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Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
Official journal of the Indian Association of Pediatric Surgeons         
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ORIGINAL ARTICLE
Honey dressing in pediatric burns
AK Bangroo, Ramji Khatri, Smita Chauhan
July-September 2005, 10(3):172-175
DOI:10.4103/0971-9261.16970  
The medicinal properties of honey have been recognized since antiquity. Although used as an adjuvant method of accelerating wound healing from ancient times, honey has been sporadically used in the treatment of burns. Honey acts mainly as a hyperosmolar medium and prevents bacterial growth. Because of its high viscosity, it forms a physical barrier, and the presence of enzyme catalase gives honey an antioxidant property. Its high-nutrient content improves substrate supply in local environment promoting epithelialization and angiogenesis. In pediatric burn patients no exclusive study has been conducted using honey as a burn dressing. An attempt is being made to evaluate the effect of honey in the management of burns in pediatric patients.
  20 14,341 568
REVIEW ARTICLE
Congenital pouch colon - Then and now
Devendra K Gupta, Shilpa Sharma
January-March 2007, 12(1):5-12
DOI:10.4103/0971-9261.31081  
Congenital pouch colon (CPC), a condition associated with anorectal agenesis has been reported mainly from the Indian subcontinent though there have been few case reports from other areas. The pouch differs from a normal colon structurally, histologically and functionally. The management involves a diversion colostomy at birth with or without the excision of pouch followed by pull through. This review article attempts to compile all the available literature on pouch colon along with the authors' experience and discuss the relevant issues for proper diagnosis and management. A changing trend has been seen in the most common type of CPC seen over the years from complete congenital pouch colon that accounted for more than 70% of cases earlier to incomplete pouch colon that is more commonly seen now.
  20 10,466 631
ORIGINAL ARTICLE
Salmonella intestinal perforation: (27 perforations in one patient, 14 perforations in another) Are the goal posts changing?
JO Adeniran, JO Taiwo, LO Abdur-Rahman
October-December 2005, 10(4):248-251
DOI:10.4103/0971-9261.19275  
The pathology of salmonellosis after a faeco-oral transmission was first clearly described by Jenner in 1850. Over the years, the pathological manifestations in different tissues of the body have been described. The ileum is however mostly involved leading to enlarged Peyer's patches, ulceration, and sometimes bleeding and perforation. Efforts at control have largely been improvement in public water supply, safe disposal of waste, and general public health measures. Despite these measures, intestinal perforation from salmonellosis remains the commonest cause of emergency operation in children above 3 years. The incidence continues to rise, so also the mortality, despite new antibiotics and improvement in facilities in the hospitals. Even more disturbing is that we now see more perforations per patient, and more involvement of the colon. Three recently managed patients with multiple ileal/colonic perforations were reviewed. Presenting problems, delay in referral, choice of antibiotics and postoperative complications were noted. One patient had 27 perforations and another 14 perforations. Both survived. Is salmonella changing? Are our patients changing? Is the environment changing? Are the goal posts changing? This article details our recent experience with this dreadful disease, reviews the new literature and makes suggestions for the way forwards.
  13 9,086 314
ORIGINAL ARTICLES
Delayed presentation of anorectal malformations
Shandip Kumar Sinha, Ravi P Kanojia, Ashish Wakhlu, JD Rawat, SN Kureel, RK Tandon
April-June 2008, 13(2):64-68
DOI:10.4103/0971-9261.43023  PMID:20011470
Aims and Objectives: Delayed management of anorectal malformation (ARM) increases the surgical and functional complications for the patient. We defined "delayed presentation of ARM" and reviewed our patients with ARM to find out the incidence and causes of delayed presentation. Materials and Methods: Patients satisfying the criteria of "delayed presentation of ARM" were involved. Detailed information of each patient including the mode of presentation, associated anomalies, plan of management and follow-up was obtained from the hospital records. Results: Between 2003 and 2006, 43 patients satisfied our criteria of "delayed presentation of ARM". There were 21 males and 22 females. Seventeen of these males presented with low-type ARM. Eleven of them were managed by a single-stage procedure. These "delayed presenters" had to live with constipation, inadequate weight gain and parental anxiety for a greater time. Analysis of the outcomes showed more functional complications in patients who had undergone failed perineal surgery previously. In females with low ARM, the procedure of choice was anterior sagittal anorectoplasty (ASARP). Single stage surgery provides good outcomes for most of low type of ARMs. High-type ARMs in males and females were managed by a staged procedure. Conclusion: "Delayed presentation of ARM" is a major group of ARM in our setup. The management and results of their treatment are not different from those of the early presenters. The most common cause of delayed ARM is wrong advice given by the health care providers followed by inadequate treatment elsewhere. Corrective surgeries taking second attempt in perineum always produces poor outcomes.
