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Introduction and Importance: Vagal paragangliomas of neck are rare tumours of neural crest origin usually arising in elderly age with female predominance. They have a vague clinical presentation therefore difficult to diagnose preoperatively. We hope that this case report and literature review would add to the existing literature and help devise a comprehensive diagnostic and therapeutic plan for vagal paragangliomas., Case Presentation: We report a case of vagal paraganglioma occurring in a 13-year-old male which is an extremely rare presentation in this age group. The patient presented with a large solitary painless progressively growing mass in posterior triangle of neck. External jugular vein was stretched and trachea was deviated medially. The mass was arising via a twig from vagus nerve and was surgically excised. Diagnosis was established post-operatively through histopathological analysis., Clinical Discussion: Vagal paraganglioma is a rare occurrence in male teenagers and may mimic schwannoma, neuroma, jugular meningioma, or other gangliomas. Surgical excision is mainstay of treatment but resultant vagal complications and neurological consequences are usually unavoidable. Nonetheless, the prognosis may be easily improved with sound surgical judgement, skill, and routine follow-up., Conclusions: Vagal paraganglioma usually presents as a swelling in neck and cannot be diagnosed on simple clinical examination. CT scan and MRI are imaging modalities of choice and can be coupled with angiography to increase diagnostic accuracy. Although both radiation therapy and surgical excision have both been found to be successful treatment options, it is still unclear which is more beneficial., Competing Interests: Declaration of competing interest None., (Copyright © 2023. Published by Elsevier Ltd.)

Introduction: Enterocolitis associated with Hirschsprung's disease is a fatal and serious complication. Number of scoring systems are in vogue to grade the severity of Hirschsprung's disease associated with enterocolitis (HDAEC), but none of these scoring systems help predict mortality. Hence, we attempt to develop a mortality prediction model (MPM) for HDAEC., Materials and Methods: A retrospective analysis of all cases of HDAEC encountered was analyzed. We also used the parameters of Elhalaby et al . for data collection. A total number of 71 cases were analyzed with regard to mortality in relation to each parameter. Sensitivity and specificity were calculated by statistician, and based on these values, a scoring model was proposed. All those with predicted mortality were given score 2 and those who did not were given score 1., Results: A total score of more than 16 predicted mortality, a score of <10 predicted survival, and a score between 11 and 15 predicted survival with morbidity., Conclusion: A MPM for HDAEC is being proposed., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Indian Association of Pediatric Surgeons.)

An isopiestic experimental facility for the measurement of vapor pressures has been designed, fabricated, and commissioned. Using the vapor pressure data as a function of temperature, useful thermodynamic properties of alloys and compounds of interest can be derived. The isopiestic facility comprises a pair of furnaces, temperature controllers, thermocouple movement mechanism, user interface, and data collection. Four such experimental setups have been commissioned. This experimental facility is useful to determine the vapor pressures of a volatile component over the condensed phases as a function of temperature and composition. Using the vapor pressure data, the thermodynamic properties of various systems can be determined. The experimental setup was validated by a Pr-Cd isopiestic run, and the results are compared with the data reported in the literature.

Introduction: Pyloric atresia is a rare cause of congenital gastric outlet obstruction. It is often associated with epidermolysis bullosa (EB). Rarity and experience with 11 cases are the reason for this publication., Aims and Objectives: The aim and objective of this study is to present our experience of 11 cases of congenital pyloric atresia and correlate with available literature., Materials and Methods: This was retrospective cohort of 11 cases correlative comparative study. Data of all the 11 cases from 1982 to 2019 were collected, reviewed, and analyzed. The parameters studied included age, gender, antenatal diagnosis, postnatal diagnosis, preoperative management, intraoperative findings, postoperative course outcome, associated anomalies, and any genetic studies if done. All these parameters were compared with published data., Results: There were 11 cases in the present series with six boys and five girls. Most of them presented at varying periods from birth to day 1 of life., Discussion: Congenital pyloric atresia may be isolated or associated with EB. Three varieties of pyloric atresia were described. Association with EB increases the mortality., Conclusions: Review and analysis of 11 cases of pyloric atresia compared with published literature is being reported., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Indian Association of Pediatric Surgeons.)

