Pediatric tracheostomy has been reported to be a surgical procedure with significant morbidity and mortality. The use of tracheostomy in airway management has changed over time as regards indication and outcome. A review of the last 13 years' experience in our institution was carried out to focus on this group of patients and the recent trends in airway management. A retrospective analysis of hospital records was done and information collected with respect to age, gender, indication for tracheostomy, duration, complications, and follow-up. Thirty-nine tracheotomies were done in 36 patients, of whom males outnumbered females 2:1. The mean patient age was 41.6 months while nearly a third were newborns. The indications were congenital and acquired obstructive lesions. Apart from nine cases, all have been treated and decannulated. Follow-up ranged from 1 month to 8 years, and decannulation time from 48 h to 45 months. Home tracheostomy care was very well managed by the parents. One tracheostomy-related death was encountered. Complications were minor and transient and occurred post-decannulation in our series, in contrast to the major complications, both acute and chronic, reported in the literature. More neonates and infants are undergoing tracheostomy and surviving. Pediatric tracheostomy is a safe procedure with home care by parents feasible.

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In patients with bleeding gastric varices from causes other than splenic vein thrombosis, endoscopic sclerotherapy and ablative surgery have yielded poor results. Over a 3-year period starting in June 1989, a total of 30 distal splenorenal shunts were performed prospectively on 19 paediatric and 11 adult patients with bleeding gastric varices and good liver function. The mean (s.d.) age was 17(12) (range 6-50) years; there were 20 male and ten female patients of whom six had cirrhosis, four non-cirrhotic portal fibrosis and 20 portal vein thrombosis. Two patients died and two more had shunt thrombosis; all four were considered failures of treatment. Hypersplenism was present in 15 patients but reverted to normal in 13. In 26 patients the gastric varices disappeared. Concomitant oesophageal varices were present in 22 patients and showed marked regression, with no rebleeding over a mean (s.d.) follow-up of 21(10) (range 7-39) months. A distal splenorenal shunt was effective in controlling gastric variceal haemorrhage in 26 of 30 patients in whom liver function was well preserved.

Neonatal gastrointestinal (GI) mucormycosis is a rare, usually fatal, opportunistic fungal infection, which is difficult to diagnose early or preoperatively. We report three babies, only one of whom survived, with a review of the literature. All three had similar findings of necrosis of colon with multiple perforations. While the first baby was diagnosed as long segment Hirschsprung's, the second was treated as small left colon but went on to show signs of peritonitis. The third presented with pneumonia, which progressed to sepsis and peritonitis. All three were diagnosed by histology postoperatively and two of them succumbed, one in spite of amphotericin and the other as he was too sick to start antifungals and had a rapid downhill course. The one who survived did so even though she did not receive amphotericin, but had clear margins of resection. The only chance of survival in this fatal disease is early diagnosis and rapid institution of aggressive therapy inclusive of adequate surgical debridement and appropriate antifungal medications.

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