Lateral cleft lip and macrostomia: Case report and review of the literature.

Lateral clefts are rare in occurrence. The lateral cleft is cause by failure of fusion of the maxillary and mandibular dermatomes. It is also associated with preaurical tags. We present a case of a lateral cleft of the lip with multiple bilateral preauricular tags that was repaired using triangular flaps.

Chemical approaches for the biomass valorisation: a comprehensive review of pretreatment strategies.

The most abundant natural renewable resource in the world, lignocellulosic biomass (LCB), has the potential to be exploited as a substitute green feedstock for the synthesis of various chemicals, materials, and biofuels. The annual global production of 13 billion tonnes of LCB offers an opportunity to cater to the increasing energy and materials requirement of process industries and also restricts the discharge of greenhouse gases. Although LCB is enriched with valuable ingredients such as cellulose, lignin, and hemicellulose, its recalcitrant nature limits its efficient utilisation. These components of LCB are strongly interlinked with each other, which resists their isolation and conversion valorisation into useful products. To disrupt the complicated structure of LCB and to isolate the lignocellulosic components in pure form, pretreatment is a crucial process in the bio-refinery, ensuring the economic feasibility of downstream processes. This review provides an outline of the structure, composition, and various sources of LCB; and the necessity of the pretreatment. Moreover, this article provides an in-depth analysis of the underlying mechanisms, advantages, and limitations of various pretreatment methods, such as physical, chemical, biological, and physicochemical. Further, the impact of chemical pretreatment techniques on the physicochemical characteristics of the material that is extracted from the biomass is also covered in detail through the rigorous evaluation of performance metrics, including substrate digestibility, sugar yield, inhibitor production, and energy requirements. This review provides a balanced and comprehensive overview of the state-of-the-art pretreatment strategies and their impact on biomass valorisation that will be useful to the scientists, engineers, and policy makers interested in biomass conversion technologies.

Role of magnetic resonance urography in diagnosis of duplex renal system: Our initial experience at a tertiary care institute.

AIM: To determine diagnostic value of magnetic resonance urography in cases of duplex renal system. METHOD: Twenty cases between five month to nine years with suspected or known duplex renal system were evaluated by ultrasound (USG), micturating cystourethrography (MCU), intravenous urography (IVU) and magnetic resonance urography (MRU). The findings of these diagnostic imaging studies were then compared with each other and against the results of final diagnosis established at surgery. RESULTS: Duplex renal system could be identified in two of these cases on USG, was diagnosed in four in IVU and could be diagnosed in all cases with MRU. CONCLUSION: MRU is superior and far accurate than IVU, MCU and USG in diagnosing duplex renal system.

Endoscopic thyroidectomy: Our technique.

UNLABELLED: Minimally invasive surgery is widely employed for the treatment of thyroid diseases. Several minimal access approaches to the thyroid gland have been described. The commonly performed surgeries have been endoscopic lobectomies. We have performed endoscopic total thyroidectomy by the anterior chest wall approach. In this study, we have described our technique and evaluated the feasibility and efficacy of this procedure. MATERIALS AND METHODS: From June 2005 to August 2006, 15 cases of endoscopic thyroidectomy were done at our institute. Five patients were male and 10 were female. Mean age was 45 years. (Range 23 to 71 years). Four patients had multinodular goiter and underwent near-total thyroidectomy; four patients had follicular adenoma and underwent hemithyroidectomy. Out of the seven patients of papillary carcinoma, four were low-risk and so a hemithyroidectomy was performed while three patients in the high risk group underwent total thyroidectomy. A detailed description of the surgical technique is provided. RESULTS: The mean nodule size was 48 mm (range 20-80 mm) and the mean operating time was 85 min (range 60-120 min). In all cases, the recurrent laryngeal nerve was identified and preserved intact, the superior and inferior parathyroids were also identified in all patients. No patients required conversion to an open cervicotomy. All patients were discharged the day after surgery. All thyroidectomies were completed successfully. No recurrent laryngeal nerve palsies or postoperative tetany occurred. The postoperative course was significantly less painful and all patients were satisfied with the cosmetic results. CONCLUSIONS: It is possible to remove large nodules and perform as well as total thyroidectomies using our endoscopic approach. It is a safe and effective technique in the hands of an appropriately trained surgeon. The patients get a cosmetic benefit without any morbidity.

