Per rectal bleeding in children

To find out different causes and management of bleeding per rectum in infants and children. Descriptive study. The study was conducted at various hospitals where authors worked, from January 2005 to December 2007. All children under 12 years of age presenting with a common symptom of bleeding per rectum were included. The data was reviewed for age, gender, clinical characteristics and management. In all cases CBC and in selective cases stool DR were done. Some patients were subjected to sigmoidoscopy. Rectal polyp and mucosal biopsy were sent for histopathology. The study included 80 patients, of whom 57 [71.25%] were boys and 23[28.75%] girls with male to female ratio of 2.5:1. The mean age at diagnosis was 6.31 years. Rectal polyps were the most common cause and found in 45[56.25%] children. Polyps were diagnosed with digital rectal examination and by sigmoidoscopy. Twenty one [26.25%] children were treated conservatively with the suspicion of infectious colitis. Non specific colitis [n=2], intusssusception [n=3], Meckel's diverticulum [n=1], ulcerative colitis[n=2] and anal fissure[n=2] were the other causes. Colorectal polyps are common cause of rectal bleeding in children. Proper physical examination including per rectal digital examination along with the endoscopy promotes both rapid and accurate diagnosis and the opportunity for immediate therapeutic measures

Post operative analgesia in infants

To compare the effects of local wound infiltration of bupivacaine with intramuscular nalbuphine in infants as post operative analgesia. Comparative study. Place and Duration of study: Department of Paediatric Surgery, National Institute of Child Health, Karachi, during years 2002-2003. A total of 60 patients included in this study. They were divided into 3 groups of 20 patients each. All were selected for elective inguinal herniotomy and randomly distributed in 3 groups. Group I was control group in which no analgesia was given and patients were observed for pain. Group II consisted of patients who were given nalbuphine post operatively and in group III bupivacaine was infiltrated into the wound margins just before wound closure. Observational pain assessment was performed according to Infants Pain Scale of Barrier et al. Results of the mean of 3 groups were compared with each other to assess severity of pain. Group I [control] showed signs of moderate to severe pain. Out of 20 patients, 16 had moderate and 4 had severe pain. In Group II [nalbuphine] 18 patients demonstrated mild pain while only 2 patients remained symptom free and in group III [bupivacaine] out of 20 patients 9 developed mild pain while 11 patients had no pain at all. Thus bupivacaine proved significantly better than nalbuphine [p<0.01] as post operative analgesia in infants. Bupivacaine as compared to nalbuphine is more effective as a post operative analgesia. This makes the drug most suitable for routine use, especially in day care surgery