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Desmoplastic Small Round Cell Tumour (DSRCT) - A Case Report and Review of Literature 结缔组织增生小圆细胞瘤(DSRCT) 1例报告及文献复习
Pub Date : 2014-07-16 DOI: 10.3329/JPSB.V2I2.19552
A. Morshed, F. Afroz, C. Galib, S. Islam, K. Hasina, A. Ghosh
Desmoplastic small round cell tumor (DSRCT) is a rare pathologic entity that most frequently affects the peritoneal cavity and presents in pediatric and adolescent boys. It often presents at an advanced stage and has a generally poor prognosis. Sometimes it may involve liver at diagnosis. We present an unusual case of DSRCT who was present with mass in lower abdomen, pain, hepatomegaly and mild ascites. This tumor is characterized by nests of small undifferentiated cells that show immunohistochemical evidence of epithelial, mesenchymal and neural differentiation. In our patient histologicaly tumor had the characteristic features of DSRCT and were composed of small round cells with hyperchromatic nuclei and scanty cytoplasm. With various difficulties in diagnosis we ultimately reached at diagnosis by open biopsy and immunohistochemistry. Now patient is on multidrug chemotherapy (modified p6 protocol). Diagnosis and management of a rare tumor needs high level of suspicion and in time intervention. DOI: http://dx.doi.org/10.3329/jpsb.v2i2.19552
结缔组织增生小圆细胞瘤(DSRCT)是一种罕见的病理实体,最常见于儿科和青少年男孩的腹膜腔。它经常出现在晚期,通常预后较差。有时在诊断时可能累及肝脏。我们提出一个不寻常的病例DSRCT谁是目前肿块在下腹,疼痛,肝肿大和轻度腹水。这种肿瘤的特征是小的未分化细胞巢,显示上皮、间充质和神经分化的免疫组织化学证据。本例患者的肿瘤具有DSRCT的组织学特征,由小而圆的细胞组成,细胞核深染,细胞质稀少。由于诊断困难重重,我们最终通过开放活检和免疫组织化学进行诊断。目前患者正在接受多药化疗(修改后的p6方案)。一种罕见肿瘤的诊断和治疗需要高度的怀疑和及时的干预。DOI: http://dx.doi.org/10.3329/jpsb.v2i2.19552
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引用次数: 1
Outcome of Vesiciureteric Reflux After Primary Fulguration of Posterior Urethral Valves 原发性后尿道瓣膜灼烧后膀胱输尿管反流的结局
Pub Date : 2014-07-15 DOI: 10.3329/JPSB.V2I2.19542
M. Pervez, K. Hasina, Md. Ashraf Ul Huq, M. Nooruzzaman, A. Hanif
Introduction: Congenital obstruction of the urethra is one of the most devastating anomalies to occur in the urinary tract and one of the few that are life-threatening in the neonatal period. Posterior urethral valve (PUV) is the most frequent cause of urethral obstruction in male child. These lesions usually result in lifelong disabilities with incontinence and decreased renal function despite optimal medical management. Primary fulguration without upper tract diversion is the preferred modality of treatment in most cases of PUV. Regular follow-up is needed to check completion of valve fulguration, renal function, status of hydronephrosis, vesicoureteric reflux (VUR), urinary tract infection (UTI), and bladder function. Materials and methods: We conducted interventional study among 30 purposively selected patients of PUV in the Department of Pediatric surgery, Dhaka Medical College Hospital (DMCH), Dhaka, over a period of 16 months from December 2009 to March 2011. Age of study subjects varied from 2 days to 14 years. Among the 30 patients, 16 were children in the age group between 1year to14 years (53.3%), 11(36.7%) were infants and the rest 03(10%) were neonates. Most of the patients presented with weak urinary stream, dribbling of urine, straining at micturition, UTI and