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Sharma SP, Chowdhary S, Kumar R, Yadav MK, Sharma SP, Panigrahi P. Urinary flow rates in anterior hypospadias: Before and after repair and its clinical implication. Afr J Paediatr Surg 2023; 20:102-105. [PMID: 36960503 DOI: 10.4103/ajps.ajps_125_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Context Hypospadias is a common urological anomaly which could be surgically corrected with good cosmetic results. Aims We aimed to detect changes in urinary flow parameters both before and after tubularised incised plate urethroplasty (TIPU) using uroflowmetry. Settings and Design Data collected were clinically implemented hypothesising the probability of urethrocutaneous fistula following stricture with Qmax variation. Materials and Methods This study is a prospective analysis done from December 2017 to October 2019. A total of 104 cases of anterior hypospadias were included in the study. A single surgical unit did TIPU. Pre-operative and post-operative uroflowmetry was done, and Qmax was recorded at 3 months, 6 months and 1 year after surgery. Mean Qmax was calculated for all intervals. A significant decrease in Qmax of a child (<2 standard deviation) was ascertained. Urethral calibration was done in those cases with a significant decrease of Qmax and analysed statistically. Results The mean age was 6.97 ± 2.41 years. Out of 104 children, 73 (70.2%) and 31 (29.8%) had distal and mid-shaft hypospadias, respectively. The pre-operative mean Qmax of the population was 6.20 ± 0.42 ml/s. Arithmetic mean Qmax at 3 months, 6 months and 1 year was 8.53 ± 0.42, 11.18 ± 0.47 and 13.71 ± 0.44 ml/s, respectively. On comparing the pre-operative with post-operative mean Qmax, a significant increase was found postoperatively (P < 0.0001). Twenty-four patients had significantly decreased Qmax value after 6 months. In these patients, follow-up urethral dilation was done with significant improvement. Conclusion The changes in maximum flow rate (Qmax) are suitable for use in routine follow-up. A significant decrease in Qmax over time indicates the onset of urethral stricture. These cases are to be intervened before venturing to redo urethroplasty.
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Affiliation(s)
| | - Sarita Chowdhary
- Department of Paediatric Surgery, IMS Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Rakesh Kumar
- Department of Paediatric Surgery, IGIMS, Patna, Bihar, India
| | - Manoj Kumar Yadav
- Department of Paediatric Surgery, IMS Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - S P Sharma
- Department of Paediatric Surgery, IMS Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Pranay Panigrahi
- Department of Paediatric Surgery, IMS Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Tiwari P, Pandey V, Bera RN, Tiwary N, Mishra A, Sharma SP. Sandwich therapy in the management of propranolol resistant infantile hemangioma of the lip. J Stomatol Oral Maxillofac Surg 2022; 123:e499-e505. [PMID: 35217221 DOI: 10.1016/j.jormas.2022.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/15/2022] [Accepted: 02/16/2022] [Indexed: 06/14/2023]
Abstract
RATIONALE Propranolol has evolved as a first line management of infantile haemangiomas. Nevertheless, the resistance to propranolol has warranted alternative treatment modalities. We hypothesize that combination of medical and surgical therapy (sandwich therapy) to be beneficial in the management. METHODS Patients were divided into three groups (total=31), Group A (bleomycin sclerotherapy), Group B (surgical group), Group C (sandwich therapy). A p value <0.05 was taken as significant. RESULTS In Group A 54.5% of patients had excellent response, 27.3% partial response and 18.2% had no response. Comparing cosmetic outcome, 25% of patients in Group B and 16.7% of patients in Group C had excellent upshot. On the contrary 18.2% of patients in bleomycin had unsatisfactory and 18.2% had poor cosmetic outcome. Sandwich therapy was cosmetically more acceptable than Bleomycin sclerotherapy (p- value = 0.049). In terms of recurrence, sandwich therapy differed significantly from surgical therapy with fewer recurrences (p-value= 0.049). CONCLUSION Sandwich therapy is superior to bleomycin sclerotherapy in terms of cosmetic outcome and has fewer recurrences compared to surgical group and requires single stage resection. However, further studies with the help of Doppler ultrasound are required in this regard.
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Affiliation(s)
- Preeti Tiwari
- Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University Varanasi 221005, India
| | - Vaibhav Pandey
- Department of Pediatric surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India
| | - Rathindra Nath Bera
- Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University Varanasi 221005, India.
| | - Narendra Tiwary
- Department of Community Medicine, RG KAR medical college and hospital, Kolkata, India
| | - Akash Mishra
- Department of Pediatric surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India
| | - Shiv Prasad Sharma
- Department of Pediatric surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India
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Pandey V, Srivastava V, Panigrahi P, Kumar R, Sharma SP. Modified Laparoscopic Excision of Choledochal Cyst: Technique and Early Results. J Indian Assoc Pediatr Surg 2021; 26:311-316. [PMID: 34728916 PMCID: PMC8515537 DOI: 10.4103/jiaps.jiaps_150_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: 05/11/2020] [Revised: 07/03/2020] [Accepted: 07/23/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Choledochal cyst is a common congenital anomaly requiring surgical treatment. Nowadays, laparoscopic excision is the preferred approach. We studied a modification in the classical laparoscopic approach to facilitate the dissection of a cyst. MATERIALS AND METHODS A prospective comparative study was done on 42 Type I choledochal cyst children. One group was operated by classical laparoscopic technique, while the other group was operated by modification of classical technique by deliberately opening the cyst wall and dividing the cyst into two hemi-cups, followed by dissection and excision. The intraoperative and postoperative parameters were assessed in both the groups. RESULTS The age, gender ratio, clinical presentation, and cyst diameter were comparable in both the groups. There was a significantly higher success rate (95.7% vs. 73.7%, P = 0.042) and lesser time for cyst excision (96.43 ± 12.15 vs. 120.91 ± 17.38 min P < 0.001) in the modified technique when compared to the classical technique. Further in three patients, it was possible to convert the classical procedure to a modified technique and complete the cyst excision. The postoperative outcomes were similar in both the groups. CONCLUSION The modified laparoscopic excision shortens the operative time with higher success rate and comparable short-term morbidity vis-a-vis classical laparoscopic technique.
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Affiliation(s)
- Vaibhav Pandey
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Vivek Srivastava
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Pranay Panigrahi
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Rakesh Kumar
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Shiv Prasad Sharma
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Pandey V, Tiwari P, Imran M, Mishra A, Kumar D, Sharma SP. Adverse Drug Reactions Following Propranolol in Infantile Hemangioma. Indian Pediatr 2021; 58:753-755. [PMID: 34465658] [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: 06/13/2023]
Abstract
OBJECTIVES To assess the adverse effects of propranolol therapy in infantile hemangioma. METHODS An ambispective study was conducted from August 2011 to December 2019. In retrospective arm all children managed for infantile hemangioma with propranolol were included and case records were assessed for adverse reactions. In prospective arm the adverse reactions were identified on the basis of predefined criteria. RESULTS A total of 514 patients (358 retrospective records) were included. A majority, 378 (73.5%) patients had an excellent response, 75 (14.5%) had partial response and 61 (11.8 %) had no response. A total of 82 (15.9%) patients experienced at least one adverse effect. Diarrhea with weight loss (27, 32.9%) and irritability with decreased sleep (21, 25.6%) were the most common adverse effects. The adverse effects in 22 (4.2%) cases lead to the discontinuation of propranolol. Younger age, low body weight and early onset were risk factors for development of severe adverse reactions. CONCLUSIONS Young children with low body weight were at higher risk for adverse effects of propranolol.
