The patients suffering from various maxillary defects of palate and lips require a form of definitive treatment after attaining adulthood. These defects affect the patients psychologically giving them negative impact of life, the treatment of these defects with definitive prosthesis will enhance the aesthetics along with occlusal rehabilitation and giving them the confidence they require. This case report describes the rehabilitation of 18yrs old female patient with unilateral cleft palatal defect which is rehabilitated with porcelain fused to metal (PFM) crowns covering the defect and as well providing the confidence the patient required.

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Sinus pericranii (SP) is a rare, generally benign venous varix in extra cranial location that is connected to intracranial venous system. In this study, we will share our experience with five cases of sinus pericranii operated at our institute along with considerations of preoperative surgical risk. In this study, two cases of Sinus pericranii with associated craniosynostosis were not included. Out of 5 patients in this study, 4 patients were of congenital origin and another with history of trauma. The study population consisted of three male and two female. There were three children with age of 11, 18 and 36 months. Other two were young adults (one male and other female). One child was referred to us in hemodynamically unstable condition after wrongly diagnosed and operated as epidermoid cyst. All five sinus pericranii patients were operated with excellent results. We will share our experience with these five cases followed by a review of literature.

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Background: Previously, many different types of solid renal tumors were clubbed together under the heading of "Wilms Tumor". However, some of these have been proved to be distinct pathological entities in their own right which include Nephroblastomatosis, Renal cell Carcinoma, Mesoblastic nephroma, Multilocular cystic renal tumor, Clear cell sarcoma, Rhabdoid tumor etc. Aim: We aim to evaluate Ultrasound and Computed Tomography features of malignant renal neoplasms in paediatric population and correlate the same with histopathological findings to assess the diagnostic accuracy of these two imaging modalities. Material and methods: A prospective study of 30 patients was done and data was summarized under location, size, extent of involvement and imaging characteristics of renal tumours and metastases. Calculation of sensitivity, specificity, positive and negative predictive value and accuracy of the imaging modalities was done. Result: Mean age at presentation was 3.74 years with male to female ration being 1.73:1. Spectrum of features on Ultrasound and CT scan is diverse and wide-ranging with variable amounts of necrosis, calcification and vascular thrombosis. Wilms tumor was found in 24(80%) cases making it the most common renal neoplasm in children followed by cystic nephroma. One case each of mesoblastic nephroma, clear cell sarcoma, renal cell carcinoma and secondary lymphoma was seen. Internal architecture is varied and it is often difficult to differentiate these tumors from Wilms Tumor. Conclusion: A vast majority of renal tumors do not have characteristic imaging features and may sometimes remain indistinguishable from Wilms tumor on both US and CT scan.

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A 2 years old boy presented with cold, cough, fever (respiratory distress) for 5 days and irritability for 3 days. On examination he had marked Pallor with hepatosplenomegaly. He was referred to the haematology depart-ment for work up. Complete Blood Count with Peripheral Blood film examination suggestive of Acute Lym-phoblastic Leukaemia. Atypical immature blasts are seen in peripheral blood. They have irregular nuclear outline with convolutions. RBCs show dismorphic cell population. Bone marrow aspiration showed presence of blast cells, fine nuclear chromatin with presence of nucleoli. Chest X ray revealed Hilar prominence. Morphologic findings are those of acute leukemia, possibly Acute lymphoblastic leukaemia (ALL) but Flow cytometry sug-gestive of 16% immature myelomonocytic precursor cells with monocytic differentiation. On follow up after 3 months no. of blasts cells and monocytic cells has come down significantly suggesting reactive cause of previ-ous proliferation exclude noninfectious causes(usually a hematologic malignancy).

