Prevention and management of BK-virus associated haemorrhagic cystitis in children following haematopoietic stem cell transplantation--a systematic review and evidence-based guidance for clinical management.

Haemorrhagic cystitis (HC) is a common and, in its severe form, potentially life-threatening complication of Haematopoietic stem cell transplantation (HSCT) in children. Recent data indicate an important role of BK virus reactivation during the time of maximal post-transplant immune suppression in the pathogenesis of late-onset HC. Treatment of HC is mainly symptomatic and often frustrating. To give clinicians guidance on prevention and treatment options and their backing by scientific evidence, we have systematically assessed the available literature and devised evidence-based guidelines. Our comprehensive review demonstrates that evidence for the most commonly used interventions (such as cidofovir, oestrogen, hyperbaric oxygen, bladder instillation with formalin, alum salts or prostaglandin) is very limited. Some of these interventions also carry significant risks. Higher level evidence exists only for 2-mercaptoethane sodium (MESNA) and hyperhydration as a preventative intervention, and for systemic recombinant Factor VII as a treatment to stop acute haemorrhage. Further high-quality studies are required to establish effective and safe prevention and treatment options for HC.

Recognising serious umbilical cord anomalies.

Umbilical vessel catheterisation is a common intervention in neonatal care. Many complications are recognised, some of which are life-threatening. We report the case of a term neonate who was compromised at birth following antepartum haemorrhage with evidence of multiorgan ischaemic injury. Following resuscitation and umbilical vessel catheterisation, she developed pneumoperitoneum. At laparotomy, a patent vitellointestinal duct was identified and resected. Intestinal perforation was found in the duct wall, most plausibly explained by the unintentional catheterisation of the duct via the umbilicus. Learning to recognise umbilical cord anomalies, such as patent vitellointestinal duct, can be simple and could prevent potentially serious complications.

Haematuria and the retro-aortic left renal vein.

The authors present the case of a 10-year-old boy with a 2-year history of intermittent macroscopic haematuria. After exclusion of other causes of haematuria through history, examination and a number of investigations, MRI revealed the finding of a retro-aortic left renal vein, which appeared to be compressed between the aorta and the L3 vertebral body. The retro-aortic left renal vein or 'posterior nutcracker syndrome" is a rare but important cause of haematuria and other manifestations of left renal vein hypertension. A discussion about the implications of this finding in children with symptoms consistent with left renal vein hypertension, and the potential options for management is undertaken.

Neonatal urinary ascites secondary to urinary bladder rupture.

We describe the clinical presentation, radiology and clinical management of four neonates with spontaneous urinary bladder rupture and secondary urinary ascites seen in 1984 and two recent cases seen in 2007. All neonates had normal genitourinary systems on antenatal serial ultrasound scans. The management of these cases ranged from conservative management (n=3) to surgical repair of bladder (n=1). We present a review of the current literature covering management strategies and the possible role of ischemia in the pathogenesis of neonatal bladder rupture which continues to be a clinically challenging entity to diagnose and manage.