RESUMO
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.
Assuntos
Anormalidades Urogenitais , Malformações Anorretais , Bangladesh , Humanos , Refluxo VesicoureteralRESUMO
The present study has been designed to compare the postoperative pain relief for inguinal hernia repair in children through wound infiltration with levobupivacaine with that provided by paracetamol administration per rectaly. This interventional study was carried out in the Department of Paediatric surgery, Mymensingh Medical College Hospital, Mymensingh and Dhaka Medical College Hospital, Dhaka, during the period from January 2009 to September 2010. A total of 120 patients were included in this study. Among them 60 patients in Group-A (study group) where post incisional wound infiltration with levobupivacain after inguinal herniotomy and before skin closure was done and 60 patients in Group-B (control group) where paracetamol was given per rectally after anesthesia induction. Both groups were followed up post operatively for 23 hours. In Group A maximum analgesic period was 8.30 hours and minimum analgesic period was 5.30 hours. On the other hand in Group B maximum analgesic period was 6.50 hours and minimum analgesic period was 4.50 hours. Duration of post operative analgesia between two groups of the patients were significant [p<0.01]. Post incisional wound infiltration with levobupivacain has significantly better efficacy to rectal administration of paracetamol with respect to providing pain relief following inguinal hernia repair in children. Longer duration of analgesic action is more achieved in the Levobupivacaine group.
Assuntos
Anestésicos Locais/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Bupivacaína/administração & dosagem , Bupivacaína/análogos & derivados , Criança , Pré-Escolar , Feminino , Hérnia Inguinal/cirurgia , Humanos , Levobupivacaína , Masculino , Fatores de TempoRESUMO
Acute experimental hydronephrosis induces increased output of renin from ipsilateral kidney. In most clinical presentation of unilateral hydronephrosis the patients are however, normotensive with normal circulating plasma renin activity. In consideration of this argument we undertook this prospective study of ipsilateral renal vein renin activity in children with congenital Pelvic Ureteric Junction Obstruction (PUJO) and compared with other wise normal children. In this prospective cross-sectional study, started from July 99 to June 2001, twenty patients, age upto 12 years, with unilateral hydronephrosis and in control group ten patients without hydronephrosis were taken. 2ml blood was taken from the renal vein in study group and from infrarenal portion of inferior vena cava during exploratory laparotomy from the control group. All the patients had advanced grade of hydronephrosis and two patients (13%) had mild hypertension. In this study the mean plasma renin activity (PRA) was 45.58 ng/ml/hr (range: 11.69-67.56 ng/ml/hr) in study group. The mean PRA in control group was 5.9ng/ml/hr. The result of study group was significantly higher than normal (P value 0.0003). In Bangladesh we are doing more conservative kidney preserving surgery for PUJO, but need long term follow up of the patients undergoing surgery for PUJO in childhood for potential of developing renin-angiotensin induced hypertension in later life.