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Aim: To report clinical outcomes of deep anterior lamellar keratoplasty (DALK) in patients with varied corneal opacities. Design: Retrospective noncomparative interventional study. Methods: 54 patients were subjected to DALK and followed for at least six months. Outcome measures were intraoperative and postoperative complications, uncorrected and best corrected visual acuity (UCVA and BCVA), mean refractive spherical equivalent (MRSE) and mean cylinder at final follow-up. Results: Intraoperative complications includes Descemet's perforation (6). Postoperative complications includes interface haze (4), graft infection (3), pupillary block glaucoma (1), graft melting (1), graft rejection (3). Mean preoperative and postoperative UCVA and BCVA was 1.56±0.35D; 1.09±0.47D and 1.56+0.35D;0.76+0.54D respectively. Mean MRSE and mean cylinder at final follow up was -0.76+5.94DS and 0.41±10.72D respectively. Conclusion: DALK provides stable long term visual and refractive outcomes.

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Infection is one of the serious complications in an implanted permanent pacemaker. Pasteurella species are a component of the normal oropharyngeal flora in many different animals. In humans, the skin and soft tissue are the most common sites for Pasteurella infection. We report a case of permanent pacemaker infection by Pasteurella aerogenes in a patient after four month of implantation. There was no history of contact with any animal during this period.

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Knee pain is one of the commonest orthopaedic complain in paediatric age group. Itis mainly due to hyper mobility and growing pains. It may be due to hip pathology which presents with knee pain. Here we present a case series of children who presented with referred knee pain due to hip pathology.

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Background: The aim of the study was to assess the efficacy of ropivacaine with clonidine given as single shot caudal epidural in pediatric patients undergoing infraumblical sugary for intraoperative and postoperative pain relief. Materials and Methods: In this study, 30 children of ASA-I-II, aged 1-6 years scheduled for infraumblical surgical procedures were given ropivacaine 0.125% 1 ml/kg + clonidine 1μmg/kg as single shot caudal epidural analgesia. After induction of general anaesthesia Caudal block was performed. Patients were observed in postoperative ward for relief of pain, sedation, hemodynamic and any adverse effects or complications. Results: All the patients exhibited stable hemodynamics. There was good intraoperative and postoperative analgesia. No patient required intraoperative rescue analgesic. Adverse effects like respiratory depression, vomiting, bradycardia, hypotension, residual motor blockade, pruritus were statistically insignificant. Conclusions: Ropivacaine with clonidine has prolonged duration of analgesia after single shot caudal epidural administration. This combination has not clinically and statistically significant adverse effects. So ropivacaine with clonidine can be used as caudal analgesia in children.

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A 73 year old female presented with Intestinal Obstruction and did not respond to conservative management. A 73 year old lady presented with unable to pass faeces and abdominal distension for 6 days for which she was admitted and conservative management was done with emphasis of Electrolyte correction and supportive management. An abdominal X-ray revealed 3-4 Air fluid levels and the patient was passing flatus and occasionally liquid stools. A CECT abdomen was done to rule out other causes of mechanical obstruction which revealed a right sided obturator hernia with dilated bowel loops and features of intestinal obstruction. Exploratory Laparotomy was done an ileal loop was seen herniating into the bony foramen which could not be reduced. A separate incision was given on the Right Groin extending till the femoral region and hernia sac was reduced. A partial enterocoele (Richter's Hernia) was seen which became viable on warm compression. Obturator Foramen was closed and mesh plugging was done. Patient had uneventful smooth recovery and resumed normal oral diet after 48 hours. Patient was followed up for 3 months and was asymptomatic. The aim of this paper is to emphasize on the rarity of such conditions and discuss on the management with emphasis on the role of an early radiological diagnosis.

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H-type anorectal malformation characterized by a fistulous communication between urethra and rectum with patency of both epithelial tracts is a rare abnormality in male children. We recently managed a 15-year old male child with on and off passage of urine per rectum. We present the clinical details and the difficulties encounterd in managing this extremely rare malformation in a grown-up male patient.

