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Banerjee DB, Appasawmy N, Caldwell S, Wade RL, Owen A, Patwardhan N, Eradi B. Impact of Colorectal Nurse Specialist supervised parental administration of rectal washouts on Hirschsprung's disease outcomes: a retrospective review. Pediatr Surg Int 2024; 40:107. [PMID: 38615130 DOI: 10.1007/s00383-024-05687-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 04/15/2024]
Abstract
PURPOSE To highlight the utility of Colorectal Nurse Specialist (CNS) supervised parental administration of rectal washouts in the management of Hirschsprung's disease (HD). METHODS Retrospective case note review of HD patients treated at a tertiary children's hospital in United Kingdom from January 2011 to December 2022. Data collected included demographics, complications, enterocolitis, obstructive symptoms and stomas. Primary pull-through (PT) is done 8-12 weeks after birth. Parental expertise in performing rectal washouts at home is ensured by our CNS team before and after PT. RESULTS PT was completed in 69 of 74 HD patients. Rectal washouts were attempted on 63 patients before PT. Failure of rectal washout efficacy necessitated a stoma in four patients (6.4%). Of the 65 patients who had PT and stoma closed, three (4.5%) required a further stoma over a mean follow-up period of 57 months (Range 7-144 months). Two of these had intractable diarrhoea due to Total Colonic Aganglionosis (TCA). One patient (1.5%) had unmanageable obstructive symptoms requiring re-diversion. Hirschsprung-associated enterocolitis (HAEC) requiring hospital admission occurred in 14 patients (21%). CONCLUSION Our stoma rates are lower compared to recent UK data. This could potentially be due to emphasis on parental ability to perform effective rectal washouts at home under CNS supervision.
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Affiliation(s)
- Debasish B Banerjee
- Department of Paediatric Surgery, Leicester Royal Infirmary (LRI), Infirmary Square, Leicester, LE1 5WW, UK
| | - Nalini Appasawmy
- Department of Paediatric Surgery, Leicester Royal Infirmary (LRI), Infirmary Square, Leicester, LE1 5WW, UK
| | - Stephen Caldwell
- Department of Paediatric Surgery, Leicester Royal Infirmary (LRI), Infirmary Square, Leicester, LE1 5WW, UK
| | - Rachel L Wade
- Department of Paediatric Surgery, Leicester Royal Infirmary (LRI), Infirmary Square, Leicester, LE1 5WW, UK
| | - Anthony Owen
- Department of Paediatric Surgery, Leicester Royal Infirmary (LRI), Infirmary Square, Leicester, LE1 5WW, UK
| | - Nitin Patwardhan
- Department of Paediatric Surgery, Leicester Royal Infirmary (LRI), Infirmary Square, Leicester, LE1 5WW, UK
| | - Bala Eradi
- Department of Paediatric Surgery, Leicester Royal Infirmary (LRI), Infirmary Square, Leicester, LE1 5WW, UK.
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Leone F, Durell J, Dagash H, Patwardhan N. Cosmetic incision for paediatric muscle biopsy. Ann R Coll Surg Engl 2024; 106:92. [PMID: 36476044 PMCID: PMC10757885 DOI: 10.1308/rcsann.2022.0141] [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] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 06/17/2023] Open
Affiliation(s)
- Fmt Leone
- Hull University Teaching Hospitals NHS Trust, UK
| | - J Durell
- University Hospitals of Leicester NHS Trust, UK
| | - H Dagash
- University Hospitals of Leicester NHS Trust, UK
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Puttock D, Kumbhar V, Dagash H, Patwardhan N. Peritoneal lavage during laparoscopic appendectomy for complex appendicitis is associated with increased post-operative morbidity. Afr J Paediatr Surg 2022; 19:241-244. [PMID: 36018206 PMCID: PMC9615951 DOI: 10.4103/ajps.ajps_146_21] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM Appendicitis is one of the most common paediatric surgical pathologies seen by paediatric surgeons worldwide. Laparoscopic appendectomy is undertaken for all cases of appendicitis in our institute. Intraperitoneal lavage following appendectomy is the conventional way of managing complicated appendicitis; however, some surgeons debate the efficacy of this practice. The aim of this study was to compare outcomes of intraperitoneal lavage versus suction only in children with complicated appendicitis. METHODS Data were collected retrospectively between January 2018 and January 2019. All patients undergoing laparoscopic appendectomy for complex appendicitis were included and divided into two groups, patients who had suction only and those who had lavage and suction. Outcome parameters studied were the length of stay (LOS), number of temperature spikes > 37.7 (TS), operative times (OT) and readmission for intra-abdominal collections. Comparison between the two groups was performed using two sample t-test with unequal variance, significance was set at P < 0.05. RESULTS A total of 115 patients were included (lavage n = 52, Suction n = 63). The LOS (P = 0.0054), TS (0.0109), OT (P < 0.0001) were significantly higher in the lavage group compared to the suction-only group. Overall rates of readmission were similar between groups, however, readmission for the confirmed intra-abdominal collection was more common in the lavage group. CONCLUSION Based on our study, it appears that there is no advantage in performing an intraperitoneal lavage for complex appendicitis. It resulted in a prolonged stay, more post-operative TS and longer operative duration. The likelihood of being readmitted with an intra-abdominal collection following a lavage was higher compared to suction only.
