A stem cell is an undifferentiated cell in the body with undetermined function capable of forming various tissues under definite signals received from the body. Stem cell research in animals using embryonal stem cells has been an ongoing program in the west with fruitful results. However, only limited information is available with the use of stem cells in human beings. Of the various sources of stem cells, umbilical cord blood stem cell research has shown potential for future treatment in Alzheimer's, Parkinson's, heart attack, stroke and spinal cord injuries. Human trials have been done in diseases like spinal cord injury and chronic liver cirrhosis. Cord blood stem cells have already been effectively used in the treatment of sickle cell, leukemia, non-Hodgkin's lymphoma and some other cancers, life threatening anemias and auto-immune diseases. Current challenges with the use of stem cells in clinical practice include the provisions to direct the differentiation of embryonic stem cells into specialized cell populations, and also devise ways to guard their development or proliferation once placed in vivo. Only further research and its clinical application will solve the many unanswered queries.

Postpneumonic empyema still remains quite common in developing countries, especially during the hot and humid months. While most cases would respond to antibiotic therapy, needle aspiration and intercostal drainage, few cases require further surgical management. The most common nontubercular etiological agent is Staphylococcus. Tubercular etiology is not uncommon in India, especially due to delayed presentation, multiresistant strains, mismanaged cases, and noncompliance with antitubercular treatment amidst malnutrition and anemia. Clinical symptoms, a skiagram chest followed by thoracentesis are enough for diagnosis. Pleural fluid is usually diagnostic and helps in choosing the appropriate antibiotics. Further investigations and management depends on the stage of the disease. Thoracentesis alone may be sufficient for the exudative phase. In fibrinopurulent stage, a properly sized and well-placed tube thoracostomy with underwater seal is curative in most cases. Interventional radiologists have placed small-bore catheters, specifically directed to the loculated collection and have used fibrinolytics like urokinase, streptokinase, and tissue plasminogen activator (TPA) to break loculations, ameliorate fibrous peel formation, and fibrin deposition. Thoracoscopic debridement and thoracoscopic decortication is an alternative with distinct advantages over thoracotmy and are indicated if there was no response with intercostal drainage procedure. In the organizing stage, a thoracotomy (for decortication) would be required if there is a loculated empyema, underlying lung disease or persistently symptomatic effusions. Timely institution of proper management prevents the need for any surgical intervention and avoids long-term morbid complications.

This review article covers the spectrum of congenital thoracic wall deformities along with their historical background. Willital's classification divides these deformities into 11 types - funnel chest (4 types), pigeon chest (4 types), and combination of funnel and pigeon chest, chest wall aplasia and cleft sternum. Records of patients at our center comprised 90% depression deformities, 6% protrusion deformities, 3% combined depression-protrusion deformities and 1% other forms. Mild forms of abnormalities warrant the wait- and-watch approach during the first 4-5 years. The deformities manifest primarily during the pubertal spurt often with rapid progression with subjective complaints like dyspnea, cardiac dysthesia, limited work performance and secondary changes. Operative correction in young adults is more favorable in mild cases. The Willital technique has been the standard technique for the correction of pectus excavatum, pectus carinatum and other combined forms of deformities at our center with excellent long term results. The Nuss procedure and the Pectus Less Invasive Extrapleural Repair (PLIER) technique for pectus excavatum and pectus carinatum have also been described in this article. Surgical correction for Poland's syndrome is reserved for patients with severe aplasia of the ribs with major depression deformity. Sternal defects including various types of ectopia cordis are discussed. Even after surgical correction, there is significant reduction in the total capacity and inspiratory vital capacity of the lungs, probably a result of the decreased compliance of the chest wall. However, the efficiency of breathing at maximal exercise improves significantly after operation.

The management of posterior urethral valves remains a challenge to the paediatric urologist. Many cases diagnosed early may be managed by endoscopic surgery. However, where there is a gross upper tract dilatation, consideration needs to be given to temporary diversion to allow recovery of renal function and the elimination of infection. Western literature leans strongly towards nondiversion. However, in those countries, most patients present early, and often by antenatal diagnosis. Countries not having universally, highly developed medical services encounter more of the complicated cases. Evaluation of the role of upper tract diversion in such circumstances has not been conclusively established, but literature review indicates a role in selected cases.

