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Upadhyaya VD, Pandey A, Gangopadhyay AN. Sparing the Perineal Body in the Vestibular Fistula. Eur J Pediatr Surg 2023; 33:328. [PMID: 37406662 DOI: 10.1055/s-0043-1770997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Affiliation(s)
- V D Upadhyaya
- Department of Pediatric Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A Pandey
- Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - A N Gangopadhyay
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Upadhyaya VD, Pandey A, Gangopadhyay AN. Saving the perineal body in the vestibular fistula. Pediatr Surg Int 2023; 39:193. [PMID: 37155020 DOI: 10.1007/s00383-023-05481-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2023] [Indexed: 05/10/2023]
Affiliation(s)
- V D Upadhyaya
- Department of Pediatric Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - A Pandey
- Department of Pediatric Surgery, King George's Medical University, Lucknow, UP, 226010, India.
| | - A N Gangopadhyay
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India
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Tripathi BK, Ghosh A, Pandey V, Gangopadhyay AN, Chawdhary S, Sharma SP. Acetylcholinesterase histochemistry: A very useful technique in the diagnosis of Hirschsprung’s disease. J Neonatal Surg 2022. [DOI: 10.47338/jns.v11.1026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Hirschsprung’s disease (HD) is a common congenital paediatric disorder. The gold standard for its diagnosis is the demonstration of the absence of ganglion cells on H&E stained sections from a spastic segment of the bowel, still at times; conclusive diagnosis of HD is difficult. This study was done to assess the accuracy of rapid Hematoxylin & Eosin (H&E) staining and AChE histochemistry in combination for the diagnosis of HD, especially in frozen section specimens. Samples from 36 clinically suspected HD cases were evaluated for the presence or absence of ganglion cells on H&E staining on both fresh-frozen and paraffin-embedded sections, whereas AChE staining was done on frozen sections only. Of the 36 cases of frozen section specimens from the spastic region of the colon, GCs were absent in 28 cases on H&E staining while positive staining patterns on AChE histochemistry were observed in 29 cases. Formalin-fixed paraffin-embedded sections showed the absence of GC on H&E staining in 28 cases. The sensitivity and specificity of frozen sections with rapid H&E were 77.78% and 81.82% while the sensitivity and specificity of AChE histochemistry were 80.56% and 81.82% respectively in the diagnosis of HD. Application of AChE histochemistry as an ancillary technique on frozen sections specimens of HD in combination with rapid H&E staining is very useful for definitive diagnosis of HD.
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Gangopadhyay AN. Pediatric Surgery in Rural India: Past, Present, and Future. J Indian Assoc Pediatr Surg 2020; 25:193-194. [PMID: 32939108 PMCID: PMC7478274 DOI: 10.4103/jiaps.jiaps_113_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- Ajay N Gangopadhyay
- Ex-Professor and Head, Department of Pediatric Surgery, IMS, BHU, Varanasi, Uttar Pradesh, India
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Sharma S, Joshi M, Gupta DK, Abraham M, Mathur P, Mahajan JK, Gangopadhyay AN, Rattan SK, Vora R, Prasad GR, Bhattacharya NC, Samuj R, Rao KLN, Basu AK. Consensus on the Management of Posterior Urethral Valves from Antenatal Period to Puberty. J Indian Assoc Pediatr Surg 2019; 24:4-14. [PMID: 30686881 PMCID: PMC6322183 DOI: 10.4103/jiaps.jiaps_148_18] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The need for successful management of posterior urethral valves always captivates the minds of pediatric surgeons. Its success, however, depends on several factors ranging from prenatal preservation of upper tracts to postoperative pharmacological compliance. Regardless of measures available, some cases do not respond and progress to end stage. The management depends on several issues ranging from age and severity at presentation to long-term follow-up and prevention of secondary renal damage and managing valve bladder syndrome. This article is based on a consensus to the set of questionnaires, prepared by research section of Indian Association of Paediatric Surgeons and discussed by experienced pediatric surgeons based in different institutions in the country. Standard operating procedures for conducting a voiding cystourethrogram and cystoscopy were formulated. Age-wise contrast dosage was calculated for ready reference. Current evidence from literature was also reviewed and included to complete the topic.
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Affiliation(s)
- Shilpa Sharma
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manoj Joshi
- Consultant Pediatric Surgeon, Department of Pediatric Surgery, King Saud Hospital, Uneyzha City, Kingdom of Saudi Arabia
| | - Devendra K Gupta
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Mohan Abraham
- Department of Pediatric Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Praveen Mathur
- Department of Pediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India
| | - J K Mahajan
- Department of Pediatric Surgery, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A N Gangopadhyay
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Simmi K Rattan
- Department of Pediatric Surgery, Maulana Azad Medical College, Delhi, India
| | - Ravindra Vora
- Department of Paediatric Surgery, Paediatric Surgery Centre and PG Institute, Sangli, Maharashtra, India
| | - G Raghavendra Prasad
- Department of Paediatric Surgery, Deccan College of Medical Sciences, Hyderabad, India
| | - N C Bhattacharya
- Department of Paediatric Surgery, Gauhati Medical College, Guwahati, Assam, India
| | - Ram Samuj
- Department of Pediatric Surgery, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - K L N Rao
- Department of Pediatric Surgery, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A K Basu
- Consultant Pediatric Surgeon, Institute of Child Health, Kolkata, West Bengal, India
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Srivastava PK, Jaiman R, Gangopadhyay AN, Gupta DK. Gastric teratoma presented as gastric outlet obstruction and melena; report of rare case. Indian J Surg 2017; 79:64-66. [PMID: 28331270 DOI: 10.1007/s12262-016-1464-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Accepted: 11/16/2009] [Indexed: 11/26/2022] Open
Abstract
Gastric teratoma is a very rare tumor, accounting for less than 1 % of all teratomas in infants and children. Melena or upper gastrointestinal tract bleeding in newborns and infants is a rare event and is usually caused by a benign lesion. Gastric teratoma has been reported as a cause of gastrointestinal bleeding on a few occasions. As gastric teratomas generally present as a palpable abdominal mass, more aggressive solid masses of childhood must be excluded. We present intramural extension of gastric teratoma presented as symptom of gastric outlet obstruction and melena.
