Determining the Spinal Canal Depth in Neonates Using Bedside Ultrasonography.

OBJECTIVE: To provide a gestation age- and weight-specific mathematical formula for predicting the optimal depth of spinal needle insertion. METHODS: The study included 127 neonates between 28 and 40 weeks of gestation and weighing 700 to 4000 grams, and a total of 202 ultrasound examinations were performed. Anterior and posterior borders were delineated using ultrasound and measured as spinal canal depth in lateral decubitus position at L3- L4 vertebral interspace. The mid-spinal canal depth (MSCD) was calculated. RESULTS: Spinal canal dimensions showed an increasing trend with an increase in weight and post-menstrual age of the babies. The best correlation was found between weight and MSCD with an r2 of 0.85, which is given by the formula MSCD (cm) = 0.2 X weight in kg + 0.45. CONCLUSION: Knowledge of the spinal canal depth using the formula may facilitate accurate needle placement, thereby decreasing traumatic lumbar puncture.

Endoscopic Repair of Nasopharyngeal Glial Heterotopia in a Neonate with Persistent Craniopharyngeal Canal: A Case Report.

A case of nasopharyngeal glial heterotopia with persistent craniopharyngeal canal is being reported. These lesions though rare should be considered in the differential diagnosis of neonates who present with nasal obstruction. Careful radiological evaluation for a persistent craniopharyngeal canal and differentiating the nasopharyngeal mass from brain tissue is of paramount importance.

Post Incisional Hernia Meshplasty Vesicocutaneous Fistula - A Rare Complication.

Laparoscopic meshplasty is gold standard in hernia surgery. Mesh migration into bowel/bladder has been documented after laparoscopic repair, though migration into bowel is more common than bladder. Only 12 cases of migration into bladder have been described post inguinal meshplasty. We report the 1st case of mesh migration into bladder post Incisional hernia meshplasty, presenting as vesicocutaneous fistula. The objectives of this report are highlighting important points enabling earlier diagnosis, treatment. We would also like to suggest important preventive measures during meshplasty which we believe will go a long way in avoiding this important complication, thus immensely benefiting patients.

Isolated Renal Mucormycosis.

Mucormycosis in humans has been described as early as 1885 in literature. Isolated renal mucormycosis is rare as it has been mainly described in developing countries like India and China. It is rarer still to find this entity in immunocompetent young males without any risk factors. Specific guidelines on the treatment is not yet known but combined surgical and medical therapy is considered the best modality for its management. We describe a young male who presented with bilateral hydroureteronephrosis. He was initially treated as a case renal tuberculosis which is relatively more common in TB endemic country like ours. However when he did not respond to the anti-tuberculosis drug (ATT), a biopsy revealed mucormycosis. He was treated with nephrectomy and liposomal amphotericin B and oral posaconazole. On follow up of 2 years he is healthy and leading his normal life.

Spontaneous Bladder Rupture Masquerading as Pseudo-diverticulum.

Spontaneous bladder rupture is rare. Presentation is non-specific and in absence of history of trauma, radiation, inflammatory conditions and other leading causes, there is considerable diagnostic delay. Absence of clear cut diagnostic signs leads to increased morbidity and mortality. In many patients, omentum seals perforation, giving diverticular appearance in Cystogram. The objective of this case report is to highlight important specific diagnostic points in history and radiology which will help in clear, early diagnosis and treatment causing immense benefit to the patient. We would also like to highlight a specific radiological point to distinguish true from pseudo-diverticulum.

Anteromedial pneumothorax in a neonate: 'the diagnostic dilemma' and the importance of clinical signs.

A premature neonate born at 32 weeks of gestation was admitted to the neonatal unit with respiratory distress syndrome. The infant received late rescue surfactant therapy with continued mechanical ventilation in view of continuous positive airway pressure (CPAP) failure. Owing to worsening distress and an air leak, he was switched over to high-frequency oscillatory ventilation. The air leak required drainage for possible pneumopericardium. This was initially attempted ineffectually with echo-assisted pericardial drainage, and later successfully with the use of chest tubes for anteromedial pneumothorax.

Extensive disseminated cysticercosis.

Cysticercosis, especially neurocysticercosis, is a major public health problem in India. We report an unusual case of disseminated cysticercosis with extensive infiltration of the skin, central nervous system, skeletal muscles, eye, lung, and heart. A patient with extensive cutaneous cysticercosis must be thoroughly investigated for widespread internal organ involvement.

Possible role of neonatal infection with the asymptomatic reassortant rotavirus (RV) strain I321 in the decrease in hospital admissions for RV diarrhea, Bangalore, India, 1988-1999.

We sought to determine the proportion of rotavirus (RV) infections among children with severe diarrhea in Bangalore, India, and to determine the role of neonatal infection with the asymptomatic RV strain I321 in protection against subsequent RV diarrhea. At 2 major hospitals, there was a >42% decrease in diarrhea-specific admissions during the study period. At 6 hospitals, asymptomatic infections were found in 25%-50% of neonates, when screening was performed randomly, and in >58% of neonates, when screening was performed daily, with the majority of infections occurring within the first 7 days of life. All the RVs found in asymptomatic neonates were strain I321. A 24-month follow-up of a cohort of 44 children who had been neonatally infected with strain I321 and 28 children who had not (control group) revealed comparable rates of RV detection but a marked decrease in the number of RV diarrhea episodes in the strain I321-infected group (2.3%), compared with the control group (39.3%) (P<.0001). This preliminary study suggests a possible association between neonatal infection with strain I321 and protection against subsequent RV illness.