Spontaneous expulsion of unusual tracheobronchial foreign body.

An extremely rare case of long, thin and sharp pin in a young boy which was inhaled initially and defied removal at branchoscopy was eventually recovered in stool after a long and variable course through alimentary tract has been reported.

Spina bifida.

Spina bifida is the most common central nervous system birth defect encountered by the pediatric neurosurgeon. It is defined by characteristic development abnormalities of the vertebrae and spinal cord and associated changes in the cerebrum, brainstem and peripheral nerves. The expression of spina bifida encompasses the entire central nervous system, ranging in severity from merely an absent spinous process with normal intraspinal structures to the other extreme of myelomeningocoele, Chiari malformation, hydrocephalus, and cortical cytoarchitectural changes. Most children with myelomeningocoele have some degree of weakness of their lower extremities and many have significant orthopaedic problems. As a result of denervation, muscle imbalance ensues and can result in abnormalities at the hip, knee and foot. Anesthesia of various portions of the skin can lead to pressure sores, particularly later in life. Anorectal neuropathy may cause a variety of defecatory dysfunctions. Urologic abnormalities are also common. These multisystem abnormalities associated with spina bifida contribute to its widely accepted identity as the most complex development defect compatible with long life.

Gastric volvulus in childhood.

Gastric volvulus is an uncommon condition more so in the paediatric age group. The cause of gastric volvulus may be idiopathic or secondary to various congenital or acquired conditions. In this short series of three patients, one had volvulus which was due to ligamentous laxity and mobile spleen, second had congenital postero-lateral diaphragmatic defect and the third had hiatus hernia.

Cystic mesenchymal hamartoma of the liver--a rare condition.

Cystic Mesenchymal Hamartoma of the liver is a rare benign tumour of infancy. Congenital cysts of the liver are of two main types: mesenchymal hamartoma and non parasitic cysts. The latter are encountered frequently while liver hamartomas are rare. The first reported case of mesenchymal hamartoma was that of Maresch in 1903. In 1956 Edmondson reviewed the literature and proposed the term "Mesenchymal Hamartoma" as a new clinical entity. In this paper we are discussing a rare case of cystic mesenchymal hamartoma of the liver, its clinical presentation, pathological characteristics, options of management and reviewing the relevant literature.

Blastopathies--symmetrical conjoined twins.

Conjoined twins are one of the rarest blastopathies, challenging the medical profession. The incidence in India is reported to be 1:60,000 pregnancies. This report records two cases of female conjoined twins. The sharing of various organs and complex cardiac anomalies encountered were very fascinating. Omphalopagus conjoined twins had only three lower extremeties, a common gastro-intestinal tract beyond the terminal ileum, crossed ectopia, hypoplastic kidneys and bicornuate uterus. The heart showed dextrocardia, A.S.D. and V.S.D. No attempt was made for surgical separation in this case. The second case was a thoracopagus, with the heart showing V.S.D., cor triatrium dexter with a posterior venous chamber. Surgical separation was attempted, but was unsuccessful. Both cases showed a single fused liver. The need for antenatal diagnosis and successful separation with good pre- and post-operative management is stressed.

Hepatic hemangioendothelioma of infancy with congestive cardiac failure--report of a case.

A case of infantile hemangioendothelioma of the liver is reported in a 18 day-old male neonate. The neonate presented with CHF. He had hepatomegaly, but lacked the third component of the classical triad i.e. cutaneous hemangiomas. The S.A.F.P levels were raised to 920 ng/ml, though rise is rare in infantile hemangioendothelioma and led to the clinical diagnosis of hepatoblastoma. A left hepatic resection was performed, the histology showed a type I pattern of the tumor. This is known to be associated with a good prognosis. The baby is well post resection for a follow up period of six months.

Rectal duplication.

Duplications of the alimentary tract are of a great rarity, particularly so in the rectum. Because of its rarity, the difficulty of making a correct diagnosis and of selection of proper approach for treatment, this entity bears a special significance. The present case report deals with a female newborn who presented with imperforate anus and a rectovestibular fistula and a mass prolapsing at the introitus. Complete excision of the mass was carried out through the perineal approach and the child then underwent, a PSARP for the correction of the rectal anomaly. Histology confirmed the mass to be a rectal duplication.

Spectrum of pediatric urolithiasis in western India.

Of 1,211 patients with urolithiasis treated at this institution over a nine years period, there were 77 (6.4%) pediatric cases. The commonest age group was 6-10 years (55.8%). Male:female ratio was 7.6:1. Hindus constituted 72.7% of the patients. There was no significant seasonal variation. The commonest site was urinary bladder (67.5%). The upper: lower urinary tract stone ratio was 1:2.85. Majority belonged to the lower-middle or poor income groups having a cereal based diet with minimal or poor protein intake. The common constituents of stones were calcium (98.7%), oxalate (87%), phosphate (84.4%) and uric acid (76.6%). Of all these, uric acid had the richest concentration (grade of ++ or more) in 93.2%. Only 4 stones (5.2%) were "pure": calcium oxalate--3 and calcium phosphate--1; whereas 73 (94.8%) were mixed stones. Of these, 9 (11.7%) were "predominant" mixed stones, with only one constituent having rich concentration (grade of ++ or more) and all others being either trace or +. The rest 64 (83.1%) were "heterogenous" mixed stones having rich concentration of more than one constituent.

Intussusception in infancy and childhood: evaluation of a prognostic scoring pattern.

This is a retrospective analysis of 82 patients of intussusception in infancy and childhood. Males were more than females in the ratio 2.4 : 1, the ages varied from 2 months to 12 years. Majority (73%) were less than 1 year old. Commonest presentations were pain, vomiting, distension, palpable lump and blood and mucus in stools. The management of these patients varied from barium enema reduction (3 cases), reduction by surgery and manipulation (59 cases) and resection with primary anastomosis (20 cases). We analysed our patients by giving scores based on clinical criteria. We concluded that the patients in our circumstances do not show any correlation of the scoring pattern with morbidity or mortality, chances of reduction by barium enema or manually. Resection, however, did correlate with a high incidence of death (75%). Resections were required slightly more in ileo-ileal intussusceptions than in those having a colonic involvement, morbidity in the form of wound dehiscence, and sepsis was higher in those patients who had undergone resections.