Etiological Spectrum of Acute Intestinal Obstruction.

Gastrointestinal obstruction in children may be due to a variety of conditions. 150 cases of acute intestinal obstructions seen over a period of 180 months were reviewed. Intestinal atresia was the comonest cause (34, 22.4%).

Marchiafava-Bignami disease.

Marchiafava- Bignami disease is the symmetrical demyelination of the middle portion of the corpus callosum observed in people with chronic alcoholism. We report two male patients who had history of chronic alcoholism, different clinical presentation and MRI findings consistent with the diagnosis of Marchiafava-Bignami disease.

Primary vesicoureteral reflux: progress of disease, somatic growth and renal parameters.

Thirty children (45 units) in the age group 1 day-12 yrs with primary vesicoureteral reflux were studied prospectively and periodically assessed for renal function, scarring, grade of reflux and somatic growth parameters. Four children (6 units) with grade IV reflux underwent ureteric reimplantation. Complete resolution with medical management was seen in all 12 units of grade I-III reflux and in 5 of the remaining 27 units of grade IV-V reflux over 6 months-6 yrs. This group showed highly significant improvement in height . The weight gain of the above 2 groups was statistically significant compared to those with persistent reflux. Focal defects were seen initially in 62 percent refluxing units. None of the patients showed deterioration in renal function or formation of new scars over the next 1-7 years. Three children on conservative management showed persistent growth retardation with associated breakthrough infection, hypertension, multiple renal scars and poor renal functional volume.

Bronchial transection: delayed diagnosis and successful repair.

Traumatic bronchial transection is usually recognized and repaired immediately after injury. Bronchial transection has a variety of clinical presentations due to air leak into the pleural cavity and it is very rare to have total absence of air leak from the transected bronchus at presentation. We present one such case of main right bronchus injury with total absence of initial clinical signs and symptoms, leading to a delay in the diagnosis. However, the surgical repair eight months after injury showed excellent recovery of the chronically collapsed lung.

Ultrasonic variables in the diagnosis of intrauterine growth retardation.

Ultrasonic biparietal diameter (BPD), femur length, abdominal circumference, femur length/abdominal circumference ratio, estimated fetal weight, ponderal index, estimated fetal length were measured within 72 h of delivery of 30 small-for-date (SFD) and 174 non-SFD newborns. Evaluation of each ultrasound variable in the antenatal diagnosis of SFD fetus was assessed. Abdominal circumference and estimated fetal weight were the best predictors in confirming SFD in 73.3 and 76.6 per cent respectively, followed by BPD (63.3%). Other variables (femur length, femur length/abdominal circumference ratio, estimated fetal length and ponderal index) were less accurate in diagnosis of SFD babies. For all variables studied negative predictive value was high (almost 90% or above). However, positive predictive value for abdominal circumference and estimated fetal weight were satisfactory. This study demonstrates the usefulness of abdominal circumference and estimated fetal weight in recognising SFD. It also shows that various growth variables could be used to rule out the diagnosis of IUGR with reasonable accuracy (negative predictive value greater than or equal to 90).

Fetal ponderal index in predicting growth retardation.

Fetal ponderal indices were calculated by ultrasound examination and compared with the neonatal ponderal indices in 154 pregnancies. No significant difference was found between the prenatal and postnatal values of weight, length and ponderal indices of the entire sample as well as in babies with intrauterine growth retardation (IUGR). The fetal ponderal index had a sensitivity and specificity of 56.7 and 84.6 per cent respectively. These data suggest that fetal ponderal index could be used to rule out IUGR with reasonable accuracy (negative predictive value: 86%).

Status of newborn care in India.

A questionnaire regarding the existing facilities and concept of newborn care was sent to 135 hospitals. A total of 18 teaching, 9 non-teaching and 5 private hospitals responded. Space provided for most of the nurseries was inadequate. Ratios of nurse: baby and doctor: baby fell short of the recommended. Maintenance of asepsis was lacking in many NSCUs. Regarding equipment, the general concept seems to be that having incubators and phototherapy units is adequate and most of the NSCUs did not go beyond it. Only 40% of the hospitals run special antenatal clinic for high risk deliveries and not all hospitals followed up high risk babies. Among the admitted LBW babies, those belonging to 1000-1500 g group outnumbered others, had higher morbidity and mortality, thereby taking away a major share of newborn care. It was a pleasure to note that most nurseries preferred breast milk for LBW babies. It is concluded that status of newborn care in India has a long way to go.