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Tiwari P, Pandey V, Gangopadhyay AN, Sharma SP, Gupta DK. Role of propranolol in ulcerated haemangioma of head and neck: a prospective comparative study. Oral Maxillofac Surg 2016; 20:73-77. [PMID: 26481918 DOI: 10.1007/s10006-015-0528-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 09/14/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE Infantile haemangiomas comprise the majority of vascular anomalies and are considered the predominant vascular tumour type 1. We performed this prospective study to evaluate the therapeutic response and propranolol tolerance in infants with ulcerated infantile haemangioma of head and neck region. METHODS Sixty-four patients with ulcerated infantile haemangiomas (IHs) of head and neck region, without any prior treatment and with age older than 1 month, were included in the study, after informed consent was obtained, and were randomly divided into groups A and B. Group A patients were given oral propranolol at a dose of 2 mg/kg per day in three divided doses as outpatients. Group B patients were given oral ibuprofen at a dose of 10 mg/kg 8-hourly and paracetamol at dose of 16.2 mg/kg 8-hourly. Documentation of gender, age, haemangioma location, duration of ulceration and pain was measured on the second and fifth day after commencement of treatment in both groups using the Children's Hospital of Eastern Ontario Pain Scale. RESULTS There was no difference in pain score between the two groups (P value 0.074). Mean duration of healing of ulceration in group A was 17.93 ± 2.22 days and in group B was 27.71 ± 2.33 days (P value <0.001). In group A, out of 28 patients, 8 (28.5 %) were complete responders, 16 (57.1 %) were partial responders and 4 (14.2 %) were non-responders. CONCLUSION Propranolol is a valuable therapeutic alternative for treatment of ulcerated haemangiomas and effectively reduces pain.
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Affiliation(s)
- Preeti Tiwari
- Department of Oral & Maxillofacial Surgery, Faculty of Dental Sciences, IMS, BHU, Varanasi, India.
| | - Vaibhav Pandey
- Department of Oral & Maxillofacial Surgery, Faculty of Dental Sciences, IMS, BHU, Varanasi, India
| | - Ajay N Gangopadhyay
- Department of Oral & Maxillofacial Surgery, Faculty of Dental Sciences, IMS, BHU, Varanasi, India
| | - Shiv P Sharma
- Department of Oral & Maxillofacial Surgery, Faculty of Dental Sciences, IMS, BHU, Varanasi, India
| | - Dinesh K Gupta
- Department of Oral & Maxillofacial Surgery, Faculty of Dental Sciences, IMS, BHU, Varanasi, India
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Abstract
AIM The present study was aimed to assess the contractile status of neonatal small intestinal smooth muscle of dilated pre-atretic part of intestinal atresia to resolve debatable issues related to mechanisms of persistent dysmotility after surgical repair. MATERIALS AND METHODS A total of 34 longitudinally sectioned strips were prepared from pre-atretic dilated part of freshly excised 8 jejunal atresia type III a cases. Spontaneous as well as acetylcholine- and histamine-induced contractions were recorded in vitro by using organ bath preparations. Chemically evoked contractions were further evaluated after application of atropine (muscarinic blocker), pheniramine (H1 blocker), and lignocaine (neuronal blocker) to ascertain receptors and neuronal involvement. Histological examinations of strips were made by using Masson trichrome stain to assess the fibrotic changes. RESULTS All 34 strips, except four showed spontaneous contractions with mean frequency and amplitude of 5.49 ± 0.26/min and 24.41 ± 5.26 g/g wet tissue respectively. The response to ACh was nearly twice as compared to histamine for equimolar concentrations (100 μM). ACh (100 μM) induced contractions were attenuated (by 60%) by atropine. Histamine (100 μM)-induced contractions was blocked by pheniramine (0.32 μM) and lignocaine (4 μM) by 74% and 78%, respectively. Histopathological examination showed varying degree of fibrotic changes in muscle layers. CONCLUSIONS Pre-atretic dilated part of jejunal atresia retains functional activity but with definitive histopathologic abnormalities. It is suggested that excision of a length of pre-atretic part and early stimulation of peristalsis by locally acting cholinomimetic or H1 agonist may help in reducing postoperative motility problems in atresia patients.
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Affiliation(s)
- Preeti Tyagi
- Department of Physiology, Hamdard Institute of Medical Sciences, Jamia Hamdard, New Delhi, India
| | - Maloy B Mandal
- Department of Physiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ajay N Gangopadhyay
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Shashikant C U Patne
- Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Tripathi BK, Gangopadhyay AN, Sharma SP, Kar AG, Mandal MB. In Vitro Evaluation of Carbachol and Endothelin on Contractility of Colonic Smooth Muscle in Hirschsprung’s Disease. Indian J Physiol Pharmacol 2016; 60:22-29. [PMID: 29953180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The hypomotility of colon observed in Hirschsprung’s disease (HD) has been attributed to congenital aganglionosis only. So far, it is not clear whether the contractility of colonic smooth muscle in this condition is altered or not. Therefore, the present study attempted to understand the contractile status of colonic segments of HD patients by examining carbachol and endothelin (ET-1) evoked colonic smooth muscle contractions in vitro . METHODS Contractile responses were recorded from strips of colonic segments obtained from HD patients, using organ bath preparations. Cholinergic agonist carbachol and ET-1 along with their antagonists were used to evoke contractile responses. Thereafter, the samples were histopathologically confirmed for HD. RESULTS Colonic strips of HD did not show any spontaneous contractions but responded to carbachol and ET-1 to a lesser extent. In HD, response of carbachol was blocked by atropine and hexamethonium by nearly 73% and 50% respectively. ET-1 induced contractile responses were blocked by ET-A and ET-B antagonist up to 40%, signifying the possible role of ET-A and ET-B receptors in HD colon contractility. CONCLUSION As evidenced by lack of spontaneous contractions and impaired carbachol and ET-1-induced contractile responses, it is concluded that, in addition to aganglionosis, decreased contractility of colonic smooth muscle may contribute to hypomotility observed in patients with HD.
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Chatopadhayay R, Tiwari P, Gangopadhyay AN, Pandey V. Respiratory Distress Secondary to Rhabdomyosarcoma of the Tongue and Co-existent Choanal Atresia. J Maxillofac Oral Surg 2015; 15:258-61. [PMID: 27408448 DOI: 10.1007/s12663-015-0772-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 02/28/2015] [Indexed: 11/26/2022] Open
Abstract
Whilst rhabdomyosarcoma (RMS) is the third most common solid tumour in children, congenital RMS of the tongue is extremely rare and usually present as painless progressive mass since birth (Dagher and Helman in Oncologist 4:34-44, 1999; Childs and Goudy in Int J Pediatr Otorhinolaryngol 5:126-128, 2010). In neonates, presentation with respiratory distress is unexpected as neonates are preferential nasal breathers and restricted oral breathing due to tumour usually poses no problem. We herein report a case of rhabdomyosarcoma of the tongue with co-existent unilateral choanal atresia, presenting with respiratory distress. The baby developed upper respiratory tract infection following which developed severe respiratory distress. Airway symptoms were precipitated as there was combined obstruction of both the nostrils due to infection or adenoid enlargement and unilateral chonal atresia. Treatment of respiratory distress in the presence of RMS and bilateral nasal pathology must first prioritise the security of the airway, before taking a multi-factorial approach to the therapy of the lingual mass (Childs and Goudy in Int J Pediatr Otorhinolaryngol 5:126-128, 2010). This case illustrates the importance of vigilance with respect to co-existent nasal pathology, in order to avoid the occurrence of complete airway obstruction. We therefore feel that any diagnosis of lingual RMS should warrant a formal examination of both nasal cavities.
