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We performed early decortication in 32 cases of postpneumonic empyema during the period of February 1991 to December 1995. Twenty of them were male and 12 of them were female. We evaluated these cases retrospectively. Decortication was saved for the patients where antimicrobial therapy and closed-tube drainage had failed to achieve a cure and was performed on the 10-15th day after the diagnosis was established. Indications for the decortication were persistent fever (9), pulmonary air leakage (7), localized effusion (7), persistent respiratory distress (5) and pleural thickening without resolution (28). Decortication was performed through the standard posterolateral thoracotomy. Patients were discharged on the 8th postoperative day with minimal morbidity and no mortality. Because of the simplicity of the procedure (short hospitalization periods, low mortality and morbidity rates) good results were achieved with early decortication.

Congenital hernias in the lumbar region are very uncommon. Two cases with congenital lumbar hernia associated with the lumbocostovertebral syndrome are presented. The first case of a 14-month-old girl presented with the type of a superior lumbar triangle hernia. The second case was a 2-year-old girl presenting with diffuse lumbar hernia. The anatomy, embryology and treatment of this congenital abnormality are discussed.

Although classical exstrophy of the bladder is not a rare anomaly, variants of exstrophy are extremely uncommon. We report a male pseudoexstrophy case with appearance of a low set umbilicus associated with umbilical hernia and penile anomaly. Although this mild exstrophy variant does not normally require surgical management, penile reconstruction was necessary in our patient.

We report the case of a posterior large mediastinal neurenteric cyst demonstrated by prenatal ultrasound (US). Postnatal chest radiography and CT studies demonstrated a posterior, large cystic mediastinal mass associated with vertebral abnormalities including scoliosis, hemivertebrae and anterior spina bifida. Because postnatally respiratory distress developed and rapidly progressed, an emergency operation was performed 12 hours after delivery. The cyst was excised via right posterolateral thoracotomy. Postoperatively, respiratory distress regressed. This is the third reported case of a neurenteric cyst demonstrated by prenatal ultrasound.

Congenital "H-type" urethrorectal communication with complete urethral stenosis is extremely rare in the pediatric population. The evaluation and surgical treatment of a "H-type" urethrorectal communication with complete urethral stenosis presenting in a 4-month-old infant is described. Additionally, he had a left renal agenesis and anal stenosis.