Background: Blood group incompatibility (ABOi) is the most common barrier to living donor kidney transplantation. Options for such recipients include kidney paired donation (KPD) or desensitization methodology to reduce blood antibody response., Objective: The objective of this study is to report on the first North America experience in ABOi living donor kidney transplantation using Glycosorb ABO immunoadsorption columns., Design: Retrospective observational cohort study., Setting: Renal transplant program at St. Michael's Hospital, Unity Health Toronto, University of Toronto., Patients: Twenty-six ABOi living donor transplants from August 2011 through February 2020 were undertaken at our center., Measurements: Renal allograft and patient survival postdesensitization for ABOi living donor transplants and isohemagglutinin titer reduction., Methods: Preoperative immunosuppressive regimen consisted of a single dose of Rituximab 375 mg/m 2 IV on day -28; tacrolimus, mycophenolic acid, and prednisone to start on day -7. Immunoadsorption treatments with Glycosorb A or B columns were performed on day -7 through day -1 based on anti-A or anti-B titers on Spectra Optia Apheresis System. Immunosuppression included basiliximab, solumedrol followed by oral prednisone, once-daily tacrolimus, and mycophenolic acid. The mean follow-up was 53 months (3-96 months)., Results: A total of 26 individuals underwent an attempt at desensitization of whom 24 patients underwent immediate transplant. One patient had a rebound in titers and subsequently was transplanted from a blood group compatible living donor. A second patient had an unrelated medical issue and desensitization was discontinued. Five-year patient survival was 96% and death censored allograft survival was 92%. Posttransplant anti-A or anti-B titers were monitored daily for the first 7 days posttransplant and every 2 days from days 7 to 14. There were no acute rejections seen in this cohort of transplant recipients., Limitations: As our protocol was first initiated as proof of concept, a few recipients had low initial isohemagglutinin titers. This may have contributed to improved clinical outcomes., Conclusions: ABO column immunoadsorption with specific columns is a safe and effective method for ABOi living donor kidney transplantation, and an option when KPD is less than ideal.Trial not registered as this was a retrospective cohort review., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2020.)

Objective: Intussusception has been linked with rotavirus vaccine (RVV) as a rare adverse reaction. In view of limited background data on intussusception in India and in preparation for RVV introduction, a surveillance network was established to document the epidemiology of intussusception cases in Indian children., Methods: Intussusception in children 2-23 months were documented at 19 nationally representative sentinel hospitals through a retrospective surveillance for 69 months (July 2010 to March 2016). For each case clinical, hospital course, treatment and outcome data were collected., Results: Among the 1588 intussusception cases, 54.5% were from South India and 66.3% were boys. The median age was 8 months (IQR 6, 12) with 34.6% aged 2-6 months. Seasonal variation with higher cases were documented during March-June period. The most common symptoms and signs were vomiting (63.4%), bloody stool (49.1%), abdominal pain (46.9%) and excessive crying (42.8%). The classical triad (vomiting, abdominal pain, and blood in stools) was observed in 25.6% cases. 96.4% cases were diagnosed by ultrasound with ileocolic location as the commonest (85.3%). Management was done by reduction (50.8%) and surgery (41.1%) and only 1% of the patients' died. 91.1% cases met Brighton criteria level 1 and 3.3% Level 2. Between 2010 and 2015, the case load and case ratio increased across all regions., Conclusion: Intussusception cases have occurred in children across all parts of the country, with low case fatality in the settings studied. The progressive rise cases could indicate an increasing awareness and availability of diagnostic facilities., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The need for successful management of posterior urethral valves always captivates the minds of pediatric surgeons. Its success, however, depends on several factors ranging from prenatal preservation of upper tracts to postoperative pharmacological compliance. Regardless of measures available, some cases do not respond and progress to end stage. The management depends on several issues ranging from age and severity at presentation to long-term follow-up and prevention of secondary renal damage and managing valve bladder syndrome. This article is based on a consensus to the set of questionnaires, prepared by research section of Indian Association of Paediatric Surgeons and discussed by experienced pediatric surgeons based in different institutions in the country. Standard operating procedures for conducting a voiding cystourethrogram and cystoscopy were formulated. Age-wise contrast dosage was calculated for ready reference. Current evidence from literature was also reviewed and included to complete the topic., Competing Interests: There are no conflicts of interest.

