Paediatric ureterolithotripsy: Tips and tricks - Experience at a single center.

BACKGROUND: Paediatric stone disease is very common in certain regions of India. Traditionally, the endourology for the stones even in paediatric age group is managed by adult urologist and paediatric surgeons tend to do open surgeries. The nonavailability of paediatric size equipments and lack of training at the teaching and tertiary care paediatric surgical centers in India are factors due to which there is continued apathy of paediatric surgeons to endourology. The aim of this study was to discuss the feasibility of paediatric ureterolithotripsy for successful procedure. We introduced the paediatric ureterolithotripsy as per the predecided indications of stone size up to 15 mm in paediatric ureterolithiasis at a tertiary care center in rural set up. SUBJECTS AND METHODS:: Patients up to 18 years of age presenting with ureterolithiasis and not responding to conservative treatment or who needed endourological intervention were included in the study. RESULTS:: Thirty-one patients underwent uretero lithotripsy (URSL) for ureteric calculus with more than 95% clearance rate. CONCLUSIONS:: Single-stage paediatric ureterolithotripsy is quite feasible and effective in achieving the stone clearance in paediatric ureterolithiasis.

Lateral cleft lip and macrostomia: Case report and review of the literature.

Lateral clefts are rare in occurrence. The lateral cleft is cause by failure of fusion of the maxillary and mandibular dermatomes. It is also associated with preaurical tags. We present a case of a lateral cleft of the lip with multiple bilateral preauricular tags that was repaired using triangular flaps.

Orchidopexy san ligation technique of orchidopexy.

Pediatric hernia surgery is the most common operation done by pediatric general surgeons and it is a core competency for general surgeons in the developing world. Herniotomy is performed for the surgical repair of hernia and along with orchiopexy for the closure of associated patent processus vaginalis. Traditionally, ligation of hernial sac during orchiopexy is considered mandatory to prevent postoperative development of hernia. The present report was designed to study the results of non-ligation of the hernial sac during orchiopexy. It was found that non-ligation has no untoward effect on early complications and recurrence rate on long-term follow-up. It is suggested that it is not necessary to ligate the hernial sac during orchiopexy in children.

Neonatal carrier: An easy to make alternative device to costly transport chambers.

The transport of sick neonates to the surgical centers or transportation within the center is an essential requirement of neonatal surgery. Neonatal transport incubators are costly, space occupying, and are not available at many places in the developing countries. We report here a cheap yet effective and easy to make, alternate neonatal carrier device.

Mayer-Rokitansky-Kuster-Hauser syndrome and anal canal stenosis: case report and review of literature.

Mayer-Rokitansky-Kuster-Hauser (MRKH) is a characteristic syndrome in which the mullerian structures are absent or rudimentary. It is also associated with anomalies of the genitourinary and skeletal systems. There are very few cases reported regarding its association with anorectal malformations, particularly perineal fistulas. To the best of our knowledge, there have not been any reported cases of anal canal stenosis in patients with MRKH. We describe a very rare association of MRKH with anal canal stenosis and multiple renal calculi. The patient underwent corrective surgery for the anomalies and removal of renal calculi. She has been under regular follow-up for the last few months and is doing well.

Acute gastric volvulus in operated cases of tracheoesophageal fistula.

A report of two neonates of esophageal atresia with tracheoesophageal fistula who had acute gastric volvulus in the postoperative period and required gastropexy after correction of the volvulus. Such postoperative complication has not been reported in the literature so far.

Congenital pouch colon with rectal atresia: a case report.

The association of congenital pouch colon with rectal atresia is quite rare with only 2 cases previously reported in literature. We describe the third such case and the second instance to survive. Although the prior survivor was managed by a single-stage procedure, we successfully managed our case by staged procedures. In this case report, we discuss the etiology and surgical options available for this rare condition.

Gastric volvulus in children: experience of 6 years at a tertiary care centre.

BACKGROUND: The aim of the study was to review the cases of all children who had gastric volvulus from 2002 to 2007 at a tertiary care centre in India and to compare the outcome of management with the reported series on gastric volvulus in a paediatric age group. MATERIALS AND METHODS: This was a retrospective study of eight children with an age range between 10 days and 2 years who were managed for gastric volvulus between 2002 and 2007. The records of these patients were reviewed for clinical features, investigations, management and outcome. RESULTS: All patients were less than 3 years of age with female preponderance (n = 5). Three patients had acute presentation and three had acute-on-chronic symptoms, while two had chronic gastric volvulus. The commonest symptom was abdominal distension. Two patients were diagnosed by barium studies and six had clinical suspicion because of their symptoms and were confirmed intra-operatively. Seven had secondary gastric volvulus of organo axial type with associated pathologies as congenital diaphragmatic hernia (n = 5), Para oesophageal hiatus hernia (n = 2), and one had primary gastric volvulus in a postoperative period in an operated case for a tracheo-oesophageal fistula (n = 1). Seven patients were symptom free at follow-up; one patient succumbed due to septicaemia in the immediate post-operative period which was not related to the pathology of gastric volvulus. CONCLUSION: Gastric volvulus is a rare condition in children and requires prompt diagnosis and urgent intervention in acute presentation where it mimics acute abdomen and strong clinical suspicion.

