A.The urachus allows the urine to drain from the bladder out the umbilicus when an infant is in utero. This passage closes at birth, but a cyst may develop and collect urine later in life. While the umbilicus cyst is present from birth, it is possible for it to grow larger over time, and so it may have been missed on your earlier ultrasound. Still, I agree with you. It is not the only thing we should be concerned about in your case. Another possibility is a cyst involving the ovaries (you did not rule that out in your description of the ultrasound). Endometriosis (as your doctors had told you) or cysts of another structure are possible. The ultrasound is excellent at evaluating these structures, but sometimes another technique such as a CT scan will provide additional information. Certainly, surgery is a possibility, but only necessary if the cyst causes significant problems or problems in the future.

I've read about endometrial ablation to remove the uterine lining and fibroids. Can you tell me what the size of the fibroids should be to do this? What are the complications of this procedure?

A.Good news if you don't want a hysterectomy: you probably won't get one. Hysterectomy used to be one of the most common surgeries in the U.S., and many feared that women were needlessly having them. To help address this potential problem, several groups developed guidelines for when a woman should have a hysterectomy. These guidelines depend on the amount of the woman's bleeding, the cause of the bleeding and other symptoms, and when the woman is expected to reach menopause.

The size of the fibroids is a factor, but only in that larger fibroids tend to cause more symptoms. The primary symptom of concern is abnormal menstrual bleeding, which you have been experiencing. Since you are almost 50, you can expect that your periods will end soon. When your periods end, the bleeding will likely stop. Other concerns about the fibroids are that their size may cause problems, much like the pregnant woman notices some symptoms. For example, a large fibroid may push on the bladder, making you urinate more frequently.

However, as your gynecologist said, if you are not bothered by this symptom now, you will not be in the future. The fibroids won't grow after menopause (they may shrink), and so you should not have any new symptoms.

A.One possibility is a complication of mycoplasma pneumoniae. Mycoplasma pneumoniae is well known as a common cause of pneumonia, but it also associated with a significant number of extrapulmonary effects. The most frequent extrapulmonary complication is neurologic. These neurologic complications can be seen a few days to a few weeks, possibly more, after respiratory symptoms resolve, even though nearly half the patients may not have a history of a respiratory infection. Since it can result in a coma or a stroke, encephalitis is the most feared neurologic complication. Pericarditis, heart block, and migratory arthritis are potential complications of mycoplasma pneumoniae infection. Ophthalmologic complications include iritis, conjunctivitis, and optic neuritis with optic nerve atrophy. Other ophthalmologic complications include retinal hemorrhages and exudates.

A.The congenital fourth nerve palsy is a nerve paralysis that moves the eye. Since children are unable to move their eye to the side, they are forced to move their head in the direction. This gives the appearance of having a stiff neck (or torticollis).

The treatment for the congenital fourth nerve palsy is surgery. This is usually done after the first birthday. Some information about congenital fourth nerve palsy is available on a pediatric ophthalmology Web site by doctors from New York at www.pedseye.com.

A. The best resource for you is a book by Anita Taylor. How to Choose a Medical Specialty, 3rd edition (September 1999), W B Saunders Co; ISBN: 0721674623]

A.I am not aware of the laws in all states, but I believe suspensions of privileges are required for such reporting. The Medical Boards go by different names in different states. In California, it is called the Medical Board of California, located within the Department of Consumer Affairs.

Look in your telephone directory under state government for a phone number. Or call the state capital. You also can get the phone number and address from your physician's office. This type of information is public record, so you may go directly to the Board.

A. As you know, most physicians do not believe that yeast causes the broad number of infections that is popular to read about in the lay press. Certainly, current treatment with antibiotics can cause one to get a yeast infection. However, I am not aware of a systemic yeast infection causing recurrent ear infections, especially if the child already has tube placements. Frequently what happens is that the child is unable to complete a course of antibiotics (primarily because oftentimes these antibiotic courses are for several weeks, longer than the usual course). Without a complete course of medication, the infection is more likely to recur. In addition, frequently these chronic infections are not caused by bacteria but rather by viruses that will not respond to the usual antibiotic treatment. Obviously, since the child has had tubes placed, she has seen an ENT specialist. I suggest re-evaluating the potential of non-compliance with medication and considering an extended (3 weeks) of treatment. The parents may be reassured that usually these infections stop by the time the child is six or seven years old. Hopefully, your patient will not problems for much longer.

A.First you should be commended for thinking of abuse in this case. The number one issue for the provider is to think about the possibility of abuse. If you don¹t think about it, certainly nothing can be done about it.

The guideline is relatively straightforward: If you consider that abuse is possible, then you should refer to the local agency. While this is oftentimes very difficult, most parents appreciate the referral. Note that I called this a referral rather than a reporting. Generally speaking, I walk up to the parents and say that I am concerned that there is some bruising, that I understand how difficult it is to raise a child, and that I can offer them a referral to Child Protective Services in order to see what kinds of things can be done in and around the home to make it a safer place for the child. This is done in a non-accusatory manner; not saying that I think the parents are hurting the child, but rather there are things we might be able to do to help prevent the child from injuries. If the parents say, "No, thank you, we¹re not interested in such a referral," I then tell them it is my legal obligation to make the referral. Again, this is done primarily to benefit the child. To date, the only parents who¹ve objected are those who have something to hide.

All fifty states require that health care professionals report known or suspected child abuse. You can get a number for the Child Abuse Hotline for your state from the following Web site: http://www.acf.dhhs.gov/programs/cb/rpt_abu.htm

A. There are several causes of strokes in young children, including some infections and things like sickle-cell anemia. Most of these, though, would be thought of by the doctors taking care of your child at a children¹s hospital. So the fact that they are having a difficult time making the diagnosis may mean that it is a more obscure cause in this case. The important first step in preventing future strokes is to find out what the cause is, and I am certain that the doctors are doing the best that they can. Typical physicians that would be involved with this would include hematologists (blood doctors), neurologists, and infectious disease physicians.

A. Marfan Syndrome is a relatively rate (1 in 10,000 Americans) inherited condition of the connective tissue. This problem, usually in a tall person, leads to long slender fingers and occasionally other problems, such as the aorta leaving the heart. Many Marfan Syndrome people do quite well. Occasionally, you hear of a death. Clearly, Marfan Syndrome people should be under the care of a physician. Some of the best Web sites related to Marfan Syndrome (providing either information or support) are: http://babynet.ddwi.com/tic/pregnancy/marfanis.html as part of the Tender Loving Care site and the http://www.marfan.org/pub/factsheet.html foundation Web site.