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Kinjalk M, Goyal D, Neogi S, Ratan SK. Spontaneous Closure of Double Barrel Ileostomy in a Boy following Laparotomy. J Indian Assoc Pediatr Surg 2024; 29:88-89. [PMID: 38405240 PMCID: PMC10883163 DOI: 10.4103/jiaps.jiaps_188_23] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/03/2023] [Accepted: 11/12/2023] [Indexed: 02/27/2024] Open
Affiliation(s)
- Meghna Kinjalk
- Department of Pediatric Surgery, Maulana Azad Medical College Campus, New Delhi, India
| | - Deepak Goyal
- Department of Pediatric Surgery, Maulana Azad Medical College Campus, New Delhi, India
| | - Sujoy Neogi
- Department of Pediatric Surgery, Maulana Azad Medical College Campus, New Delhi, India
| | - Simmi K Ratan
- Department of Pediatric Surgery, Maulana Azad Medical College Campus, New Delhi, India
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Kinjalk M, Jain N, Neogi S, Ratan SK, Panda SS, Sehgal M, Arora V. Pediatric Age-adjusted Shock Index (SIPA): From Injury to Outcome in Blunt Abdominal Trauma. J Indian Assoc Pediatr Surg 2024; 29:33-38. [PMID: 38405261 PMCID: PMC10883172 DOI: 10.4103/jiaps.jiaps_156_23] [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: 07/19/2023] [Revised: 08/16/2023] [Accepted: 08/27/2023] [Indexed: 02/27/2024] Open
Abstract
Purpose The Shock Index Pediatric Age-Adjusted (SIPA) score is a useful tool for identifying pediatric trauma patients at a risk of poor outcomes and for triaging. We are studying the relationship between elevated SIPA score and specific outcomes in pediatric trauma patients. Materials and Methods A retrospective study was conducted in which case records of 58 pediatric patients with blunt abdominal trauma were evaluated and tabulated for their SIPA scores only at the time of their initial presentation and categorized into two groups - normal SIPA and elevated SIPA. The primary outcomes were need for blood transfusion, need for any intervention, and need for emergency surgery, and the secondary outcomes were need for computed tomography (CT) scan, need for a ventilator, intensive care unit (ICU) stay, length of hospital stay, and mortality. Statistical methods were applied to find a relationship between elevated SIPA score and the primary and secondary outcomes. Results An elevated SIPA score was noted in 27 (46%) patients. There was a significant relationship between elevated SIPA scores and patients needing blood transfusion (68.75%, n = 11) and length of hospital stay (10.48 ± 7.54 days). A significant relationship between elevated SIPA score and need for emergency surgery (54.54%, n = 6), need for a CT scan (56%, n = 14), and ICU stay (50%, n = 2) was not found. Conclusion We have seen in our study that elevated SIPA scores at presentation are significantly related to need for blood transfusion and length of hospital stay. In more than half of the patients, elevated SIPA was associated with need for emergency surgery and requirement of CT scan, but it was statistically not significant. Therefore, assessment of this parameter can help in identifying such poor outcomes.
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Affiliation(s)
- Meghna Kinjalk
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Nitin Jain
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Sujoy Neogi
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Simmi K. Ratan
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | | | - Mehak Sehgal
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Vanshika Arora
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
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Chaturvedi A, Tomar R, Balhara K, Khurana N, Ratan SK, Mitra A. A Rare Case of Extragonadal Mixed Germ Cell Tumor of the Sacrococcygeal Region with Mature Thymic Tissue in the Teratoma Component. J Indian Assoc Pediatr Surg 2023; 28:541-543. [PMID: 38173627 PMCID: PMC10760622 DOI: 10.4103/jiaps.jiaps_150_23] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 01/05/2024] Open
Abstract
A rare extragonadal mixed germ cell tumor of the sacrococcygeal area presenting with mature thymic tissue in the teratomatous component, a rare finding and the first reported case of such an association.
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Affiliation(s)
- Anubhuti Chaturvedi
- Department of Pathology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Reena Tomar
- Department of Pathology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Kirti Balhara
- Department of Pathology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Nita Khurana
- Department of Pathology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Simmi K. Ratan
- Department of Pediatric Surgery, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Aparajita Mitra
- Department of Pediatric Surgery, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
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Ratan SK, Kumar P, Kishore J, Aggarwal SK. Modified Pediatric Penile Perception Scale to Evaluate Cosmetic Outcome in Children With Hypospadias Repair. Indian Pediatr 2023; 60:655-658. [PMID: 37209054] [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: 05/22/2023]
Abstract
OBJECTIVES To compare the interpretation for cosmesis post-hypospadias repair by child, parents and surgeons using modified Pediatric Penile Perception Scale (PPPS). METHODS This cross-sectional study involving 50 children (aged 2 to 17 years) with hypospadias was conducted at the pediatric surgery department of our public sector tertiary care hospital. Subjects were assessed 6 months after completion of all stages of hypospadias repair. Cosmetic assessment was done using modified PPPS. We clubbed together the variables 'meatus' and 'glans' as MG (meatus-glans) complex due to their extreme proximity (embedding), while cosmesis of phallus was considered independently. The modified PPPS scoring parameters included phallus, MG complex, shaft skin, and general appearance. Independent assessment by surgeon, patients and parents was compared, and analyzed using SAS 9.2 statistical software. Cosmetic results of single vs staged repair, and different repair types was compared. RESULTS Assessment using modified PPPS showed that MG complex cosmesis and skin scarring were the most heeded parameters by all three categories of observers. PPPS by surgeons remained least affected by phallic cosmesis and that of the patient by the overall phallic appearance. Tubularized incised plate urethroplasty (TIPU) scored better on cosmesis. CONCLUSION Phallic cosmesis should be considered an independent variable for assessing cosmetic outcome of hypospadias, apart from MG cosmesis.
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Affiliation(s)
- Simmi K Ratan
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi. Correspondence to: Dr Simmi K Ratan, Director-Professor and Head, Department of Paediatric Surgery, Maulana Azad Medical College, New Delhi 110 002.
| | - Parveen Kumar
- Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalya, New Delhi
| | - Jugal Kishore
- Department of Pediatric Surgery, Vardhman Mahavir Medical College, New Delhi
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Ashish K, Ratan SK, Sarin YK, Khurana N, Kumar J. Variation in the Expression of Interstitial Cell of Cajal-like Cell (CD117) Across Congenital Pelvic-ureteric Junction Obstruction and its Renal Sonological and Functional Correlation: A Prospective Observational Study. J Indian Assoc Pediatr Surg 2023; 28:116-121. [PMID: 37197239 PMCID: PMC10185035 DOI: 10.4103/jiaps.jiaps_112_22] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/06/2022] [Accepted: 10/09/2022] [Indexed: 05/19/2023] Open
Abstract
Aims and Objectives This study aims to study the variation in the expression of CD117-positive interstitial cells of Cajal-like cells (ICC-LC) across the upper urinary tract region in children presenting with pelvic-ureteric junction obstruction (PUJO) and its association with renal functional and sonological parameters of patients. Materials and Methods A prospective observational study was done on 20 children with congenital PUJO who underwent dismembered pyeloplasty. All children underwent renal sonography (anteroposterior pelvic diameter [APPD], pelvicalyceal ratio [P/C ratio], Mid polar renal parenchymal diameter [MPPD]) and functional imaging scan (LLEC scan or DTPA scan). Three specimens were taken intraoperatively from above PUJ, at the level of PUJ, and below PUJ. Those were examined immunohistochemically using CD117 to count ICC-LC using standard criteria. Variation in the expression of CD117-positive ICC-LC was correlated with the abovestated parameters. Results The number of CD117-positive ICC-LC showed a continuous decreasing trend above downward. P/C ratio and APPD showed a parallel trend with ICC-LC distribution, whereas split renal function (SRF) showed an inverse relationship with the expression of ICC-LC. Children with lesser severity of obstruction (APPD <30 mm and SRF >40%) showed a uniform decreasing trend in the number of CD117-positive ICC-LC across PUJ. Children with more severe obstruction (APPD >30 mm and SRF <40%) showed a decrease in the expression of ICC-LC up to the level of PUJO followed by a sudden relatively increased expression of ICC-LC below the obstruction. Conclusion The expression of ICC-LC shows a uniformly decreasing trend across obstruction when the severity of obstruction is less. Resurgence in the number of ICC-LC below PUJ in subjects with severe obstruction hints at the emergence of a new pacemaker area below severely blocked PUJ akin to that seen in complete heart block patients and deserves early attention.