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Affiliation(s)
- Darren Puttock
- Department of Paediatric Surgery, Leicester Children's Hospital, University Hospitals of Leicester, Leicester, England
| | - Vikrant Kumbhar
- Department of Paediatric Surgery, Leicester Children's Hospital, University Hospitals of Leicester, Leicester, England
| | - Haitham Dagash
- Department of Paediatric Surgery, Leicester Children's Hospital, University Hospitals of Leicester, Leicester, England
| | - Nitin Patwardhan
- Department of Paediatric Surgery, Leicester Children's Hospital, University Hospitals of Leicester, Leicester, England
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Henderson L, Hussein N, Patwardhan N, Dagash H. Outcomes During a Transition Period from Open to Laparoscopic Pyloromyotomy. J Laparoendosc Adv Surg Tech A 2017; 28:481-485. [PMID: 29265912 DOI: 10.1089/lap.2017.0366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Previous studies suggest that laparosopic pyloromyotomy may have some benefits over an open approach. We examined our results during a transition period from open to laparoscopic pyloromyotomy to see whether these benefits are sustained during the learning curve. METHODS This is a retrospective case note review of all patients undergoing pyloromyotomy at a tertiary institution for a 5-year period (2010-2015). Data are presented as median (range). Statistical analysis was performed with Fisher's exact and Student's t-test. RESULTS A total of 185 pyloromyotomies were performed, with data available for 90 open and 60 laparoscopic procedures. Duration of surgery was 42 (16-102) minutes for open and 28 (14-97) minutes for laparoscopic procedures (P = .0001). Total paracetamol requirements were 23.5 (0-169.4) mg/kg for open and 13.9 (0-95.3) mg/kg for laparoscopic cases (P = .008). No postoperative analgesia was required for 23 open and 29 laparoscopic patients (P = .005). Complications in the open group included incomplete pyloromyotomy (n = 1) and wound infection (n = 4); complications in the laparoscopic group included incisional hernia (n = 1), omental port-site herniation (n = 2), and suspected perforation with conversion to open procedure, although no perforation was found (n = 1; P = 1.000). CONCLUSION Our results suggest that when the laparoscopic technique is first introduced, overall complication rates are not statistically higher, and operative times and analgesia requirements are significantly shorter, despite the learning curve.
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Affiliation(s)
- Lucy Henderson
- 1 Department of Paediatric Surgery, Leicester Children's Hospital , Leicester, United Kingdom
| | | | - Nitin Patwardhan
- 1 Department of Paediatric Surgery, Leicester Children's Hospital , Leicester, United Kingdom
| | - Haitham Dagash
- 1 Department of Paediatric Surgery, Leicester Children's Hospital , Leicester, United Kingdom
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Durell J, Dagash H, Eradi B, Rajimwale A, Nour S, Patwardhan N. 13 ribs as a predictor of long gap esophageal atresia: myth or reality? Analysis of associated findings of esophageal atresia and abnormal rib count. J Pediatr Surg 2017; 52:1252-1254. [PMID: 28545763 DOI: 10.1016/j.jpedsurg.2017.04.019] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 04/17/2017] [Accepted: 04/27/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND The presence of 13 pairs of ribs on pre-operative chest x-ray has been postulated to be an indicator for long gap esophageal atresia (EA). This study sought to determine the validity of this theory and identify associated pathological conditions in patients with EA and abnormal rib count. METHODS Babies with EA from January 2005 - December 2012 were retrospectively analyzed. Information was gathered from neonatal health records and operation notes. Chest x-rays were reviewed to determine rib count. Long gap EA was defined as failure to achieve primary esophageal anastomosis. Statistical analysis performed with Fisher's exact test. RESULTS Seventy-six patients were identified. Eight patients had long gap EA, with none of these patients having 13 pairs of ribs. Paradoxically, 10 patients with esophageal atresia +/- trachea-esophageal atresia (EA +/- TEF) and supernumerary ribs underwent primary repair. Nine patients had 11 pairs of ribs, of which 2 had pure EA and a long gap. Using Fisher's exact test to compare the groups of supernumary ribs and non-supernumary ribs there is a p value of 0.587. VACTERL association was identified in 40% of those with supernumerary ribs. Various associated syndromes and concomitant abnormalities were identified. CONCLUSION We found no association between 13 pairs of ribs and long gap in esophageal atresia. Those with 13 pairs of ribs were more likely to have associated anomalies, although this was not statistically significant. Our cohort of patients was found to have a range of pathology related to genetic syndromes, further atresias, and malformations, which is well known to be associated with children born with EA +/- TEF. LEVEL OF EVIDENCE Prognosis study - level IV.
