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ABSTRACT: We present a rare case of a 17-month-old child diagnosed with MS-stage neuroblastoma and associated chronic diarrhea due to elevated vasoactive intestinal peptide (VIP) levels. The unusual occurrence of a VIP-secreting tumor in a patient with MS neuroblastoma is a rare combination, not previously reported in the literature. The patient underwent exploratory laparotomy and excision of the tumor, leading to a significant decline in VIP levels and resolution of symptoms. [ABSTRACT FROM AUTHOR]

Background: Extrahepatic biliary atresia (BA) is seen in infants, with an incidence of 1 in 15,000 live births. The presentation is progressive jaundice, dark-colored urine, and clay-colored stools. Kasai portoenterostomy (KPE) is the commonly performed surgical procedure in these patients. Postoperatively, phenobarbitone, ursodeoxycholic acid (UDCA), steroids, and other drugs are given to improve bile drainage and prevent inflammation and fibrosis. However, a definitive protocol regarding the need for different drugs, dosage, and duration varies across individual surgeons and centers. No universally accepted protocol exists for postoperative management after KPE. Aim: The aim of this study was to know the prevailing postoperative management of BA by subject experts and use the Delphi process to know if the experts want to change their practice based on the results from the survey. Material and Methods: A questionnaire was made after discussing with two experts in the field of BA. The questionnaire was mailed to 25 subject experts. The first survey data were analyzed and shared with all responders. In the second survey, change in the management based on the results from the first survey was assessed. Results: The Delphi questionnaire was answered by 17 experts. Postoperatively, prophylactic antibiotics are prescribed for 6-12 weeks by around 40% and >12 weeks by 30% of respondents. Phenobarbitone is prescribed for <3 months by nearly 50%. UDCA is prescribed for <3 months, <6 months, and 6 months-1 year by 47.1%, 23.5%, and 23.5% responders, respectively. Nearly 50% prescribe steroids (mostly prednisolone), and among them, two-thirds prescribe it for 6-12 weeks. Approximately 60% give antiviral drugs to children who are cytomegalovirus immunoglobulin M positive. In our survey, 50% of experts perform 5-10 KPE per year, and 25% each perform 10-15 and >15 KPE per year. The second survey noted that a significant percentage of responders want to change their practice according to consensus. Conclusion: From our Delphi survey, an overview of the postoperative management of BA could be made. However, multicentric studies are required for uniform protocol on the postoperative management of BA. [ABSTRACT FROM AUTHOR]

Background: The use of face masks by all community members for the prevention of COVID-19 infection is considered one of the most effective strategies. However, the use of masks by community members was influenced by many factors which affected its efficacy as a preventive measure. Aim: To evaluate the attitudes toward the use of masks during the COVID-19 pandemic in the Indian community. Materials and Methods: We did an online survey with the help of a questionnaire which included information about demographic data, awareness and attitudes about COVID-19 infection and its preventive measures, and attitudes towards mask use in particular. Results: Participants had a positive attitude towards mask use. However, there were certain reasons for not using masks some of which were gender specific. Conclusion: People had good awareness and attitude towards mask use. However, some gender differences in perception of masks used in various settings should be addressed for future awareness and education of the community about mask use. [ABSTRACT FROM AUTHOR]

Background: Kasai portoenterostomy (KPE) is the initial treatment for biliary atresia (BA). Even after initial jaundice clearance, a significant number of children presented with the reappearance of symptoms due to ongoing fibrosis involving porta and intrahepatic ducts. Mitomycin-C (MMC) is an antifibrotic agent, and the study hypothesized that local application of MMC at porta can decrease fibrosis, which can improve jaundice clearance and lead to better native liver survival (NLS). Materials and Methods: This prospective randomized control trial included children with BA, who were allocated to groups A or B. The patients in both groups underwent standard KPE; in addition, a 5 French infant feeding tube (IFT) was placed near the porta through the Roux limb in Group B children. During the postoperative period, MMC was locally instilled over the porta in Group B children through IFT. Postoperative jaundice clearance and NLS were assessed and compared. Results: A total of 27 children were enrolled in the study, 16 in Group A and 11 in Group B. Both groups were comparable preoperatively. Although the NLS was not statistically significant in Group B, the survival was quite higher, that was 91%, 81%, and 73% at 6 months, 1 year, and 2 years, respectively, compared to 63%, 50%, and 38% in Group A. Conclusion: Children in Group B clinically showed an early jaundice clearance and a better trend of serial bilirubin levels as well as longer NLS than Group A, but it was not statistically significant. The procedure was technically easy, and no complication was encountered related to surgical technique or MMC instillation. [ABSTRACT FROM AUTHOR]

