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Vol. 59, No. 3

TIlE INDIAN JOURNAL OF PEDIATRICS

of the bladdcr, as was the case in this patient, and becomes trapped in the pelvis, the bladder is further displaced upwards and the urethera stretched and compressed, thereby causing urinary retention.

Janak Raj, Harpinder Singh, Ashok Kumar and Kulwant Singh Department of Pediatric Surgery, Government Medical College and Rajendra Hospital, Patiala-14 7001 REFERENCES

l. Shah KJ. Bladder diverticulum : A n uncommon cause of acute urine retention in a male child. Br J Radiol 1979; 52 : 504506. 2. Jarow JP, Brendler CB. Urinary retention caused by a large bladder diverticulum : A simple method of diverticalectomy. J Urol 1988; 139 : 1260-1263. 3. Williams DI, Eckstein HB. Bladder disorders : diverticula. In : Williams DI, ed. Pediatric Urology, London : Butterworths, 1968; 213-227.

Association of Giardia lamblia with Vibrio in Cholera Cases Sir, Both cholera and giardiasis are endemic in India. I~ Giardia lamblia is responsible for mild dehydration particularly in the pediatric age group. V. cholerae is responsible for severe type of dehydration and involves all age groups. Though both are transported by faeco-oral route, their association has not yet been reported. But in our study on cholera outbrcak in rural area, we found the presence of trophozoites of G. lamblia in cholcra cases, while observing for darting type of motility of V. cholerae (el. To O in rice water stool.

Considering cholera as an emergency, we report darting type of motility of 1/.. cholerae dircctly by observing stool samples and confirming the results by culture and serological methods) During the cholera outbreak in the rural area of Ahmednagar district, we studied 37 cases of cholera, of which 17 were in the pediatric age group. The stool sample from all the 17 patients was collected in a sterile container and transported immediately to the microbiology laboratory, and observed for motility by hanging drop preparation. During the study of darting type of motility, we observed trophozoites of Giardia in 11 stool samples which were confirmed cases of cholera. We observed patients clinically, and found that there was not much difference as far as the severity of disease was concerned. Now we may say that, what role does G. lamblia play in cases of cholera. Whether it adds to sevcrity, is not certain. Also how does it occur is an important factor. The possibilities are that : (i) it may occur because of consumption of water contaminated with both the organisms or (if) it may be possible that the patients are carriers of Giardia cysts which are converted into trophozoite due to lowered rcsistance of host because of cholera infection, favouring the conversion of cyst to trophozoite form.

B.S. Nagoba, S.R. Oeshmukh, S.M. Dharane and J.V. Narute Department of Microbiology, Maharashtra Institute of Medical Sciences and Research, Latur-413512. REFERENCES

I. Ananthanarayanan R, Jayram Panikar CK. Text Book of Microbiology, 4th edition, New Delhi : Orient Longman Limited, 1990; 295. 2. Chattcrjec KD. Parasitology, ]2th edition,

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LETI'ERSTO TI 1E EDITORS Calcutta : Chatterjee Medical Publisher, 1980; 37. 3. Collce .IG, Duguid JP, Fraser AG, Matinion BP. Practical M~,dical Mictobiology, 13th edition, Vol. 2, London : Churchill Livingstone, 1989 : 505. i i

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Syrinomelia Bipus (Mermaid) with Meningocele Sir, Syrinomelia is a syrnpodial abnormality representing sea nymph appearance of Greek mythology. Because of rarity of occurrence & pathogenecity, syrinomelia is very scanty, and only 7 Indian reports of syrinomelia have appeared in literature in the past 15 years. 1Syrinomelia bipus (fusion of lower limbs up to ankle) or true mermaid appearance is a still rarer anomaly~ and its association with meningocele has not been reported. A 1.3 kg infant with indistinguishable sex was born to a 28 year lady by normal vaginal delivery. There was no significant antenatal sickness & medication. The baby had severe birth asphyxia (APGAR 2/10 at 1 rain. and 5/10 at 10 minutes). On examination the child showed normal upper half of body, while lower half of body showed midline fusion of lower limbs except terminal portion i.e. distal portion of fcet were separate (Figure 1). There were no genitals on front of fused lower limb mass but on the back of fused buttocks, there was a small pouch of 5 mm. size in the midline, mimicking rudimentary scrotum & there was no penile tubercle. Posterior to 9 this pouch, there was a pin hole opening which probably was the anal opening and there was no separate urethral opening.There was associated lumbosacral meningocele and a midlinc enlarged liver (8

Fig. 1 Syrinomelia bipus without genitalia cm below xyphisternum, space on both side empty). There was no other apparent congenital anomaly and the baby had 2 umbilical arteries. The child had poor neonatal reflexes, cyanosis, bradycardia, and aponea, for which all resuscitative measures were taken, but the baby died at the age of 5 hours. The postmortem was

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Fig. 2. Roentgenogram showing fused limb mass with separate long bones.