Brijesh Kumar Lahoti

Cystic lymphangioma of the breast in a 6-year-old boy☆

Cystic lymphangiomas commonly occur in childhood, but breast involvement is an extremely rare entity that tends to be more common in adults, with only a few cases reported in children. We describe a 6-year-old boy who presented with a lump in the left breast that measured 4.5 x 3.5 x 2.5 cm. A local excision was performed, and a diagnosis of cystic lymphangioma was confirmed. There was no recurrence of the lesion after 18 months after surgical excision. A brief case description and review of the relevant literature is presented.

Epidemiological trends of pediatric trauma: A single-center study of 791 patients

Aim: To assess the various epidemiological parameters that influence the causation of trauma as well as the consequent morbidity and mortality in the pediatric age group. Materials and Methods: A prospective study of 791 patients of less than 12 years age, was carried out over a period of 1 year (August 2009 to July 2010), and pediatric trauma trends, with regards to the following parameters were assessed: Age group, sex, mode of trauma, type of injury, place where the trauma occurred and the overall mortality as well as mortality. Results: Overall trauma was most common in the school-going age group (6-12 years), with male children outnumbering females in the ratio of 1.9:1. It was observed that orthopedic injuries were the most frequent (37.8%) type of injuries, whereas fall from height (39.4%), road traffic accident (27.8%) and burns (15.2%) were the next most common modes of trauma. Home was found out to be the place where maximum trauma occurred (51.8%). Maximum injuries happened unintentionally (98.4%). Overall mortality was found out to be 6.4% (n = 51). Conclusions: By knowing the epidemiology of pediatric trauma, we conclude that majority of pediatric injuries are preventable and pediatric epidemiological trends differ from those in adults. Therefore, preventive strategies should be made in pediatric patients on the basis of these epidemiological trends.

Sternal cleft repair: A report of two cases and review of literature

A cleft sternum is a rare congenital anomaly often diagnosed as asymptomatic at birth. Clinical outcome may be unfavourable when an associated anomaly, particularly, an intra cardiac anomaly coexists with the defect. Primary repair should be employed in the neonatal period because the flexibility of the chest wall is maximal and thus the compression of underlying structures is minimal. However, patients with sternal cleft may even present late in the childhood or adolescence period. We herein report two cases of successful repair of sternal clefts with review of the available literature.

Rhabdomyosarcoma of the posterior chest wall in a newborn: a case report

Rhabdomyosarcoma is the most common soft tissue malignancy of childhood, but may occur extremely rarely in the neonatal period. There are only a few reports of rhabdomyosarcoma in neonates. Although, it may arise anywhere in the body, the head and neck, and genitourinary regions are the most frequent sites. Truncal and chest wall rhabdomyosarcoma is relatively rare occurrence. We report a neonate with embryonal rhabdomyosarcoma arising from the posterior chest wall muscles at birth. Computer Tomography scan raised the possibility of rhabdomyosarcoma or neurofibroma, fine-needle aspiration cytology was inconclusive. Total excision was done and chemotherapy given. At 6 months child is without recurrence.

Hemostasis during hypospadias surgery via topical application of feracrylum citrate: A randomized prospective study

Aim: Report of our experience with topical feracrylum citrate to minimize hemorrhage-related complications in pediatric hypospadiac patients. Materials and Methods: One hundred and fifty consecutive pediatric hypospadiac patients over 3 years (75 in study group and 75 controls - random allocation) were studied. One hundred milliliter of 1% feracrylum citrate solution was used in study cases and equivalent normal saline in controls. The parameters assessed were frequency of cauterizations, intraoperative blood loss, wound edema and postoperative complications. Results: Average number of cauterizations was 1.55 per patient in study group and 5.7 per patient among controls. Among cases, average number of blood soaked gauge pieces was 3.56 per patient, correlating with average intraoperative blood loss of 17.8 ml. In controls, average blood soaked gauge pieces were 6.2 per patient corresponding to an average blood loss of 31 ml. Postoperative hematoma was seen in 8% cases compared with 18% controls. Wound edema appeared in 13.3% cases and 47% controls. Postoperative complications were higher among controls. Conclusions: Feracrylum is an effective and safe topical hemostatic agent to minimize significantly diffuse capillary oozing and surface bleeding. It reduced the frequency of cauterization and tissue damage, intraoperative blood loss, postoperative hematoma, wound edema and postoperative complications.

