Posttraumatic Intrahepatic Bilioma.

Blunt injury abdomen causing biliary injury is rare in children. Collection of bile within or outside the liver after biliary injury is called bilioma. CT scan images of late presenting intra-hepatic bilioma are shown.

Segmental dilatation of near total colon managed by colon preserving surgery.

Segmental dilatation of the colon is a rare congenital disorder of colonic motility and often involves a short segment that causes chronic constipation in children. There are only 10 cases of neonatal colonic segmental dilatation described in literature. We managed a case who presented in the neonatal period with abdominal distension. There was dilatation of whole of the colon except part of ascending colon and the rectum. The case was managed by tubularization of the segmental dilatation of colon with stoma formation as first stage followed by delayed anastomosis during second stage.

Exstrophy bladder: Effect of sigmoid colocystoplasty on physical growth and bone mineral density.

BACKGROUND AND AIMS: Introduction of intestinal tissue in the urinary tract results in numerous metabolic changes. This study investigates the effects of augmentation sigmoid colocystoplasty on the physical growth and bone mineralization in bladder exstrophy patients. MATERIALS AND METHODS: Physical growth, serum biochemistry and bone mineral density were assessed pre and post augmentation in 34 of 54 patients who were treated by staged sigmoid colocystoplasty for classical bladder exstrophy during the period 1985-2007. Physical growth was determined by comparing the height and weight for age with standard growth charts. Serum biochemistry included calcium, phosphate and alkaline phosphatase levels. Bone mineral density (BMD) was determined at the femoral head using the dual energy X-ray absorptiometry (DEXA) scan at 15 ± 4.5 months after the augmentation. The DEXA scan findings were compared with 22 normal Indian children who served as controls and 18 unaugmented patients with bladder exstrophy. In 13 augmented patients, the DEXA scan could be repeated after an interval of six months. RESULTS: The mean percentile height and weight were comparable in the pre and post-augmentation period with no statistically significant difference (P=0.135 for height and P=0.232 for weight). Biochemical parameters of bone metabolism also did not show any statistically significant changes after colocystoplasty. The BMD was 0.665 ± 0.062 g/cm(2) in the controls and 0.612 ± 0.10 g/cm(2) in the unaugmented bladder exstrophy patients. In the augmented patients, the BMD was 0.645 ± 0.175 g/cm(2) and six months later it was 0.657 ± 0.158 g/cm(2). These differences were not statistically significant. CONCLUSIONS: In our study, no significant effects on the physical growth and bone mineral metabolism were observed in exstrophy bladder patients following sigmoid colocystoplasty.

Surgery in Hashimoto's thyroiditis: indications, complications, and associated cancers.

BACKGROUND: Indications for surgery in Hashimoto's thyroiditis (HT) patients are compressive symptoms and suspicion of malignancy. A high incidence of thyroid malignancy has been reported in patients with HT. The effect of surgery on discomfort in swallowing and tightness in the neck has not been properly evaluated. AIMS: The aim of our study is to compare the indications, complications, and associated cancers in patients operated for HT with those surgically treated for other benign goitres. The effect of surgery on minor symptoms like tightness in the neck and discomfort in swallowing is included. SETTING AND DESIGN: This was a retrospective case-control study at a tertiary care centre. PATIENTS AND METHODS: A total of 271 patients who had undergone surgery for benign thyroid diseases were included. Group A consisted of 35 patients who had HT and Group B consisted of patients operated for other benign thyroid diseases (236 patients). STATISTICAL ANALYSIS: Data were analyzed using SPSS 12 software. Independent group's t-test was used to compare the means and Fisher's exact test was used for categorical data. RESULTS: In Group A, the common indications for surgery were discomfort associated with swelling (45.7%), cosmesis (34.3%), and pain with swelling (11.4%) whereas in Group B, the indication was predominantly cosmetic (80%). A total of 22.9% patients of Group A and 6% of Group B were hyperthyroid. The sensitivity of FNAC for diagnosing thyroiditis was 62.8% (n = 22). Postoperative complication rates were similar in both the groups. The mean operating time was higher in Group A even though the gland was smaller. Incidental malignancy was 3.4% in Group B whereas there was none in Group A. Discomfort in swallowing and tightness in the neck were relieved at 3 months after surgery. CONCLUSIONS: Large, euthyroid and apparently asymptomatic HT occasionally need surgical intervention. Discomfort in swallowing and tightness in the neck are relieved after surgery. Thyroidectomy is safe to perform and has a low incidence of permanent complications. There was no associated malignancy in our series of HT.

Tetra-amelia with lung hypoplasia and facial clefts, Roberts-SC syndrome: report of two cases.

Although limb anomalies are a common clinical problem, they are rarely studied. The spectrum of limb anomalies ranges from very mild disorders such as syndactyly to very severe forms such as absent limb (amelia). Tetra-amelia is a rare anomaly with complete or partial deficiency of all four limbs. It may be isolated or associated with other anomalies. Roberts-SC phocomelia syndrome comprises four limb deficiencies, lung hypoplasia, facial clefts and other anomalies. We describe two cases that presented to us.