palpable bladder. All children were subjected to ultrasonography(USG),blood urea, serum creatinine, routine urine examination and culture studies. Structured questionnaire was used to collect information regarding improvement of VUR and renal functional status before & after primary fulguration of PUV. Results: Average serum creatinine level was found gradually decreased in subsequent follow up in comparison with the previous one. This difference of creatinine level was found statistically significant in t test (p<0.01). Average blood urea nitrogen (BUN) was also decreased which was found statistically significant (p<0.05). VUR was present in 63.3% cases. Non- VUR was found in 60% cases on right side and 50% cases on left side. On the third follow-up  after 3 months it became 73.3% on right side and 63.3% on left side. Positive correlation found in Pearson correlation test about the changes of reflux grades before and after fulguration was significant at the level of 0.01(p<0.001). It was significant on both left and right kidneys. Positive correlation found in Pearson correlation test about the changes of GFR before and after fulguration was also significant at the level of 0.01(p <0.001). Collected data was cleaned, edited and analyzed with the help of software SPSS window version 15.0. Conclusion: In this study, VUR disappeared in some cases and decreased in majority of the cases by 3 months after adequate restoration of urethral patency. Renal function came to normal range in two thirds of the cases. DOI: http://dx.doi.org/10.3329/jpsb.v2i2.19542
导读:先天性尿道梗阻是发生在尿路中最具破坏性的异常之一,也是少数危及新生儿生命的异常之一。后尿道瓣膜(PUV)是男孩尿道梗阻最常见的原因。这些病变通常导致终身残疾,尿失禁和肾功能下降,尽管最佳的医疗管理。在大多数PUV病例中,首选的治疗方式是原发性电灼治疗,而不是上尿路转移。需要定期随访,检查瓣膜电灼的完成情况、肾功能、肾积水情况、膀胱输尿管反流(VUR)、尿路感染(UTI)和膀胱功能。材料与方法:2009年12月至2011年3月,我们在达卡医学院附属医院(DMCH)儿科外科有目的选择30例PUV患者进行介入研究,时间为16个月。研究对象的年龄从2天到14岁不等。30例患者中,1 ~ 14岁儿童16例(53.3%),婴儿11例(36.7%),新生儿03例(10%)。多数患者表现为尿流弱、尿滴、排尿吃力、尿路感染和可触及膀胱。所有患儿均行超声、尿素、血肌酐、尿常规及培养检查。采用结构化问卷调查法收集原发性PUV电灼前后VUR改善情况及肾功能状况。结果:随访时平均血清肌酐水平较术前逐渐下降。经t检验,肌酐水平差异有统计学意义(p<0.01)。平均血尿素氮(BUN)也降低,差异有统计学意义(p<0.05)。63.3%的病例存在VUR。右侧非VUR占60%,左侧非VUR占50%。在3个月后的第三次随访中,右侧为73.3%,左侧为63.3%。Pearson相关检验发现,电灼前后反流等级的变化在0.01水平上呈显著正相关(p<0.001)。左肾和右肾均有明显病变。经Pearson相关检验,电灼前后GFR变化在0.01水平上也有显著正相关(p <0.001)。使用SPSS window version 15.0软件对收集到的数据进行整理、编辑和分析。结论:在本研究中,部分病例的VUR消失,大多数病例在充分恢复尿道通畅3个月后下降。三分之二的患者肾功能恢复正常。DOI: http://dx.doi.org/10.3329/jpsb.v2i2.19542
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引用次数: 0
Laparoscopic Repair of Peptic Ulcer Perforation - Our Initial Experience 腹腔镜修复消化性溃疡穿孔-我们的初步经验
Pub Date : 2014-07-15 DOI: 10.3329/JPSB.V1I2.19535
Md. Saiful Hoque, Gazi Md. Zakir Hossain, Nur Hossain Bhuiyan, Md. Rashedul Hasan, Mayin Uddin Mahmud, Alamgir Rashid Chowdhury
Background: Laparoscopic repair of perforated peptic ulcer was reported in 1990 but has not gained wide acceptance. The aim of this study was to evaluate the safety and efficacy of laparoscopic repair in routine clinical practice. Methods: This was a prospective analysis of 30 patients who underwent laparoscopic repair of a perforated peptic ulcer between July 2009 and June2010. Results: Thirty patients of mean age 45 (range 25-52) years had perforated ulcer diagnosed by clinical examination and x-ray abdomen and confirmed by laparoscopy. 