Neonatal surgery: a ten year audit from a university hospital.

Neonatal surgery is the flagship and most challenging component of pediatric surgery, which is the youngest subspeciality of surgery. Neonatal surgery carried a survival rate of only 30% three decades ago. In the last decade there has been a significant change in the scenario. Earlier recognition and referral of these anomalies, availability of neonatal intensive care, better preoperative planning, decision, and techniques have lead to the change in the management. This is an audit into the outcome of neonatal surgery from one of the largest units in India over a ten year period. This audit reveals an across the board survival of 65-70% newborns after surgery on nearly two thousand case over a ten year period. It has an important message that while pediatric surgery units expand, risk stratification of surgical newborns and their treatment in suitable units is mandatory to maintain and improve these figures to match international standards over the next decade.

Chondroid lipoma in a child.

Chondroid lipoma (CL), a rare lipoma variant, has not been described well for patients younger than 14 years of age. We herein report an extremely unusual instance of CL in a 7-year-old child. The cut surface of the tumor showed peculiar tan-brown and yellow-white areas. Histopathological sections showed the presence of eosinophilic variably vacuolated round- to oval-spindle cells in a myxo-hyaline background. The findings were consistent with CL. The case is reported because of its extreme rarity.

Spinal cord hamartoma with pseudopancreatic cyst.

A 2-year-old boy presented with weakness of both lower limbs with bladder and bowel involvement and history of frequent falls. Magnetic resonance imaging of the spine revealed a T2 altered signal intensity enhancing mass lesion seen in the spinal epidural space extending from sixth cervical to fourth thoracic vertebrae, which was compressing the adjacent spinal cord. Histopathology of the lesion was suggestive of hamartoma. A brief review of the literature including its embryogenesis is discussed here. The child subsequently developed pseudopancreatic cysts possibly because of repeated falls leading to blunt trauma abdomen.

Conservative treatment for round worm intestinal obstruction.

OBJECTIVE: The ascariasis is one of the most cosmopolitan intestinal parasite infections and it can be in inhospitable regions inhabited by human being, but its biggest prevalence is observed in the tropical and subtropical areas. Intestinal obstruction has been estimated to occur in 2 per 1000 ascaris-infected children per year. We are presenting a study emphasizing the conservative treatment for complete intestinal obstruction due to roundworms without sign and symptom of peritonitis and perforation. METHODS: A total of 22 patients of roundworm obstruction partial or complete without signs of and symptoms of peritonitis were admitted in the Department of Pediatric Surgery IMS, BHU Varanasi India in the period form 2003-2005. Patients were put nil by mouth, intravenous fluid, antibiotics, piperazine salt through nasogastric tube and glycerine + liquid paraffin emulsion enemas and were evaluated for duration of hospital stay, rate of conversion to surgical treatment and complications. RESULTS: 19 (86%) patients were treated successfully with conservative line of management. Only 3 patients required surgical intervention. No mortality, complication and mean hospital stay was 4.1 days (range 4-5 days). CONCLUSION: Round worm intestinal obstruction can be effectively treated by conservative line of management.

Obstructed Morgagni's hernia.

Morgagni's Hernia is the direct herniation of the intra-abdominal organs through the anterior retrocostoxiphoid diaphragmatic defect. We are presenting a case of obstructed Morgagni's hernia in a five-year-old child. Who presented with colicky abdominal pain, distention of upper abdomen, vomiting with constipation of three days duration.. Morgagni hernia is a rare disease even rarer in pediatric age group, and is usually diagnosed incidentally; presentation of this disease with obstruction had been reported in adult but not in children.

Ivemark syndrome in association with congenital septum transversum defect and pancreatic divisum.

A four-month-old female baby presented with cyanosis and respiratory distress. A provisional diagnosis of congenital posterolateral diaphragmatic hernia was made but on exploration there was a defect in the septum transversum along with features of Ivemark syndrome - asplenia with visceroatrial heterotaxia, malrotation and pancreatic divisum - an association not yet reported in literature. The child did well after operative correction of the hernia. Echocardiography showed situs inversus with dextrocardia with double outlet right ventricle, atrial septal defect, ventricular septal defect, patent ductus arteriosus and pulmonary stenosis.

Local steroid therapy in cutaneous hemangiomas.

OBJECTIVES: To evaluate the efficacy of intralesional triamcinolone in enhancing regression in various type of hemangiomas. SETTING: Outpatients department of a teaching hospital Subjects: One hundred and five patients with rapidly growing surface hemangioma. The age ranged from 1 month to 15 months (mean 7 months). INTERVENTION: Intralesional triamcinolone administered at monthly intervals, ranging from single injection to 7 injections (mean 3.6 injections). MAIN OUTCOME MEASURE: Regression of the hemangioma. RESULTS: The overall response rate was 88.6% (excellent 51.4%, and good 37.2%). Maximum response was observed in children below 1 year of age (> 90%), lesions over the face (92.8%) and strawberry hemangiomas (99.9%). CONCLUSION: Intralesional administration of triamcinolone devoid of systemic side effects and an effective initial modality for rapidly growing hermangiomas.

Estimation of tissue DNA content in Wilm's tumour.

DNA genome, is affected by malignant processes. Estimation of DNA content was carried out biochemically using Gile's and Myer's technique to assess its prognostic value in 21 cases of Wilm's tumour. The DNA content of tumour tissue and normal adjoining renal tissue was estimated in each case. The DNA content was significantly higher in Wilm's tumour tissue as compared to normal renal tissue (p < 0.05). As the disease advanced, the DNA content of the tumour further increased. The tumours having unfavourable histology had significantly higher DNA content as compared to favourable histology cases (p < 0.001). Similarly, the patients who died because of the disease, had a very high DNA content as compared to those who survived. Further, it was seen that two fold increase in DNA content indicated advanced stage (III & IV), whereas a three fold or more increase indicated grave prognosis as it was usually seen in advanced stage with unfavourable histology and such cases died early. Thus, the DNA content estimation has a prognostic significance in Wilm's tumour.