Introduction: Quantification of surgical sepsis was never done beyond superficial, subfascial, and deep surgical site infection (SSI). Invasive surgical sepsis with systemic manifestation has not been tried to be quantified in general and pediatric surgery in particular. Hence, this attempts to develop a novel grading system to quantify neonatal surgical infections., Materials and Methods: Predisposing factors, infection, response, and organ failure (PIRO) is being used in critical care institutions for medical sepsis; it was modified with neonate-specific surgical parameters. Authors have developed a grading of these parameters into Grade I, II, and III., Results: A blinded statistical test was performed and results were put to test. Extended Mantel-Haenszel Chi-square test validated linear relationship with grade and outcome, hospital stay, deep SSI, and organ dysfunction. Analysis of variance also showed the significant relationship of changing trends in grade and outcome. (1) Higher the grade indicated the probability of death. (2) Grade I patients had less duration of hospital stay compared to Grade II and III ( P = 0.04). (3) The requirement of organ support and SSI were also more in Grade III. (4) Grade I patients had less increase in trends compared to Grade II and III (F = 4.86). Authors therefore feel Neo-PIRO seems to be the first scoring system that shows a linear relationship between scores and grade., Conclusion: Neo-PIRO is a novel grading system with surgical neonate-specific parameters. Future versions to include molecular parameters, as well as parameters selected by regression analysis., Competing Interests: There are no conflicts of interest.

Introduction: Abdomen, a closed compartment, is prone to raised intra-abdominal pressure (IAP) in the postoperative period. After a critical value of ≥ 15 cm of water, IAP produces abdominal compartment syndrome (ACS). ACS leads to reduced venous return, reduced cardiac output, and domino effect of organ dysfunction, leading to death. Hence, it is the need of hour to monitor IAP to pick up intra-abdominal hypertension (IAH) and ACS. This routine facilitates early institution of treatment measures., Aims and Objectives: To study IAP in abdominal operations in neonates, infants, and older children and to promote concept of routine measurement of IAP as standard care., Materials and Methods: Intravesical route was used to measure IAP in this prospective observational study. Seventy-nine pediatric abdominal surgeries met with criteria of availability of complete data for analysis and formed the cohort of the study. All major, infective, traumatic, tumor-related abdominal surgeries were included in the study. Outcome, C-reactive protein (CRP), procalcitonin, platelet counts, Simplified Sequential Organ Failure Assessment Score, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score were the parameters analyzed. The World Society of ACS grading was adopted in the study with subdivision of normal into low-normal and high-normal subgroups., Results: Extended Mantel-Haenszel Chi-square statistical tool when applied for linear relationship showed a linear relationship with outcome ( P < 0.05), CRP ( P < 0.05), procalcitonin ( P < 0.05), Simplified Sequential organ failure Assessment Score, and APACHE II. Platelet counts ( P > 0.05) were not significantly correlated. Decision for laparotomy was delayed in cases of ACS., Conclusion: Routine measure of IAP facilitates early recognition of IAH. This facilitates therapeutic measures to be initiated to reduce IAP. Early decision to decompress by laparotomy/laparostomy saves lives. Hence, routine IAP measurement should be a part of standard care in pediatric abdominal surgery., Competing Interests: There are no conflicts of interest.

A comprehensive all-inclusive resource on plain radiograph in neonatal intestinal obstruction is presented. This is an attempt to develop a protocol and to regain expertise in evaluating a plain radiograph that most often yields more than enough clues to diagnose and to decide a plan of action.

