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Purpose Pelvi-ureteric junction obstruction (PUJO) is the leading cause for Hydronephrosis in children. Diuretic renography used in the pre and post operative evaluation of Pyeloplasty may not be reliable in predicting the outcome. Methods A prospective study was conducted from October 2018 – November 2020, including all children with unilateral PUJO undergoing Pyeloplasty. Renal Diuretic renography scans done in the pre and post operative periods were assessed for Transit time. The time taken for the isotope to reach the renal pelvis was noted by a single observer as the Transit time, from the dynamic frames of the Diuretic renogram. Results Of the 65 children, 74% were boys. The transit time (median) in the preoperative renography was 10minutes, whereas the same was 4minutes 45seconds in the postoperative period, the decrease was statistically significant. On evaluation of Transit time with ROC (Receiver Operating Characteristics) curve, a cut off of 4minutes and 25 seconds was arrived at, which could identify the delayed drainage reliably. Conclusion Improvement in Transit time is a reliable predictor of renal function improvement after Pyeloplasty, comparing favorably in relation to split renal function.

IntroductionChildhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality.MethodsProspective cohort study in 109 institutions in 41 countries. Inclusion criteria: children ResultsAll-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3–11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); pConclusionsChildren with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer.

Tumours of the children involving the head and neck region are seen infrequently. Melanotic Neuroectodermal Tumor is an uncommon tumour of infancy involving the head and neck region typically. The case report describes a cheek swelling in an infant which on investigation was confirmed to be a Maxillary Melanotic Neuroectodermal tumour, subsequently subjected to excision and doing well on follow up.

Background: Congenital anomalies of the kidney and urinary tract (CAKUT) are a group of disorders responsible for the majority of pediatric end-stage renal disease cases. There are only a few studies on CAKUT. Objectives: A study was conducted to determine the clinical and biochemical profile of children with CAKUT and to estimate the prevalence and the factors associated with hypertension in CAKUT. Methods: A cross-sectional study was conducted in a tertiary center for 18 months from March 2014 to August 2015. Demographic data were recorded, and clinical examination including blood pressure measurement was performed. Various biochemical parameters including plasma renin activity (PRA), urinary beta-2-microglobulin (B2M), and microalbuminuria were evaluated. Results: A total of 81 patients with CAKUT were studied. Twenty-two (27%) patients were underweight, 4 (5%) patients were stunted, and 26 (32%) were both underweight and stunted. Children with bilateral disease had a higher incidence of underweight (21/44 vs. 8/37; p = 0.04; 95% CI; Fisher exact test), and both underweight and stunted (25/44 vs. 10/37; p = 0.006; 95% CI; Fisher exact test) compared to children with unilateral disease. Hypertension was found in 27% cases. No association was found between hypertension and PRA, BM2, or microalbuminuria in our study. PRA was inversely proportional to the estimated glomerular filtration rate (eGFR) (Pearson test; 95% CI; p = 0.006). Conclusions: Bilateral disease in CAKUT was significantly associated with poor somatic growth. PRA was inversely proportional to eGFR. The prevalence of hypertension was higher in children with CAKUT than in normal children and is possibly multifactorial as it was not associated with elevated PRA, B2M, or microalbuminuria.

In a child, lower gastrointestinal tract bleeding can be attributed to different etiologies. Unusually, the presence of bowel arteriovenous malformations can lead to multiple bouts of painless bright red bleeding per rectum, which develop into severe anemia. The article focuses on the diagnosis and management of bowel arteriovenous malformation in a child.