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Affiliation(s)
- Jonathan Durell
- Department of Paediatric Surgery, Leicester Royal Infirmary, Leicester, United Kingdom LE1 5WW
| | - Haitham Dagash
- Department of Paediatric Surgery, Leicester Royal Infirmary, Leicester, United Kingdom LE1 5WW.
| | - Bala Eradi
- Department of Paediatric Surgery, Leicester Royal Infirmary, Leicester, United Kingdom LE1 5WW
| | - Ashok Rajimwale
- Department of Paediatric Surgery, Leicester Royal Infirmary, Leicester, United Kingdom LE1 5WW
| | - Shawqui Nour
- Department of Paediatric Surgery, Leicester Royal Infirmary, Leicester, United Kingdom LE1 5WW
| | - Nitin Patwardhan
- Department of Paediatric Surgery, Leicester Royal Infirmary, Leicester, United Kingdom LE1 5WW
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Abstract
Objectives We observed whether general practitioners are referring more appropriately for balanitis xerotica obliterans in regards to circumcision, especially at a time of clinical concern, and whether their discriminative abilities were affected by age. We also aimed to explore if balanitis xerotica obliterans was over-diagnosed by surgeons potentially leading to unnecessary circumcisions of healthy foreskins. Design Cross-sectional descriptive study. Setting Leicester Royal Infirmary. Participants All children less than 16 years of age were included and were subsequently split into two categories: those less than or equal to five years and those above five years. Circumcision was justified if surgeon found pathology under foreskin commissioning guidelines set by the Royal College of Surgeons of England. After clinical diagnosis of balanitis xerotica obliterans, the pathological database was searched for histological confirmation. Main outcome measures Has diagnostic accuracy improved amongst general practitioners for balanitis xerotica obliterans and is there a high clinical to histological confirmation. Results Of the total patients, 14.5% were diagnosed clinically with balanitis xerotica obliterans. Only 66.7% of cases were histologically confirmed with chronic inflammation found in the rest; 5.5% of all boys referred had balanitis xerotica obliterans on histology; and 8.2% of children <5 had clinical balanitis xerotica obliterans with 1.7% confirmed histologically. This was in contrast with 18.1% and 9.2% found in the older cohort. Conclusion There remains a high diagnostic inaccuracy amongst general practitioners when referring for balanitis xerotica obliterans. This is greatest in those under five years. Although balanitis xerotica obliterans was over-diagnosed, no healthy foreskin underwent unnecessary circumcision.
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Affiliation(s)
- Khalis Boksh
- Department of Paediatric Surgery, University Hospitals Leicester, Leicester Royal Infirmary, Leicester LE1 5WW, UK
| | - Nitin Patwardhan
- Department of Paediatric Surgery, University Hospitals Leicester, Leicester Royal Infirmary, Leicester LE1 5WW, UK
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7
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Verma P, Verma KG, Khosa R, Kumar S, Basavaraju S, Patwardhan N. Combined use of frontal sinus and nasal septum patterns as an aid in forensics: a digital radiographic study. N Am J Med Sci 2015; 7:47-52. [PMID: 25789248 PMCID: PMC4358048 DOI: 10.4103/1947-2714.152078] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: Skull radiographic examination is a potentially useful procedure for the personal identification in cases where fragments of skull persist with no likelihood of identification based on dental arch. Aims: The study was to determine the uniqueness and reliability of combined frontal sinus (FS) and nasal septum (NS) patterns as observed on posterioanterior (PA) cephalograms for personal identification. Materials and Methods: The randomly selected 149 digital PA cephalograms taken on Kodak 8000C Digital Panoramic and Cephalometric system were evaluated for patterns of FS and NS. Also the distribution of lobulations, area, and ratio of height/width of FS was calculated. The data obtained was statistical analyzed using Pearson's coefficient correlation. Results: FS symmetry was observed in 78.5% and asymmetry in 7.3% subjects. Bilateral aplasia was noticed in 5.3% and unilateral aplasia in 8.7% of subjects. The total lobulation of FS was noted more in males on both sides while center lobes were observed slightly more in females. The straight NS was maximally seen followed by reverse sigmoid. The mean ratio of width/height of FS was observed more in males and highly significant correlation was observed with both sexes. The mean area of FS was noted more in males. There was significant correlation found between patterns of NS and FS except in right dominated asymmetrical FS. Conclusion: The combined use of FS and NS patterns could be used as method for identification by exclusion in forensics.