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Affiliation(s)
- Kumar Ashish
- Department of General Surgery, Narayan Medical College and Hospital, Sasaram, Bihar, India
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Simmi K. Ratan
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Yogesh Kumar Sarin
- Department of Pediatric Surgery, Lady Hardinge Medical College, New Delhi, India
| | - Nita Khurana
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Jyoti Kumar
- Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
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Jain N, Mitra A, Ratan SK, Panda SS. “Necklace of magnets” in the abdomen: an unusual case with “multiple” bowel perforations. Med J Armed Forces India 2022. [DOI: 10.1016/j.mjafi.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Banerjee A, Ratan SK, Neogi S, Goswami B, Dixit R, Panda SS. Role of Ultrasonography and Inflammatory Markers in Predicting Complicated Appendicitis. J Indian Assoc Pediatr Surg 2022; 27:448-454. [PMID: 36238313 PMCID: PMC9552632 DOI: 10.4103/jiaps.jiaps_140_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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 01/04/2022] [Accepted: 03/04/2022] [Indexed: 11/26/2022] Open
Abstract
AIM The aim is to compare the diagnostic accuracy of laboratory investigations and ultrasonography (USG) in distinguishing complicated appendicitis (C-AA) from uncomplicated appendicitis (UC-AA). MATERIALS AND METHODS Forty-six children who underwent appendicectomy at our center between November 2018 and July 2020 were included. Based on intraoperative findings, they were divided into two groups - complicated (perforated, gangrenous, or associated with fecal peritonitis; n = 18) and UC-AA (n = 28). USG findings and inflammatory markers were compared in both groups at admission. RESULTS At admission, the mean values for total leukocyte count (TLC) (16090.56 vs. 11739.29 per mm3), high sensitivity C-reactive protein (hsCRP) (35.8 vs. 31.62 mg/L), and procalcitonin (PCT) (3.83 vs. 1.41 ng/mL) were significantly higher in C-AA. Visualization of a blind tubular aperistaltic structure was the only sonographic sign showing statistical significance - significantly lower in C-AA (50% vs. 90%). Independent predictors of C-AA were - duration of symptoms >48 h (odds ratio [OR] 6.3), free fluid/loculated collection in right iliac fossa (OR 3.75), TLC >11000/mm3 (OR 3.6), hsCRP >35 mg/L (OR 6.0), PCT >0.6 ng/mL (OR 4.02), and nonvisualization of appendix on USG (OR 8.33). Biochemical factors were sensitive (89%) and specific (55%) in differentiating C-AA from UC-AA but the addition of sonological parameters significantly improved the specificity of predicting complicated AA to 61% (P = 0.0036). CONCLUSION Combining laboratory data with sonological findings significantly improves the predictive value for differentiating C-AA from UC-AA and can help decide operative approach and prognosticating.
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Affiliation(s)
- Arka Banerjee
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Simmi K. Ratan
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India,Address for correspondence: Dr. Simmi K. Ratan, Room No. 428, BL Taneja Block, Lok Nayak Hospital, New Delhi - 110 002, India. E-mail:
| | - Sujoy Neogi
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Binita Goswami
- Department of Biochemistry, Maulana Azad Medical College, New Delhi, India
| | - Rashmi Dixit
- Department of Radiology, Maulana Azad Medical College, New Delhi, India
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Ratan SK, Kumar C, Batra R, Bhalotra A. Minimally Jointed Symmetrical Pygopagus Twins - Successful Surgical Separation. J Indian Assoc Pediatr Surg 2022; 27:255-257. [PMID: 35937133 PMCID: PMC9350660 DOI: 10.4103/jiaps.jiaps_357_20] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/18/2021] [Accepted: 04/21/2021] [Indexed: 11/05/2022] Open
Abstract
Conjoined pygopagus accounts for about 17% of all conjoined twins and commonly share the gluteal region, terminal spine, lower gastrointestinal, urological, and reproductive tracts. This makes their separation a very challenging task. We report herein pygopagus twins who had minimal fusion in coccygeal region and could be separated without a complicated procedure. The case is being reported to add to the literature and emphasize that simple fusion in conjoined twins can be relatively easy to manage.
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Affiliation(s)
- Simmi K. Ratan
- Department of Paediatric Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India,Address for correspondence: Dr. Simmi K. Ratan, G-8/6 (2nd Floor), Malviya Nagar, New Delhi - 110 017, India. E-mail:
| | - Chiranjiv Kumar
- Department of Paediatric Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Radhika Batra
- Department of Radio-Diagnosis, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Anju Bhalotra
- Department of Anaesthesia, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
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Kumar S, Panda SS, Neogi S, Ratan SK, Kumar A. Triple Diversion Technique in Complete Duodenal Transaction Following Blunt Trauma Abdomen: A Time-Tested Method in a Very Rare Injury. J Indian Assoc Pediatr Surg 2022; 27:245-247. [PMID: 35937121 PMCID: PMC9350657 DOI: 10.4103/jiaps.jiaps_284_20] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/25/2020] [Accepted: 09/14/2021] [Indexed: 11/09/2022] Open
Abstract
Duodenal injury following blunt abdominal trauma is extremely rare in children and many times, it has delayed presentation, leading to increased morbidity and mortality. A patient with complete duodenal transaction is a surgical challenge and management involves the time of presentation and extent of visceral damage. A 10-year-old boy was brought with features of bowel perforation after road traffic accident and underwent emergency laparotomy which revealed complete transaction of duodenum at D1 and D2 and pyloroduodenal junction extending toward lesser curvature. Primary closure of pyloroduodenal junction and D1-D2 was done with omental patch along with triple tube decompression (cholecystostomy, gastrostomy, and jejunostomy). The patient had an uneventful recovery. Primary closure of disturbed ends with triple diversion is a safe approach in young children with complete duodenal transaction in absence of gross peritoneal contamination and early presentation.
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Affiliation(s)
- Shishir Kumar
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Shasanka Shekhar Panda
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India,Address for correspondence: Dr. Shasanka Shekhar Panda, Department of Paediatric Surgery, Maulana Azad Medical College, New Delhi - 110 002, India. E-mail:
| | - Sujoy Neogi
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Simmi K Ratan
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Ashish Kumar
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
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Ratan SK, Kumar C, Aggarwal SK. Simultaneous Endoscopic Management of Urethral Duplication and Postposterior Sagittal Anorectoplasty Urethral Diverticulum in a Boy with Anorectal Malformation. J Indian Assoc Pediatr Surg 2021; 26:200-202. [PMID: 34321796 PMCID: PMC8286025 DOI: 10.4103/jiaps.jiaps_114_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)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/07/2020] [Accepted: 09/16/2020] [Indexed: 11/18/2022] Open
Abstract
We report a case of urethral duplication with high anorectal malformation (ARM). A 12-year-old boy who had undergone transverse colostomy on day 2 of life and posterior sagittal anorectoplasty (PSARP) for ARM (rectobulbar fistula) at 8 years and also had urinary dribbling from a midscrotal opening in addition to normal voiding, presented with recurrent urinary tract infections and dysuria. Midscrotal dribbling had continued postoperatively. Colostomy had been closed 3 months after PSARP. Investigations revealed a large urethral diverticulum at the site of rectourethral fistula due to a segment of the gut being left behind during fistula closure. In addition, he had a sagittal urethral duplication originating at bulbar urethra and opening externally at midscrotum. The highlight of this report is successful endoscopic management of both the urethral duplication and the diverticulum.
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Affiliation(s)
- Simmi K Ratan
- Department of Paediatric Surgery, Maulana Azad Medical College, Associated Lok Nayak Hospital, New Delhi, India
| | - Chiranjiv Kumar
- Department of Paediatric Surgery, Maulana Azad Medical College, Associated Lok Nayak Hospital, New Delhi, India
| | - Satish Kumar Aggarwal
- Department of Paediatric Surgery, Maulana Azad Medical College, Associated Lok Nayak Hospital, New Delhi, India
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11
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Das MK, Arora NK, Gupta B, Sharan A, Kameswari K, Padmalatha P, Prasad GR, Shad J, Shyamala J, Harish Kumar S, Nagender Y, Sharmila K, Shad R, Garge S, Bharadia L, Gupta A, Goswami JK, Lahiri K, Sankhe L, Mane S, Patwari YP, Ajayakumar MK, Santhosh Kumar A, Sarangi R, Tripathy BB, Mohapatra SSG, Sahoo SK, Kumar V, Kumar R, Sarkar S, Sarkar R, Sarkar NR, Wakhlu A, Ratan SK, Dubey AP, Mohan N, Luthra M, Vyas BR, Trivedi H, Mathai J, Sam CJ, Jothilakshmi K, Arunachalam P, Bhat JI, Mufti G, Charoo BA, Jena PK, Debbarma SK, Ghosh SK, Aggarwal MK, Haldar P, Zuber PLF, Maure C, Bonhoeffer J, Ray A. Intussusception in children aged under two years in India: Retrospective surveillance at nineteen tertiary care hospitals. Vaccine 2020; 38:6849-6857. [PMID: 32553492 PMCID: PMC7528221 DOI: 10.1016/j.vaccine.2020.04.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Received: 01/22/2020] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 11/28/2022]
Abstract
Objective Intussusception has been linked with rotavirus vaccine (RVV) as a rare adverse reaction. In view of limited background data on intussusception in India and in preparation for RVV introduction, a surveillance network was established to document the epidemiology of intussusception cases in Indian children. Methods Intussusception in children 2–23 months were documented at 19 nationally representative sentinel hospitals through a retrospective surveillance for 69 months (July 2010 to March 2016). For each case clinical, hospital course, treatment and outcome data were collected. Results Among the 1588 intussusception cases, 54.5% were from South India and 66.3% were boys. The median age was 8 months (IQR 6, 12) with 34.6% aged 2–6 months. Seasonal variation with higher cases were documented during March-June period. The most common symptoms and signs were vomiting (63.4%), bloody stool (49.1%), abdominal pain (46.9%) and excessive crying (42.8%). The classical triad (vomiting, abdominal pain, and blood in stools) was observed in 25.6% cases. 96.4% cases were diagnosed by ultrasound with ileocolic location as the commonest (85.3%). Management was done by reduction (50.8%) and surgery (41.1%) and only 1% of the patients’ died. 91.1% cases met Brighton criteria level 1 and 3.3% Level 2. Between 2010 and 2015, the case load and case ratio increased across all regions. Conclusion Intussusception cases have occurred in children across all parts of the country, with low case fatality in the settings studied. The progressive rise cases could indicate an increasing awareness and availability of diagnostic facilities.
