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Background: The Page kidney phenomenon, whilst a known condition, is in itself a rare entity. This report illustrates a case following partial nephrectomy which presented as post-operative renal failure. Case Presentation: The authors present a case of renal cell carcinoma in a solitary kidney that after partial nephrectomy resulted in a subcapsular haematoma formation and acute renal failure. Conclusion: The condition of Page kidneys are typically described in young patients after trauma. However, with the increasing usage of surgical interventions, post-operative bleeding can result in a compression-induced necrosis.

SUMMARYNon-attendance for barium enema investigation wastes resources, prolongs waiting times and delays diagnosis of colorectal carcinoma. In an inner-city hospital with a previous non-attendance rate of over 20% for barium enema we investigated the value of systematic personal contact with a nurse practitioner at the time of booking. We compared two groups of patients, all of whom received an explanation of the procedure from the referring clinician.Patients referred from the colorectal clinic were accompanied by the colorectal nurse practitioner to the radiology department for booking, an appointment being sent later by mail. The nurse practitioner reiterated the details of the procedure, provided supplementary information, confirmed the patient's contact details and provided a telephone number in case further information or assistance was needed. Patients referred from the gastroenterology clinic were managed as previously, making their own way to the radiology department and receiving supplementary information only on request.The patients referred from the two clinics were closely similar; however, the non-attendance rate for the intervention (colorectal) clinic was 4/157 (2.5%) compared with 17/110 (15.5%) for the comparison clinic (P50.001).A year previously the non-attendance rates in these clinics had been 23% and 20%, respectively.These results indicate that personal contact, with supplementary information, can substantially reduce the nonattendance rate for barium enema.The tendency of patients not to keep appointments applies not only to outpatient clinics but also to planned investigations. Non-attendance rates vary between regions and specialties and are sometimes as high as 34% 1 . Nonattendance is influenced by patient gender, age, length of waiting time for the appointment and deprivation 2,3 . For certain investigations, such as barium enema, nonattendance not only wastes resources but can also delay the diagnosis of malignant disease. In our inner-city hospital, anecdotal evidence suggested that the high nonattendance rate for barium enema was attributable partly to clerical errors and partly to fear of the investigation or the result. It was proposed that the introduction of personal contact combined with supplementary advice might improve rates of attendance. PATIENTS AND METHODSAs previously, all patients in whom a barium enema was requested received an explanation of the procedure by the requesting clinician. Patients from the gastroenterology clinic then took the request form directly to the radiology department. Subsequently, by mail, they received an appointment date and bowel preparation material, along with directions for its use. Patients from the colorectal clinic followed the same procedure but were accompanied from the clinic to the radiology department by the colorectal nurse practitioner. She reiterated the explanation of the procedure and of bowel preparation and provided each patient with supplementary written information. She also confirmed the patient's contact details and p...

Background: Schistosomiasis is rare in western countries, but remains a potentially serious disease. It is known to result in severe urogenital complications; prompt diagnosis can therefore significantly affect outcomes.Case Presentation: We report the case of a 41-year-old male with pleuritic chest pain and visible hematuria who had emigrated from Zimbabwe to the United Kingdom 20 years previously. CT imaging revealed a hydronephrotic right pelvicaliceal system, with a dilated ureter to its distal portion. Preliminary tests for schistosomiasis, including terminal urine microscopy and serology, were negative. An initial ureteroscopy was challenging owing to a tight ureteral stricture such that a retrograde stent insertion and not ureteroscopic visualization or biopsy was carried out. A relook ureteroscopy after 6 weeks revealed a dense distal ureteral stricture, biopsies were taken, the stricture was ablated with LASER, and a retrograde stent was placed. Microscopic examination of the biopsies confirmed Schistosomiasis haematobium. Treatment consisted of a divided dose of praziquantel and a reducing dose of steroids. At a third look ureteroscopy the stricture was ablated with LASER again, and the stent was removed. Subsequent renograms indicated recurrent obstruction despite LASER treatment and a retrograde ureteral stent was replaced. The patient ultimately had a Boari flap ureteral reimplant with good results.Conclusion: This case illustrates the clinical challenges of diagnosing and treating ureteral schistosomiasis. It shows that all the initial tests can be negative, but where the clinical picture points toward schistosomiasis it is worth persevering and a good tissue biopsy may be the only way to verify an otherwise elusive diagnosis.