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The usual treatment for empyema in children varies from a simple thoracocentesis to thoracotomy and open decortication. We studied the role of thoracoscopy in the management of empyema thoracis in 10 immunocompetent children after failure of medical management. All children recovered well with an early removal of intercostal tube and reduced postoperative hospital stay and showed complete resolution of empyema on follow up. Thoracoscopy has come as a new ray of hope for the patients with empyema, with the advantages of complete evacuation, minimal pulmonary dysfunction, reduced pain and hospital stay.

When managing neonatal jaundice, there is no single test or imaging modality that can reliably define biliary atresia and neonatal hepatitis. Early diagnosis is an important step for surgical success in extra hepatic biliary atresia. In many situations, exploratory laparotomy and operative cholangiography may be needed to settle the definitive diagnosis, with the risk of having negative exploration in those high risk patients with medical etiology. The use of laparoscopy may help in avoiding unnecessary exploration for such group of patients and arriving at a definite diagnosis. Six patients with conjugated hyperbilirubinemia were evaluated with a diagnostic laparoscopy, laparoscopic cholangiography and liver biopsy. Three of the six patients were diagnosed to have neonatal hepatitis and so an unnecessary laparotomy was avoided in these cases.

Among the various anomalies associated with Down syndrome, leukemia is quite common. The variant transient myeloid leukemia is seen almost exclusively in the Down syndrome patients. On the other hand, urological anomalies are infrequently found both in the Down syndrome and leukemia patients. We report a case who had the rare combination of a urological anomaly along with Down syndrome and transient myeloid leukemia.

We report a 9-month-old child with anorectal anomaly which was surgically treated in the neonatal period for a colostomy and was referred to us for a definitive procedure. The child had features suggestive of low anorectal abnormality; however, investigations indicated that he had a supralevator type of imperforate anus associated with a rectopenile subcutaneous fistula. The surgical treatment of this infant is discussed.

Penile agenesis is a rare anomaly, occurring once in every 30 million births. Early gender reassignment and genital reconstruction helps the family to accept the child's altered gender and to reduce psychological problems. In the past, multiple operations were carried out to form feminized external genitalia. This report describes a single-stage gender reassignment and genital reconstruction by anterior sagittal anorectovaginourethroplasty in a neonate with penile agenesis.

The authors report 3 cases of Hirschsprung's disease that were treated by laparoscopic-assisted transanal pull-through after a colostomy already had been performed. Two of these patients presented with severe enterocolitis, and a primary laparoscopic-assisted single-stage transanal pull through was not feasible. The third patient had a colostomy performed and was referred to us for a definitive procedure. Many centers over the world now perform laparoscopic-assisted single-stage pull-through as a primary modality of management for Hirschsprung's disease. But for a country like India, where patients with Hirschsprung's disease present or are referred late and frequently with enterocolitis, performing a primary procedure is not possible in all cases. However, this has been used as the definitive procedure after performing a diverting colostomy and histopathologic determination of the length of the aganglionic bowel. The procedure gives excellent results and permits early postoperative feeding, early hospital discharge, and good cosmetic results.

Vancomycin susceptibility was checked in isolates from initial and final blood samples obtained from 22 patients with persistent or recurrent methicillin-resistant Staphylococcus aureus bacteremia. The minimum inhibitory concentration of vancomycin was determined using Etest and found to have increased in 2 pairs of isolates, and results of screening in 4 mu g vancomycin and a modified population analysis profile suggested heteroresistance in 3 isolates (13.6%). Heteroresistance is not a common cause of persistent or recurrent bacteremia.

Priapism is a rare condition in childhood. The majority of reported cases are boys with sickle cell disease, in whom nonoperative management may be successful when patients present early. We report a 14-year-old boy with sickle cell disease who presented with priapism of 72-h duration and was successfully treated by bilateral saphenocorporal shunts.

With the increasing popularity of laparoscopic urologic surgery, many different methods have been used to dissect the extraperitoneal space and gain access to the kidney and ureter. We present our initial experience using a Foley catheter to gain retroperitoneal access. This technique was successfully used in 30 children. We have not encountered any major complications and recommend its use in children.

Duplications of the alimentary tract are rare anomalies that have been reported to occur all along the gastrointestinal tract. Of the various alimentary tract duplications, pyloric duplications are extremely rare. We report the case of a 3-day-old neonate who was antenatally diagnosed as having a cystic mass in the abdomen and who presented with vomiting on the 2nd day of life. At operation, a duplication cyst of the pylorus was removed successfully and a pyloroantrectomy performed.