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Affiliation(s)
- Vaibhav Pandey
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh
| | - Preeti Tiwari
- Department of Oral and Maxillofacial Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh. Correspondence to: Dr Preeti Tiwari, Associate Professor, Oral and Maxillo-facial Surgery, Faculty of Dental science, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh.
| | - Mohammed Imran
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh
| | - Akash Mishra
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh
| | - Deepak Kumar
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh
| | - S P Sharma
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh
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Pandey V, Tiwari P, Imran M, Mishra A, Kumar D, Sharma SP. Adverse Drug Reactions Following Propranolol in Infantile Hemangioma. Indian Pediatr 2021:S097475591600306. [PMID: 33772532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To assess the adverse effects of propranolol therapy in infantile hemangioma. METHODS An ambispective study was conducted from August 2011 to December 2019. In retrospective arm all children managed for infantile hemangioma with propranolol were included and case records were assessed for adverse reactions. In prospective arm the adverse reactions were identified on the basis of predefined criteria. RESULTS A total of 514 patients (358 retrospective records) were included. A majority, 378 (73.5%) patients had an excellent response, 75 (14.5%) had partial response and 61 (11.8 %) had no response. A total of 82 (15.9%) patients experienced at least one adverse effect. Diarrhea with weight loss (27, 32.9%) and irritability with decreased sleep (21, 25.6%) were the most common adverse effects. The adverse effects in 22 (4.2%) cases lead to the discontinuation of propranolol. Younger age, low body weight and early onset were risk factors for development of severe adverse reactions. CONCLUSIONS Young children with low body weight were at higher risk for adverse effects of propranolol.
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Affiliation(s)
- Vaibhav Pandey
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Preeti Tiwari
- Department of Oral and Maxillofacial Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India. Correspondence to: Dr Preeti Tiwari, Associate Professor, Oral and Maxillo-facial Surgery, Faculty of Dental science, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
| | - Mohammed Imran
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Akash Mishra
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Deepak Kumar
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - S P Sharma
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Chowdhary S, Sharma SP, Panigrahi P, Yadav MK, Sharma SP. Endoscopic Third Ventriculostomy in Infants Less than One Year of Age: A Short Series of 14 Cases. Pediatr Neurosurg 2021; 56:105-109. [PMID: 33652442 DOI: 10.1159/000513359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/23/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Endoscopic third ventriculostomy (ETV) is currently considered as an alternative to cerebrospinal fluid (CSF) shunt systems in the treatment of obstructive hydrocephalus. This procedure allows the CSF to drain in the basal cisterns and reabsorbed by arachnoid granulations, and avoiding implantation of exogenous material. AIMS AND OBJECTIVES The purpose of this study was to assess the success rate of ETV in infants less than 1 year of age with congenital noncommunicating hydrocephalus. MATERIAL AND METHODS This study was a 2-year prospective study from August 2017 to July 2019. ETVs were performed in 14 patients younger than 1 year with diagnosis of noncommunicating hydrocephalous. A failure was defined as the need for shunt implantation after ETV. Phase-contrast MRI of the brain was done after 6 months to see patency of ETV fenestration and CSF flow through ventriculostomy. RESULTS ETV was tried in 18 patients and successfully performed in 14 patients. Out of the 14 patients, shunt implantation after ETV was performed in 3 patients (failed ETV). In the successful cases, etiology was idiopathic aqueductal stenosis in 8, shunt complications in 2, and 1 case was a follow-up case of occipital encephalocele; the mean age was 7.7 months (range 3-12). In the 3 failed cases, etiology was aqueductal stenosis, mean age was 7.6 months (range 3-11). In all ETVs, failed patients MPVP shunting was done. Follow-up of nonshunted patients was done from 6 to 24 months (mean 15 months). There was no mortality or permanent morbidity noted following ETV. CONCLUSION ETV is a good surgical procedure for less than 1-year-old children.
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Sharma SP, Chowdhary S, Panigrahi P, Sharma SP. Management of Mesenteric Cysts in Pediatric Population: Five-year Experience in Tertiary Care Center. Annals of the National Academy of Medical Sciences (India) 2020. [DOI: 10.1055/s-0040-1718611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Abstract
Introduction To study the clinical features, diagnosis and treatment of mesenteric cysts in pediatric age group (< 15 years).
Materials and Methods This was a retrospective analysis which inculded 35 children diagnosed and treated for mesenteric cysts in the pediatric surgery department from January 2014 to January 2019. Patient’s data were retrieved from case sheets and analyzed. Patients with atleast one year follow-up were included in the study.
Results Thirty-five patients were included in the study. Twenty-one (60%) were males and fourteen (40%) were females. Mean age of presentation and surgery was 24 months. Twenty-six (74.2%) patients were managed by bowel resection, while 9 (25.7%) were managed by simple cystectomy. The average size of the cyst was 15 cm (ranging from 5 to 25 cm). Content of cysts was mostly chylous (82.9% cases). No recurrence was found throughout the follow-up period (1–2 years).
Conclusion Mesenteric cyst should be considered as a differential diagnosis in pediatric patients with acute or subacute intestinal obstruction and with or without a palpable lump in the abdomen. Mesenteric cysts can be managed surgically with favorable outcomes.
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Affiliation(s)
- Shyamendra Pratap Sharma
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Sarita Chowdhary
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Pranay Panigrahi
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Shiv Prasad Sharma
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Panigrahi P, Chowdhary S, Sharma SP, Kumar R, Agarwal N, Sharma SP. Role of Urinary Transforming Growth Factor Beta-B1 and Monocyte Chemotactic Protein-1 as Prognostic Biomarkers in Posterior Urethral Valve. J Indian Assoc Pediatr Surg 2020; 25:219-224. [PMID: 32939113 PMCID: PMC7478284 DOI: 10.4103/jiaps.jiaps_104_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/28/2019] [Revised: 08/09/2019] [Accepted: 01/26/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Posterior Urethral Valves (PUV) are the most common cause of congenital LUT obstruction in males. Biomarkers of glomerular or tubular injury may be of particular value in predicting the need for surgical intervention or in tracing progression of chronic kidney disease. Measurement of biomarker in urine is relatively easy. Aim: To evaluate the changes in values of urinary Transforming Growth Factor Beta 1(TGF-B1) and Monocyte Chemotactic Protein (MCP-1) before and after valve ablation and its prognostic value in Posterior urethral valve. Material and Method: This prospective study was conducted from September 2016 to August 2018. The study group included 20 consecutive male babies with the diagnosis of PUV treated and followed up versus equal numbers of age matched control without any renal or urinary tract disease. Pre-operative urine samples were collected in Operative room. Cystoscopy and valve ablation was done. Follow up was done clinically by urinary stream and radiologically with VCUG. Follow-up was planned at 1 month, 3 months and 6 months following cystoscopic valve ablation. All collected urine samples were centrifuged at 10,000 rpm for 20 minutes. Supernatant was collected and two divided aliquots were stored at -200c to be thawed on the day of assay. Optical density of each well was recorded at 450 nm and 540 nm A p-value of <0.05 was considered to be statistically significant. Result and Discussion: Out of 20 cases of PUV, 14 (70%) cases were 1st born males of their family. The median age at the time of valve ablation in PUV cases was 2.5 (1.20-3.87) years.. Most common symptoms are fever and UTI. The preoperative median serum creatinine level was 1.65 mg/dl(1.22-2.42) pre-ablation, and fall significantly after ablation. Median eGFR level (calculated) was 25.635 (16.38-35.40) and after 6 months was 71.490 (45.44-96.93). Preoperative median MCP1 in PUV cases was 147.2 (82.8-512.5) and significant difference was also found in 1st, 3rd and 6th months after surgery (p<0.001, p=0.004 and p=0.002).Preoperative median TGF-B1 level was 197.8 pg/ml (79.9-386.4). There was no statistically significant change in TGF-B1 level at preoperative to 1 month and preop to 3 months after surgery but at 6 months after surgery the median TGF-B1 level significantly decreased as compared with preoperative TGF-B1 level. Conclusion: TGF β1 and MCP1 can be considered as prognostic urinary biomarkers in patients of PUV and can be used to specify and counsel patient's attendant regarding possibility of ESRD and need for further intervention.