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Background: Ovarian tumour in children and adolescent girls is uncommon but important part of gynaecological malignancies. They account for 1% of all the childhood malignancies and 8% of all abdominal tumours in children. Incidence is reported to be 2.6 cases per 100,000 girls per year and almost 10-30% of all the ovarian neoplasms occurring in girls up to 17 years of age are malignant We share our experience in childhood ovarian cancers, analysing a series of cases with respect to the clinical profile, treatment and survival. Methods: All newly diagnosed ovarian tumours in children up to 20 years of, registered in Gynaecological Oncology of Indira Gandhi institute of medical science between 2014 and 2017 were retrospectively reviewed. Observations: There were 12 patients with newly diagnosed ovarian malignancies. The mean age at presentation was 14 ± 4 years. The most common symptoms at presentation were acute abdominal pain (48.9%) and abdominal mass (40.4%). Histology was germ cell tumours in 11 cases and nongerm cell tumours in one cases. Out of 11 GCTs, 10 patients underwent fertility sparing surgery and one patient lost after neoadjuvant chemotherapy. One patient of mucinous adenocarcinoma underwent debulking surgery. Six patients lost to follow up after surgery and three had taken post-surgery chemotherapy. At a median follow up of 15 month, the 3 year disease?free survival was 46. 62 ± 2.3 % and 3 year overall survival (OS) was 38 ± 3.46 %. Conclusion: Germ cell tumours are the most common ovarian malignancy in children. With surgery and chemotherapy using BEP, good outcome can be expected in these patients.

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The digastric muscle is a suprahyoid muscle which consists of two bellies: anterior & posterior. Above the hyoid bone these two bellies are connected by an intermediate tendon, which is anchored to the hyoid bone by a fascial sling of investing layer of deep cervical fascia. The variations of the anterior belly of digastric muscle are uncommon. In the present case, we found a bilateral symmetric variation in the anterior bellies of digastric muscle in a 58 year old female cadaver. Both accessory bellies were present bilaterally medial to the anterior digastric muscles. Each accessory bellies consisted of two segments: anterior and posterior. Both segments crossed each other & looked like the letter "X". Both accessory bellies originated from the digastric fossa & inserted to the anterior digastric muscle. In the midline these accessory bellies were attached to each other by dense connective tissue that also connected these bellies to the mylohyoid muscle superiorly. Anatomical variations of the digastric muscle may affect the mastication as well as deglutition. Moreover, the accessory digastric muscles also affect the different diagnostic imaging and therapeutic procedures in the region of head and neck. Therefore this type of variations must be considered in procedures involving this area.

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Chilaiditi syndrome is the interposition of the right colon between the liver and the right hemi diaphragm. Generally, the patients are asymptomatic but can present symptoms mimicking intestinal obstruction. Although, there are many complications related to colostomy in the patients of anorectal malformation, appearance of Chilaiditi syndrome is unusual Further, hypokalemia can be a precipitating factor for the development of Chilaiditi syndrome.

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Granulosa cell tumour (GCT) is an uncommon low grade malignant neoplasm. It primarily arises from the sex-cord stromal cells of the ovary and produces oestrogen in most of the cases. They manifest themselves with pain and pressure symptoms due to expansile growth on adjacent organs. Granulosa cell tumours usually produce oestrogens, and leads to symptoms and signs of oestrogen excess. Granulosa cell tumour (GCT) is characterized by a relatively low malignant potential, slow growth, less aggressive and late recurrence; however prognosis is influenced by many factors, such as age and stage at presentation, tumour size, necrosis, mitotic activity and histological staging. We report a case of GCT in postmenopausal woman having history of previous two laparotomy for ovarian mass.

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Pyrexia of unknown origin is one of the most difficult diagnostic problems in Internal Medicine and could be caused by infection, inflammation, neoplasm and other miscellaneous causes. Subacute thyroidtis is one of the rare causes of PUO. Case: 55 years old male who was a known diabetic on insulin was admitted with history of fever of one month duration. Clinical examination and investigation revealed tender thyromegaly, high ESR, high CRP, low TSH, high T4 and T3. Based on the above clinical and laboratory findings the diagnosis of subacute thyroiditis with diabetes mellitus was made. Patient was treated with beta-blocker, steroid, insulin and paracetamol. Patient responded with treatment. Conclusion: Subacute thyroidits is one of the rare causes of PUO and should be considered as a differential diagnosis even if clinical symptoms of thyrotoxicosis are not present.

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