Antero-posterior trans pelvic diameter (APD) and renal scintigraphy play a significant role in the diagnosis of pelvi-ureteric junction (PUJ) obstruction and postoperative follow-up following pyeloplasty. However, the APD varies irrespective of improvement, deterioration, or preserved function in a hydronephrotic kidney and is not a reliable parameter due to various factors (hydration status, compliance, and reduction pyeloplasty). Calyx to Parenchymal Ratio (CPR) is the ratio of the depth of the calyx and parenchymal thickness measured on ultrasound (USG) in coronal image. We assessed the utility of CPR in the follow up of pyeloplasty and compared it with the commonly used APD of the pelvis and renal scintigraphy.A prospective cohort study was done from July 2016 to October 2017. During this period 73 pyeloplasties were done, and 62 cases meeting the inclusion criteria were enrolled. All the children underwent ultrasound and Technetium-99 m Ethylene dicysteine isotope renogram (EC) scan before and after pyeloplasty. APD and CPR values were measured on USG and compared with isotope renogram outcomes in these children in the preoperative versus postoperative period. Two defined objective variables ΔAPD, percent ΔAPD and ΔCPR, percent ΔCPR were compared with categorical variables that would predict the surgical outcome as - failed, successful or equivocal. Multinomial logistic regression analysis and receiver operating curve (ROC) analysis was used to identify predictive accuracy.The mean (range) APD value recorded in the preoperative period was 3.67 cm (1.40-8.00 cm), which decreased to 1.67 cm (0.40-6.50) postoperatively, which was 54.2% lower (P=0.001). The mean (range) CPR value decreased from 5.96 (1.20-20.00) in the preoperative period to 2.57 (0.43-10.90) postoperatively, which was 56.8% lower (P=0.001). On multinomial logistic regression analysis, ΔCPR was found to be a significant predictor of outcome with an overall accuracy of 95.1%, change in CPR was a better predictor of success after pyeloplasty as compared to change in APD, which had an overall accuracy of 85.2% (p = 0.01). Further, on ROC curve analysis, we observed that ΔCPR and %ΔCPR can strongly predict successful pyeloplasty with a sensitivity of each with 96% and 98% respectively and AUC of 0.897 and 0.799 respectively.USG (APD) and renogram are the most widely used investigation in follow-up of pyeloplasty; however, APD has its own limitations like operator variability and slower improvement. CPR has the advantages that neither calyceal depth nor parenchymal thickness is directly altered during the surgery, and early resolution of calyceal dilatation and rapid parenchymal growth following pyeloplasty and thus a surgeon independent parameter. Our results have shown that ΔCPR can identify successful pyeloplasty with strong prediction than ΔAPD and thus renal scans can be avoided if there is visible improvement in CPR on follow-up.Our study identified a change in CPR, i.e., ΔCPR as a strong predictor of surgical outcome, as it is not influenced by extent of pelvis reduction during pyeloplasty and early to change. Using this parameter, we can avoid unnecessary repeated nuclear scans based on persistent high APD values and optimize resource utilization. We recommend the use of CPR in routine practice in the preoperative and postoperative follow-up of PUJ obstruction following pyeloplasty.

Multiple small bowel atresia is a relatively uncommon cause of intestinal obstruction in neonates. About one-third of the neonatal intestinal obstruction is caused by intestinal atresia. As suggested by Louw and Barnard, the vascular accident in utero is the principal reason, resulting in bowel atresia.1 The condition presents soon after birth, with bilious vomiting and abdominal distension, requiring emergency surgical intervention. A subtype of small bowel atresia (type IV), which presents with involvement of multiple segments, is unique due to the difficulties in management, accompanied by a variety of postoperative morbidities, which are highlighted in this case. The choice lies between resection of all the atretic segments with resultant single anastomosis and conservation with anastomoses of multiple small bowel segments involving meticulous repair by fine sutures, taking care to maintain luminal patency. The dilemma of whether to conserve the atretic segments of bowel, which is a time consuming procedure but preserves the bowel length or to proceed with excision of the atretic bowel segments, accepting the likelihood of short bowel, in order to provide a quick, safe and stable single anastomosis in a timely manner, is a valid challenge. The background of limited resource setting also need to be taken into consideration. Key Words: Atresia, Neonates, Bowel segments, Anastomosis.

Introduction: The aim of this study was to analyze the presentation and management of major grade renal trauma in children. Method: A retrospective study was performed including data collected from the patients who were admitted in Pediatric surgery with major grade renal injury (grade 3 and more) from January 2015 to August 2018. Demography, clinical parameters, management, duration of hospital stay and final outcome were noted. Results: Out of 13 children (9 males and 4 females), with age range 2-12 years (mean of 8 years), reported self-fall was the commonest mode of injury followed by road traffic accident. The majority (10/13, 75%) had a right renal injury. Eight children had a grade IV injury, one had a grade V injury, and four children had grade III injury. Duration of hospital stay varied from 3 to 28 (mean of 11.7) days. Three children required blood transfusion. One child required image guided aspiration twice and two required pigtail insertion for perinephric collection. All the 13 children improved without readmission or need for any other surgical intervention. Conclusion: Children with major grade renal trauma due to blunt injury can be successfully managed without surgical intervention and minimal intervention may only be needed in select situations. RESUMO Introdução: O objetivo deste estudo foi analisar a apresentação e tratamento de grande trauma renal em crianças. Método: Foi realizado um estudo retrospectivo incluindo dados coletados dos pacientes que foram internados na cirurgia pediátrica com lesão renal de grau importante (grau 3 ou mais) de janeiro de 2015 a agosto de 2018. Coletamos dados a respeito de demografia, parâmetros clínicos, manejo, tempo de internação e resultado final. Resultados: Das 13 crianças (9 homens e 4 mulheres) com faixa etária de 2-12 anos (média de 8 anos), a queda auto-relatada foi o modo de lesão mais comum seguido de acidente de trânsito. A maioria (10/13, 75%) apresentou lesão renal direita. Oito crianças tiveram uma lesão grau IV, uma apresentou uma lesão grau V e quatro crianças apresentaram lesão grau III. A duração da internação hospitalar variou de 3 a 28 (média de 11,7) dias. Três crianças necessitaram de transfusão de sangue. Uma criança necessitou de aspiração guiada por imagem duas vezes e duas inserções de dreno pigtail exigidas para coleções perinefréticas. Todas as 13 crianças melhoraram sem re-internação ou necessidade de qualquer outra intervenção cirúrgica. Conclusão: Crianças com trauma renal de alto grau devido a lesão contusa podem ser manejadas com sucesso sem intervenção cirúrgica, e intervenção mínima pode ser necessária apenas em situações selecionadas.