Chronic myeloid leukaemia (CML) is amongst the most common haematological malignancies encountered in adults. The younger age of onset and increased incidence of CML in Indians leads to higher chances of encountering it in pregnancy. Pregnancy in CML is a complex situation as first line therapy with tyrosine kinase inhibitors (TKI), is fraught with multiple fetal safety issues. The fetal aspects have been elucidated in literature, but there is scarcity of information on the obstetric outcome per se in presence of CML, excluding the influence of TKI. Obstetric outcomes of 5 pregnancies in four patients with CML are being reported. Literature on interplay of CML and bleeding or thrombotic manifestations is reviewed. The major complications encountered were antepartum (APH) and postpartum haemorrhage (PPH), preterm labour, intrauterine growth retardation and intrauterine fetal death. Patients in the reproductive age group with diagnosis of CML should be carefully counseled regarding the effect of disease and TKI on the maternal-fetal health. Bleeding complications, particularly APH and PPH may be encountered in CML patients. Close coordination of the obstetrician, haematologist, and neonatologist is required in managing these cases successfully. The need for absolute contraception till the remission of disease needs to be emphasized for further pregnancies.

Multidrug-resistant tuberculosis (MDR-TB) is identified from the time of introduction of antituberculosis treatment and is a known worldwide public health crisis affecting women of reproductive age group. Management issues raised by pregnant women with MDR tuberculosis are challenging due to the limited clinical experience available with the use of second line drugs. We hereby report two cases of MDR-TB during pregnancy: one patient was on second line drugs, while another one was evaluated and diagnosed to have MDR-TB in last trimester. At 6 months of follow-up both mothers and babies are doing well. The approach to such cases along with review of the literature is discussed.

Lateral presentation of meningocele and meningomyelocele is extremely rare. Most of the lateral meningocele described are associated with other syndromes. Isolated lateral meningomyelocele cases are rarer still. We herein report a neonate with isolated lateral gluteal meningomyelocele.

Introduction: Malrotation of midgut is considered to be a condition of childhood. This study evaluated malrotation in adults with recurrent abdominal pain (RAP)., Methods: Sixty-four consensus-confirmed cases of intestinal malrotation were reviewed. The diagnosis was based on radiological criteria, and the consensus was arrived at by at least three of the five authors in any individual case., Results: Abnormal duodenojejunal junction (DJJ) was a consensus finding in 64 cases referred for RAP. Most were in their fourth decade of life, and 12 were beyond 60 years. Besides RAP, intolerance to food was the next common symptom. Acute intestinal obstruction was seen in 16. Forty-two of 64 patients consented for surgery. Ladd's procedure was the commonest. All patients who underwent surgery were symptom free except for two, of which, one had liver cyst and the other had hernia. Of those who refused surgery (22), all had continued symptoms and 10 patients took alternative therapies. On follow up of initially unwilling patients (for surgery) with abnormal DJJ, only eight consented for surgery; three underwent open Ladd's procedure, and one had laparoscopic Ladd's done., Conclusion: Malrotation is not uncommon as a cause of RAP in adults.

Complete hydatidiform mole with a coexisting live fetus (CHMCF) is a rare obstetric occurrence. So far, approximately 177 cases have been documented in the literature with consequent 66 live births. We report a review article along with two cases of CHMCF, one presenting as incomplete abortion and other continued as CHMCF but terminated because of antepartum hemorrhage. Both had histopathologically proven one normal and other complete molar placenta with coexisting normal fetus. No evidence of persistent trophoblastic disease was observed. The dilemma of continuation versus termination of pregnancy is being emphasized in the review of literature. Pregnancy complicated by CHMCF may result in a viable live born infant in approximately one third of the cases. A potentially viable fetus with CHMCF may result in normal live birth with antecedent high risk maternal complications. A decision of termination of pregnancy in all CHMCF will however nullify all the chances of a live birth. An individualistic approach and an informed doctor patient consensus may improve the likely outcome. Appropriate counseling of the mother regarding high incidence of antenatal complications plays an integral part of decision of continuation of such pregnancies., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