A prospective comparison of topical feracrylum citrate versus adrenaline as haemostatic agent in hypospadias surgery in children

Background: A comparative study of topical feracrylum citrate versus adrenaline to minimise haemorrhage-related complications in paediatric hypospadiac patients. Patients and Methods: A total of 108 consecutive paediatric hypospadiac patients (48 in the study group and 60 control - random allocation) were studied. In the study group, 1% feracrylum citrate solution was used and adrenaline (1:100,000) in controls. Results: Among the study group, average number of blood-soaked gauge pieces were 2.95/patient, correlating with average intraoperative blood loss of 14.74 ml. In controls, average blood-soaked gauge pieces were 4.83/patient corresponding to an average blood loss of 24.13 ml. The average amount of blood loss during surgery in the <5 years was 13.70 ml/patient in the feracrylum group, while the same in the adrenaline group was 23.45 ml. Average duration of surgery was 79 min in the study group, while the same in controls was 94 min/patient. Average number of cauterisations was 0.255/patient in the study group and 0.583/patient among controls. Postoperative haematoma was seen in 8% study group compared with 18% controls. Wound oedema appeared in 4.17% study group and 11.67% controls. Postoperative complications were higher among controls. Conclusions: Feracrylum is more efficient and safer topical haemostatic agent than adrenaline. It reduced the frequency of cauterisation and tissue damage, intraoperative blood loss, and postoperative complications.

Immature cystic teratoma of head of pancreas

Cystic pancreatic tumors are rare in children and the immature cystic teratoma of the pancreas is even rarer. A review of the world literature shows 18 documented cases involving all the age groups. The preoperative evaluation of this lesion is rather questionable, with definitive diagnosis taking place intraoperatively. We report the 19th case, in a 5-month-old male child. The clinical presentation and preoperative diagnosis of this anomaly are discussed.

Total urogenital sinus mobilization in common cloaca: experience of 25 cases.

OBJECTIVE Common cloaca is a complex anorectal and genitourinary malformation in which the rectum, vagina and urinary tract are fused to form a single channel. Surgical treatment is complicated especially when the channel is long. Our aim was to emphasize the importance of joint mobilization of the urogenital sinus after separation from the rectum. This maneuver avoids separation of the urinary tract from the genital tract, and reduces operating time by more than 60%. The functional and cosmetic results are also excellent. PATIENTS AND METHODS We retrospectively reviewed all consecutive cases of persistent cloaca managed by total urogenital mobilization via a posterior sagittal approach during 2005-2009. There were 25 patients, with a median age of 18 months (10 months-3 years). Two patients with a long common channel required additional maneuvers after mobilization to complete the reconstruction. Each patient had a primary covering colostomy. After distal loop colograms, genitograms, renal ultrasound and genitoscopy, patients were planned for definitive surgery at 1-3 years of age. CONCLUSION Total urogenital sinus mobilization in cases of common cloaca represents a surgical advance, and is a promising procedure with reasonably good results for this complex anomaly.

Megacystis microcolon intestinal hypoperistalsis syndrome complicated by perforation

Megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS) is a quite rare congenital and fatal disease. The disease is three to four times more prevalent in females than males. Most of the cases die within the early months of their lives. We present the case of a newborn male with antenatal ultrasound suggesting the diagnosis of MMIHS. The case was admitted for perforation complicated with prematurity after birth. This case is th e only one where MMIHS presented as perforation.

Leiomyoma of the mesentery in an infant

Leiomyoma of the mesentery is an uncommon tumor among gastrointestinal stromal tumors. This has been documented in adults and children. However, there is only one case reported in an infant and we are presenting such a rare second case in a 6-month-old male infant. Exploration of the abdomen revealed a solid mass within the leaves of the mid-ileal mesentery that could be enucleated out entirely after careful dissection. Histopathology suggested it to be leiomyoma of mesentery.