Pseudoexstrophy in a female child.

A six-year-old female patient presenting with a swelling in the infraumbilical part of the abdomen, bulging out on straining, was diagnosed to have pseudoexstrophy bladder. The urinary tract was normal. The patient had bifid clitoris. There was no other associated malformation. Surgical repair of abdominal wall defect was done successfully. A new classification of exstrophy variants is proposed.

Aplasia cubs congenmta associated with meningomyelocoel.

Aplasia cutis congenita is a rare congenital anomaly where skin is missing over part of the body. Most of the cases are present on the scalp. We present a case of ACC where skin was absent over the lumbosacral area. It was associated with meningomyelocoel.

Choledochal cyst: a 10-year experience.

A retrospective study of 11 cases of choledochal cyst over a period of 10 years is presented. There were 8 females and 3 males in a ratio of 2.67:1. The classical triad of jaundice, mass and abdominal pain was seen in none of our patients. Ultrasonography was diagnostic in 9 out of 11 (80%) patients. Surgical procedures performed were, complete excision of the cyst with Roux en Y hepaticojejunostomy (nine cases), internal drainage of the cyst (one case) and excision of the extrahepatic cyst with Roux en Y hepaticojejunostomy in one case of Type IV choledochal cyst. One patient died in the immediate postoperative period. Others have remained well upto 10 years follow-up. We recommend total cyst excision with hepaticojejunostomy as the treatment of choice.

Caudal duplication--a case report.

Caudal duplication is a rare entity due to incomplete separation of mono-ovular twins. It is usually associated with various congenital malformations involving mainly the genitourinary and gastrointestinal tracts. We report such a case operated upon successfully in which there was no other associated anomaly.

Multiple neurilemmomas of the penis.

A 10-year-old male with multiple small swellings over the shaft of the penis for 2 years was found to have multiple neurilemmomas on histopathologic examination. The case is reported in view of the extreme rarity of the entity.

Cystic lymphangioma with special reference to rare sites.

A 10 year retrospective study of 45 cases of cystic lymphangioma (CL) in children is presented. There were 25 females and 20 males. Age ranged from 6 months to 8 years. Common sites were involved in 38 and rare sites in 7 patients. Rare sites were--gluteal region (1), pelvis (1), retroperitoneum (1), mesentery (2), inguinal region (1) and inguinoscrotal region (1). The clinical presentation included sudden increase in size (25), lump abdomen (3), gluteal abscess (1), abdominal distension (1) and inguinal swelling (2). Diagnosis was established preoperatively in 38 cases, and after surgery and histopathology in 7 cases. Near total or subtotal excision was carried out in all cases. Facial nerve palsy (1) and recurrence (2) were the complications of surgery. The study is presented to highlight the occurrence of the cystic lymphangioma at rare sites to avoid diagnostic errors and unnecessary mutilating surgery.

Post traumatic bile ascites.

A 4 year old girl with progressive distension of abdomen and previous history of blunt abdominal trauma was found to have bile ascites due to left hepatic duct (LDH) injury. The management with a brief review of literature is discussed below.

Toast and tea before elective surgery? A national survey on current practice.

UNLABELLED: A more tolerant approach to preoperative fasting guidelines for healthy adults undergoing elective surgery was recently recommended by a task force appointed by the American Society of Anesthesiologists. This recommendation liberalizes the intake of clear liquids and specifically allows a light breakfast (e.g., toast and tea or coffee) up to 6 h before elective surgery. We conducted a national survey to determine whether anesthesiologists giving anesthesia in an outpatient setting in the United States were currently following these recommendations, and whether institutional policy reflects these new guidelines. The population consisted of the entire active membership of the Society for Ambulatory Anesthesia, providing an initial sample size of 623 subjects. Most conservatively calculated, we had a response rate of 59.6%. A total of 62% of the respondents said they have an institutional policy in place to allow clear liquids orally 2-3 h before the induction of anesthesia. However, only 35% of the respondents said their institutions had a policy in place allowing a light breakfast 6 h before elective surgery. Nevertheless, only 3% of the responders said they would cancel the operation if a patient actually arrived at the facility after consuming a light breakfast, such as toast and tea 6 h before elective surgery, 32% would delay surgery to later that day, and 65% would proceed without delay. We concluded that most anesthesiologists practicing outpatient anesthesia in the United States have already changed their practice pattern to conform to the recent recommendations of the American Society of Anesthesiologists task force on preoperative fasting time. IMPLICATIONS: Findings of this national survey conducted among active members of the Society for Ambulatory Anesthesia may encourage anesthesiologists throughout the world to take a more liberal attitude toward allowing clear liquids 2-3 h and a light breakfast 6 h before an elective surgery in healthy patients.

