ABSTRACT: An 11-year old girl, diagnosed as a case of lymphoblastic lymphoma was started on continuous Cyclophosphamide, Adriamycin, Vincristine and Prednisolone regimen, she developed hoarseness of voice while on 2nd phase of maintenance therapy. Direct laryngoscopy revealed right vocal cord palsy. Laryngeal nerve paralysis induced by Vincristine is a known but rare complication. Hence we present this case report of an infrequent complication of Vincristine with a review of the literature.

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ABSTRACT: Aim : To prospectively audit 75 consecutive children referred for foreign body airway obstructions in a 2 year period and to highlight the rarer forms of presentations and morbidity of this procedure. Observations : Of the 75 patients, 63 were boys. Thirty eight (50 percent) of the patients were 1 to 3 years of age. There was a seasonal increase in vegetable foreign bodies during Lohri (winter). Chest X-rays of these patients showed obstructive features in 52 patients. Three patients with foreign bodies in the airway presented with unusual radiological features like pneumothorax, subcutaneous and mediastinal emphysema, and pneumoperitoneum. Five patients presented with refractory bronchial asthma and 2 of them had vegetable foreign bodies in the airway. Two patients with foreign bodies in the airway presented with acute aphonia. One needed a tracheostomy to remove a very large foreign body. Five of the older children had chosked with a whistle dislodged from toys. In 3 patients the bronchoscopy was complicated by attacks of temporary intraoperative hypoxia without sequela due to foreign body in both the bronchi. Two patients needed postoperative ventilatory therapy due to multiple foreign bodies in the respiratory tree and needed more than one attempt at bronchoscopy. Majority of the foreign bodies were vegetable in nature though some toy parts, stones, bones, screws and nails were also found. There were 2 mortalities, 1 due to a missed postoperative pneumothorax resulting in refractory cardiac arrest and the other due to an impacted foreign body at the carina. Conclusions : Children between the age groups 1-3 years are more susceptible to foreign body bronchus though no age group is exempt. The usual presentation is an acute onset of respiratory distress with or without history of choking. One must suspect foreign bodies in the respiratory tract in situations like refractory asthma, bronchiectasis, or hemoptysis without any underlying cause. Uncommon X-ray findings like pneumothorax, pneumomediastinum, and presentations like massive subcutaneous emphysema of sudden onset must make one suspect an underlying foreign body bronchus. The patients must be managed at selected centers with a backup Intensive Care facility. The existing mechanisms of referral must be strengthened with supervised ambulance transportation, preventive education and effective legislation regarding toys.

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ABSTRACT: This study was carried out in a tertiary care hospital on 40 patients and 20 controls, over a period of 2 years. The age of the patients ranged from 1 day to 9 years. There were 15 females and 25 males. Out of 49 patients we had 10 neonates, 13 infants and 17 children. Head circumference, resistive index (RI) and pressure provocation test (PPT) were done preoperatively and on 10th postoperative day. The direct intracranial pressure was also measured during shunt placement. Twenty nine patients underwent shunt placement, of which direct intracranial pressure measurement was done in 27 patients. The cut off value for normal RI was 0.60 without pressure and 0.70 with pressure provocation. The cut off value for normal intracranial pressure is 10 cms of CSF. The mean preop RI was 0.66 +_ 0.12 and mean pre-op PPT was 0.75 +_ 0.12. Postsurgery mean RI and PPT fell to 0.58 +_ 0.07 and 0.59 +_ 0.07 respectively. These differences were statistically significant. The sensitivity, specificity and diagnostic accuracy of RI was 72.5 percent, 80 percent and 75 percent respectively. The sensitivity, specificity and diagnostic accuracy of PPT was 75 percent, 100 percent and 83 percent respectively. The application of PPT mainly improved the specificity of the RI by eliminating the false positives. The PPT was found very useful for follow up of patients with suspected shunt malfunction.

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ABSTRACT: Surgery for Portal hypertension (PH) has an operative mortality of 5 percent for a good risk patient and 5-year survival 65-70 percent. In a poor risk patient, the mortality is as high as 50 percent. The success or failure of shunt surgery depends on the duration of patency and the cross sectional area of the shunt used. Regular follow-up of these patients, with checking of shunt patency, permits early diagnosis of potentially morbid complications. This is preliminary report of a prospective study being conducted on the evaluation of the use of Doppler sonography (DS) to confirm shunt patency in the early and long term periods following surgery for Extra-Hepatic Portal Venous Obstruction (EHPVO).

