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1.  Omphalomesenteric Duct Cyst in an Omphalocele: A Rare Association 
Omphalomesenteric duct (OMD) remnants and omphalocele are not infrequently seen in paediatric patients. In most of the cases, OMD remnant in an omphalocele is a Meckel’s diverticulum; however rarely there may be other lesions. A one-day old male baby underwent surgery for omphalocele. At exploration a 10 x 12 cm cyst containing gut contents was found as the content of the omphalocele, with proximal and distal ileal loops running in continuity with it. Resection of the cyst with end to end primary gut anastomosis was done. Baby also had complex associated cardiac anomalies and died few days after surgery due to sepsis.
PMCID: PMC3809310  PMID: 24353646
Omphalomesenteric duct remnants; Omphalocele; Omphalomesenteric duct cyst; Newborn
3.  Comparison of eutectic mixture of local anesthetics cream with dorsal penile nerve block using lignocaine for circumcision in infants 
Objective: Circumcision is a commonly performed surgical procedure but choice of anesthesia remained an issue of research and debate. This study was conducted to find out the effectiveness of the eutectic mixture of local anesthetic (EMLA) cream with dorsal penile nerve block (DPNB) using lignocaine, for reduction of pain during circumcision.
Methodology: This was comparative study carried out in Surgical Unit B of National Institute of Child Health Karachi, from May 2008 to October 2008. Patients under six month of age were randomized in to two groups (EMLA and DPNB) of fifty patients each. The effectiveness of pain control was assessed by measuring the baseline heart rate (HR), respiratory rate (RR) and Neonatal infant Pain Scale (NIPS scale) before the start of procedure and measuring of these parameters for each step of circumcision. Independent sample t -test was used to compare means and repeated ANOVA was used to compare means of HR, RR, oxygen (O2) saturations and NIPS.
Results: The mean age in both the groups was 2.3 months. There was no statistically significant difference in baseline parameters in both the groups except the respiratory rate, which was significantly raised in DPNB group (33 breaths/min in EMLA and 38 in DPNB P < 0.04). During circumcision there was significant increase in heart rate in DPNB group, especially in step three and step four (p < 0.04). Oxygen saturation dropped in both the groups (baseline saturation 98% up to 91% in step 4). While assessing NIPS scores in both the groups, statistically significant difference was found between NIPS at step two and step four in two groups (p < 0.04).
Conclusions: The overall pain control was equal in both the groups, although NIPS score was higher in DPNB in step two and four of circumcision. There was difference in application and cost. EMLA was easy to apply but has increased cost; while DPNB required expertise.
doi:10.12669/pjms.291.2944
PMCID: PMC3809213  PMID: 24353502
Circumcision; EMLA; Anesthesia- circumcision; Penile nerve block; Pain; Infant
4.  Making Home Safe for Children 
PMCID: PMC3418039  PMID: 22953295
6.  Delayed Presentation of Trichobezoar with Small Bowel Obstruction 
Small bowel obstruction is a common surgical emergency but trichobezoar as an etiology, rarely reported. A seven year old school going female child presented with acute intestinal obstruction with a palpable and mobile mass in the abdomen. At exploration, a 10 cm long trichobezoar was found in the distal ileum which was removed through enterotomy. Postoperative course remained uneventful. Further probing revealed that child used to eat her own scalp hairs at the age of 2 years and the habit persisted for about 18 months which resulted in alopecia at that time. Later on she started showing normal behavior.
PMCID: PMC3418006  PMID: 22953273
Trichobezoar; Intestinal obstruction; Child
9.  Mucinous Adenocarcinoma of Colon 
Bleeding per rectum is a common complaint in pediatric age group and mostly relates to benign conditions. Underlying colorectal carcinoma is a rare cause and carries a poor prognosis. We report two cases of mucinous adenocarcinoma of colon, one in a 9 years old male and other in a female of 12 years. The boy presented with rectal bleeding and increasing constipation of more than three years duration. He had mucinous adenocarcinoma (T3N0MX) of rectosigmoid region and underwent local complete resection of the tumor with colostomy. He also received postoperative chemotherapy and later underwent colostomy reversal. He is tumor free at two years follow up. The girl presented with signs of intestinal obstruction and at colonoscopy a stricture found in descending colon. The tumor was resected and biopsy reported as poorly differentiated mucinous adenocarcinoma with positive mesenteric nodes positive for tumor (T3N2MX). She is on chemotherapy.
PMCID: PMC3417995  PMID: 22953263
Colorectum;  Mucinous adenocarcinoma;  Bleeding per rectum;  Child
10.  Conjoined Twins: The Flip Side 
PMCID: PMC3418001  PMID: 22953266
11.  Pneumoscrotum: A Rare Presentation of Gastric Perforation in a Neonate 
Pneumoperitoneum in neonates is not an uncommon condition. Free air in peritoneum may be secondary to host of pathological lesions. Usually the patient presents with signs of intraperitoneal sepsis, however presence of air in the scrotum as a concomitant sign is a rare event. Herein we report a 4-day-old neonate who presented with 2 days history of fever and scrotal swelling. Abdominal signs were subtle. Scrotum was hugely distended and tense. Workup of the patient revealed free intraperitoneal gas with air in the scrotum. At exploration, two perforations were found near the greater curvature of stomach and repaired. Post-operative course was uneventful.
PMCID: PMC3418002  PMID: 22953258
Gastric perforation;  Pneumoscrotum;  Neonate
13.  A Giant Lymphatic Cyst of the Transverse Colon Mesentery 
Mesenteric cysts are not uncommon in pediatric age group but giant lymphatic cysts of mesentery are reported infrequently. This is a report of six years old female who had vague abdominal pain with distension for two years. Investigations revealed a large cystic mass in abdomen. On exploration a giant lymphatic cyst in the mesentery of transverse colon found. More than 1500 ml of milky fluid was drained. The cyst was unilocular and appeared to be the collection of lymph (chyle) between two leaves of the mesentery of transverse colon. It is postulated that trauma to or malformation of lymphatics at the root of mesentery might have lead to this pathology.
PMCID: PMC3417989  PMID: 22953250
Lymphatic cyst; Mesenteric cyst; Lymphatic malformation; Abdominal mass

Results 1-13 (13)