Congenital tuberculosis

We report a case of congenital tuberculosis diagnosed by liver biopsy in a 8-week-old infant presented with acute abdomen. Liver biopsy showed multiple lymphoepitheloid cell granulomas with Langhans’ giant cells and central necrosis. The culture of caseous material from the liver showedMycobacterium tuberculosis. Antituberculous treatment was started. Endometrial biopsy in the asymptomatic mother confirmed the source of infection.     

Detection of 22 q11.2 hemizygous deletion by interphase FISH in a patient with features of CATCH 22 syndrome

We report an eight years female child with clinical and molecular cytogenetic findings consistent with CATCH 22 syndrome characterized by cardiac defect, typical facial dysmorphism, mental deficiency and chromosome 22 q11.2 deletion. Interphase FISH with 22q 11.2 probe demonstrated hemizygous deletion in 98.5% nuclei. Interphase FISH for diagnosis of CATCH 22 syndrome has not been reported previously from India to our knowledge.     

Posterior mediastinal hemangioma

We report posterior mediastinal hemangiomas in a 4-month-old and a 6-month-old girl. The masses were identified on radiographs of the chest followed by contrast-enhanced CT. Histological evaluation of the surgical specimens established the final diagnosis. Although mediastinal hemangiomas have been described, they remain a rare entity. A diagnosis can be suggested by relatively high attenuating masses on contrast-enhanced CT. Posterior mediastinal hemangiomas sometimes mimic neuroblastomas, which is the most common posterior mediastinal in this age group.     

Quality Improvement Guidelines for Placement of Esophageal Stents

Esophageal cancer is now the sixth leading cause of death from cancer worldwide [1, 2]. During the past three decades, important changes have occurred in the epidemiologic patterns associated with this disease [1]. Due to the distensible characteristics of the esophagus, patients may not recognize any symptoms until 50% of the luminal diameter is compromised, explaining why cancer of the esophagus is generally associated with late presentation and poor prognosis [3]. Esophageal cancer has a poor outcome, with an overall 5 year survival rate of less than 10%, and fewer than 50% of patients are suitable for resection at presentation. As a result palliation is the best option in this group of patients [3, 4]. The aims of palliation are maintenance of oral intake, minimizing hospital stay, relief of pain, elimination of reflux and regurgitation, and prevention of aspiration [3, 5, 6]. For palliative care, current treatment options include thermal ablation [7–9], photodynamic therapy [10–12], radiotherapy [13], chemotherapy [14, 15], chemical injection therapy [16–18], argon beam or bipolar electrocoagulation therapy [19], enteral feeding (nasogastric tube/percutaneous endoscopic gastrostomy) [20–22], and intubation (self-expanding metal stents (SEMS) or semi-rigid prosthetic tubes) [5, 6, 23–26] with different success and complications rates.     

Posttraumatic pediatric distal tibiofibular synostosis: a case report

INTRODUCTION: Posttraumatic pediatric distal tibiofibular synostosis is a rare complication of fractures at this level, unreported at this time. Implications include limb length discrepancy, angular malalignment, and gait and biomechanical abnormalities. MATERIALS AND METHODS: The authors present a case report of this complication in a 7-year-old child and review the relevant English literature. The patient was treated for a closed distal tibia-fibula fracture and developed a synostosis at that level, with valgus malalignment of the ankle joint. The synostosis was resected and latest follow-up 16 months postresection showed near normalization of the ankle malalignment. Possible etiologies, the anatomical and functional ramifications, and treatment recommendations for this condition are discussed. SUMMARY: Posttraumatic tibiofibular synostosis is a rare complication that has a potential effect on limb length and alignment, both at the ankle and the knee in the skeletally immature patient. Prevention, early recognition, and prompt treatment prevent the anatomic and functional abnormalities that could result from it.     