  12 4,071 329
REVIEW ARTICLE
Management of Wilms' tumor: NWTS vs SIOP
Sushmita Bhatnagar
January-March 2009, 14(1):6-14
DOI:10.4103/0971-9261.54811  PMID:20177436
With the availability of several protocols in the management of Wilms' tumor, there is dilemma in the minds of the treating oncologists or pediatric onco-surgeons as to whether the child should receive upfront chemotherapy or should be operated upon primarily. It is necessary for us to understand why do we follow either of the protocols, NWTS which follows the upfront surgery principle or the SIOP which follows the upfront chemotherapy principle in all stages of the disease. While deciding which protocol to follow, it is imperative to know the pros and cons of the treatment strategies and also to study the outcome patterns in both the treatment regimes which is what this article highlights. In an attempt to compare all the differences in both the major protocols, it was realized that most of our patients in the Indian scenario present with advanced disease and thus poorer outcomes if intensive and appropriate treatment strategies are not utilized. Hence, it is imperative that we should study our own patients through the Indian Wilms' tumor study group and adopt the policies which improve the overall event free survival on a nationwide basis.
  11 8,482 1,287
ORIGINAL ARTICLE
Topical application of mitomycin-C in corrosive esophageal strictures
Arun Kumar, V Bhatnagar
January-March 2005, 10(1):25-27
DOI:10.4103/0971-9261.16071  
Introduction: Corrosive ingestion is the major cause of esophageal stricture in our country. Mitomycin-C, an anthracycline derived from Streptomyces caespitosus, has both antineoplastic and antiproliferative properties. Use of mitomycin-C have been well documented in various ophthalmologic procedures and laryngo-tracheal conditions where it has been shown that mitomycin-C inhibited fibroblast proliferation during the postoperative phase without damaging the mucosal and epithelial growth. This preliminary report documents the use of mitomycin-C in caustic stricture esophagus. Materials and Methods: A prospective study was carried out in ten known patients of caustic esophageal strictures. After taking informed consent patients were subjected to antegrade or retrograde esophageal dilatation under general anesthesia and mitomycin-C was applied topically by a 10 mm cottonoid sponge soaked in mitomycin-C solution (0.4 mg/ml) for 5 minutes at the stricture site. The procedure was repeated at 4 weekly intervals thereafter and need for further dilatation was assessed. Outcomes in terms of symptomatic relief and radiological evaluation were assessed after therapy and results were analyzed for effectiveness of mitomycin-C and compared with retrospective results of previous cases of corrosive ingestion managed at the same institution. Results: Total number of dilatations required were 34 (mean - 3.4) Two patients required single dilatation while two required six sessions. Symptomatic as well as radiological improvement was present in nine patients. Conclusions: Use of mitomycin-C seems to improve the outcome in patients of corrosive esophageal strictures. Patients who have undergone esophageal replacement also seem to benefit from mitomycin-C.
  10 9,589 252
Experience with 40 cases of congenital pouch colon
RK Ghritlaharey, KS Budhwani, DK Shrivastava, G Gupta, AS Kushwaha, R Chanchlani, M Nanda
January-March 2007, 12(1):13-16
DOI:10.4103/0971-9261.31082  
Aim : The aim of this study was to analyze the clinical and management aspect of congenital pouch colon. Materials and Methods : This retrospective study was carried out on 40 cases of congenital pouch colon managed in the department of paediatric surgery from 01, January 2000 to 31, December 2005. Results : The incidence of congenital pouch colon (CPC) in the present study was 11.290 % (40 of 354) of all anorectal malformations (ARM) and 19.60% (40 of 204) of high ARM. Of these 40 cases of CPC included in the study, 82.5% were male and 17.5% were female. The average age of presentation to hospital was 3.36 days with a range of 1-11 days; of these 25% patients were admitted with poor general condition. Preoperative diagnosis of CPC was possible in 75% of cases in our study. 60% ( n =24) of cases had incomplete pouch colon (Type III and IV) while 40% ( n =16) had complete pouch colon (Type I and II). Right transverse colostomy was done in 16 patients and colostomy at descending colon just proximal to pouch in two patients for incomplete (Type III and IV) CPC as a primary initial procedure. Ileostomy was done in 14 patients and window colostomy in three patients for complete (Type I and II) CPC. As definitive procedures, pouch excision and abdomino-perineal pull-through of colon was done in 17 patients, coloplasty and abdomino-perineal pull-through of coloplasty colon was done in four patients and pouch excision and abdomino-perineal pull-through of terminal ileum in four patients in our series. None of our patients underwent primary single stage procedure. Conclusion: (1) CPC comprises 11.290 % of all ARM and 19.60% of high ARM. (2) Right transverse colostomy was opted for incomplete pouch colon, while Ileostomy and window colostomy were opted for complete pouch colon as initial surgical procedures. (3) Staged surgical procedures for management of CPC were well tolerated in our series.