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Affiliation(s)
| | | | - Bini Gupta
- The INCLEN Trust International, New Delhi, India.
| | | | - K Kameswari
- Andhra Medical College, Vishakhapatnam, Andhra Pradesh, India.
| | - P Padmalatha
- Andhra Medical College, Vishakhapatnam, Andhra Pradesh, India.
| | | | - Jimmy Shad
- Apollo Hospitals, Chennai, Tamil Nadu, India.
| | - J Shyamala
- Apollo Hospitals, Chennai, Tamil Nadu, India.
| | | | | | - K Sharmila
- Apollo Hospital, Hyderabad, Telengana, India.
| | - Rashmi Shad
- Choithram Hospital and Research Centre, Indore, Madhya Pradesh, India.
| | - Saurabh Garge
- Choithram Hospital and Research Centre, Indore, Madhya Pradesh, India.
| | | | - Atul Gupta
- Fortis Escorts Hospital, Jaipur, Rajasthan, India.
| | | | | | - Lalit Sankhe
- Grant Medical College & JJ Hospital, Mumbai, Maharashtra, India.
| | - Sushant Mane
- Grant Medical College & JJ Hospital, Mumbai, Maharashtra, India.
| | | | - M K Ajayakumar
- Government Medical College & SAT Hospital, Thiruvananthapuram, Kerala, India.
| | - A Santhosh Kumar
- Government Medical College & SAT Hospital, Thiruvananthapuram, Kerala, India.
| | - Rachita Sarangi
- IMS & SUM Medical College & Hospital, Bhubaneswar, Odisha, India.
| | | | - S S G Mohapatra
- IMS & SUM Medical College & Hospital, Bhubaneswar, Odisha, India.
| | | | - Vijayendra Kumar
- Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.
| | - Rakesh Kumar
- Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.
| | - Suman Sarkar
- Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India.
| | - Ruchirendu Sarkar
- Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India.
| | - Nihar Ranjan Sarkar
- Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India.
| | - Ashish Wakhlu
- King George's Medical University, Lucknow, Uttar Pradesh, India.
| | | | | | | | | | - Bhadresh R Vyas
- MP Shah Government Medical College, Jamnagar, Gujarat, India.
| | - Harsh Trivedi
- MP Shah Government Medical College, Jamnagar, Gujarat, India.
| | - John Mathai
- PSG Institute of Medical Sciences, Coimbatore, Tamil Nadu, India.
| | - Cenita J Sam
- PSG Institute of Medical Sciences, Coimbatore, Tamil Nadu, India.
| | - K Jothilakshmi
- PSG Institute of Medical Sciences, Coimbatore, Tamil Nadu, India.
| | | | - Javeed Iqbal Bhat
- Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir, India.
| | - Gowhar Mufti
- Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir, India.
| | - Bashir Ahmad Charoo
- Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir, India.
| | - Pradeep K Jena
- SCB Medical College and SVP Postgraduate Institute of Paediatrics, Cuttack, Odisha, India.
| | | | - Sunil K Ghosh
- Agartala Government Medical College, Agartala, Tripura, India.
| | - Mahesh K Aggarwal
- Ministry of Health & Family Welfare, Government of India, New Delhi, India.
| | - Pradeep Haldar
- Ministry of Health & Family Welfare, Government of India, New Delhi, India.
| | | | | | - Jan Bonhoeffer
- University of Basel Children's Hospital, Basel, Switzerland.
| | - Arindam Ray
- Bill and Melinda Gates Foundation, India Country Office, New Delhi, India.
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Abstract
Formulation of research question (RQ) is an essentiality before starting any research. It aims to explore an existing uncertainty in an area of concern and points to a need for deliberate investigation. It is, therefore, pertinent to formulate a good RQ. The present paper aims to discuss the process of formulation of RQ with stepwise approach. The characteristics of good RQ are expressed by acronym “FINERMAPS” expanded as feasible, interesting, novel, ethical, relevant, manageable, appropriate, potential value, publishability, and systematic. A RQ can address different formats depending on the aspect to be evaluated. Based on this, there can be different types of RQ such as based on the existence of the phenomenon, description and classification, composition, relationship, comparative, and causality. To develop a RQ, one needs to begin by identifying the subject of interest and then do preliminary research on that subject. The researcher then defines what still needs to be known in that particular subject and assesses the implied questions. After narrowing the focus and scope of the research subject, researcher frames a RQ and then evaluates it. Thus, conception to formulation of RQ is very systematic process and has to be performed meticulously as research guided by such question can have wider impact in the field of social and health research by leading to formulation of policies for the benefit of larger population.
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Affiliation(s)
- Simmi K Ratan
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Tanu Anand
- Department of Community Medicine, North Delhi Municipal Corporation Medical College, New Delhi, India
| | - John Ratan
- Department of Pediatric Surgery, Batra Hospital and Research Centre, New Delhi, India
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Abstract
Aims: To study the role of uroflowmetry in the preoperative and early postoperative period in children undergoing hypospadias repair. Materials and Methods: Twenty-six cases undergoing hypospadias repair over 1 year (tubularized incised plate [TIP] Snodgrass [17 patients], TIP with Snodgraft [5 patients], Duckett's onlay flap [2 patients], and Duckett's tube [2 patients] urethroplasty) were prospectively evaluated with preoperative ultrasound and uroflowmetry and postoperative uroflowmetry at 3 months after the surgery and at 6 and 9 months interval if these dates fell within the study period on follow-up. The parameters studied were maximum flow rate (Qmax), average flow rate (Qav), total voided volume, voiding time, and type of curve. Preoperative and postoperative uroflow data were compared. Results: Twenty-six cases comprised of anterior hypospadias (n = 8), mid penile (n = 11), and posterior hypospadias (n = 7). Fourteen patients had obstructed flow rates preoperatively. While 69% patients (18/26) had obstructed flow rates at 3 months postoperatively, it dropped to 43% at 9 months. Following TIP (Snodgrass) repair, 88% (15/17) had obstructed flow rates postoperatively. Best results were seen in patients undergoing circumferentially epithelialized urethral reconstruction (TIP with Snodgraft, Duckett's onlay flap, and Duckett's tube). Conclusions: Abnormal uroflow is an inherent aspect of hypospadias in 50% of the cases. Both preoperative and postoperative uroflow evaluation is necessary for meaningful conclusion. Patients with preoperative normal flow rates but obstructed postoperative flow rates need clinical evaluation. Obstructive flow rates are more common after TIP (Snodgrass) repair. The urinary flow rates improve with time.
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Affiliation(s)
- Rajat Piplani
- Department of Paediatric Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Satish K Aggarwal
- Department of Paediatric Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Simmi K Ratan
- Department of Paediatric Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
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Affiliation(s)
| | | | - Simmi K Ratan
- Paediatric Surgery, Maulana Azad Medical College, New Delhi, India
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15
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Chinya A, Ratan SK, Aggarwal SK, Garg A, Mishra TK. Association of Levels of Serum Inhibin B and Follicle-stimulating Hormone with Testicular Vascularity, Volume, and Echotexture in Children with Undescended Testes. J Indian Assoc Pediatr Surg 2017; 22:3-8. [PMID: 28082768 PMCID: PMC5217136 DOI: 10.4103/0971-9261.194609] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Aims: The aim of our study was to assess the association between reproductive hormones (inhibin B [inh B], follicle-stimulating hormone [FSH]) with testicular volume, echogenicity, and blood flow (resistive index [RI]) in children with undescended testis (UDT). Settings and Design: This was a prospective study of 1-year study duration. Materials and Methods: A total of 33 patients (16 unilateral and 17 bilateral) UDTs aged 5–12 years with palpable UDT were included in the study. Morning fasting blood samples were taken for estimation of serum inh B and FSH as well as inh B/FSH ratio. Testicular ultrasound was done to compute testicular volume, testicular echogenicity, and testicular vascularity in terms of RI. Results: The mean age of patients enrolled in the study was 8.29 years for unilateral UDT and 7.97 years in bilateral UDT and it was comparable. The study groups were further subdivided into two age-wise subgroups school goers (5–8 years) and prepubertal (9–12 years). The values of inh B, FSH, and inh B/FSH ratios as well as mean testicular volume were comparable between both groups and subgroups. Overall mean testicular volume had a positive correlation with FSH, inh B, and inh B/FSH, but statistical significance was reached only for inh B (P < 0.001) in children with both unilateral and bilateral UDT. Apart from five patients with hypoechogenicity within the testis, all remaining testes were of homogenous echotexture with no instances of irregular echogenicity or tumor. Children with RI >0.6 were separately studied. The incidence of high RI (>0.6) was also comparable in unilateral or bilateral disease. These subjects had unfavorable biochemical parameters in terms of low inh B levels and high FSH levels. Conclusions: Our findings hint to the fact that palpable UDT forms a homogenous group, whether unilateral or bilateral, whereas impalpable testes may form a separate category and need further studies to substantiate this hypothesis.