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Affiliation(s)
- Pradhuman Verma
- Department of Oral Medicine and Radiology, Surendera Dental College and Research Institute, Sriganganagar, Rajasthan, India
| | - Kanika Gupta Verma
- Department of Pedodontics and Preventive Dentistry, Surendera Dental College and Research Institute, Sriganganagar, Rajasthan, India
| | - Rameen Khosa
- Department of Oral Medicine and Radiology, Surendera Dental College and Research Institute, Sriganganagar, Rajasthan, India
| | - Sandeep Kumar
- Department of Orthodontics, Institute of Dental Sciences, Sehora, Jammu, India
| | - Suman Basavaraju
- Department of Periodontics, Jagadguru Sri Shivarathreeswara Dental College, Mysore, Karnataka, India
| | - Nitin Patwardhan
- Department of Public Health Dentistry, Teerthankar Mahavir University, Moradabad, Uttar Pradesh, India
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8
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Verma P, Verma KG, Verma D, Patwardhan N. Craniofacial brown tumor as a result of secondary hyperparathyroidism in chronic renal disease patient: A rare entity. J Oral Maxillofac Pathol 2014; 18:267-70. [PMID: 25328310 PMCID: PMC4196298 DOI: 10.4103/0973-029x.140779] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 07/25/2014] [Indexed: 11/04/2022] Open
Abstract
Brown tumors are erosive bony lesions caused by rapid osteoclastic activity and peritrabecular fibrosis due to primary or secondary hyperparathyroidism resulting in a local destructive phenomenon. The differential diagnosis based on histological examination is only presumptive. Clinical, radiological and laboratory data are necessary for definitive diagnosis. Here, we report a very rare case of brown tumor involving maxilla and mandible, which is the result of secondary hyperparathyroidism in 30-year-old female patient with chronic renal disease.
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Affiliation(s)
- Pradhuman Verma
- Department of Oral Medicine and Radiology, Surendra Dental College and Hospital, Sriganganagar, Rajasthan, India
| | - Kanika Gupta Verma
- Department of Pedodontics and Preventive Dentistry, Surendra Dental College and Hospital, Sriganganagar, Rajasthan, India
| | - Dinesh Verma
- Department of Oral and Maxillofacial Surgery, Surendra Dental College and Hospital, Sriganganagar, Rajasthan, India
| | - Nitin Patwardhan
- Department of Preventive and Community Dentistry, Vaidik Dental College and Hospital, Daman, Daman and Diu, India
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Kumar H, Patel R, Patwardhan N, More B. Pseudocyst and a collar stud abscess: new face of necrotizing enterocolitis. J Neonatal Surg 2014; 3:46. [PMID: 26023517 PMCID: PMC4420331] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 10/09/2014] [Indexed: 10/26/2022] Open
Abstract
Meconium pseudocyst formation secondary to antenatal perforation is well described. We present a preterm infant who had intra-abdominal pseudocyst formation following postnatal intestinal perforation secondary to necrotizing enterocolitis (NEC) and secondarily leading to extra-abdominal collar stud abscess. This is new face of NEC and this presentation has not been reported earlier.
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Affiliation(s)
| | | | | | - Bharat More
- Correspondence: Bharat More M.S., MCh, F.R.C.S. (Paeds) Department of Paediatric Surgery, Directorate of Children’s Services, Univeristy Hospitals of Leicester NHS Trust, Leicester Royal Infirmary , Infirmary Square, Leicester LE1 5WW United Kingdom. E-mail:
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Abstract
Meconium pseudocyst formation secondary to antenatal perforation is well described. We present a preterm infant who had intra-abdominal pseudocyst formation following postnatal intestinal perforation secondary to necrotizing enterocolitis (NEC) and secondarily leading to extra-abdominal collar stud abscess. This is new face of NEC and this presentation has not been reported earlier.
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11
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Jayakumar S, Patwardhan N. Characteristic Radiological findings in Preterm Infants with Missed Intestinal Perforation. J Neonatal Surg 2014; 3:27. [PMID: 26023498 PMCID: PMC4420441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 06/29/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Pneumoperitoneum on radiological imaging is typical in intestinal perforation in necrotizing enterocolitis [NEC]. However, it is not seen in all cases and intestinal perforation is missed on occasions. We present a series of preterm infants with characteristic x-ray findings that on exploration revealed missed intestinal perforation. METHODS Retrospective review of neonates with intra-operative diagnosis of intestinal perforation which was missed on x-ray abdomen over a period of 6 months is being presented here. RESULTS Three neonates born at 24 (24-30) weeks of gestation were identified. PDA was noted in all 3 patients and they required ventilator and inotropic support. Feeds were commenced at 5 (2-7) days of life. All three patients were treated for NEC. Surgical opinion was sought in view of localized gas shadow in a fixed position seen on repeated x-rays in all three patients. All three patients had laparotomy and small bowel resection with ileostomy formation at a mean age of 26 (24-46) days. Intra-operatively, small bowel perforation and adjacent pseudocysts filled with air and intestinal contents were noted in all 3 patients. Post-operatively full feeds were established in all patients. CONCLUSION In premature infants with NEC, intestinal perforation can be missed on occasions. Our patients interestingly, developed characteristic abdominal x-ray findings that in our experience should prompt for surgical intervention.