  10 5,850 417
REVIEW ARTICLE
Empyema thoracis: Surgical management in children
Prema Menon, Ravi Prakash Kanojia, K.L.N Rao
July-September 2009, 14(3):85-93
DOI:10.4103/0971-9261.57698  PMID:20376247
Empyema thoracis can produce significant morbidity in children if inadequately treated. Correct evaluation of the stage of the disease, the clinical condition of the child and proper assessment of the response to conservative treatment is crucial in deciding the mode of further surgical intervention. This ranges from intercostal chest tube drainage and video-assisted thoracoscopic surgery to open decortication. Surgical decortication becomes mandatory in neglected cases; it gives very gratifying results ameliorating the disease rapidly and is well tolerated by young patients. This article reviews the current literature and discusses the important considerations while managing these patients. Indications for surgery are highlighted, based on our large experience at a tertiary care center.
  10 4,630 572
Pectus excavatum, pectus carinatum and other forms of thoracic deformities
Amulya K Saxena
July-September 2005, 10(3):147-157
DOI:10.4103/0971-9261.16964  
This review article covers the spectrum of congenital thoracic wall deformities along with their historical background. Willital's classification divides these deformities into 11 types - funnel chest (4 types), pigeon chest (4 types), and combination of funnel and pigeon chest, chest wall aplasia and cleft sternum. Records of patients at our center comprised 90% depression deformities, 6% protrusion deformities, 3% combined depression-protrusion deformities and 1% other forms. Mild forms of abnormalities warrant the wait- and-watch approach during the first 4-5 years. The deformities manifest primarily during the pubertal spurt often with rapid progression with subjective complaints like dyspnea, cardiac dysthesia, limited work performance and secondary changes. Operative correction in young adults is more favorable in mild cases. The Willital technique has been the standard technique for the correction of pectus excavatum, pectus carinatum and other combined forms of deformities at our center with excellent long term results. The Nuss procedure and the Pectus Less Invasive Extrapleural Repair (PLIER) technique for pectus excavatum and pectus carinatum have also been described in this article. Surgical correction for Poland's syndrome is reserved for patients with severe aplasia of the ribs with major depression deformity. Sternal defects including various types of ectopia cordis are discussed. Even after surgical correction, there is significant reduction in the total capacity and inspiratory vital capacity of the lungs, probably a result of the decreased compliance of the chest wall. However, the efficiency of breathing at maximal exercise improves significantly after operation.
  10 38,384 501
CASE REPORT
Isolated hepatic tuberculosis
AK Bangroo, Amit Singh Malhotra
April-June 2005, 10(2):105-107
DOI:10.4103/0971-9261.16474  
Hepatic tuberculosis is usually associated with an active pulmonary or miliary tuberculosis, but rarely localizes as a liver tumor mass. The clinical presentation of isolated liver tuberculosis is so rare and atypical that it challenges the clinical acumen of the treating physician. Diagnostic modalities like ultrasound and computed tomography can miss the diagnosis. Ultimately, the diagnosis is confirmed by demonstrating an acid fast Mycobacterium in aspirated pus or necrotic material.