28 was duodenal ulcer perforation and rest 2 was gastric ulcer perforation. Only 3 patients required conversion to laparotomy out of them 2 were DU perforation and one was gastric ulcer perforation. Mean operation time was 75 (range 75-150) minutes. Mean postoperative hospital stay was 6 (5-10) days. Postoperative convalescences were good. There was no operation related complication but one patient needs transfer to ICU for delayed recovery and the patient eventually recovered well. Post-operative leakage occurred in one patient and that was treated by laparotomy. One of 3 conversion cases developed wound infection but wound related complications in laparoscopic cases were very negligibe. Conclusion: Laparoscopic repair is a safe and effective procedure for repair of perforated peptic ulcer. DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19535
背景:腹腔镜下修复穿孔性消化性溃疡早在1990年就有报道,但尚未被广泛接受。本研究的目的是评估腹腔镜修复在常规临床实践中的安全性和有效性。方法:这是对2009年7月至2010年6月间接受腹腔镜修复穿孔性消化性溃疡的30例患者的前瞻性分析。结果:30例患者经临床检查及腹部x线片诊断为穿孔性溃疡,经腹腔镜确认,平均年龄45岁(25 ~ 52岁)。十二指肠溃疡穿孔28例,胃溃疡穿孔2例。其中2例为DU穿孔,1例为胃溃疡穿孔,3例需转开腹。平均手术时间75分钟(75-150分钟)。术后平均住院时间6(5-10)天。术后恢复良好。无手术相关并发症,但1例患者因延迟恢复需要转至ICU,最终恢复良好。1例患者术后发生渗漏,经剖腹手术治疗。3例转换病例中有1例出现伤口感染,但腹腔镜病例中与伤口相关的并发症非常少。结论:腹腔镜修复是一种安全、有效的消化性溃疡穿孔修复方法。DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19535
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引用次数: 0
Early Post-operative Outcome of Primary Repair of Bladder Exstrophy With or Without Osteotomy 有或没有截骨术膀胱外翻一期修复的早期术后效果
Pub Date : 2014-07-15 DOI: 10.3329/JPSB.V2I2.19546
S. Uddin, Md. Abu Bakar Akan, Rajib Khastgir, Muhammad Amin
Background: Bladder exstrophy (BE) is a variety of infraumbilical midline anterior abdominal wall defect. This rare spectrum of anomalies involves the urinary tract, genital tract, musculoskeletal, system and sometimes the intestinal tract. Surgical reconstruction with or without osteotomy is the treatment of choice for BE. Objective: To evaluate the intersymphyseal gap (ISG) before, during and after operation (pubic diastasis) and to evaluate the status of post-operative wound healing. Materials & Methods: This cross sectional study was conducted on 18 patients of paediatric age group over a period from February 2007 to October 2008 who were admitted with classical bladder extrophy (BE) in the department of paediatric surgery, BSMMU.. They were divided into two groups. In group-A: 8 patients of BE were undergone primary repair with osteotomy and in group-B primary repair done in 10 patients without osteotomy. Results: Two (2) months post-operative follow-up revealed that all osteotomy patients (group- A) developed re-diastasis of pubic symphysis. Statistically no significant difference of ISG was observed in two groups of patients. Wound healing was better in without osteotomy (group-B) patients (80% vs 50%) and wound failure was more in osteotomy patients (50% vs 20%). Moreover, osteotomy group need hospitalization for longer period of time. Conclusions: Although osteotomy is an essential step in the management of BE, this study revealed that it does not improve the early post-operative outcome. DOI: http://dx.doi.org/10.3329/jpsb.v2i2.19546