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Affiliation(s)
- Abhishek Chinya
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Simmi K Ratan
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Satish K Aggarwal
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Anju Garg
- Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
| | - T K Mishra
- Department of Biochemistry, Maulana Azad Medical College, New Delhi, India
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Abstract
Gastric teratoma is very rare tumor and usually presents in early infancy. An 8-year-old boy presented with a huge mass in abdomen extending from epigastrium to the pelvis. Ultrasound and CT scan of abdomen revealed a huge mass with solid and cystic components and internal calcifications. The preoperative diagnosis was a teratoma but not specifically gastric one. At operation, it was found to be gastric teratoma. The mass was excised completely with part of the stomach wall. The histopathology confirmed it to be mature gastric teratoma. The rarity of the teratoma with delayed presentation prompted us to report the case.
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Affiliation(s)
- Rajpal S Sisodiya
- Department of Pediatric Surgery, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi-110002
| | - Simmi K Ratan
- Department of Pediatric Surgery, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi-110002
| | - Parveen K Man
- Department of Pediatric Surgery, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi-110002
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Ratan SK, Sharma A, Kapoor S, Polipalli SK, Dubey D, Mishra TK, Sinha SK, Agarwal SK. Polymorphism of 3' UTR of MAMLD1 gene is also associated with increased risk of isolated hypospadias in Indian children: a preliminary report. Pediatr Surg Int 2016; 32:515-24. [PMID: 26815876 DOI: 10.1007/s00383-016-3856-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 01/05/2016] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To study MAMLD1 gene polymorphisms, serum LH and testosterone levels amongst Indian children with isolated hypospadias (IH) and controls. MATERIALS AND METHODS Screening of the MAMLD1 gene was performed by PCR sequencing method in 100 Indian children aged 0-12 years presenting with IH and 100 controls. LH and testosterone hormone levels were also assessed (categorized in four age-wise groups). RESULTS IH subjects had significantly higher incidence of MAMLD1 polymorphism as compared to controls (33 vs 15 %, p = 0.01). Of various genomic variants identified in this study, the noteworthy novel ones were missense mutation P299A and single nucleotide polymorphism c.2960C>T in 3' UTR of Exon 7. While p 299A was found to cause protein structural instability consequent to amino acid change, eighty percent subjects with c.2960C>T in 3' UTR of Exon 7 (corresponding to newly discovered currently non-validated exon 11) were found to have lower testosterone levels when compared with their age group mean. IH showed statistically higher incidence of c.2960C>T in comparison to controls (22 vs 10 %, p value 0.046) and about 2.5-folds higher risk of this anomaly. CONCLUSION Occurrence of MAMDL1 gene polymorphisms, specially of c.2960C>T in 3' UTR of its exon 7 is associated with a higher risk of IH in Indian children, probably by lowering androgenic levels.
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Affiliation(s)
- Simmi K Ratan
- Department of Pediatric Surgery, Maulana Azad Medical College and Associated LokNayak Hospital, G-8/6, Second Floor, Malviya Nagar, New Delhi, 110017, India.
| | - Anju Sharma
- Department of Biochemistry, Maulana Azad Medical College and Associated LokNayak Hospital, New Delhi, India
| | - Seema Kapoor
- Department of Pediatrics, Maulana Azad Medical College and Associated LokNayak Hospital, New Delhi, India
| | - Sunil K Polipalli
- Department of Biochemistry, Maulana Azad Medical College and Associated LokNayak Hospital, New Delhi, India
| | - Divya Dubey
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi, India
| | - Tarun K Mishra
- Department of Biochemistry, Maulana Azad Medical College and Associated LokNayak Hospital, New Delhi, India
| | - Shandip K Sinha
- Department of Pediatric Surgery, Maulana Azad Medical College and Associated LokNayak Hospital, G-8/6, Second Floor, Malviya Nagar, New Delhi, 110017, India
| | - Satish K Agarwal
- Department of Pediatric Surgery, Maulana Azad Medical College and Associated LokNayak Hospital, G-8/6, Second Floor, Malviya Nagar, New Delhi, 110017, India
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Aggarwal SK, Sinha SK, Ratan SK, Dhua A, Sethi GR. Complications of Long-Standing Foreign Body in the Airway and Their Outcomes After Endoscopic Management: An Experience of 20 Cases. J Laparoendosc Adv Surg Tech A 2015; 25:81-7. [DOI: 10.1089/lap.2014.0354] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Satish Kumar Aggarwal
- Department of Pediatric Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Shandip Kumar Sinha
- Department of Pediatric Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Simmi K. Ratan
- Department of Pediatric Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Anjan Dhua
- Department of Pediatric Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Gulshan Rai Sethi
- Department of Paediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
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Ratan SK, Dhua AK, Sinha S, Mathur M, Rao S, Aggarwal S. Acquired nonspecific cicatrizing inflammation causing pyloric stricture and gastric outlet obstruction in infancy: is it Jodhpur disease? ACTA ACUST UNITED AC 2014; 34:274-7. [PMID: 25046896 DOI: 10.7869/tg.150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ratan SK, Aggarwal SK, Mishra TK, Saxena A, Yadav S, Pandey RM, Sharma A, Dhanwal D. Hormonal profile in children with isolated hypospadias associates better with comprehensive score of local anatomical factors as compared to meatal location or degree of chordee. Indian J Endocrinol Metab 2014; 18:558-564. [PMID: 25143917 PMCID: PMC4138916 DOI: 10.4103/2230-8210.137519] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND To evaluate if hormonal profile of children with isolated hypospadias (IH) associates better with comprehensive local anatomical factor score (LAFS) than with clinically adjudged urethral meatus location or severity of chordee/k.j. MATERIAL AND METHODS Ninety-nine children with IH were enrolled, as per inclusion criteria. Meatal location was recorded at first clinical examination in OPD; while LAFS was computed per-operatively using indigenously devised scale, except for neonates. Hypospadiacs were first classified into three standard meatal based groups and subsequently into LAFS based two groups (≤19, >19). For all participants, pre HCG and post HCG (96 hour post- injection) estimation of serum gonadotropins, DHEA-S, estrogen (E), progesterone (P), testosterone (T) and Dihydrotestosterone (DHT) was done. Statistical tests were applied to assess significance of hormonal levels with respect to meatal location, chordee and LAFS. RESULTS Only FSH levels differed significantly among meatal based groups; while among LAFS groups, multiple hormonal differences were noted; with poor LAFS associated significantly with higher FSH, LH and lower E, T/DHT. Children with severe degree of chordee had poorer T output and a significantly lower LAFS as compared to those with moderate/mild chordee. CONCLUSION Serotoli cell dysfunction, indirectly indicated by high FSH was found among midpenile hypospadiacs and those with poorer LAFS. Since groups based on LAFS revealed multiple intergroup hormonal differences than what was seen for meatal/chordee based groups; LAFS should be considered a better guide for prognostication and for deciding about hormonal supplementation. Lower androgenic output was particularly noted in children with severe chordee.
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Affiliation(s)
- Simmi K. Ratan
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Satish K. Aggarwal
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Tarun Kumar Mishra
- Department of Biochemistry, Maulana Azad Medical College, New Delhi, India
| | - Alpna Saxena
- Department of Biochemistry, Maulana Azad Medical College, New Delhi, India
| | - Sangeeta Yadav
- Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
| | - Ravindra M. Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Anju Sharma
- Department of Biochemistry, Maulana Azad Medical College, New Delhi, India
| | - Dinesh Dhanwal
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
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Mathur MK, Aggarwal SK, Ratan SK, Sinha SK. Laparoscopic-assisted transanal pull-through for Hirschsprung's disease: Comparison between partial and near total laparoscopic mobilization of rectum. J Indian Assoc Pediatr Surg 2014; 19:70-5. [PMID: 24741208 PMCID: PMC3983770 DOI: 10.4103/0971-9261.129596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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
Background: Transanal pull-through with laparoscopic assistance is gaining popularity. How much rectal dissection to do laparoscopically and how much transanally is not clear. Laparoscopic rectal mobilization is akin to open pelvic dissection of Swenson's operation — the most physiological procedure. Through this comparative study, we aim to evolve a technique that maximizes the benefits of Swenson's technique and minimizes the problems of a transanal procedure. Materials and Methods: Twenty patients (19 boys and one girl, newborn to 6 years) with Hirschsprung's disease (HD) were randomized for laparoscopic-assisted transanal pull-through (LATAPT) either by near complete (Group A) or partial (Group B) laparoscopic mobilization of rectum. Patients were followed up for at least 3 months. Demographic profile; operative details (time taken, blood loss, operative difficulty, and complications); postoperative course (duration of urinary catheter, oral feeding, and hospital stay); and follow-up stooling pattern, consistency, and continence were compared in the two groups. Results: The time taken for laparoscopic mobilization was marginally higher in group A, but the time taken for transanal dissection in this group was significantly less than in group B. All other comparisons showed no significant difference in the two groups. Stool frequency and continence improved with time in both groups. Conclusion: Extent of laparoscopic mobilization of rectum does not appear to be a factor deciding the outcomes. No recommendations could be made in view of the small number of cases. However, it shows that laparoscopic assistance can be used to maximize the benefits of Swenson type of operation and a transanal pull-through.