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Affiliation(s)
| | - Preeti Tiwari
- Trauma Centre, Oral and Maxillofacial Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP India
| | - A N Gangopadhyay
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP India
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Pandey V, Tiwari P, Gangopadhyay AN, Gupta DK, Sharma SP, Kumar V. Propranolol for infantile haemangiomas: experience from a tertiary center. J Cutan Aesthet Surg 2014; 7:37-41. [PMID: 24761098 PMCID: PMC3996789 DOI: 10.4103/0974-2077.129975] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim: Infantile haemangiomas are the most common tumor of infancy. We report the use of propranolol for treatment of problematic and complicated haemangiomas. Patients and Methods: Propranolol was given to 52 children with mean age of 18.2 months at onset of treatment. After clinical and electrocardiographic evaluations, propranolol was administered with a starting dose of 2 mg/kg per day, given in 3 divided doses. Monthly follow up was done, response to oral propranolol therapy and any complications of therapy were recorded. Response to propranolol was classified as Complete Response, Excellent Response, Partial Response and Non Responder. Results: Total 49 patients showed significant improvement after propranolol therapy out of which 4 patients were complete responder, 30 patients (56.7%) were excellent responders; 15 patients (28.8%) were partial responders. 3 patients (5.7%) had growth of haemangiomas despite propranolol therapy and were classified as non-responder. Side effect like hypotension, rashes, gastroesophageal reflux was reported by 3 patients. In our study mean duration of treatment was 6.5 months. At the end of treatment propranolol was stopped by with gradual tapering of dose over a period of 2 weeks. Conclusion: Propranolol administered orally at 2 mg/kg per day has rapid effective therapeutic effect in treatment of ulcerated haemangiomas and it appears to be a valuable and effective treatment option for infantile haemangiomas beyond the proliferative phase, and esthetically disfiguring haemangiomas.
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Affiliation(s)
- Vaibhav Pandey
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Preeti Tiwari
- Oral and Maxillofacial Surgery, Smayan Hospital, Varanasi, Uttar Pradesh, India
| | - Ajay N Gangopadhyay
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Dinesh K Gupta
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Shiv P Sharma
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Vijayendar Kumar
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Pandey V, Gangopadhyay AN, Gupta DK, Sharma SP, Kumar V. Non-operative management of giant omphalocele with topical povidone-iodine and powdered antibiotic combination: early experience from a tertiary centre. Pediatr Surg Int 2014; 30:407-11. [PMID: 24509569 DOI: 10.1007/s00383-014-3479-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of the study was to evaluate topical povidone-iodine and topical powdered antibiotic combination (Polymyxin, Bacitracin and Neomycin) in initial non-operative management with delayed closure of the defect of giant omphaloceles. METHODS A prospective study was conducted between July 2010 and June 2013 including all neonates with giant omphalocele without signs of intestinal obstruction. All cases were managed by daily application of povidone-iodine (5% solution) followed by spraying topical powdered antibiotic combination to promote eschar formation and eventual epithelialisation. Record was made of sex, associated anomalies, length of stay, and thyroid function tests. RESULTS Twenty-four neonates with giant omphaloceles were treated with topical povidone-iodine and topical powdered antibiotic combination. No sac ruptures were observed in our series. All patients had a normal thyroid function test at presentation and after 10 days of initiation of treatment. Six patients have undergone delayed repair. CONCLUSION Topical povidone-iodine and powdered antibiotic combination promotes more rapid escharification and epithelialisation of the omphalocele than povidone-iodine alone. We also hypothesise that combination minimises the chances of hypothyroidism associated with use of povidone-iodine alone.
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Affiliation(s)
- Vaibhav Pandey
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India,
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Pandey V, Gangopadhyay AN, Tiwari P, Gupta DK, Sharma SP, Kumar V. Author's reply. J Cutan Aesthet Surg 2014; 7:138-9. [PMID: 25136224 PMCID: PMC4134653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Affiliation(s)
- Vaibhav Pandey
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India E-mail:
| | - AN Gangopadhyay
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India E-mail:
| | - Preeti Tiwari
- Senior Resident, Department of Oral & Maxillofacial Surgery, Trauma Center, BHU, Varanasi, Uttar Pradesh, India
| | - DK Gupta
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India E-mail:
| | - SP Sharma
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India E-mail:
| | - Vijayendar Kumar
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India E-mail:
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Upadhyaya VD, Gangopadhyay AN, Srivastava PK, Hasan Z, Sharma SP. Tracheoesophageal fistula with esophageal atresia with absent external ear: a unusual association. Indian J Surg 2013; 74:337-9. [PMID: 23904729 DOI: 10.1007/s12262-012-0410-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Accepted: 03/23/2009] [Indexed: 10/28/2022] Open
Abstract
Esophageal atresia with tracheoesophageal fistula (TEF with EA) is a common disease which is associated with many other congenital abnormalities. The most common association is with VACTERL syndrome.. Various types of ear malformations have been reported in CHARGE syndrome associated with EA and TEF. However, absence of external ear has not been described which is being reported in this article. We could not found this association even on extensive search of literature.
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Kumar V, Kumar P, Pandey A, Gupta DK, Shukla RC, Sharma SP, Gangopadhyay AN. Intralesional bleomycin in lymphangioma: an effective and safe non-operative modality of treatment. J Cutan Aesthet Surg 2012; 5:133-6. [PMID: 23060708 PMCID: PMC3461790 DOI: 10.4103/0974-2077.99456] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Introduction: Lymphangiomas are benign hamartomatous lymphatic tumors. The mainstay of the therapy is surgical excision, but due to its infiltration along the nerves and muscles, total excision is not always possible. In the present study, we have evaluated the clinical profile of all the cases of lymphagiomas coming to our department and evaluated the efficacy of intralesional Bleomycin as a sclerosing agent in its management. Materials and Methods: In this prospective study, all patients were evaluated clinically and color Doppler ultrasonography (USG). The required dose was calculated as 0.5 mg/kg body weight, not exceeding 10 units at a time. The response was assessed clinically and on the basis of color Doppler USG. Results: Thirty-five patients of lymphangioma were included in the study. The neck region was the most common site of involvement. The response was excellent in 7 (20%), good in 26 (74.29%), and poor in 2 (5.71%) patients. The complications included fever, transient increase in size of swelling, local infection, intraluminal bleed, and skin discoloration in 10 patients. Conclusion: This therapy may be used as primary modality instead of surgery in selected group of patients.