背景:膀胱外翻(BE)是一种脐下中线前腹壁缺损。这种罕见的异常包括泌尿道、生殖道、肌肉骨骼、系统,有时也包括肠道。手术重建伴或不伴截骨是BE的治疗选择。目的:评价耻骨分离术前、术中、术后的耻骨联合间隙(ISG)及术后创面愈合情况。材料与方法:本横断面研究于2007年2月至2008年10月在BSMMU儿科外科以典型膀胱外翻(BE)入院的18例儿科年龄组患者进行。他们被分成两组。a组8例BE行截骨一期修复,b组10例未行截骨一期修复。结果:术后2个月随访,A组截骨患者均出现耻骨联合再移位。两组患者ISG差异无统计学意义。未截骨组(b组)患者伤口愈合较好(80% vs 50%),截骨组患者伤口失败较多(50% vs 20%)。而且截骨组住院时间较长。结论:虽然截骨术是治疗BE的必要步骤,但本研究显示截骨术并不能改善早期术后预后。DOI: http://dx.doi.org/10.3329/jpsb.v2i2.19546
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引用次数: 1
Post A-H Pyeloplasty Analysis of Renal Function in Unilateral Hydronephrosis Due to Congenital Pelviureteric Junction Obstruction 先天性肾盂输尿管连接处梗阻致单侧肾积水的A-H肾盂成形术后肾功能分析
Pub Date : 2014-07-15 DOI: 10.3329/JPSB.V2I2.19543
N. K. Majumder, Muhammad Amin, Rajib Khastgir, Mizanur Rahman, Md. Abu Bakar Akan
Background: The objective of this study was to analyze the functional improvement of renal function in terms of split renal function (SRF) & glomerular filtration rate (GFR) by DTPA renogram in early post operative period who underwent A-H pyeloplasty for unilateral hydronephrosis due to congenital pelvi ureteric junction obstruction. Methods: A prospective observational study was conducted to see the post operative renal function improvement in patient with unilateral hydronephrosis due to congenital pelvi ureteric junction obstruction in department of paediatric surgery, BSMMU from July 2007 to October 2008. All the patients were followed up at 4 weeks interval for 12 weeks. Results: Total 13 Patients both male & female were observed with age ranging from 03 months to 15 years. Out of 13, eleven patients showed gradual improvement of renal function in terms of SRF & GFR in three successive DTPA renogram done at 4, 8 & 12 weeks post operatively but two patients showed deterioration of renal function in 1st two renogram but improved at 12th weeks period. Conclusion: DTPA renogram is the best method to see the functional improvement of renal function after A-H pyeloplasty but should be done on 12th post operative day. DOI: http://dx.doi.org/10.3329/jpsb.v2i2.19543
背景:本研究的目的是分析先天性肾盂输尿管连接梗阻致单侧肾盂积水行A-H肾盂成形术患者术后早期的肾功能改善情况,包括分裂肾功能(SRF)和肾小球滤过率(GFR)。方法:对2007年7月至2008年10月在北京医科大学儿科外科治疗的先天性盆腔输尿管连接处梗阻单侧肾积水患者术后肾功能改善情况进行前瞻性观察研究。所有患者每隔4周随访12周。结果:共13例患者,男女均有,年龄从03个月到15岁不等。在13例患者中,11例患者在术后4,8和12周连续三次DTPA肾图中表现出肾功能的SRF和GFR逐渐改善,但2例患者在前两次肾图中表现出肾功能恶化,但在12周时有所改善。结论:DTPA肾图是观察A-H型肾盂成形术后肾功能改善的最佳方法,但应在术后第12天进行。DOI: http://dx.doi.org/10.3329/jpsb.v2i2.19543
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引用次数: 0
INFLAMMATORY PSEUDOTUMOUR OF MESENTERY: A CASE REPORT 肠系膜炎性假瘤1例
Pub Date : 2014-07-15 DOI: 10.3329/JPSB.V1I2.19538
B. Mirza, A. Sheikh
1. Dr. Bilal Mirza*, Dr. Afzal Sheikh, Department of Paediatric surgery, The Children’s Hospital & The Institute of Child Health Lahore, Pakistan. Correspondence to: Dr. Bilal Mirza, Department of Paediatric surgery, The Children’s Hospital & The Institute of Child Health Lahore, Pakistan. Email: blmirza@yahoo.com Ultrasound abdomen revealed a mass of mixed echogenicity in that region. CT scan abdomen showed a heterogeneous mass in the periumbilical region with internal calcifications. The preoperative diagnosis was neuroblastoma. All the laboratory parameters were in normal limits. The patient was optimized for surgery and an exploratory laparotomy was performed.
