causes of morbidity and mortality in Esophageal Atresia Peculiar to our prevailing conditions

To evaluate the causes of morbidity and mortality in cases of esophageal atresia [EA] with distal tracheoesophageal fistula [TEF].Descriptive study conducted from Dec. 1999 to Dec. 2000.Department of Pediatric Surgery, Children Hospital, PIMS, Islamabad.30 patients with Esophageal Atresia.The data of these patients was collected and analyzed.Out of these 30 patients,seven were not fit for surgery and died before surgery. Three patients had cardiac arrest during surgery; two of them were successfully revived but the third one died. Ten patients were discharged home in satisfactory condition. Thr overall mortality was 67% with 33% survival; however the mortality of operated cases was 57% with 43% survival.Esophageal atresia and tracheoesophageal fistula is a major challenge for the pediatric surgeons. In our set up several factors contribute to the high morbidity and mortality. To name a few are adolescent pregnancies, multiparity, illiteracy and limited facilities of operating upon small babies

Palliative surgery for advance osteosarcoma of shoulder region

We are presenting here eight cases of advanced osteosarcoma of shoulder region involving scapula and upper humerus in children upto the age of thirteen years. All patients had complete loss of movement. Five patients underwent fore quarter amputation. Extensive amputation although a major mutilating procedure, provides patients a dramatic relief for the period that he survives

experience with four cases of split notochord syndrome and review of literature

To evaluate the rarity of split notochord syndrome, to access frequency of various associated anomalies and to find out compatibility of this condition with survival. All those cases who presented with vertebral abnormalities and those who presented with spina bifida associated with gastrointestinal and urological abbarasion were further investigated for possible association of split notochord syndrome. The study was conducted at the Department of Paediatric surgery the Children Hospital Pakistan Institute of Medical Sciences from 1987-2001. All those children and aborted fetuses who had gross spinal cord defect, accessory limb, or teratoma like lesion associated with mylomeningocele or those who had gross duplication of pelvic genitourinary organs were further assessed by detailed examination of the local lesions and further radiological, contrast and histopathological studies. We could identify four such cases, each had completely different anatomical presentation. One was an aborted fetus of 24 weeks gestation. Another child died soon after the delivery. One had pelvic skeletal and organs duplication with enteric fistulae, double exstrophy of bladder, double penis, and split lumbosacral spine, and the fourth case had complete duplication of external genitourinary organs in the form of fully formed double vulvae and split spinal column in the region of sacrum and coccyx. Split notochord syndrome is perhaps rare abnormality, but often it may not be identified especially if it is not specifically looked for. Fifty percent of our cases were either aborted or still-born, therefore to assess the actual incidence of split notochord syndrome it is suggested that study should be conducted by antenatal ultrasounds and all fetuses who show spinal column defects and aborted should be examined with detailed dissection and histopathology analysis of the tissues