Antibiotic prophylaxis is unnecessary in clean surgery.

A significant number of paediatric surgical patients undergone clean surgical procedures. Most of the paediatric surgeon use perioperative prophylactic antibiotic in this clean procedure because of undue fear of infection in their mind. The objective of this study is to evaluate whether the use of perioperative prophylactic antibiotics have an effect to prevent post operative wound infection in clean operation in paediatric surgical patients. This study was conducted in the paediatric surgery department of Bangabandhu Sheikh Mujib Medical University and some private clinics of Dhaka city from January 2009 to December 2009. Two hundred patients who were undergone clean elective surgical procedure on day case basis were included in this study. They were divided into two equal groups (Group A and Group B). The patients of Group A were given intransverse Cephradine 30 minutes before incision and then oral Cephradine was advised postoperatively for 7 days. The patients of Group B were not given any perioperative antibiotic. All the patients of both groups were advised to come on 3rd, 6th and 10th postoperative day for examination of wound. In Group A (With chemo prophylaxis), five patients (5%) developed postoperative wound infection and in Group B (without chemo prophylaxis), three patients (3%) developed postoperative wound infection. Thus the rate of postoperative wound infection is slightly more in patients with chemo prophylaxis but it was not statistically significant by chi-square test. Based on the result of this study, it may be concluded that the antibiotic prophylaxis is not necessary in clean surgery in paediatric age group.

Congenital bladder diverticulum causing acute urinary retention in an infant.

Congenital bladder diverticula (CBD) are unusual but not rare in childhood. Report of acute urinary retention due to congenital bladder diverticula are rarely found in the literature. Here we report a case of congenital bladder diverticulum with acute urinary retention in a ten months old male infant. Urinary tract infection and urinary retention are the most frequent presentation forms. In this case CBD produce urinary obstruction as a result of compression of the urethra which causes urinary retention. Voiding cystourethrogram revealed a large bladder diverticulum. Bladder diverticulum should be a differential diagnosis in male children, presenting with urinary retention, fever and an abdominal mass. Ultrasonography, voiding cystourethrogram & cystoscopy confirm the diagnosis and diverticulectomy was successfully done for the child.

Melanotic neuroectodermal tumour of infancy.

Melanotic neuroectodermal tumour in infancy is rare, mainly benign with little tendency to recur after excision or effective curettage. This pigmented neoplasm of neural crest origin occurring in infants before 1 year of age. The most common site of occurrence is the anterior maxillary alveolar ridge (70%), following by the skull, brain and mandible. The genital organ is the most frequent extra cranial site. We report a 6 months old male baby with a similar tumour arising from right half of cheek involving the maxilla. We diagnosed the case after histological report. We remove the tumour through a sub-labial incision. The mass was blackish in colour, and was mobilized from all side including from the maxillary sinuses. The author thought that this should be reported for improving the clinical awareness and treatment of pigmented soft tissue mass in children. Almost one year follow up of the patients showed no recurrence.

A retrospective study on genito urinary Rhabdomyosarcoma.

A retrospective study was carried out on Genitourinary Rhabdomyosarcoma in the Department of Paediatric Surgery of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh during the period January 1990 to December 1999. Total thirteen patients were treated during this period, age ranging from 1 month to 12 years. Eight patients were male and five were female (M: F = 1.6: 1). Diagnosis was made by history, thorough physical examination, digital rectal examination, ultrasonography, intravenous urography, CT scan and biopsy. All the patients were treated with chemoradiation theraphy as a first line of management and surgical excision was done for local residual tumours. Eight children (61.5%) were asymptomatic after completion of chemo-radiation therapy. Three (23.07%) patients discontinued the chemo-radiation schedule. Residual mass was present in one (7.7%) case for which partial cystectomy was done and the patient died in the 5th post operative day. Another patient (7.7%) who had pulmonary metastasis at the time of diagnosis, died during chemo-radiation therapy.