1. 巴基斯坦拉合尔儿童医院和儿童健康研究所儿科外科Bilal Mirza医生*、Afzal Sheikh医生。收信人:巴基斯坦拉合尔儿童医院和儿童保健研究所儿科外科Bilal Mirza医生。邮箱:blmirza@yahoo.com腹部超声显示该区域可见混合回声团块。腹部CT扫描显示脐周有一不均匀肿块伴内部钙化。术前诊断为神经母细胞瘤。所有实验室参数均在正常范围内。患者被优化为手术,并进行了探查性剖腹手术。
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引用次数: 0
Bilateral Lumbar Hernia - a Rare Occurence in Infant 双侧腰疝——罕见的婴儿病例
Pub Date : 2014-07-15 DOI: 10.3329/JPSB.V1I2.19537
S. Islam, A. Morshed, Md. Ashraf Ul Huq, M. Alam, S. Mondal, K. Hasina
Lumbar hernias are rare in children. We report a case of bilateral lumbar hernia in a 39 days old boy who was admitted at pediatric surgery department in Dhaka Medical College Hospital with the chief complaints of bilateral flank swellings since birth. There were no urinary or bowel complaints. Palpation revealed reducible, non-tender, soft to firm swellings involving iliolumbar region in left and lumbar region in right . These were increased on crying. On auscultation bowel sounds were present in left side and absent in right side. There were no other congenital anomalies.Ultrasonography revealed herniated bowel loops in left iliolumbar region and mild pelvicalicial dilatation in left kidney and slightly bigger right kidney in right lumbar region. On the basis of these findings a diagnosis of congenital bilateral lumbar hernias were made. Closer of the defects were done by prosthetic material and non- absorbable suture material. He came back for follow-up after 2 weeks, 4 weeks and 6 weeks. Defects were clinically absent and the patient was pain and recurrence-free. DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19537
腰疝在儿童中很少见。我们报告一例双侧腰椎疝在39天的男孩谁住在儿科外科在达卡医学院医院出生后的主要投诉双侧侧腹肿胀。没有尿路或肠道不适。触诊显示可复位,无触痛,软硬肿胀累及左侧髂腰区和右侧腰椎区。一哭这些就增加了。听诊左侧有肠音,右侧无。没有其他先天性异常。超声示左髂腰区肠袢突出,左肾轻度盆腔扩张,右腰区右肾略大。在这些发现的基础上诊断先天性双侧腰疝。修复材料和不可吸收缝线材料修复的缺损较多。术后2周、4周、6周随访。临床无缺陷,患者无疼痛和复发。DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19537
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引用次数: 0
To Manage Infantile Hypertrophic Pyloric Stenosis by "Double-Y Pyloromyotomy" is a better Surgical Approach 双y型幽门肌切开术治疗婴儿肥厚性幽门狭窄是一种较好的手术方法
Pub Date : 2014-07-15 DOI: 10.3329/JPSB.V1I2.19532
Md. Ansar Ali, K. Hasina, S. Islam, Md. Ashraf Ul Huq, M. Alam, S. Mondal
Background: Different treatment modalities and procedures have been tried for the management of infantile hypertrophic pyloric stenosis. But surgery remains the mainstay for management of IHPS. Ramstedt’s pyloromyotomy was described almost over a hundred years ago and to date remains the surgical technique of choice. An alternative and better technique is the double-Y pyloromyotomy, which offer better results for management of this common condition. Methods: A prospective comparative interventional study of 40 patients with IHPS was carried out over a period of 2 years from July 2008 to July 2010. The patients were divided into 2 equal groups of 20 patients in each. The study was designed that all patients selected for study were optimized preoperatively regarding to hydration, acid-base status and electrolytes imbalance. All surgeries were performed after obtaining informed consent. Standard preoperative preparation and postoperative feeding regimes were used. The patients were operated on an alternate basis, i.e., one patient by Double-Y Pyloromyotomy(DY) and the next by aRamstedt’s Pyloromyotomy (RP). Data on patient demographics, operative time, anesthesia complications, postoperative complications including vomiting and weight gain were collected. Patients were followed up for a period of 3 months postoperatively. Statistical assessments were done by using t test. Results: From July 2008 through