Background & Aim: Urogenital anomalies are common associated anomalies in anorectal malformations and are major contributory factor for high morbidity and mortality in anorectal malformation. There is a intense need to search out the factors responsible for high association of urogenital anomalies in anorectal malformation A prospective study was conducted in the Department of pediatric surgery, Guntur Medical college & Government Hospital. The objective of this study was to review the incidence of urogenital anomalies associated with anorectal malformation in our set-up. Results: Of the 90 patients with anorectal malfonnation, 52(57.78%) were male and 38(42.22%) were female. Ultra sonogram of abdomen was normal in 51(56.67%o) patients and abnormal in 29 patients (32.22%). High anorectal anomalies are most commonly associated with urological and genital anomalies. Of the 52 male patients 26(50%>) had urological and 10 (19.23%>) of them had genital anomalies. 22 of 90(24.44%) patients had vesicoureteric reflux which the most common urologic anomalies. 6(6.67%) of the 90 patients had hypospadias which is commonest among other genital anomalies. As both urologic and genital anomalies are more commonly observed in males there is a sexual preponderance. Hypospadias is the most common genital anomaly associated with anorectal malformations. VCUG when performed in all cases of anorectal malformations detected vesicoureteric reflux in 25cases out of which 10 were normal on Ultrasound. Early detection and management of these anomalies dictates the overall prognosis of a child with anorectal malformation. Conclusion:In the present study we conclude all cases of anorectal malformations should undergo VCUG to detect urological anomalies which may go unnoticed on USG. Patients with urogenital anomalies require careful assessment and timely intervention for better out come.
Background: Severe acute malnutrition (SAM) is one of the most common health problems. SAM children are more prone to serious infections that culminate in different co-morbid conditions and result in electrolyte disturbances. Objective: To study the electrolyte profile in severely malnourished children. Subjects and Methods:This was Hospital based cross sectional study. Duration: 1 year from June 2018 to May 2019. Setting: Department of Pediatrics. Participants: 50 Children.Detailed history and physical examination were made. Anthropometric measurements, such as weight and height, were recorded. On admission, electrolytes were performed and children were classified as either hypo / hypernatramic or hypo / hyperkalemic, which depend on the levels of the electrolytes.Result:The Hyponatremia was high with 72% on the day 1, and hypernatremia was 6%, on day 3 hyponatremia was 60% and hypernatremia was 4% and on day 8 Normal sodium was seen in around 68% of the children. The mean sodium significantly improved from day 1 to day 8 with a mean of 135.8±9.9 on the day 8th. The Hypokalemia was highest with 38% on the day 1, Hyperkalemia was seen in 28% of the patients on day 3 and normal potassium was seen in 80% of the children on the day 8th. The mean potassium significantly improved from day 1 to 8 with a mean of 5.5±1.24 on the day 8th. Conclusion:Most of the children with SAM and electrolyte derangements also had diarrhoea. Therefore determination of the electrolyte profile of all patients with SAM immediately on admission and proceeding days after admission is vital as it helps the clinician to decide on the most appropriate fluids to give to help reduce on the morbidity and mortality associated with life threatening electrolyte derangements.
Background: Anorectal malformations are one of the most common congenital defects. This study was undertaken to study the hospital incidence of anorectal malformations (ARM), frequency of various types of defects, their sex distribution and the spectrum of anomalies associated with ARM. Materials and Methods: Ninety consecutive children attending the paediatric surgery department were included in this study. A detailed history was taken, and examination was performed for the primary as well as the associated defects. Appropriate investigations like invertogram, cologram were done wherever indicated. Management was as per the standard protocol. The data was recorded and analyzed. Results: Out of the 90 patients, 52(57.77%) male patients and 38(42.22%) female patients. Most of our patients presented within first 24 hours of life. Patients who presented after 72 hours were either female patients with anovestibular malformation or male patients with anocutaneous fistula. In the present study, High anomalies are the most common anorectal malformation in this study. Cardiac and Urological abnormalities are the most common associated anomalies with anorectal malformation. In this study we have performed ultra sound in all and voiding cystourethrogram in 87/90 patients. In 29 patients ultrasound was abnormal. VCUG was abnormal in 25 patients. Conclusions: Anorectal malformations occurred equally in males and females. Females had intermediate defects more frequently, rectovestibular fistula being the commonest. Males were more likely to have high lesions; anorectal agenesis without fistula was the commonest defect. The most common associated defects seen were vesicoureteric reflux and esophageal atresia. Complications were seen more commonly in males with high lesions. There was a significant association between presence of an associated defect and mortality and morbidity.
Background and objectiveCerebral aneurysm with endovascular coil embolization is a well established treatment modality. Endovascular therapy can be complex with primary coiling versus stent or balloon assisted coil embolization. Limited data exist that compares the safety and clinical outcome of balloon versus stent assisted coiling of cerebral aneurysm. This is a substudy of the large Endovascular Coil Embolization of Small Unruptured Cerebral Aneurysm (ECOSA) study comparing stenting versus balloon assisted coiling in a large multicenter cohort.MethodData from 11 US medical centers are collected on technical and procedural outcome of unruptured small cerebral aneurysm coiling (<7 mm) with the selection for comparison the subgroups of stenting and balloon assisted coiling. Data on clinical baseline variables and periprocedural outcome of thromboembolic event (TEE) and procedural rupture is collected and compared between the two groups in univariate and multivariate analysisResults351 patients were identified to have an adjunctive device use for coiling cerebral aneurysm. 247 underwent stent assisted coiling and 104 underwent balloon assisted coiling.Mean age of the stenting group was 55.6±11 versus 53.5±12.5 for the balloon group (p value 0.06). The majority were women with 75.7% in the stenting and 77.8% in the balloon group, and the majority were white (73.4%). Mean size of the aneurysm in the stenting group was 5 mm±1.2 mm versus 4.6 1.2 mm for the balloon (p=0.003).Overall events rate of all TEE and rupture complications were 4.2% for the stenting versus 1.6% for the balloon (p=0.02); there was a difference in the symptomatic complication of TEE or rupture.ConclusionContrary to the other literature, in our retrospective large case series comparing stent versus balloon assisted coiling, the event rate of TEE and rupture were significantly higher in the stent group. A larger prospective study is needed to confirm this result.
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