Modified Pediatric Penile Perception Scale to Evaluate Cosmetic Outcome in Children With Hypospadias Repair

Objectives: To compare the interpretation for cosmesis post-hypospadias repair by child, parents and surgeons using modified Pediatric Penile Perception Scale (PPPS). Methods: This cross-sectional study involving 50 children (aged 2 to 17 years) with hypospadias was conducted at the pediatric surgery department of our public sector tertiary care hospital. Subjects were assessed 6 months after completion of all stages of hypospadias repair. Cosmetic assessment was done using modified PPPS. We clubbed together the variables ‘meatus’ and ‘glans’ as MG (meatus-glans) complex due to their extreme proximity (embedding), while cosmesis of phallus was considered independently. The modified PPPS scoring parameters included phallus, MG complex, shaft skin, and general appearance. Independent assessment by surgeon, patients and parents was compared, and analyzed using SAS 9.2 statistical software. Cosmetic results of single vs staged repair, and different repair types was compared. Results: Assessment using modified PPPS showed that MG complex cosmesis and skin scarring were the most heeded parameters by all three categories of observers. PPPS by surgeons remained least affected by phallic cosmesis and that of the patient by the overall phallic appearance. Tubularized incised plate urethroplasty (TIPU) scored better on cosmesis. Conclusion: Phallic cosmesis should be considered an independent variable for assessing cosmetic outcome of hypospadias, apart from MG cosmesis.

Isolated Solitary Intramuscular Cysticercosis involving lateral chest wall: An uncommon presentation

Cysticercosis is a Parasitic disease caused by the larval form of the pork tapeworm Taenia solium. This disease is a major health concern especially in developing world including India but its incidence is underestimated. Not too many cases of isolated intramuscular cysticercosis have been reported in pediatric population. Here we report a case of 4 years old female child presented with swelling over left lower chest over 3-4 months, diagnosed with intramuscular cysticercosis by ultrasonography.

Omphalomesenteric duct cyst as a content of omphalocele.

A rare occurrence of an omphalomesenteric duct cyst in an exomphalos minor sac is reported herein. The noteworthy points in this case were an unusual presentation of the rarest variety of umbilical cord cyst. The tapering intra-abdominal end of the cyst was found to be attached to the ileal mesentry, thereby simulating a herniating mesenteric cyst till the histolopathological report resolved the issue.

Associated anomalies with anorectal malformation (ARM).

OBJECTIVE: To find the prevalence of associated anomalies in children with anorectal malformation (ARM). METHODS: One hundred and forty patients (80 males and 60 females) with expand were studied to detect associated anomalies and to find their prevalence. High and low type of ARM was seen in 52.14% and 47.86% of patients respectively. Associated anomalies were more common with high type of ARM (78.08%) than in patients with low type of ARM (37.31%). 58.57% patients had associated anomalies which included those of urinary system (37.14%), vertebral system (34.28%), skeletal system other than vertebral (15.17%), genital system (14.29%), cardiovascular system (12.14%), gastrointestinal tract (10.7%) and spinal cord (10%). RESULTS: 37.43% patients had 3 or more than 3 components of VACTERL association. Two patients had all six components of VACTERL. Most common association was vertebral, anal and renal anomalies seen in 16 patients. CONCLUSION: Patients with ARM should undergo a detailed general physical, systemic and radiological examination (infanto-gram, echocardiography, US of urogenital system) in neonatal period to detect associated anomalies in early period.

Neonatal adrenal hemorrhage with intraperitoneal spill managed conservatively.

A neonate presented with anemia, hyperbilirubinemia and bilateral flank fullness at 23 days of age. Ultrasound abdomen showed bilateral adrenal hemorrhage with intraperitoneal extension on the left side. This was managed nonoperatively and the hematoma resolved completely. Literature regarding this rare entity is described.

Perineal accessory scrotum.

A boy with perineal accessory scrotum but without any other congenital anomaly is being described. He presented with a rugose skin tag on a midline perineal mound and the diagnosis could be confirmed by the histological findings of subcutaneous smooth muscles. Other reports of perineal scrota have been reviewed and a simple classification has been proposed for such cases, based on the appearance of the accessory scrotum and the associated anomalies.