Endotracheal intubation (ETI) is a common intervention performed in a pediatric emergency. The pediatric laryngeal anatomy creates a challenge and requires an expertise for this procedure. Tracheal injury is a rare but serious complication that can occur during ETI. The stylet, if used improperly, can lead to this life-threatening complication. Here, we present a case of tracheal injury in an infant that happened during ETI with stylet use. [ABSTRACT FROM AUTHOR]

Background: Outcome of Isolated ventriculomegaly diagnosed antenatally depends on size of ventricles and associated malformations. There is scarcity of literature on the guidelines for prognostication based on outcomes as per the ventricle size.Aim: The aim of this work was to study outcome of antenatally detected isolated ventriculomegaly in terms of medical termination, postnatal neuro-developmental milestones, and mortality; and also to propose a new prognostication classification.Methods: Prospective and retrospective observational study on antenatal mothers with isolated ventriculomegaly diagnosed in fetus. Outcomes in terms of termination of pregnancy, postnatal mortality, need of surgery, and morbidity were recorded. Patients were categorized into four groups: Group 1--ventricle size <10 mm, II--11-15 mm, III--16-20 mm, and IV > 20 mm and neuro-developmental milestones were co-related. Association with chromosomal anomalies, congenital heart disease, and maternal infection were also analyzed.Results: 521 antenatal females were referred with fetal anomalies with 163 having CNS malformations. Isolated ventriculomegaly was seen in only 44. Patients of groups 1 and 2 had 100% normal neuro-developmental milestones without any intervention. Group 3 patients had normal neurodevelopmental milestones in 60% only while shunt surgery was required in 40% of patients. All patients of group 4 had poor outcome with only 50% survival. No association with chromosomal anomalies and heart disease was found.Conclusions: Prognosis of isolated ventriculomegaly depends upon size of ventricles and its progressive increase on serial ultrasounds. New proposed classification is simple and would be useful for the treating surgeons to explain the prognosis to parents so as to relieve them of anxiety. [ABSTRACT FROM AUTHOR]

Background and Aims: Operation theater (OT) complex is an important area for a hospital as it needs expensive infrastructure, disposable, and reusable resources and a multidisciplinary highly qualified and efficient team, the metrics of which are key in generating revenue, and improved productivity. The efficient utilization of OT ensures maximum output in view of the investment of highly qualified doctors, equipment, and outcomes. Our study aimed to evaluate the utilization of OT functioning stepwise, reasons for delays, case cancellations, and areas of improvement if any. Material and Methods: This prospective observational study was planned in three phases; in phase 1 audit of OT functioning was carried out for 1 month and based on data analysis recommendations were given for improvement. In phase 2, the recommendations would be implemented over 3 months and in phase 3 re-audit will be carried out for 1 month. Data analysis was done on IBM SPSS version 26 software. Descriptive statistics measures were calculated by the mean and standard deviation. Results: The total available resource time was 52920 min and the total time utilized was 37740 min. Overall, raw utilization was 71.31%. OT was started late 63.50% times. Case cancellation occurred on 8.99% occasions. Conclusion: We conclude that utilization of operating room time can be maximized by proper planning and realistic scheduling of elective lists, communication among team members, and resource management. Audit of OT utilization is an important tool to identify problem areas and formulate protocols accordingly. [ABSTRACT FROM AUTHOR]

Neurologic disorders impede oral hygiene measures and routine clinical follow-up, along with the various drugs used may jeopardise oral health and the peri- implant tissue health. A total of 7 studies were considered eligible for the current systematic review. The overall estimated effect was categorized as significant where P < 0.05. Funnel plot was used to assess the publication bias within the studies. Difference in means was used as principal summary measure. P value <0.05 was considered as statistically significant. 1069 implants survived in test group and 4677 implants survived in control group (odds ratio: 2.58, 95% CI: 1.93-3.43) indicating significant success in patient without any disorders or taking medications for these disorders. Subgroup analysis was done to check the implant survival rate in patients taking selective serotonin reuptake inhibitors (SSRI) compared with SSRI non-users. Subgroup analysis showed that SSRI non-users had higher implant survival rate than patients taking SSRI (odds ratio: 2.45, 95% CI: 1.82-3.31). Serotonin significantly inhibits bone mineralization and osteoblast differentiation. The presence of any form of neuropsychiatric or neuromuscular disorders precludes proper oral hygiene and may contribute towards implant failure. [ABSTRACT FROM AUTHOR]