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12
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Abstract
BACKGROUND: Pneumoperitoneum on radiological imaging is typical in intestinal perforation in necrotizing enterocolitis [NEC]. However, it is not seen in all cases and intestinal perforation is missed on occasions. We present a series of preterm infants with characteristic x-ray findings that on exploration revealed missed intestinal perforation.METHODS: Retrospective review of neonates with intra-operative diagnosis of intestinal perforation which was missed on x-ray abdomen over a period of 6 months is being presented here.RESULTS: Three neonates born at 24 (24-30) weeks of gestation were identified. PDA was noted in all 3 patients and they required ventilator and inotropic support. Feeds were commenced at 5 (2-7) days of life. All three patients were treated for NEC. Surgical opinion was sought in view of localized gas shadow in a fixed position seen on repeated x-rays in all three patients. All three patients had laparotomy and small bowel resection with ileostomy formation at a mean age of 26 (24-46) days. Intra-operatively, small bowel perforation and adjacent pseudocysts filled with air and intestinal contents were noted in all 3 patients. Post-operatively full feeds were established in all patients.CONCLUSION: In premature infants with NEC, intestinal perforation can be missed on occasions. Our patients interestingly, developed characteristic abdominal x-ray findings that in our experience should prompt for surgical intervention.
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Affiliation(s)
- Ramnik V Patel
- Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Paediatric Urology, Great Ormond Street Children Hospital NHS Trust, London, UK
| | - Gregory Shepherd
- Department of Paediatric Surgery, Leicester Royal Infirmary, Leicester, UK
| | - Hemant Kumar
- Department of Paediatric Surgery, Leicester Royal Infirmary, Leicester, UK
| | - Nitin Patwardhan
- Department of Paediatric Surgery, Leicester Royal Infirmary, Leicester, UK
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14
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Jayakumar S, Hatsell L, Patwardhan N. Asymptomatic meconium peritonitis presenting as inguinal hernia in a female neonate. J Neonatal Surg 2013; 2:43. [PMID: 26023463 PMCID: PMC4420300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 09/08/2013] [Indexed: 11/20/2022] Open
Abstract
Inguinal hernias in girls are often irreducible when they contain ovaries. Rarely the hernial sacs may have unusual contents like vermiform appendix, uterus and urinary bladder. We report a case of a female infant who presented with bilateral irreducible inguinal hernias presumed to be due to ovaries. However at exploration, the hernial sacs contained bilaterally an omental mass with calcifications. Presence of mucin with meconium- laden macrophages in the mass on histology suggested an antenatal intestinal perforation. To the best of our knowledge no such case has been reported in a female neonate. We present this rare case and discuss the unusual findings and the outcome.
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Jayakumar S, Hatsell L, Patwardhan N. Asymptomatic Meconium Peritonitis Presenting as Inguinal Hernia in a Female Neonate. J Neonatal Surg 2013. [DOI: 10.47338/jns.v2.55] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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
Inguinal hernias in girls are often irreducible when they contain ovaries. Rarely the hernial sacs may have unusual contents like vermiform appendix, uterus and urinary bladder. We report a case of a female infant who presented with bilateral irreducible inguinal hernias presumed to be due to ovaries. However at exploration, the hernial sacs contained bilaterally an omental mass with calcifications. Presence of mucin with meconium- laden macrophages in the mass on histology suggested an antenatal intestinal perforation. To the best of our knowledge no such case has been reported in a female neonate. We present this rare case and discuss the unusual findings and the outcome.
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Affiliation(s)
- Ramnik V Patel
- Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, London, UK.
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17
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Patel RV, Kumar H, Patwardhan N, Antao B. Pneumoperitoneum: a rare air leak in an infant with bronchiolitis and high-frequency oscillatory ventilation. BMJ Case Rep 2013; 2013:bcr-2013-010447. [PMID: 23887992 PMCID: PMC3736656 DOI: 10.1136/bcr-2013-010447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Ramnik V Patel
- Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, London, UK.