We are reporting two cases of uterine necrosis and lumbosacral-plexopathy in patients, who underwent pelvic vessel embolization (PVE) following postpartum hemorrhage. Embolization was performed with gelfoam slurry, polyvinyl alcohol (PVA) particles and coil in one patient and with gelfoam slurry only, in second patient. Both patients had lower limbs weakness and had persistent fever in the postembolization period. Nerve conduction study in both were suggestive of common peroneal and tibial neuropathy. An ultrasonography and computed tomography of abdomen and pelvis revealed bulky uterus with no identifiable endometrium and multiple air foci in subendometrial region suggestive of uterine necrosis, confirmed later by histology of expelled uterine mass. Lumbosacral ischemia resulting in paraparesis and uterine necrosis presenting as longstanding fever after embolization are extremely rare but overwhelming complications of embolization. Only 19 cases of uterine necrosis and <10 cases of lumbosacral plexopathy have been reported in the literature. The overall effectiveness of PVE is high in treatment of obstetric hemorrhage with low complication rate and highly selective PVE may further prevent these complication. To the best of our knowledge the co-existing uterine necrosis and lumbosacral plexopathy secondry to PVE has not been described prevoiusly in patients with postpartum hemorrhage. Both patients recovered with conservative management.

Background: Tacrolimus is a widely used calcineurin inhibitor in kidney transplantation. It is available as twice-daily Prograf® (Tac-BID) and once-daily Advagraf® (Tac-OD). Although therapeutically equivalent, some patients require dose adjustments to achieve similar trough concentrations [C0] after conversion. Tacrolimus exposure is affected by ethnicity in the de novo setting but the role of ethnicity in determining dose requirements and adjustments after conversion is unknown., Methods: In this study, 496 renal transplant recipients (RTRs) were prospectively converted from Tac-BID to Tac-OD, with dose adjustments targeted to achieve similar [C0] at 12 months post-conversion. Renal function, acute rejection and Tac dose adjustments by ethnicity were analyzed., Results: There were similar numbers of recipients from living and deceased donors. The mean transplant duration was 7 years. Of the RTRs, 60% were Caucasian and 40% were identified as belonging to an ethnic minority. There was no change in estimated renal function (eGFR) post-conversion to Tac-OD. At 12 months, 35/488 (7%) RTRs were receiving a reduced dose, 101/488 (21%) required a dose increase of which 77 (16%) were receiving at least a 30% increase in dose over baseline. The percentage of those in ethnic groups requiring a dose increase of >30% varied from 8.0% for South Asians to 27.5% for East Asians (P = 0.03), despite East Asians having a similar baseline dose of Tac-BID (3.59 mg/day) compared to the entire cohort (3.53 mg/day)., Conclusions: Ethnicity may play an important role in dosing requirements when converting from Tac-BID to Tac-OD, unrelated to baseline dose. Further investigation is required to determine the reasons for ethnic variability when patients are converted between tacrolimus preparations.

Extrahepatic biliary atresia (EHBA) is an uncommon cause of neonatal jaundice. Antenatal Magnetic Resonance Imaging (MRI) diagnosis of EHBA has not been published to the best of our knowledge till date. EHBA with cystic component is likely to be mistaken for choledochal cyst. A case that was antenatally predicted and postnatally confirmed by surgery and histopathology is being reported. All imaging signs are analyzed herewith. Imaging helps in the prediction of EHBA and also helps in early postnatal surgical referral which in turn improves the results of Kasai's portoenterostomy.

Extrahepatic portal hypertension is not an uncommon disease in childhood, but isolated inferior mesenteric portal varices and lower gastrointestinal (GI) bleed have not been reported till date. A 4-year-old girl presented with lower GI bleed. Surgical exploration revealed extrahepatic portal vein obstruction with giant inferior mesenteric vein and colonic varices. Inferior mesenteric vein was joining the superior mesenteric vein. The child was treated successfully with inferior mesenteric - inferior vena caval anastomosis. The child was relieved of GI bleed during the follow-up.

Mesiodens, a common supernumerary tooth, is found in the midline in anterior maxilla between the incisors. Its occurrence as multiples is termed as 'mesiodentes'. Double mesiodentes, a rare phenomenon, is seldom reported in literature and show a plethora of manifestations as described in the case report. They may not be apparent clinically, necessitating the use of imaging modalities and require careful evaluation to prevent complications. This paper presents a report of six double mesiodentes cases with negative family history for supernumerary teeth and absence of any syndromes. This is an effort to educate dentists about signs, symptoms, complications and management of mesiodentes.