Background and Aims: α2 agonists have been utilised in regional blocks, but very little data is available for their use in transversus abdominis plane (TAP) block in paediatric laparoscopic (LAP) surgeries. This study investigated the analgesic effect of ropivacaine alone versus its combination with dexmedetomidine for TAP block in children undergoing LAP surgery. Methods: A randomised, double-blind trial was conducted in 50 American Society of Anesthesiologists (ASA) 1 and 2 children of 2–8 years undergoing LAP abdominal surgery. Children were randomised to receive a total volume of 0.5 ml/kg of 0.2% ropivacaine (LA group) or 0.2% ropivacaine with 1 μg/kg dexmedetomidine (LAD group) for performing ultrasound-guided bilateral TAP block postoperatively (PO). Patients were monitored PO for vital signs, pain, sedation, time to first rescue analgesic and total analgesic consumption for 24 h. Time to first rescue analgesic was expressed as mean ± standard deviation (SD) and analysed using Kaplan–Meier survival analysis. Pain and sedation scores were expressed as median [interquartile range (IQR)] and analysed using Mann–Whitney U test. Results: First rescue analgesic demand was significantly longer (P = 0.001) in LAD (474.8 min) versus LA group (240.9 min) but total analgesics consumption in first 24 h was comparable. Pain scores were significantly lower (P < 0.05) in LAD compared to LA group at all times PO. Each group had comparable but significantly lower sedation scores up to 24 h PO. Conclusion: Addition of dexmedetomidine to ropivacaine in TAP block prolongs the time to first analgesic requirement without a difference in the total analgesic consumption. [ABSTRACT FROM AUTHOR]

Aim: The aim is to prospectively study 125 trauma patients admitted in the pediatric surgery ward in our institute. Materials and Methods: Pediatric patients admitted in the ward after initial resuscitation in the triage room were included. Isolated neurosurgical and orthopedic injuries were excluded. X-ray cervical spine, hip, and chest and a focused assessment with sonography in trauma ultrasound were done for all patients. Computed tomography of the abdomen or chest was done where relevant. Injury profile and surgical intervention when needed were analyzed. Results: Road traffic accidents and fall from height caused 73.6% of the injuries. School-going children were most commonly affected (60.8%). Distinctive injuries were noted such as abdominal wall hernias and delayed bladder perforation. All solid organ injury irrespective of grade treated conservatively. Forty percent of the children required surgical intervention. Five patients after laparotomy were found to have surgical conditions unrelated to trauma, whereas another 14 required delayed surgery. Five patients had injuries secondary to sexual abuse. All except two patients were discharged in a satisfactory condition and are doing well in the follow-up. Conclusion: In spite of extensive injuries and the need for multiple surgeries, children with trauma have a good prognosis. Close observation during admission and also in follow-up are essential, as many patients may require delayed surgery ≥1 week from injury. [ABSTRACT FROM AUTHOR]

Extrarenal calyces (ERC) is a rare renal anomaly where calyces lie outside the renal parenchyma and are connected to pelvis by draining infundibulum. Its presentation with pelviureteric junction obstruction presents a confusing intraoperative finding. We report two cases of ERC with pelviureteric junction obstruction in the ectopic kidney. Emphasis is laid on the defining the anatomy so that reader can identify the condition if he comes across similar situation. The two patients were managed by minimal access approach. Management of these cases and review of pediatric cases reported in literature are discussed. [ABSTRACT FROM AUTHOR]

Background: High and intermediate types of anorectal malformations (ARMs) in male neonates may be managed either by primary neonatal reconstruction without colostomy cover or by traditional policy of staged reconstruction after neonatal colostomy. Posterior sagittal anorectoplasty (PSARP) is the current widely practiced reconstructive technique with varied results. Aim: To assess our functional results of PSARP without colostomy in male neonates with high and intermediate ARMs compared to 3-stage (neonatal colostomy -- PSARP -- colostomy closure) methodology in a high volume tertiary care institution of a developing country. Patients and Methods: The number of colostomies performed for male high/ intermediate anomalies and the number of babies who completed 3-stage reconstruction during a 10-year period is analyzed. The outcome of primary neonatal PSARPs during the same period was analyzed. Eighty primary PSARPs were compared to 81 staged reconstructions for outcome analysis, using Kelly score. Results: A total of 453 colostomies were performed, but only 253 of them completed all stages of reconstruction (52%). Good continence was achieved in 45% of cases of primary PSARP versus 26% in 3-taged surgery. Conclusions: Primary PSARP in neonatal period without colostomy is a good option for high and intermediate ARMs in males if the treating surgeon is reasonably skilled in neonatal surgery and PSARP procedures. [ABSTRACT FROM AUTHOR]