Paediatric ureterolithotripsy: Tips and tricks - Experience at a single center.

BACKGROUND: Paediatric stone disease is very common in certain regions of India. Traditionally, the endourology for the stones even in paediatric age group is managed by adult urologist and paediatric surgeons tend to do open surgeries. The nonavailability of paediatric size equipments and lack of training at the teaching and tertiary care paediatric surgical centers in India are factors due to which there is continued apathy of paediatric surgeons to endourology. The aim of this study was to discuss the feasibility of paediatric ureterolithotripsy for successful procedure. We introduced the paediatric ureterolithotripsy as per the predecided indications of stone size up to 15 mm in paediatric ureterolithiasis at a tertiary care center in rural set up. SUBJECTS AND METHODS:: Patients up to 18 years of age presenting with ureterolithiasis and not responding to conservative treatment or who needed endourological intervention were included in the study. RESULTS:: Thirty-one patients underwent uretero lithotripsy (URSL) for ureteric calculus with more than 95% clearance rate. CONCLUSIONS:: Single-stage paediatric ureterolithotripsy is quite feasible and effective in achieving the stone clearance in paediatric ureterolithiasis.

Effect of quaternary ammonium cations on dye sorption to fly ash from aqueous media.

The efficacy of the surface modification of fly ash by quarternary ammonium cations in the removal of dyes from aqueous solution is demonstrated. A series of organo-fly ash materials were synthesized by treating fly ash with quarternary ammonium cations such as tetraethylammonium, hexadecyltrimethylammonium, and benzyldimethyltetradecylammonium (TEA, HDTMA, and BDTDA). Two types of dyes were used for the investigation, disperse and anionic dyes. The effects of initial dye concentration, contact time, temperature, and the mechanism of dye sorption were investigated. The sorption was found to be affected by the structure and size of the quaternary ammonium cations as well as that of the dyes. Sorption of dyes was considerably enhanced by the surface modification. Thermodynamic parameters such as free energy (DeltaG0), enthalpy (DeltaH0), and entropy (DeltaS0) for the sorption process were also calculated.

Treatment of oil spill by sorption technique using fatty acid grafted sawdust.

Treatment of oil spills remains a challenge to environmental scientists and technologists. Among all the existing techniques used for oil treatment, sorption is a popular technique because it is cheap, simple and effective. Among the various sorbents used, sawdust appears to be the most attractive material in terms of cost, versatility and abundance. In the present work, the efficacy of surface modification of sawdust by fatty acids (oleic acid, stearic acid and decanoic acid) and vegetable oils (castor oil or mustard oil) is demonstrated. Sorption of seawater contaminated with crude oil and also weathered oil was greatly enhanced by the surface modification. The results show that oleic acid grafted sawdust (OGSD) has the best sorption capacity for crude oil as well as weathered oil.

Orchidopexy san ligation technique of orchidopexy.

Pediatric hernia surgery is the most common operation done by pediatric general surgeons and it is a core competency for general surgeons in the developing world. Herniotomy is performed for the surgical repair of hernia and along with orchiopexy for the closure of associated patent processus vaginalis. Traditionally, ligation of hernial sac during orchiopexy is considered mandatory to prevent postoperative development of hernia. The present report was designed to study the results of non-ligation of the hernial sac during orchiopexy. It was found that non-ligation has no untoward effect on early complications and recurrence rate on long-term follow-up. It is suggested that it is not necessary to ligate the hernial sac during orchiopexy in children.

Acute gastric volvulus in operated cases of tracheoesophageal fistula.

A report of two neonates of esophageal atresia with tracheoesophageal fistula who had acute gastric volvulus in the postoperative period and required gastropexy after correction of the volvulus. Such postoperative complication has not been reported in the literature so far.

