Recurrent parotitis is an uncommon condition in children. Its etiological factors have not been proved till date although causes due to genetic inheritance, local autoimmune manifestation, allergy, viral infection and immunodeficiency have been suggested. The exact management of this disorder is not yet standardized, but a conservative approach is preferred and all affected children should be screened for Sjogren's syndrome and immune deficiency including human immunodeficiency virus. We report a 12 years female child who presented with 12 episodes of non-painful recurrent swellings of the bilateral parotid gland in the past 3 years.

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Purpose: Use of the Mitrofanoff principle is a valuable adjunct to many reconstructive urological procedures in the pediatric age group requiring clean intermittent catheterization (CIC) especially if the urethra is not easily catheterizable. We present our experience with 122 children and analyze the results of this operation. Materials and Methods: 133 Mitrofanoff channels (100 appendicular, 31 ureteric and 2 Monti) were constructed in 122 children (93 boys and 29 girls) of mean age 6.3 years over the period from 1997 to 2005. The procedure was part of the reconstructive procedure in patients of neurogenic bladder (n=44), exstrophy-epispadias (n=40), posterior Urethral valve (n=30), and other diseases (n=8). Additional procedures included augmentation cystoplasty (n=90) and bladder neck procedure (n=46). Results: Mean follow-up was 2.6 years in 109 patients. Overall results were satisfactory. Major complication rates with the Mitrofanoff conduit using appendicular and ureteric channels were 7.4 % in and 25.8%, respectively, most of the ureteric channels due to non-use, there being alternate channels for catheterization. Only six (4.5%) children required re-operation for significant problems with the Mitrofanoff conduit: revision of stoma due to stenosis or kinking (n=4) and closure of stoma due to troublesome leak (n=2). Children and parents were satisfied with the results of the operation and the majority was compliant with regular CIC. All children were socially well accepted and those above 6 years of age were attending regular school. Conclusions: The Mitrofanoff procedure is a feasible and acceptable option, with a low complication rate, for use as part of complex urinary reconstruction in a developing country. Patient education, family motivation, and cost reduction are important factors for success.

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Introduction: Stem cells with potential to transform into healthy cells and repair damaged cells may prove beneficial in various congenital malformations. Aim: To explore the use of stem cells in liver cirrhosis and meningomyelocele. Materials and Methods: During July 2005 to July 2006, stem cells were used in 27 patients; 12 with liver cirrhosis and 15 with meningomyelocele. Autologous stem cells were injected during definite surgery into hepatic artery and portal vein or hepatobiliary radicles for liver cirrhosis or spinal cord and caudal space for meningomyelocele. The pre-operative status of the patient served as control for that patient. Results: The patients with liver cirrhosis were between 1.5 and 9 months (mean 4.12 months). Liver cirrhosis was due to extra hepatic biliary atresia (EHBA); neonatal hepatitis and choledochal cyst in 8; 2 and 2 patients, respectively. About five patients expired due to late presentation and ongoing cirrhosis. Follow up results evaluated at 3-12 months (n=7) showed absence of cholangitis (4/7); yellow stools (5/7); decreased liver firmness (3/7); improved liver functions (6/7) and improved appetite (6/7). Hepatobiliary scan was excretory in 6/7 with improved uptake in 4/7. Histopathology repeated after stem cells demonstrated comparative improvement in fibrosis in three. The meningomyelocele patients were between 0 and 1 month; 1-5 months, and 1-4 years in 5; 8 and 2 cases, respectively. 5 had history of rupture. 3 had undergone meningocele repair in past with neurological deficits. Redo surgery for tethered cord was done in 1. Follow up (3-11 months) in 14 cases showed improved power in 4 (28%), dramatic recovery in 3 (22%), and status quo in 7 (50%). One patient is still under observation. Conclusion: Initial use of stem cells in EHBA and meningomyelocele has shown beneficial results. However, long-term evaluation with randomized-controlled trials is essential to draw further conclusions.

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Aims: There are many surgical techniques to repair bilateral congenital choanal atresia, among them trans-nasal approach with simple puncture, dilation and stenting technique is most frequently used. We describe a series of trans-nasal puncture and stenting technique, by using pediatric urethral sounds and nalaton N 14. Materials and Methods: We used this technique in 10 patients with equal sex distribution, between 1997 and 2004 in our hospital. Mean age at operation was 3.5 days. Mean duration of stenting was 33.6 days (2-8 weeks) and patients were followed for an average duration of 28.8 months after surgery. Results: Three patients (30%) developed re-stenosis after stent removal, which was easily managed by simple dilatation and re-stenting for more two weeks. There was a minimal operative bleeding with no infection or central nervous system trauma. Conclusion: This safe, simple operation by using pediatric urethral sounds is a non-expensive way to treat this anomaly with a low complication rate.

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Spontaneous scrotal faecal fistula is a rare complication of incarcerated inguino-scrotal hernia in the neonate and infants. Only five previous cases have been reported in the English medical literature. We report another case of a 28-day-old neonate, who presented with fecal fistula following prolonged incarceration of a right inguino-scrotal hernia. The etiology and management of this rare complication is discussed.

