decreased by 55% (p < 0.001) which persisted during the entire study period. Elevated plasma phenylalanine was associated with decreased ICP and increased SjvO(2), while higher plasma isoleucine and leucine levels were associated with increased ICP and higher plasma leucine and valine were linked to decreased SjvO(2). The amount of enterally administered amino acids was associated with significantly increased plasma levels with the exception of phenylalanine. Contrary to the initial assumption that elevated AAA and decreased BCAA levels are detrimental, increased plasma phenylalanine levels were associated with beneficial signs in terms of decreased ICP and reduced cerebral oxygen consumption reflected by increased SjvO(2); concomitantly, elevated plasma isoleucine and leucine levels were associated with increased ICP while leucine and valine were associated with decreased SjvO(2) following severe TBI, respectively. The impact of enteral nutrition on this observed pattern must be examined prospectively to determine if higher amounts of phenylalanine should be administered to promote beneficial effects on brain metabolism and if normalization of plasma BCAA levels is without cerebral side effects