ABSTRACT: Adenosine deaminase (ADA) is an enzyme of purine metabolism that catalyses hydrolytic and irreversible deamination of deoxyadenosine and adenosine to deoxyadenosine and adenosine respectively. Lymphocytic proliferation and differentiation requires ADA. The levels of ADA rise incases of tuberculosis. We studied the role of pleural fluid ADA estimation to detect tuberculosis in pediatric patients presenting with suppurative thoracic lesions. Thirty six patients with suppurative thoracic lesions who underwent surgery form June 1999 to July 2001 were included in the study. The age group was between 1.5 years to 9 years. The suppurative thoracic lesions included empyema thoracis, bronchiectasis, lung abscess and tubercular lobe destruction. Pleural fluid of all these patients was quantitatively assessed for ADA levels. Biopsies of pleura and lung were done in all patients. Pleural fluid ADA levels above 40IU/L was taken as suggestive of tuberculosis. Histopathological proof of tuberculosis was sought in all the patients. Sensitivity of ADA to detect tuberculosis was 88.2 percent, specificity was 89.5 percent, positive predictive value was 88.2 percent and negative predictive value was 89.5 percent.

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ABSTRACT: The study was aimed at finding a suitable premedicant which facilitates induction of anesthesia without causing significant undesirable side effects. Sixty children of ASA grade I and II, aged between 3 and 8 years were enrolled randomly in observer-blinded fashion into 3 different groups in equal numbers (n=20). Each group received midazolam (0.5 mg/kg) or ketamine (5 mg/kg) or combination of midazolam (0.25 mg/kg) plus ketamine (2.5 mg/kg) per orally, 30 minutes before induction of anesthesia. Children were evaluated preoperatively for the acceptance of the premedicants, sedation, separation from parents, response to intravenous cannulation and acceptance of face mask. There were no statistically significant differences with reference to the above mentioned parameters, in the 3 groups of patients. Some differences however, were noticed. The combination of midazolam plus ketamine provides good acceptability and predictable sedation within 30 minutes of administration. Smooth separation from the parents was not seen in this group. Intravenous cannulation was significantly uneventful (P0.05) with midazolam. Mask acceptance was better with midazolam or ketamine given alone. The incidence of side effects like nystagmus (50 percent) was higher with ketamine given along. No respiratony distress, tachycadia or poor arterial saturation was noted perioperatively in all 3 groups. We conclude that midazolam 0.5 mg/kg or combination of midazolam 0.25 mg/kg plus ketamine 2.5 mg/kg provides better premedication in children than ketamine 5 mg/kg when given orally 30 minutes before the induction of anesthesia.

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ABSTRACT: Authors report a 5-month old female child with fetus in fetu confirmed by X-ray, ultrasound and CT scan of the abdomen, morbid anatomy and histopathology. The clinical, imaging, macroscopic and microscopic features are illustrated.

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ABSTRACT: Background/aims: Doxorubicin, a potent chemo-therapeutic agent for treatment of pediatric neoplastic diseases, has a major side effect limiting its use-cardiotoxicity. The role of vitamin E in doxorubicin induced cardiotoxicity in rats has been studied. Methods: Eighteen Wistar male rats (age 60-100 days, weighing 175-260g) were divided into 3 groups of 6 each: group A (controls they received neither doxorubicin nor vitamin E); group B (doxo-rubicin treated rats-the experimental model of doxorubicin induced acute cardiotoxicity was created by giving intraperitoneal injection of doxorubicin 4 mg/kg for 7 days); group C (received pre-treatment with high dose vitamin e, 1000 IU/kg for 2 weeks by enteral route, followed by intraperitoneal doxorubicin injection, 4mg/kg, for 7 days. During these 7 days vitamin E supplementation was continued as earlier). The weights of the rats were measured daily. The rats were sacrificed 7 days after the last dose of doxorubicin injection by an overdose of ether. Rat heart tissues were taken for estimation of thiobarbituric acid reactants (TBARS) and for histopathological evaluation. Histological evaluation of rat heart was done by light and transmission electron microscopy. Special stains eg Masson's Trichrome and VanGieson were also done. Results: Mean weight of rats ranged from 205-226g. Mean total dose of doxorubicin in groups B & C: 36-38mg. Mean total dose of vitamin E in group C: 680mg (range 525-780mg). Weight loss was noted 2-3 days after doxorubicin injection in all 6 rats of group B and in 2 rats of group C (p=0.015). TBARS level in ng/g in the 3 groups were 65.07, 235.71 and 98.08 in groups A, B and C respectively (p=0.00511). Light microscopy: Focal and mild myocarditis and fibrosis were seen in 2 rats of group B. Sarcoplasmic vacuolization was not seen in any of the 3 groups. Light microscopy findings were statistically not significant. Electron microscopy showed sarcotubular dilatation and extracellular collagen deposition in 50-60 percent of rats in group B (p=0.04, 0.005). Lipid vacuolization, myofibril loss and mitochondrial disarray and dilatation differences were not statistically significant. Conclusion: Vitamin E pre-treatment prevented the TBARS elevation and the sarcotubular dilatation extracellular collagen deposition caused by doxorubicin induced oxidant damage. There is sufficient evidence to believe that vitamin E protects the rat myocardium from doxorubicin induced damage.