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Patel R, Patwardhan N, Ninan G. Laparoscopic nephrectomy for xanthogranuloma pyelonephritis in a 3-year-old girl. Journal of Pediatric Surgery Case Reports 2013. [DOI: 10.1016/j.epsc.2013.03.004] [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: 02/08/2023] Open
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Patel RV, Durell J, Dagash H, Patwardhan N. Neonatal spontaneous bile duct perforation presenting as giant intraabdominal cyst. Journal of Pediatric Surgery Case Reports 2013. [DOI: 10.1016/j.epsc.2013.02.013] [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: 02/08/2023] Open
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Abstract
BACKGROUND Gastroenteric fistula occurs in 2% to 3% of patients undergoing percutaneous endoscopic gastrostomy (PEG). The authors identified 12 children with this major complication. METHODS A retrospective case note review was performed. RESULTS Over a 5-year period, the complication rate for gastroenteric fistula was 3.5% (12 of 343 procedures). Presentation ranged from 1 day to 25 months post-PEG insertion. Eight patients presented with acute intestinal obstruction. The gastroenteric fistulous tract involved the posterior wall of the stomach in all cases. The plain abdominal x-ray was useful in establishing the diagnosis of the gastroenteric fistula. CONCLUSIONS Patients with gastroenteric fistula as a complication of PEG insertion can remain asymptomatic for prolonged periods. It often is difficult to make the diagnosis. A plain abdominal x-ray is a useful diagnostic modality.
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Affiliation(s)
- Nitin Patwardhan
- Department of Paediatric Surgery, Great Ormond Street Hospital NHS Trust, London, England, UK
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21
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Rezk S, Brynes RK, Nelson V, Thein M, Patwardhan N, Fischer A, Khan A. beta-Catenin expression in thyroid follicular lesions: potential role in nuclear envelope changes in papillary carcinomas. Endocr Pathol 2004; 15:329-37. [PMID: 15681857 DOI: 10.1385/ep:15:4:329] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [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] [Indexed: 01/13/2023]
Abstract
The morphologic distinction of benign and malignant thyroid follicular lesions can sometimes be challenging, therefore an immunohistochemical marker to aid in this distinction would be useful. beta-Catenin is one such potential marker. It is part of a membrane-bound cell growth-signaling complex that plays a role in cell adhesion, as well as in promotion of growth through activation of the Wnt signaling pathway. Oncogenic signaling occurs when beta-catenin is released, accumulates in the cytoplasm, translocates into the nucleus, and promotes transcription of genes including bcl-1 (cyclin D1) and c-myc that induce cell proliferation. Paraffin blocks from 133 thyroidectomy specimens were stained with monoclonal antibodies reactive with beta-catenin and cyclin D1. These included 53 cases of papillary thyroid carcinoma (PTC), 46 cases of follicular variant of papillary carcinoma (FVPC), 10 cases of follicular carcinoma (FC), and 24 cases of follicular adenoma (FA). Tissue from six normal thyroid specimens served as a control. The malignant lesions (PTC, FC, and FVPC) expressed strong cytoplasmic/nuclear staining and minimal residual membranous staining in 87%, 80%, and 71% of cases, respectively. In contrast, all normal thyroid tissue and 79% of FAs showed strong membranous reactivity with very minimal cytoplasmic staining. Interestingly, in 83% of PTC cases and 20% FVPCs, the intranuclear inclusions were distinctly beta-catenin positive. Cyclin D1 over expression correlated with cytoplasmic relocalization of beta-catenin in almost all cases, and no evidence of cyclin D1 gene amplification was observed. beta-Catenin can be of a diagnostic utility for thyroid lesions, because it highlights intranuclear inclusions in PTC, and shifts from a membranous localization to a cytoplasmic localization in malignant lesions. We speculate that the localization of beta-catenin in intranuclear inclusions may reflect a cytoskeletal remodeling activity of beta-catenin that is functionally significant for the PTC pathway.
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Affiliation(s)
- S Rezk
- Department of Pathology, University of Massachusetts Medical School, Worcester, MA 01655, USA
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Abstract
A boy with a long history of dysphagia attributed to neurological impairment was shown to have a large oesophageal foreign body. It had remained undetected for five years as a central lumen allowed the passage of liquids and semisolids. Foreign bodies must be excluded in children with dysphagia.
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Abstract
PURPOSE The aim of this study was to characterize the type and incidence of complications related to colostomy formation in newborn infants with anorectal anomalies. METHODS The authors reviewed a 5-year (1994 to 1999) experience of a single institution in the management of neonates with high and intermediate anorectal anomalies who required colostomy at birth. Patients with colostomy still in place have been excluded from the study to maximize the chances of detecting colostomy-related complications. RESULTS There were 80 neonates with anorectal malformations, of whom, 49 (31 boys and 18 girls) were included in the study. The site of colostomy was sigmoid colon (n = 32), transverse colon (n = 7), and descending colon (n = 10). Thirty-nine colostomies were loop, and the remaining 7 were divided. The median birth weight was 2.96 kg (range, 1.46 to 3.88). The age at colostomy formation was 2 days (range, 1 to 210). Mechanical complications related to colostomy formation were observed in 16 infants (32%) with 3 infants having more than 1 mechanical complication. These included prolapse in 8 (50%), intestinal obstruction (adhesions, intussusception, and volvulus) in 7 (44%), and skin dehiscence in 3 (19%). One neonate had necrotizing enterocolitis (NEC) after colostomy formation. Urinary tract infection was observed after colostomy in 14 infants (29%). The incidence of urinary tract infection was not higher in infants who had loop colostomy (11 of 39, 28%) compared with infants who had divided colostomy (3 of 10, 30%). There were no differences in the incidence of colostomy-related complications and urinary tract infection between male and female infants. There were no deaths in this series. CONCLUSIONS Formation of colostomy for anorectal anomalies should not be considered a minor procedure. In our experience the incidence of complications after colostomy formation is high. The incidence of urinary tract infections does not seem to be affected by the type of colostomy performed.
