ABSTRACT: Magnetic Resonance Imaging (MRI) is a relatively new diagnostic tool in the management of Anorectal Malformation (ARM) and this investigative modalityin evaluation of patients with ARM is unique due to its exquisite soft tissue imaging ability in a ll three planes. It is noninvasive in nature. Both, pre and postoperative patients have been studied by imaging the pelvis and lumbosacral spine in the sagittal, transverse and coronal planes in the present study. MRI provided detailed information on the type of malformation, extent of the pelvic musculature and the skeletal status particularly of the lumbosacral spine in preoperative evaluation. This can be very helpful to study the relationship between the pulled through bowel and the muscle complex in patients with incontinence before one considers redo surgery. The cost factor may be a little prohibitive; however, the information obtained is worthwhile in selected patients with ARM. MRI performed on neonates at the time of first presentation may provide all the information necessary and other investigations like invertogram, intravenous pyelogram and lopogram etc. with their own major drawbacks can be avoided. This paper deals in depth regarding our experience with MRI in the management of ARM in 20 cases.

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ABSTRACT: A case report of posttraumatic leptomeningeal cyst in a 10-year old girl is presented. She had a swelling in the right parietal region of the skull since the age of 6 months. There was history of fall at the age of 3 months. Physical examination, plain skull radiograph and CT scan confirmed the diagnosis. Cranioplasty with rib graft was done. She recovered fully and is now asymptomatic in regular follow up.

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ABSTRACT: The association of imperforate anus with Mayer-Rokitansky-Kuster-Hauser (MRKH) Syndrome is extremely rare. Clinically, this association may masquerade as a case of rectal agenesis with ano/recto vaginal fistual and the diagnosis is often missed. We describe a case of this unusual association and briefly describe the various surgical reconstructive options available.

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ABSTRACT: A 3-year old male child presented with distention of abdomen, severe anemia, constipation, lump in lower abdomen and fever. Ultrasonography revealed a mass in the lower abdomen which was reported as a mesenteric mass. On laparotomy, a fleshy tumor like mass at the jejunoileal junction with associated mesenteric lymphadenopathy was found. Resection of the mass with end to end anastomosis of the bowel and lymph node biopsy was done. Histopathology revealed the mass to be an inflammatory fibroid polyp (inflammatory pseudotumor). The patient fully recovered and is on regular follow-up.

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ABSTRACT: Traumatic diaphragmatic hernia is rare in children, and has not been reported with pancreatic injury along with pseudoaneurysm of splenic artery. We encountered a case of traumatic diaphragmatic hernia in a child associated with pancreatic injury leading to pancreatic pseudocyst formation and pseudoaneurysm of the splenic artery. Pseudocyst formation alongwith pseudoaneurysm of splenic artery and traumatic diaphragmatic hernia is a rare occurrence.

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ABSTRACT: Over a period of 15 years (January, 1985 to September, 2000) we treated 5 patients with chronic pancreatitis with pancreatic ductal stones. The youngest and the eldest patients were 6 and 14 years respectively; 3 were boys and 2 girls. All the patients presented to us with upper abdominal pain of varying duration. Besides blood biochemistry, other most helpful investigations done were Ultrasonography (USG) and Endoscopic Retrograde Cholangio Pancreatography (ERCP). Lateral Pancreatico Jejunostomy and Jejunojejunostomy were done in all of our patients. There was no mortality and no significant postoperative morbidity.

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ABSTRACT: Lung abscess is not an uncommon entity in children. Most of them resolve with medical treatment. Those attributable to infective complications of congenital lesions require surgical intervention. We present a rare etiology of lung abscess in a child where the correct diagnosis could be made only in retrospect.

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ABSTRACT: Chondroblastoma is a benign chondroid neoplasm that predominantly occurs in the second decade of life. These tumors are characteristically centered in the epiphyses of long tubular bones and appear as, well demarcated radiolucent lesions. The diagnosis is confirmed by presence of mononuclear chondroblasts, which tend to lie individually like pebbles in contrast to the mononuclear cells of Giant cell tumor, which are spindle shaped and occur mostly in clusters.

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ABSTRACT: Spontaneous perforation of the biliary tract in infancy is rare with less that 100 cases being reported in the English Literature till date. There are no such reports available for an older child. We report a case of spontaneous common bile duct perforation in an 8 year old girl who presented as a case of acute peritonitis, and was subsequently found to have no biliary tree abnormality.

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ABSTRACT: A boy aged 1 year and 7 months, diagnosed clinically and radiologically as Wilms' tumor, was operated and the histopathology report was Clear Cell Sarcoma of Kidney (CCSK). He was given chemotherapy. During the course of treatment he developed recurrence of lump in the operation swite and Toxic Epidermal Necrolysis. On investigations the patient showed evidence of bony metastases. The rarity of CCSK and TEN and their management is discussed.

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ABSTRACT: Controversy exists regarding operative versus non-operative treatment, as well as in the selection of operative procedure for esophageal perforation. We reviewed 11 cases of esophageal perforations treated in the last 2 years. Iatrogenic injury was the most common cause of esophageal perforation in our series (55 percent). There was a distressingly high incidence of perforation following dilatations for 'early tight' strictures resulting from primary repair for esophageal atresia; 67 percent of all such patients. None of the patients underwent aggressive and early surgery for closure of the perforation. We had 4 deaths with a mortality rate of 36 percent. The average hospital stay in the survivors was 80 days. We believe that a shift to an early aggressive surgical approach is a more desirable option. Another conclusion drawn from this review is to avoid dilatations in early tight strictures of repaired esophageal atresias.

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ABSTRACT: Clear cell sarcoma of the kidney (CCSK) is a rare childhood tumor which has to be differentiated from Wilms' tumor. It has poor prognosis with a tendency to metastasis to bone. It requires aggressive chemotherapy. We present a case of CCSK that we treated and review its treatment to emphasize its existence as a separate entity from that of Wilms' tumor.

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ABSTRACT: In spite of availability of a variety of newer antibiotics, necrotising fasciitis in the newborn continues to be a surgical challenge not only in the general management, but also because of the severe skin and soft tissue loss. The author here reports 8 patients who presented with necrotising fasciitis resulting in large areas of necrosis of the skin and exposure of the skull bones due to necrosis of pericranium as well. The paper lays stress on through debridement and deals with guidelines used to harvest granulation tissue in case of exposed skull bones, before they can be covered by a skin graft. Since the size of skin grafts is large and graft mesh machines are not available easily, details of obtaining large grafts from the newborn's back is discussed. The author feels that the burns due to the low heat generated by the customary 'Sigree', used to keep the baby and the mother warm, could be one of the etiological factors.

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