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Thoracoscopic Repair of Esophageal Atresia with Tracheoesophageal Fistula (TREAT) is now an established procedure. The anastomosis performed thoracoscopically is always compared to the hand sewn anastomosis in open surgery. The present study analyses the outcome of TREAT versus open repair in terms of radiological index representing the esophageal calibre. Patients with esophageal atresia-tracheoesophageal fistula (EA-TEF) operated by open repair and TREAT were evaluated. An esophageal calibre anastomotic index (EACI) was formulated based on measurements performed on contrast esophagogram at 3 months or later. The diameter of the esophagus at the level of anastomosis was measured, along with ratios of radiologically measured values both above and below the anastomosis; based on which an index was calculated. A value closer to 1 was considered normal, whereas a ratio

To describe epidemiology of intussusception post-introduction of the rotavirus vaccine. Hospital-based active surveillance system was set up in three tertiary care hospitals in Chandigarh and Haryana, India, to enroll children

Background Hydatid disease is relatively uncommon in children and thus rarely reported in literature. Pediatric patients with large hydatid cysts can have grave complications due to mass effect. Postoperative bile leak is the most common morbidity and continues to be a challenge for the treating surgeon. Case presentation A 7-year-old boy diagnosed with a giant hydatid cyst of the liver, almost replacing the right lobe, and underwent a laparotomy and excision of cyst with tube drainage. He developed postoperative major bile leak which did not subside even after a redo laparotomy and closure of the suspected bile leak areas. The child underwent a third laparotomy after a hepatobiliary scintigraphy (HIDA scan) which confirmed a persisting major leak. A Roux En Y cystojejunostomy was done this time which drained the bile adequately postoperatively with no evidence of bile in the subhepatic drain. Oral feeds were resumed on the fifth postoperative day. He was discharged in a satisfactory condition and is doing well in the follow-up. Repeat HIDA scan showed no evidence of spillage, with adequate bilio-enteric drainage. Conclusion Persistent major bile leak requiring ERCP with sphincterotomy can be managed successfully in children by internal drainage as Roux En Y cystojejunostomy.

Background: Acute exogenous lipoid pneumonia is an extremely rare pathology in children and occurs because of aspiration of oil or lipid-containing material. The presentation and radiological findings vary widely and the exact mechanism of injury to the lungs is not clear. Case Presentation: An 18-month-old girl presented with gradually increasing swelling and subcutaneous emphysema over the chest wall, neck, and face. The investigation revealed pneumomediastinum, pneumorachis, and soft tissue density in the left bronchus. The child underwent rigid bronchoscopy and retrieval of an organic foreign body. Conclusion: Acute exogenous lipoid pneumonia can occur in children because of aspiration of oil-secreting organic foreign body. The presentation can be atypical, clinical suspicion and early diagnosis with timely intervention are crucial for the appropriate management.

INTRODUCTION Neurogenic bladder (NB) post-meningomyelocele (MMC) repair is a major challenge and needs lifelong follow-up. Many cytokines have been implicated in the pathogenesis of NB. To avoid repeated urodynamic studies (UDS) and renal scans, we studied urinary tissue inhibitors of metalloproteinases-2 (TIMP-2) levels and correlated with urodynamic profiles to establish their efficacy. MATERIALS AND METHODS Prospective case-control study on children between 6 months to 12 years of age, who were at least 6 months post-MMC repair and had NB on UDS. Patients were evaluated under 4 cohorts of 20 patients each: Group A (NB on treatment), Group B (NB not on treatment), Group C (no NB), and Group D (Controls). All groups underwent radiofrequency thermocoagulation, urine culture, ultrasonography. Urine samples were stored at -800°C and analyzed using a validated Human ELISA kit for TIMP-2. RESULTS Eighty patients with a mean age of 3.54 ± 2.1 years were studied. A common ultrasound finding was a thickened urinary bladder (33.3%). All UDS parameters showed a statistically significant differences between groups with NB (Groups A and B) and a group without NB (Group C). Analysis of TIMP-2 levels between individual groups was statistically significant. The area under the receiver operating characteristic curve between urinary TIMP-2 and cystometric parameters indicated that urinary TIMP-2 levels are highly diagnostic of NB. TIMP-2 value of 358.5 pg/ml was found to be the least value with 93.5 sensitivity and 86.2% specificity. CONCLUSION This study highlights the potential of urinary marker TIMP-2 as noninvasive and cost-effective test to initially diagnose and predict the progression of disease in NBs with reasonable sensitivity and specificity.