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Affiliation(s)
- V Kumar
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, Uttar Pradesh, India
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Kumar V, Chaudhary S, Kumar M, Gangopadhyay AN. Rhabdomyosarcoma of biliary tract- a diagnostic dilemma. Indian J Surg Oncol 2012; 3:314-6. [PMID: 24293970 DOI: 10.1007/s13193-012-0186-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 09/04/2012] [Indexed: 11/26/2022] Open
Abstract
Rhabdomyosarcoma is a soft tissue malignant musculoskeletal tumor. It is a rare tumor in children but the most common cause of malignant obstructive jaundice in them. A 4-year-old child presented to us with obstructive jaundice and palpable liver. He was misdiagnosed as choledochal cyst on imaging studies; however, intraoperative and histopathological features confirmed the diagnosis of rhabdomyosarcoma. Mass excision and Roux en Y portoenterostomy was performed. Post operatively; the patient was put on multimodal chemotherapy. This, being an uncommon entity, is being reported with a review of the available literature.
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Affiliation(s)
- V Kumar
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005 U.P. India
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Srivastava PK, Gangopadhyay AN, Gupta DK, Sharma SP, Kumar V. Unusual content of omphalocele: a congenital mature cystic teratoma of falciform ligament of the liver. Pediatr Surg Int 2011; 27:1355-6. [PMID: 21499881 DOI: 10.1007/s00383-011-2898-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2011] [Indexed: 11/26/2022]
Abstract
Omphalocele is a congenital midline abdominal wall defect that results in herniation of intraabdominal contents covered by a lining of peritoneum and amnion. The severity of the defect often ranges from a minor herniation of the umbilical cord to a significant protrusion that includes large proportions of intestine and liver. We report unusual content of omphalocele that is congenital mature cystic teratoma of falciform ligament of liver which was confirmed by histopathology. This is a very uncommon entity and not described in world literature.
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Abstract
BACKGROUND Necrotizing fasciitis (NF) is a serious infection of soft tissues. This paper presents experience with pediatric NF and suitability of conservative surgery in its management. MATERIALS AND METHODS In this retrospective study, 70 patients of NF were managed during the study period of eight years. The study was divided into two time periods- first period (June 1998 to June 2001- group 1) and second period (June 2001 to June 2006- group 2). The parameters studied were age, sex, site of involvement and treatment. The treatment included intravenous antibiotics, supportive therapy and either aggressive (group 1) or conservative surgery (group 2). RESULTS Age of presentation ranged from 10 days to 11 years. Male to female ratio was 1.69:1. Back was the commonest site to be involved. Culture reports were polymicrobial in 70% with predominance of Staphylococcus species. Predisposing factors included malnourishment, boils, scratch injury, intravenous cannulation and injections. Conservative surgery had better outcome in terms of hospital stay, complications and cost of treatment. CONCLUSION NF is a serious and disease which requires immediate and all out attention. Early diagnosis, aggressive supportive treatment and conservative surgery improve survival.
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Affiliation(s)
- A Pandey
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221 005, U.P. India
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Abstract
Split notochord syndrome (SNS) is an extremely rare congenital malformation associated with anomalies of the vertebral column, gastrointestinal tract and central nervous system. Twenty cases of SNS associated with dorsal enteric fistula have been reported in literature till date. The present report describes a unique case of SNS associated with lumbosacral meningomyelocele, dorsal neuroenteric fistula and dorsal herniation of right kidney along with vessels. The neonate was well managed by excision of enteric fistula, closure of duramater of meningomyelocele and repair of posterior wall hernia after placement of kidney in renal fossa. This kind of entity is uncommon and not been reported earlier.
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Affiliation(s)
- Punit Srivastava
- Department of Pediatric Surgery, IMS, BHU, Varanasi, Uttar Pradesh, India
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Srivastava P, Gangopadhyay AN, Gupta DK, Kumar V, Sharma SP, Upadhyaya VD, Jaiman R. Giant meconium hydrocele: a rare presentation of antenatal gastrointestinal perforation. J Paediatr Child Health 2011; 47:153. [PMID: 21401778 DOI: 10.1111/j.1440-1754.2011.02008.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
BACKGROUND/AIM Mesenchymal hamartoma of liver (MHL) is a rare liver tumor of childhood. About 200 cases have been reported till now. Most of the work on MHL is limited to case reports and there are not many long term follow-up studies. We present our 20 years of experience with this uncommon entity. This study aims to highlight clinical features, diagnosis and treatment of MHL. MATERIALS AND METHODS All patients with a diagnosis of MHL in last 20 years were included in this retrospective study. The patients were evaluated clinically, radiologically and pathologically. RESULTS The total number of patients with a diagnosis of MHL was nine. Mean age of the patients was 19.89 ± 2.75 months. Right lobe was involved in eight patients. The prominent clinical features were distension of abdomen and anorexia. Surgical options used were hepatic lobectomy, wedge resection and enucleation. Histopathology of the specimens showed cysts of variable size with normal hepatocytes, bile ducts and connective tissue stroma. Overall mortality was one (11.11%). CONCLUSION MHL is a benign tumor that can present with various clinical features. It should be differentiated carefully from other liver masses especially malignant ones. The diagnosis can be made with the help of radiology and histopathology. Adequate resection is curative in most of the cases and long-term follow up is satisfactory.
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Affiliation(s)
- Anand Pandey
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221 005, U.P., India
| | - Ajay N. Gangopadhyay
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221 005, U.P., India,Address for correspondence: Prof. Ajay N. Gangopadhyay, Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221 005 U.P., India. E-mail:
| | - Shiv P. Sharma
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221 005, U.P., India
| | - Vijayendra Kumar
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221 005, U.P., India
| | - Dinesh K. Gupta
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221 005, U.P., India
| | - Saroj C. Gopal
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221 005, U.P., India
| | - Shashikant C. Patne
- Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221 005, U.P., India
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Pandey A, Gangopadhyay AN, Kumar V, Sharma SP, Gupta DK, Gopal SC. Functional Evaluation of Mid and Distal Penile Hypospadias Surgery with Special Reference to Uroflowmetry. Curr Urol 2011. [DOI: 10.1159/000327473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Pandey A, Gangopadhyay AN, Kumar V, Sharma SP. High anorectal malformation in a five-month-old boy: a case report. J Med Case Rep 2010; 4:296. [PMID: 20807404 PMCID: PMC2936323 DOI: 10.1186/1752-1947-4-296] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 08/31/2010] [Indexed: 11/26/2022] Open
Abstract
Introduction Anorectal malformation, one of the most common congenital defects, may present with a wide spectrum of defects. Almost all male patients present within first few days of life. Case presentation A five-month-old baby boy of Indian origin and nationality presented with anal atresia and associated rectourethral prostatic fistula. The anatomy of the malformation and our patient's good condition permitted a primary definitive repair of the anomaly. A brief review of the relevant literature is included. Conclusion Delayed presentation of a patient with high anorectal malformation is rare. The appropriate treatment can be rewarding.
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Affiliation(s)
- Anand Pandey
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, UP, India.
