ABSTRACT: Surgical intervention is the mainstay of treatment of obstructive cholangiopathy like biliary atresia and choledochal cyst, however, the addition of hepato-protective drugs like ursodeoxycholic acid (UDCA) and steroids may add to the surgeon's armamentarium and improve the results. We created obstruction of the common bile duct in 30 Albino rats, so as to produce cholestasis and progressive liver cell damage. Ten served as control and received no medication. A liver wedge biopsy was taken at the first surgery to note normal liver histology of the rat. The other 20 rats were divided randomly into two groups, one received UDCA only (25 mg/Kg/day), and the other received UDCA and betamethasone (0.5 mg/kg/day). At 4 weeks the rats were weighed and sacrificed. The liver and bile ducts were harvested and examined for cholestasis, hepatocellular alteration, portal changes, fibrosis and evidence of cirrhosis. There was poor weight gain in the 1st group with massive dilatation of common bile duct. There was marked destruction of cellular structure, bile ductular proliferation, liver fibrosis, but no clear cut evidence of cirrhosis in the 1st group. The liver histology of the rats in the other two groups was well preserved with moderate inflammation in group 2, and almost negligible in the 3rd group. Bile duct proliferation, fibrosis and inflammation were significantly higher in the 1st group as compared to the 2nd and 3rd groups (p0.001). This study adds to the scanty available proof that UDCA and steroids are cytoprotective and help in prolonging the life of the hepatocyte with no toxic effects. Their use in the pre and postoperative period may be of great help in children suffering from surgical obstructive jaundice.

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ABSTRACT: A 1(1/2) year old male child with history of periumbilical swelling followed by spontaneous fecal discharge from it, was diagnosed as tubercular enterocutaneous fistula, and is presented with an emphasis on management.

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ABSTRACT: During the period 1996-98, 5 neonates underwent operative repair of gastroschisis at the Department of Pediatric Surgery, Christian Medical College Hospital, Vellore. While one patient was closed primarily, the other 4 patients underwent silo creation using plastic material cut from a urine drainage bag. Two of these had a successful result and have been followed up for more than 6 months. The other two died of causes unrelated to the repair technique. We conclude that this plastic material from urine drainage bag is a freely available, cheap and effective alternative to other materials in the staged closure of gastroschisis.

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ABSTRACT: Two children with congenital diaphragmatic hernia and intestinal obstruction are reported. One was a 10 year old girl with left sided diaphragmatic hernia; a loop of colon was inside the chest cavity and the bowel was obstructed at the diaphragmatic defect. The distended colon could only be reduced after its content was aspirated with a wide bore needle. The other patient was a 12 year old boy with right sided diaphragmatic hernia who presented with intestinal obstruction. The hernia contained gangrenous bowel that required resection with end to end anastomosis. The operation began with thoracotomy but needed extension of the incision to the abdomen for safe reduction and resection of the bowel. Late presentation of congenital diaphragmatic hernia is reported to be 5 to 25 percent and its presentation as intestinal obstruction is reported rarely. Causes of late presentation of congenital diaphragmatic hernia are thought to be either due to late rupture of the small hernial sac that contained the viscera in the abdomen or plugging of the hernial defect by solid viscera prior to the development of hernia due to raised intraabdominal pressure.

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ABSTRACT: Fibrous hamartoma of infancy is an uncommon soft tissue tumor arising from the subcutaneous tissue. The axilla is the commonest site of occurrence and chest wall is rarely involved. Although histological features are well known but the relative abundance of one kind of tissue may cause diagnostic error which is alleviated by adequate tissue sampling. Local excision is curative and is the treatment of choice. A case of large sized fibrous hamartoma of infancy involving the chest wall in a neonate is presented along with review of the literature.

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ABSTRACT: The results of treatment have been analysed in 31 consecutive cases of esophageal atresia (E.A) with or without tracheoesophageal fistula (TEF) over a period of 4 years in respect to Waterston Groups, gestational age, weight, pre-existing pneumonitis, temperature, age at admission or at timing of surgery and associated life threatening anomalies. Survival was directly related to gestational age, weight, temperature and absence of pneumonitis. All the babies with core temperature less than 35 degree Celcius did not survive. Even improved survival rate in recent years is not comparable with those reports from developed countries. The factors for poor results have been studied, analysed and further improvements suggested.

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ABSTRACT: Splenogonadal fusion is a rare congenital anomaly. More than 135 cases have been reported in literature. Conventionally orchiectomy is the treatment for any solid testicular lesion, which has been adopted in the present case also but testis can be salvaged in this condition if accurate preoperative diagnosis is made.

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ABSTRACT: Serum inorganic phosphate levels were estimated in guineapigs where infarction was produced by ligating superior mesenteric artery (SMA). Serum inorganic phosphate levels rose significantly during the first 3-4 hours. The maximum level was attained by 4th hour. No serum change in inorganic phosphate level was noted when bowel gangrene was established. Therefore, rising serum inorganic phosphate levels indicate reversible state of infarction if appropriate intervention is undertaken. Significant ultrastructural changes were absent in the early part of SMA occlusion.

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