Aim: Vesicoscopic Cohen's reimplantation closely replicates the open procedure and is reported to have equally good results. Robotic assisted vesicoscopic reimplantation (RAVR) is a new procedure, ...

Background: We wish to describe a novel technique of transdiaphragmatic excision of hepatic hydatid in patients with synchronous ipsilateral lung hydatid. Patients and Methods: Two patients, aged 1...

Introduction Minimal access surgical approach to choledochal cyst (CC) is becoming a standard of care in pediatric age group. Robotic-assisted excision of CC is increasingly being practiced at centers which have access to the system. We present our experience and technique of hepaticoduodenostomy (HD). Over all initial experience, short-term outcomes and complications are also presented and discussed. Materials and Methods Patients with CC and undergoing robotic excision were retrospectively studied. Patients with active cholangitis, liver dysfunction, and perforated CC were excluded for robotic procedures. All included patients were preoperatively evaluated as per the defined protocol. They underwent excision of CC with HD. The duodenal anastomosis was done after limited mobilization and emphasis was laid on anastomosing the distal D2 part to the common hepatic duct. This prevents bile reflux into stomach. The follow-up evaluation was done for these patients. Hepatobiliary iminodiacetic acid (HIDA) scan for duodenogastric reflux (DGR) was done only if patients reported symptoms related to it. Results A total of 19 patients (10 females) were studied. The mean age was 84 months. Type 1b was present in 12 patients and the rest were type IVb. Complete cyst excision with HD was done in all patients except conversion to open in one patient. The mean surgical time was 170 ± 40 minutes with console time of 140 ± 20 minutes. Median follow-up duration is 2.5 years (range: 3.5–0.5 years). HIDA scan was done in five patients who had reported epigastric pain. Of these five, one patient had a positive DGR. He is on conservative management. Conclusion Robot-assisted CC excision with HD is feasible as proven by the outcome of 19 patients presented in this series. HD is to be done away from pylorus in distal part of down curving D2. This particular step prevents DGR and is the most important point of technique in doing HD. The presented series is the first report of robotic excision of CC with HD. The robot is a facilitator for complex and difficult operations as CC excision and HD.

Background Once an exceedingly rare entity, multiple cases of forgotten rubber band syndrome or the so-called ‘dhaaga’ syndrome have now been reported in the literature. Objectives To conduct a thorough and systematic review of the literature for all articles reporting a chronic type of rubber band syndrome and to present an additional similar case as an illustration. Study design Systematic review and case report. Methodology PubMed, EMBASE and Google Scholar databases were searched for relevant articles using different combinations of the keywords till 20th June 2017. All articles reporting cases of chronic rubber band syndrome with a discharging sinus were included. Pearling of the bibliographies of selected articles was conducted to locate articles missed by the primary database search. Data from these reports were collected on pre-defined forms and the results were analysed. Results A total of 15 cases have been reported in the literature so far and all cases are from India. Thirteen of these have been reported in the wrist region. Median duration of presentation is 7.6 months after the application of elastic band. Characteristic clinical signs are a circumferential linear scar with discharging sinus (multiple sinuses noted in around one-fourth of the cases). ‘Soft tissue constriction sign’ on plain radiograph is pathognomonic for this condition. Rate of missed/misdiagnosis is very high (46.7%) and it has been confused with tubercular osteomyelitis which is endemic in India. All cases responded to surgical debridement of circumferential fibrous tissue and foreign body removal with good functional outcomes. Conclusions A high index of suspicion must be maintained for this ‘syndrome’ in chronic osteomyelitis cases presenting with a linear, circumferential scar and discharging sinus in India. Soft tissue constriction sign on plain radiographs are pathognomonic.

