Oesophageal replacement in children with indolent stricture of the oesophagus.

OBJECTIVE: To evaluate the indications for and results of oesophageal replacement for acquired oesophageal stricture in children. METHODS: This was a descriptive interventional study. Between 1987 and 2003, patients who had peptic or corrosive stricture were included in the study. Age and gender were analysed and any history of ingestion of caustic agents or untreated reflux was noted. Types of symptoms such as progressive dysphagia to solids and liquids and extent of respiratory infections were evaluated. Nutritional deprivation was also measured. Success or failure of dilatation at the time of endoscopy was taken into account. The criterion for oesophageal replacement was recurrence of stricture within 3 weeks of the previous dilatation. Patients were prepared with general supportive care. Feeding gastrostomy was performed in 12 patients who were severely malnourished. No patients underwent oesophagectomy of the strictured oesophagus. Short- and long-term complications were recorded. RESULTS: Of the 54 patients, 34 were male and 20 were female. Colonic conduit and reverse gastric tube were used in 27 patients each. Three patients had leak and were treated conservatively. Six patients developed anastomotic stricture but benefited remarkably from periodic dilatation and, in the long-term, remained symptom-free. Results were generally very gratifying. CONCLUSION: Most patients who require oesophageal conduit do well and catch up with their growth and development.

Tubularized incised plate urethroplasty of hypospadias.

OBJECTIVE: To describe tubularized incised plate (TIP) urethroplasty, for the treatment of anterior hypospadias. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: This study was carried out in the Department of Pediatric Surgery, The Children hospital, Pakistan Institute of Medical Sciences Islamabad, from January 2003 to February 2004. MATERIALS AND METHODS: There were 30 patients with anterior hypospadias. Children between 2-years to 12 years were included in the study. Tubularized incised plate urethroplasty (Snodgrass procedure) was performed in all the patients. Meatus was matured taking care not to close too much to avoid stenosis. Dressing was kept to prevent haematoma and oedema formation. Frequent irrigation of the stent was done to avoid blockage. RESULTS: Procedure was successful in 22 patients. Meatal stenosis was noted in three patients, two required dilatations only and in one patient meatotomy was performed. Three patients developed single urethrocutaneous fistula. One patient had complete breakdown. CONCLUSION: Tubularized incised plate urethroplasty was found to be a useful procedure for distal or anterior hypospadias with less complications. Special precautions like maturing the meatus to avoid stenosis and keeping the stent patent with frequent irrigation helps in minimizing fistula formation. The dressing technique prevented postoperative haematoma and oedema of penile stuff.

Anterior sacral meningomyelocele with sacrococcygeal teratoma.

Anterior sacral meningocoele with sacrococcygeal teratoma is a rare entity. The cystic mass arising from anterior sacral and coccygeal defect, lies in the retrorectal space between the rectum and sacrum. It produces a variety of symptoms depending on its size and contents and constitutes a diagnostic problem. Such a rare association of two pathologies is presented, with review of literature, in an infant who had an anterior meningocoele with sacrococcygeal teratoma. Both the pathologies were surgically corrected individually, about a month apart.

Ectopic ureters misdiagnosed as ureterocele.

Ectopic ureters may be difficult to diagnose unless there is high index of suspicion. Examination for continuous dribbling may be difficult in infants who are still using diapers. We are reporting a case of ectopic ureter which was erroneously diagnosed as ureterocele on a cystourethrogram. Further investigations for accurate diagnosis and emerging abnormalities during the course of management are presented in this case report. Review of literature to highlight the various forms of investigations and management are also presented.

Palliative surgery for advance osteosarcoma of shoulder region.

We are presenting here eight cases of advanced osteosarcoma of shoulder region involving scapula and upper humerus in children upto the age of thirteen years. All patients had complete loss of movement. Five patients underwent fore quarter amputation. Extensive amputation although a major mutilating procedure, provides patients a dramatic relief for the period that he survives.