  9 9,943 325
ORIGINAL ARTICLES
Spectrum of head and neck cancer in children
Subhabrata Sengupta, Ranabir Pal, Somnath Saha, SP Bera, Indranil Pal, Isha Preet Tuli
October-December 2009, 14(4):200-203
DOI:10.4103/0971-9261.59601  PMID:20419020
Aim: To assess the incidence of different head and neck cancers in pediatric age group in a referral hospital. Methods: In this prospective study, children below the age of 12 years underwent a thorough clinical, ENT examination and the diagnosis was conformed histologically in all the cases. Results: Fifty-three were diagnosed to be suffering from different head and neck neoplasms among 21,216 children (0.25%). Male-to-female sex distribution was 1.78:1. The lymphomas were the most common (43.39%) followed by the rhabdomyosarcoma (20.75%) and the nasopharyngeal carcinoma (15.09%). Of the lymphomas, the non-Hodgkin's lymphoma was predominant (26.41%). Other lesions were thyroid carcinomas and mucoepidermoid carcinoma of parotid. Conclusions: Malignancy should always be considered in the differential diagnosis of masses in the head and neck region in children.
  9 4,051 286
CASE REPORT
Gastric outlet obstruction without esophageal involvement: A late sequelae of acid ingestion in children
Shyam Sharma, PR Debnath, LD Agrawal, Vipul Gupta
January-March 2007, 12(1):47-49
DOI:10.4103/0971-9261.31094  
Accidental corrosive ingestion is not a rare occurrence in children because of easy access to strong household cleansers. Gastric injury as a predominant finding following acid ingestion in pediatric age group is less widely known with a few cases being reported in Indian literature. We report two such cases of gastric outlet obstruction following accidental ingestion of dilute acid. Both children have typical clinical presentation just 4-6 weeks after the ingestion. Upper GI endoscopy and barium meal studies confirmed the diagnosis. Early surgical intervention resulted in a satisfactory recovery. Both patients are doing well on follow up.
  8 6,660 309
ORIGINAL ARTICLE
Preputial retraction in children
Abhinav Agarwal, Anup Mohta, Ritesh K Anand
April-June 2005, 10(2):89-91
DOI:10.4103/0971-9261.16468  
OBJECTIVE: The aim of the study was to assess preputial retractability in children at various ages. MATERIALS AND METHODS: Nine hundred and sixty boys attending the hospital were included in the study. Children with hypospadias or history of preputial manipulation were excluded. Preputial anatomy was studied and subjects were classified into five groups as described by Kayaba et al . RESULTS: The prepuce could not be retracted at all so as to make even the external urethral meatus visible in 61.4% children aged 0-6 months while this decreased to only 0.9% in children aged 10-12 years. At the other end of the spectrum, while prepuce could not be fully retracted in any child below 6 months, it could be done in about 60% in the age group of 10-12 years. CONCLUSION Preputial nonseparation is the major cause of preputial nonretraction in the pediatric age group. Prepuce spontaneously separates from the glans as age increases and true phimosis is rare in children. Surgical intervention should be avoided for nonseparation of prepuce.
  8 23,771 372
Anorectal malformations in children
Pranshu Bhargava, JK Mahajan, Ajay Kumar
July-September 2006, 11(3):136-139
DOI:10.4103/0971-9261.27242  
Background/Purpose: Anorectal malformations are one of the most common congenital defects. This study was undertaken to study the hospital incidence of anorectal malformations (ARM), frequency of various types of defects, their sex distribution and the spectrum of anomalies associated with ARM. The effect of presence of an associated defect on mortality and morbidity was also studied. Materials and Methods: One hundred consecutive children attending the pediatric surgery department were included in this study. A detailed history was taken, and examination was performed for the primary as well as the associated defects. Appropriate investigations like invertogram, cologram were done wherever indicated. Management was as per the standard protocol. The data was recorded and analyzed. Results: Out of the 100 patients, 51 were males and 49 females. One out of every 6.62 admission was for ARM. Twenty percent of the female babies had high, 76% intermediate and 4% had low anomalies, whereas 80.39% males had high, 3.92% intermediate and 15.6% showed low malformations. Ten percent of the patients had pouch colon. Associated anomalies were seen in 33 patients - 20 males and 13 females; 19 in high, 10 in intermediate, 1 in low group and 3 children with cloacal malformations. Associated defects seen were urogenital (17%), cardiovascular (7%), gastrointestinal (9%), genital (5%) and limb defects (7%). There were 8 deaths, and complications were seen in 13 patients. Ten patients had two or more defects associated with ARM. Conclusions: Anorectal malformations occurred equally in males and females. Females had intermediate defects more frequently, rectovestibular fistula being the commonest. Males were more likely to have high lesions; anorectal agenesis without fistula was the commonest defect. The most common associated defects seen were vesicoureteric reflux and esophageal atresia. Complications were seen more commonly in males with high lesions. There was a significant association between presence of an associated defect and mortality and morbidity.