Minimal access surgery for multiorgan hydatid cysts.

Multiorgan hydatid cysts caused by larval growth of Echinococcus granulosus, is a rare condition in paediatric age group. There are very few reports of management of multiorgan hydatid cysts, involving lung, liver, and spleen by minimally invasive approach in paediatric age group. Herewith, we are reporting a case of hydatid cysts involving lung, liver, and spleen in a six-year-old child managed by minimally invasive surgery along with the review of literature.

Laparoscopic Stephen-Fowler stage procedure: appropriate management for high intra-abdominal testes.

UNLABELLED: The length of testicular vessels is the main length-limiting factor to bring down the testes in the scrotum. Fowler and Stephen proposed the division of testicular vessels, high and as far from the testes as possible to maintain collateral blood supply, to treat high intra-abdominal testes. Cortesi introduced the diagnostic laparoscopy and Jorden first did the laparoscopic orchiopexy for nonpalpable testes. We had done Fowler-Stephen staged orchiopexy for high intra-abdominal testes, in which both stages were done laparoscopically. METHODS AND RESULTS: In total, 17 testes of 13 patients had undergone laparoscopic staged Fowler-Stephen orchiopexy. The decision to perform a staged Fowler-Stephen orchiopexy was based on the distance of the testis from the deep inguinal ring on laparoscopy. If distance was more than 2.5 cm, then we proceeded to a laparoscopic staged Fowler-Stephen orchiopexy. In the first stage, testicular vessels were cauterized by bipolar diathermy. Laparoscopic second-stage Fowler-Stephen procedure was done 6 months after the first stage. Patients were regularly followed, and the success of the procedure was assessed by the size of the testes and the position in the scrotum. Testicular vascularity was assessed by color Doppler ultrasonography. There was no testicular atrophy on second stage and on follow-up. All testes were in the scrotum with good size on follow-up. There was no complication related to laparoscopy. CONCLUSIONS: In cases of high intra-abdominal testes, the staged Fowler-Stephen procedure should be the procedure of choice. This procedure yields a high success rate. Transaction of vessels by bipolar diathermy is a very safe, cost-effective method.

Measuring the effects of massage on exercise performance and cardiopulmonary response in children with and without heart disease: a pilot study.

BACKGROUND: Congenital heart disease, a common and serious birth defect, affects 8 per 1000 live-born infants. Decreased exercise capacity and development of obesity is common in this population. These children may benefit from therapies, such as massage therapy, that could enhance cardiovascular and skeletal muscle function when they exercise. PURPOSE: A pilot study conducted at the pediatric cardiology clinic of the Mattel Children's Hospital of the University of California-Los Angeles examined the safety and feasibility of measuring the effects of pre-exercise massage on exercise performance and cardiopulmonary response in children with and without heart disease. PARTICIPANTS AND METHODS: SIXTEEN CHILDREN (MEAN AGE: 9.2 ± 2.2 years) participated in the study. Ten participants had various forms of heart disease, and six children were healthy. A female certified massage therapist with specialized training in pediatric massage provided a 30-minute massage to the participants. Using a standard protocol, each participant underwent two exercise tests: one test with and one without pre-exercise massage. Heart rate, blood pressure, and oxygen uptake (VO(2)) were measured in the participants. RESULTS: All recruited participants completed the study. No adverse events occurred during any of the exercise tests or massage sessions. Measurements during exercise with or without a preceding massage were compared, and the pre-exercise massage condition yielded a significantly higher heart rate and higher minute ventilation. Measurements during exercise in children with heart disease and in healthy participants showed no significant differences in peak heart rate, blood pressure, peak VO(2), peak work rate, minute ventilation, or respiratory quotient. CONCLUSIONS: In this study, peak heart rate, peak VO(2), and peak minute ventilation were higher when children received a massage before exercise testing. Larger studies will be needed to investigate the strength of this finding. Future studies should include measurements of anxiety and psychological factors in addition to cardiopulmonary measures.

A radiolucent lesion crossing the midline in maxilla: a rare presentation of odontogenic keratocyst in young patient.

Odontogenic Keratocyst (OKC) is a developmental non-inflammatory odontogenic cyst which is proposed to be arising from cell rests of dental lamina. Among the jaw cysts OKCs account for third most common following radicular and dentigerous cyst. Most of the studies have stated that posterior part of the mandible is the most common site, but there are inconsistencies regarding the prominent location of OKCs in the maxilla. Very few studies and cases are reported with OKCs crossing maxillary midline. If do occur they are in older individuals. According to WHO reclassification, this cyst is considered as Keratocystic Odontogenic Tumour (KCOT) because of its neoplastic nature. This article describes a rare site of occurrence of this lesion especially in young patient.

