Aim: To study the impact of Renin-Angiotensin system blockade in experimental acute pyelonephritis, induced by a novel surgical approach via dorsal lumbotomy incision. Materials and Methods : 45 Adult female WISTAR rats aged 8-12 weeks, underwent direct inoculation of 0.1 ml of E.coli suspension into the parenchyma of the surgically exposed kidney. 3 groups of rats were studied: Group A - treated with antibiotics only; Group B- Captopril and antibiotics and Group C- Losartan and antibiotics. Changes of acute inflammation, parenchymal destruction and scarring were compared between the groups on histopathological sections. Kruskal-Wallis test was used for statistical analysis. Results : Changes consistent with acute pyelonephritis were seen in all the kidneys. Mean% scar area in Group A, Group B and Group C was 37.08±1.79, 24.40±1.88 and 24.68±1.32% respectively at end of six weeks. Mean tubular density in Group A, B and C was 17.26±1.92, 47.18±3.00 and 47.00±5.08-tubules/lac mm2 respectively. The differences between the control and the treated animals were significant, though the results did not differ between the losartan and captopril treated rats. Conclusions : Dorsal lumbotomy approach to the kidney provides a good exposure of the kidney. Induction of acute pyelonephritis by direct inoculation of bacteria into renal cortex produced a consistent scar at 6 weeks. Blockade of renin angiotensin system by either captopril or losartan decreased the renal scar area by almost 1/3 at 6 weeks.

Introduction: Corrosive ingestion is the major cause of esophageal stricture in our country. Mitomycin-C, an anthracycline derived from Streptomyces caespitosus, has both antineoplastic and antiproliferative properties. Use of mitomycin-C have been well documented in various ophthalmologic procedures and laryngo-tracheal conditions where it has been shown that mitomycin-C inhibited fibroblast proliferation during the postoperative phase without damaging the mucosal and epithelial growth. This preliminary report documents the use of mitomycin-C in caustic stricture esophagus. Materials and Methods: A prospective study was carried out in ten known patients of caustic esophageal strictures. After taking informed consent patients were subjected to antegrade or retrograde esophageal dilatation under general anesthesia and mitomycin-C was applied topically by a 10 mm cottonoid sponge soaked in mitomycin-C solution (0.4 mg/ml) for 5 minutes at the stricture site. The procedure was repeated at 4 weekly intervals thereafter and need for further dilatation was assessed. Outcomes in terms of symptomatic relief and radiological evaluation were assessed after therapy and results were analyzed for effectiveness of mitomycin-C and compared with retrospective results of previous cases of corrosive ingestion managed at the same institution. Results: Total number of dilatations required were 34 (mean - 3.4) Two patients required single dilatation while two required six sessions. Symptomatic as well as radiological improvement was present in nine patients. Conclusions: Use of mitomycin-C seems to improve the outcome in patients of corrosive esophageal strictures. Patients who have undergone esophageal replacement also seem to benefit from mitomycin-C.

Purpose: To report personal experience with Primary Laparoscopic Pullthrough Procedure (PLPP) in infants with Hirschsprung's Disease (H.D.). Materials and Methods: Sixty four PLPP were performed by the author. In addition, 17 assisted LPP were done but not reported herein. The patients' personal and anatomic data were typical for babies with H.D. Results: Average age at operation was seven weeks (range 1-28 weeks). Operative time for PLPP averaged 140 minutes. Two babies required conversion to a standard laparotomy for anatomic reasons (long segment). Average blood loss was <5 ml. No intraoperative nor immediate post operative complications were seen. Hospitalization was short (2-3 days). Two had mild diarrhea episodes which improved without hospitalization. Another child developed a severe problem with enterocolitis 3½ years following the operation. In general, stool habits fell within the normal range for those > 4 years of age. Conclusion: PLPP is an effective, problem free approach for treating neonatal H.D. It has replaced the standard two stage open procedure in babies with uncomplicated presentation.

Background: The traditional belief that attending medical conferences would further one's knowledge needs to be examined critically. Although analytical reports on the effectiveness of conferences have been published from Western countries, such studies have never been conducted in India. Materials and Methods: The author prospectively analyzed 100 free papers presented at the 30th National Conference of the Indian Association of Pediatric Surgeons. Papers were categorized as original works, case reports, audit reports, innovations and theoretical papers. They were assessed for their scientific value, nature of conclusion, quality of discussion by authors and quality et quantity of audience interaction. Results: "Original works" and "innovations" frequently contributed additional information to the existing knowledge while most of the case reports, audit reports and theoretical papers were redundant. Nearly 40% of all papers had inappropriate conclusions. Only one author conferred all the five components of discussion while 32% of authors discussed nothing useful. Case reports, audit reports and theoretical papers topped the list of papers with inappropriate conclusion and poor discussion. About 24% of papers did not evoke any audience interaction. There was no significant difference in the enthusiasm of audience to interact with contributing versus redundant papers. Conclusion: Majority of case reports, audit reports and theoretical papers are found to be unsuitable for free paper session. To improve the quality of deliberations, the number of free papers should be reduced and the time allocation for each of them should be increased. Authors must be educated and reminded of the various components and importance of discussion. Whether audience at IAPS meetings react appropriately to free papers need to be evaluated further.

