Cases reported "Acute Radiation Syndrome"

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1/3. Spontaneous rupture of the urinary bladder presenting as oliguric acute renal failure.

    A 64-year-old female was admitted to hospital for acute abdominal pain with ascites. The patient had received postoperative pelvic irradiation for carcinoma of the uterine cervix 7 years previously. serum creatinine (Scr) was elevated to 2.70 mg/dl, and urinary output was reduced to below 200 ml/day. cystoscopy revealed a small perforation from the bladder diverticulum. Following transurethral catheterization, urinary output was promptly increased, and Scr was returned to 0.65 mg/dl 4 days later. This rare case suggested that spontaneous rupture of the urinary bladder following postoperative radiotherapy could occur very late with laboratory features of oliguric acute renal failure.
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2/3. rupture of a renal cell carcinoma in a child: five-year tumor-free survival and literature review.

    The third case of presumably spontaneous rupture of a hypernephroma in a child is reported. This patient remains free of disease more than 5 years following radical nephrectomy, radiation and chemotherapy. Although renal adenocarcinoma in children remains a rare disease, more than 80 cases have appeared in the literature, making it necessary now to consider this tumor in the differential diagnosis of all childhood abdominal masses. Equally significant is the observation that presentation as an acute abdominal crisis in a child can occur, making it important that diagnostic considerations in such situations include hypernephroma, as well as Wilms' tumor. review of the literature shows that occasional cures from spontaneous retroperitoneal rupture of hypernephromas have been reported in adults, but not in children, although this child has survived in spite of tumor spillage in the free peritoneal cavity.
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3/3. pneumatosis cystoides intestinalis with abdominal free air in a 2-year-old girl after allogeneic bone marrow transplantation.

    A 2-year-old girl with acute lymphoblastic leukemia (ALL) showing a t(4;11)(q21;q23) karyotype underwent allogeneic bone marrow transplantation (BMT) with the conditioning regimen of L-PAM (70 mg/m2/d for 3 days), busulfan (140 mg/m2/d for 2 days), and total body irradiation (12 Gy). On day 57, the patient developed pneumatosis cystoides intestinalis (PCI) when she received cyclosporin A and corticosteroids for graft-versus-host disease (GVHD). Because of the presence of massive abdominal free air and the suspicion of peritonitis, she underwent surgical intervention, which, however, revealed neither intestinal perforation nor peritoneal infection. She recovered from PCI in 10 days with nasogastric suction, fasting, and systemic broad-spectrum antibiotics. PCI with massive abdominal free air after BMT should be manageable by conservative therapy alone.
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