Renal dysplasia with single system ectopic ureter: Diagnosis using magnetic resonance urography and management with laparoscopic nephroureterectomy in pediatric age.

Single system ureteral ectopia and associated congenital dysplastic kidney is surgically curable etiology of incontinence with other wise normal pattern of voiding in female child. We share our experience of eight cases in last one year and its management with laparoscopic nephroureterectomy at a tertiary care hospital in India which is one of the largest series in such a short duration of this rare anomaly. Materials and Methods : Patients presented with clinical features of continence with otherwise normal pattern of voiding were clinically examined and investigated by ultrasound (USG), nuclear renal scan, magnetic resonance urography (MRU). Laparoscopic nephroureterectomy was done in all the eight cases and renal dysplasia was confirmed on histological examination. Results : All the patients were females in the age group of five months to five years. USG detected the renal dysplasia in three out of eight cases; however, it could not detect the course of the ectopic ureter in any of the cases. MRU picked up the dysplastic moieties and their location as well as functional status and also depicted the course of the ectopic ureter opening into the vaginal wall in all the eight cases. Laparoscopic nephroureterectomy was done in all the cases and patients were cured off their symptoms. Conclusion : Single system ectopic ureter associated with congenital renal dysplasia is exceedingly rare. MRU is definitely the better investigation for the diagnosis of this condition as compared to the conventional radiological investigations. Laparoscopic nephroureterectomy is a very good procedure for the management of these cases.

Role of magnetic resonance urography in the diagnosis of single-system ureteral ectopia with congenital renal dysplasia: a tertiary care center experience in India.

OBJECTIVE: The purpose of this article is to study the role of magnetic resonance urography (MRU) in single-system ureteral ectopia with congenital renal dysplasia in children. MATERIALS AND METHODS: Patients of incontinence with an otherwise normal voiding pattern were investigated by MRU and conventional radiology. All the patients underwent laparoscopic nephroureterectomy after MRU. RESULTS: Magnetic resonance urography picked up the dysplastic moieties and their location as well as functional status and also depicted the course of the ectopic ureter in all the 7 patients. CONCLUSION: Magnetic resonance urography is the better method of investigation for the diagnosis of this condition than conventional radiologic investigations and renal scan.

Role of magnetic resonance urography in diagnosis of duplex renal system: Our initial experience at a tertiary care institute.

AIM: To determine diagnostic value of magnetic resonance urography in cases of duplex renal system. METHOD: Twenty cases between five month to nine years with suspected or known duplex renal system were evaluated by ultrasound (USG), micturating cystourethrography (MCU), intravenous urography (IVU) and magnetic resonance urography (MRU). The findings of these diagnostic imaging studies were then compared with each other and against the results of final diagnosis established at surgery. RESULTS: Duplex renal system could be identified in two of these cases on USG, was diagnosed in four in IVU and could be diagnosed in all cases with MRU. CONCLUSION: MRU is superior and far accurate than IVU, MCU and USG in diagnosing duplex renal system.

"Meckel scan" findings in an infant with ileocolic intussusception.

A 7-month-old male infant who presented with bleeding per rectum was evaluated and diagnosed to have ileocolic intussusception on ultrasonography. Despite ultrasonography-guided saline reduction, there was persistence of bleeding per rectum. He was given blood transfusion and referred for Tc-99m pertechnetate scan to rule out ectopic gastric mucosa. The scan was done as per the standard institution protocol and the images revealed a focus of progressively increasing tracer uptake in the right lower abdominal quadrant suggesting the presence of ectopic gastric mucosa. An exploratory laparotomy revealed ileocolic intussusception secondary to Meckel diverticulum acting as a pathologic lead point (PLP). A wedge resection of the intestinal wall containing the diverticulum with suture closure was performed. The presence of Meckel diverticulum and ectopic gastric mucosa was confirmed on subsequent histopathological examination of the specimen. The patient rapidly improved postoperatively and was discharged 9 days after surgery. Bleeding per rectum can be seen in both intussusception and in Meckel diverticulum with ectopic gastric mucosa. Intussusception originating from a Meckel diverticulum as PLP remains a diagnostic challenge because of the overlapping symptoms.The Meckel scan findings, in this case, avoided the further CT scan, angiography, and endoscopy for the diagnosis of the cause of symptoms, sparing not only the time but cost of investigations and unnecessary radiation exposure to the patient.

Juvenile thyroid malignancy.

Thyroid malignancy is an uncommon tumor of the pediatric population. Patients can present with asymptomatic thyroid nodule and it requires thorough work up to rule out the malignancy. Radiological and pathological procedures are a standard part of the management. A 10-year-old girl had asymptomatic thyroid nodule; the cytological examination and the frozen section and final histology of the nodule was different each time. The girl had to undergo total thyroidectomy on the basis of histology of the nodule which was well differentiated papillary carcinoma of thyroid and is under regular follow-up for last two years on thyroid supplementation.