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Affiliation(s)
- Pranay Panigrahi
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Sarita Chowdhary
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Shyamendra Pratap Sharma
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Rakesh Kumar
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Neeraj Agarwal
- Department of Endocrinology and Metabolism, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Shiv Prasad Sharma
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Kumar R, Sharma SP, Sharma R. Electron impact ionization cross sections of hydrogen fluoride molecule. Eur J Mass Spectrom (Chichester) 2020; 26:195-203. [PMID: 31810379 DOI: 10.1177/1469066719893230] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Partial and total ionization cross sections of hydrogen fluoride molecule are determined from the ionization threshold to high energy (5 KeV) by using a modified Jain-Khare semiempirical approach. Partial single and double differential cross sections with their sums (total) through direct and dissociative ionization have been also evaluated at fixed primary electron energies 100 eV, 200 eV, and 500 eV. There is no other data for partial ionization cross sections and differential ionization cross sections for comparison. In this paper, the total ionization cross sections data have compared with available experimental data and/or with other theoretical data which are available from intermediate to high energy. It is found that the present result gives a better account for the ionization cross sections up to higher energies.
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Affiliation(s)
- Rajeev Kumar
- Department of Physics, D. J. College, Baraut, Baghpat, Uttar Pradesh, India
| | - S P Sharma
- Department of Chemistry, Baba Mast Nath University, Rohtak, Haryana, India
| | - Ravinder Sharma
- Department of Chemistry, Baba Mast Nath University, Rohtak, Haryana, India
- Department of Biomedical Engineering, DCRUST, Murthal, Sonepat, Haryana, India
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Sharma SP, Chowdhary S, Upadhyay A, Yadav MK, Sharma SP. A foreign body in the urinary bladder leads to bladder stone and vesicorectal fistula: A case report. j-pucr 2020. [DOI: 10.14534/j-pucr.2020258449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Sharma SP, Chowdhary S, Panigrahi PK, Sharma SP. Bilateral single system vaginal ectopic ureters: A rare variant. j-pucr 2020. [DOI: 10.14534/j-pucr.2020156927] [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: 11/06/2022] Open
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Pandey V, Tiwari P, Sharma SP, Kumar R, Panigrahi P, Singh OP, Patne S. Development of a biomarker of efficacy in second-line treatment for lymphangioma of the tongue: a pilot study. Br J Oral Maxillofac Surg 2019; 57:1137-1142. [PMID: 31727434 DOI: 10.1016/j.bjoms.2019.10.303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 10/11/2019] [Indexed: 02/07/2023]
Abstract
Lymphangioma of the tongue is a rare lymphatic malformation, and various authors have reported the successful use of sirolimus for its treatment. However, the safety of sirolimus in children needs further evaluation so that those who do not respond are not necessarily exposed to its potential adverse effects. We hypothesised that assessment of lymphangiogenesis can be used to predict whether the patient will respond to sirolimus, so we organised a prospective study after ethics committee approval had been given. After clinical and histological diagnoses of lymphangioma of the tongue had been confirmed, 16 patients were given sirolimus 0.8mg/day in three divided doses. Clinical response was assessed and compared with lymphatic microvessel density (LMVD), which was calculated immunohistochemically using the monoclonal antibody D2-40 as the lymphatic endothelial marker. Nine patients responded well, five partially, and two failed to respond. Mean (SD) LVD among the good responders was 21.00 (3.74), whereas among non-responders it was 8.00 (4.24). There was a significant difference in mean LVD between good responders, partial responders, and non-responders (p=0.04). Sirolimus is effective in treating children with lymphangioma of the tongue, and lymphangiogenesis is a useful therapeutic predictive marker.
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Affiliation(s)
- V Pandey
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P., India.
| | - P Tiwari
- Department of Oral and Maxillofacial Surgery, Faculty of Dental sciences, Institute of Medical Sciences, Banaras Hindu University.
| | - S P Sharma
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P., India
| | - R Kumar
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P., India.
| | - P Panigrahi
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P., India.
| | - O P Singh
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University.
| | - S Patne
- Department of Pathology, Institute of Medical Sciences, Banaras Hindu University.
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Gupta R, Kumari P, Pandey S, Joshi D, Sharma SP, Rai SK, Singh R. Homocysteine and vitamin B12: Other causes of neural tube defects in Eastern Uttar Pradesh and Western Bihar population. Neurol India 2019; 66:1016-1019. [PMID: 30038085 DOI: 10.4103/0028-3886.236968] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Neural tube defects (NTDs) are congenital malformations with an incidence of 1-10/1000 live births. Homocysteine and vitamin B12 metabolism have been shown to be associated with NTDs. Aim To investigate the status of maternal and neonate's folic acid, homocysteine, and vitamin B12 levels and their association with the risk of development of NTDs in the population of Eastern Uttar Pradeshand Western Bihar, India. Materials and Methods This study is a cross-sectional, retrospective study where 96 mothers who either had a first NTD child or had a history of NTD child in the family and 126 neonates with spina bifida were recruited during the period 2012-2015. Eighty-four control mothers whose previous and current pregnancies were normal, and 87 control neonates who had no defects and were within the same age range as the NTD affected neonates, recruited from the department of pediatric surgery, were enrolled in the study. Plasma concentrations of folic acid, vitamin B12, and homocysteine were compared between cases and controls. Results The folic acid level in the mothers and neonates was within the normal limit. A significant increase in the level of homocysteine in mothers with affected pregnancy and in neonate cases in comparison to control mothers was obseved. Further, a significant decrease in the level of vitamin B12 in mothers with NTD neonates and in the affected neonates was noted. A negative correlation was found between homocysteine and vitamin B12 levels in case and control mothers. Conclusion A correlation of an increase in serum homocysteine with a decrease in vitamin B12 was seen in mothers of neonates with NTD. A similar observation as made in the neonates with NTDs. It may be suggested that maternal decrease in vitamin B12, in mothers who have normal folic acid may be associated with NTD in their children.
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Affiliation(s)
- Rashmi Gupta
- Department of Anatomy, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Preeti Kumari
- Department of Anatomy, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Sharad Pandey
- Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Deepika Joshi
- Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Shiv Prasad Sharma
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Sunil Kumar Rai
- Department of Anatomy, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Royana Singh
- Department of Anatomy, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Chowdhary S, Sharma SP. A new anatomic variant of urethral duplication. Journal of Pediatric Surgery Case Reports 2018. [DOI: 10.1016/j.epsc.2018.04.008] [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: 11/16/2022] Open
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Pandey V, Tiwari P, Sharma SP, Kumar R, Singh OP. Role of intralesional bleomycin and intralesional triamcinolone therapy in residual haemangioma following propranolol. Int J Oral Maxillofac Surg 2018; 47:908-912. [PMID: 29665992 DOI: 10.1016/j.ijom.2018.03.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/17/2018] [Accepted: 03/22/2018] [Indexed: 11/29/2022]
Abstract
With the emergence of propranolol as the first choice of treatment for problematic infantile haemangioma at many centres, the number of patients with a partial or non-response to propranolol has also been growing. This study investigated the role of intralesional bleomycin and triamcinolone in patients with residual disease following propranolol therapy for infantile haemangioma. Sixty-seven patients with residual haemangioma were assigned randomly to receive either intralesional bleomycin (group A, n=36) or intralesional triamcinolone (group B, n=31). The response to treatment and adverse effects were assessed in both groups. All patients received at least four doses and a maximum of six doses of the assigned drug. In group A (mean follow-up 9.38months), 47.2% had an excellent response and 44.4% a good response. In group B (mean follow-up 7.42months), 25.8% had an excellent response and 48.4% a good response. There was no difference in overall response between the groups (P=0.074). Among patients who were initially non-responders to propranolol, bleomycin showed a better response than triamcinolone (P=0.037). This may be due to an overlap in the mechanism of action of propranolol and triamcinolone. Thus, intralesional bleomycin should be preferred in patients with no initial response to propranolol therapy, while bleomycin or triamcinolone can be used in patients with a partial response to propranolol therapy, as they have equal efficacy.