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ABSTRACT: Preoperative intravenous chemotherapy for advanced inoperable solid pediatric malignancies has considerable side effects. We have started using chemotherapy by direct intratumoral route which produces better local effects on the tumor and has significantly lower rates of adverse effects. During the past 2 years we have given intratumoral chemotherapy in 15 patients with various advanced pediatric solid malignancies, 8 patients had advanced Wilms' tumor, 4 patients had advanced abdominal neuroblastoma and 3 had rhabdomyosarcoma. The drugs used were the standard VAC regimen for pediatric solid tumors. Intratumoral chemotherapy was given by a fine 25 G spinal needle into the tumor site under ultrasound guidance. Injection hyaluronidase was mixed with the chemotherapeutic agent to enhance local spread of the drug. A record of all the symptoms and signs was maintained to assess the adverse effects of chemotherapy. Preoperative intratumoral chemotherapy produced marked reduction in tumor size in all types of solid tumors. Seven cases of Wilms' tumor were operated following intratumoral chemotherapy. Two cases of neuroblastoma and 2 of abdominal rhabdomyosarcoma were also successfully excised. The adverse effects observed with conventional intravenous chemotherapy were far less with intratumoral chemotherapy. Intratumoral chemotherapy produces a better local reduction on tumor size without causing much adhesions. The adverse effects have also been observed to be considerably less than intravenous chemotherapy.

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ABSTRACT: A 6-year old female child presented with complaints of low-grade fever, pain in the abdomen and fullness of the left side of the abdomen. USG abdomen, CT abdomen and renal angiography revealed the mass to be a Wilms' tumor involving the left moiety of a horseshoe kidney. Left nerphro-ureterectory was done. Histopathology revealed Wilms' tumor. The patient received post-operative chemotherapy and radiotherapy.

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ABSTRACT: A 12-year old boy with mucin secreting adenocarcinoma of rectum is being presented in the article. The patient presented with recurrent episodes of bleeding per rectum, abdominal pain and progressive constipation and had a hard rectal swelling on digital examination. Laparotomy revealed extensive metastasis and an unresectable mass in the rectum. Pelvic colostomy was done and the patient received postoperative chemotherapy.

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ABSTRACT: An 8-month old female child presented with complaints of malena and hematochezia requiring 13 units of blood. All investigations prior to surgery could not ascertain the cause of bleeding. Exploratory laparotomy and peroperative endoscopy revealed thickened jejunum and multiple mucosal erosions in the distal jejunum and the proximal ileum. Small gut biopsy revealed (i) moderate flattering and ulceration of jejunal mucosa (ii) diffuse infiltration of lamina propria and submucosa by eosinophils and (iii) prominent and congested capillaries. Lymph node biopsy showed follicular hyperplasia and lympho-histiocytes. Post-laparatomy, stool examination, done by concentration method, revealed ova of Ancylostoma duodenale. The patient was treated with albendazole for 21 days, starting on the fourth postoperative day, following which the gastrointestinal bleeding stopped completely.

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ABSTRACT: Obstruction of the anterior urethra by a congenital valve is an uncommon condition. This report describes a male infant who presented with poor urinary stream, recurrent UTI and a visible, fluctuant swelling in the ventral aspect of distal penis. VCUG and crytourethroscopy revealed an anterior urethral diverticulum with a valve like distal margin (anterior urethral valve). Transurethral fulguration of the valve has been done and the child is presently doing well.

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ABSTRACT: The authors studied 19 cases of Wilms' tumor over 5 years. During the first 2 years of the study, clinical diagnosis and imaging studies of Wilms' tumor was followed by nephrectomy without performing FNAC from the tumor mass. No pre-surgery chemotherapy was administered. But during the later 3 years of study, FNAC was done in patients clinically suspected to the suffering from Wilms' tumor. If cytodiagnosis and imaging study reports corroborated with the clinical diagnosis, then the patients were put on pre-surgery chemotherapy. Nephrectomy was done at a later date, followed by chemotherapy and/or radiotherapy. Results of the two phases showed the benefits of cytodiagnosis and neo-adjuvant chemotherapy.

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