Aim: To review the technique of thoracoscopic repair of esophageal atresia with tracheoesophageal fistula (TREAT) and results reported in literature and with authors' experience. Patients and Methods: The technique of TREAT was reviewed in detail with evaluation in patients treated at authors' institution. The patients were selected based on selection criteria and were followed postoperatively. The results available in literature were also reviewed. Results: A total of 29 patients (8 females) were operated by TREAT. Mean age was 2.8 days (range 2-6 days). Mean weight was 2.6 kg (range 1.8-3.2 kg). There was a leak in four patients, and two patients had to be diverted. They are now awaiting definitive repair. Twenty-one patients have completed a mean follow-up of 1.5 years and are doing well except for two patients who had a stricture and underwent serial esophageal dilatations. The results from current literature are provided in tabulated form. Conclusions: TREAT is now a well-established procedure and currently is the preferred approach wherever feasible. The avoidance of thoracotomy is a major advantage to the newborn and is proven to benefit the recovery in the postoperative patient. The technique demonstrated, and the tweaks reported make the procedure easy and is helpful to beginners. The outcome is very much comparable to the open repair as proven by various series. Various parameters like leak rate, anastomotic stricture are the same. The outcome is comparable if you TREAT these babies well. [ABSTRACT FROM AUTHOR]

Aim: Airway foreign body (FB) is a very common pediatric surgical emergency. On certain difficult occasions, the extraction of FB with optical forceps (OFs) is difficult. These conditions create a life-threatening scenario. We present some of the alternative methods of FB extraction for these situations. Patients and Methods: This is a retrospective case review of patients presenting to pediatric emergency with airway FB. All patients had a chest X-ray done before the procedure. Rigid bronchoscopy was performed in all patients for retrieval. Results: A total of 20 patients (6 females) were successfully scoped. The age ranged from 1.5 years to 12 years (mean 3.5 years). Bronchoscopic removal was aided by dormia basket (DB) in 13, Fogarty's catheter (FC) in 6, and magnet aided removal in 1. Complete removal was achieved in all patients. Conclusions: We recommend that DB, FC, and a magnet should form an indispensable part of bronchoscopy set. The use of these alternative methods is successful and allows ventilation during the removal in contrast to removal by OFs. These should be kept as an option if retrieval is difficult. [ABSTRACT FROM AUTHOR]

Wilms’ tumor (WT) is the most common pediatric renal tumor that often spreads to inferior vena cava and sometimes up to right atrium (RA). We describe successful management of 3‑year‑old child diagnosed with WT having extension up to RA. He was operated under cardiopulmonary bypass and extubated on postoperative day 2 and discharged. Perioperative anesthesia concerns were shock from dynamic tricuspid valve obstruction, intraoperative massive blood loss, and a higher risk of pulmonary thromboembolism during tumor manipulation. [ABSTRACT FROM AUTHOR]

The article reports a study of 54 children (81 renal units) who received treatment for vesicoureteral reflux (VUR) that ranges from no cure, surgery, long-term antibiotic prophylaxis or a combination of prophylaxis and surgery. Out of these units, 72 had the resolution of reflux, whereas the remaining 9 did not resolve. The study concluded that the therapy of VUR was successful and eventually improved the quality of life of patients by reducing the rate of recurrence of invasive procedures.

Aim: To study the role of urinary enzymes N-acetyl-β-glucosaminidase (NAG), alkaline phosphatase (AKP) and gamma glutamyl transferase (GGT) in the diagnosis and follow-up of patients with suspected pelviureteric junction obstruction (PUJO). Materials and Methods: A total of 70 patients, 29 managed conservatively (group A) and 41 managed by pyeloplasty (group B), were studied prospectively. A serial measurement of urinary enzymes NAG, AKP and GGT level was performed in both the groups. The mean levels of these urinary enzymes were compared between the two groups and among the patients of the same group at presentation as well as during follow-up. Results: There was a significant fall in the mean AKP level in patients managed conservatively at 8 months of follow-up. Similarly, in the operated group, there was a significant fall in the AKP levels at both 3 months and 8 months of follow-up. The mean level of GGT also showed a significant fall after 3 months of surgery but did not show further significant change at 8 months after surgery. The mean levels of NAG and GGT in the conservatively managed group were significantly low compared with that of patients requiring pyeloplasty at presentation as well as in the follow-up. The mean level of AKP was significantly low in the conservatively managed group when compared with the patients requiring surgery, but did not differ significantly in both the follow-ups after surgery. Conclusions: The level of urinary enzymes NAG, AKP and GGT are significantly high in the patients with hydronephrosis (HDN) requiring pyeloplasty when compared with the patients managed conservatively. The level of AKP significantly falls after pyeloplasty in the patients of HDN due to PUJO. There is a negative correlation with the preoperative level of enzyme NAG with split renal function in the patients of HDN requiring pyeloplasty. [ABSTRACT FROM AUTHOR]

