Background: Neonatal intestinal obstruction is one of the emergency conditions with many etiologies, amongst which congenital segmental dilatation of small intestine is one, which is characterized by three to four folds increase in diameter of the bowel. Immaturity of ganglion cells of large intestine is also one of the congenital intestinal neuronal malformations which may cause neonatal intestinal obstruction. Prompt diagnosis of these conditions is very difficult as clinical and radiological features are non-specific to them. Case Presentation: A 3-day-old male baby presented with failure to pass meconium, abdominal distension, and bilious vomiting. At surgery, the baby had congenital segmental pseudo-dilatation of jejunum with immature ganglion cells in colon. Since it was not typical of a congenital segmental dilatation, it was left as such. The baby needed another laparotomy for resection of segmental pseudo-dilatation along with ileostomy. Conclusion: Because of rarity and diagnostic dilemma, re-laparotomy with ileostomy, which could have been avoided, were performed in the baby. Lack of typical features of congenital segmental dilatation along with presence of immature ganglion cells in the colon were unusual findings in this case

Adaptive optics scanning laser ophthalmoscope (AOSLO) capillary perfusion images can possess large variations in contrast, intensity, and background signal, thereby limiting the use of global or adaptive thresholding techniques for automatic segmentation. We sought to develop an automated approach to segment perfused capillaries in AOSLO images. Methods: 12,979 image patches were extracted from manually segmented AOSLO montages from 14 eyes and used to train a convolutional neural network (CNN) that classified pixels as capillaries, large vessels, background, or image canvas. 1764 patches were extracted from AOSLO montages of four separate subjects, and were segmented manually by two raters (ground truth) and automatically by the CNN, an Otsu's approach, and a Frangi approach. A modified Dice coefficient was created to account for slight spatial differences between the same manually and CNN-segmented capillaries. Results: CNN capillary segmentation had an accuracy (0.94), a Dice coefficient (0.67), and a modified Dice coefficient (0.90) that were significantly higher than other automated approaches (P < 0.05). There were no significant differences in capillary density and mean segment length between manual ground-truth and CNN segmentations (P > 0.05). Conclusions: Close agreement between the CNN and manual segmentations enables robust and objective quantification of perfused capillary metrics. The developed CNN is time and computationally efficient, and distinguishes capillaries from areas containing diffuse background signal and larger underlying vessels. Translational Relevance: This automatic segmentation algorithm greatly increases the efficiency of quantifying AOSLO capillary perfusion images.

Introduction: Intussusception is one of the commonest emergency conditions in children. Pneumatic reduction of intussusception, a minimally invasive technique, has a higher success rate and lower incidence of complications as compared to barium enema & hydrostatic reduction and also omits the need for unnecessary laparotomy. The aim of this study was to evaluate the results of the pneumatic reduction in our hospital as a treatment of idiopathic pediatric ileocolic intussusception and to identify the pretreatment factors associated with pneumatic reduction failure. Methods: This was a prospective analytical study. A total of 12 children were enrolled in the study between January to November 2018 at Nepal National Hospital, Kathmandu. Patients were given air enema under Ultrasound-guidance, using locally assembled equipment. All procedures were performed under intravenous anesthesia. The intraluminal pressure was monitored with a pressure gauge and was not permitted to go above 100 mmHg. A total of three attempts of 3 minutes each were allowed. Results: Average age of the patients was 2.7 years, with a male-female ratio of 3:1. Eleven (92%) of the cases were successfully reduced while 1 (8%) case failed to reduce. No bowel perforation occurred in this study. The mean duration of symptoms before presentation was 42 hours. The mean length of intussusceptum was 3.058 cm. the mean duration of pneumatic reduction was 1.97 minutes and total intervention time i.e. from induction of anesthesia to reversal from anesthesia was 18.55 minutes. Conclusion: The technique described is easy to assemble, safe and effective. I recommend it for regular use in pneumatic reduction of intussusception, especially in centers with limited resources.

Necrotizing pneumonia, rare complication of Community-acquired bacterial pneumonia (CABP), bear its own morbidity and mortality. Even though CABP generally respond well to the antibiotic treatment, but complications like empyema, necrotizing pneumonia with pneumatocoel formation (cavitary necrosis) supervene in mainly immune-compromised patient. Although cavitary necrosis is manifested as a severe disease, most children show complete recovery even without surgical treatment and have normal chest radiographs at long term. Some cases may required surgical intervention like tube thoracotomy or open thoracotomy. A case is presented of an infant that developed necrotizing pneumonia with pneumatocoel formation during treatment of bacterial pneumonia. Tube thoracotomy was performed due to conservative treatment failure.

There are some common genetic heritages between human and mammals. Human tail, though rare is one of the most noticeable. Till the date, around 60 cases reported in the literature. A true human tail is a benign vestigial caudal cutaneous structure composed of adipose, connective tissue, muscle, vessels and nerves. A true human tail can be distinguished from a pseudotail as the latter is commonly associated with underlying spinal dysraphism, which requires specialised management. We report a case series of four caudal appendages. Two clients were infants, while others two were toddler and presented with cutaneous appendage arising from the lumbosacral region. Out of four, only one had associated spinal dysraphism and neurological manifestation while others did not have spinal dysraphism and neurological manifestation. The appendage was removed by the surgical excision. Clinicians should emphasise the use of ’true tail’ and ’pseudo-tail’ as the specific disparate terms as the clinical, radiological and histological findings of these conditions differs significantly, along with the management strategies and outcomes.