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Affiliation(s)
- Mohit Kumar Mathur
- Senior Resident of Paediatric Surgery, Maulana Azad Medical College, New Delhi, India ; Senior Resident at Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Satish Kumar Aggarwal
- Senior Resident of Paediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Simmi K Ratan
- Senior Resident of Paediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Shandip Kumar Sinha
- Senior Resident of Paediatric Surgery, Maulana Azad Medical College, New Delhi, India
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Pant N, Aggarwal SK, Ratan SK. Laparoscopic repair of hernia in children: Comparison between ligation and nonligation of sac. J Indian Assoc Pediatr Surg 2014; 19:76-9. [PMID: 24741209 PMCID: PMC3983771 DOI: 10.4103/0971-9261.129597] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Aim: The essence of the current techniques of laparoscopic hernia repair in children is suture ligation of the neck of the hernia sac at the deep ring with or without its transection. Some studies show that during open hernia repair, after transection at the neck it can be left unsutured without any consequence. This study was aimed to see if the same holds true for laparoscopic hernia repair. Materials and Methods: Sixty patients (52 boys and eight girls, 12-144 months) with indirect inguinal hernia were randomized for laparoscopic repair either by transection of the sac alone (Group I) or transection plus suture ligation of sac at the neck (Group II). Outcome was assessed in terms of time taken for surgery, recurrence, and other complications. Result: Thirty-eight hernia units in 28 patients were repaired by transection alone (Group I) and 34 hernia units in 29 patients were repaired by transection and suture ligation (Group II). Three patients were found to have no hernia on laparoscopy. Recurrence rate and other complications were not significantly different in the two groups. All recurrences occurred in hernias with ring size more than 10 mm. Conclusion: Laparoscopic repair of hernia by circumferential incision of the peritoneum at the deep ring is as effective as incision plus ligation of the sac.
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Affiliation(s)
- Nitin Pant
- Assistant Professor of Paediatric Surgery, Lady Hardinge Medical College, New Delhi, India
| | - Satish Kumar Aggarwal
- Director Professor of Paediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Simmi K Ratan
- Associate Professor of Paediatric Surgery, Maulana Azad Medical College, New Delhi, India
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Ratan SK, Gangurde A, Sinha SK, Singh S, Sharma BC, Aggarwal SK. Pedicled omental onlay flap for post-traumatic intrahepatic major ductal injury. APSP J Case Rep 2013; 4:38. [PMID: 24381834 PMCID: PMC3863827] [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: 05/26/2013] [Accepted: 07/03/2013] [Indexed: 11/30/2022] Open
Abstract
We report a 5-year-old girl who presented with post traumatic biliary leakage that failed to respond to conservative management for two weeks. Surgical exploration in the third week revealed a partially healed 5 cm long hepatic laceration in the right lobe of the liver. Bile was found leaking through a rent in the major right intra-hepatic duct at the apex of liver laceration. A pedicled onlay omental flap was used to buttress this rent as direct closure was not possible due to friable tissue. The child recovered uneventfully.
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Affiliation(s)
- Simmi K Ratan
- Department of Pediatric Surgery, Maulana Azad Medical College and Lok Nayak Hospital
| | - Anita Gangurde
- Department of Pediatric Surgery, Maulana Azad Medical College and Lok Nayak Hospital
| | - Shandip K Sinha
- Department of Pediatric Surgery, Maulana Azad Medical College and Lok Nayak Hospital
| | - Sudhir Singh
- Department of Pediatric Surgery, Maulana Azad Medical College and Lok Nayak Hospital
| | | | - Satish K Aggarwal
- Department of Pediatric Surgery, Maulana Azad Medical College and Lok Nayak Hospital
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Dhua AK, Ratan SK, Aggarwal SK. Chylothorax after Primary Repair of Esophageal Atresia with Tracheo-esophageal Fistula: Successful Management by Biological Fibrin Glue. APSP J Case Rep 2012; 3:16. [PMID: 23061032 PMCID: PMC3468335] [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: 05/13/2012] [Accepted: 05/22/2012] [Indexed: 11/28/2022] Open
Abstract
A neonate, who had undergone primary repair of esophageal atresia with tracheo-esophageal fistula, developed right pleural effusion in the postoperative period. It was initially misdiagnosed as an anastomotic leak, but later confirmed to be chylothorax. Conservative treatment failed. Application of biological fibrin glue (sealant) on the mediastinum through a thoracotomy was curative.
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Dhua AK, Aggarwal SK, Sinha S, Ratan SK. Authors' reply. J Indian Assoc Pediatr Surg 2012; 17:142-3. [PMID: 22869987 PMCID: PMC3409909] [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: 11/03/2022] Open
Affiliation(s)
- Anjan K. Dhua
- Department of Pediatric Surgery, Maulana Azad Medical College, Delhi, India
| | - Satish K. Aggarwal
- Department of Pediatric Surgery, Maulana Azad Medical College, Delhi, India
| | - Shandip Sinha
- Department of Pediatric Surgery, Maulana Azad Medical College, Delhi, India
| | - Simmi K. Ratan
- Department of Pediatric Surgery, Maulana Azad Medical College, Delhi, India
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Abstract
AIM To compare tunica vaginalis with dartos flap as soft tissue cover in primary hypospadias repair. MATERIALS AND METHODS 25 cases (age range: 12-132 months; all fresh cases) of primary hypospadias were prospectively repaired by tubularized incised plate (TIP)/TIP + graft urethroplasty using tunica vaginalis flap (TVF) as soft tissue cover to urethroplasty (group A). Their results were compared with another set (group B) of age- and anatomy-matched controls (25 patients operated during the previous 3 years) who had undergone TIP repair using dartos flap as soft tissue cover. Statistical analysis of results was done with Fischer's exact test. RESULTS GROUP A No fistula, skin necrosis, meatal stenosis, urethral stricture. One case had partial wound dehiscence that resolved on conservative treatment with no sequelae. One case required catheter removal on 3(rd) day because of severe bladder spasm. There was no testicular atrophy/ascent. Group B: 3 fistulae - all required surgery. There were three cases of superficial skin necrosis that healed spontaneously without sequel. There was no meatal stenosis/urethral stricture. The difference in fistula rate between both the groups, however, was not statistically significant (P = 0.4). CONCLUSION TVF may have an edge over dartos fascia for soft tissue coverage of the neourethra.
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Affiliation(s)
- Anjan Kumar Dhua
- Department of Pediatric Surgery, Maulana Azad Medical College, Delhi, India
| | | | - Shandip Sinha
- Department of Pediatric Surgery, Maulana Azad Medical College, Delhi, India
| | - Simmi K. Ratan
- Department of Pediatric Surgery, Maulana Azad Medical College, Delhi, India
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Ratan SK, Aggarwal S, Mishra TK, Saxena A, Yadav S, Pandey R, Sharma A, Dhanwal D. Children with isolated hypospadias have different hormonal profile compared to those with associated anomalies. J Pediatr Endocrinol Metab 2012; 25:111-9. [PMID: 22570959 DOI: 10.1515/jpem.2011.421] [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] [Indexed: 11/15/2022]
Abstract
AIM The objective of this study is to compare the hormonal profile of children with isolated hypospadias to controls and hypospadiacs with associated anomalies. STUDY DESIGN Prospective observation at a tertiary referral hospital. STUDY SUBJECTS One hundred consecutive children (0-12 years) with isolated hypospadias (H), 23 with hypospadias and associated anomalies (HO). CONTROLS One hundred children (0-12 years) without any genitourinary/endocrine abnormalities (C). PROCEDURE Prehuman chorionic gonadotropin (HCG) and post-HCG fasting blood samples were drawn for estimation of serum gonadotropins, dehydroepiandrosterone sulfate (DHEA-S), estrogen (E), progesterone (P), and testosterone (T) and dihydrotestosterone (DHT). STATISTICAL ANALYSIS Differences in hormonal levels between controls and subjects were computed with p < or = 0.05 as significant. RESULTS Compared with controls, "H" had significantly higher follicular stimulating hormone (FSH) (1.37 vs. 1.29 mIU/mL p=0.01), lower estrogen (8.08 vs. 13.78 pg/mL, p=0.00), and lower DHEA-S (27.34 vs. 40.24 microg/dL, p=0.03) levels; HO had higher FSH, lower basal T (0.13 vs. 0.46 ng/mL, p=0.01), and lower peak testosterone (1.53 vs. 2.32 ng/mL, p=0.01). "HO" had lower androgens (basal T, 0.13 vs. 0.29 ng/mL, p=0.03; peak T, 1.53 vs. 2.36 ng/mL, p=0.01), and higher estrogen (12.56 vs. 8.08 pg/mL, p=0.001) and progesterone (0.46 vs. 0.31 ng/mL, p=0.04) levels in comparison with H. CONCLUSION Consistently lower output of androgens among HO explains the association of other anomalies (generally undescended testes) in them. High FSH among hypospadiacs hints at the possibility of Sertoli cell dysfunction and may have long-lasting sequelae for reproductive functions during adulthood. However, Leydig cell functions are affected more among HO.
