Factors affecting survival in patients with oesophageal atresia and tracheo-oesophageal fistula

To evaluate the various factors affecting survival in babies with oesophageal atresia and tracheo-oesophageal fistula. Descriptive study. The study was carried out at the Department of Paediatric Surgery, The Children's Hospital, Pakistan Institute of Medical Sciences [PIMS], Islamabad from March 2004 to March 2005. All neonates with oesophageal atresia [EA] and tracheo-oesophageal fistula [TEF] during the study period were included in the study. Patients having isolated EA were excluded. A total of 80 patients were included in the study. Patients were received from the emergency department, OPD and Neonatal ICU. Diagnosis was confirmed by passing a radio opaque orogastric tube. Investigations were done to look for other associations. After stabilisation, right thoracotomy was performed, fistula was ligated and divided. An attempt was made to do a primary oesophago-oesopahgostomy. Nasogastric feeding was started on 2nd post-operative day. A contrast oesophagogram was performed on the 7th postoperative day and having ruled out leak, oral feeding was started. Out of the total, 33 [41%] survived and 47 [58%] patients died. Out of 47 deaths 20 [25%] died before surgery and 27 [34%] died after surgery. Mean follow up period was 6 months. Sixteen [20%] patients had anastomotic leak, 24 [30%] had anastomotic stricture, and 64 [80%] patients had postoperative pneumonia. We conclude that proper antenatal check ups will detect the problem early, avoid home deliveries and hence improve survival. Pneumonitis and septicaemia significantly affect survival. Availability of ICU is one of the main determinants of survival. The likely cause of high mortality rate in pre-operative patients in our series is non-availability of NICU due to limited space in our setup

Successful revascularization of severely damaged lower limb in a three years old child

Reimplantation and revascularization surgery is essential component of all trauma centres in the developed countries. In children revascularization can only be performed using special microsurgical techniques. We are presenting a case of a three years old female child who was referred to us from another hospital with history of trauma to the right leg by falling of a steel object. It resulted in fracture of tibia and fibula near the knee joint with division of major vessels and loss of circulation to the limb. Successful revascularization using an autologous long saphenous vein graft resulted in full recovery and function of the limb

Splenic cyst - a rare entity

Splenic cyst is a rare condition and is usually asymptomatic unless very large in size. We are reporting a case of large splenic cyst in an 11 year old girl who presented with a 3-month history of left upper quadrant pain and abdominal distension. Total splencctomy was performed due to the involvement of the splenic blood vessels and minimal residual splenic pulp

Management of an ancurysmal bone cyst

Aneurysmal bone cyst is a rare, non-neoplastic, expansile bony lesion that mainly affects children and young adults. It may cause diagnostic confusion with a bone tumor. These cysts are frequently treated surgically, but recurrence is very common and surgery is hazardous, especially when the lesion is adjacent to the growth plate. A case report of an aneurysmal bone cyst in an 11 year old child is presented with serial radiographic changes and discussion on its management