ABSTRACT: Ambulatory Surgical Procedures/EC; Ambulatory Surgical Procedures/HI; Cost Benefit Analysis; Stress, Psychological; Postoperative Complications; Perioperative Nursing; Anesthesia; Anesthetics; Halothane Monitoring; Intraoperative; Human; Infant; Child

ABSTRACT: Pediatric day care surgery is becoming popular and success of such centers depend much on postoperative analgesia provided to the patients. Postoperative analgesia by different locoregional blocks with bupivacaine given to 230 patients in 18 months confirm excellent analgesia provided by these blocks. Additional benefits of day care surgery like cost effectiveness, early ambulation, less hospital stay, parental convenience, no child mother separation and avoidance of stronger analgesics with their side effects could be achieved successfully.

ABSTRACT: The aim of this study is to evaluate DNA ploidy as a tool to detect subtle morphological changes in the contralateral (C/L) descended testis, and to detect serum antisperm antibodies, in rats with experimentally created unilateral undescended testis (U/L UDT) and to correlate these changes to fertility potential. Wistar rat pups with experimentally created U/L UDT at 2 days of age were followed-up till adulthood to detect any alteration in fertility potential. Changes in DNA ploidy of the C/L descended testicular tissue and the levels of antisperm antibodies were compared to controls and those rats with U/L UDT who received immunosuppression and those in whom the UDT was later excised. Neither DNA ploidy changes or anti-sperm antibodies were found in those rats with U/L UDT who were simultaneously administered immuno-suppressants or those in whom the UDT had been excised at 30 days of age. The presence of serum anti-sperm antibodies and a significant reduction in the haploid cell population in the C/L testicular tissue of rats with U/L UDT correlated well with a significant reduction of fertility in this group. Reduction in C/L haploid cell population and the presence of serum anti-sperm antibodies correlates well with significantly decreased fertility in rats with U/L UDT and is indicative of immunologically mediated C/L testicular damage which is initiated and perpetuated by the continuing presence of the undescended testis.

ABSTRACT: Two hundred and fifty-six cases of congenital diaphragmatic hernia (CDH) admitted to the department of pediatric surgery from the year 1974 to 1993 were studied. Ninety-one cases were symptomatic within the first 24 hours (CDH less than 24 hours). The incidence of CDH showed a progressive increase during the period of study. The CDH less than 24 hours also showed a progressive increase in incidence with a peak during the third phase of the study (from 1984-88), in spite of a drop in the birth rate at Kerala. Clinical scoring method evolved by us definitely helped in predicting the prognosis. A combination of clinical, radiological and biochemical scoring methods helped in predicting the prognosis in CDH less than 24 hours with reasonable accuracy. Our study has shown an improvement in the survival-overall survival as well as survival of newborns presenting within 24 hours of birth.

ABSTRACT: Thirty-four fetuses (37 units) were diagnosed to have unilateral or bilateral hydronephrosis. They were followed up postnatally with a standard protocol which we have devised for our patients' need. They were followed up with serial sonography and DTPA renal scan to study any deterioration in function. Safe time for surgery was found to be around 6 months of age. Early surgery was performed in 7 patients, for one side in 3 cases of bilateral disease, the rest for either DTPA scan function less than 25 percent or deteriorating function on serial scan. Three cases of congenital hydronephrosis resolve spontaneously and six cases turned out to be multicystic kidneys. We do not advocate any antenatal interventions.

ABSTRACT: Cord blood levels of cortisol were estimated in one preterm and 29 term babies and were found to be 140.0 and 14.1 plus minus 7.8 meug/dl respectively. Factors which did not significantly influence the cord blood levels included maternal age, gestation, parity, type of labor, sex of baby, intra-uterine growth and birth weight. However, presence of fetal distress and Apgar score less than 9 were associated with significantly lower values (p 0.04). The duration of second stage of labor directly affected the increase in cord blood levels of cortisol (p 0.05). Caesarian section deliveries were associated with significantly lower values as compared to vaginal deliveries (p 0.02). These findings appear significant in the light of another study in which postoperative cortisol values were found to be lower when the pre-operative values were high.