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Affiliation(s)
- V Pandey
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India
| | - P Tiwari
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India.
| | - S P Sharma
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India
| | - R Kumar
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India
| | - O P Singh
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University Varanasi, UP, India
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Verma S, Sharma SP. Effectiveness of Proseal laryngeal mask airway and laryngeal tube suction in elective non-laparoscopic surgeries of up to ninety minutes duration: A prospective, randomized study. J Anaesthesiol Clin Pharmacol 2018; 34:58-61. [PMID: 29643624 PMCID: PMC5885450 DOI: 10.4103/joacp.joacp_101_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background and Aims: Proseal laryngeal mask airway (LMA) and laryngeal tube suction (LTS) are both supraglottic devices with an esophageal suction port. In the present prospective, randomized study, the effectiveness of airway seal, hemodynamic variables, ability to pass orogastric tube, and postoperative complications with the two devices were evaluated. Material and Methods: This was a prospective, randomized, single-blind study conducted in a hospital-based setting. Sixty patients (American Society of Anesthesiologists Grade I and II) undergoing elective general surgery were randomly allocated to Group A (Proseal LMA) or Group B (LTS), and airway seal pressure (primary outcome), peak pressure, hemodynamic parameters (blood pressure, pulse rate and pulse oximetry) during and 5 min after insertion, insertion time, ease of insertion, and postoperative complications (sore throat and hoarseness of voice for a period of 24 hours) (secondary outcomes) were noted. The quantitative data was summarized as mean and standard deviation, and analyzed using Student's t-test. All the qualitative data were summarized as proportions and analyzed using Chi-square test. The levels of significance and α-error were kept 95% and 5%, respectively, for all statistical analyses. P ≤ 0.05 was considered significant (S). Results: Proseal LMA had shorter insertion time (16.4 ± 5.6 vs. 20.0 ± 3.9 s), higher seal pressure (27.6 ± 4.6 vs. 24.1 ± 5.6 cm of H2O), lesser peak pressure (16.3 ± 2.3 vs. 18.5 ± 3.9 cm of H2O), higher success rate of orogastric tube passage (86.7 vs. 76.7%), and lesser postoperative sore throat (3.3 vs. 10%). Conclusions: Both Proseal LMA and LTS were acceptable alternatives for airway management in elective surgeries with controlled ventilation, but the quality of ventilation was found to be significantly better with Proseal LMA (in terms of higher seal pressure, lesser peak pressure, lesser insertion time, and lesser complications).
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Affiliation(s)
- Swapnil Verma
- Department of Anesthesiology, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan, India
| | - S P Sharma
- Department of Anesthesiology, Mahatma Gandhi Medical College, Jaipur, Rajasthan, India
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Pandey A, Gopal SC, Kumar V, Gangopadhyay AN, Sharma SP. Intradural teratoma in a neonate with meningomyelocele. Asian J Neurosurg 2016; 11:323-4. [PMID: 27366286 PMCID: PMC4849328 DOI: 10.4103/1793-5482.145111] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Meningomyelocele is a common congenital problem. The teratoma is a neoplasm composed of tissues foreign to the part in which they arise. An intradural teratoma within a meningomyelocele is a very rare association. We report a case of intradural teratoma with a brief review of the relevant literature.
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Affiliation(s)
- Anand Pandey
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Saroj Chooramani Gopal
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Vijayendra Kumar
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ajay Narayan Gangopadhyay
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Shiv Prasad Sharma
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Dhar M, Singh RB, Ranjan P, Sharma SP, Pai VK. A novel manoeuvre in a case of foreign body esophagus: An unusual management of a usual presentation. Egyptian Journal of Anaesthesia 2016. [DOI: 10.1016/j.egja.2016.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Mridul Dhar
- Department of Anaesthesiology and Critical Care, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ram Badan Singh
- Department of Anaesthesiology and Critical Care, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Pushkar Ranjan
- Department of Anaesthesiology and Critical Care, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Shiv Prasad Sharma
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Vishal Krishna Pai
- Department of Anaesthesiology and Critical Care, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Katiyar R, Patne SCU, Dixit VK, Sharma SP. Primary Eosinophilic Gastritis in a Child with Gastric Outlet Obstruction. J Gastrointest Surg 2016; 20:1270-1. [PMID: 26768007 DOI: 10.1007/s11605-016-3074-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 01/02/2016] [Indexed: 01/31/2023]
Abstract
A 3-year-old girl presented with multiple episodes of vomiting, fever, and hematemesis for the past 2 months. Except for hemoglobin, her rests of the laboratory tests were unremarkable. Her barium X-ray showed absence of the duodenal bulb and the C-loop. Her endoscopy showed deformed stomach with multiple ulcers and diverticuli. The gastric outlet was not visualized. Distal gastrectomy with gastro-duodenal anastomosis was performed. Histopathological findings revealed transmural dense infiltrates of eosinophils, consistent with eosinophilic gastritis.
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Affiliation(s)
- Richa Katiyar
- Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221 005, U.P., India
| | - Shashikant C U Patne
- Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221 005, U.P., India.
| | - Vinod Kumar Dixit
- Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221 005, U.P., India
| | - Shiv Prasad Sharma
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221 005, U.P., India
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Tripathi BK, Gangopadhyay AN, Sharma SP, Kar AG, Mandal MB. In Vitro Evaluation of Carbachol and Endothelin on Contractility of Colonic Smooth Muscle in Hirschsprung’s Disease. Indian J Physiol Pharmacol 2016; 60:22-29. [PMID: 29953180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The hypomotility of colon observed in Hirschsprung’s disease (HD) has been attributed to congenital aganglionosis only. So far, it is not clear whether the contractility of colonic smooth muscle in this condition is altered or not. Therefore, the present study attempted to understand the contractile status of colonic segments of HD patients by examining carbachol and endothelin (ET-1) evoked colonic smooth muscle contractions in vitro . METHODS Contractile responses were recorded from strips of colonic segments obtained from HD patients, using organ bath preparations. Cholinergic agonist carbachol and ET-1 along with their antagonists were used to evoke contractile responses. Thereafter, the samples were histopathologically confirmed for HD. RESULTS Colonic strips of HD did not show any spontaneous contractions but responded to carbachol and ET-1 to a lesser extent. In HD, response of carbachol was blocked by atropine and hexamethonium by nearly 73% and 50% respectively. ET-1 induced contractile responses were blocked by ET-A and ET-B antagonist up to 40%, signifying the possible role of ET-A and ET-B receptors in HD colon contractility. CONCLUSION As evidenced by lack of spontaneous contractions and impaired carbachol and ET-1-induced contractile responses, it is concluded that, in addition to aganglionosis, decreased contractility of colonic smooth muscle may contribute to hypomotility observed in patients with HD.
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Pande PK, Sharma SP. A Record of Rotaloid Foraminifera from the Upper Permian-Lower Triassic Rocks of Kashmir, India. mejs 2015. [DOI: 10.4314/mejs.v7i2.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Pandey V, Gangopadhyay AN, Gupta DK, Sharma SP, Kumar V. Decortication through muscle-sparing axillary skin crease incision (MSASCI) in late paediatric empyema thoracic. Indian J Thorac Cardiovasc Surg 2015. [DOI: 10.1007/s12055-015-0400-7] [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: 11/28/2022] Open
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Pandey V, Gangopadhyay AN, Gupta DK, Sharma SP. Single stage management of a unique variant of congenital pouch colon with triplet fistula and normal anus. J Indian Assoc Pediatr Surg 2015; 20:148-9. [PMID: 26166988 PMCID: PMC4481629 DOI: 10.4103/0971-9261.154665] [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: 12/12/2022] Open
Abstract
Congenital pouch colon (CPC) in the female patient presents with highly variable and anomalous anatomy. We herein report the first case of CPC with uterus didelphys having normal anal opening, H-type vestibular fistula, two other fistulous communications between pouch colon and two vagina managed in a single stage with excellent postoperative outcome.