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ABSTRACT: In the past 20 months we have performed laparoscopy on 14 boys with 18 impalpable testes. Their age ranged between 1 year 3 months and 7 years. Seven boys had left empty scrotum, 3 had right empty scrotum while the other 4 had bilateral disease. At laparoscopy on 6 occasions the vasdeferens was found to enter the internal ring. Four of these 6 patients had closed internal ring and groin exploration was done in them to excise atrophied testis. On 2 occasions the vas was entering an open internal ring. One of these patients had an inguinal testis which was pexed through the groin route while the other had an atrophied small testis which was excised laparoscopically. Of the 12 testes located in the abdomen one was atrophic and at the internal ring. This was removed laparoscopically. The other 11 were either at the internal ring or at a higher level. All these 11 testes were brought down in to the scrotum by mobilization of the testicular vessels and the vaszdeferens. Two testes in the same patient were brought down through the inguinal canal while the other 9 were brought down through the anterior rectus sheath making a new opening. On 5 occasions the mobilization was difficult. All the testes were placed in the subdartos pouch. Operating time varied between 1/2 hour (diagnostic) and 2 hours. The average postoperative stay was 2 days. One child had urine leak from an injury to the urinary bladder. At follow up 3 testes were at high scrotal position while one was near the pubic crest. There was no testicular atrophy.

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ABSTRACT: Paragangliomas of the head and neck are ubiquitous in distribution, originating from the paraganglia or glomus cells, within the carotid body, vagal nerve and middle ear. It typically affects the middle aged. The patients present late in the course of the disease with a painless slow growing mass. Clinical manifestations include upper lateral neck mass, hoarseness of voice, lower cranial nerve palsies, pulsatile tinnitus and other neurological symptoms. But paragangliomas in a child is a rare entity as the present case is.

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ABSTRACT: Pyeloplasty for hydronephrosis due to pelvi ureteric junction obstruction (BUJ) is now a routine surgical procedure in the newborn period. To stent or not to stent the anastomosis has its votaries for and against it. For the stent group, another dilemma arises about the placement of a nephrostomy tube. We at the Pediatric Surgery Department ICH & HC Egmore, Chennai, have confronted the problem by making a simple modification in an infant feeding tube by which this tube acts as a stent cum nephrostomy tube.

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ABSTRACT: Molecular biology has revolutionized the medicine and added a new dimension to our knowledge of disease processes, especially in the field of oncology. Proto oncogenes are proteins normally present in the genome and they may be converted to oncogenes by mutations, rearrangements, translocation and deletion. One such protooncogene is the N-myc proto-oncogene seen in neuroblastoma. Amplification of the N-myc oncogene identifies a group of patients who have a poor prognosis. At present, it is generally agreed that the amplification of N-myc is still the most important prognostic factor to be investigated in every patient with neuroblastoma because of it's reliability as a prognostic indicator. There are many conventional methods to detect N-myc amplification but PCR is simple, cost-effective and less time consuming. The polymerase chain reaction (PCR) requires a tiny amount of tissue sample for DNA extraction. It makes PCR of particular interest in small tumor samples obtained by fine needle aspiration or bone marrow aspiration. our study was aimed at two goals. Firstly, to attempt detecting amplification by polymerase chain reaction and secondly to see the influence of N-myc amplified tumors on overall survival. Twenty six patients were included in this study. The fresh surgical specimen were obtained during excision or during bone marrow or fine needle aspiration and analysed for N-myc amplification by polymerase chain reaction. N-myc amplification was seen in 30 percent of our patients. N-myc amplification was seen more in patients older than 1 year, stage IV disease, male, and adrenal primary tumor. N-myc amplification was also associated with early progression of the disease. The rapidity with which N-myc amplified tumors progressed' was found statistically significant as compared to the unamplified tumors. The overall median survival for N-myc amplified tumors was 10 months and that for the nonmplified tumors was greater than 26 months. Our study reinforces the importance of N-myc amplification on tumor progression and survival in neuroblastoma.

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