Retrocaval Ureter with Proximal Hydroureteronephrosis Presenting as Flank Pain in a Child: A Rare Case Report with Review of Literature

Retrocaval ureter also referred to as pre-ureteral vena cava or circumcaval ureter is a rare congenital anomaly with the ureterpassing posterior to the inferior vena cava. Although it is a congenital anomaly, patients do not normally present with symptomsuntil the 3rd and 4th decades of life after a resulting hydronephrosis. We present the report of a 12-year-old male child with ahistory of right flank pain and associated right proximal hydroureteronephrosis. Diagnosis was confirmed with computerizedtomography urography, and an open surgical repair was done for the anomaly. The case is discussed here along with reviewof recent literature.

Evaluation on Bacteriological Profile of Chronic Suppurative Otitis Media in Eastern Bihar

Background: Chronic suppurative otitis media (CSOM) is defined as persistent or intermittent infection of ear for more than three months duration where the infected discharge occurs through the perforated tympanic membrane caused by bacteria ,fungi and virus resulting in inflammation of mucosal lining that results in partial or total loss of the tympanic membrane and ossicles. Methods: A total of 66 patients with symptoms of CSOM were enrolled in the study. Out of 66 patients, 54 were unilateral cases and 12 were bilateral cases. Thus the total 78 samples were available for culture. Samples from 78 discharging ears were collected with the help of aural speculum by swabbing the discharging ears with two sterile cotton swabs.Results: Antimicrobial susceptibility testing was carried out for all the isolates. Imipenem resistance was not seen to any of the isolate. Amikacin was the most effective antibiotic in the present study. It was effective against maximum number of strains 74 (94.9%) followed by levofloxacin 72 (92.3%), Gentamicin 70 (89.7%), Ofloxacin 68 (87.2%) and Ciprofloxacin 62 (79.5%).Conclusion:The chronic suppurative otitis media has become public health importance in the present days in developing countries like India. It is well known disease of multiple etiology and its recurrence and persistence. Irregular, haphazard and indiscriminate use of antibiotics has precipitated the emergence of multi resistant bacteria. The most common the bacteriological agent associated with CSOM in our area was Pseudomonas aeruginosa with a gradual decline in their sensitivity pattern to a number of fluoroquinolones. Amikacin and levofloxacin has proven to be the drug of choice.