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Pandey A, Gangopadhyay AN, Sharma SP, Kumar V. Esophageal atresia with tracheo-esophageal fistula: Role of nebulized N-acetylcysteine in the outcome. J Indian Assoc Pediatr Surg 2010; 14:232. [PMID: 20419032 PMCID: PMC2858892 DOI: 10.4103/0971-9261.59612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- A Pandey
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, U.P., India
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Abstract
Aim: To evaluate the role of end-to-end oblique bowel anastomosis in bowel atresia. Methods: End-to-end oblique anastomosis was done in 25 neonates of bowel atresia and the results were compared with traditional method of end to back anastomosis in 25 cases. Results: We found less mortality and morbidity (5%) in our technique as compared to end to back technique (20%). Conclusions: We recommend this technique, as anastomosis is wide with less angulations, flow of effluent is linear, and there is less force exerted over post-anastomotic side wall.
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Affiliation(s)
- Zaheer Hasan
- Department of Pediatric Surgery, IMS, BHU, Varanasi, India
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Srivastava P, Gangopadhyay AN, Gupta DK, Sharma SP, Upadhyaya VD, Kumar V, Jaiman R. Atresia of ileocecal junction, ileocecal valve: Rare variants of bowel atresia. J Indian Assoc Pediatr Surg 2010; 14:117-8. [PMID: 20376255 PMCID: PMC2847138 DOI: 10.4103/0971-9261.57706] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Atresia of ileocecal junction and isolated atresia of ileocecal valve are rare types of intestinal atresia with very few reports in literature. We report two such cases. Radiology showed dilated ileal segment and distal micro colon in both the cases. At laparotomy there was atresia of ileocecal junction in the first case and isolated ileocaecal valve atresia with normal ileocecal junction in the other case. Both the babies were managed by ileocolic resection with an end to end anastomosis. The prognosis of ileocecal atresias is satisfactory.
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Gangopadhyay AN, Srivastava A, Srivastava P, Gupta DK, Sharma SP, Kumar V. Twin fetus in fetu in a child: a case report and review of the literature. J Med Case Rep 2010; 4:96. [PMID: 20338036 PMCID: PMC2852393 DOI: 10.1186/1752-1947-4-96] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Accepted: 03/25/2010] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Fetus in fetu is an extremely rare condition wherein a malformed fetus is found in the abdomen of its twin. This entity is differentiated from teratoma by its embryological origin, its unusual location in the retroperitoneal space, and the presence of vertebral organization with limb buds and well-developed organ systems. The literature cites less than 100 cases worldwide of twin fetus in fetu. CASE PRESENTATION A two-and-a-half-month-old Asian Indian baby boy had two malformed fetuses in his abdomen. The pre-operative diagnosis was made by performing an ultrasound and a 64-slice computer tomography scan of the baby's abdomen. Two fetoid-like masses were successfully excised from the retroperitoneal area of his abdomen. A macroscopic examination, an X-ray of the specimen after operation, and the histological features observed were suggestive of twin fetus in fetu. CONCLUSION Fetus in fetu is an extremely rare condition. Before any operation is carried out on a patient, imaging studies should first be conducted to differentiate this condition from teratoma. Surgical excision is a curative procedure, and a macroscopic examination of the sac should be done after twin or multiple fetus in fetu are excised.
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Affiliation(s)
- Ajay N Gangopadhyay
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Arvind Srivastava
- Department of Radiodiagnosis, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Punit Srivastava
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Dinesh K Gupta
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Shiv P Sharma
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Vijayendra Kumar
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Gangopadhyay AN, Srivastava P, Upadhyaya VD, Hasan Z. Is primary chemotherapy effective in large hydatid cyst of liver? J Indian Assoc Pediatr Surg 2010; 14:40. [PMID: 20177447 PMCID: PMC2809466 DOI: 10.4103/0971-9261.54806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Pandey A, Gangopadhyay AN, Sharma SP, Kumar V, Gupta DK, Gopal SC. Evaluation of topical steroids in the treatment of superficial hemangioma. Skinmed 2010; 8:9-11. [PMID: 20839418 DOI: pmid/20839418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Infantile hemangioma is a common disease. Steroids have been used for its treatment; however, intralesional steroids cause pain and other problems. A treatment modality that can avoid these problems is desirable. The authors evaluated the role of topical steroids as an alternative to intralesional steroids in the treatment of superficial hemangioma. Inclusion criteria were <2 superficial type ofhemangiomas <5 cm. The topical steroid mometasone furoate was applied twice daily. Intralesional triamcinolone acetonide was injected at monthly intervals using a 24-gauge needle at doses of 1 to 2 mg/kg. Forty-five (86.5%) patients responded to treatment with the topical steroids, of which 50% had excellent and 36.5% had good response. In the intralesional group, the response rate was 95.7%, of which 63.8% had excellent and 31.9% had good response. Complications in the topical steroid group were mild itching and irritation (19.2%) and hypopigmentation (7.6%). Complications in the intralesional group were pain (100%), bleeding (17%), infection (17%), cutaneous atrophy (8.5%), cushingoid facies (2.1%), and growth retardation (2.1%). Topical steroids are a reasonably good alternative to intralesional steroids as an initial choice for treating superficial hemangioma.
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Affiliation(s)
- Anand Pandey
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
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Hasan Z, Gangopadhyay AN, Gupta DK, Srivastava P, Sharma SP. Sutureless skin closure with isoamyl 2-cyanoacrylate in pediatric day-care surgery. Pediatr Surg Int 2009; 25:1123-5. [PMID: 19760198 DOI: 10.1007/s00383-009-2485-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2009] [Indexed: 11/26/2022]
Abstract
Importance of day-care surgery in pediatric age group is ever increasing and nowadays bulk of surgery is performed as a day-care procedure. Day-care procedure requires short intra-operative period and less postoperative complications. The introduction of tissue adhesive has been received enthusiastically since they may result in equivalent tensile strength-improved cosmetic appearance of the scar and lower infection rate when compared to sutures, staples and adhesive tape. We have used isoamyl 2-cyanoacrylate as a tissue adhesive for skin closure in day-care surgery. Novocryl is ideal for such procedure as it is a sterile, inert, non-toxic, biocompatible and bacteriostatic liquid topical skin adhesive containing isoamyl 2-cyanoacrylate formulation. We applied isoamyl 2-cyanoacrylate glue in 100 patients over skin cut margin after stitching subcutaneous tissue. Skin margin were held together by means of skin hook for 1-2 min. The cosmesis was better as there were no suture marks or lumpiness. There were no major complications in our study. Thus, isoamyl 2-cyanoacrylate can be considered as an alternative to skin suturing in the pediatric day-care surgery.
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Affiliation(s)
- Zaheer Hasan
- Department of Pediatric Surgery, IMS, BHU, Varanasi, India.