Aim: To assess the changes in urethral morphology 3 months post fulguration of posterior urethral valves (PUVs) on micturating cystourethrogram (MCUG) and correlate these changes with the overall clinical status of the patient. Materials and Methods: A total of 217 children, managed for PUVs during a period of 6 years in a single surgical unit were prospectively studied. The ratio of the diameters of the prostatic and bulbar urethras (PU/BU) was calculated on the pre- and post-fulguration MCUG films. They were categorized into three groups based on the degree of normalization of posterior urethra (post-fulguration PU/BU ratio). Results: Group A: Of the 133 patients, 131 had normal urinary stream and 4 (3%) had nocturnal enuresis. Vesicoureteral reflux (VUR), initially seen in 83 units (31% units), regressed completely at a mean duration of 6 months in 41 units (49%). Of the 152 non-VUR, hydroureteronephrosis (HUN) units, 11 were poorly functioning kidneys. Persistent slow but unobstructed drainage was seen in 23 units (16%) over a period of 1.5-5 years (mean 2.5 years). Group B: All the 11 patients had a normal stream. Four (36.4%) had daytime frequency for a mean duration of 1 year and one (9%) had nocturnal enuresis for 1 year. Grade IV-V VUR was seen in five patients (three bilateral), which regressed completely by 3 months in five units (62.5%). In the non-VUR, HUN patients, slow (but unobstructed) drainage was persistent in two units (14%) at 3 years. Group C: Of the 16 patients, only 5 (31.3%) were asymptomatic. Six patients (nine units) had persistent VUR for 6 months to 3 years. Of the 20 units with HUN, 17 (85%) were persistent at 1-4 years (mean 2 years). Eight patients (50%) required a second fulguration while 3 (18.7%) required urethral dilatation for stricture following which all parameters improved. Conclusions: Adequacy of fulguration should be assessed by a properly performed MCUG. A postop PU/BU ratio >3 SD (1.92) should alert to an incomplete fulguration or stricture. Patients within normal range ratio have faster recovery of slow draining units, reflux and less voiding dysfunction. There is a strong correlation between incomplete fulguration and persistent slow draining units, uremia, voiding dysfunction and urinary tract infections. [ABSTRACT FROM AUTHOR]

Aim: Report of 125 pediatric patients of empyema thoracis treated by open decortication, highlighting the presentation, delay in referral, operative findings, the response to surgical intervention and follow-up. Materials and Methods: All the children who underwent open decortication for stage III empyema thoracis during the study period were included. Preoperative workup included hemogram, serum protein, chest radiographs and contrast-enhanced computed tomographic (CECT) scan of the chest. Results: One hundred and twenty-five patients (81 males, 44 females) (age 3 months-12 years, mean 4.9 years) were operated during a 4.5-year period. Among them, two children underwent bilateral thoracotomies. Also, 81.6% patients were referred 3 weeks after the onset of disease (mean duration 9 weeks). Intercostal chest drainage (ICD) had been inserted in (119) 95% cases. Thickened pleura, multiloculated pus and lung involvement were invariably seen on CECT scan. Bronchopleural fistula was present in 10 patients and empyema necessitatis in 2. Decortication, removal of necrotic tissue and closure of air leaks was performed in all the patients. Necrotizing pneumonia was seen in (35) 27.5% cases. Mean duration of postoperative ICD was 7 days. Follow-up ranged from 3 months to 4 years (mean 12 months). There was no mortality. Six patients had proven tuberculosis. Conclusions: The duration of the disease had a direct relationship with the thickness of the pleura and injury to the underlying lung. Delayed referral causes irreversible changes in the lung prolonging recovery. Only 18% presented within the early period of the disease. Meticulous open surgical debridement gives gratifying results. The status of the lung at the end of surgery is a major prognostic factor. [ABSTRACT FROM AUTHOR]

Foreign body (FB) ingestion is a common problem among the pediatric population. On numerous occasions, the FB is left to pass out spontaneously without expecting Q any harm. There are instances when the FB is either to dangerous to be left alone, that is a button battery or a sharp object. There may be FB, which is either stuck in GIT or have migrated. The situation in these instances demand active intervention. The traditional option has been laparotomy and retrieval. We present here three cases where two needles and a belt buckle were removed by laparoscopy thus avoiding a laparotomy. These cases prove that laparoscopy should be the first choice for such L kind of retrieval. These cases had a successful outcome with full recovery. [ABSTRACT FROM AUTHOR]