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Affiliation(s)
- N Patwardhan
- Department of Paediatric Surgery, The Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, University College London, London, England, UK
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Jain M, Khan A, Patwardhan N, Reale F, Safran M. Follicular variant of papillary thyroid carcinoma: a comparative study of histopathologic features and cytology results in 141 patients. Endocr Pract 2001; 7:79-84. [PMID: 11421549 DOI: 10.4158/ep.7.2.79] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To characterize the histopathologic features of follicular variant of papillary thyroid carcinoma (FVPC) and its cytology results on fine-needle aspiration (FNA) biopsy and compare them with those of papillary thyroid carcinoma (PC). METHODS We searched the University of Massachusetts Medical Center pathology database for all surgical specimens associated with a diagnosis of FVPC or PC between January 1992 and February 1998 and reviewed the related pathology reports. In addition, the associated preoperative FNA results were analyzed. RESULTS On initial assessment, FVPC was associated with a significantly lower incidence of cervical lymph node metastatic involvement in comparison with PC (5.6% versus 35.7%; P<0.001). Even though the mean size of FVPC was larger than that of PC (2.57 cm versus 1.75 cm; P<0.05), FVPC showed a lower incidence of thyroid capsule invasion (5.6% versus 11.4%), infiltrative resection margins (2.8% versus 20.0%; P = 0.01), local soft tissue invasion (7.0% versus 25.7%; P<0.005), and multicentricity (25.4% versus 47.1%; P<0.01). Lymphocytic thyroiditis was a common feature of both FVPC (36.6%) and PC (35.7%). FNA biopsy revealed the presence of malignant cells in 9.8% of patients with FVPC in comparison with 67.5% of patients with PC. Most cytology specimens of FVPC (58.8%) were interpreted as suspicious for a malignant lesion or as a follicular neoplasm. CONCLUSION FVPC is associated with a significantly lower incidence of cervical lymph node metastatic lesions and invasive histologic features than is PC. Long-term prospective clinical studies are needed to determine whether these findings translate into a more benign natural history for this variant of PC. Results of FNA biopsy in FVPC are more commonly interpreted as suspicious rather than malignant; this factor has major implications for preoperative planning.
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Affiliation(s)
- M Jain
- Division of Endocrinology, Department of Pathology, and Department of Surgery, University of Massachusetts School of Medicine, Worcester, Massachusetts, USA
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Patwardhan N, Dave R. Dermatomycosis in and around Aurangabad. INDIAN J PATHOL MICR 1999; 42:455-62. [PMID: 11127378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
A total of 175 cases of dermatophytoses were studied. Out of all the clinical types, Tinea corporis (T. corporis) was found to be the predominant clinical type (24.57%) followed by tinea cruris (T. cruris) (22.28%). Incidence of Tinea barbae (T. barbae) and Tinea imbricata (T. imbricata) was the least (2.85%) and 0.57% respectively. Out of 175 cases of dermatophytoses, 66 (37.71%) cases were positive on microscopic examination, out of which 27 (40.90%) cases were positive by culture also. Out of the 175 cases of dermatophytoses, 109 (62.28%) were engative on microscopic examination, out of which 13 (11.92%) were culture positive. In this study, Trichophyton was the commonest genus of dermatophyte isolated, with Trichophyton rubrum (T. rubrum) being the commonest species (28.12%), followed by Trichophyton mentagrophyte. (T. mentagrophyte) (25.0%) Trichophyton soudanense (T. soundanense), which is a rare species (not reported from any studies) was isolated from cases of T. corporis and T. cruris.