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Affiliation(s)
- Vaibhav Pandey
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ajay Narayan Gangopadhyay
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Dinesh Kumar Gupta
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Shiv Prasad Sharma
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Pandey V, Gangopadhyay AN, Gupta DK, Sharma SP, Kumar V. Novel technique of repair of large tracheo-esophageal fistula following battery ingestion in children: review of two cases. Pediatr Surg Int 2014; 30:537-9. [PMID: 24658970 DOI: 10.1007/s00383-014-3498-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2014] [Indexed: 11/26/2022]
Abstract
Surgical repair of acquired tracheo-esophageal fistula may result in tracheal stenosis or esophageal stricture. We used fistula with esophageal cuff as flap to repair the tracheal defect. Esophageal repair was performed by rotating ends through 90° in opposite direction. This technique offers excellent repair in a single stage.
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Pandey V, Gangopadhyay AN, Gupta DK, Sharma SP, Kumar V. Non-operative management of giant omphalocele with topical povidone-iodine and powdered antibiotic combination: early experience from a tertiary centre. Pediatr Surg Int 2014; 30:407-11. [PMID: 24509569 DOI: 10.1007/s00383-014-3479-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of the study was to evaluate topical povidone-iodine and topical powdered antibiotic combination (Polymyxin, Bacitracin and Neomycin) in initial non-operative management with delayed closure of the defect of giant omphaloceles. METHODS A prospective study was conducted between July 2010 and June 2013 including all neonates with giant omphalocele without signs of intestinal obstruction. All cases were managed by daily application of povidone-iodine (5% solution) followed by spraying topical powdered antibiotic combination to promote eschar formation and eventual epithelialisation. Record was made of sex, associated anomalies, length of stay, and thyroid function tests. RESULTS Twenty-four neonates with giant omphaloceles were treated with topical povidone-iodine and topical powdered antibiotic combination. No sac ruptures were observed in our series. All patients had a normal thyroid function test at presentation and after 10 days of initiation of treatment. Six patients have undergone delayed repair. CONCLUSION Topical povidone-iodine and powdered antibiotic combination promotes more rapid escharification and epithelialisation of the omphalocele than povidone-iodine alone. We also hypothesise that combination minimises the chances of hypothyroidism associated with use of povidone-iodine alone.
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Affiliation(s)
- Vaibhav Pandey
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India,
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Pandey V, Gangopadhyay AN, Tiwari P, Gupta DK, Sharma SP, Kumar V. Author's reply. J Cutan Aesthet Surg 2014; 7:138-9. [PMID: 25136224 PMCID: PMC4134653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Affiliation(s)
- Vaibhav Pandey
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India E-mail:
| | - AN Gangopadhyay
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India E-mail:
| | - Preeti Tiwari
- Senior Resident, Department of Oral & Maxillofacial Surgery, Trauma Center, BHU, Varanasi, Uttar Pradesh, India
| | - DK Gupta
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India E-mail:
| | - SP Sharma
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India E-mail:
| | - Vijayendar Kumar
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India E-mail:
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Kumar V, Ramaswami N, Pandey A, Shukla RC, Sen MR, Sharma SP, Gupta DK, Gangopadhyay AN. Clinico-immunological response to intratumoral versus intravenous neoadjuvant chemotherapy in advanced pediatric solid malignancies. Indian J Med Paediatr Oncol 2013; 34:80-4. [PMID: 24049292 PMCID: PMC3764749 DOI: 10.4103/0971-5851.116183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: There is minimal literature on the use of intralesional chemotherapy in the pediatric age group. We undertook this present study to evaluate the two modalities (intratumoral and intravenous) of giving chemotherapy in terms of toxicity of chemotherapy, hematological parameters, efficacy of chemotherapy in reduction in volume of the tumor as well as resectability of tumor with special emphasis on immunological parameters. Materials and Methods: Advanced cases of Wilms’ tumor and Neuroblastoma were included in the study. Intratumoral chemotherapy was given through 25 G spinal needle under aseptic precautions and ultrasound guidance in the same dose as in systemic chemotherapy. Intravenous group was given chemotherapy in the usual way. Reassessment was carried out after every course of chemotherapy. Results: Group A included 16 cases of Wilms’ tumor and 6 cases of neuroblastoma. In group B, there were 14 cases of Wilms’ tumor and 8 of neuroblastoma. Vomiting, diarrhea, mucositis, and thrombophlebitis were more common in the intravenous group (P<0.05). The fall in Immunoglobulin A, Immunogloblulin G, Immunoglobulin M, and T-cell rosetting was more common in the intravenous group (P<0.05). Seventy percent of patients had completely resectable tumor at the end of 6 doses of intratumoral chemotherapy as compared to 50% resectability in the intravenous group (P<0.05). Conclusion: Intratumoral chemotherapy, besides causing less of the adverse effects and increasing the resecability rate, also causes less suppression of the immune system. This may be offered as an alternative safe and effective modality of treatment for advanced solid tumors.
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Affiliation(s)
- Vijayendra Kumar
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Abstract
Hemangiomas are tumors identifed by rapid endothelial cell proliferation in early infancy, followed by involution over time. All other abnormalities are malformations resulting from anomalous development of vascular plexuses. The malformations have a normal endothelial cell growth cycle that affects the veins, the capillaries or the lymphatics and they do not involute. Hemangiomas are the most common tumors of infancy and are characterized by a proliferating and involuting phase. They are seen more commonly in whites than in blacks, more in females than in males in a ratio of 3:1.
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Affiliation(s)
- Tarun Ahuja
- Professor and Head, Department of Conservative Dentistry and Endodontics, Maharana Pratap College of Dentistry and Research Centre, Gwalior, Madhya Pradesh, India
| | - Nitin Jaggi
- Professor and Head, Department of Oral and Maxillofacial Surgery Maharana Pratap College of Dentistry and Research Centre, Gwalior Madhya Pradesh, India, e-mail:
| | - Amit Kalra
- Professor and Head, Department of Orthodontics and Dentofacial Orthopedics, Maharana Pratap College of Dentistry and Research Centre, Gwalior, Madhya Pradesh, India
| | - Kanishka Bansal
- Reader, Department of Orthodontics, Maharana Pratap College of Dentistry and Research Centre, Gwalior, Madhya Pradesh, India
| | - Shiv Prasad Sharma
- Lecturer, Department of Oral and Maxillofacial Surgery, Maharana Pratap College of Dentistry and Research Centre, Gwalior, Madhya Pradesh, India
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Kumar V, Singh A, Sharma SP, Srivastava A, Saxena A, Gangopadhyay AN. Clinical spectrum of neural tube defects with special reference to karyotyping study. J Pediatr Neurosci 2012; 7:82-4. [PMID: 23248680 PMCID: PMC3519089 DOI: 10.4103/1817-1745.102560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Neural tube defects are common congenital malformations of the central nervous system. Despite years of intensive epidemiological, clinical, and experimental research, the exact etiology of NTD remains rather complex and poorly understood. The present study attempted to look into the association of occurrence of NTD with reference to folic acid levels, along with karyotyping status. MATERIALS AND METHODS Detailed history was taken with emphasis on age of the baby and mother, parity, antenatal folic acid intake. Five milliliters of blood was drawn from all the babies and their mothers and divided equally in preheparinized vials (for karyotyping) and plain vials (for folic acid estimation). The total duration was 2 years. RESULTS The total number (n) in the study group was 75. The folic acid level was less in affected babies and their mother when compared to matched controls. Chromosomal defect was observed in nine of the 75 patients. Karyotyping defects were higher in children born to mothers of the age group 31-40 years and when their birth order was second. CONCLUSION Folic acid supplementation needs to be continued to prevent the occurrence of NTD, and the perinatal identification of NTD should alert one to the possibility of chromosomal abnormalities and prompt a thorough cytogenetic investigation and genetic counseling.