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Tyagi P, Mandal MB, Mandal S, Patne SCU, Gangopadhyay AN. Pouch colon associated with anorectal malformations fails to show spontaneous contractions but responds to acetylcholine and histamine in vitro. J Pediatr Surg 2009; 44:2156-62. [PMID: 19944226 DOI: 10.1016/j.jpedsurg.2009.04.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2009] [Revised: 04/24/2009] [Accepted: 04/26/2009] [Indexed: 11/17/2022]
Abstract
PURPOSE Congenital pouch colon (CPC) associated with anorectal malformation (ARM) is most commonly reported from Northern India. So far, no physiologic study comparing the detailed contractile status of CPC with non-CPC conditions are available. The present article deals with the contractile study and histopathologic observations in CPC, which may be useful for better surgical management. METHODS Freshly excised 12 neonatal CPC and similar number of non-CPC (control) specimens were transferred to ice-cold (4 degrees C-6 degrees C) Krebs-Ringer solution bubbled with 100% oxygen. Longitudinally prepared 2 to 4 colonic strips were obtained from central part of each specimen and subjected to the contraction recording after exposure to cumulative concentrations of acetylcholine (ACh) and histamine. Acetylcholine-induced contractions were evaluated after application of atropine (muscarinic blocker), and histaminergic contractions were recorded after pheniramine (H(1) blocker), lignocaine (neuronal blocker), and atropine. Histopathologic observations were made by using H&E and Masson trichrome stains. RESULTS Control specimens showed spontaneous contractions, but CPC strips did not. Both control and CPC responded to ACh and histamine. The response to histamine was greater (P < .05) in CPC as compared to control, whereas the response to ACh was more (P < .05) in control. In CPC, response of histamine (100 micromol/L) was blocked by pheniramine (0.32 mmol/L) and lignocaine (4 mmol/L) by 97% and 80%, respectively, and enhanced by 57% after preapplication of atropine (10 micromol/L). Acetylcholine (100 micromol/L)-induced contractions were attenuated (86%) in presence of atropine. Histopathologic examination showed fewer mature ganglion cells with various changes in muscle layers including fibrosis, disruption, hypertrophy, atrophy, and constriction bands. CONCLUSION Congenital pouch colon associated with ARM lacks normal spontaneous contractions but retains ACh and histamine-induced contractility. In view of the functional and histologic abnormalities, we propose that CPC associated with ARM is an abnormally functional and developed tissue. Therefore, resection of the pouch should be considered for better functional outcome of the remaining bowel.
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Affiliation(s)
- Preeti Tyagi
- Department of Physiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, UP, India
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Gangopadhyay AN, Srivastava P, Upadhyaya VD, Hasan Z, Vijayendra KR, Sharma SP. Mature cystic teratoma in falciform ligament of the liver in an infant. Afr J Paediatr Surg 2009; 6:132-3. [PMID: 19661652 DOI: 10.4103/0189-6725.54785] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Srivastava P, Gangopadhyay AN, Upadhyaya VD, Sharma SP, Jaiman R. An unusual presentation of hydatid cyst in anterior abdominal wall. Kathmandu Univ Med J (KUMJ) 2009; 6:511-3. [PMID: 19483436 DOI: 10.3126/kumj.v6i4.1746] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hydatid disease is a parasitic infestation caused by the larval form of the cestode worm Echinococcus. The most commonly encountered form of the disease is visceral hydatid cyst caused by Echinococcus granulosus or dog tapeworm. Muscular involvement has been reported in only 3-4% cases. We are reporting this case because of its rarity, difficulty to diagnose clinically, dramatic response to medical treatment and to alert the reader of this rare infestation so that open biopsy will be avoided.
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Affiliation(s)
- P Srivastava
- Department of Pediatric Surgery, IMS, BHU, Varanasi, India.
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Pandey A, Kumar V, Gangopadhyay AN, Upadhyaya VD, Srivastava A, Singh RB. A pilot study on the role of T-tube in typhoid ileal perforation in children. World J Surg 2009; 32:2607-11. [PMID: 18825454 DOI: 10.1007/s00268-008-9746-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Ileostomy is usually performed for patients of typhoid intestinal perforation with poor general condition, but it is associated with significant morbidity. We have used the T-tube in such patients as an alternative to ileostomy. METHODS This is a prospective evaluation of a cohort of children with proven typhoid intestinal perforation. Patients with multiple perforations and poor general condition were managed with a T-tube inserted into the bowel lumen after closing all distal perforations (group 3). They were compared with patients who had primary closure of perforation (group 1) or bowel resection (group 2) to determine the efficacy of the use of T-tube. RESULTS The total number of patients for groups 1, 2, and 3 was 51, 4, and 12 (n = 67). The mean number of perforations for the three groups was 1, 3.5 +/- 0.58, and 4.25 +/- 0.97. The operation time for the three groups was 37.29 +/- 3.24, 59.25 +/- 3.09, and 59.17 +/- 4.17 minutes, respectively. The T-tube was removed after 13.17 days. The mean duration of fistula at T-tube site to heal was 8.58 +/- 2.11 days. The overall follow-up period was 10.94 +/- 1.15 months and none of the patients with T-tube placement had features of intestinal obstruction. CONCLUSIONS In children with multiple typhoid intestinal perforations and poor general condition, the use of T-tube may be an effective management option.
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Affiliation(s)
- Anand Pandey
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, Uttar Pradesh, India
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Gangopadhyay AN, Upadhyaya VD, Gupta DK, Agarwal DK, Sharma SP, Arya NC. Histology of the terminal end of the distal rectal pouch and fistula region in anorectal malformations. Asian J Surg 2009; 31:211-5. [PMID: 19010766 DOI: 10.1016/s1015-9584(08)60089-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Until recently, surgeons have been posed with a dilemma---whether or not they should preserve the terminal end of the distal rectal pouch and the fistula region in anorectal malformations (ARMs). A detailed histological study of this region was conducted to establish a consensus for preserving or excising this region for reconstruction of ARMs. METHODS Histopathological examination using haematoxylin and eosin-stained sections of the terminal portion of the distal rectal pouch and proximal portion of the rectourogenital or rectoperineal connection was performed in 60 cases of high, intermediate and low ARMs. RESULTS Distorted internal sphincter was present in 93.3% of high, 90% of intermediate and 100% of low ARMs. The proximal fistula region was lined by transitional epithelium in 50% of cases, and anal glands were present in 83.3% and anal crypts in 68.3% of cases. The rectal pouch in the region of the internal sphincter and fistula was aganglionic in all cases. CONCLUSION This study shows that the terminal end of the distal rectal pouch and proximal fistula region possess distorted anal features with aganglionosis, and contradicts the recommendation that this region should be reconstructed in patients with malformations.