  8 7,649 459
ORIGINAL ARTICLES
Salvage hypospadias repairs
V Sripathi, M Satheesh, K Shubha
October-December 2008, 13(4):132-136
DOI:10.4103/0971-9261.44763  PMID:20011495
Aim: Review of our experience and to develop an algorithm for salvage procedures in the management of hypospadias cripples and treatment of urethral strictures following hypospadias repair. Methods: This is a retrospective review of hypospadias surgeries over a 41-month period. Out of a total 168 surgeries, 20 were salvage/re-operative repairs. In three children a Duplay repair was feasible, while in four others a variety of single-stage repairs could be done. The repair was staged in seven children - buccal mucosal grafts (BMGs) in five, buccal mucosal tube in one, and skin graft in one. Five children with dense strictures were managed by dorsal BMG inlay grafting in one, vascularized tunical onlay grafting on the ventrum in one, and a free tunical patch in one. Three children were treated by internal urethrotomy and stenting for four weeks with a poor outcome. Results: The age of children ranged from 1.5-15 years (mean 4.5). Follow-up ranged from 3 months to 3.5 years. Excellent results were obtained in 10 children (50%) with a well-surfaced erect penis and a slit-like meatus. Glans closure could not be achieved and meatus was coronal in three. Two children developed fistulae following a Duplay repair and following a staged BMG. Three repairs failed completely - a composite repair broke down, a BMG tube stenosed with a proximal leak, and a stricture recurred with loss of a ventral free tunical graft. Conclusions: In salvage procedures performed on hypospadias cripples, a staged repair with buccal mucosa as an inlay in the first stage followed by tubularization 4-6 months later provides good results. A simple algorithm to plan corrective surgery in failed hypospadias cases and obtain satisfactory results is devised.
  8 3,649 346
REVIEW ARTICLE
Tissue engineering: Present concepts and strategies
Amulya K Saxena
January-March 2005, 10(1):14-19
DOI:10.4103/0971-9261.16069  
  8 14,257 601
CASE REPORTS
Partial duplication of vas deferens: How important is it?
Ayse Karaman, Ibrahim Karaman, Beytullah Yagiz, Yusuf Hakan Cavusoglu
October-December 2010, 15(4):135-136
DOI:10.4103/0971-9261.72437  PMID:21170196
This study reports a 1-year-old boy with unilateral partial duplication of vas deferens, diagnosed during surgery for undescended testis. Pediatric surgeons need to be aware of this kind of anomaly in order to avoid injury to this vital structure.
  7 3,355 104
EDITORIAL
Congenital pouch colon: Present lacunae
Devendra K Gupta
January-March 2007, 12(1):1-2
DOI:10.4103/0971-9261.31079  
  7 4,359 396
ORIGINAL ARTICLE
Role of laparoscopic cholecystectomy in children
Sanjay N Oak, SV Parelkar, T Akhtar, R Pathak, N Vishwanath
April-June 2005, 10(2):92-94
DOI:10.4103/0971-9261.16469  
The present study is undertaken to establish the usefulness of laparoscopic cholecystectomy and to know its merits and demerits as compared to open cholecystectomy in children. In all, 28 patients who underwent cholecystectomy (8 open and 20 laparoscopic cholecystectomy) in B.Y.L. Nair hospital between July 1999 and March 2004 were analyzed. Calculous cholecystitis was found to be the most common indication for surgery. Operative time for laparoscopic cholecystectomy was more than that in open cholecystectomy in the early phase of laparoscopy, which got reduced as we gained experience. The requirement of parenteral antibiotics and analgesics and the duration of stay were significantly shorter with laparoscopy. The advantages for a child in laparoscopic cholecystectomy as compared to open cholecystectomy are minimal pain, avoidance of an upper abdominal incision, cosmesis and shorter duration of hospitalization with quick return to home and school. Thus, laparoscopic cholecystectomy is safe and efficacious in children.
