ABSTRACT: VATS (Video assisted thoracoscopic surgery) is gaining acceptance as a primary modality of treatment in cases of early empyema. It decreases the morbidity and reduces the hospital stay of the patient. Fourteen cases of empyema presented at a medical college hospital in the Department of Pediatric Surgery from June 2000 to Dec 2002. All of these cases were subjected to VATS and an attempt for debridement and drainage was made in all of them. The patients who had presented early in the fibrinopurulent stage of empyema settled with thorough debridement and those who had presented later in the fibrous stage required decortication, There were 9 male patients and 5 females. The ages of these patients ranged from 11 months to 12 years. Eleven cases were treated only thoracoscopically and three had to be converted to open method for a thorough decortication. Eight of these patients underwent primary thoracoscopic debridement and drainage without prior tube thoracostomy. The results in all the patients were good.

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ABSTRACT: We operated on 11 patients by LAARP over a 2-year period from March 2001 to February 2003. There were 8 males and 3 females. The age ranged from 2 months to 4 years. Follow up period ranged from 1 month to 2 years. Initially all 11 patients were managed with diverting sigmoid colostomy followed by LAARP. All patients were preoperatively evaluated with ECHO (echocardiogram), USG (ultra sonogram) abdomen, MCU (Micturating Cysto Urethrogram) and distal cologram to assess the cardiac status, genitourinary system and type of fistula. The abdomen was accessed by 3 or 4 ports, with the help of 30 degree telescope; colorectum was dissected up to distal end of the fistula. Fistula was ligated and divided (3 cases) or divided alone (8 cases). Levator Ani Muscle contraction was demonstrated by diathermy probe with low intensity current from above; dissected colorectum was brought down through the centre of the muscle complex in the midline with the help of a laparoscope and external muscle stimulator from the perineum and anoplasty was done. All the patients withstood surgery well. Postoperatively we encountered adhesive intestinal obstruction (1), mucosal prolapse (1) and anal Stenosis (1). Postoperative CT pelvis revealed the rectum is sited within the sphincter complex in all children. Fistula ligation was optional or not obligatory, fecal continence was satisfactory till date. We are presenting the technical aspects of 11 cases LAARP for high ARM from our institute.

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ABSTRACT: It is well accepted that increased nerve trunk density and thickness are common in aganglionic segments of colon in Hirschsprung's disease (HD). Attempts have been made previously to quantitate the degree of increase in density as well as thickness of nerves. In this study, 36 cases of defective intestinal innervation were analysed, 30 of which were HD. Sections of ganglionic and aganglionic colon were taken and a detailed histological analysis was performed. Nerve trunk were studied in terms of density and thickness. It was found that nerve trunks were more numerous in the aganglionic portion and also thicker compared to those in the ganglionic colon. Average number of nerve trunks in ganglionic and aganglionic colon were 27.50/10 mm2 and 70.28/10 mm2 respectively. Nerve trunks thicker than 45mu was found helpful in the diagnosis of HD when used as additional positive objective criteria apart from absence of ganglion cells. Histopathological study of suspected cases of HD is important as it serves to distinguish cases of HD from those of neuronal intestinal dysplasia (NID) thus helping in selecting the therapeutic approach.

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