A 4-week-old female infant is referred to the pediatric surgery department with abdominal distention. Antenatal ultrasonography had showed dilated bowel loops and mild polyhydramnios (amniotic fluid index 24) at 22 weeks of gestation. The neonate was born via vaginal delivery at 34 weeks of gestation with a birthweight of 2.5 kg. She had been feeding well since the time of birth, and passed meconium within 24 hours of birth. She developed abdominal distention after 2 weeks of age. She has no history of vomiting, and has passed small amounts of stool every day. On examination, the infant weighs 2.2 kg. She is dehydrated, with mild facial dysmorphism in the form of triangular facies and a prominent forehead. Her vital parameters are stable. The abdomen is distended. In view of the abdominal distention, the infant is given nothing by mouth and a nasogastric tube inserted. Her urine output is 3 to 4 mL/kg per hour. Abdominal radiography shows grossly dilated bowel loops (Figs 1 and 2). Investigations show hypokalemic hypochloremic metabolic alkalosis with severe hypokalemia and hyponatremia (pH 7.56; Pco2 48 mm …

To estimate the impact of delayed presentation of anorectal malformation (ARM) in neonates and to compare the presenting characteristics and outcomes of early versus delayed presentation.This is a prospective observational study of all neonates (age 28 d) with ARM over 2 y. Delayed presentation was defined as presentation beyond 48 h of birth. Various presenting features and their early postoperative outcomes were compared.Nearly half (26, 48%) of the 54 neonates with ARM had delayed presentation. Early and late presenters did not differ in terms of gender, gestational age, birth weight, place of delivery, and type of ARM (p 0.05 for all). Delayed group had lower weight at presentation (p = 0.008), higher incidence of severe abdominal distension (p = 0.05), and sepsis (p = 0.171) and required longer time for resuscitation (p = 0.007) and more inotropes (p = 0.015), preoperatively. Early postoperative outcomes including time for stoma to function, initiate feeds and time to reach full feeds were significantly delayed in late presenters. They also had more wound infections, longer hospital stay and higher mortality.Delayed diagnosis of ARM is associated with significantly higher morbidity and mortality. Adequate awareness and training of health workers for early identification of ARM by careful perineal examination of all newborns at birth is the need of the hour.

Association of spinal or vertebral anomalies and the iatrogenic denervation during surgical correction of anorectal malformation patients especially in boys can lead to neurogenic bladder inthese subset of patients. The paucity of literature with regard to urodynamic studies focusing exclusively in male children with high-anorectal malformations (HARM) lead us to analyze the urodynamic changes. The objective was to study urodynamic profile in male patients who have undergone surgery for anorectal malformation. Male high-anorectal malformation patients who had completed all the stages of repair were prospective studied. Following the basic work up, all patients based on the urodynamics were categorized into 2 groups as safe or unsafe bladders. Unsafe bladder was defined as detrusor pressure > 40 cm (high detrusor pressure) or pressure variability of 15 cm of water (detrusor overactivity) or significant post-void residue. MRI was limited to patients with only abnormal urodynamics to rule out spinal causes of neurogenic bladder and due to financial constraints, it could not be offered to all patients. 41 HARM meet the exclusion criteria. All patients were asymptomatic with none having history of urinary tract infections. Ultrasound showed bladder wall thickening in 31.7% patients. UDS revealed reduction in bladder capacity and compliance was noted in 31.7% and 30% patients, respectively. Elevated detrusor pressures (> 40 cm of water) were noted in 10% (4/41), detrusor overactivity with concomitant elevated detrusor pressures in 19.5% (8/41) and normal UDS in 70% (29/41). 13 patients (31.7%) had abnormal cystometric parameters with 12(30%) having unsafe bladders. MRI confirmed sacral agenesis in 1 patient with unsafe bladder. Urodynamics can demonstrate occult neurovesical dysfunction in patients with HARM. This would help in early renal protective therapy and prevent the burden of long-term sequelae of neurovesical dysfunction in HARM patients.

To report the data of burden of rotaviral acute gastroenteritis in under-five children from two states post-introduction of the vaccine. Children under 5 y of age hospitalized with diarrhea from the states of Haryana and Himachal Pradesh in north India were recruited in the study. Commercially available ELISA kits were used for testing rotavirus in the collected stool samples. Genotyping of the positive samples was done by reverse-transcription polymerase chain reaction. Out of 345 samples collected, 69 (20%) were found to be positive for rotavirus by ELISA. Genotyping was done and G3P[8] (31.3%), G1P[8] (13.4%), G2P[4] (13.4%) were found to be prevalent strains. Mixed strains were also found in 19.4% stool samples. The study highlighted the high burden of rotavirus associated diarrhea in north Indian states. The data is helpful for evaluating the impact of vaccine on the severity of acute gastroenteritis and the changing strains after the introduction of rotavirus vaccine in the Universal Immunization Program.