  7 6,954 206
Therapeutic use of stem cells in congenital anomalies: A pilot study
Shilpa Sharma, DK Gupta, P Venugopal, Lalit Kumar, S Dattagupta, MK Arora
October-December 2006, 11(4):211-217
DOI:10.4103/0971-9261.29603  
Introduction: Stem cells with potential to transform into healthy cells and repair damaged cells may prove beneficial in various congenital malformations. Aim: To explore the use of stem cells in liver cirrhosis and meningomyelocele. Materials and Methods: During July 2005 to July 2006, stem cells were used in 27 patients; 12 with liver cirrhosis and 15 with meningomyelocele. Autologous stem cells were injected during definite surgery into hepatic artery and portal vein or hepatobiliary radicles for liver cirrhosis or spinal cord and caudal space for meningomyelocele. The pre-operative status of the patient served as control for that patient. Results: The patients with liver cirrhosis were between 1.5 and 9 months (mean 4.12 months). Liver cirrhosis was due to extra hepatic biliary atresia (EHBA); neonatal hepatitis and choledochal cyst in 8; 2 and 2 patients, respectively. About five patients expired due to late presentation and ongoing cirrhosis. Follow up results evaluated at 3-12 months (n=7) showed absence of cholangitis (4/7); yellow stools (5/7); decreased liver firmness (3/7); improved liver functions (6/7) and improved appetite (6/7). Hepatobiliary scan was excretory in 6/7 with improved uptake in 4/7. Histopathology repeated after stem cells demonstrated comparative improvement in fibrosis in three. The meningomyelocele patients were between 0 and 1 month; 1-5 months, and 1-4 years in 5; 8 and 2 cases, respectively. 5 had history of rupture. 3 had undergone meningocele repair in past with neurological deficits. Redo surgery for tethered cord was done in 1. Follow up (3-11 months) in 14 cases showed improved power in 4 (28%), dramatic recovery in 3 (22%), and status quo in 7 (50%). One patient is still under observation. Conclusion: Initial use of stem cells in EHBA and meningomyelocele has shown beneficial results. However, long-term evaluation with randomized-controlled trials is essential to draw further conclusions.
  7 7,936 314
ORIGINAL ARTICLES
Outcome analysis of shunt surgery in hydrocephalus
Ashraf Ahmed, Gursev Sandlas, Paras Kothari, Dinesh Sarda, Abhaya Gupta, Parag Karkera, Prashant Joshi
July-September 2009, 14(3):98-101
DOI:10.4103/0971-9261.57700  PMID:20376249
Aim: To study the clinical outcome of shunt surgeries in children suffering from hydrocephalus. Methods: A prospective study of 50 children with hydrocephalus who underwent a ventriculo-peritoneal shunt insertion over a period of two years. These patients were then followed up for shunt related complications, shunt revisions and outcome. Results : Twenty six of the 50 patients (52%) suffered from complications. The most common complications were shunt blockage (n=7) and shunt infection (n=6). These complications necessitated repeated shunt revisions. Conclusions: Infective complications of hydrocephalus are more likely to leave behind an adverse neurological outcome in the form of delayed milestones and mental retardation.
  7 4,653 299
Vaginal agenesis: Experience with sigmoid colon neovaginoplasty
Jiledar Rawat, Intezar Ahmed, Anand Pandey, Tanvir R Khan, Sarita Singh, Ashish Wakhlu, Shiv N Kureel
January-March 2010, 15(1):19-22
DOI:10.4103/0971-9261.69136  PMID:21180499
Aim: Objective of this study is to report our experience with sigmoid vaginoplasty in adolescents. Materials and Methods: A retrospective study of children with vaginal atresia and Mayer-Rokitansky-Kuster-Hauser syndrome. The sigmoid segment was used for vaginoplasty in all the cases. Results: Eight children were studied over a period of 7 years. The postoperative complications were ileus in 2, mucosal prolapse of the neovagina in 1, and minor wound infection in 1 patient. Seven patients are on regular follow-up. All the neovaginas were patent and functional. One patient had unacceptable perineal appearance, that is, badly scarred perineum as a late complication. None of the patients had vaginal stenosis or excessive mucus discharge, during follow-up visits. Out of the 7 patients, 2 patients are sexually active and satisfied. Conclusions: Sigmoid vaginoplasty is a safe and acceptable procedure for vaginal agenesis with good cosmetic results and acceptable complications rate. Sigmoid colon vaginoplasty is the treatment of choice because of its large lumen, thick walls resistant to trauma, adequate secretion allowing lubrication, not necessitating prolonged dilatation, and short recovery time.
