Urinary tract anomalies in patients with anorectal malformation.

Urinary tract anomalies are common associated anomalies in anorectal malformation (ARM) and major contributory factor for high morbidity and mortality in ARM. In this study, urinary tract anomalies were evaluated in 72 patients of ARM (43 high varieties & 29 low varieties) that were admitted in Dhaka Medical College & Hospital (DMCH) during the period of January 2007 to April 2008. In all cases, evaluation was done by ultrasonogram (USG) and voiding cysto-urethrography (VCUG). Intravenous urography (IVU) was done in selected cases. Urinary tract anomalies were found in 20(27.85%) cases of ARM patients. These anomalies were significantly higher 16(37.2%) in high variety of ARM than 4(13.8%) those with low variety of ARM. The pattern of urological anomalies were vesicoureteral reflux (VUR - 35%), hydronephrosis due to PUJ obstruction (25%), posterior urethral valve (PUV - 15%), renal agenesis (10%), duplex ureter (10%) and bladder diverticulum (5%). Before definite management of ARM urological evaluation is essential to prevent renal damage and to reduce the morbidity and mortality.

A 9 years boy with MEN-2B variant of medullary thyroid carcinoma.

To highlight a rare disease like multiple endocrine neoplasia (MEN)-2B variant of medullary thyroid carcinoma and to optimize the management option in such cases, we present a nine year old boy with thyroid swelling, cervical lymphadenopathy and thick lips. His calcitonin level was raised. Investigation's results of the boy were as following fine needle aspiration cytology (FNAC) was medullary carcinoma of thyroid, preoperative calcitonin was >2000pg/ml, post operative histopathological report was medullary carcinoma. Total thyroidectomy with aggressive initial neck surgery may reduce the recurrence and increase better prognosis and survival rate. Calcitonin is used as diagnostic and follow-up marker.

Ultrasonographic evaluation of contralateral exploration of patent processus vaginalis in unilateral inguinal hernia.

To see accuracy of ultrasound scan to detect patent processus vaginalis in padiatric patient. We investigated the presence of contralateral patent processus vaginalis (CPPV) by Ultrasound scan (US) in children with clinically diagnosed unilateral inguinal hernia. Thirty patents (17 boys and 13 Girls) with unilateral inguinal hernia underwent US examination using a 7.5 MHZ transducer. If a CPPV was visible as a hydrocele (inflow of peritoneal fluid) in to a processus vaginalis on straining, then US scanning was performed while the patient was at rest and while inducing straining by standing, coughing and or crying. A groin with hydrocele in the inguinal canal on straining was diagnosed as a CPPV and was explored bilaterally through surgery. The US findings were compared with surgical results. In 30 patients, 12 cases were diagnosed by US as patients with a CPPV, these patients underwent bilateral surgery. Eleven of 12 Cases were confirmed surgically as CPPV. From the findings of the present study it could be concluded that a PPV could be correctly detected by US in pediatric patients with the accuracy of 91.67%. US is a non invasive and accurate method for evaluating the presence of a PPV. Preoperative diagnosis of CPPV is important to remove the need for a second operation with patients presenting with unilateral inguinal hernia.