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Affiliation(s)
- Vijayendra Kumar
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Garg H, Sharma SP. Stochastic behavior analysis of complex repairable industrial systems utilizing uncertain data. ISA Trans 2012; 51:752-762. [PMID: 22795801 DOI: 10.1016/j.isatra.2012.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2011] [Revised: 06/26/2012] [Accepted: 06/26/2012] [Indexed: 06/01/2023]
Abstract
The purpose of this paper is to present a novel technique for analyzing the behavior of an industrial system stochastically by utilizing vague, imprecise, and uncertain data. In the present study two important tools namely Lambda-Tau methodology and particle swarm optimization are combinedly used to present a novel technique named as particle swarm optimization based Lambda-Tau (PSOBLT) for analyzing the behavior of a complex repairable system stochastically up to a desired degree of accuracy. Expressions of reliability indices like failure rate, repair time, mean time between failures (MTBF), expected number of failures (ENOF), reliability and availability for the system are obtained by using Lambda-Tau methodology and particle swarm optimization is used to construct their membership function. The interaction among the working units of the system is modeled with the help of Petri nets. The feeding unit of a paper mill situated in a northern part of India, producing approximately 200ton of paper per day, has been considered to demonstrate the proposed approach. Sensitivity analysis of system's behavior has also been done. The behavior analysis results computed by PSOBLT technique have a reduced region of prediction in comparison of existing technique region, i.e. uncertainties involved in the analysis are reduced. Thus, it may be a more useful analysis tool to assess the current system conditions and involved uncertainties.
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Affiliation(s)
- Harish Garg
- Department of Mathematics, Indian Institute of Technology Roorkee, Roorkee 247667, Uttarakhand, India.
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Kumar V, Kumar P, Pandey A, Gupta DK, Shukla RC, Sharma SP, Gangopadhyay AN. Intralesional bleomycin in lymphangioma: an effective and safe non-operative modality of treatment. J Cutan Aesthet Surg 2012; 5:133-6. [PMID: 23060708 PMCID: PMC3461790 DOI: 10.4103/0974-2077.99456] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Introduction: Lymphangiomas are benign hamartomatous lymphatic tumors. The mainstay of the therapy is surgical excision, but due to its infiltration along the nerves and muscles, total excision is not always possible. In the present study, we have evaluated the clinical profile of all the cases of lymphagiomas coming to our department and evaluated the efficacy of intralesional Bleomycin as a sclerosing agent in its management. Materials and Methods: In this prospective study, all patients were evaluated clinically and color Doppler ultrasonography (USG). The required dose was calculated as 0.5 mg/kg body weight, not exceeding 10 units at a time. The response was assessed clinically and on the basis of color Doppler USG. Results: Thirty-five patients of lymphangioma were included in the study. The neck region was the most common site of involvement. The response was excellent in 7 (20%), good in 26 (74.29%), and poor in 2 (5.71%) patients. The complications included fever, transient increase in size of swelling, local infection, intraluminal bleed, and skin discoloration in 10 patients. Conclusion: This therapy may be used as primary modality instead of surgery in selected group of patients.
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Affiliation(s)
- V Kumar
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, Uttar Pradesh, India
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Sharma K, Sharma SP, Lahiri SC. Spectrophotometric, Fourier transform infrared spectroscopic and theoretical studies of the charge-transfer complexes between methyldopa [(S)-2 amino-3-(3,4-dihydroxyphenyl)-2-methyl propanoic acid] and the acceptors (chloranilic acid, o-chloranil and dichlorodicyanobenzoquinone) in acetonitrile and their thermodynamic properties. Spectrochim Acta A Mol Biomol Spectrosc 2012; 92:212-224. [PMID: 22446770 DOI: 10.1016/j.saa.2012.02.072] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 02/11/2012] [Accepted: 02/17/2012] [Indexed: 05/31/2023]
Abstract
Methyldopa is a much used antihypertensive drug. It is the subject matter of study mostly for the determination and estimation of methyldopa in pharmaceutical properties. These considerations led us to study the charge-transfer interactions between methyldopa, a centrally acting antihypertensive agent of limited use with the known acceptors like o-chloranil (o-ClN), chloranilic acid (ClA) and dichlorodicyanobenzoquinone (DDQ). Methyldopa (MDP) formed beautifully colored complexes (having absorption maxima at 581 nm and 368 nm; 519 nm; 583.5 nm, 547 nm and 346 nm, respectively) with the acceptors mentioned before. The physico-chemical properties of the complexes were studied using UV-visible spectrophotometry and FTIR measurements. The composition, the accurate association constants and thermodynamics of the complexes were determined spectrophotometrically. Attempts were made to interpret the thermodynamics of complexes in terms of I(D)(V), E(A)(V) and hν(CT). Solid CT complexes between MDP+o-ClN, MDP+ClA and MDP+DDQ were prepared and FTIR spectra of the complexes were studied. The energies hν(CT) of the charge-transfer complexes and vertical ionization potential I(D)(V) of methyldopa were compared with the theoretical values of hν(CT) obtained from HOMO and LUMO of the donors and acceptors calculated using Density Function Theory utilizing different basis sets. The agreement between the results can be regarded to be reasonable. Oscillator strengths and dipole strengths of the complexes were determined theoretically and experimentally and the limitations of the calculations were outlined.
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Affiliation(s)
- K Sharma
- Vivekananda Mahavidyalaya, Haripal, Hooghly, West Bengal, India.
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Kumar V, Rathore RA, Gangopadhyay AN, Gupta DK, Sharma SP. Minimizing the postoperative complications of severe hypospadias using a simple technique. Annals of Pediatric Surgery 2012. [DOI: 10.1097/01.xps.0000412347.06720.64] [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: 11/25/2022] Open
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Srivastava PK, Gangopadhyay AN, Gupta DK, Sharma SP, Kumar V. Unusual content of omphalocele: a congenital mature cystic teratoma of falciform ligament of the liver. Pediatr Surg Int 2011; 27:1355-6. [PMID: 21499881 DOI: 10.1007/s00383-011-2898-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2011] [Indexed: 11/26/2022]
Abstract
Omphalocele is a congenital midline abdominal wall defect that results in herniation of intraabdominal contents covered by a lining of peritoneum and amnion. The severity of the defect often ranges from a minor herniation of the umbilical cord to a significant protrusion that includes large proportions of intestine and liver. We report unusual content of omphalocele that is congenital mature cystic teratoma of falciform ligament of liver which was confirmed by histopathology. This is a very uncommon entity and not described in world literature.
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Abstract
BACKGROUND Necrotizing fasciitis (NF) is a serious infection of soft tissues. This paper presents experience with pediatric NF and suitability of conservative surgery in its management. MATERIALS AND METHODS In this retrospective study, 70 patients of NF were managed during the study period of eight years. The study was divided into two time periods- first period (June 1998 to June 2001- group 1) and second period (June 2001 to June 2006- group 2). The parameters studied were age, sex, site of involvement and treatment. The treatment included intravenous antibiotics, supportive therapy and either aggressive (group 1) or conservative surgery (group 2). RESULTS Age of presentation ranged from 10 days to 11 years. Male to female ratio was 1.69:1. Back was the commonest site to be involved. Culture reports were polymicrobial in 70% with predominance of Staphylococcus species. Predisposing factors included malnourishment, boils, scratch injury, intravenous cannulation and injections. Conservative surgery had better outcome in terms of hospital stay, complications and cost of treatment. CONCLUSION NF is a serious and disease which requires immediate and all out attention. Early diagnosis, aggressive supportive treatment and conservative surgery improve survival.
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Affiliation(s)
- A Pandey
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221 005, U.P. India
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Abstract
Split notochord syndrome (SNS) is an extremely rare congenital malformation associated with anomalies of the vertebral column, gastrointestinal tract and central nervous system. Twenty cases of SNS associated with dorsal enteric fistula have been reported in literature till date. The present report describes a unique case of SNS associated with lumbosacral meningomyelocele, dorsal neuroenteric fistula and dorsal herniation of right kidney along with vessels. The neonate was well managed by excision of enteric fistula, closure of duramater of meningomyelocele and repair of posterior wall hernia after placement of kidney in renal fossa. This kind of entity is uncommon and not been reported earlier.