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Affiliation(s)
- Simmi K Ratan
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India.
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Dhua AK, Ratan SK, Aggarwal SK. Use of pre and intra-operative bronchoscopy in management of bronchial injury following blunt chest trauma. J Indian Assoc Pediatr Surg 2011; 16:113-4. [PMID: 21897575 PMCID: PMC3160053 DOI: 10.4103/0971-9261.83498] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Blunt chest trauma resulting in right bronchial tear in an 8-year-old girl is reported. Use of bronchoscopy in the management of such an injury is highlighted.
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Affiliation(s)
- Anjan Kumar Dhua
- Department of Pediatric Surgery, Maulana Azad Medical College, Delhi, India
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Aggarwal SK, Sinha SK, Ratan SK, Dhua A, Pant N, Borkar N, Nirwal G. Laparoscopic or laparoscopic-assisted pelvic surgery in small infants: our experience. J Laparoendosc Adv Surg Tech A 2011; 21:543-8. [PMID: 21391829 DOI: 10.1089/lap.2010.0521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The objective of this study was to review our experience of laparoscopic (LA) or laparoscopic-assisted pelvic surgery (LAPS) in small infants. MATERIALS AND METHODS The medical records of 35 patients who underwent an LA or LAPS between January 2007 and June 2010 were studied and 21 patients who were younger than 1 year or whose weight was less than 10 kg were included. Indications, procedures, results, and complications were analyzed. RESULTS The indications of surgery and procedures done were impalpable undescended testes (7 cases--3 single-stage orchidopexy and 4 Fowler Stephen stage I ligation of testicular vessels), Hirschsprung's disease (HD; 5 cases--all laparoscopic-assisted transanal pull-through), anorectal malformation (ARM; 3 cases--all laparoscopic-assisted pull-through), disorders of sexual differentiation (3 cases--1 herniotomy and 2 gonadal biopsy), sacrococcygeal teratoma (1 case--laparoscopic mobilization of pelvic component and posterior sagittal excision), and ovarian mass (2 cases; laparoscopic oophorectomy). There were 14 males, 4 females, and 3 of indeterminate sex. All procedures could be successfully completed without conversion. There was no anesthesia-related complication or need for postoperative ventilatory support. There were no immediate procedure-related complications. One female child with ARM had rectal mucosal prolapse; 1 HD case had rectovaginal fistula that healed following fecal diversion. The major advantages of laparoscopy in different indications were magnified access into the depth of pelvis and early frozen section biopsies in HD, accurate placement of neoanus in the center of muscle complex in ARM, early ligation of vessels and avoidance of laparotomy in sacrococcygeal teratoma, ease of decision making and better mobilization of vessels in undescended testes, and diagnostic accuracy and therapeutic procedure in ambiguous genitalia. CONCLUSION Laparoscopic pelvic surgery in small infants is a safe procedure with advantage of magnification, access, and cosmesis.
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Affiliation(s)
- Satish Kumar Aggarwal
- Department of Pediatric Surgery, Maulana Azad Medical Collage and Lok Nayak Hospital, New Delhi, India.
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Ratan SK, Ratan KN, Bishnoi K, Jhanwar A, Kaushik V, Makkar A. Gastric duplication cysts: diagnostic dilemma with pancreatic pseudocysts. Trop Gastroenterol 2010; 31:129-130. [PMID: 20862996] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Simmi K Ratan
- Department of Pediatric Surgery, Pt. B D Sharma PGIMS, Haryana, India.
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Ratan SK, Rattan KN, Jhajhria P, Mathur YP, Jhanwar A, Kondal D. The surged faradic stimulation to the pelvic floor muscles as an adjunct to the medical management in children with rectal prolapse. BMC Pediatr 2009; 9:44. [PMID: 19602234 PMCID: PMC2715404 DOI: 10.1186/1471-2431-9-44] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2008] [Accepted: 07/14/2009] [Indexed: 11/22/2022] Open
Abstract
Background To assess the role of the surged faradic stimulation to the pelvic floor muscles as an adjunct to the conservative management in the children of idiopathic rectal prolapse Methods Study design: Prospective Setting: Pediatric Surgery Department, Pt BD Sharma, Post Graduate Institute of Medical Sciences, Rohtak Subjects: 47 consecutive children with idiopathic rectal prolapse attending the Pediatric Surgery out patient department from July 2005 to June 2006 Methodology: The information pertaining to duration and the extent of rectal prolapse, predisposing or associated medical conditions, results of local clinical examination were noted. Surged faradic stimulation using modified intraluminal rectal probe, was given on the alternate days. The conventional conservative medical management was also continued. The extent of relief and the number of the sittings of faradic stimulation required were noted at various stages of follow-ups Statistical Methods: Mean values between those completely cured and others; poor responders and others were compared with t-test and proportions were compared with Chi square test. The p-value < 0.05 was considered statistically significant. Results The mean number of sittings in the completely cured group (n = 28(64%)) was (12.4 ± 7.8) and was comparable with very poor responder (n = 6(13%). There was higher percentage of relief (76%) at the first follow up (at 15 days) in completely cured Vs other (37%) and also the poor responders showed (20%) Vs other (68%) and was statistically significant. Conclusion With use of faradic stimulation, even the long-standing rectal prolapse can be fully cured. The follow up visit at 2 weeks is very important to gauge the likely success of this modality in treatment of the patients with rectal prolapse. Those showing poor response at this stage may require alternative treatment or take a long time to get cured
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Affiliation(s)
- Simmi K Ratan
- Department of Pediatric Surgery, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
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Abstract
Nephrotoxicity is a well-known side effect of intravenous acyclovir treatment but occurs rarely by oral treatment. A 76-y-old healthy male, with normal baseline renal functions (blood creatinine 0.6 mg%), received oral acyclovir at a dose of 800 mg five times daily for 10 days for treatment of herpes zoster ophthalmicus. He developed renal failure with blood creatinine levels of 3 mg% and his renal function failed to improve within eight months of end of treatment. Affection of renal function has to be considered also in relation to oral acyclovir treatment, especially in elderly subjects.
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Ratan SK, Rattan KN, Pandey RM, Singhal S, Kharab S, Bala M, Singh V, Jhanwar A. Evaluation of the levels of folate, vitamin B12, homocysteine and fluoride in the parents and the affected neonates with neural tube defect and their matched controls. Pediatr Surg Int 2008; 24:803-8. [PMID: 18463884 DOI: 10.1007/s00383-008-2167-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [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] [Accepted: 04/10/2008] [Indexed: 10/22/2022]
Abstract
The aim of this study is to evaluate the folate, vitamin B12, fluoride and homocysteine levels in newborns with neural tube defect (NTD) and their parents. The study included 35 neonates with NTD and their parents, 31 neonates with congenital anomalies other than NTD formed control 1, 24 neonates with no anomalies, with the highest birth order and normal siblings formed control 2. These groups matched for socio-economic and nutritional status. Demographic, antenatal history, parental habits, folate (RBC, whole blood and serum), serum vitamin B12 and homocysteine levels were estimated using chemiluminescence technology. Chi-square test was used to assess association between factors and the outcome. One-way ANOVA was used to compare means in the three groups. To determine the risk factors for NTD, odds ratios (95% CI) was computed using bivariate and multivariate logistic regression analysis (STATA 9.0). No difference was found between NTD group and 'control 1' group. The fathers in NTD group had significantly lower folate and vitamin B12 and a higher homocysteine, in comparison to 'control 2' group (i.e. with normal babies). The babies with NTD had higher homocysteine while their mothers had significantly low folate levels in comparison to 'control 2' mothers. Low RBC folate, low serum vitamin B12 and high plasma homocysteine in both the parents had an association with NTD. Multivariate logistic regression revealed high homocysteine of father as the only independent significant risk factor [OR(95% CI):2.6(2.6, 226)] for NTD and also for other anomalies. NTD (and other congenital anomalies) may not only be due to nutritional deficiency in the mothers but also due to more intricate gene-nutrient interaction defects in the affected families, probably some abnormal folate-homocysteine metabolism. These defects seem to be affect the fathers more severely and in all likelihood, get transmitted to the babies from either or both the parents. The emergence of father's serum homocysteine levels as an independent risk factor for NTD and also other congenital anomalies calls for further studies to evaluate if this can be taken as a marker for congenital anomalies in the fetus during antenatal screening.