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Affiliation(s)
- N Patwardhan
- Department of Microbiology, Government Medical College, Aurangabad
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Abstract
The cell cycle is controlled in part by cyclin-dependent kinases (CDKs), which are activated by forming complexes with cyclins. CDKs phosphorylate certain substrates to facilitate the proliferating cells through the cell cycle. CDK inhibitors (CDKIs) such as p27 inhibit cyclin-CDK complexes and function as a negative cell cycle regulator. The overexpression of the positive regulators (cyclins) or the underexpression of the negative regulators including p27 has been seen in a variety of neoplasms, but their role and interaction in thyroid carcinogenesis is yet to be established. We studied the expression of cyclins D1 and E, and the CDKI, p27 by immunohistochemistry in 116 cases, including 59 cases of follicular variant of papillary carcinoma (FVPC) and 57 cases of follicular adenoma (FA). The positive staining was divided into four grades: 1+ if less than 10%, 2+ if 11% to 25%, 3+ if 26% to 50%, and 4+ if greater than 50% of the nuclei of tumor cells stained positively. Cyclin D1 expression was seen in 37 (63%) FVPC and 34 (60%) FA. Cyclin E-positive cells were seen in 51 (86%) FVPC and 47 (82%) FA. No significant differences in the grade of cyclins D1 (P = .261) and E (P = .284) staining was seen between FVPC and FA. Of the 59 FVPC, 53 (89%) showed p27-positive cells; of these, 33 were 1+, nine were 2+, seven were 3+ and only four were 4+ positive. Conversely, all 57 FA were p27 positive, 53 were 4+, and four were 3+ positive. This difference in the grade of p27 staining between FVPC and FA was statistically significant (P < .001). This study shows a significant underexpression of p27 in FVPC compared with FA, suggesting that a decrease in p27 expression plays a more important role than overexpression of cyclins D1 and E alone in thyroid carcinogenesis and that p27 immunostaining may be helpful in the diagnosis of FVPC.
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Affiliation(s)
- S Wang
- Department of Pathology, University of Massachusetts Medical Center, Worcester 01655, USA
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Phillips DA, Wertheimer MD, Patwardhan N, Swanson R, Zawacki J. Preoperative angiography and embolization of the site of intermittent acute small bowel bleeding with a radiopaque microcoil: facilitated precise surgical excision of the source. Surgery 1996; 119:714-7. [PMID: 8650615 DOI: 10.1016/s0039-6060(96)80199-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- D A Phillips
- Department of Radiology, University of Massachusetts Medical Center, Worcester 01655, USA
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Abstract
Papillary cancer is the most common thyroid cancer occurring in all age groups and is usually an indolent tumor, and patients have an excellent prognosis. The majority of patients with papillary cancer do well. It is for the small number of patients who do poorly that it is critical to carry out the appropriate initial operation. The recognized primary treatment of papillary cancer is surgical excision, and the controversy regarding lobectomy versus total thyroidectomy continues. We favor total thyroidectomy because it eradicates multicentric disease, facilitates postoperative radioactive iodine ablation, and allows thyroglobulin levels to be used as a tumor marker for follow-up. Total thyroidectomy should be done by an experienced surgeon to decrease morbidity. Otherwise a total lobectomy on the side of the nodule with subtotal removal on the opposite side is preferred to avoid serious postoperative complications.
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Affiliation(s)
- N Patwardhan
- University of Massachusetts Medical Center, Worcester, USA
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Abstract
Laparoscopic adrenalectomy (LA) was performed in 6 patients (4 right and 2 left). A transperitoneal approach in a lateral position was used. Pheochromocytoma was present in two patients and Conn's syndrome, with a solitary functioning adenoma, was the diagnosis in four. Early vascular control was obtained in the two patients with pheochromocytoma, resulting in very stable intraoperative blood pressure. Operative time for LA was 152 +/- 26 min and was associated with a short length of stay (2.0 +/- 0.6 days) and minimal intraoperative blood loss (82 +/- 30 ml). There were no conversions to laparotomy and one complication was noted. LA is a safe and effective operation for patients requiring adrenalectomy for hormone-secreting tumors.
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Affiliation(s)
- M E Stoker
- Department of Surgery, Fallon Clinic, St. Vincent Hospital, Worcester, MA 01606, USA
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Matesanz JM, Patwardhan N, Herrmann JB. A simplified method for evaluating peripheral arterial occlusive disease in a clinical vascular laboratory. Angiology 1978; 29:791-9. [PMID: 727560 DOI: 10.1177/000331977802901102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A relatively simple, inexpensive, and accurate procedure for the vascular laboratory evaluation of patients with suspected peripheral arterial occlusive disease is described. This method was evaluated in a series of 110 limbs in 58 patients seen in the Vascular Laboratory at the Worcester City Hospital. All patients were evaluated clinically and angiographically as well, to provide additional standards for evaluation. The method described was 100% accurate in predicting the presence or absence of significant occlusive disease, and over 90% accurate in defining the location of the major occlusive process. The method utilizes a combination of two well-established measurements--ankle systolic pressure and ankle pulse wave amplitude--as a screening method for determining the presence or absence of significant occlusive disease. Only patients with abnormal findings are tested further, resulting in a considerable savings in time and expense in the clinical vascular laboratory. The method may also prove valuable for following patients with known vascular disease for evidence of progression and for evaluating the effectiveness of various reconstructive procedures. Other methods and instruments may be adapted utilizing the same general principles.
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