A radiolucent lesion crossing the midline in maxilla: a rare presentation of odontogenic keratocyst in young patient.

Odontogenic Keratocyst (OKC) is a developmental non-inflammatory odontogenic cyst which is proposed to be arising from cell rests of dental lamina. Among the jaw cysts OKCs account for third most common following radicular and dentigerous cyst. Most of the studies have stated that posterior part of the mandible is the most common site, but there are inconsistencies regarding the prominent location of OKCs in the maxilla. Very few studies and cases are reported with OKCs crossing maxillary midline. If do occur they are in older individuals. According to WHO reclassification, this cyst is considered as Keratocystic Odontogenic Tumour (KCOT) because of its neoplastic nature. This article describes a rare site of occurrence of this lesion especially in young patient.

Mayer-Rokitansky-Kuster-Hauser syndrome and anal canal stenosis: case report and review of literature.

Mayer-Rokitansky-Kuster-Hauser (MRKH) is a characteristic syndrome in which the mullerian structures are absent or rudimentary. It is also associated with anomalies of the genitourinary and skeletal systems. There are very few cases reported regarding its association with anorectal malformations, particularly perineal fistulas. To the best of our knowledge, there have not been any reported cases of anal canal stenosis in patients with MRKH. We describe a very rare association of MRKH with anal canal stenosis and multiple renal calculi. The patient underwent corrective surgery for the anomalies and removal of renal calculi. She has been under regular follow-up for the last few months and is doing well.

Laparoscopic Stephen-Fowler stage procedure: appropriate management for high intra-abdominal testes.

UNLABELLED: The length of testicular vessels is the main length-limiting factor to bring down the testes in the scrotum. Fowler and Stephen proposed the division of testicular vessels, high and as far from the testes as possible to maintain collateral blood supply, to treat high intra-abdominal testes. Cortesi introduced the diagnostic laparoscopy and Jorden first did the laparoscopic orchiopexy for nonpalpable testes. We had done Fowler-Stephen staged orchiopexy for high intra-abdominal testes, in which both stages were done laparoscopically. METHODS AND RESULTS: In total, 17 testes of 13 patients had undergone laparoscopic staged Fowler-Stephen orchiopexy. The decision to perform a staged Fowler-Stephen orchiopexy was based on the distance of the testis from the deep inguinal ring on laparoscopy. If distance was more than 2.5 cm, then we proceeded to a laparoscopic staged Fowler-Stephen orchiopexy. In the first stage, testicular vessels were cauterized by bipolar diathermy. Laparoscopic second-stage Fowler-Stephen procedure was done 6 months after the first stage. Patients were regularly followed, and the success of the procedure was assessed by the size of the testes and the position in the scrotum. Testicular vascularity was assessed by color Doppler ultrasonography. There was no testicular atrophy on second stage and on follow-up. All testes were in the scrotum with good size on follow-up. There was no complication related to laparoscopy. CONCLUSIONS: In cases of high intra-abdominal testes, the staged Fowler-Stephen procedure should be the procedure of choice. This procedure yields a high success rate. Transaction of vessels by bipolar diathermy is a very safe, cost-effective method.

Neonatal carrier: An easy to make alternative device to costly transport chambers.

The transport of sick neonates to the surgical centers or transportation within the center is an essential requirement of neonatal surgery. Neonatal transport incubators are costly, space occupying, and are not available at many places in the developing countries. We report here a cheap yet effective and easy to make, alternate neonatal carrier device.

Gastric volvulus in children: experience of 6 years at a tertiary care centre.

