ABSTRACT: Two cases of accidental entry of a leech per urethra into the urinary bladder are described. The first, a 7-year old boy, while playing in a waterlogged paddy field, fell on the ground and a leech entered through his urethra. The second, an 11-year old boy, while bathing in a pond, encountered a similar experience. Both the patients were managed by infusion of 50 ml of normal saline through a Foley catheter, this was clamped for 3 hours and then released. In both the cases leeches were micturated out intact on the next day after removal of the catheter. Both the patients presented with pain, dysuria and hematuria, which resolved spontaneously within several hours.

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ABSTRACT: In this study, we tried to evaluate the role of endoscopic 'STING' procedure in treating primary vesico-ureteral reflux in children in terms of its effectiveness, patient morbidity and complications. Between Aug 1999 and Aug 2001, 7 children with primary vesicoureteral reflux were treated endoscopically by 'sting' procedure. Post procedure and follow up voding cystourethrograms showed complete resolution of reflux and no recurrence so far. Our initial experience suggests that the endoscopic subureteral Deflux injection is a simple, safe and effective day care procedure for treating all grades of vesico-ureteral reflux.

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ABSTRACT: In this series (from Jan. 1999 to Dec. 2000), we encountered 6 cases of congental bladder diverticula (including 1 bilateral diverticula) which were not secondary to any neurogenic bladder dysfunction or bladder outflow obstruction. The diverticula had caused varying degree of bladder outflow obstruction, vesicureteral reflux (VUR) and probably ureteral obstruction leading to obstructive uropathy. Out of 6 cases, 5 had bilateral mild to moderate hydrouretoronephrosis, 3 had ipsilateral VUR and 5 showed mild to moderately raised urea and creatinine levels. All cases had plenty of pus cells in the urine with positive culture report. Presenting features in all cases were UTI with urinary retention, dribbling (chronic retention in 5 and acute in 1) and a palpable bladder; 5 cases had symptomatic urinary tract infection. Diagnosis and evaluation was done by voiding cystourethrogram (VCUG), ultrasonography (USG), renal biochemistry and routine urine examination with culture and sensitivity. All the cases were subjected to diverticulectomy and ureteric reimplantation. Postoperatively the patients recovered uneventfully. Follow up USG and VCUG showed resolving hydronephrosis and no VUR.

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ABSTRACT: Adhesion formation is considered to be an inevitable result of surgical trauma to peritoneal surfaces of intraperitoneal organs. Liquid paraffin is thought to prevent adhesions by forming a barrier between the apposing tissues. Methylene blue is hypothesized to inhibit the generation of free radicals thus preventing adhesions. The combined effect of the two in preventing adhesions has not been studied before. A total of 60 rats were studied. They were divided into 4 groups of 15 rats each: (i) Control group, (ii) Liquid paraffin group, (iii) Methylene blue group, (iv) Emulsion group. Talcum powder was used as the adhesion forming agent. Each rat was operated upon twice. In the first operation the control solution or experimental chemical was instilled into the peritoneal cavity at laparotomy. The second operation was done after two weeks of the first. At this operation, grading of adhesions was done. In our study, we have noted the deposition of talc and adhesion formation at certain anatomical sites which have not been described before. Severe adhesion formation was noted in the control group. Liquid paraffin reduces the severity and extent of adhesions significantly. The results with methylene blue were not conclusive. The emulsion group also showed a significant reduction of adhesion formation. Severe adhesions were noted in presence of ongoing intraperitoneal infection. To conclude: 1. The presence of liquid paraffin in the peritoneal cavity reduces adhesion formation significantly; 2. Ongoing intraperitoneal infection bars the effect of adhesion preventing agents. Dose and safety of these chemicals in human beings remains to be established.