July 2010, fourty patients were finally analyzed for this study. Any statistical differences were observed in patient population regarding age, sex, weight at presentation, symptoms and clinical condition including electrolytes imbalance and acid-base status were recorded. Significant differences were found in postoperative vomiting and weight gain. Data of post operative vomiting and weight gain in both groups were collected. Vomiting in double-Y(DY) pyloromyotomy group (1.21 ± 0.45days) vs Ramstedt’s pyloromyotomy (RP) group(3.03 ± 0.37days) p= 0.0001.Weight gain after 1st 10 days DY vs RP is ( 298 ± 57.94 gm vs193±19.8 gm p=0.0014), after 1 month (676.67±149.84 gm vs 466.67 ± 127.71 gm, p=0.0001), after 2months (741.33± 278.74 gm vs 490±80.62 gm, p=0.002) and after 3 months (582±36.01gm vs 453.33±51.64 gm, p=0.0001).No long-term complications were reported and no re-do yloromyotomy was needed. Conclusion: The double-Y pyloromyotomy seems to be a better technique for the surgical management of IHPS. It may offer a better functional outcome in term of postoperative vomiting and weight gain. DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19532
背景:不同的治疗方式和程序已经尝试了治疗婴儿肥厚性幽门狭窄。但是手术仍然是治疗IHPS的主要方法。Ramstedt的幽门肌切开术早在100多年前就已被描述,至今仍是首选的手术技术。另一种更好的方法是双y型幽门切开术,它对治疗这种常见疾病有更好的效果。方法:2008年7月至2010年7月对40例IHPS患者进行前瞻性比较介入研究。将患者分为2组,每组20例。本研究的设计是,所有入选研究的患者术前均对水合作用、酸碱状态和电解质失衡进行了优化。所有手术均在获得知情同意后进行。采用标准的术前准备和术后喂养方案。患者采用双y型幽门肌切开术(DY)和aRamstedt型幽门肌切开术(RP)交替手术。收集患者人口统计学数据、手术时间、麻醉并发症、术后并发症包括呕吐和体重增加。术后随访3个月。统计学评价采用t检验。结果:从2008年7月到2010年7月,最终分析了40例患者。在年龄、性别、就诊时体重、症状和临床状况(包括电解质失衡和酸碱状态)方面观察到患者人群的统计学差异。在术后呕吐和体重增加方面存在显著差异。收集两组患者术后呕吐及体重增加情况。双y型(DY)幽门肌切开术组呕吐(1.21±0.45天)vs Ramstedt幽门肌切开术组呕吐(3.03±0.37天)p= 0.0001。1个月后(676.67±149.84 gm vs 466.67±127.71 gm, p=0.0001), 2个月后(741.33±278.74 gm vs 490±80.62 gm, p=0.002), 3个月后(582±36.01gm vs 453.33±51.64 gm, p=0.0001)体重增加(298±57.94 gm vs193±19.8 gm, p=0.0014)。无长期并发症报道,无需再次做子宫肌瘤切开术。结论:双y型幽门肌切开术是治疗IHPS的较好方法。就术后呕吐和体重增加而言,它可能提供更好的功能结果。DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19532
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引用次数: 0
Vaccination in Pregnancy 怀孕期间接种疫苗
Pub Date : 2014-07-15 DOI: 10.3329/JPSB.V1I2.19536
S. Nargis, M. S. Rahman
Routine vaccines that generally are safe to administer during pregnancy include diphtheria, tetanus, influenza, and hepatitis B, Other vaccines such as meningococcal and rabis, may be considered, Vaccines that are contraindicated because of the theoretic risk of fetal transmission include measles, mumps and rubella, varicella and bacilli Calmette-Guerin. A number of other vaccines have not yet been adequately studied; therefore risks of vaccination must be weighed against the risks of the disease to the mother and fetus. Inadvertent administration of any of these vaccination, however is not considered an indication for termination of the pregnancy. DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19536
通常在怀孕期间安全接种的常规疫苗包括白喉、破伤风、流感和乙型肝炎,其他疫苗如脑膜炎球菌和狂犬病也可考虑接种,由于理论上存在胎儿传播风险而禁忌接种的疫苗包括麻疹、腮腺炎和风疹、水痘和卡介苗。许多其他疫苗尚未得到充分研究;因此,必须权衡接种疫苗的风险与疾病对母亲和胎儿的风险。然而,无意中接种任何这些疫苗都不被认为是终止妊娠的指征。DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19536
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引用次数: 0
Evaluation of Congenital Upper Urinary Tract Anomalies in Hypospadias 尿道下裂先天性上尿路异常的评价
Pub Date : 2014-07-15 DOI: 10.3329/JPSB.V2I2.19547
Md Abdullah Al Farooq, S. Hoque