Empyema thoracis can produce significant morbidity in children if inadequately treated. Correct evaluation of the stage of the disease, the clinical condition of the child and proper assessment of the response to conservative treatment is crucial in deciding the mode of further surgical intervention. This ranges from intercostal chest tube drainage and video-assisted thoracoscopic surgery to open decortication. Surgical decortication becomes mandatory in neglected cases; it gives very gratifying results ameliorating the disease rapidly and is well tolerated by young patients. This article reviews the current literature and discusses the important considerations while managing these patients. Indications for surgery are highlighted, based on our large experience at a tertiary care center. [ABSTRACT FROM AUTHOR]

Aim: To know whether laboratory or clinical parameters can predict disease progression, need for laparotomy in patients managed with peritoneal drain and mortality in surgical neonatal necrotizing enterocolitis patients. Materials and Methods: The study was retrospectively carried out on 27 neonates over a period of one and a half year. All neonates who had surgical neonatal necrotizing enterocolitis in the form of bowel perforation, positive paracentesis, abdominal wall erythema and abdominal lump were included. Patients with Bell's stage I and those developing enterocolitis after surgery were excluded. The patients were evaluated with parameters, namely, clinical, laboratory and radiological. These included age and stage at presentation, primary symptom/sign at presentation with laboratory parameters of blood counts, pH, base deficit, platelet counts, electrolytes and random blood sugar levels. A comparison was done between survivors and nonsurvivors, patients with primary peritoneal drainage versus those requiring laparotomy after drain, Bell' stage II versus III patients and operated versus nonoperated patients. Statistical significance was observed in the above mentioned comparisons. Results: There were 22 male and 5 females patients with mean birth weight of 1.85 kg. Age at presentation ranged from 2 to 19 days, mean 9.25 days. Mortality was 37% (10/27). Majority of the stage II patients presented with feed intolerance and abdominal distension. The neonates with severe disease had abdominal distension with wall erythema. Sixty percent of the patients had shock at the time of admission. In the comparison of peritoneal drain only and patients with peritoneal drain followed by laparotomy patients, it was observed that neonates who were acidotic and had higher base deficit had more chances of requirement of laparotomy. They also had progressive fall in platelets counts. There was no difference in the birth weight, gestational age, total counts, serum electrolytes, blood sugar and other measured parameters; thus, these carry negligible predictive value to judge deteriorating neonate. In the remaining of the comparison, patients not presenting with shock were more likely to survive. Conclusion: In the present study, neonate with persistently low pH, higher base deficit and presentation with shock predicted need for laparotomy in drain managed patients as well as chances of survival. [ABSTRACT FROM AUTHOR]

Aims and Objectives: Delayed management of anorectal malformation (ARM) increases the surgical and functional complications for the patient. We defined .delayed presentation of ARM. and reviewed our patients with ARM to find out the incidence and causes of delayed presentation. Materials and Methods: Patients satisfying the criteria of .delayed presentation of ARM. were involved. Detailed information of each patient including the mode of presentation, associated anomalies, plan of management and follow-up was obtained from the hospital records. Results: Between 2003 and 2006, 43 patients satisfied our criteria of .delayed presentation of ARM.. There were 21 males and 22 females. Seventeen of these males presented with low-type ARM. Eleven of them were managed by a single-stage procedure. These .delayed presenters. had to live with constipation, inadequate weight gain and parental anxiety for a greater time. Analysis of the outcomes showed more functional complications in patients who had undergone failed perineal surgery previously. In females with low ARM, the procedure of choice was anterior sagittal anorectoplasty (ASARP). Single stage surgery provides good outcomes for most of low type of ARMs. High-type ARMs in males and females were managed by a staged procedure. Conclusion: .Delayed presentation of ARM. is a major group of ARM in our setup. The management and results of their treatment are not different from those of the early presenters. The most common cause of delayed ARM is wrong advice given by the health care providers followed by inadequate treatment elsewhere. Corrective surgeries taking second attempt in perineum always produces poor outcomes. [ABSTRACT FROM AUTHOR]

The article describes the case of an 11-month-old child with intramedullary osteoid osteoma. Topics discussed include presentation of osteoid osteoma in children, types of osteoid osteoma, radiofrequency thermal ablation as treatment of choice for osteoid osteoma and complete surgical removal of nidus as preferred treatment.