  7 9,993 211
Embryogenesis of bladder exstrophy: A new hypothesis
Bharati Kulkarni, Navin Chaudhari
April-June 2008, 13(2):57-60
DOI:10.4103/0971-9261.43017  PMID:20011468
Aims and Objective: To postulate a hypothesis to explain the embryogenesis of exstrophy bladder based on our clinical observations. Materials and Methods: In 27 cases of exstrophy, we measured the distance between the lowermost inguinal skin crease to the root of the penis (clitoris) (B) and the distance between the penis (clitoris) and the scrotum (labia majora) (C). These were compared with age, height and XP distance (distance between xiphisternum and symphysis pubis) matched control group of normal children. The distance between the lowermost inguinal skin crease and the penis (clitoris) (A) was measured in control group. Results: The observation was A = B + C. This implies that in exstrophy bladder, the position of the penis (clitoris) has moved cephalad from the lower border of A to the junction of B and C. Conclusion: Based on the observations, we postulate that abnormal origin of genital tubercle may be the cause of exstrophy bladder. The abnormal origin of primordia of the genital tubercle in more cephalad direction than normal causes wedge effect, which will interfere with the medial migration of the mesoderm as well as the midline approximation of mesodermal structures in the lower abdominal wall, thereby resulting in the exstrophy of bladder.
  7 4,105 285
REVIEW ARTICLE
Pediatric rhabdomyosarcomas and nonrhabdomyosarcoma soft tissue sarcoma
Sandeep Agarwala
January-March 2006, 11(1):15-23
DOI:10.4103/0971-9261.24632  
Tumors arising from the soft tissues are uncommon in children, accounting for about 6% of all childhood malignancies. More than half (53%) of these originate from the striated muscles and are called rhabdomyosarcomas (RMS) the remaining are nonrhabdomyosarcoma soft tissue sarcomas (NRSTS). Almost two-thirds of RMS cases are diagnosed in children <6 years of age. They can arise at varied locations like the head and neck region, genitourinary tract, extremities, trunk and retroperitoneum. Pathologically RMS is now classified as superior, intermediate and poor outcome histologies. For stratification of treatment and also comparison of results the RMS are now staged both by the clinical grouping and the TNM staging systems. The ultimate outcome depends on the site, extent of disease and histology. Currently, approximately 70% of the patients survive for 5 years or more and are probably cured. This is credited to the use of multi-modal, risk-adapted therapy, refinements in tumor grouping and better supportive care which has emerged out of cooperative studies like Intergroup Rhabdomyosarcoma Study (IRS) and the International Society of Pediatric Oncology studies (SIOP). The treatment involves chemotherapy, radiotherapy and organ/function preserving surgery. The gold standard chemotherapy is still vincristine, actinomycin D and cyclophosphamide (VAC) regime with high doses of intensity bone marrow rescue with colony stimulating factors. The NRSTS are rare and of heterogenous histologies and so it has been difficult to arrive at a treatment strategy for these. What is definitely understood is that these are usually immature and poorly differentiated tumors that respond poorly to chemotherapy and so surgical resection forms the mainstay of treatment with adjuvant radiotherapy and chemotherapy to prevent local recurrences. In all likelihood, the molecular analysis of RMS will further refine current classification schemes and knowledge of genetic features of the tumors will significantly improve the ability of investigators to identify patients at lower or higher risk of treatment failures, thus paving the way for advances in risk-based therapy.
  7 7,868 353
REVIEW ARTICLES
Psychological issues in cleft lip and cleft palate
Avinash De Sousa, Shibani Devare, Jyoti Ghanshani
April-June 2009, 14(2):55-58
DOI:10.4103/0971-9261.55152  PMID:20671846
Vocational and social issues affect rehabilitation and development of patients with cleft lip and cleft palate. However, psychological problems like lowered self esteem and difficulties in social interaction have also been noted in them. Not many pediatric reconstructive surgery teams have a psychiatrist on their panel. It is likely that psychological problems are higher in incidence than literature actually suggests. Hence it is very essential that such cases are identified by the surgical team to maximize positive outcome of surgery and rehabilitation. This study discusses psychological issues revolving around cleft lip and cleft palate along with lacunae in many psychological research studies.
  7 7,344 569
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  2005 - Journal of Indian Association of Pediatric Surgeons | Published by Wolters Kluwer - Medknow 

Online since 1st May '05