Background: Hypospadias may be associated with other congenital upper urinary tract anomalies. Literature showed various opinions to evaluate or not to evaluate upper urinary tract in hypospadias patient. Frequency of upper urinary tract anomalies also varies. This study was carried out on this background to avoid confusion. Objectives: Morphological evaluation of upper urinary tract to find out the frequency of upper urinary tract anomalies associated with uncomplicated hypospadias patients and give a guideline for investigation of such patients. Methods: This prospective study was designed and accomplished in the Departments of Paediatric Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka; Dhaka Medical College Hospital (DMCH), Dhaka and Chittagong Medical College Hospital (CMCH), Chittagong; Bangladesh from October 2004 to June 2006. Eighty five (85) patient with hypospadias having neither any congenital anomalies, nor other genital ambiguity, nor any secondary vesicoureteric reflux (VUR) or meatal stenosis were selected for the study. Detailed history and examination were carried out. Upper urinary tract of all patients were evaluated by Ultrasonography (USG), Intravenous Urography (IVU), and Micturating Cystourethrography (MCU).To exclude genital ambiguity in perineal hypospadias, karyotype were done to ascertain male sex. Results were analyzed by SPSS with the help of Chi-square and Z approximation test . Result : Eighty five (85) patients were taken. All patients were evaluated by USG, IVU and MCU to detect congenital upper urinary tract anomalies. Results: Four (4) patients had had upper urinary tract anomalies. One (1) patient found to have left sided pelviureteric junction obstruction (PUJO) while one (1) patient had right sided pelviureteric junction obstruction (PUJO). One (1) patient was found to have left sided pelviureteric duplication and the last patient with left renal agenesis. USG detected three (3) anomalies in 85 patients (3.53%) and IVU detected all four (4) anomalies in 85 patients (4.7%), but no primary reflux was detected by MCU. Overall frequency of upper urinary tract anomalies was 4.7%. Eighty one (81) patients (95.3%) had no anomalies. USG detected 3 (three) anomalies out of 4 (four) patients (75%) & IVU detected all four anomalies (100%). Absence of upper urinary tract anomaly was statistically significant. Conclusion: Frequency of upper urinary tract anomalies are significantly low  (4.7%) in uncomplicated hypospadias. USG can detect 75% congenital upper urinary tract anomalies in hypospadias patients. So USG is good enough and recommended to evaluate upper urinary tract anomalies in uncomplicated hypospadias patients. There is no need to evaluate upper urinary tract by IVU or MCU in such patients, if asymptomatic otherwise. DOI: http://dx.doi.org/10.3329/jpsb.v2i2.19547
背景:尿道下裂可能与其他先天性上尿路异常有关。文献对尿道下裂患者的上尿路评价或不评价有不同的看法。上尿路异常的频率也各不相同。本研究是在此背景下进行的,以避免混淆。目的:通过上尿路形态学评价,了解无并发症尿道下裂患者上尿路异常的发生频率,为此类患者的诊治提供指导。方法:本前瞻性研究是在达卡Bangabandhu Sheikh Mujib医科大学(BSMMU)儿科外科设计并完成的;达卡医学院医院(DMCH),达卡和吉大港医学院医院(CMCH),吉大港;2004年10月至2006年6月在孟加拉国。85例尿道下裂患者没有任何先天性异常,没有其他生殖器模糊,也没有继发性膀胱输尿管反流(VUR)或金属狭窄。进行了详细的病史和检查。所有患者均采用超声(USG)、静脉尿路造影(IVU)和尿路膀胱造影(MCU)对上尿路进行评估。为了排除会阴尿道下裂患者生殖器模糊,我们进行了核型分析以确定男性性别。采用SPSS统计软件进行统计分析,采用卡方检验和Z近似检验。结果:共收治85例患者。所有患者均行USG、IVU和MCU检查先天性上尿路异常。结果:4例患者有上尿路异常。1例患者发现左侧肾盂输尿管交界处梗阻(PUJO), 1例患者发现右侧肾盂输尿管交界处梗阻(PUJO)。1例患者发现左侧肾盂输尿管重复,最后一例患者发现左侧肾发育不全。USG在85例(3.53%)患者中检测到3(3)个异常,IVU在85例(4.7%)患者中检测到全部4(4)个异常,但MCU未检测到原发性反流。上尿路异常的总频率为4.7%。81例(95.3%)患者无异常。4(4)例患者中USG检出3(3)例异常(75%),IVU检出4例异常(100%)。无上尿路异常有统计学意义。结论:单纯尿道下裂的上尿路异常发生率较低(4.7%)。超声造影可检出尿道下裂患者75%的先天性上尿路异常。因此,USG是足够好的,建议评估上尿路异常的无并发症尿道下裂患者。如果这些患者无症状,则无需通过IVU或MCU评估上尿路。DOI: http://dx.doi.org/10.3329/jpsb.v2i2.19547
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Journal of Paediatric Surgeons of Bangladesh
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