Shahid Iqbal

Management of biliary perforation in children

BACKGROUNDnTo study the aetiology, management and outcome of biliary perforations in paediatric age group.nnnPATIENTS AND METHODSnIn a retrospective study, the records of patients presented with biliary peritonitis due to biliary perforations, managed from March 2006 to July 2009, are reviewed.nnnRESULTSnEight male patients with biliary peritonitis due to biliary perforation were managed. These patients were divided in two groups, A and B. Group A, (n = 3) patients, had common bile duct (CBD) perforation, and Group B (n=5) patients had gallbladder perforation. The presenting features were abdominal pain, fever, abdominal distension, vomiting, constipation, jaundice and signs of peritonism. The management of CBD perforations in Group A was by draining the site of perforation and biliary diversion (tube cholecystostomy). In Group B, the gallbladder perforations were managed by tube cholecystostomy in four patients and cholecystectomy in one patient, however, one patient had to be re-explored and cholecystectomy performed due to complete necrosis of gall bladder. There was no mortality in our series. All patients were asymptomatic on regular follow-up.nnnCONCLUSIONnEarly optimal management of biliary perforations remarkably improved the very high mortality and morbidity that characterised this condition in the past.

Laparoscopic management of 128 undescended testes: our experience.

BACKGROUNDnTo describe different laparoscopic procedures in the management of impalpable undescended testes (UDT) and their outcome. Descriptive study.nnnMATERIALS AND METHODSnThe medical records of all the patients, managed laparoscopically for impalpable UDT between January 2008 to March 2011 at the department of Pediatric surgery, the Childrens Hospital and The Institute of Child Health Lahore, Pakistan were reviewed for demography, history and clinical examination, investigations, operative notes, complication and outcome.nnnRESULTSnThere were a total of 90 patients (128 testes) with impalpable UDT managed laparoscopically. The mean age of presentation was 4.25 years (SD±3.47). In 38 (42.2%) patients, UDT were bilateral, whereas in 33 (36.7%), these were right sided and in 19 (21%), these were left sided. Laparoscopic findings revealed 65 (50.8%) testes lying higher up in the abdomen, 26 (20.3%) testes at internal ring, vas and vessel going into the deep ring in 22 (17%) cases and 15 (11.7%) atrophied/vanishing testes. Laparoscopic 2-Stage Fowler-Stephen (FS) orchidopexy was performed in 65 testes, laparoscopic orchidopexy was performed in 26 testes, laparoscopy followed by inguinal exploration and orchidopexy in 19 testes (3 testes were atrophied) and orchidectomy was performed in 9 testes. There were three conversions to laparotomy, one for external iliac iatrogenic injury and two for adhesions of the testes with the intestine. During follow-up at 6 months, 2 patients had testicular atrophy and the parents of 5 patients where testes could be brought to the scrotum neck were worried for the location.nnnCONCLUSIONnLaparoscopic management of impalpable UDT is an effective way of managing every kind of impalpable UDT. It is safe and its complications are very few.

Cystic hygroma of unusual sites: report of two cases.

Cystic hygroma is the cystic variety of lymphangiomas. Its common site is cervico-facial region, followed by axilla, superior mediastinum, mesentery and retroperitoneal region. Its occurrence in upper extremity is rarely reported, whereas its location at sternum has not been reported before. We report two cases of cystic hygroma occurring at unusual sites.

Persistent mullerian duct syndrome: A 24-year experience.

BACKGROUNDnPersistence of mullerian duct derivatives in otherwise normal male child is a very rare disorder. This may lead to diagnostic as well as management dilemma.nnnMATERIALS AND METHODSnThe medical record of 27 cases of persistent mullerian duct syndrome (PMDS) operated in three teaching hospitals more than a period of 24years is retrieved and analyzed for demography, clinical presentation, investigations, and treatment.nnnRESULTSnThere were a total of twenty seven male children with PMDS. The age was ranged between 3months and 19years. Ten patients presented with isolated bilateral UDT, six patients with bilateral UDT and unilateral inguinal hernia (4 left and 2 right sided inguinal hernia), and eight patients presented with right inguinal hernia and left sided UDT. Eight of 27 patients showed familial trends i.e. four pairs of brothers had PMDS in our series. In 21 patients, the diagnosis was made incidentally while operating for UDT and inguinal hernia. At operation 5 patients had female type of PMDS and 22 patients had male type PMDS. In 6 patients (male type), the PMDS was associated with transverse testicular ectopia. In 18 patients the initial operation was performed through inguinal incision with excision of mullerian remnants in the same settings in 12 patients. In 4 patients, straightforward laparotomy performed (familial cases) to excise mullerian remnants. In 5 patients, the PMDS was diagnosed on laparoscopy; initially biopsy of these remnants and gonads was done followed by excision of remnants by laparotomy approach. Biopsies taken from gonads in each patient revealed testicular tissue with variable degree of immaturity and dysplasia. The biopsy of mullerian remnants did not reveal any malignancy. All patients were genotypically male.nnnCONCLUSIONnIsolated undescended testes, left UDT and right inguinal hernia, bilateral UDT and unilateral inguinal hernia are the main presenting features of PMDS. About 30% of the patients showed familial tendency. Inguinal exploration for UDT or inguinal hernia, and laparoscopy for UDT reveal incidental findings of mullerian remnants. PMDS can be managed as single stage procedure however two stage procedure including gonadal biopsies in first stage followed by mullerian remnants excision and orchidopexy in the second stage can be opted if there is doubt about gonads and genotype.

Exploring the Potential of Quinoa Accessions for Salt Tolerance in Soilless Culture

Pakistan has more than 6 million hectares of salt affected land and quinoa is tested as a facultative halophyte having super food characteristics. A hydroponic study was conducted to explore salt tolerance of two quinoa accessions, Ames-13737 (Q7) and PI-634919 (Q9) under a range of NaCl levels (0, 100, 200 and 300 mM) in wirehouse during 2016. Plant nursery was raised, and at four leaf stage, the seedlings were transferred to plastic tubs containing 20 L half strength Hoagland’s solution as nutrient source. Salinity was developed incrementally to avoid osmotic shock after two days of transplanting. Results showed that growth (shoot length, root length and dry weight/plant) reduced drastically in Q9 by increasing the salinity level as compared to Q7. However, a comparable growth was observed in Q-7 at 0 and 100 mM i.e. the dry weight at 0 and 100 mM salinity were 0.8643 g and 0.8125 g, respectively. Furthermore, genotype Q7 was found better than Q9 by producing 10% more dry weight (0.2790 g) at the highest salinity level which was linked to 57% more leaf K accumulation (28.64 mg K g dry weight) as compared to Q9 (12.54 mg K g dry weight). It is concluded that tolerance of Q7 to salt stress might be due to more absorption of K by the roots at increased Na level.