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ABSTRACT: Hepatocyte transplantation (HT) has generated interest because of potential clinical applications especially in fulminant hepatic failure and in ex-vivo gene therapy. Studies conducted in recent years have shown survival of heterotopically transplanted hepatocytes with improved survival in acute hepatic failure and correction of congenital enzyme deficiency diseases. The present study aims to establish a murine model for intrasplenic hepatocyte transplantation and confirm long term survival of hepatocytes by histopathological examination and by in vivo 99m Tc-HIDA scintigraphy. The study used inbred Fisher rats for hepatocyte isolation and transplantation. Hepatocyte isolation was carried out using a modified collagenase digestion method to achieve a 85 cell viability. Hepatocyte transplantation was performed in 6 rats by injecting 0.5ml (8 X 10 to the power 6 cells ) of the isolated hepatocyte suspension into the splenic parenchyma. The control group of 4 rats were injected with 0.5 ml normal saline. In vivo dynamic 99m Tc-HIDA scintigraphy was performed 90 days after transplantation. The rats were sacrificed and the spleen was evaluated histopathologically using routine H & E staining and periodic acid Schiff (PAS) stain for glycogen deposits. The scintigraphic studies showed that 5 of the 6 transplanted rats demonstrated uptake of HIDA in contrast to none of the control animals. Further, the time activity curves of the liver and spleen of transplanted rats showed similar kinetic patterns. Histological evaluation showed hepatocytes in the splenic red pulp with fatty vacuolation and PAS positive glycogen granules in the transplanted group of rats. In conclusion, hepatocyte transplantation is feasible in syngenic rat spleens and the collagenase digestion method adopted in this study, achieves a high yield of viable cells. In vivo dynamic HIDA scintigraphy is an easy and reliable modality for noninvasive graft function monitoring.

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ABSTRACT: There were 127 casualities evaluated during the Gujrat Earthquake by Indian Air Force. These include 12 Pediatric Surgical casualties. There were 8 males and 4 females between 1 and 12 years of age. In these babies 25 injuries were detected and each baby had 1 to 5 injuries. Six babies had head injuries and injuries involved other systems also. They were treated by different surgical techniques. All 12 children survived. This paper will highlight the experience with mass casualties following the earthquake in Gujarat.

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ABSTRACT: Clubfoot remains an unsolved problem, inspite of serious research through centuries. Although Egyptians and Aztecs knew about clubfoot in ancient times, the treatment of clubfoot was first documented by Hippocrates. The treatment pattern has changed through centuries from repeated gentle manual correction and mechanical devices for gradual correction to forcible correction using splints or wrenches. Use of adhesive plaster for the correction of clubfoot, has been succeeded by use of plaster of paris cast. The present author has tried a new forefoot abduction device in the treatment of clubfoot. Surgery after failure of conservative treatment has been in practice since the late eighteenth century. The operative procedures included soft tissue surgery for early correction of deformity and bony surgery in late cases where secondary bony changes have occurred. Tendon transfers and correction of supramalleolar lateral tibial rotation in clubfoot by osteotomy have also been suggested by various authors. Slow and controlled distraction of soft tissues by different devices has been used in the twentieth century for correcting clubfoot. Inspite of various methods for the correction of clubfoot the mainstays of treatment are correction of contracted soft tissues at an early age and bony surgery for secondary deformities.

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ABSTRACT: Complete rectal prolapse or procidentia denotes a full-thickness eversion of the rectal wall through the anal canal. The authors present the case of a 12-year old boy who had presented with chronic rectal prolapse, which was successfully repaired laparoscopically.

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ABSTRACT: A retrospective study of patients with anorectal malformations and associated urogenital abnormalities admitted to the Pediatric Surgery ward of Assam Medical College Hospital between 1996 and 2001 was undertaken. A total of 200 patients with anorectal malformations were admitted of which 59 patients had associated anomalies involving other systems. Urogenital abnormalities were found in 28 patients. Incidence of different types of urogenital anomalies with various types of anorectal malformations were analysed and possible management and outcome discussed.

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