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Popliteal fossa masses are rare in paediatric age group. Even rarer are the malignancies of this area. Low-grade fibromyxoid sarcoma (LGFMS) is a distinctive variant of fibrosarcoma. It is a rare tumor with benign histologic appearance but high metastasizing potential. We describe an 11-year-old child with a popliteal fossa mass, which was excised, and histopathological report revealed LGFMS.

Introduction: Tobacco exposure during pregnancy has a negative influence on fetal growth. Maternal smoking causes placental vaso­constriction and fetal growth restriction (FGR). In India, the tobacco industry employs women to hand roll cigarettes called bidis. A bidi roller handles 120 g of tobacco and therefore 3 g of nicotine per day. Aim: To evaluate the effect of occupational tobacco handling by pregnant women on fetal growth and wellbeing. Methods: In this cohort study, 177 pregnant bidi rollers (exposed cohort) and 354 pregnant non-rollers (unexposed cohort) were followed up from 18-22 weeks of pregnancy until delivery with fetal sonogram and Doppler. Fetal surveillance data (including fetal biometry, Doppler indices, amniotic fluid index, biophysical profile and placentation) were recorded and compared. Maternal nicotine absorption was quantified by serum cotinine. Intergroup differences and relative risk (RR) were determined by Chi-square test (or Fisher exact when the count was ≤ 5), and adjusted odds ratio (OR) by binary logistic regression. Intrauterine growth trend was plotted. Results: Fetal surveillance results were ab­normal in 37.9% of the tobacco-exposed group, with a RR of 1.6 (p = 0.001) and adjusted OR of 1.8 (p = 0.005) in comparison with the unex­posed group. Nicotine absorption was evident in 28.4% of the bidi rollers that had abnormal fetal surveillance results. The mean estimated fetal weight and head circumference demonstrated a sustained deceleration, starting at 28-30 weeks of gestation, in the exposed group. Doppler data suggested fetal adaptation to maintain cerebral circulation. We found a higher frequency of oligohydramnios (statistically significant), pla­cental abruption (not statistically significant), and placenta previa (not statistically significant) in the tobacco-exposed group. Conclusions: Occupational tobacco handling in bidi rollers resulted in early-onset symmetric FGR and compromised wellbeing. Pregnant women with any form of tobacco exposure require vigilant fetal surveillance.

Congenital gastric outlet obstruction is a rare clinical entity. It may be confused with more common conditions (like idiopathic hypertrophic pyloric stenosis and others) and is difficult to diagnose. Patients have a dilated stomach with intermittent intolerance to feeds and have normal meconium and stool passage. Here is reported a case of a 10-day-old girl with recurrent non-bilious vomiting and upper abdominal distension after feeds. X-rays showed distended stomach with distal gas. On further investigation the baby was found to have a web in the pylorus. The web was excised via a prepyloric gastrotomy and reconstruction with a Heineke-Mikulicz pyloroplasty was done. Postoperative period was uneventful. On follow-up, the baby is asymptomatic and is thriving well. To conclude, presence of a pyloric web should be considered in neonates with non-bilious vomiting with a normal pylorus and a persistently distended stomach.

Aim: Anorectal malformations (ARMs) are often associated with other anomalies. At present, there is no comprehensive protocol to detect these associated anomalies. This study aims to study prevalence of associated anomalies in the Eastern Indian population. Materials and methods: All patients admitted with ARM in our institute (Department of Paediatric Surgery, NRS Medical College & Hospital, Kolkata, West Bengal, India) were studied from 2010 to 2012 (n = 182). Clinical examination and basic laboratory and radiological investigations were done in all patients. Advanced radiological investigations followed if abnormality was detected in the basic investigation. Incidence of associated anomalies was compared with known literature and correlation between level of ARM and other associated anomalies was studied. Results: 102 of 182 ARM patients studied had associated anomalies. More associated anomalies were present in high ARM than low ARM (59.65% vs 50%). Genitourinary anomalies were the most common associated anomaly, followed by spinal, cardiovascular, tracheo-esophageal, gastrointestinal tract, limbs and facial anomalies. Conclusion: In the Eastern Indian population, there is no significant sexual difference in patients who have associated anomalies with ARM. Full laboratory and radiological investigations are required in all ARM patients to detect and treat the associated anomalies as they may not be clinically apparent.