Choledochal cysts in African infants: a report of 3 cases and a review of the literature.

Choledochal cysts are relatively rare and are an uncommon cause of cholestasis. Early diagnosis and prompt treatment can prevent complications such as cholangitis, cirrhosis and portal hypertension. This article reviews a rarely reported disease in Africans in whom only 3 cases were documented over the 18 year period in Nigeria. The 3 cases were all females with ages between less than a month and 13 months at presentation. All presented with abdominal swelling with or without jaundice or acholic stools. The use of real-time ultrasonography antenatally and postnatally aided the diagnosis in our patients. Two of the patients presented and were operated and both made full recovery confirming the importance of early surgical intervention. The third patient died, and exemplified the consequences of delayed diagnosis and treatment which occur not uncommonly in developing countries mostly because of sparse and or expensive tertiary health care facilities.

Neonatal colorectal spindle cell sarcoma.

Intestinal spindle cell sarcomas occur very rarely in the neonatal period. There have been 10 previous reported cases. A neonate with colorectal spindle cell sarcoma is reported. The clinical features of the 11 cases and the prognosis of the tumor are discussed.

Maternal response to anomalies detected by antenatal ultrasonography.

OBJECTIVE: To determine the effect of an atypical antenatal scan on the expectant mother. DESIGN: Postnatal postal questionnaire. SETTING: Questionnaires completed at home after the infants had been investigated at a regional paediatric surgical unit. SUBJECTS: Twenty-nine mothers. RESULTS: The mothers had a very positive attitude to antenatal ultrasonography. The information that the scan was atypical resulted in a high level of parental anxiety which sometimes persisted into the postnatal period. CONCLUSION: A multidisciplinary approach is required for the management of the expectant mother who has an atypical scan.

Unilateral biorchism associated with contralateral rudimentary uterus.

A healthy 5-year-old boy presented with two palpable masses in the right hemiscrotum. An examination also showed a palpable mass in the left groin. During surgery, he was found to have right-sided biorchism and a left groin nodule attached to the left vas deferens and spermatic cord. The nodule was excised and histologic examination showed the presence of persistent Mullerian structures. A chromosome analysis showed the normal male karyotype. Both conditions have been previously reported, but this is the first report of both conditions occurring in the same patient.

Clinical outcome of fetal uropathy.

Thirty seven infants (27 boys and 10 girls) whose uropathy had been diagnosed antenatally were reviewed at a mean age of 24.4 months. Antenatal ultrasonography was found to be an accurate detector of renal disease, as uropathy was subsequently confirmed in 33 of the 37 infants (89%). A smaller proportion of patients required operations than in other series reported. Shortly after birth the kidney undergoes physiological adjustments and investigation may be carried out too soon. It should be delayed, especially if the infant is well. The timing of postnatal ultrasonography is important and the advice of a paediatric urologist should be sought before investigations are carried out.

Testicular salvage following spermatic cord torsion.

There have been several reports indicating that men who have suffered from spermatic cord torsion are likely to have abnormal seminal analyses. It is now well recognized that unilateral spermatic cord torsion can result in contralateral testicular damage. This study was instituted to evaluate possible methods of preventing post-torsion contralateral testicular damage. Experimental torsion was produced in 250 g Wistar rats. The duration of torsion was either 3, 6, or 24 hours. The rats were then treated by one of three methods, namely, detorsion, immediate ipsilateral orchidectomy, or detorsion and adjuvant immunotherapy. Contralateral testicular damage was prevented by immediate ipsilateral orchidectomy and by detorsion with adjuvant immunotherapy. The immunotherapeutic agents administered were either hydrocortisone, azathioprine, or cyclosporin A. The results strongly support the premise that detorsion with adjuvant immunotherapy results in salvage of the ipsilateral testis while preventing contralateral testicular damage. Hydrocortisone is the immunotherapeutic agent of choice because its administration was associated with the fewest complications.