A 12-year-old girl presented with chronic suppurative lung disease secondary to an old forgotten, foreign body (plastic whistle) in the right lower lobe bronchus, confirmed by Contrast enhanced computer tomography (CECT) chest. Rigid bronchoscopic removal was attempted twice but the foreign body could not be removed. Under general anesthesia, a flexible bronchoscope was inserted through the rigid bronchoscope and the foreign body was grasped and removed using rat-toothed forceps inserted through the suction channel of the flexible scope. Although there are a few reports of sequential use of flexible and rigid bronchoscopies, this report highlights the feasibility and utility of flexible through rigid bronchoscopy technique for foreign body removal in the distal airways.

Proximal migration of double J-stent (DJ stent) can be a reason for failure of its cystoscopic removal. Antegrade percutaneous nephrostomic removal of the stent can be done in such cases. Although the technique is described in adults and older children, the technique requires some modification when used in infants because of smaller calibre of pelvicalyceal system. Here we describe a case of a 6 month old male child who was treated by robotic assisted pyeloplasty for left sided ureteropelvic junction obstruction followed by placement of DJ stent. Cystoscopic removal of the stent 6 weeks after surgery was not possible due to proximal migration of the stent. Hence, antegrade percutaneous nephrostomic removal of the stent was performed using micro-snare. Certain novel technical modifications, like advancement of a diagnostic angiographic catheter in pelvicalyceal system, has been used in this case to reduce the risk of urothelial injury. Thus, antegrade removal of DJ stent with few technical modifications can be used safely in infants for removal of proximally migrated stents.

Purpose This study is carried out to characterize the prognosis and outcome of antenatally diagnosed cystic hygroma in a series of registered pregnancies. Methods This is a prospective cohort study, carried out over a period of 4 years (Jan 2016–Sept 2019). All the pregnancies referred from the department of obstetrics with antenatally detected cystic hygroma or increased nuchal thickness on level II ultrasonography suggestive of lymphangiomas were registered in the Pediatric Surgery outpatient department. Amniocentesis, fetal ECHO and fetal MRI (if indicated)were done. Prognosis was explained to the family and mode of delivery was planned as per the obstetric indications. Postnatal evaluation included general physical examination along with ultra sound (USG)doppler of the lesion. The neonates were admitted in neonatal surgical ICU for the administration of intralesional bleomycin in a dose of 0.3 IU/kg under strict observation. All the babies were followed up at 3, 6 and 12 months. Results were segregated as excellent, good and still in follow up cohort as per the final outcome. The fetal neck masses detected antenatally and the age at first dose of bleomycin were compared with the number of sclerotherapy doses required to achieve good response. Results Only nine patients out of 626 registered pregnancies (1.4%) were diagnosed with cystic hygroma. One antenatal mother opted for termination of pregnancy at 19 weeks of gestation and another patient was lost to follow up after receiving two doses of bleomycin in postnatal period. Maternal hypothyroidism was noted in two pregnancies. Antenatal USG shows increased nuchal thickness in 2 cases (first trimester) and 6 cases in level II scan. Amniocentesis shows normal fetal karyotyping in all these pregnancies. Fetal ECHO suggests normal biventricular function in 100% cases while fetal MRI done in one case completely ruled out any aerodigestive compromise. Mode of delivery is found to be planned elective LSCS in 57% of cases while normal vaginal delivery attained in 43% of cases as per the obstetric guidelines. Six cases achieved good response with >50% reduction in size out of which 4 cases received the dose at the first 10 days of life. Complete disappearance of lesion at the end of 6 months of follow up were seen in two babies. Conclusions Antenatal screening for early detection of fetal cystic hygroma with possible associated congenital aneuploidies helps in prognostication and planning the mode of delivery. A multimodality approach during intra and postpartum increases safety margin. Even huge neck masses without associated anomalies carry fair prognosis. Intralesional bleomycin is safe and prevents surgical morbidity.