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Affiliation(s)
- Punit Srivastava
- Department of Pediatric Surgery, IMS, BHU, Varanasi, Uttar Pradesh, India
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Pandey A, Gangopadhyay AN, Sharma SP, Kumar V. Esophageal atresia with tracheo-esophageal fistula: Role of nebulized N-acetylcysteine in the outcome. J Indian Assoc Pediatr Surg 2010; 14:232. [PMID: 20419032 PMCID: PMC2858892 DOI: 10.4103/0971-9261.59612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- A Pandey
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, U.P., India
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Srivastava P, Gangopadhyay AN, Gupta DK, Sharma SP, Upadhyaya VD, Kumar V, Jaiman R. Atresia of ileocecal junction, ileocecal valve: Rare variants of bowel atresia. J Indian Assoc Pediatr Surg 2010; 14:117-8. [PMID: 20376255 PMCID: PMC2847138 DOI: 10.4103/0971-9261.57706] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Atresia of ileocecal junction and isolated atresia of ileocecal valve are rare types of intestinal atresia with very few reports in literature. We report two such cases. Radiology showed dilated ileal segment and distal micro colon in both the cases. At laparotomy there was atresia of ileocecal junction in the first case and isolated ileocaecal valve atresia with normal ileocecal junction in the other case. Both the babies were managed by ileocolic resection with an end to end anastomosis. The prognosis of ileocecal atresias is satisfactory.
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Hasan Z, Gangopadhyay AN, Gupta DK, Srivastava P, Sharma SP. Sutureless skin closure with isoamyl 2-cyanoacrylate in pediatric day-care surgery. Pediatr Surg Int 2009; 25:1123-5. [PMID: 19760198 DOI: 10.1007/s00383-009-2485-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2009] [Indexed: 11/26/2022]
Abstract
Importance of day-care surgery in pediatric age group is ever increasing and nowadays bulk of surgery is performed as a day-care procedure. Day-care procedure requires short intra-operative period and less postoperative complications. The introduction of tissue adhesive has been received enthusiastically since they may result in equivalent tensile strength-improved cosmetic appearance of the scar and lower infection rate when compared to sutures, staples and adhesive tape. We have used isoamyl 2-cyanoacrylate as a tissue adhesive for skin closure in day-care surgery. Novocryl is ideal for such procedure as it is a sterile, inert, non-toxic, biocompatible and bacteriostatic liquid topical skin adhesive containing isoamyl 2-cyanoacrylate formulation. We applied isoamyl 2-cyanoacrylate glue in 100 patients over skin cut margin after stitching subcutaneous tissue. Skin margin were held together by means of skin hook for 1-2 min. The cosmesis was better as there were no suture marks or lumpiness. There were no major complications in our study. Thus, isoamyl 2-cyanoacrylate can be considered as an alternative to skin suturing in the pediatric day-care surgery.
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Affiliation(s)
- Zaheer Hasan
- Department of Pediatric Surgery, IMS, BHU, Varanasi, India.
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Abstract
Ulceration is the most common complication of haemangioma and occurs in 5-15% of cases. The present study was carried out to evaluate the clinical features of ulcerated haemangioma and efficacy of the management protocol adopted by us over a period of 20 years. All patients with ulcerated haemangioma were evaluated on the basis of age at presentation, sex, rural or urban distribution and site of haemangioma. Treatment included application of topical antibiotic and systemic antibiotic and analgesic for pain. The total number of patients was 608. The male to female ratio was 1: 2.28. The rural:urban distribution was 2.43:1. The most common site of involvement was head and neck. Mean age of patients was 5.60 +/- 2.44 months. Mean size of haemangioma and ulceration was 47.30 +/- 20.67 cm(2) and 7.49 +/- 4.52 cm(2), respectively. The mean time for ulcer healing was 40.06 +/- 19.41 days. Ulcer size of more than 10 cm(2) took more time to heal. Response to treatment was satisfactory. Ulcerated haemangioma usually occurs before completion of 1 year of age; hence, every patient with haemangioma needs careful attention. Adequate treatment and regular follow up brings satisfactory response in the patients.
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Affiliation(s)
- Anand Pandey
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Gangopadhyay AN, Srivastava P, Upadhyaya VD, Hasan Z, Vijayendra KR, Sharma SP. Mature cystic teratoma in falciform ligament of the liver in an infant. Afr J Paediatr Surg 2009; 6:132-3. [PMID: 19661652 DOI: 10.4103/0189-6725.54785] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Srivastava P, Gangopadhyay AN, Upadhyaya VD, Sharma SP, Jaiman R. An unusual presentation of hydatid cyst in anterior abdominal wall. Kathmandu Univ Med J (KUMJ) 2009; 6:511-3. [PMID: 19483436 DOI: 10.3126/kumj.v6i4.1746] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hydatid disease is a parasitic infestation caused by the larval form of the cestode worm Echinococcus. The most commonly encountered form of the disease is visceral hydatid cyst caused by Echinococcus granulosus or dog tapeworm. Muscular involvement has been reported in only 3-4% cases. We are reporting this case because of its rarity, difficulty to diagnose clinically, dramatic response to medical treatment and to alert the reader of this rare infestation so that open biopsy will be avoided.
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Affiliation(s)
- P Srivastava
- Department of Pediatric Surgery, IMS, BHU, Varanasi, India.
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Pandey A, Gangopadhyay AN, Gopal SC, Kumar V, Sharma SP, Gupta DK, Sinha CK. Twenty years' experience of steroids in infantile hemangioma--a developing country's perspective. J Pediatr Surg 2009; 44:688-94. [PMID: 19361627 DOI: 10.1016/j.jpedsurg.2008.10.038] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Revised: 10/05/2008] [Accepted: 10/06/2008] [Indexed: 02/08/2023]
Abstract
BACKGROUND Hemangioma is a common vascular tumor. Though it involutes spontaneously, results are unpredictable. Steroid therapy is an effective mode of its regression. We present our experience of largest series and possible recommendations for treatment. MATERIALS AND METHODS A total of 2398 patients were treated during the study period of 20 years. They were given oral prednisolone, intralesional triamcinolone, or combination of both as per the protocol and followed for the response. Response to the treatment was graded as excellent, good, poor, or no response. RESULTS The male-to-female ratio was 1:2.3. In 81% of patients, hemangioma was noticed within first month of life. The commonest site of involvement was head and neck (57%). The commonest clinical presentation was discoloration and swelling. Mean age and size were 8.43 +/- 7.04 months and 23.64 +/- 20.13 cm(2). Response rate was highest for superficial type using any modality of treatment. Patients younger than 1 year showed better response (90.3%) in comparison with children older than 1 year (80.8%). The specific complications occurring were infections in 249 (12.4%), cushingoid facies and growth delay in 62 (3.1%), and hypertension in 51 (2.5%) patients. CONCLUSION Steroid therapy either oral or intralesional as per the requirement is an easy and safe modality. Results are good to satisfactory in most patients. The complications are minimal. If treatment is needed, it should be used as a first-line therapy, especially when cost is an important concern.
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Affiliation(s)
- Anand Pandey
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, UP, India
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Gangopadhyay AN, Upadhyaya VD, Gupta DK, Agarwal DK, Sharma SP, Arya NC. Histology of the terminal end of the distal rectal pouch and fistula region in anorectal malformations. Asian J Surg 2009; 31:211-5. [PMID: 19010766 DOI: 10.1016/s1015-9584(08)60089-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Until recently, surgeons have been posed with a dilemma---whether or not they should preserve the terminal end of the distal rectal pouch and the fistula region in anorectal malformations (ARMs). A detailed histological study of this region was conducted to establish a consensus for preserving or excising this region for reconstruction of ARMs. METHODS Histopathological examination using haematoxylin and eosin-stained sections of the terminal portion of the distal rectal pouch and proximal portion of the rectourogenital or rectoperineal connection was performed in 60 cases of high, intermediate and low ARMs. RESULTS Distorted internal sphincter was present in 93.3% of high, 90% of intermediate and 100% of low ARMs. The proximal fistula region was lined by transitional epithelium in 50% of cases, and anal glands were present in 83.3% and anal crypts in 68.3% of cases. The rectal pouch in the region of the internal sphincter and fistula was aganglionic in all cases. CONCLUSION This study shows that the terminal end of the distal rectal pouch and proximal fistula region possess distorted anal features with aganglionosis, and contradicts the recommendation that this region should be reconstructed in patients with malformations.