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Affiliation(s)
- A N Gangopadhyay
- Department of Paediatric Surgery Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
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Gangopadhyay AN, Rajeev R, Sharma SP, Upadhyaya VD, Arya NC, Kumar V, Gopal SC. Anterior intratumoural chemotherapy: a newer modality of treatment in advanced solid tumours in children. Asian J Surg 2009; 31:225-9. [PMID: 19010769 DOI: 10.1016/s1015-9584(08)60092-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Advanced and inoperable solid tumours in children have high mortality despite aggressive multimodal treatment. Intravenous chemotherapy is abandoned at times because of systemic toxicity. This study investigated intratumoural chemotherapy and compared it with intravenous chemotherapy. METHODS Forty children with advanced inoperable solid tumours (Wilms' tumour and neuroblastoma) were randomly allocated into two groups of 20. Group A was given intratumoural chemotherapy and group B was given intravenous chemotherapy. Both groups were compared for reduction in tumour size and volume, tumour resectability, histopathological changes and drug side effects. RESULTS Intratumoural chemotherapy was superior to intravenous chemotherapy in terms of reducing tumour size and volume (63% in group A vs. 22% in group B). The resectability was 70% in the intratumoural group compared with 40% in the intravenous group. The overall good histopathological response was 71% in group A as opposed to 0% in group B. Moreover, the incidence and severity of drug side effects and morbidity were less with intratumoural chemotherapy. Mortality was also low in group A (5%) compared to group B (20%). CONCLUSION Intratumoural chemotherapy can be offered as an effective and safe alternative treatment modality for advanced and inoperable Wilms' tumour and neuroblastoma.
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Affiliation(s)
- A N Gangopadhyay
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
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Upadhyaya VD, Srivastava PK, Jaiman R, Gangopadhyay AN, Gupta DK, Sharma SP. Duplication cyst of pyloroduodenal canal: a rare cause of neonatal gastric outlet obstruction: a case report. Cases J 2009; 2:42. [PMID: 19138408 PMCID: PMC2631535 DOI: 10.1186/1757-1626-2-42] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Accepted: 01/12/2009] [Indexed: 11/10/2022]
Abstract
BACKGROUND A 21 day old male child presented with non bilious vomiting and abdominal mass. CASE PRESENTATION This case is reported because pyloroduodenal duplication cysts are an extremely rare congenital anomaly, whose clinical presentation often mimics those of hypertrophic pyloric stenosis. Ultrasound examination showed cystic mass at pyloric region and barium study was suggestive of extrinsic mass compressing the pyloric region. A laparotomy, a tense cystic mass was present at the pyloroduodenal junction (PDC) which was resected and end to end anastomosis was done. Patients followed an uneventful recovery and doing well. CONCLUSION The clinical and radiological analysis can reveal configurational changes consistent with a large extrinsic mass rather than muscular hypertrophy and can lead to accurate preoperative diagnosis.
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Affiliation(s)
| | | | - Richa Jaiman
- Department of pediatric surgery IMS, BHU, Varanasi, India
| | | | - Dinesh K Gupta
- Department of pediatric surgery IMS, BHU, Varanasi, India
| | - Shiv P Sharma
- Department of pediatric surgery IMS, BHU, Varanasi, India
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Srivastava P, Gangopadhyay AN, Gupta DK, Upadhyaya VD. Pseudotumor of the urinary bladder in a child: A case report and review of the literature. Urol Ann 2009. [DOI: 10.4103/0974-7796.48785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Pandey A, Gangopadhyay AN, Sharma SP, Upadhyaya VD, Kumar V, Gopal SC, Gupta DK, Srivastava A. Placement of the peritoneal end of a ventriculoperitoneal shunt in the suprahepatic space: does it improve prognosis? Pediatr Neurosurg 2009; 45:6-10. [PMID: 19221457 DOI: 10.1159/000202618] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2007] [Accepted: 07/02/2008] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Hydrocephalus is a common pediatric problem. Ventriculoperitoneal shunts (VPS) are the most frequent operative procedures used to treat hydrocephalic children. The peritoneal end is usually placed in the general peritoneal cavity. We present an alternative site of peritoneal end placement in the suprahepatic space in an attempt to reduce the abdominal complications. MATERIAL AND METHODS All patients with a diagnosis of congenital hydrocephalus were included in the study. In group 1, the lower end of the VPS was placed in the suprahepatic space. Patients were evaluated for abdominal complications like pseudocyst formation, intestinal obstruction and blockage of the lower end of the VPS. The data were compared with those patients in whom the peritoneal end was placed in the general peritoneal cavity (group 2). RESULTS The total number of patients in groups 1 and 2 was 133 and 175, respectively. Complications in group 1 were dislodgement of the shunt in the general peritoneal cavity in 28 (21.05%), suprahepatic pseudocyst formation in 2 (1.5%) and blocked lower end in 2 patients (1.5%). In group 2, complications noted were pseudocyst formation in 5 (2.8%), blocked lower end in 25 (14.2%), intestinal obstruction in 9 (5.1%), inguinoscrotal migration in 10 (5.7%) and perforation of viscera in 6 patients (3.4%). The overall follow-up period ranged from 1 to 7 years. CONCLUSIONS Placement of the lower end of the shunt in the suprahepatic space can be advantageous to placing it in the general peritoneal cavity. The procedure is simple and results can be rewarding.
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Affiliation(s)
- A Pandey
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Gangopadhyay AN, Upadhyaya VD, Sharma SP. Neonatal surgery: a ten year audit from a university hospital. Indian J Pediatr 2008; 75:1025-30. [PMID: 19023525 DOI: 10.1007/s12098-008-0205-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Accepted: 07/10/2008] [Indexed: 11/29/2022]
Abstract
Neonatal surgery is the flagship and most challenging component of pediatric surgery, which is the youngest subspeciality of surgery. Neonatal surgery carried a survival rate of only 30% three decades ago. In the last decade there has been a significant change in the scenario. Earlier recognition and referral of these anomalies, availability of neonatal intensive care, better preoperative planning, decision, and techniques have lead to the change in the management. This is an audit into the outcome of neonatal surgery from one of the largest units in India over a ten year period. This audit reveals an across the board survival of 65-70% newborns after surgery on nearly two thousand case over a ten year period. It has an important message that while pediatric surgery units expand, risk stratification of surgical newborns and their treatment in suitable units is mandatory to maintain and improve these figures to match international standards over the next decade.
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Affiliation(s)
- A N Gangopadhyay
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
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Affiliation(s)
- Anand Pandey
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221 005, U.P., India. E-mail:
| | - Ajay N. Gangopadhyay
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221 005, U.P., India. E-mail:
| | - Vijayendra Kumar
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221 005, U.P., India. E-mail:
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Abstract
INTRODUCTION Gastric volvulus is a rare, potentially life-threatening condition, which is difficult to diagnose. This study presents a series of acute gastric volvulus in neonates with the aim of describing this rare disease and its varied clinical manifestations. MATERIAL AND METHODS The data of all neonates presenting with acute gastric volvulus between January 2001 and January 2007 was retrospectively reviewed. Diagnosis was made on suspicion and was documented by a barium study. All patients were operated by open anterior gastropexy with or without a feeding gastrostomy. RESULTS Four patients were male and 1 was female. All were treated with gastropexy with or without feeding gastrostomy. Four patients recovered well after surgery. There was one postoperative death. CONCLUSION Gastric volvulus is extremely rare in neonates but it should be considered in the differential diagnosis after sudden onset or recurrent vomiting in the pediatric age group. Early diagnosis and treatment gives excellent results.