We report 3 previously healthy children of postneonatal age who developed fatal form of gastrointestinal mucormycosis after systemic inflammatory response syndrome, shock and metabolic acidosis. Abdominal distension and peritonitis were secondary complications. The study highlights the importance of clinical suspicion of gastrointestinal mucormycosis when the triad of shock requiring vasoactive drugs, metabolic acidosis and abdominal distension is present.

A 6-week-old male child presented with a right-sided congenital diaphragmatic hernia (CDH), large perimembranous (PM) ventricular septal defect (VSD) and multiple muscular VSDs, and a patent ductus arteriosus (PDA) with severe pulmonary arterial hypertension (PAH). The child was found to be allergic to frusemide. The VSDs were closed, the PDA was ligated, and the CDH was repaired through a right subcostal incision. Postoperatively, there were recurrent episodes of right lung lobar collapse, but the child responded to intravenous antibiotics and nasal continuous positive airway pressure (CPAP). The child is medically stable and on outpatient follow-up. We present this rare combination of diseases in view of a successful simultaneous surgical repair.

Background Baseline data on intussusception are needed to compare the intussusception rates following introduction of rotavirus vaccine. Methods A hospital-based bidirectional surveillance (retrospective from 2009 to 2012; and prospective from 2013 to 2015) was set up in a tertiary care hospital in Chandigarh, India, to enrol children

Background Anticholinergics are well established in the management of neurogenic bladders. However, some patients do have sub-optimal response or severe side effects. This study is designed to assess and compare efficacy of gabapentin with oxybutynin in neurogenic bladders after surgery for spina bifida. Methods Patients were randomized into three groups after urodynamic studies and started on oxybutynin, gabapentin, and combination of both, respectively. Thorough clinical and urodynamic reassessment was done at 6months and one year after starting treatment. Results Forty-four patients (3–19years) were studied. Improvement was noted in symptoms as well as urodynamic parameters in all groups. Maximal improvement of symptom score was with combination of drugs at 1year. In urodynamic studies, compliance, pressures, and capacity showed improvement, which was significant between the groups at both six months and 1year for bladder pressures and volume. Improvement in compliance though marked was not statistically significant. Best response was seen in group receiving both drugs. Gabapentin was better tolerated than oxybutynin. Conclusion Gabapentin is a good alternative to oxybutynin for management of neurogenic bladder, both as monotherapy and as an add-on therapy. It has potential application in patients with inadequate response to anticholinergics. Level of evidence: prospective competitive treatment study – level II.

Aim: Airway foreign body (FB) is a very common pediatric surgical emergency. On certain difficult occasions, the extraction of FB with optical forceps (OFs) is difficult. These conditions create a life-threatening scenario. We present some of the alternative methods of FB extraction for these situations. Patients and Methods: This is a retrospective case review of patients presenting to pediatric emergency with airway FB. All patients had a chest X-ray done before the procedure. Rigid bronchoscopy was performed in all patients for retrieval. Results: A total of 20 patients (6 females) were successfully scoped. The age ranged from 1.5 years to 12 years (mean 3.5 years). Bronchoscopic removal was aided by dormia basket (DB) in 13, Fogarty's catheter (FC) in 6, and magnet aided removal in 1. Complete removal was achieved in all patients. Conclusions: We recommend that DB, FC, and a magnet should form an indispensable part of bronchoscopy set. The use of these alternative methods is successful and allows ventilation during the removal in contrast to removal by OFs. These should be kept as an option if retrieval is difficult.

Aim: The aim is to prospectively study 125 trauma patients admitted in the pediatric surgery ward in our institute. Materials and Methods: Pediatric patients admitted in the ward after initial resuscitation in the triage room were included. Isolated neurosurgical and orthopedic injuries were excluded. X-ray cervical spine, hip, and chest and a focused assessment with sonography in trauma ultrasound were done for all patients. Computed tomography of the abdomen or chest was done where relevant. Injury profile and surgical intervention when needed were analyzed. Results: Road traffic accidents and fall from height caused 73.6% of the injuries. School-going children were most commonly affected (60.8%). Distinctive injuries were noted such as abdominal wall hernias and delayed bladder perforation. All solid organ injury irrespective of grade treated conservatively. Forty percent of the children required surgical intervention. Five patients after laparotomy were found to have surgical conditions unrelated to trauma, whereas another 14 required delayed surgery. Five patients had injuries secondary to sexual abuse. All except two patients were discharged in a satisfactory condition and are doing well in the follow-up. Conclusion: In spite of extensive injuries and the need for multiple surgeries, children with trauma have a good prognosis. Close observation during admission and also in follow-up are essential, as many patients may require delayed surgery ≥1 week from injury.

