N. Zachariah

External laryngotracheal trauma in children.

External laryngotracheal trauma in the paediatric population, although rare, presents a diagnostic and therapeutic dilemma for the attending surgeon. The purpose of this study was to evaluate the clinical profile, treatment and outcome and to establish a simple, effective management protocol in this emergency. A retrospective case series was studied. There were 12 patients aged 2-14 years in this series, eight of them (67%) having closed injuries. Their clinical presentation was correlated to conservative management, tracheostomy and surgical intervention. In the open injury group all the patients (100%) underwent tracheostomy, upper endoscopy and neck exploration. One patient (25%) in this group developed subglottic stenosis. In the closed injury group, seven patients (88%) had tracheostomy with upper endoscopy, and two of them (25%) had neck exploration in addition. One patient (13%), however, developed glottic stenosis. The patients with stenosis underwent multiple surgical interventions prior to final decannulation. There was no mortality. Breathing difficulty/stridor were the commonest clinical presentations in children with acute external laryngotracheal trauma. Tracheostomy and early surgical intervention appeared to be the treatment of choice. A protocol with major and minor criteria of clinical presentation is suggested for effective management.

Temporal dermoid--an unusual presentation.

Abstract It is rare for a frontotemporal dermoid cyst to present as a discharging sinus, and even more rare for it to have intracranial extensions. Only a few cases of intraorbital extension have been reported. We report a 14-month-old girl who presented with all the aforementioned features. She had a temporal dermoid with three discharging sinuses over the temporal area, lower lid, and cheek. It also had an intraorbital extension through the lateral orbital wall and an intracranial extension through the temporal bone. Preoperative computed tomography was done as there was a history of “orbital cellulitis”. Excision of the cyst was done using a hemicoronal-preauricular incision. A lateral orbitotomy was required to remove the orbital component in continuity with the rest of the cyst.

Varied presentations of unilateral lung hypoplasia and agenesis: a report of four cases

Abstract Unilateral lung hypoplasia or agenesis can be asymptomatic or␣present with recurrent respiratory symptoms. The latter may be amenable to surgical treatment in␣selected cases. Of four children in this report, two are being managed without surgery. A third was relieved of his symptoms by pneumonectomy. The fourth presented with acute foreign-body inhalation into the healthy right main bronchus, and coexistent left pulmonary agenesis was discovered at bronchoscopy. Bronchoscopy and computed tomography were found to be the most useful investigations in management.

Gender assignment in male pseudohermaphroditism: an Indian perspective

Parents of 21 out of 30 children with male pseudohermaphroditism (MPH) opted for a male upbringing for their child and appropriate management was instituted. The phallic size in these 21 children varied from adequate to microphallus, although at least one externally visible testis was present in all cases. Nine children who were assigned a female gender were being reared as girls at home prior to medical consultation and 7 of them had a female-type vulvar outlet. This predominance of male gender assignment in MPH is in striking contrast to the Western experience. The reasons for this difference in India are discussed in the light of the Indian social and economic background.

Bilateral high loop ureterostomy in the primary management of posterior urethral valves in a developing country

Abstract Of 200 consecutive cases of posterior urethral valves (PUV) managed in a single institution, 26 underwent bilateral high loop ureterostomy (BU) as their first operative intervention. Indications for BU were persistently raised serum creatinine levels after bladder drainage, severe urosepsis, and urinary ascites, especially in a neonate or infant. After a median period of 1 year of diversion, the serum creatinine fell from a median value of 2.5 to 0.6 mg%. Twelve cases have been fully undiverted without deleterious effects (median serum creatinine level 0.5 mg%). Three patients died. Of the 14 renal units with documented persistent vesicoureteric reflux at the time of undiversion, only 1 has been reimplanted. One child has undergone bladder augmentation.

Pulmonary lipoblastoma: a case report

Abstract. We report a case of pulmonary lipoblastoma in a 2-year-old child. This pathology has not been previously reported in the English literature.

Choledochal cyst sans cyst--experience with six "forme fruste" cases.

Abstract Six children presented with clinical symptoms suggestive of a choledochal cyst (CC), but were found to have only mild dilatation of the common bile duct. Further imaging revealed a long common pancreaticobiliary channel in all cases. There was complete relief after surgery provided a pancreaticobiliary disconnection was incorporated in the operative management. A high index of suspicion is required to diagnose this condition, which has been previously reported as “forme fruste CC”.

Mucosal-lined hemiperineal anomaly possibly caused by antenatal rupture of a caudal duplication

Abstract.In a 1-month-old infant with a mucosal-line left hemiperineal defect associated with penoscrotal hypospadias, penoscrotal transposition (PST) and an overhanging caudal skin-covered soft-tissue flap resembling a caudal appendage, perineal anatomy could be restored by excising the mucosa and using the overhanging flap to cover the resultant defect. The PST was corrected at the same time. Squamous, gastric, small-intestinal, and respiratory epithelia were present histologically in the mucosa in addition to adjacent cartilaginous elements. A caudal duplication that had ruptured in utero through the hemiperineum could explain the anomaly.

Pneumonostomy in the surgical management of bilateral hydatid cysts of the lung.

Abstract During the period 1994–1998, three patients with bilateral hydatid cysts of the lung (HCL) underwent operative removal of the cysts. In three of the six lungs operated upon the conventional technique was used: after removal of the cyst and suture closure of bronchial leaks, the chest was closed with an intercostal drainage tube. Two of these patients developed bronchopleural fistulae requiring rethoracotomy and prolonged hospital stays. The other three lungs were operated upon using the pneumonostomy technique: after excision of the cyst a separate catheter is fixed within the residual lung cavity and brought out through the adjacent chest wall, effectively marsupialising the residual cavity to the atmosphere. All these patients had an uneventful postoperative recovery. We conclude that the pneumonostomy technique is a very useful method of treating HCL surgically, especially when the cysts are bilateral and complicated.

Torted ovarian cyst with lethal bleeding diathesis in an infant.

Abstract We report a 9-month-old infant with a torted ovarian cyst who presented with an acute consumptive coagulopathy (CC) with lethal outcome. That ischemic tissue can act as a trigger for a CC is well-known, but we did not find any report of a torted ovarian cyst causing a coagulopathy in the pediatric literature. This potential complication constitutes one more reason for the prompt surgical removal of torted ovarian cysts in infants.