Surgical care has an incontrovertible, crosscutting role in achieving child health. Children develop different surgical diseases compared to adults, present unique anesthetic challenges, and have special perioperative needs. The Optimal Resources for Children’s Surgery document provides a strategy for integrating surgical care for children into National Surgical, Obstetric and Anesthesia Plans. There is an important opportunity to prevent death and reduce disability in children by scaling up surgical care in low- and middle-income countries.

Neonatal Gastrointestinal mucormycosis is a rare fungal infection carrying high morbidity and mortality. Clinically, it is not easily distinguishable from the more common necrotizing enterocolitis. Diagnosis is made by histopathology of the involved bowel. We report a neonate with gastrointestinal mucormycosis, bringing to notice the fatality of this infection.J Nepal Paediatr Soc 2016;36(2):198-200.

Introduction: Children with solitary functioning kidney (SFK) are prone to develop long term problems, which are not well represented in the literature. The extent to which the presence of associated congenital anomalies of kidney and urinary tract (CAKUT) further de-stabilize renal function is to be addressed. Objective: This study was conducted to evaluate the etiology, presentation, presence of CAKUT, and renal damage in children with SFK. Methods: All children with SFK who presented to the department of pediatric surgery from March 2014 to May 2016 were included in the study. Children with malignancy were excluded from the study. Results: Of the 20 patients with SFK, 14 (70%) had primary SFK (8 with agenesis and 6 with multicystic dysplastic kidney), 6 (30%) belonged to secondary SFK group, among them 3 had pelviureteric junction obstruction, 2 had posterior urethral valves and 1 had vesicoureteric reflux. Eight (40%) had associated CAKUT, 4 (20%) were asymptomatic while 8 (40%) had UTI and 6 (30%) had hypertension. Ten (50%) patients had reduced glomerular filtration rate (GFR) suggesting compromised renal function. Conclusion: Children with SFK have high morbidity especially when associated with ipsilateral CAKUT. Long-term periodical follow up is essential in these patients to improve clinical outcome. RESUMO Introdução: Crianças com rim solitário funcional (RSF) tendem a desenvolver problemas de longo prazo, que não são bem representados na literatura. Devemos abordar o quanto a presença de malformações congênitas do rim e do trato urinário (CAKUT) desestabiliza ainda mais a função renal. Objetivo: Este estudo foi realizado para avaliar a etiologia, apresentação, presença de CAKUT e dano renal em crianças com RSF. Métodos: Todas as crianças com RSF que se apresentaram no departamento de cirurgia pediátrica de março de 2014 a maio de 2016 foram incluídas no estudo. Crianças com doença maligna foram excluídas do estudo. Resultados: dos 20 pacientes com RSF, 14 (70%) tinham RSF primário (8 com agenesia e 6 com rim displásico multicístico), 6 (30%) pertenciam ao grupo RSF secundário, dentre eles 3 tinham obstrução da junção pelveuretérica, 2 tinham valvas uretrais posteriores e 1 refluxo vesico-uretral. Oito (40%) tinham ACRTU associado, 4 (20%) estavam assintomáticos, enquanto 8 (40%) tinham ITU e 6 (30%) tinham hipertensão. Dez (50%) pacientes apresentaram redução da taxa de filtração glomerular (TFG), sugerindo comprometimento da função renal. Conclusão: Crianças com RSF apresentam alta morbidade, especialmente quando associadas à CAKUT ipsilateral. O acompanhamento periódico a longo prazo é essencial nesses pacientes para melhorar o resultado clínico.