Background and Aims: α2 agonists have been utilised in regional blocks, but very little data is available for their use in transversus abdominis plane (TAP) block in paediatric laparoscopic (LAP) surgeries. This study investigated the analgesic effect of ropivacaine alone versus its combination with dexmedetomidine for TAP block in children undergoing LAP surgery. METHODS: A randomised, double-blind trial was conducted in 50 American Society of Anesthesiologists (ASA) 1 and 2 children of 2–8 years undergoing LAP abdominal surgery. Children were randomised to receive a total volume of 0.5 ml/kg of 0.2% ropivacaine (LA group) or 0.2% ropivacaine with 1 μg/kg dexmedetomidine (LAD group) for performing ultrasound-guided bilateral TAP block postoperatively (PO). Patients were monitored PO for vital signs, pain, sedation, time to first rescue analgesic and total analgesic consumption for 24 h. Time to first rescue analgesic was expressed as mean ± standard deviation (SD) and analysed using Kaplan–Meier survival analysis. Pain and sedation scores were expressed as median [interquartile range (IQR)] and analysed using Mann–Whitney U test. Results: First rescue analgesic demand was significantly longer (P = 0.001) in LAD (474.8 min) versus LA group (240.9 min) but total analgesics consumption in first 24 h was comparable. Pain scores were significantly lower (P < 0.05) in LAD compared to LA group at all times PO. Each group had comparable but significantly lower sedation scores up to 24 h PO. Conclusion: Addition of dexmedetomidine to ropivacaine in TAP block prolongs the time to first analgesic requirement without a difference in the total analgesic consumption.

A 4-year old child, previously operated case of tetralogy of Fallot present with recurrent episodes of massive lower gastrointestinal bleed of one year duration. Endoscopic evaluation revealed multiple bluish vascular lesions in the duodenum and proximal jejunum and a single rectal polyp. Histology of the lesion was suggestive of venous malformation consistent with blue rubber bleb nevus syndrome (BRBNS). Child underwent endoscopic snaring and surgical resection with end to end anastomosis. At six months’ follow-up child was asymptomatic without any bleed episodes.

A preterm baby born at 32 weeks of gestation with a birth weight of 1.4 kg referred to us on day 11 of life with feed intolerance and scrotal swelling. Examination revealed slightly distended abdomen, absent bowel sounds and a huge scrotal swelling which was soft in consistency with shiny skin (figure 1A) and brilliant transillumination (figure 1B). Abdominal radiograph showed air under the right dome of the diaphragm (figure 1C, white arrows) and hugely distended scrotum with gas which was extending up to the inguinal canal (figure 1C, yellow arrows). He was managed as a case of necrotising enterocolitis (NEC) with intravenous antibiotics, nil per oral, gastric aspiration and primary peritoneal drainage (peritoneal …

Aim: To evaluate the health related quality of life (HRQOL) after endoscopic injection treatment for vesico ureteral reflux (VUR) in children. Materials and Methods : Fifty four children received treatment and were prospectively evaluated for their quality of life scores, according to resolution of reflux on cystograms and status of renal scars. Results: Of the 81 refluxing units, 72 (89%) had resolution of reflux whereas 9 (11%) did not resolve. The total average QOL was higher for the patients in the resolved group as compared to the non resolved group. Comparison of pre and post procedure renal DMSA scans in 44 patients showed status quo in 26, regression of scars in six, progression in two and formation of new scars in 6.The total increase in HRQOL was highest in regression group (67.91), and lowest in progression group (36.45). Conclusions: Successful endoscopic treatment of VUR is associated with improved quality of life, as indicated by higher HRQOL scores in the resolved group.

Blunt trauma represents a major cause of death in children. The incidence of renal arterial injuries in these cases is less than 1%. Traumatic renal artery occlusion is a rare occurrence in the pediatric age group. However, there is lack of information on the exact incidence and results of the management of these rare cases in the pediatric age group. We report herein a case and we review the available literature of this severe injury in the pediatric age group.