Peripherally inserted central venous lines versus central lines in surgical newborns--a comparison.

OBJECTIVE: To compare the insertion characteristics, utilization profile, life span and the complication rates of Central lines (CL) and Peripherally inserted central lines (PICL). METHODS: A prospective study of all CL or PICL insertions during January 2007 to September 2007 in the Neonatal Surgical Intensive Care Unit of a tertiary care center was done. The number of attempts, procedure time, duration of catheter stay, number of dressing done, complication during insertion and maintenance and cause of removal were noted and the differences analyzed statistically using Pearson chi square / t test. P value. 0.05 was considered significant. RESULTS: Ninety two neonates were included in the present study of whom 60 were PICL insertions and 32 CL insertions. The two groups were comparable in terms of age, weight and the use of total perental nutrition (TPN) through the catheters. On comparing the PICL and CL groups, the number of attempts for successful insertion (p=0.003), the time taken (p=0.005), the number of dressing changes required during the indwelling period (p=0.005) and the overall complication rates (p=0.002) were significantly less in the PICL group. The PICL could be maintained for longer periods of time (p= 0.005) and only in 11.5% of the patients it had to be removed before completion of therapy as compared to 37.5% early removals for CL (p=0.02) CONCLUSION: PICL is a safe, effective and reliable method of providing prolonged IV access in newborns. It also has the least incidence of complications during insertion and maintenance over prolonged period of time when compared to CL and should be recommended for routine use in neonatal surgical patients.

Development of an indirect enzyme immunoassay using monoclonal antibodies for the measurement of 17alpha-hydroxyprogesterone in human serum.

An indirect enzyme immunoassay for the measurement of total 17alpha-hydroxyprogesterone (17OHP) in serum using monoclonal antibodies generated in our laboratory was developed. Here, (a) instead of extraction with solvents, serum was heated to free protein-bound 17OHP and assay was performed at pH 9.6, (b) to ensure uniform assay conditions for both standards and samples, buffer for standards contained charcoal-stripped pre-heated pooled cord serum. Assays were done in 96-well EIA microplates pre-coated with 17alpha-hydroxyprogesterone-3-(o-carboxymethyl)oxime: bovine serum albumin. Secondary antibody was horseradish peroxidase-linked sheep anti-mouse IgG polyclonal antibody. The method was accurate and suitable for screening for congenital adrenal hyperplasia.

Peritoneal penetrating pencil injury.

An 8 year old school going boy sustained an accidental peritoneal penetrating injury while playing with a pencil in his trouser pocket. Surgical exploration revealed intact intraperitoneal and retroperitoneal viscera and the pencil could be successfully removed. In addition to the acute injuries there are numerous late sequlae of pencil injuries that cause concern.

Production and characterization of monoclonal antibodies against 17alpha-hydroxyprogesterone.

Hybridomas secreting monoclonal antibodies (MAbs) against 17alpha-hydroxyprogesterone (17OHP) have been generated. These MAbs are highly specific and have an affinity of 7-12 x 10(7) M(1). The hybridomas were obtained by fusion of spleen cells from immunized mice with mouse myeloma P3X63 Ag8.653 cells. The antigen used for immunization was 17OHP conjugated to bovine serum albumin (17OHP:BSA). Fused cells were plated and cloned in 96-well microtiter plates. Wells containing hybridomas were screened simultaneously for specific gamma globulin (IgG) and anti-17OHP activity using an enzyme-linked immunosorbent assay (ELISA)-based method, which is faster than the conventional radioimmunoassay (RIA) screening procedure. Limiting dilution methods were used to obtain single hybridoma clones producing MAb. The stable hybridomas secreting anti-17OHP MAbs were expanded into bioreactors or ascites fluid for large-scale production of the required antibodies. These MAbs will be used in the formulation of a 17OHP assay kit to screen for congenital adrenal hyperplasia (CAH) in local newborn human population.

The effects of oestradiol and relaxin on extensibility and collagen organisation of the pregnant rat cervix.

The effects of exogenously introduced oestradiol-17 beta (E) and relaxin (RLX) on cervical extensibility and collagen organisation were tested in rats ovariectomised in late pregnancy. When the cervices were stretched in vitro by 1 mm increments, it was found that those from rats given E alone generated significantly higher tensions than those from control rats, while cervices from rats given both E and RLX had tensions similar to controls. Examination of cervical sections under the light microscope and ultra-thin sections under the electron microscope showed that the collagen fibres in the cervices from E-treated rats were highly organised, whereas those from animals given E+RLX and control animals were disorganised and dispersed. It was concluded that E decreased cervical extensibility, while RLX counteracted the effect of E to maintain a soft and easily extensible cervix.