Objective: To assess the usefulness of angiographic embolization in hemorrhage due to gestational trophoblastic neoplasia (GTN)., Study Design: We conducted a retrospective analysis of data of patients with gestational trophoblastic disease within the time period 2002-2008., Results: Eight women with GTN presented with massive hemorrhage during this time period. According to the International Federation of Gynecology and Obstetrics Scoring system 2000, 4 of those patients had high-risk GTN. Vaginal metastasis was present in 50% of the women. All women underwent angiography, and embolization was performed in 7 of the 8 patients. One patient could not undergo embolization due to technical reasons. Two patients underwent embolization of bilateral internal iliac arteries, 4 had bilateral uterine artery embolization and 1 had bilateral uterine and hepatic artery embolization. Embolization was successful in 85.7% of the patients. All patients received chemotherapy: high-risk patients received combined regimen chemotherapy (EMA-CO), while low-risk cases received methotrexate/folinic acid regimen. Out of the 8 patients, 5 are in remission and 3 succumbed to the disease. In 2 women who tried to conceive, 1 delivered a term infant and the other had a miscarriage. The most common side effect of embolization was pain requiring parenteral analgesia., Conclusion: Transcatheter embolization is a safe and quick procedure and should be considered in GTN patients with acute hemorrhagic life-threatening complications.

Fluoride is toxic to neuronal development and its excessive intake during pregnancy cause adverse effects on neonatal development. The present study examined the presence of oxidative stress during maternal exposure of fluoride and the therapeutic strategy of Aloe vera, Curcuma longa and Ocimum sanctum extracts in functional prevention of fluoride led oxidative stress. The pregnant Wistar rats were exposed to 100 ppm fluoride in drinking water and pups born to them were supplemented with phytoextracts daily. On 21st postpartum day, the pups were sacrificed to analyse fluoride and oxidative stress markers. Fluoride exposure significantly increased its accumulation, lipid peroxidation and decreased the activities of catalase, superoxide dismutase, glutathione peroxidase, glutathione-S-transferase and glutathione levels in discrete regions of the central nervous system (CNS) of pups indicating oxidative stress and inhibited antioxidant defense. The results implied the vulnerability of developing CNS to fluoride toxicity. On phytoextract supplementation, the oxidant devastation was suppressed by regaining antioxidant homeostasis near normal level proving efficacy and therapeutic strategy. Among the phytoextracts supplemented the Ocimum sanctum is found to be more effective.

The presence of a CD133+/nestin+ population in brain tumors suggests that a normal neural stem cell may be the cell of origin for gliomas. We have identified human CD133-positive NSCs from adult glioma tissue and established them as long-term in vitro cultures human neuroglial culture (HNGC)-1. Replicative senescence in HNGC-1 led to a high level of genomic instability and emergence of a spontaneously immortalized clone that developed into cell line HNGC-2 with features of cancer stem cells (CSCs), which include the ability for self-renewal and the capacity to form CD133-positive neurospheres and develop intracranial tumors. The data from our study specify an important role of genomic instability in initiation of transformed state as well as its progression into highly tumorigenic CSCs. The activated forms of Notch and Hes isoforms were expressed in both non-neoplastic neural stem cells and brain tumor stem cells derived from it. Importantly, a significant overexpression of these molecules was found in the brain tumor stem cells. These findings suggest that this model comprised of HNGC-1 and HNGC-2 cells would be a useful system for studying pathways involved in self-renewal of stem cells and their transformation to cancer stem cells. Disclosure of potential conflicts of interest is found at the end of this article.

