Primary intracranial malignant melanoma

Primary intracranial melanoma is an extremely rare lesion of the brain. A 28 years old lady, without any co-morbid conditions, presented with headache and left side facial numbness. MRI of brain showed a mass lesion in left middle cranial fossa extending into posterior fossa, with signals characteristics of melanoma. Histology and immunohistochemistry confirmed the diagnosis after surgical excision of that lesion. Patient remained symptom-free till the last follow-up that was four years postoperatively

Surgical management of suspected enteric ileal perforations in children

To find the outcome of protocol adopted for suspected enteric ileal perforations in children. Descriptive case series. Department of Paediatric Surgery National Institute of Child Health [NICH] Karachi, from December 2010 to November 2011. A total of 23 patients were managed during the study period. The protocol varied depending upon condition of the child at presentation. Tube laparostomy was done as initial procedure in patients who were judged unfit for surgery within 24 hours of admission based upon need of resuscitation. Once optimized, children underwent surgery. Procedure was tailored according to the operative findings and included either primary repair of the perforation or stoma formation [exteriorization of perforation - Ileostomy]. There were 16 male and 7 female patients. Age ranged from 3-13 year [mean 7.82, + 2.94 year]. Duration of symptoms ranged from 7-45 days [mean 15.56, + 9.39 days]. Free intraperitoneal gas under diaphragm on x-ray abdomen was found in 19 patients. Initial tube laparostomy was done in 12 cases. Laparotomy was performed in our hospital in 21 patients while one child had surgery done elsewhere and referred with stoma already made. A single perforation found at antimesenteric border of distal ileum in 20 cases. Primary closure of perforation was done in 5 patients. Ileostomy was made in 16, of whom 11 had reversal in 2 to 5 months time. The patient who had surgery done outside, developed burst abdomen and was re-explored. More perforations were found in proximal ileum and stoma was refashioned. This patient died later. Two patients in whom stoma was made expired in early postoperative period. In one patient only tube laparostomy was performed. He died before any definitive procedure. Overall mortality was 17.3% [n 4]. Patients with enteric perforation had varied presentation. The surgical procedure has to be tailored according to the condition of the child. Mortality remained significant in this condition