To evaluate the role of human chronic gonadotropin (HCG) and compare the results when it is given preoperatively and postoperatively in bilateral nonpalpable undescended testes (BNUDT) to facilitate the surgical outcome. Sixty-six cases of BNUDT, from January 1997 to January 2004, were divided equally into two groups on a random basis: Group A - control group received HCG doses which were completed 7-10 days preoperatively and Group B - test group received postoperative HCG doses started 7-10 days after surgery. The HCG was given as per WHO recommendation. The results were assessed clinically, by color Doppler ultrasound and HCG stimulated testosterone assay. Standard orchidopexy was done in all cases. Both groups were comparable in terms of age, testicular size, and vascularity as assessed by the Doppler ultrasonographic study. The mean basal serum testosterone and the HCG stimulation were also comparable in both the groups. At the sixth week follow up, the difference in the serum testosterone level was statistically significant, Group A 60.50 + 7.19 ng/dl vs Group B 81.17 + 5.88 ng/dl. The testicular vascularity at the sixth week follow up was more in Group B (74% normal vs 55% normal). Sixteen (24%) testis were retracted in Group A, while none were in Group B. Postoperative HCG therapy has been proved to be more effective than conventional preoperative therapy for better surgical outcome in BNUDT.

Needlescopic techniques have been used recently in repairing inguinal hernias (IH), which has made this type of surgery more feasible and less invasive. The technique is being developed further. The objective of this study is to describe and assess the results that can be achieved by using a new simplified techinque (Reverdin needle, RN) in needlescopic inguinal herniorrhaphy (NH) in children. All patients with symptomatic IH confirmed by clinical examination were subjected to elective needlescopic herniorrhaphy. One-hundred and fifty patients with 186 groin hernias, from two hospitals in Egypt and Saudi Arabia, in the period from October 1999 to May 2002, were assinged to NH using RN. The RN was used to insert a purse-string suture around the internal inguinal ring (IIR) to be tied extracorporeally. A total of 186 IH defects in 150 children were repaired successfully. There were 130 males and 20 females with a mean age of 20.58 + 21 months (range 8-96 months). Right-sided IH was present in 86 patients (57.33%); among these patients, an opened IIR was found and repaired in 12 cases (8%). Left-sided IH was present in 30 cases (20%), bilateral hernia in 19 cases (12.67%), and recurrent IH in 20 cases (10%). The mean duration of surgery was 8.7 + 1.18 min for unilateral and 12.35 + 2 min for bilateral hernia repair. No intra or postoperative complications. The mean hospital stay was 7.79 + 1.28 h. The new technique had all the advantages of needlescopic herniorrhaphy in children (less invasive, less pain, short hospital stay) combined with the advantages of reduced operating time, simplicity, and feasibility. It may be preferable for the intracorporeal suturing and knot tying. However, it needs long-term follow up.

The medicinal properties of honey have been recognized since antiquity. Although used as an adjuvant method of accelerating wound healing from ancient times, honey has been sporadically used in the treatment of burns. Honey acts mainly as a hyperosmolar medium and prevents bacterial growth. Because of its high viscosity, it forms a physical barrier, and the presence of enzyme catalase gives honey an antioxidant property. Its high-nutrient content improves substrate supply in local environment promoting epithelialization and angiogenesis. In pediatric burn patients no exclusive study has been conducted using honey as a burn dressing. An attempt is being made to evaluate the effect of honey in the management of burns in pediatric patients.

Splenic cysts are rare lesions. Primary cysts have a cellular lining that can be caused by congenital events or parasitic infection (Echinococcus). Secondary cysts have no cellular lining and may be of hemorrhagic, serous, inflammatory, or degenerative origin. We report a case of pseudocyst treated successfully by splenectomy, and we review the literature.

Acute perforated appendicitis is described as a rare clinical entity in 20 days old male neonate presented clinically with features suggestive of peritonitis. Surgical exploration revealed perforated appendix with free fluid in peritoneal cavity. Appendectomy with general supportive measures resulted in a satisfactory recovery. Authors review their experience with this rare entity along with pertinent literature.

We report here a 7-month-old baby presenting with a large paraganglioma arising from the right side of neck and extending to the scalp. Catecholamine screening was within normal limits. Ultrasound of the abdomen, CT-scan, and whole body MRI excluded any other coexisting neuroendocrine tumor. The tumor was treated by radical excision, and the resultant soft tissue defect was resurfaced using a pectoralis major muscle flap with split skin grafting. There has been no recurrence or metastasis during the 2-year follow up. To the best of our knowledge, this is the youngest reported patient with paraganglioma of the neck. Surgical excision of paraganglioma is feasible and curative in the absence of metastasis.

This communication is the summary of Internet discussions held by members of the Indian Association of Pediatric Surgeons (IAPS) in June 2005. It reflects the opinion and practice of Indian pediatric surgeons on the treatment of childhood empyema thoracis (ET). Despite the availability of broad-spectrum antibiotics, a large number of ET in advanced stages is still seen in India. The management of ET appears to depend on the stage of pathology, the status of underlying lung and proper usage of antibiotic adjuncts. Intercostal tube drainage of pleural space is sufficient for stage 1 empyema. Thoracoscopic decortication reduces the treatment cost and morbidity of stage 2 disease. However, stage 3 lesions with very thick pleural peels require open decortication. Pros and cons of these three modalities of treatment are discussed. The members also describe the various innovative techniques, that they found useful in the surgical management of ET.