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A new instrument for suction rectal biopsy in infants suspected of having Hirschsprung's disease is described that can be completely dismantled, physically cleaned, lubricated, and heat sterilised. Triple rectal suction biopsy instrument with the patent application, which involves (0.5 cm diameter) suction of mucosa and sub-mucosa and provides taking three different biopsies within a 2 cm distant from each other with a single shot, instead of only one or taking a full layer biopsy under general anesthesia for the diagnosis of Hirschsprung disease. As a preliminary study, in the 36 and 12 biopsy materials taken from the rabbits and children, respectively, it was found that mucosa and sub-mucosa were sufficient and in all of the cross sections, parasympathetic nerve fibers, and ganglion cells were existed. A successful biopsy was usually achieved and no complications occurred.

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Purpose: Open lung biopsy (OLB) is claimed to be a sensitive tool for the diagnosis of interstitial lung disease. It is reported to be associated with significant morbidity and mortality. Aim: Evaluate whether lung biopsy helped us to make a specific diagnosis, it had resulted in change in therapy and assessment of its morbidity and mortality. Materials and Methods: This was a retrospective analysis of 91 lung biopsies performed in 83 patients between January 2000 and December 2003. These children were allocated to three groups: a. Primary pulmonary pathology (22), b. Immunocompromised (49) i. Primary immunodeficiency (10), ii. Postchemotherapy and BMT (39), c. Pulmonary metastases from solid tumors (20) Results: A specific diagnosis was reached in 87/91 children (95%), but this resulted in a change in therapy (excluding lung meet) in only 23/71 (32%). It is lower in those postchemo/BMT 8/39 (20.6%). Postoperative morbidity occurred in 11/91 (12%) but procedure-related morbidity was only (3.2%). Death within a month of the biopsy occurred in six children (6.5%), with one (1.1%) procedure-related. Conclusion: 1. OLB is a safe procedure at our institution. 2. OLB is a sensitive tool to determine the specific cause of pulmonary infiltrate. 3. Change in therapy expected to be only in 32% of patients and even lower in postchemotherapy and BMT children.

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Aims: Our objective was to evaluate the feasibility and efficacy of laparoscopic nephrectomy in infants and children. Materials and Methods: From 2000 to 2005, 28 children, aged 3 months to 14 years underwent laparoscopic nephrectomy, laparoscopic nephroureterectomy and heminephrectomy. Medical records were reviewed retrospectively for clinically relevant data. Results: There were no conversions. Mean operating time was 75 minutes and there were no intraoperative complications in our series. Cosmetic results were excellent in all cases. Average hospital stay was 4 days. Conclusions: Laparoscopic nephrectomy, laparoscopic nephroureterectomy and heminephrectomy may be safely performed in infants and children with minimal morbidity, post-operative discomfort and improved cosmesis.

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Aims: To report our experience with laparoscopic inguinal hernia repair in children. Materials and Methods: A total of 45 children, who underwent laparoscopic inguinal hernia repair between November 2003 and June 2005 were included in the study. Data were obtained by retrospective review of the case notes. Results: A total of 63 laparoscopic inguinal hernia repairs (18 right, 9 left and 18 bilateral) were performed on 45 children (29 boys and 16 girls). Age of the children ranged from 4 weeks to 4 years. The operative time ranged from 30 to 70 minutes for unilateral repair and 38 to 95 minutes for bilateral repair (median for unilateral was 48 minutes and for bilateral 55 minutes). This time decreased with surgeon experience, though not reflecting directly due to the fact that the training registrars performed part of the procedures in the last 23 patients. There were no intraoperative complications. The follow up period ranged from 3 to 15 months. One child developed umbilical port site infection, which was treated with appropriate antibiotics. Conclusions: Laparoscopic inguinal hernia repair in children is safe, with minimal complications. With experience operative time decreases.

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Minimal invasive surgical techniques have gained high acceptance in thoracic surgery during the last 10 years. Video-assisted thoracoscopy (VATS) is less invasive than open thoracotomy and its development is associated with expansion of indication for lung biopsies. Lung biopsy remains an important investigation in the diagnosis of few of the lung disorders despite improved diagnostic yield of high resolution computed tomography scanning. Thoracoscopic lung biopsy is becoming the procedure of first choice for the diagnosis of many localized and diffuse lung diseases. We report a small series of eight patients who underwent VATS lung biopsy to demonstrate the safety and efficacy of this procedure.

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Thoraco-abdominal ectopia cordis is an unusual congenital anomaly. The case of a 45-days-old female child, who presented with a defect in the chest and upper abdomen and visible cardiac pulsations and bulge during crying, is being reported. There was an inferior sternal cleft with divarication of the recti up to the umbilicus. The cleft was covered with a thin translucent membrane. Primary repair was accomplished successfully without causing mediastinal compression.

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Both diagnostic and operative laparoscopy was used in the management of 189 impalpable testes. 66 were either vanishing or atrophied, 17 were found in the inguinal canal, 19 in the groin, and 87 intra-abdominal. Four of the latter group were associated with persistent Mullerian duct syndrome and one with splenogonad fusion. Four atrophied abdominal testes were excised laparoscopically, 47 were treated with one stage laparoscopic orchidopexy and 34 with laparoscopic Fowler Stephen (FS) procedure. A good scrotal position was achieved in 63% of the one stage procedure and 69% with the two stage FS approach.

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Presence of intraspinal air (pneomorachis) is usually iatrogenic after epidural injections or spinal manipulations. It may also be associated with degenerative disc disease, epidural abscess and synovial cysts. Presented herein is a case of a child with pneomorachis following blunt thoracic trauma.

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