Vivek Manchanda

Bilateral clear cell sarcoma of the kidney

Fig. 1 A, Axial contrast enhanced CT scan showing large heterogenous left renal mass lesion (solid arrow) with areas of necrosis with surrounding thin rim of normal renal parenchyma posteroinferiorly. Bilateral renal veins and inferior vena cava show no evidence of thrombosis (hollow arrows). B, Axial contrast enhanced CT scan showing predominantly solid mass lesion arising from lower pole of the right kidney (solid arrow) in addition to the left renal mass (hollow arrow). Bilateral clear cell sarcoma of the kidney

Intercostal variant of lumbar hernia in lumbocostovertebral syndrome: our experience with 6 cases

Lumbocostovertebral syndrome (LCVS) is a rare type of congenital lumbar hernia. Its features include lumbar hernia associated with genitourinary, vertebral, and rib anomalies. Less than 25 cases have been reported to date. We describe the clinical manifestations and associated anomalies in 6 cases of LCVS managed by us. The patients with suspected LCVS syndrome should be evaluated by detailed clinical history, examination, conventional radiography, magnetic resonance imaging spine, ultrasound abdomen, and echocardiography. The defect can be repaired using local tissues in infancy. There is a need for long-term follow-up for possible late recurrence and scoliosis.

Epidermoid cyst of clitoris mimicking clitoromegaly

Clitoromegaly in pediatric and adolescent age group is usually indicative of a disorder of sexual differentiation. We report a girl child presenting with clitoral enlargement due to an epidermoid cyst. The cyst was excised with complete cosmetic recovery.

Subcutaneous bronchogenic cyst

Bronchogenic cysts occur due to the anomalous development of the primitive tracheobronchial tree early in fetal life. They are usually present in middle mediastinum. Rarely, they have been found in other locations. We describe two patients with subcutaneous bronchogenic cysts located over manubrium sterni with special emphasis on the difficulties in pre-operative diagnosis. The two boys were managed by complete excision of the cysts. The children are well on follow-up.

Mitchell's technique for epispadias repair: Our preliminary experience

Aim: We present here experience of a single surgeon with Mitchells procedure for correction of epispadias. Materials and Methods: Nine boys (mean age 5½ years, range 9 months to 16 years) underwent Mitchells repair in Department of Pediatric Surgery over a period of 5½ (September 1999 to March 2005) for correction of epispadias. Six of these patients had come for the second stage of exstrophy-epispadias repair after primary bladder closure; the other three had incontinent penopubic epispadias. Results: The penis was cosmetically acceptable as regards to size, glans shape and peno-pubic angle in all the patients. However, there was a high incidence of penopubic fistula (44%). These patients with penopubic fistula also required postoperative urethral dilatations, at times repeated. One of the common factors to these subset patients was their younger age when Mitchells urethroplasty was performed. Limitations: The series is descriptive in nature, short in numbers and does not provide statistical comparison of Mitchells procedure with the previously done procedures. Conclusions: Mitchells complete penile disassembly technique for epispadias repair is more acceptable anatomical procedure that results in near-pendulous penis. However, when performed at young age, it is fraught with the complication of penopubic fistula similar to that as seen with Cantwell-Ransleys procedure. Mitchells procedure creates a hypospadiac meatus initially and the meatal advancement is required as for any other distal penile/coronal hypospadias.

Bronchopulmonary foregut malformation mimicking pseudocyst of pancreas

We report a four-yr-old girl who was successfully treated for a large gastro-duodenal duplication that communicated with extra-lobar pulmonary sequestration on one end and the main pancreatic duct on the other. Such an association has not been reported hitherto.

Novel Presentation of Labial Synechiae: Two Urinary Streams

Labial synechiae, also referred to as labial adhesion or labial agglutination, is a disorder of the female genitalia characterized by thin, membranous adherence of the labia minora. Typically, the fusion originates from the posterior fourchette and advances toward the clitoris. Complete labial fusion may conceal the vaginal introitus completely. Partial labial fusion is also possible and may occur near the posterior fourchette.