Glial heterotopia is a rare congenital mass lesion which often presents as a clinical surprise. We report a case of extranasal glial heterotopia in a neonate with unusual features. The presentation, management strategy, etiopathogenesis and histopathology of the mass lesion has been reviewed. [ABSTRACT FROM AUTHOR]

Vascular anomalies involving the small bowel are an uncommon cause of gastrointestinal bleeding in childhood. We present here an 11-year-old boy who presented with severe anemia and malena. The routine investigations did not reveal any pathology. A capsule endoscopy study was performed, which clinched the diagnosis and identified two intestinal hemangiomas. The hemangiomas were resected and the child recovered. [ABSTRACT FROM AUTHOR]

Neonatal ingestion of foreign body is a very uncommon occurrence. We describe a 25-day-old neonate who had a large-sized stone impacted in the cervical oesophagus. The stone was accidently lodged by one of the elder siblings while playing. The stone, after failure to be retrieved endoscopically, was successfully removed by open esophagotomy. The case describes the unusual occurrence at a very uncommon age. It also re-affirms the successful role of open surgery in such situations, which are otherwise commonly treated endoscopically. [ABSTRACT FROM AUTHOR]

We report a 12-year-old-boy with gastric lipoma. Upper gastrointestinal (GI) endoscopy with biopsy and abdominal computed tomogram (CT) scan revealed the diagnosis. Open surgical excision of the mass with stomach preservation was done. The clinical presentation and management are discussed and the literature reviewed here. This is the sixth pediatric case reported in the English literature. [ABSTRACT FROM AUTHOR]

Small bowel intussusception (SBI) in infants and children are ususally associated with a lead point. With increased use of radiological investigations, more idiopathic SBIs are identifi ed. As reduction by hydrostatic or air enema are less successful in these cases, most of them require surgical exploration in children. However, now many cases of SBI have been found to reduce spontaneously. We report two cases of SBI with spontaneous reduction and review the literature for the management guidelines. [ABSTRACT FROM AUTHOR]

Isolated cleft sternum is a rare congenital defect of the anterior chest wall and is the result of failed ventral midline fusion of sternal bands. We present two cases operated 18 and 24 days after birth with satisfactory results. Surgery is indicated to protect the heart and mediastinal contents. [ABSTRACT FROM AUTHOR]

Retrocaval ureter (RCU) is a rare congenital anomaly with the ureter looping around inferior vena cava (IVC). We present the case of 10-year-old boy. Diagnosis was confirmed with ultrasound and CT. He underwent retroperitoneoscopic uretero-ureterostomy. [ABSTRACT FROM AUTHOR]

Congenital cystic adenomatoid malformation (CCAM) of the lung is an uncommon anomaly that arises from excessive disorganised proliferation of tubular bronchial structures excluding the alveoli. These are believed to represent focal pulmonary dysplasia because skeletal muscle may be identified from within the cyst wall. This report describes a case of an infant operated for presumed diagnosis of congenital diaphragmatic hernia. Diaphragm was found to be normal and further investigations revealed cystic mass in the lower lobe of the left lung. Thoracotomy was done to resect the lesion that revealed a type II CCAM on histopathological examination. The case stresses the need for better clinical examination and advanced radiological investigations in doubtful cases. [ABSTRACT FROM AUTHOR]

The author focuses on abortion laws in India. He discusses the 1971 MTP act operating in India, which says that no pregnancy can be terminated after 20 weeks unless there is a life-threatening emergency. He suggests that the 20-week period must be changed to 24 weeks before the mother can resort to abortion if she feels that the process can save her health or that of the baby's. The author also comments on antenatal health care in India.

The article discusses the case of a 10-year old boy with huge infrarenal abdominal aortic aneurysm. The boy had a painless progressively increasing lump on the left side of the abdomen. Magnetic resonance angiography showed that aneurysm replaced the whole of the boy's abdominal aorta from the infrarenal region up to the level of aortic bifurcation. Dacron graft was performed in order to repair the aorta.

A letter to the editor about surgical misadventure of transecting tumor infiltrated infrarenal vena cava in a patient is presented.

A response by Mitul Parikh, Ram Samujh, Ravi Prakash Kanojia to a letter to the editor about their article "Decision-making in surgical neonatal necrotizing enterocolitis. "