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Affiliation(s)
- Simmi K Ratan
- Department of Pediatric Surgery, Pandit BD Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
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Rattan KN, Ratan SK, Parihar D, Kaushal V, Yadav SP. Giant neonatal cervical teratoma associated with facial clefts--a rare association. J Otolaryngol 2007; 36:E19-20. [PMID: 17711756 DOI: 10.2310/7070.2006.0081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Kamal Nain Rattan
- Department of Pediatric Surgery, Pandit Bhagwal Daval, Sharma, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
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Abstract
A rare occurrence of an omphalomesenteric duct cyst in an exomphalos minor sac is reported herein. The noteworthy points in this case were an unusual presentation of the rarest variety of umbilical cord cyst. The tapering intra-abdominal end of the cyst was found to be attached to the ileal mesentry, thereby simulating a herniating mesenteric cyst till the histolopathological report resolved the issue.
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Affiliation(s)
- Simmi K Ratan
- Department of Pediatrics Surgery, Pt B.D. Sharma PGIMS, Rohtak, Haryana, India.
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Ratan SK, Rattan KN, Rohilla S, Magu S. Cystogastrostomy: a valid option for treating pancreatic pseudocysts of children in developing countries. Pediatr Surg Int 2006; 22:532-5. [PMID: 16736224 DOI: 10.1007/s00383-006-1674-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2006] [Indexed: 11/26/2022]
Abstract
Twelve children with pancreatic pseudocysts were managed for over 10 years at our institute that is a tertiary referral center of our country. A majority of them had posttraumatic pancreatic pseudocysts. Six of them were early referrals and presented within 1-2 weeks of pancreatic injury while the remaining six were referred later than 6 weeks with thick cyst walls. An initial conservative management and observation (with serial ultrasounds) led to a resolution of the pseudocysts in three patients (25% resolution rate). All the remaining subjects were treated using surgical modality (cystogastrostomy). In all the subjects where cystogastrostomy was done, the pseudocysts resolved completely, except in one child, who required the procedure to be repeated. The authors encountered no complications of the pancreatic pseudocyst disease in children i.e. infection, rupture, etc, that have been frequently described for adults. The authors conclude that pancreatic pseudocyst is a comparatively benign entity in children with a better outcome than in adults. Though various sophisticated treatment modalities are in vogue in the developed countries for managing pancreatic pseudocysts in children, cystogastrostomy is still a valid option for this purpose in the developing countries with suboptimal infrastructure and gives good results.
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Affiliation(s)
- Simmi K Ratan
- Department of Pediatric Surgery, Pt BD Sharma PGIMS, Rohtak, Haryana, India.
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Rattan KN, Bhatia V, Ratan SK, Sharma M, Rohilla S. Catheterless and drainless open suprapubic cystolithotomy in children: a safe procedure. Pediatr Surg Int 2006; 22:255-8. [PMID: 16416282 DOI: 10.1007/s00383-005-1619-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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2005] [Indexed: 10/25/2022]
Abstract
The objective of this study is to compare the outcome of the children with vesical stones undergoing conventional open suprapubic cystolithotomy with those undergoing catheterless and drainless suprapubic cystolithotomy. The study included 176 children aged 1-15 years with bladder stones. It was a prospective study stretching over 14 years (1991-2003). In the initial years (1991-1994), 40 patients were used to put a urethral catheter for 5 days and retropubic drain for 48 h post-operatively, as has been recommended conventionally. From 1995 onwards we resorted to a catheterless-drainless (no suprapubic drain) suprapubic cystolithotomy in children with bladder stones. In all the patients, two-layered closure of bladder with absorbable sutures was done. The results of both protocols with regards to duration of hospitilisation and complications were compared. We observed that if the bladder is closed meticulously in two layers and complete haemostasis is achieved, bladder drainage by means of a catheter and drainage of retropubic space is not required. This approach allowed an early post-operative recovery without increasing the risks of complications. However, the catheterisation was required for patients with infected urine, recurrent stones and those operated earlier for ano-rectal malformations. The authors feel that for vesical stones, the catheterless-drainless suprapubic cystolithotomy in children is a safe procedure barring a few above-stated situations. The advantages of this procedure are a shorter hospital stay, early mobility and decreased morbidity.
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Affiliation(s)
- Kamal Nain Rattan
- Department of Pediatric Surgery, Pt. BD Sharma PGIMS, Rohtak, Haryana, India
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Abstract
A 2-day-old male infant, born of a non-consanguineous marriage and uneventful pregnancy was found to have anomalies of vertebral, anal, cardiac, tracheo-esophageal, radial and limb (VACTERL) association. The striking feature was the simultaneous occurrence of two rare limb defects of right upper and lower limb in the baby who also had imperforate anus and ventricular septal defect. These limb defects were-meromelia of the right upper limb (due to transverse deficiency of right humerus and absence of all the bony elements distally), and a short right lower limb due to co-existence of proximal femoral hypoplasia and fibular hemimelia. We could not trace the co-existence of these rare skeletal defects in any case with VACTERL association in the existing English literature, as was observed by us. The simultaneous occurrence of the defects involving distant anatomic sites supports the hypothesis of 'axial mesodermal dysplasia' in our patient, rather than 'caudal regression syndrome', as is popularly held in patients with anorectal malformation (ARM). Further, it points to occurrence of an early embryonic insult, probably taking place at blastogenic stage, when the developing embryo can be considered a polytopic development field. However, in absence of antenatal history suggestive of exposure to a known teratogen and a chromosomal analysis, it appears that the spectrum of anomalies in this neonate might have resulted secondary to early amniotic leak and temporary oligohydramnios.
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Affiliation(s)
- Simmi K Ratan
- Department of Paediatric Surgery, Pt. B.D.Sharma PGIMS, Rohtak, Haryana, India.
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Ratan SK, Rattan KN, Malhotra N, Sodhi PK, Ratan J. Second branchial cleft cysts with mediastinal extension: the diagnostic challenge. ACTA ACUST UNITED AC 2005; 34:196-8. [PMID: 16089225 DOI: 10.2310/7070.2005.03049] [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] [Indexed: 11/18/2022]
Affiliation(s)
- Simmi K Ratan
- Department of Pediatric Surgery, Pandit Bagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
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Abstract
We report a 4-year-old boy with a hitherto undescribed case of abortive epispadiac duplication of the urethra presenting as a blind-ending penopubic sinus proximally and a mucosa-lined groove overlying the glanular corona distally but with absent midurethra. The patient was treated for cosmetic reasons with good results. A plausible embryological genesis of this defect is discussed.
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Affiliation(s)
- Simmi K Ratan
- Department of Pediatric Surgery, Pt BD Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
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Ratan SK, Rattan KN, Ratan J, Bhatia V, Sodhi PK, Bhatia M. Temporary transgastric fistula occlusion as salvage procedure in neonates with esophageal atresia with wide distal fistula and moderate to severe pneumonia. Pediatr Surg Int 2005; 21:527-31. [PMID: 15937658 DOI: 10.1007/s00383-005-1407-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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] [Accepted: 02/07/2005] [Indexed: 10/25/2022]
Abstract
A method to achieve distal fistula occlusion by inflating the balloon of a catheter placed at the gastroesophageal junction via a transgastric route was tried in seven consecutive neonates with esophageal atresia and wide distal fistula. Due to associated moderate or severe pneumonia, these infants were at poor anesthetic risk for the definitive repair. The procedure was done under local anesthesia with mild sedation and took an average of half an hour for completion. Another feeding tube was negotiated through another gastrotomy across the pylorus to allow early enteral feeds. Temporary transgastric fistula occlusion (TTFO) allowed better ventilation of the hypocompliant lungs (by increasing resistance at the fistulous end), prevented lung injury due to aspiration of the refluxing gastric juices, and facilitated optimal ventilation by preventing epigastric distension. All study subjects survived this procedure except for one of our earlier study subjects who died of massive pneumothorax that was a procedure-related complication. None of the remaining subjects required mechanical ventilation either after TTFO or after the definitive esophageal repair that was carried out 5-7 days subsequent to TTFO, except for one other neonate with right lung aplasia who began deteriorating 48 h after thoracotomy and died of cardiac failure. There were no anastomosis-related problems among the survivors over a 12-month follow-up. The gratifying results of our study prompt us to suggest that this procedure deserves attention, and its role should be explored for salvaging neonates with type C esophageal atresia with wide fistula and pneumonia in developing countries with few neonatal intensive care services.
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Affiliation(s)
- Simmi K Ratan
- Department of Pediatric Surgery, Pt BD Sharma PGIMS, Rohtak, Haryana, India.