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Affiliation(s)
- V D Upadhyaya
- Department of Pediatric Surgery, Institute of Medical Sciences, BHU, Banaras Hindu University, Varanasi, India
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Pandey A, Gangopadhyay AN, Upadhyay VD. Evaluation and management of infantile hemangioma: an overview. Ostomy Wound Manage 2008; 54:16-8, 20, 22-6, 28-9. [PMID: 18493091 DOI: pmid/18493091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Infantile hemangiomas are the most common tumors of infancy and commonly last 7 to 9 years. Although their pathophysiology is not completely understood, recent studies have provided useful information regarding differential diagnosis, assessment approaches, and management options. To enhance understanding of infantile hemangiomas and highlight recent advances in knowledge of pathophysiology and newer diagnostic and therapeutic modalities, a literature search of pertinent articles published between 1985 and 2006 in PubMed was conducted using the term hemangioma with the words types, pathophysiology, treatment, and complications. Despite the generally benign nature of the condition, treatment is required for cosmetic and psychological reasons and requires differential diagnosis, particularly with regard to congenital hemangiomas and vascular and non-vascular tumors, to determine cause and address potential complications such as ulceration. Various emerging treatment modalities are available (interferon, vincristine, cyclophosphamide, bleomycin, imiquimod, becaplermin, and laser therapy) but steroids remain the treatment of choice in cases when hemangiomas require intervention. Overall prognosis in terms of healing hemangiomas using conservative measures is good. Additional research to better understand the pathophysiology and role of genetics is needed. Emerging treatment options should be evaluated through controlled studies to assess effects and side effects.
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Affiliation(s)
- Anand Pandey
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Upadhyaya VD, Gangopadhyay AN, Pandey A, Kumar V, Sharma SP, Gopal SC, Gupta DK, Upadhyaya A. Single-stage repair for rectovestibular fistula without opening the fourchette. J Pediatr Surg 2008; 43:775-9. [PMID: 18405735 DOI: 10.1016/j.jpedsurg.2007.11.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2007] [Revised: 11/26/2007] [Accepted: 11/27/2007] [Indexed: 02/08/2023]
Abstract
BACKGROUND Anorectal malformations are one of the most common congenital defects. This study is conducted to demonstrate new technique for treatment of rectovaginal fistula without disturbing the fourchette through posterior sagittal approach. METHOD All the patients of rectovestibular fistula admitted after the neonatal age were treated with posterior sagittal anorectoplasty without opening the fourchette. The results were evaluated for cosmetic appearance and anal continence. RESULT A total of 40 patients were included in our study. All patients were more than 1 month old. Operative time ranges from 70 to 150 minutes. The cosmetic appearance was good. Anal continence was good in 72% cases and fair in 20% cases. Fifteen percent of patients had minimal constipation and 7.5% patients had mucosal prolapse. CONCLUSION Single-stage repair for vestibular anus through posterior sagittal anorectoplasty without opening fourchette has a good cosmetic appearance and good anal continence.
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Affiliation(s)
- Vijai Datta Upadhyaya
- Department of Pediatric Surgery, Institute of Medical Sciences, BHU, Varanasi, 221005 UP, India
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Abstract
Rectal atresia is a rare condition in which the anus and sphincter muscles are normally developed, with usually no fistulous communication with the urinary tract. We describe an unusual case of membranous rectal atresia with recto-labial fistula. It was treated by blind perforation of rectal membrane with lay opening of fistlous tract.
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Affiliation(s)
- S P Sharma
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Gupta S, Kumar A, Gangopadhyay AN, Kumar M. Spinal cord hamartoma with pseudopancreatic cyst. Indian J Pediatr 2008; 75:281-3. [PMID: 18376099 DOI: 10.1007/s12098-008-0060-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
A 2-year-old boy presented with weakness of both lower limbs with bladder and bowel involvement and history of frequent falls. Magnetic resonance imaging of the spine revealed a T2 altered signal intensity enhancing mass lesion seen in the spinal epidural space extending from sixth cervical to fourth thoracic vertebrae, which was compressing the adjacent spinal cord. Histopathology of the lesion was suggestive of hamartoma. A brief review of the literature including its embryogenesis is discussed here. The child subsequently developed pseudopancreatic cysts possibly because of repeated falls leading to blunt trauma abdomen.
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Affiliation(s)
- Shalu Gupta
- Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi (U.P.), India.
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Upadhyaya VD, Gangopadhyay AN, Pandey A, Upadhyaya A, Mohan TV, Gopal SC, Gupta DK. Is pneumoperitoneum an absolute indication for surgery in necrotizing enterocolitis? World J Pediatr 2008; 4:41-4. [PMID: 18402251 DOI: 10.1007/s12519-008-0008-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Necrotizing enterocolitis (NEC) is the most common gastrointestinal medical/surgical emergency in neonates. Non-operative support is needed in 70% of NEC cases, and surgical intervention in the rest 30%. Historically, pneumoperitoneum has been considered as an absolute indication for laparotomy. In the present study we emphasize that pneumoperitoneum is not an absolute indication for exploratory laparotomy in NEC cases. METHODS We prospectively studied 58 patients with severe NEC having pneumoperitoneum on abdominal X-ray in the last 5 years. At the time of admission, the patients were given intravenous fluid, total parental nutrition, blood transfusion and broad spectrum antibiotics followed by abdominal tapping (paracentesis). All the patients with pneumoperitoneum were closely monitored for 48 hours if abdominal tapping was repeated. When the disease seemed to worsen clinically, radiologically and laboratorially, the patient was subjected to exploratory laparotomy. RESULTS Of the 58 patients, 40 were treated conservatively whereas 18 underwent surgical intervention. The overall mortality in the present study was 12.1%, including 5% of the patients managed conservatively and 27% of the patients undergoing surgery. CONCLUSIONS Pneumoperitoneum is not an absolute indication for surgery in cases of neonatal NEC. Most of the patients can be treated conservatively.
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Abstract
While the incidence is very low, necrotising fasciitis in neonates and children is a potentially life-threatening infection that requires rapid diagnosis and treatment. This review describes its aetiology, symptoms, clinical feature and treatment.
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Affiliation(s)
- A Pandey
- Institute of Medical Sciences, Banaras Hindu University,Varanasi, India
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Gupta DK, Pandey A, Gangopadhyay AN, Prasad S, Singh TB, Khanna HD, Upadhyaya VD. Estimation and correlation of serum folic acid levels in spina bifida babies and their mothers. J Pediatr Neurosci 2008. [DOI: 10.4103/1817-1745.43640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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