ABSTRACT: Pseudomonas is one of the most common organisms infecting chronic superficial wounds particularly burns and is known to be most difficult to treat. The pre-eminent role of Pseudomonas aeruginosa in hospital infection is due to its resistance to common antiseptics and disinfectants and its ability, to establish itself widely in hospitals. It possesses a considerable degree of natural resistance to many antibiotics. Ozone, the triatomic form of oxygen has powerful oxidizing properties and is known to possess strong antibacterial property, hence has a potential for its use as an antimicrobial agent. A device has (Fig 1) been developed indigenously and jointly by professor S C Gopal and Dr D Pal to deliver ozone made from air instantaneously. The superficial wounds infected with Pseudomonas aeruginosa were exposed to ozone treatment. Its efficacy in controlling infection was judged both in vitro and in vivo by noting the growth of organisms on culture plate and the appearance of healthy granulation tissue respectively. It was found that it is highly effective in controlling wounds infected with Pseudomonas aeruginosa. It is also effective against those wounds infected with Pseudomonas aeruginosa strains, resistant to gentamicin/amikacin. This newer modality of treatment by ozone exposure for superficial wounds infected with Pseudomonas aeruginosa is quite simple and effective and is an effective alternative to treat the wounds where gentamicin/amikacin is ineffective.

ABSTRACT: Peristomal and perineal excoriations and excoriations around gastro-intestinal fistulas occur commonly despite preventive measures. The continuous chemical irritation leads to cutaneous denudation and chronic discomfort. A multitude of topical agents have been tried. We present our experience using topical sucralfate, a drug commonly used in peptic ulceration. Sixty patients divided into two groups-prevention (n=25) and healing (n=35) were included in the study. Each group was divided into subgroups for comparison of results with topical aluminium paint and siloderm ointment. Sucralfate, prepared either as a powder or an emollient (in glycerol base) was applied liberally for both prevention and healing of skin excoriations. Complete prevention of excoriations was achieved in patients in whom topical sucralfate was applied and more than 90 percent cases had complete healing of excoriations with topical sucralfate. General observations included; (1) A lag time of 2 to 3 days before visible healing was evident; (2) sucralfate was soothing, non-toxic and non-allergic even after long term use; (3) complete re-epithelization occurred in more than 90 percent cases after 110 days of application of sucralfate and (4) sucralfate was cost effective and superior to both aluminium paint and siloderm ointment.

ABSTRACT: This retrospective clinical study highlights the importance of fungal infections as cause of morbidity and mortality in children with posterior urethral valves treated at a tertiary care centre. The incidence of proven fungal infection of the urinary tract was 15.5 percent and fungal sepsis contributed to mortality in 53 percent patients of all the valve patients who died during the first hospital admission over a 4-year period. The patient group which was at the highest risk of developing fungal infection consisted of newborns and infants with deranged renal function and obstructed urinary tracts who were subjected to prolonged hospital care and indwelling catheters and multiple broad-spectrum antibiotics. Persistent non-specific clinical features of sepsis, despite antibiotics, associated mucocutaneous candidiasis and an unhealthy looking urinary stoma in a predisposed baby were used as indications for screening for fungal infection. Fluconazole was found to be an effective, well tolerated and convenient antifungal therapy. The message for a clinician from this clinical study is to keep a high index of suspicion and to treat expeditiously in the presence of substantial clinical evidence and a positive screening test.

ABSTRACT: Sixty-two cases of appendicectomy, in the age group of 2-12 years, have been performed by laparoscopic procedure during the last five years in a private set up at Calcutta. It was observed that they were well matched with other series in respect to the stages of appendicitis, operative findings, postoperative convalescence, complications and follow-up. It is also concluded that this laparoscopic procedure for removal of appendix is comparable to conventional methods of removal in certain aspects.

ABSTRACT: Pentology of Cantrell is an extremely rare condition. We report a variant of pentology of Cantrell, with omphalocele, diaphragmatic defect, pericardial defect and distal sternal cleft. The patient was managed surgically with primary closure with prosthetic mesh. He was followed up for 6 months.

ABSTRACT: A 2 month-old girl presented with swelling of abdomen and failure to thrive. On examination the liver was found grossly enlarged. CT scan showed enlarged liver with multiple nodular masses. A mini lap was performed. Biopsy was taken from right lobule of the liver. Based on microscopical findings, the diagnosis of infantile hemangio-endothelioma was made. However the patient expired shortly with a generalized bleeding tendency.

ABSTRACT: Pena (1) notes that since the publication of the technique of posterior sagittal anorectoplasty (PSARP) the reaction of pediatric surgeons 'has varied from very enthusiastic, unconditional acceptance to almost violent rejection'. Some modified versions particularly sphincter-conserving ones have since been attempted as Smith (2) remarked 'the bathwater needs changing, but don't throw away the baby' We have been practicing the following procedure based on PSARP (3) for last 10 years and find results comparable-in all the intermediate types forming bulk of this group of anomalies and some high lesions also.

ABSTRACT: D K clip-a stainless steel clip used in 9 cases by the author in Duhamel's operation for Hirschsprung's disease. In this article the author describes the D K clip which, not only is effective but eliminates most of the drawbacks of Dr Irani's clamp which is popularly used in many centers in India.