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
{"title":"Desmoplastic Small Round Cell Tumour (DSRCT) - A Case Report and Review of Literature","authors":"A. Morshed, F. Afroz, C. Galib, S. Islam, K. Hasina, A. Ghosh","doi":"10.3329/JPSB.V2I2.19552","DOIUrl":"https://doi.org/10.3329/JPSB.V2I2.19552","url":null,"abstract":"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","PeriodicalId":137868,"journal":{"name":"Journal of Paediatric Surgeons of Bangladesh","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121836658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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
{"title":"Outcome of Vesiciureteric Reflux After Primary Fulguration of Posterior Urethral Valves","authors":"M. Pervez, K. Hasina, Md. Ashraf Ul Huq, M. Nooruzzaman, A. Hanif","doi":"10.3329/JPSB.V2I2.19542","DOIUrl":"https://doi.org/10.3329/JPSB.V2I2.19542","url":null,"abstract":"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","PeriodicalId":137868,"journal":{"name":"Journal of Paediatric Surgeons of Bangladesh","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116249075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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
{"title":"Laparoscopic Repair of Peptic Ulcer Perforation - Our Initial Experience","authors":"Md. Saiful Hoque, Gazi Md. Zakir Hossain, Nur Hossain Bhuiyan, Md. Rashedul Hasan, Mayin Uddin Mahmud, Alamgir Rashid Chowdhury","doi":"10.3329/JPSB.V1I2.19535","DOIUrl":"https://doi.org/10.3329/JPSB.V1I2.19535","url":null,"abstract":"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","PeriodicalId":137868,"journal":{"name":"Journal of Paediatric Surgeons of Bangladesh","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117330553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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
{"title":"Early Post-operative Outcome of Primary Repair of Bladder Exstrophy With or Without Osteotomy","authors":"S. Uddin, Md. Abu Bakar Akan, Rajib Khastgir, Muhammad Amin","doi":"10.3329/JPSB.V2I2.19546","DOIUrl":"https://doi.org/10.3329/JPSB.V2I2.19546","url":null,"abstract":"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","PeriodicalId":137868,"journal":{"name":"Journal of Paediatric Surgeons of Bangladesh","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122038179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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
{"title":"Post A-H Pyeloplasty Analysis of Renal Function in Unilateral Hydronephrosis Due to Congenital Pelviureteric Junction Obstruction","authors":"N. K. Majumder, Muhammad Amin, Rajib Khastgir, Mizanur Rahman, Md. Abu Bakar Akan","doi":"10.3329/JPSB.V2I2.19543","DOIUrl":"https://doi.org/10.3329/JPSB.V2I2.19543","url":null,"abstract":"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","PeriodicalId":137868,"journal":{"name":"Journal of Paediatric Surgeons of Bangladesh","volume":"63 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131568977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"INFLAMMATORY PSEUDOTUMOUR OF MESENTERY: A CASE REPORT","authors":"B. Mirza, A. Sheikh","doi":"10.3329/JPSB.V1I2.19538","DOIUrl":"https://doi.org/10.3329/JPSB.V1I2.19538","url":null,"abstract":"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.","PeriodicalId":137868,"journal":{"name":"Journal of Paediatric Surgeons of Bangladesh","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125393063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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
{"title":"Bilateral Lumbar Hernia - a Rare Occurence in Infant","authors":"S. Islam, A. Morshed, Md. Ashraf Ul Huq, M. Alam, S. Mondal, K. Hasina","doi":"10.3329/JPSB.V1I2.19537","DOIUrl":"https://doi.org/10.3329/JPSB.V1I2.19537","url":null,"abstract":"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","PeriodicalId":137868,"journal":{"name":"Journal of Paediatric Surgeons of Bangladesh","volume":"146 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114889302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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. Ramstedts 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 aRamstedts 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 Ramstedts 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
{"title":"To Manage Infantile Hypertrophic Pyloric Stenosis by \"Double-Y Pyloromyotomy\" is a better Surgical Approach","authors":"Md. Ansar Ali, K. Hasina, S. Islam, Md. Ashraf Ul Huq, M. Alam, S. Mondal","doi":"10.3329/JPSB.V1I2.19532","DOIUrl":"https://doi.org/10.3329/JPSB.V1I2.19532","url":null,"abstract":"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. Ramstedts 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 aRamstedts 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 Ramstedts 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","PeriodicalId":137868,"journal":{"name":"Journal of Paediatric Surgeons of Bangladesh","volume":"30 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133136649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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
{"title":"Vaccination in Pregnancy","authors":"S. Nargis, M. S. Rahman","doi":"10.3329/JPSB.V1I2.19536","DOIUrl":"https://doi.org/10.3329/JPSB.V1I2.19536","url":null,"abstract":"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","PeriodicalId":137868,"journal":{"name":"Journal of Paediatric Surgeons of Bangladesh","volume":"371 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133151416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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
{"title":"Evaluation of Congenital Upper Urinary Tract Anomalies in Hypospadias","authors":"Md Abdullah Al Farooq, S. Hoque","doi":"10.3329/JPSB.V2I2.19547","DOIUrl":"https://doi.org/10.3329/JPSB.V2I2.19547","url":null,"abstract":"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","PeriodicalId":137868,"journal":{"name":"Journal of Paediatric Surgeons of Bangladesh","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133451625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}