Objective: To assess pregnancy outcome in patients with severe chronic hypertension., Methods: A retrospective analysis of a 10-year period (1995-2004) in a referral hospital in northern India. The outcome was compared with those women with mild chronic hypertension who registered in the hypertensive disorders with pregnancy clinic immediately before and after each woman with severe chronic hypertension., Results: Hospital data identified 25 such women. Superimposed preeclampsia (36.4% versus 8%), preterm delivery (86.4% versus 42%), and perinatal mortality (27.2% versus none) were increased in patients with severe chronic hypertension as compared to those with mild hypertension., Conclusions: The small number of cases reflects the lack of antenatal supervision in developing countries. A much larger number of women are referred in the third trimester with eclampsia or severe preeclampsia, at which time it is not possible to identify whether or not they had underlying hypertension. Adverse events were found to occur more often in patients with severe chronic hypertension compared with those with mild hypertension.

Anterior abdominal wall hernias are uncommon, and herniation of a gravid uterus into these hernias is even rarer. Although reducible initially, the herniation of pregnant uterus may be complicated by incarceration and subsequent strangulation within the hernial sac, late in the course of pregnancy. There is no consensus over the management of this rare condition. Each case should be individualized. If uncomplicated, a conservative approach until term followed by delivery and herniorrhaphy is a good option. Here, 2 cases of herniation of gravid uterus into the anterior abdominal wall are described along with a brief review of literature pertaining to its presentation, complications, and management.

Leiomyoma of the vagina is a very rare tumour of the lower urogenital tract. These slow-growing masses may be asymptomatic or present with pain, dyspareunia or urinary symptoms. Rarely, these tumours may present with life-threatening haemorrhage. These hypervascular tumours are treated by surgical excision. Preoperative embolization therefore may aid in devascularization of these tumours before surgical excision. We present the MRI features of a case of vaginal leiomyoma, which was managed by preoperative embolization and was then excised in toto. To the best of our knowledge, this is the first report where preoperative embolization was performed before excision of a vaginal leiomyoma with minimal peroperative blood loss.

We report a 45-year-old lady who presented with recurrent vomiting, retching and epigastric pain, and was diagnosed to have gastric volvulus. After correction of the volvulus by endoscopic detorsion, a tumor was seen along the greater curvature. This was excised surgically. Histology showed leiomyoma.

Cisplatinum based chemotherapy has become the standard treatment for ovarian cancers due to its proved superiority over non-cisplat based regimes. However, the therapeutic impact of cisplat based regimes compared to cheaper non-cisplatinum based regimes is questionable when multiple variables such as residual disease, histologic type, grade are introduced. This report is a study of 110 Stage III ovarian cancer patients from 1985-89, with cisplat (n = 69) and non cisplat (n = 41) based chemotherapy. The results of both regimes with reference to the multiple variable factors are presented. We conclude that cisplat based regimes appear to be superior to non-cisplat based regimes except probably in poorly differentiated ovarian tumors where the results were similar with either regimen.

Meticulous staging of ovarian cancer has so far been a prerequisite for treatment planning. However, more than 80% of patients operated by non-oncologists all over the world do not under go a complete staging. Recently there have been reports questioning the need for extensive staging from the point of cervical benefit. We have analysed our data of 64 stage ovarian cancer patients to see if clinical staging was adequate or relaparotomy with restaging is necessary. We conclude that though pathological staging is important for proper reporting of results and evaluation of treatment modalities, in the existing circumstances, a judicious use of clinical methods and taking available pathological factors into account, we can still produce comparable results with restricted use of relaparotomy.

Thirty-six babies born with an anorectal anomaly were evaluated for vesicoureteric reflux in the neonatal period and the progress of the reflux with age was followed. The overall incidence of reflux was 47%, with higher rates in the more severe types of anomaly. Generally, the reflux was of mild grade and tended to resolve with time, except in the short colon syndrome. Urinary sepsis due to a rectourinary communication may have an important role in the development of reflux.

The prone cross-table lateral radiograph provides equal or sometimes better information, compared to the invertogram, for demonstration of the level of rectal atresia in neonates. Easy positioning, better cooperation of the patient, elimination of the effect of gravity, and better delineation of the rectal gas shadow are the advantages of the prone lateral view. Among the 45 cases compared, equal findings were noted in 37, but in eight babies the level of rectal atresia was more caudal in the prone radiograph than in the invertogram.