Ureteral triplication is one of the rare anomalies of the urinary system. The following case describes management of child with triple system of right kidney with refluxing upper moiety ureter. It is not unusual to find such clinical presentations but the embryology with relevance to these malformations has been intriguing. The recent knowledge of the molecular mechanisms governing the process of ureteral budding and elongation raises some important questions. The current report discusses and hypothesizes the concept that certain family of molecules may be responsible for helping the ureteral bud to find its way to the respective metanephros. Keywords : embryology of ureter, Robo2, Slit2, ureteral triplication, Weigert–Meyer law

Aim To perform a qualitative assessment of research publications coming from two premier medical institutes in India. Materials and methods Research publications from AIIMS and PGIMER published during 2004 to 2008 were analyzed. The publications were categorized into five types. A year-wise analysis was done for both the institutes. Data was obtained from Scopus. The collected data included the number of papers published in a category, total citations received by a type of publication in a year, number of publications which have no citations, number of publications with only one citation, h-index, number of zero and only one citation were added to get publications with negligible citations. Results A total number of 4,828 and 2,882 research publications were analyzed from AIIMS and PGIMER respectively. The original articles attracted highest no of citations that is 64 and 66% of the total citations in a year for AIIMS and PGIMER respectively. Approximately 37 to 42% of the original articles get negligible citations. The h-index for various categories of article was higher for the original articles (18/13), whereas it was very low for other category of research publications. Conclusion The original articles fetch more citations in long run. Close to 40% of the original research done in the studied institutes get negligible citations pointing toward their outcome utility and quality. More than 60% of the minor category publications remain uncited. This sort of data if periodically obtained should serve as a benchmark for quality analysis of scientific research. How to cite this article Kanojia RP, Rathod KK, Rao KLN. Qualitative Assessment of Research done at Two Premier Medical Institutes in India: Some Data for Introspection. J Postgrad Med Edu Res 2012;46(1):24-33.

Aim: To study the role of urinary enzymes N-acetyl-b-glucosaminidase (NAG), alkaline phosphatase (AKP) and gamma glutamyl transferase (GGT) in the diagnosis and follow-up of patients with suspected pelviureteric junction obstruction (PUJO). Materials and Methods: A total of 70 patients, 29 managed conservatively (group A) and 41 managed by pyeloplasty (group B), were studied prospectively. A serial measurement of urinary enzymes NAG, AKP and GGT level was performed in both the groups. The mean levels of these urinary enzymes were compared between the two groups and among the patients of the same group at presentation as well as during follow-up. Results: There was a significant fall in the mean AKP level in patients managed conservatively at 8 months of follow-up. Similarly, in the operated group, there was a significant fall in the AKP levels at both 3 months and 8 months of follow-up. The mean level of GGT also showed a significant fall after 3 months of surgery but did not show further significant change at 8 months after surgery. The mean levels of NAG and GGT in the conservatively managed group were significantly low compared with that of patients requiring pyeloplasty at presentation as well as in the follow-up. The mean level of AKP was significantly low in the conservatively managed group when compared with the patients requiring surgery, but did not differ significantly in both the follow-ups after surgery. Conclusions: The level of urinary enzymes NAG, AKP and GGT are significantly high in the patients with hydronephrosis (HDN) requiring pyeloplasty when compared with the patients managed conservatively. The level of AKP significantly falls after pyeloplasty in the patients of HDN due to PUJO. There is a negative correlation with the preoperative level of enzyme NAG with split renal function in the patients of HDN requiring pyeloplasty.

Hepatobiliary scintigraphy is a widely used functional imaging modality for diagnosis of a variety of liver diseases, as well as for detecting biliary tract abnormalities. Neonates or infants with persistent jaundice beyond the physiological period are usually evaluated with hepatobiliary scintigraphy. The authors present a 5-month-old girl with neonatal jaundice, ascites, and umbilical and bilateral inguinal hernias in whom spontaneous rupture of the biliary duct resulted in intraperitoneal bile leak with passage of tracer into bilateral inguinal hernial sacs.

Retrocaval ureter (RCU) is a rare congenital anomaly with the ureter looping around inferior vena cava (IVC). We present the case of 10-year-old boy. Diagnosis was confirmed with ultrasound and CT. He underwent retroperitoneoscopic uretero-ureterostomy.