Urinary citrate excretion in idiopathic nephrolithiasis.

OBJECTIVE: To determine urinary citrate excretion in children with nephrolithiasis and normal controls. DESIGN: Prospective. SETTING: Tertiary care center in New Delhi. METHODS: This study was done on 50 children, below the age of 12 years, with idiopathic urinary calculi and 150 age and weight matched controls. The children were divided into 3 groups: Group 1 (1-4 years), Group 2 (5-8 years) and Group 3 (9-12 years). Urinary citrate was estimated in a 24-hour urine sample using colorimetric method. The stones removed from these children were also analysed. RESULTS: There was a preponderance of urinary stones in males; the highest incidence being in Group 1. Excretion of citrate in 24-hour urine sample was significantly lower in patients compared to controls, for males in all age groups and for females in Group 3. However, there was no statistically significant difference in the urinary citrate value between males and females in a given age group for either controls or patients. The urinary citrate excretion increased with age in patients and controls, but the levels in patients were lower. Depending upon the constituents, four types of stones were identified, calcium phosphate, calcium oxalate, uric acid and magnesium ammonium phosphate. Nine stones had at least more than one major constituent. Hypocitraturia was detected in 43 percent cases. The incidence was 76 percent for calcium phosphate, 87 percent for calcium oxalate, 40 percent for uric acid stones and 50 percent for magnesium ammonium phosphate. CONCLUSION: This study shows that low urinary citrate is associated with urinary stones in children, especially in endemic areas, in the absence of obvious etiological factors. Urinary citrate excretion should be determined in all children with nephrolithiasis.

Detecting protein losing enteropathy by Tc-99m dextran scintigraphy: a novel experience.

OBJECTIVE: To evaluate protien using enteropathy by Tc-99m dextran scintigraphy. METHODS: Methods for detecting protein loss from the intestine revolve around fecal nitrogen excretion, the clearance of alpha-1 antitrypsin in stools and by endoscopic biopsy. RESULT: The diagnosis of protein-losing enteropathy (PLE) can also be established by a scintigraphic method that is noninvasive, simple and requires no patient preparation or motivation. This diagnostic modality can also delineate the site of protein loss, thereby offering a targeted approach, and if need be, surgery. Radiolabelling of a non-protein, noncolloidal, nonparticulate and biofriendly molecule like dextran with Technetium-99m for imaging enteric protein loss was utilized in imaging eight children with PLE. CONCLUSION: The results were encouraging. The authors advocate the use of this diagnostic tool in identifying patients with PLE, particularly in the pediatric age group.

Risk factors for mortality within first 24 hours of head injury.

OBJECTIVE: Immediate or instantaneous death following cranial trauma occurs due to unpreventable primary brain insults. However, death occurring within 24 hours of head injury can be averted by timely institution of the therapeutic measures that could prevent secondary brain insults. From the management point of view, this is the most important subset of all head injured patients. Therefore, it is important to study risk factors associated with such deaths. METHODS: In a retrospective study undertaken at Trauma Center, Safdarjang Hospital, New Delhi, the demographic characteristics, neurological and radiological findings were studied for 100 head injured children admitted in the pediatric surgical ward, who later died after surviving the initial neurosurgical resuscitation. Death occurring within first 24 hours of head injury was defined as "early" death; and "late death", if it occurred thereafter. RESULTS: Bivariate analysis revealed the severity of head injury GCS<=8 (OR: 3.09; 95% CI: 1.22-7.8), a finding of diffuse brain edema, (OR: 3.73; 95% CI: 0.95-14.74), midline shift (OR: 4.8; 95% CI: 1.03-22.37) on cranial CT scans were found to be statistically associated with early deaths. Child's age or gender, the mode of injury and the presence of extracerebral injuries were not found to be significantly associated. When these variables were simultaneously considered in a multivariate logistic regression model, the diffuse brain edema on head CT scan was found to be both clinically and statistically significant of early death (Adj. OR: 527; 95% CI: 1.23-22.6). However, absence of hemorrhagic contusion was clinically important predictor of an early death (Adj. OR: 6.45; 95% CI: 0.68.-62.5) though not statistically significant