Various surgical procedures are described and practiced for operative management of uncomplicated meconium ileus. In our series, we have tried an approach of minimally invasive procedure to minimize the operative stress in already sick neonates. Ten cases of meconium ileus operated between 01/01/2003 to 21/06/2004 were screened. Three cases presented with complications like peritonitis (2) and volvulus (1) and so were not included in this study. Seven cases were uncomplicated. Out of them three were managed conservatively. Operative management by minilaparotomy - enterotomy and T-tube insertion was done in the remaining four cases, which did not resolve by conservative approach. In this group, patients passed stool by approximately seventh day (range - sixth to eight day). Oral feeds begun on approximately ninth day (range - eighth to tenth day). All four babies survived. This approach of minilaprotomy, T-tube insertion and N acetyl cysteine instillation, could be of significant benefit in an already sick neonate. Also, T- tube helps in post- operative bowel decompression, distal bowel wash and check dye study

Background: Acute abdomen in children has been aptly described as Pandora's box. Unlike computerized tomography (CT scan), ultrasonography (USG) has no radiation hazard and the present study analyses the diagnostic yield of the USG in acute abdomen in children. Materials and Methods: Between September 2001 to October 2003, 75 patients with acute abdomen underwent clinical examination, routine biochemical tests, erect X-ray abdomen, USG and CT scan. Laparotomy and histological examination established final diagnosis. Results: The accuracy of correct diagnosis was 60%, 66.6%, 64%, 98.7% with clinical examination alone, USG alone, clinical examination combined with conventional radiography, and clinical evaluation combined with conventional radiography and USG respectively. USG helped to prevent unnecessary laparotomy in 16.3% of patients. Conclusions: USG is good investigative modality in the management of acute abdomen in children.

Background: The objective of the paper is to review the incidence and types of associated urogenital anomalies (U.G.A.) we encountered in patients with anorectal malformations (A.R.M.) and compare the results with previously published world literature. Materials and Methods: Retrospective review was done of 220 cases of A.R.M., treated from May 2002 to April 2003. All patients routinely underwent ultrasound (U.S.) study of the K.U.B. region and pelvis and lumbosacral radiography. Voiding cystourethrography (V.C.U.G.), nuclear renography and other investigations like buccal smear and karyotyping were done in selected cases only. Results: Genital anomalies were found in 30 cases (13.63%) and urologic anomalies in 25 cases (11.36%), a direct correlation being found between the level of A.R.M. and the incidence of urogenital anomalies (U.G.A.). Conclusion: The high incidence of associated anomalies (24.54%) makes careful clinical examination and evaluation of the urinary tract during the neonatal or early infantile period mandatory in all cases of A.R.M., particularly to avoid deterioration of renal function in future.

Three infants who presented with clinical features of neonatal cholestasis and clinically suspected to have biliary atresia were found on imaging studies and surgery to have extrahepatic bile duct atresia in association with choledochal cyst. All patients were treated by bilio-enteric bypass procedure. Post operatively jaundice cleared in only two patients. The prognosis of this association depends on the pre-existent liver damage due to biliary atresia.

Juvenile dermatomyositis classically manifests as necrotising vasculitis in multiple organs. It mainly involves the vessels of skin and muscle and is associated with subcutaneous deposits of calcium. Ureteric involvement in dermatomyositis is extremely rare. The authors present a case of a 14-year-old girl with juvenile dermatomyositis with intramural ureteric calcification mimicking pelviureteric junction (PUJ) obstruction.

An 11-month old boy presented with frequent episodes of fever and cough over the past 6 months. Investigations revealed a large space-occupying lesion in the upper lobe of the left lung, the remaining lung fields being clear. There was no history of contact with tuberculosis and the tuberculin test was negative. A CT scan of the chest suggested the presence of a pulmonary sequestration in the upper lobe of the left lung. Surgical excision of the affected lobe was performed and histopathological examination of the excised lobe revealed extensive tuberculosis with caseous necrosis. The presentation of progressive primary tuberculosis in infants is discussed along with the diagnostic difficulties in cases with an atypical presentation.

A frequently unrecognized and potentially devastating form of penile strangulation is that caused by human hair. Hair tourniquet syndrome frequently occurs during the time period when post partum mothers are experiencing increased hair loss. The majority of cases are thought to be accidental, however possibility of child abuse should be considered in every case.