Oral squamous cell carcinoma is the single largest group of malignancies in the Indian subcontinent and the 6th largest group of malignancies worldwide. The overall survival rates of oral cancer patients have not changed for the last 4-5 decades. There is the dearth of a specific and sensitive early diagnostic marker for oral cancer. The development of oral cancer is a multi-step process, which includes changes like hyperplasia, dysplasia and occurrence of premalignant lesions. In humans, the molecular analysis of these multiple steps of cancer development is hampered by the unavailability of biopsies from all stages including normal tissues. Hence, in this study, an animal model of oral cancer was employed for delineating the molecular alterations in keratins and associated proteins. Male Sprague Dawley rats were fed 0.001% 4NQO in drinking water and were also painted on either side of buccal mucosa with 0.25% of 4NQO for induction of tumors in buccal mucosa. Animals were treated for different time points, namely 7, 10, 20, 40, 80, 120, 160 and 200 days for isolation of different pre-malignant and malignant tissues. Tumors were obtained after 200 days of 4NQO treatment in buccal mucosa and tongue. Keratin expression was analyzed by 1 and 2DE followed by blotting with keratin-specific antibodies. There were quantitative and qualitative differences in keratin expression at different time points, namely 160 and 200 days. Keratins interact with desmosomes via desmoplakin. Hence it was of interest to investigate desmoplakin levels in different premalignant and malignant tissues. Increased levels of desmoplakin were observed prior to 200 day group. However, all lingual tumors analyzed exhibited decreased level of desmoplakin. Also, increased levels of desmoplakin were associated with dysplastic lesions. Hence we speculate that the state associated with increased desmoplakin level may prevent the cells from entering the tumorigenic phenotype, as tumor appearance at late time point was associated with decreased levels of desmoplakin. Funding sources: Department of Biotechnology; Council of Scientific and Industrial Research. [ABSTRACT FROM AUTHOR]

Keratins (K) are epithelia specific intermediate filament (IF) proteins expressed in a differentiation-dependent and tissue-specific manner. Twenty eight different polypeptides of human keratins have been identified. Keratins are subdivided into two subfamilies, i.e. acidic - with low molecular weights and basic - with high molecular weights, and are always expressed in pairs comprising one member of each subfamily. The keratin pair of 8 and 18 is predominantly expressed by all simple epithelia. This pair is known to be aberrantly expressed by a variety of squamous cell carcinomas. FBM is an immortalized but non-transformed cell line derived in our laboratory from the buccal mucosa of a human fetus. To understand the role of K8/18 in malignant transformation of stratified epithelial cells, full-length keratin 8 gene was transfected in FBM cells. Transfection of K8 gene in these cells resulted in the formation of K8/18 filaments and concomitant malignant transformation of the cells. These cells when injected subcutaneously in nude mice, produced tumors at the site of injection. Three tumor cell lines have been established from three tumors derived from three different K8 transected FBM clones. These cell lines are being further characterized. Keratin expression pattern, cell doubling time, soft agar colony forming assay, cell cycle analysis using flow cytometry, growth supplement independence and nude mice injections were carried out. Analysis of keratin expression based on 2-D gel electrophoresis followed by western blot has demonstrated expression of keratins 1, 5, 7, 10 in one of the cell lines. Keratin 8/18 expression was seen in all the cell lines similar to transfected clones. These cell lines showed reduced doubling time compared to parental K8 transfected clones, anchorage independent growth and tumors in nude mice. These cells also showed polyploidy. These cell lines will be useful to study different aspects of oral carcinogenesis, including chemoprevention. [ABSTRACT FROM AUTHOR]

Cytokeratins (CK) are intermediate filament proteins found in epithelia and are expressed in a tissue-specific and paired manner. CK pairs comprise of one member each from acidic and basic subfamilies. Oral epithelium is stratified and is an excellent example to illustrate tissue-specific CK expression. e.g. non keratinizing buccal mucosa (BM) expresses CK 4, 5, 13 and 14 while keratinizing dorsal tongue expresses CK 1, 2, 5, 6, 10, 14 and either 16 or 17. Our group has been working on CK expression in human oral pre-cancer and cancer, and we have shown changes in CK expression during oral carcinogenesis. Some of the common changes were non-expression of CK 5 and aberrant expression of cytokeratin 1, 8 and 18. Both retrospective and prospective studies using Immunohistochemistry and RT-PCR are in progress in our laboratory for prognostication of human oral cancer. Only 20% of the samples studied exhibit simultaneous aberrant expression of CK 8, 18 and non-expression of CK 5 together. These results are being correlated with the clinical parameters of the patients. CK-associated proteins like vimentin, a6 and β4 integrins are also being analyzed for their expression patterns. An experimental murine model is being used to analyze sequential stages in tongue and buccal mucosal carcinogenesis. CK and associated proteins like desmoplakin and α6 and β4 integrins are being analyzed at various stages of oral carcinogenesis. Our preliminary experiments have shown alteration in CK as well as desmoplakin expression at various stages of lingual carcinogenesis. Our in vitro studies on role of CK 8 and 18 in malignant transformation of stratified epithelial cells have shown that this CK pair contributes to the malignant transformation of stratified epithelial cells. Thus, in conclusion, it appears that CK and their associated proteins can possibly be used as prognostic markers in oral cancer, and CK 8, 18 play an active role in the transformation of stratified epithelia. [ABSTRACT FROM AUTHOR]