Xp11.2 translocation renal cell carcinomas (TRCCs) are a group of neoplasms with distinct clinical, histopathological appearance, immunohistochemical, and cytogenetic profile. We report a case of Xp11.2 translocation TRCC in an 11-year-old male diagnosed based on immunohistochemistry and fluorescence in situ hybridization.

Wilms' tumor recurrences are notably encountered in the tumor bed, less commonly in the lungs. Metastatic involvement ureter markedly uncommon, though extension of the tumor at the presentation of primary tumor is known. We are documenting the metastasis to the ureteric stump which occurred in our patient nearly 2 years after completion of treatment for Wilms' tumor.

Retroperitoneal masses are notoriously malignant. Although they are seen commonly in adults, they have been known to occur in children as well. A benign mass in the retroperitoneal location in children is uncommon. Here we describe the presentation and management of a rare benign retroperitoneal mass in a 12-year-old boy.Keywords: abdominal mass, lipoma, paediatric tumours, retroperitoneal mass

The pathway from clinical suspicion to establishing the diagnosis of biliary atresia in a child with jaundice is a daunting task. However, investigations available help to point towards the correct diagnosis in reasonable time frame. Imaging by Sonography has identified several parameters which can be of utility in the diagnostic work up. Comparison of Sonography with imaging by Nuclear medicine can bring out the significant differences and also help in appropriate imaging. The battery of Biochemical tests, available currently, enable better understanding of the line-up of investigations in a given child with neonatal cholestasis. Management protocols enable standardized care with optimal outcome. The place of surgical management in biliary atresia is undisputed, although Kasai procedure and primary liver transplantation have been pitted against each other. This article functions as a platform to bring forth the various dimensions of biliary atresia.

Infant vaginal bleeding is an alarming symptom in an infant. Although several causes can be listed, the possibility of malignancy still needs to be ruled out in view of the guarded prognosis of these uncommon infantile tumors. This case report aims to raise the awareness towards the workup and management of infantile malignancies in a baby girl.

Renal masses account for 55% of cases presenting as palpable abdominal mass in children.[1] An eight year male presented with palpable abdominal mass and pain. The patient underwent renal dynamic scan, which raised possibility of left duplex kidney with non-functioning moiety, as the size of left kidney was smaller than seen on Ultrasonography (USG). Magnetic resonance (MR)urography confirmed the findings with patient undergoing left hemi-nephrectomy and is doing well. In case of discrepancy in size of kidney on USG and renal scan, duplex kidney should be considered as differential, other causes being, renal cyst, benign/malignant mass and renal calculi. Gross hydro-ureter presenting as palpable abdominal mass is very rare with few reported cases.[234].

Bacille Calmette–Guerin (BCG) vaccination for protection against tuberculosis has been in use for long. Although the vaccine is safe, its administration can result in complications such as BCG adenitis. We report here a series of children with BCG adenitis with a view to recognise and manage this condition. It is hoped that this case series would encourage the increased identification of this condition.

The standard treatment for pelviureteric junction obstruction (PUJO) has been dismembered pyeloplasty. The open surgical, Hellström procedure in which crossing polar vessels are relocated, has been an option in adult urological practice. We present our experience with laparoscopic vascular relocation in children.Data were retrospectively gathered on all patients who underwent laparoscopic relocation of lower pole vessels (LRLPV) at our institution between July 2004 and March 2008. Follow-up ultrasounds and MAG3 were obtained.LRLPV was performed in 10 boys and 9 girls. Patients were between 5.8 and 15.25 years (median 9.9 years). They presented with recurrent abdominal pain (n = 17), urinary tract infections (n = 7) and haematuria (n = 3). On ultrasound, MAG3 and retrograde studies they had hydronephrosis, obstructed drainage and a normal calibre ureter with a sharp cut-off. They were further assessed at laparoscopy and were found to have aberrant lower pole crossing vessels. All underwent laparoscopic mobilization of the lower pole vessels from the region of the PUJ thereby freeing the junction and relocating them superiorly onto the anterior wall of the pelvis. The median operating time was 120 min (range 60-240 min). The median hospital stay was 2 days (range 1-3 days). They were followed up for a median period of 12 months (range 6-36 months). All patients have remained asymptomatic. Ultrasound done at 6 months showed decreased hydronephrosis. MAG3 study showed improved drainage in 17, while 1 had poor drainage. This patient remains symptom free and is under regular follow up.Laparoscopic vascular relocation is an unconventional technique in carefully selected patients with PUJO. It obviates disrupting an intrinsically normal PU junction and treats the cause rather than the effect. Our intermediate-term results are encouraging and further long-term assessment is needed.