RESUMEN
AIM: Report of 125 pediatric patients of empyema thoracis treated by open decortication, highlighting the presentation, delay in referral, operative findings, the response to surgical intervention and follow-up. MATERIALS AND METHODS: All the children who underwent open decortication for stage III empyema thoracis during the study period were included. Preoperative workup included hemogram, serum protein, chest radiographs and contrast-enhanced computed tomographic (CECT) scan of the chest. RESULTS: One hundred and twenty-five patients (81 males, 44 females) (age 3 months-12 years, mean 4.9 years) were operated during a 4.5-year period. Among them, two children underwent bilateral thoracotomies. Also, 81.6% patients were referred 3 weeks after the onset of disease (mean duration 9 weeks). Intercostal chest drainage (ICD) had been inserted in (119) 95% cases. Thickened pleura, multiloculated pus and lung involvement were invariably seen on CECT scan. Bronchopleural fistula was present in 10 patients and empyema necessitatis in 2. Decortication, removal of necrotic tissue and closure of air leaks was performed in all the patients. Necrotizing pneumonia was seen in (35) 27.5% cases. Mean duration of postoperative ICD was 7 days. Follow-up ranged from 3 months to 4 years (mean 12 months). There was no mortality. Six patients had proven tuberculosis. CONCLUSIONS: The duration of the disease had a direct relationship with the thickness of the pleura and injury to the underlying lung. Delayed referral causes irreversible changes in the lung prolonging recovery. Only 18% presented within the early period of the disease. Meticulous open surgical debridement gives gratifying results. The status of the lung at the end of surgery is a major prognostic factor.
RESUMEN
Epidermoid cysts of the floor of the mouth represent <0.01% of all oral cysts. Only few cases have been reported so far. We report a case of a 24 years man with a large sublingual swelling for 17 years, unable to take solid meals. The swelling was approximately 13 × 13 cm, non-tender, non-transilluminant, with doughy consistency and with patent visible Wharton's duct openings on both the sides. Initial decompression of the lesion was done to facilitate nasotracheal intubation followed by partial excision of the cyst with marsupialization. Histopathological examination revealed a thick wall cyst lined with pseudostratified squamous epithelium without any evidence of dermal appendages suggestive of epidermoid cyst. Postoperative care included extraction of the loose infected dentures and physiotherapy of the ankylosed temporomandibular joints. Clinical progress was uneventful and cosmetic appearance was acceptable on 6 month and 2 years follow up with normal mastication function.
RESUMEN
Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is characterized by Mullerian duct structures agenesis. Anorectal malformations are uncommonly associated with MRKH syndrome, and among them, rectovestibular fistula and cloacal malformations have been commonly described. H-type of anovestibular fistula associated with MRKH syndrome has not been reported previously. One such case along with its treatment is reported.