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Treatment decisions in asthma are currently based on clinical assessment and spirometry. Sputum eosinophil, being a marker of airway inflammation, can serve as a tool for assessing severity and response to treatment in asthma patients.To measure eosinophil percentage in induced sputum in children with asthma and correlate it with clinical asthma parameters.A prospective observational study was performed at tertiary care hospital on 91 children aged 7-18 years with newly diagnosed mild or moderate persistent asthma. Theinduced sputum eosinophil percentage was obtained at the time of enrollment and three months after treatment with inhaled budesonide. Patients were specifically evaluated for five clinical parameters of asthma, i.e., days of acute exacerbations, use of salbutamol as rescue medication, emergency visits, nighttime cough and days of school absence.Sputum eosinophil percentage was high (3.1 ± 0.515%) at the time of enrollment which reduced significantly after three months of inhaled budesonide therapy [0.06 ± 0.164% (p0.0005)]. Children with moderate persistent asthma had significantly higher values of sputum eosinophil levels than children with mild persistent asthma at the time of enrollment (3.38 ± 0.64% vs. 2.99 ± 0.42%, p = 0.001) but the difference was not significant after three months of inhaled steroid therapy (0.07 ± 0.18 vs. 0.04 ± 0.12, p = 0.5104). A significant negative correlation was found between reduction in sputum eosinophil levels and improvement in FEV1 (r = -0.400, p = 0.0001). All the clinical asthma parameters also correlated significantly with the reduction in sputum eosinophil levels after three months of inhaled steroid therapy.Eosinophil levels in induced sputum correlate well with clinical asthma parameters and asthma severity in children. It is a simple, noninvasive and cheap method which can be used for the monitoring of asthma in a resource-limited setting.

Fifty-seven children with chronic diarrhoea, aged 1-5 years, were studied. Protein-energy malnutrition was present in 49 (85.9 per cent) children. Anaemia (89.5 per cent), presence of mucus and blood in stool (66.6 per cent), abdominal distension (52.6 per cent), and abdominal pain (28.1 per cent) were the common clinical findings at admission. The enteropathogens isolated from the stool of 68.4 per cent of patients were Escherichia coli (19.3 per cent), Candida albicans (12.3 per cent), E. histolytica (8.8 per cent), and Giardia lamblia (7 per cent). Secondary lactose intolerance was present in 21 per cent of children, endoscopic appearance was abnormal in 23.3 per cent of children and the commonest finding was chronic duodenitis (16.7 per cent). Abnormal histopathology was observed in 73.3 per cent of cases and villous atrophy with mononuclear cell infiltration (56.7 per cent) was the most common abnormality detected. The mean duration of diarrhoea had no impact on endoscopic appearance but it significantly affected the histopathological changes. However, no correlation was found in endoscopic and histopathological lesions in relation to malnutrition and aetiological agents.

Serum Adenosine Deaminase (ADA) activity was studied in 20 control cases and 32 patients with carcinoma breast. In control group the ADA activity ranged from 13–94 IU/L with a mean of 43.75±21.55 IU/L while in patients of carcinoma breast it was 16–95 IU/L with a mean of 47.46±22.54 IU/L, but these values were not statistically different. The ADA activity was also compared with other parameters in patients of carcinoma breast but the difference was not statistically significant in the various parameters like duration of disease, menopausal status, tumor size, hemoglobin level, total leucocyte count, absolute lymphocyte count, total serum proteins, serum albumin, histological grade of tumor and lymphocytic infiltration. The only significant difference in ADA activity was when N1 status of lymph node was compared with N2 status of lymph node.

OBJECTIVE: Advanced and inoperable solid tumours in children have high mortality despite aggressive multimodal treatment. Intravenous chemotherapy is abandoned at times because of systemic toxicity. This study investigated intratumoural chemotherapy and compared it with intravenous chemotherapy. METHODS: Forty children with advanced inoperable solid tumours (Wilms’ tumour and neuroblastoma) were randomly allocated into two groups of 20. Group A was given intratumoural chemotherapy and group B was given intravenous chemotherapy. Both groups were compared for reduction in tumour size and volume, tumour resectability, histopathological changes and drug side effects. RESULTS: Intratumoural chemotherapy was superior to intravenous chemotherapy in terms of reducing tumour size and volume (63% in group A vs. 22% in group B). The resectability was 70% in the intratumoural group compared with 40% in the intravenous group. The overall good histopathological response was 71% in group A as opposed to 0% in group B. Moreover, the incidence and severity of drug side effects and morbidity were less with intratumoural chemotherapy. Mortality was also low in group A (5%) compared to group B (20%). CONCLUSION: Intratumoural chemotherapy can be offered as an effective and safe alternative treatment modality for advanced and inoperable Wilms’ tumour and neuroblastoma. [Asian J Surg 2008; 31(4):225–9]

An extremely rare incomplete duplex system with cystic dilatation of the upper part of the conjoint ureter presenting as hydronephrosis in a 2-year-old infant is reported.

OBJECTIVE Until recently, surgeons have been posed with a dilemma—whether or not they should preserve the terminal end of the distal rectal pouch and the fistula region in anorectal malformations (ARMs). A detailed histological study of this region was conducted to establish a consensus for preserving or excising this region for reconstruction of ARMs. METHODS Histopathological examination using haematoxylin and eosin-stained sections of the terminal portion of the distal rectal pouch and proximal portion of the rectourogenital or rectoperineal connection was performed in 60 cases of high, intermediate and low ARMs. RESULTS Distorted internal sphincter was present in 93.3% of high, 90% of intermediate and 100% of low ARMs. The proximal fistula region was lined by transitional epithelium in 50% of cases, and anal glands were present in 83.3% and anal crypts in 68.3% of cases. The rectal pouch in the region of the internal sphincter and fistula was aganglionic in all cases. CONCLUSION This study shows that the terminal end of the distal rectal pouch and proximal fistula region possess distorted anal features with aganglionosis, and contradicts the recommendation that this region should be reconstructed in patients with malformations.