Stories about: Pediatric Dose May 2015

Challenging Case: UTI and undetected genitourinary anomalies

MRI solid kidney vesicoureteral reflux hydronephrosis
MRI revealing the lack of a right kidney, as well as hydronephrosis of the left kidney.

A 3-year-old boy initially presented with a 10-day history of intermittent fevers—fluctuating as high as 105°F—and abdominal pain. His abdominal pain was episodic (lasting 30-60 minutes and occurring 2-3 times per day) fairly severe, peri-umbilical, non-radiating, and worsened with fevers. Initial evaluation revealed largely unremarkable labs (wbc 11.3, urinalysis normal). The patient was admitted to the hospital overnight but cultures and other workup were negative. No imaging was obtained at that time. As his fevers and abdominal pain resolved during the hospital stay, he was discharged home with presumed diagnosis of sequential viral infections.

Three days later he presented again a fever of 104°F and recurrent abdominal pain. Urinalysis and cultures were again negative. This time, abdominal sonography was obtained, showing a solitary left kidney with hydroureteronephrosis and a cystic area posterior to the bladder. The Boston Children’s Hospital Department of Urology was called into consult, after which an MRI confirmed right renal agenensis, left hydroureteronephrosis and a presumed right seminal vesicle cyst. …Read More

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Expert’s Corner: Teens and long-acting contraception

Teens adolescents long acting reversible contraception birth control implant IUD

The use of long-acting reversible contraceptive (LARC) methods among teens is on the rise. LARC use among 15- to 19-year-olds increased from 1 to 4.5 percent between 2007 and 2009. Both the American Congress of Obstetricians and Gynecologists and the American Academy of Pediatrics recommend LARC—specifically, intrauterine devices (IUDs) or implants—as a first-line contraceptive option for teens.

Some leaders in pediatric medicine are calling for increased access to LARC for teens. S. Jean Emans, MD, chief of Adolescent Medicine at Boston Children’s Hospital, and her colleague Amy DiVasta, MD, offer some insights into LARC and teens. …Read More

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Clinicians and social media: Finding the right relationship

doctor social media

I remember the day about 15 years ago when my doctor tentatively gave me his email address, telling me he trusted that I wouldn’t abuse it. (For the record, I’ve used that address maybe five times.)

Fast forward to today, where doctors and nurses are frequently on social media the same as the rest of us, usually behaving well, sometimes not.

What place do social media have in a physician or nurse’s career? And where do the boundaries lie? …Read More

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