Cutaneous mucormycosis is a rare fungal infection in children. It is commonly found in immunocompromised children. Early diagnosis is difficult and requires a very high degree of suspicion. Recommended mainstay of treatment has been amphotericin B and extensive surgical debridement which may at times require amputation if limb is involved. The authors share their experience of two cases of successfully treated cutaneous mucormycosis.

The study evaluated the role of imaging studies in the diagnosis of impalpable undescended testes. A total of 40 children referred with 45 impalpable undescended testes had an ultrasound scan and clinical examination by a pediatric surgeon. 22 out of these 45 testes were found to be palpable on clinical examination by a pediatric surgeon. Of the remaining 23 boys (23 units of testes), 21 underwent MRI scan for identification of testes and results were compared with findings at laparoscopy. The diagnostic agreement of ultrasound and MRI in correctly localizing the testes was 19% and 52% respectively whereas the sensitivity of detection was 60% and 55% respectively. Imaging studies therefore have a limited role in pre-surgical evaluation of boys with impalpable testes.

The field of Minimally Invasive Surgery or Minimally Access Surgery (MAS) as it is commonly known has grown remarkably over the past two decades. MAS has a steep learning curve and unexpected complications with MAS are not infrequent unless approached with great caution. However it leads to a shorter hospital stay, less analgesic use, rapid return to school and a better cosmetic outcome. MAS in children started in India a decade ago, and has a great impact on the way we manage pediatric surgical problems today. This article is a brief description of most of the procedures that are being done with the help of MAS. In addition to these, new techniques, procedures and innovations are always ongoing in this fast developing field. MAS is being practiced in limited centers in our country with expanding experience and indications. Its use in children as the first option for early appendicitis, intraabdominal testis, gall stone disease and a few other conditions is now proven beyond doubt. There are other indications and areas of application of MAS which are continuously evolving and needs institutional audit and validation at every step before moving to the next phase.

The definition and management of borderline resectability for periampullary pancreatic adenocarcinoma are evolving. In this case report, we discuss the presentation, workup, and therapeutic management of a 40-year-old man who presented with borderline resectable, periampullary pancreatic cancer and underwent a margin-negative resection following neoadjuvant chemoradiotherapy.

The Mental Health Act 2007 (UK) (MHA 2007) received Royal Assent in July 2007 and has now reached the statute books after 8 years of controversy and debate. The MHA 2007 makes amendments to several pieces of existing legislation, but the main changes it makes are to the Mental Health Act 1983 (MHA 1983) and the introduction of “Deprivation of liberty safeguards” into the Mental Capacity Act 2005 (UK). Much of the concern about more patients being subject to detention is a perception of the new legislation, tempered by the antecedents to the MHA 2007 (which included an expert report, a Green paper, a White Paper and two draft Bills') as well as Government propaganda. The purpose of the present article was to highlight how the Government's approach and propaganda has fuelled these concerns, to scrutinize the amendments contained in the MHA 2007, and to consider whether these may result in more patients being subject to compulsion. [ABSTRACT FROM AUTHOR]

The Mental Health Act 1983 (UK), which governs the compulsory detention of psychiatric patients in England and Wales, includes a number of statutory safeguards to ensure that the patient's continued detention is not unlawful. One of these safeguards is the Mental Health Review Tribunal (MHRT). The primary role of MHRTs is to review the legality of a patient's detention in hospital and to direct discharge of those to whom the criteria for detention do not apply. Their powers, duties and procedures are contained within the Mental Health Act 1983 (UK) and the Tribunal Procedure (First-tier tribunal) Rules 2008. To hear individual cases, tribunals sit as a panel of three: a psychiatrist, a lay person and a legal chairperson. Article 5 of the European Convention of Human Rights (ECHR) enshrines the individual's right to liberty and security, but also includes a provision permitting the detention of persons of unsound mind. The ECHR also includes the right for an individual to have a periodic review of his or her detention and the lawfulness of it, a function that is fulfilled by the MHRT system. Currently approximately 40 000 patients per year are detained under the Mental Health Act, and almost 22 000 appeals are made to the MHRT, of which 12 000 are heard, in over 600 locations. The aim of this article is to examine the evidence as to whether MHRTs are inherently unfair to patients and biased towards overcautious professionals, and consider this in the light of various changes to the MHRT system proposed and adopted over recent years. [ABSTRACT FROM AUTHOR]