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Sodhi PK, Verma L, Pandey RM, Ratan SK. Appraisal of a modified medial canthal plication for treating laxity of the medial lower eyelid. J Craniomaxillofac Surg 2005; 33:205-9. [PMID: 15878523 DOI: 10.1016/j.jcms.2005.01.006] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 09/08/2004] [Accepted: 01/01/2005] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the efficacy of modified medial canthal tendon plication technique for correcting laxity of the medial end of the lower eyelid. MATERIAL AND METHODS Eleven patients (9 males and 2 females, 21 eyes), with an age range of 31-80 years, having laxity of the medial end of the lower lid of varying degrees were enrolled in this study. These patients presented with complaints of watering, recurrent redness, photophobia and foreign body sensation. After grading the amount of lower lid laxity, plication was performed. In patients in whom laxity was associated with ectropion, the severity of lower lid ectropion was also graded. In patients with ectropion of Grade II or more, additional procedures for its correction were performed before undertaking plication. The patients were followed up 6 months post-operatively and re-assessed for laxity, recurrence of symptoms and complications of plication. RESULTS All the lids were evaluated for the amount and extent of laxity of lower lid. Twelve (57%) eyes had Grade I, 9 (43%) had Grade II (and none Grade III) laxity of the lower lid. Twelve eyes had laxity restricted to the medial end and 9 eyes had laxity of the entire length of the lower lid. Some eyes also had an associated ectropion. Among the 21 eyes, 4 eyes (22%) had Grade 1, 11 (61%) had Grade 2, 6 (17%) Grade 3 and none Grade 4 ectropion. In the lids with associated ectropion, additional procedures had been performed. In 1 eye, the medial canthus was anchored to the tendon and this patient had poor apposition of the lower lid to the globe. Hence, in the remaining 20 eyes, the medial canthus was anchored to the orbital periosteum. The mean change in eyelid length was 2.6 mm (measured from medial to lateral canthus) from pre-operative status (33+/-3.4 mm) to the post-operative status (30+/-2.9 mm) this being statistically significant. An overriding of the lower lid was seen in 2 eyes (10%), and a residual gap between the lower lid and globe was noticed in 15 (71%) eyes. Some eyes had uncorrected symptoms including epiphora (3 eyes; 14%), redness (2 eyes; 10%), and photophobia (1 eye; 5%). All were those in which the lateral end was lax. None had a recurrence of foreign body sensation. CONCLUSION Plication is easy, effective and quick for correcting laxity of the lower lid when restricted predominantly to the medial end. Correct identification of anatomical landmarks and appropriate tension of sutures is vital to achieve proper apposition of the lower lid to the globe.
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Affiliation(s)
- Punita Kumari Sodhi
- Department of Ophthalmology (Chairman: Dr. P. K. Sodhi), Safdarjung Hospital, New Delhi, India.
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Sodhi PK, Verma L, Ratan SK. Transient recurrence of pressure regurgitation following successful conventional external dacryocystorhinostomy. J Craniomaxillofac Surg 2005; 33:210-1. [PMID: 15878524 DOI: 10.1016/j.jcms.2005.01.010] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2004] [Accepted: 01/14/2005] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To report a patient with transient recurrence of lacrimal pressure regurgitation following a successful conventional external dacryocystorhinostomy. MATERIAL AND METHODS A 22-year-old female, who had undergone conventional external dacryocystorhinostomy, presented 3 days later with a recurrence of pressure regurgitation. The patient's symptoms disappeared spontaneously 7 days later. Serial naso-endoscopic examination was used to find the cause. RESULTS Endoscopic examination showed an oedematous posterior nasal mucosal remnant obstructing the lacrimal drainage pathway. On account of its peculiar location, shape and movements, and the surgically induced tissue oedema, this mucosal remnant misdirected the fluid coming through the canalicular system away from the nasal cavity into the lacrimal pocket. Ten days later, due to healing fibrosis, this flap adhered permanently to the lateral nasal wall and the patient's symptoms disappeared spontaneously. CONCLUSION Nasal endoscopy is a simple, quick and convenient technique for diagnosing the cause of obstruction in the lacrimal drainage system. The surgeon should aim for large anterior lacrimal and anterior nasal mucosal flaps, and every remnant of posterior flaps should be excised during dacryocystorhinostomy.
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Abstract
Two infants, aged 3 months and 4 months, with acquired ileal atresia in the distal ileum are described. Both of them presented with features of intestinal obstruction following a diarrhoeal episode. In both patients the time interval between the onset of symptoms and detection of atresia at surgery was very short, i.e. 2 weeks. In our opinion, strangulation with subsequent resorption of gangrenous gut could have been the underlying mechanism in both patients. However, a short interval between initiation of symptomatology and detection of atresia prompted us to postulate a thromboembolic phenomenon as the cause of these lesions. While in one patient intussusception was noted on sonography, in the other there was no clear-cut aetiology present except for a high-lying caecum with a long mesentery that might have led to volvulus. We have reviewed the pertinent literature of this very rare sequela of gut inflammation.
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Affiliation(s)
- Simmi K Ratan
- Department of Paediatric Surgery, Pt BD Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
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Abstract
The purpose of this study was to find if direct ophthalmoscopy, a simple technique, could be used to give an approximate value of the refractive correction for a patient. This would shorten the time and lessen the effort to be expended during the following retinoscopic examination done for finding the patient's refractive correction. The use of direct ophthalmoscopy for this specific purpose is especially desirable where retinoscopic examination is quite tedious, e.g. uncooperative patients like children, bed-ridden patients and mentally retarded subjects, in patients with a large central corneal opacity and in patients having a large refractive error. The study was divided into two phases. In phase I, refractive direct ophthalmoscopy followed by classical retinoscopy was done for 92 subjects (184 eyes) in the age group of 11-35 years. The method of regression analysis was used to find a regression equation relating the readings to refractive error determined by the two above techniques. In phase II of study, the refractive correction needed for 50 other subjects in the similar age group was estimated using this regression equation by inserting their respective direct ophthalmoscopy readings. Then, these estimated values and classical retinoscopic examination values were compared. The refractive error determined after retinoscopy and that derived from regression equation (incorporating direct ophthalmoscopy readings) was statistically comparable (t = 0.52, p = 0.60). The correlation coefficient (r value) between the two methods was 0.37. Direct ophthalmoscopic lens reading can be used to give a fairly accurate estimate of refractive error in a patient's eye by using a linear regression equation, which relates these two examination techniques. The magnitude of astigmatic error, however, cannot be obtained.
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Affiliation(s)
- P K Sodhi
- Department of Ophthalmology,Safdarjung Hospital, All India Institute of Medical Sciences, New Delhi, India.
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Ratan SK, Rattan KN, Malhotra N, Bhatia V, Ratan J. Complicated Hypopharyngeal Perforation in a Child Owing to Internal Penetrating Trauma by a Knitting Needle—Parents Beware. ACTA ACUST UNITED AC 2005; 34:267-9. [PMID: 16048702 DOI: 10.2310/7070.2005.34415] [Citation(s) in RCA: 3] [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: 11/18/2022]
Affiliation(s)
- Simmi K Ratan
- Department of General Surgery, Pandit Bhagwat Dayal Post Graduate Institute of Medical Sciences, Rohtak, Haryana, New Delhi, India.
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Ratan SK, Rattan KN, Pandey RM, Mittal A, Magu S, Sodhi PK. Associated congenital anomalies in patients with anorectal malformations--a need for developing a uniform practical approach. J Pediatr Surg 2004; 39:1706-11. [PMID: 15547838 DOI: 10.1016/j.jpedsurg.2004.07.019] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [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] [Indexed: 10/26/2022]
Abstract
BACKGROUND/PURPOSE The aim of this study was to compare the incidences of various associated anomalies among subjects with high and low anorectal malformation (ARM), study the coexistence of these anomalies, and compare their frequency with those quoted in the existing literature. METHODS Ten years of data (from January 1993 through December 2002) on the 416 subjects from our center with anorectal malformations (ARM) were evaluated. The subjects with supra or translevator rectal pouch (radiologic or operative findings) were classified as high ARM and the rest as low ARM. The associated anomalies studied were vertebral, skeletal, renal, cardiac, vesicoureteric reflux (VUR), gastrointestinal, tracheoesophageal fistula, spinal, genital, and miscellaneous. For a detailed comparison, 4 subgroups were made: boys with high ARM, boys with low ARM, girls with high ARM, and girls with low ARM. Statistical methods were used for intergroup comparison. RESULTS There were 68% male and 32% female subjects. Overall, 58% of subjects had high ARM (supralevator and translevator). Our attempt to compare the incidences of anomalies in our study population with those in other populations was defeated because of nonuniformity of classification and investigation of these anomalies in different studies. We found a frequent clubbing of anomalies affecting distantly developing anatomic regions in patients with ARM in many studies. The highest incidence of associated anomalies was found among boys with high ARM. The male subjects also had significantly more genital anomalies in association with low ARM and gastrointestinal tract anomalies in association with high ARM. On the other hand, girls had more urologic anomalies with high ARM and VUR with low ARM. CONCLUSIONS Except for a low incidence of spinal anomalies (8%) and of VUR (1.7%), the incidences of most associated anomalies in our study were comparable with those of the earlier studies. Additionally, the girls with high ARM were observed to have significantly more urologic anomalies compared with the boys with high ARM in contrast to the results of the earlier reports. The existence of anomalies in distantly developing anatomic regions in patients with ARM supports the possibility of a "generalized" insult during embryogenesis rather than a ("localized") defect. It was observed that the boys with ARM are more likely to suffer morbidity because of frequent occurrence of multiple associated anomalies, and it may be worthwhile to evaluate of the role of sex chromosome in relation to ARM. The authors are also of the view that there is a need for more uniformity in classification of the anomalies and in their diagnostic approach because various reported studies have differed so widely on these aspects that any interstudy comparison is difficult or not feasible.
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Affiliation(s)
- Simmi K Ratan
- Department of Paediatric Surgery, Pt B.D. Sharma PGIMS, Tohtak, Haryana, India
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