Intrauterine intussusception--a cause for ileal atresia.

A case of ileal atresia consequent to intrauterine intussusception is reported. The baby presented with features of neonatal intestinal obstruction but signs of peritonitis were absent. The intussusception was discovered on gross examination of distal atretic ileal segment. The case was managed successfully by resection and end to back anastomosis. This case is reported to highlight intrauterine intussusception as one of the causes of ileal atresia.

Rapunzel syndrome--a case report.

The gastric trichobezoars usually occur in young girls, often those with psychiatric disorders. Rarely these are known to extend from the stomach to the small intestine as a tail, when they are termed the Rapunzel syndrome. Until 1997, only 10 such cases have been reported in the literature. We report another case in which we could extract the trichobezoar by gastrotomy and enterotomy.

Accessory scrotum.

A 2-year-old male with a perineal swelling, covered with normal skin without any rugosities, was diagnosed as having an accessory scrotum on histopathology. There was no other congenital anomaly. The case is reported due to its rarity and unique clinical picture.

Ambulatory anesthesia and surgery in America: a historical background and recent innovations.

This article describes the history of ambulatory surgery and anesthesia in the United States. The innovations in surgical instrumentation and techniques, newer anesthesia drugs and techniques, as well as insurance provider changes that have led to an increase in the numbers and types of surgeries performed in outpatient settings in the United States, are detailed.

Esophageal atresia with blocked distal tracheo-esophageal fistula.

A new born male child diagnosed for pure esophageal atresia was subsequently found to have blocked tracheo-esophageal fistula. The case is reported in view of its rarity and difficulty in management.

A report of 27 cases of congenital short colon with an imperforate anus: so-called 'pouch colon syndrome'.

This is a retrospective study of 27 cases of congenital short colon with anorectal malformation (pouch colon syndrome) treated during the last 5 years (from January 1991 to December 1995). The radiological feature of enormously dilated colonic pouch occupying more than half the width of abdomen was diagnostic in almost all cases. Excision of pouch and end enterostomy was associated with maximum survival (92.3%) in good risk patients. Proximal diverting enterostomy with decompression and irrigation of pouch is a preferable alternative to pouch colostomy in poor risk patients. Tapering coloplasty and colostomy should be reserved only for types I and II cases of pouch colon.

Morgagni hernia in a neonate with ventricular septal defect.

A neonate with Morgagni hernia and ventricular septal defect is reported. Presentation of Morgagni hernia in neonates is rare, but when it does, it is associated with other congenital anomalies.

Fasting before and after ambulatory surgery.

During the last decade, questions about the length of time patients were required to fast before elective operations, as well as when they should resume oral fluids after an outpatient operation, became important issues in anesthesia and surgical practice. This review analyzes reasons for the traditional fasting guidelines and presents recent evidence that has caused rethinking in the guidelines. Current recommendations regarding both the presurgical fasting guidelines and fluid intake requirements for discharge after outpatient surgery are outlined.

The role of irrigation in the development of hypothermia during laparoscopic surgery.

OBJECTIVES: Our purpose was to determine the incidence and etiology of hypothermia during laparoscopic surgery and to evaluate the role of irrigation fluid temperature. STUDY DESIGN: A prospective randomized study was performed of 35 women undergoing operative laparoscopy under general anesthesia who received surgical irrigation fluid either at ambient temperature or warmed to 39 degrees C. The core body temperature was determined with use of both an esophageal sensor and a tympanic membrane sensor and was expressed as the change from baseline. Additional data collected included age, height, weight, amount of irrigation fluid and intravenous fluid used, room temperature, length of anesthesia, and amount of carbon dioxide used for pneumoperitoneum. RESULTS: Hypothermia occurred in 94% of all patients, with no difference in incidence between the groups. The minimal core temperature was lower in the ambient temperature group (-1.7 degrees +/- 0.2 degrees C) than in the warmed fluid group (-1.0 degrees +/- 0.2 degrees C). Of the variables measured, length of anesthesia and the amount of ambient temperature fluid alone explained the drop in core temperature. CONCLUSION: Hypothermia is extremely common in laparoscopic surgery and is related to the length of anesthesia and the use of ambient temperature irrigation fluid. The use of warmed irrigation fluid can decrease, but not eliminate, this drop in core temperature.

Accessory scrotum with imperforate anus.

Accessory scrotum is the rarest anomaly of the scrotum; less than two dozen cases have been reported. A case of accessory scrotum with imperforate anus is reported.