The ability to treat the fetus in-utero has greatly expanded over the last twenty years. Techniques to operate on the fetus have been developed which significantly impact the ongoing pregnancy. There are also specific obstetric concerns when evaluating a patient for fetal surgery. This review will outline the perinatal management of the fetal surgery patient. It will describe pre-operative, operative, and postoperative management. Maternal outcome data and information on subsequent fertility will also be presented.
Purpose : Pediatric soft tissue sarcomas have many similarity among different tumors. These tumors present small round cell types, and cause frequent diagnostic problems in pediatric pathology. An important advance in the investigation of these small round cell tumors has been the identification of consistent chromosomal translocations associated with several types of tumor. Method : Thirty six patients with soft tissue sarcoma were available for review. Seventeen cell lines were also included in this study. The RNA from the specimens were analyzed by reverse transcriptase-polymerase chain reaction (RT-PCR). Results : PAX 3-FKHR fusion was present in six of eight alveolar rhabdomyosarcoma and PAX 7-FKHR fusion was detected in two of eight alveolar rhabdomyosarcoma. None of the specimens expressed more than one chimeric transcript. EWS-FLI 1 or EWS-ERG fusions were detected in all ten Ewing's sarcoma. No specimens showed EWS-WT 1 fusion. These results corresponded well to the histopathologic diagnosis. There were no differences in the histologic appearances of tumors with the more frequent PAX 3-FKHR or EWS-FLI 1 fusions compared with those containing the variant PAX 7-FKHR or EWS-ERG fusions. Conclusion : RT-PCR assay for chimeric transcript is an useful tool for a rapid and objective diagnosis of pediatric solid tumors. Through these tools, we can approach genetically to the differential diagnosis of undifferentiated small round tumors.
A total of 20, 202 patients of age 0-12 years, admitted in the surgical units of Dhaka Shishu (Children) Hospital and Aichi Shishu Hospital in the last 10 years, were reviewed. 57% of them were male & 43% were female. 24% were of below 1 year, 45% from 1 to 5 years and 31% were above 5 years. Gastrointestinal disorder were the commonest, constituting 47.35% (9570) of cases. They were mostly intestinal obstruction (8.01%), acute appendicitis (7.71%), ascariasis (6.28%) and congenital anorectal anomalies (5.54%). Remarkable development was achieved in the management of gastrointestinal disorders. 4029 urogenital disorders (19.9%) included inguino-scrotal swelling, phimosis, para phimosis and hypospadias securing the second position. Excellent surgical outcome was achieved in the recent years. Patients having congenital disorders (8.9%) consist of telepes equinovarus, cleftlip and cleft palate who were also managed surgically with a good success rate. Among 530 (2.62%) malignant cases, Wilms tumor & neuroblastoma were managed surgically and remaining ones got chemotherapy. Out of 39 cases of diaphragmatic hernia, 13 cases (33%) survived after the primary closure of the diaphragm. Four out of 13 cases of tracheo-esophageal fistula survived after primary anastomosis. This is for the first time, an attempt is made to present a data of surgical problems in children and their management in Bangladesh.
Cryptorchidism is one of the most common genitourinary anomalies in male infants. However, controversies still exists regarding the timing and ways of management of cryptorchid patients. We present herein our experience with 150 cryptorchid patients who were treated at Sporting's hospital for infants and school children in Alexandria, Egypt during the period from January 1998 to January 2000. Patient's age varies from 4 months up to 5 years with the mean age of 2.3 years. They were classified into 2 groups ; Group I : (56 patients) who were operated at the age of less than 1 year. Group II : (94 patients) who were operated at the age of more than 1 year. Thirty-eight patients (25.3%) showed impalpable undescended testes. [7 (18.4%) : Bilateral and 31 (81.6%) : Unilateral] while 26 (17.3) were having retractile testes and 16 patients showed ectopic testes. Ultrasonography was performed for all patients in order to verify the testicular site, while MRI was done in 30 patients with impalpable undescended testes. Surgical intervention was performed in all patients with successful scrotal orchiopexy in 143 patients, negative exploration in 5 patients and orchidectomy of atrophic testes in 2 patients. The time of surgery didn't show any statistical significant difference between the 2 groups. Follow-up period varied from one month up to 2 years. Post-operative complications were seen in 10 patients (0.7%), three patients showed post operative scrotal haematoma that had resolved conservatively, four patients with post operative oedema that also resolved conservatively. The other 3 patients had postoperative fever, one was due to wound infection and the other 2 were due to post operative chest infection and they all resolved by treatment. There was no statistical significant difference in the complication rate between the groups. In conclusion, orchiopexy is better to be performed as early as possible especially for the highly located undescended testes. In this study, there was no significant difference in neither the operative timing nor the incidence of the postoperative complications. Follow-up period is too short ; yet, a long-term follow-up will be needed to verify this concept in treating cryptorchid patients in the future.