Immunohistochemical evaluation of neuronal dysfunction in paediatric patients with Hirschsprung’s disease and allied disorder

Background: Neonatal bowel obstruction may result due to defect in the intestine wall which may be classified as neuropathic, myopathic or idiopathic types according to the pathological changes observed. The present study was conducted between September 2014 to December 2015 with the aim to study histomorphological changes and evaluate the role of various IHC markers (calretinin, S-100, CD117) in Hirschsprung’s disease (HD) to assess neuronal dysfunction in these patients.Methods: Thirty cases with clinical suspicion of HD were included in our study. The tissue sections were processed and wax blocks were prepared. Histopathological diagnosis was established on routine H and E. Representative sections were further subjected to IHC staining with calretinin, CD117 and S-100 protein. A descriptive study was carried out. Chi-square was used with P-value less than 0.05 accepted as statistically significant.Results: Out of 30 cases with clinical suspicion of HD, 13 cases were diagnosed as HD, 10 as Non-HD motility disorder whereas 7 were without any definitive diagnosis. All the cases were subjected to IHC staining using calretinin. Out of 13 cases diagnosed as HD, 1 case showed presence of ganglion cell using calretinin. All 7 equivocal cases were accurately diagnosed by calretinin. Thus 12 cases were confirmed HD while 18 were diagnosed as Non HD motility disorder. On statistical analysis, sensitivity (92.3%) of calretinin was lower than specificity (100%). Nerve bundle hypertrophy was observed in 11 cases of HD and 9 cases of Non-HD motility disorder using S-100 as an IHC marker. CD117 was used to demonstrate altered density and distribution of ICCs was statistically significant in cases of Non-HD motility disorder.Conclusions: IHC is being widely used as a reliable adjunctive test in evaluation of motility disorders of bowel. In view of its ease and reproducibility, it can be routinely used, avoiding need for repeated biopsies, and delay in treatment

Childhood Morgagni hernia: report of two cases

Morgagni diaphragmatic hernia is a rare congenital anomaly to be seen in the pediatric age group. We are reporting two cases of Morgagni hernia, which presented with non-specific symptoms and posed a diagnostic dilemma. One of the patients was 10 years old and associated with asplenia and Down’s syndrome; the second case presented as isolated Morgagni hernia in an 8 month baby. The diagnosis was confirmed with radiography and computed chest tomography. Both cases were managed successfully with surgical repair of the diaphragmatic defect through trans-abdominal approach

Delayed presentation of congenital intrinsic duodenal obstruction in children with non-bilious vomiting: a diagnostic dilemma

The duodenum is described as the most common site of intestinal obstruction, classically presenting with bilious vomiting. Of the various categories described, congenital duodenal webs are reported as a rare cause of duodenal obstruction. The clinical features may vary depending on the size and location of the duodenal web. We are reporting 5 pediatric patients with delayed presentation of congenital intrinsic (type 1) duodenal obstruction. All patients presented with recurrent non-bilious vomiting and were misdiagnosed as gastroenteritis in other centers. The diagnosis was confirmed with upper gastrointestinal tract contrast studies. The patients were managed successfully with surgical intervention

Transition-Metal Free Allylic Fluorination of Acyclic Olefins

one step allylic fluorination of alkenes is reported which furnishes the products in a highly regioselective manner via allylic rearrangement. The reaction proceeds efficiently under mild conditions with the use of trisubstituted alkenes as olefin partner and Selectfluor as an electrophilic fluorinating agent without the need of any transitionmetal catalyst or pre-functionalized substrate

Meckel's diverticulum in children: Our 12-year experience

Background: Meckel's diverticulum (MD) is the one of the most common congenital malformation of gastrointestinal tract and has varied clinical presentations. We are presenting here our 12-year experiences with MD in children at tertiary care hospital in North India. It highlights the fact that isolated gangrene of MD can occur, and it is associated with increased morbidity. Materials and Methods: This retrospective study is conducted by analysing the medical records of the patients who were operated for MD in the last 12 years in paediatric surgery department at our hospital. Results: Sixty-five patients were operated for MD in study period; in this 52 were males and 13 were females with mean age of presentation 3.2 years. The most common presentation was intestinal obstruction seen in 86.1% (56 cases). Intestinal haemorrhage was seen in 4.6% (3 cases) and diverticulitis in 3% (2 cases). Perforation of the gut with peritonitis was present in 6.1% (four cases). Cause of obstruction was intussusception in 21.4% (12 cases), fibrous band connected to umbilicus in 17.8% (10 cases), volvulus in 17.8% (10 cases), kinking in 16.0% (9 cases), knotting in 14.2% (8 cases) and herniation of gut below in 12.5% (7 cases). Isolated gangrene of MD was present in ten cases with intestinal obstruction. The ectopic gastric mucosa was seen in three and pancreatic mucosa in two cases. Mortality and morbidity during the study were one and three cases, respectively. Conclusion: MD may remain clinically silent for lifetime, or it may have life-threatening complications. In our series, intestinal obstruction and not the haemorrhage was the most common presentation. Isolated gangrene of MD with obstruction was present in significant numbers, which we failed to find in literature

Spontaneous external rupture of hydrocephalus in the occipital region in an infant: A rare case report

With the availability of advanced diagnostic and therapeutic modalities, late presentation of hydrocephalus is a very uncommon occurrence in the present era. Here, we report an 11-months infant with late presenting hydrocephalus with spontaneous rupture at the occipital region. Keywords: Hydrocephalus, Infant, Rupture, Occipita

Congenital diaphragmatic hernia: Misdiagnosis in adolescence

We report 3 cases of congenital diaphragmatic hernia (CDH) in the second decade of life which were misdiagnosed on initial presentation. The first case had an iatrogenic gastric injury because of intercostal tube drainage for suspected pleural effusion. The second case was treated for pulmonary tuberculosis for 6 months before being diagnosed as a case of CDH. The third case presented as acute chest pain on the left side. It was treated accordingly for 1 month and was diagnosed as a CDH on a CT scan of the chest when seen by a surgeon