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Affiliation(s)
- A N Gangopadhyay
- Department of Paediatric Surgery Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
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Gangopadhyay AN, Rajeev R, Sharma SP, Upadhyaya VD, Arya NC, Kumar V, Gopal SC. Anterior intratumoural chemotherapy: a newer modality of treatment in advanced solid tumours in children. Asian J Surg 2009; 31:225-9. [PMID: 19010769 DOI: 10.1016/s1015-9584(08)60092-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Advanced and inoperable solid tumours in children have high mortality despite aggressive multimodal treatment. Intravenous chemotherapy is abandoned at times because of systemic toxicity. This study investigated intratumoural chemotherapy and compared it with intravenous chemotherapy. METHODS Forty children with advanced inoperable solid tumours (Wilms' tumour and neuroblastoma) were randomly allocated into two groups of 20. Group A was given intratumoural chemotherapy and group B was given intravenous chemotherapy. Both groups were compared for reduction in tumour size and volume, tumour resectability, histopathological changes and drug side effects. RESULTS Intratumoural chemotherapy was superior to intravenous chemotherapy in terms of reducing tumour size and volume (63% in group A vs. 22% in group B). The resectability was 70% in the intratumoural group compared with 40% in the intravenous group. The overall good histopathological response was 71% in group A as opposed to 0% in group B. Moreover, the incidence and severity of drug side effects and morbidity were less with intratumoural chemotherapy. Mortality was also low in group A (5%) compared to group B (20%). CONCLUSION Intratumoural chemotherapy can be offered as an effective and safe alternative treatment modality for advanced and inoperable Wilms' tumour and neuroblastoma.
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Affiliation(s)
- A N Gangopadhyay
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
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Sethi RR, Kumar A, Sharma SP. Quantification of groundwater recharge in a hard rock terrain of Orissa: a case study. Water Sci Technol 2009; 60:1319-1326. [PMID: 19717920 DOI: 10.2166/wst.2009.403] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A study was carried out to select the best method to estimate groundwater recharge in a hard rock terrain. Various standard empirical methods, soil-moisture balance method, water table fluctuation (WTF) method and commonly adopted norms set by Groundwater Estimation Committee (GEC), Govt of India were used to estimate recharge for the Munijhara watershed in the Nayagarh block of Orissa (India). The empirical formulae gave recharge rates ranging from 13 cm to 32 cm/year with average of 22.4 cm and standard deviation of 5.34, independent of other influencing factors like soil, topography and geology. The soil-moisture balance study indicated that recharge is more dependent on the continuous heavy rainfall total annual volume of rainfall. Recharge was limited at up to 10 mm per day, possibly due to presence of hard rock below the soil surface. The rise in water table depth was 3.45 m to 5.35 m with a mean rise of 4.5 m during the year 2006-2007. Annual groundwater recharge based on the WTF approach varied from 10.3 to 16.85 cm with a mean of 13.5 cm, standard deviation of 1.57 cm and coefficient of variation 11.57%. This recharge accounted for 8 to 14% of rainfall received. With a water budget approach based on GEC norms, recharge was calculated as 17 cm per year. The study showed that the magnitudes of annual groundwater recharge as estimated by the WST method and GEC norms are in conformity with other recent findings in India under the same climate conditions. Based on the results recharge structures could be planned in suitable locations to reduce fallow areas under the watershed.
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Affiliation(s)
- Ranu Rani Sethi
- Water Technology Center for Eastern Region, Bhubaneswar Orissa, India.
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Pandey A, Gangopadhyay AN, Sharma SP, Upadhyaya VD, Kumar V, Gopal SC, Gupta DK, Srivastava A. Placement of the peritoneal end of a ventriculoperitoneal shunt in the suprahepatic space: does it improve prognosis? Pediatr Neurosurg 2009; 45:6-10. [PMID: 19221457 DOI: 10.1159/000202618] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2007] [Accepted: 07/02/2008] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Hydrocephalus is a common pediatric problem. Ventriculoperitoneal shunts (VPS) are the most frequent operative procedures used to treat hydrocephalic children. The peritoneal end is usually placed in the general peritoneal cavity. We present an alternative site of peritoneal end placement in the suprahepatic space in an attempt to reduce the abdominal complications. MATERIAL AND METHODS All patients with a diagnosis of congenital hydrocephalus were included in the study. In group 1, the lower end of the VPS was placed in the suprahepatic space. Patients were evaluated for abdominal complications like pseudocyst formation, intestinal obstruction and blockage of the lower end of the VPS. The data were compared with those patients in whom the peritoneal end was placed in the general peritoneal cavity (group 2). RESULTS The total number of patients in groups 1 and 2 was 133 and 175, respectively. Complications in group 1 were dislodgement of the shunt in the general peritoneal cavity in 28 (21.05%), suprahepatic pseudocyst formation in 2 (1.5%) and blocked lower end in 2 patients (1.5%). In group 2, complications noted were pseudocyst formation in 5 (2.8%), blocked lower end in 25 (14.2%), intestinal obstruction in 9 (5.1%), inguinoscrotal migration in 10 (5.7%) and perforation of viscera in 6 patients (3.4%). The overall follow-up period ranged from 1 to 7 years. CONCLUSIONS Placement of the lower end of the shunt in the suprahepatic space can be advantageous to placing it in the general peritoneal cavity. The procedure is simple and results can be rewarding.
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Affiliation(s)
- A Pandey
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Gangopadhyay AN, Upadhyaya VD, Sharma SP. Neonatal surgery: a ten year audit from a university hospital. Indian J Pediatr 2008; 75:1025-30. [PMID: 19023525 DOI: 10.1007/s12098-008-0205-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Accepted: 07/10/2008] [Indexed: 11/29/2022]
Abstract
Neonatal surgery is the flagship and most challenging component of pediatric surgery, which is the youngest subspeciality of surgery. Neonatal surgery carried a survival rate of only 30% three decades ago. In the last decade there has been a significant change in the scenario. Earlier recognition and referral of these anomalies, availability of neonatal intensive care, better preoperative planning, decision, and techniques have lead to the change in the management. This is an audit into the outcome of neonatal surgery from one of the largest units in India over a ten year period. This audit reveals an across the board survival of 65-70% newborns after surgery on nearly two thousand case over a ten year period. It has an important message that while pediatric surgery units expand, risk stratification of surgical newborns and their treatment in suitable units is mandatory to maintain and improve these figures to match international standards over the next decade.
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Affiliation(s)
- A N Gangopadhyay
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
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Abstract
AIM Report of a series of 12 cases of juvenile polyposis coli. METHODS The study period was from 1995 to 2005. All the patients were treated by total colectomy with rectal mucosectomy and endorectal ileoanal pullthrough with or without ileal pouch formation. Covering ileostomy was avoided in all the cases. Time taken for the surgery, postoperative complications and continence were documented. RESULTS The mean operating time was 4.2 h (range: 4-5 h). The mean duration of hospital stay was 16.3 days (range: 15-18 days). The most common postoperative complication was pouchitis and perianal excoriation. Initially, all the patients were passing stools at an interval of 2 h, and after 3 weeks, the frequency has reduced to 6-8 stools per day. In the follow-up after 3 months, the frequency was 3-5 per day with minimal soiling. CONCLUSIONS Single-stage total colectomy with rectal mucosectomy and endorectal ileoanal pull-through without covering ileostomy and pouch formation is a safe and definitive treatment for juvenile polyposis coli if the patient selection is appropriate.
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