Robot-assisted radical cystectomy and urinary diversion in female patients: technique with preservation of the uterus and vagina

BACKGROUND: After performing more than 500 robotic radical prostatectomy and robotic radical cystoprostatectomy in men, we attempted to develop the technique of robot-assisted radical cystectomy in women. This article describes two techniques of robot-assisted radical cystectomy for women, conventional and with preservation of the uterus and vagina. To the best of our knowledge, this is the first case series of robot-assisted radical cystectomy and urinary diversion in women. STUDY DESIGN: Robot-assisted radical cystectomy was undertaken in three female patients with transitional cell carcinoma of the urinary bladder. The operation was performed with the conventional anterior approach in one patient and with a new technique in two patients, which allows preservation of urethra, uterus, vagina, and both ovaries. As planned, the radical cystectomy was done robotically, using the da Vinci Surgical System (Intuitive Surgical). The bladder was entrapped in an Endocatch bag and removed through a small subumbilical incision. Urinary reconstruction was performed extracorporeally after exteriorizing the bowel through the incision used for retrieving the specimen. In two patients, the reconstructed pouch was placed in the pelvis and the abdominal incision was closed. Urethroneovesical anastomosis was done robotically, using a technique described previously for men. RESULTS: The average operating time for the robotic radical cystectomy was 160 minutes and the mean operating times for ileal conduit and orthotopic neobladder were 130 minutes and 180 minutes, respectively. The mean blood loss was less than 100 mL. The mean number of lymph nodes removed was 12 (range 3 to 21). Surgical margins were free of tumor in all three patients. CONCLUSIONS: This approach incorporates advantages of minimally invasive and open surgery. Performing the radical cystectomy with the robot allows precise and rapid removal of the bladder with minimal blood loss. Extracorporeal reconstruction of the urinary tract reduces operative time at this stage of evolution of laparoscopic and robotic instrumentation. In the future, with the development of technology, instrumentation, and with additional refinement of our technique, the entire procedure may be done completely intracorporeally with equal efficiency.     

Myofibroma of the cheek: a case report

Myofibromas are benign mesenchymal tumors that are commonly found in the dermis and subcutaneous tissues of the head and neck. Although most lesions are recognized during infancy and early childhood, several cases have been reported in older children and adults. We describe the case of a 9-year-old girl who presented with a solitary nodule in the left cheek and a history of minor trauma. Preoperative imaging detected the presence of a subcutaneous soft-tissue mass consistent with a soft-tissue neoplasm rather than a hematoma. Analysis of fine-needle aspiration material was nondiagnostic. Incisional biopsy revealed that the lesion was a myofibroma.     

Acceleration of onset of action in schedule-induced polydipsia: combinations of SSRI and 5-HT1A and 5-HT1B receptor antagonists

Onset of action is a key unmet need in the treatment of depression. However, very few preclinical models in which the effects of antidepressants can be shown are suitable for screening for onset. In this context, previous literature suggests that a slow onset of action of selective serotonin reuptake inhibitors (SSRIs) is observed in schedule-induced polydipsia (SIP). The current investigation was performed to determine the latency to reduce SIP of the SSRI, fluoxetine, and of two treatments known to facilitate 5-HT neurotransmission to a greater extent than an SSRI alone. These treatments included interaction studies for fluoxetine+the 5-HT(1A) antagonist, WAY 100635, and for fluoxetine+the 5-HT(1B) partial agonist, GR 127935. Food-restricted rats were trained on a fixed interval schedule with drinking water freely available. Once water intake was stable, rats were randomly assigned to vehicle of treatment groups. Daily treatment was continued for 3 (interaction studies) or 18 days (fluoxetine alone study). Fluoxetine significantly reduced SIP after 5-6 days of treatment, with the maximal effect evidenced after 8 days. WAY 100635 and GR 127935 accelerated the onset of action of fluoxetine, with significant effects observed on treatment day 1. These data suggest that SIP may be useful to assess the onset of action of serotonin enhancers.     

Migraine: a common cause of headache

Acute headaches in a child evoke anxiety in parents, of a possible catastrophic underlying intracranial pathology. Headaches constitute up to 2 to 6% of all emergency room visit. The prevalence of migraine is increasing. The majority of children have migraine without aura, and about one fifth have migraine with aura. Complicated migraine presents with dramatic neurologic signs and remains a diagnosis of exclusion. Children with migraine require reassurance, modification of life style and food habits, combined with judicious use of simple abortive medications and antiemetics. Prophylaxis in migraine is recommended for frequent or severe attacks and in complicated migraine.     

Carbamazepine poisoning: treatment with haemodialysis.

Sir, A 32-year-old woman was brought to the emergency room 28 h afteringesting an unknown amount of carbamazepine (probably 150–200tablets containing 200 mg each). She had been taking cabamazepine400 mg twice daily for the past 10 years for symptomatic epilepsyrelated to cerebral arterio-venous malformation. She was unconsciousbut responding to noxious stimuli. She had shallow irregularrespiration