BACKGROUND: The aim of the study was to review the cases of all children who had gastric volvulus from 2002 to 2007 at a tertiary care centre in India and to compare the outcome of management with the reported series on gastric volvulus in a paediatric age group. MATERIALS AND METHODS: This was a retrospective study of eight children with an age range between 10 days and 2 years who were managed for gastric volvulus between 2002 and 2007. The records of these patients were reviewed for clinical features, investigations, management and outcome. RESULTS: All patients were less than 3 years of age with female preponderance (n = 5). Three patients had acute presentation and three had acute-on-chronic symptoms, while two had chronic gastric volvulus. The commonest symptom was abdominal distension. Two patients were diagnosed by barium studies and six had clinical suspicion because of their symptoms and were confirmed intra-operatively. Seven had secondary gastric volvulus of organo axial type with associated pathologies as congenital diaphragmatic hernia (n = 5), Para oesophageal hiatus hernia (n = 2), and one had primary gastric volvulus in a postoperative period in an operated case for a tracheo-oesophageal fistula (n = 1). Seven patients were symptom free at follow-up; one patient succumbed due to septicaemia in the immediate post-operative period which was not related to the pathology of gastric volvulus. CONCLUSION: Gastric volvulus is a rare condition in children and requires prompt diagnosis and urgent intervention in acute presentation where it mimics acute abdomen and strong clinical suspicion.

Minimal access surgery for multiorgan hydatid cysts.

Multiorgan hydatid cysts caused by larval growth of Echinococcus granulosus, is a rare condition in paediatric age group. There are very few reports of management of multiorgan hydatid cysts, involving lung, liver, and spleen by minimally invasive approach in paediatric age group. Herewith, we are reporting a case of hydatid cysts involving lung, liver, and spleen in a six-year-old child managed by minimally invasive surgery along with the review of literature.

Measuring the effects of massage on exercise performance and cardiopulmonary response in children with and without heart disease: a pilot study.

BACKGROUND: Congenital heart disease, a common and serious birth defect, affects 8 per 1000 live-born infants. Decreased exercise capacity and development of obesity is common in this population. These children may benefit from therapies, such as massage therapy, that could enhance cardiovascular and skeletal muscle function when they exercise. PURPOSE: A pilot study conducted at the pediatric cardiology clinic of the Mattel Children's Hospital of the University of California-Los Angeles examined the safety and feasibility of measuring the effects of pre-exercise massage on exercise performance and cardiopulmonary response in children with and without heart disease. PARTICIPANTS AND METHODS: SIXTEEN CHILDREN (MEAN AGE: 9.2 ± 2.2 years) participated in the study. Ten participants had various forms of heart disease, and six children were healthy. A female certified massage therapist with specialized training in pediatric massage provided a 30-minute massage to the participants. Using a standard protocol, each participant underwent two exercise tests: one test with and one without pre-exercise massage. Heart rate, blood pressure, and oxygen uptake (VO(2)) were measured in the participants. RESULTS: All recruited participants completed the study. No adverse events occurred during any of the exercise tests or massage sessions. Measurements during exercise with or without a preceding massage were compared, and the pre-exercise massage condition yielded a significantly higher heart rate and higher minute ventilation. Measurements during exercise in children with heart disease and in healthy participants showed no significant differences in peak heart rate, blood pressure, peak VO(2), peak work rate, minute ventilation, or respiratory quotient. CONCLUSIONS: In this study, peak heart rate, peak VO(2), and peak minute ventilation were higher when children received a massage before exercise testing. Larger studies will be needed to investigate the strength of this finding. Future studies should include measurements of anxiety and psychological factors in addition to cardiopulmonary measures.

Congenital pouch colon with rectal atresia: a case report.

The association of congenital pouch colon with rectal atresia is quite rare with only 2 cases previously reported in literature. We describe the third such case and the second instance to survive. Although the prior survivor was managed by a single-stage procedure, we successfully managed our case by staged procedures. In this case report, we discuss the etiology and surgical options available for this rare condition.

Juvenile thyroid malignancy.

Thyroid malignancy is an uncommon tumor of the pediatric population. Patients can present with asymptomatic thyroid nodule and it requires thorough work up to rule out the malignancy. Radiological and pathological procedures are a standard part of the management. A 10-year-old girl had asymptomatic thyroid nodule; the cytological examination and the frozen section and final histology of the nodule was different each time. The girl had to undergo total thyroidectomy on the basis of histology of the nodule which was well differentiated papillary carcinoma of thyroid and is under regular follow-up for last two years on thyroid supplementation.