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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 ARTICLES
Management of child victims of acute sexual assault: Surgical repair and beyond
Minakshi Sham, Dasmit Singh, Uma Wankhede, Abhijeet Wadate
July-September 2013, 18(3):105-111
DOI:10.4103/0971-9261.116043  PMID:24019641
Aim: To evaluate the outcome of definitive repair of anogenital injuries (AGI) in child victims of acute sexual assault. settings and Design: It is a prospective study of emergency care provided to child victims of acute sexual assault at a tertiary care Pediatric Surgical Unit in Maharashtra, India. Material and Methods : Out of 25 children, who presented during January 2009-December 2010 with suspected sexual assault, five children (one male and four female, between 4-9 years of age), had incurred major AGI. These children underwent definitive repair and a diverting colostomy. Perineal pull-through was performed in the male child with major avulsion of rectum. One 4-year-old girl with intraperitoneal vaginal injury required exploratory laparotomy in addition. Results : The postoperative period and follow-up was uneventful in all our patients. Four out of five patients have excellent cosmetic and functional outcome with a follow-up of 2-4 years. Our continence results are 100%. Conclusion : Children with acute sexual assault need emergency care. To optimally restore the distorted anatomy, all major AGI in such children should be primarily repaired by an expert, conversant with a child's local genital and perineal anatomy. Along with provision of comprehensive and compassionate medical care, prevention of secondary injuries should be the ultimate goal.
  44,876 178 -
CASE REPORTS
Thoracoschisis with limb agenesis
Nirmal C Bhattacharyya, Manoj Gogoi, Pradip K Deuri
April-June 2012, 17(2):78-79
DOI:10.4103/0971-9261.93972  
A rare case of thoracoschisis, diaphragmatic and supraumbilical abdominal wall defect with right upper limb agenesis in a neonate is reported.
  43,021 107 -
ORIGINAL ARTICLES
"Bird-Wing" abdominal phalloplasty: A novel surgical technique for penile reconstruction
Minu Bajpai
April-June 2013, 18(2):49-52
DOI:10.4103/0971-9261.109351  PMID:23798805
Aim: To describe a technique of phalloplasty that is devoid of donor site scarring and suitable for urethral inlay and penile prosthesis in subsequent stages in cases of aphallia. Materials and Methods: Four patients with various disorders of sex development with 46 XY and severe penile deficiency, including one with complete androgen insensitivity syndrome who was initially raised as female, have been operated using a "Bird Wing" lower abdominal skin crease incision. Results: The patients' age ranged from 6 to 17 years with preoperative stretched penile lengths between 1 and 2.5 cm. Phallic sizes between 7.5 and 12.5 cm was achieved leaving the donor site unremarkable with lower abdominal skin crease linear scar and excellent postoperative recovery. Conclusions: This phalloplasty technique can be utilized as a definitive procedure in many situations of penile insufficiency. Subsequent stages of urethral repair and insertion of penile prosthesis can be easily added.
  37,963 725 -
REVIEW ARTICLE
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.
  36,041 479 10
CASE REPORTS
Epidermoid cyst of clitoris mimicking clitoromegaly
Satish Kumar Aggarwal, Vivek Manchanda, Nitin Pant
January-March 2010, 15(1):23-24
DOI:10.4103/0971-9261.69137  PMID:21180500
Clitoromegaly in pediatric and adolescent age group is usually indicative of a disorder of sexual differentiation. We report a girl child presenting with clitoral enlargement due to an epidermoid cyst. The cyst was excised with complete cosmetic recovery.
  29,708 123 1
Concealed diphallus :a Case report and review of the literature.
KK Sharma, R Jain, SK Jain, A Purohit
January-March 2000, 5(1):18-21
ABSTRACT: Duplication of the penis is an extremely rare anomaly. Approximately 100 cases have been reported since the first case report by Wecker in 1609. There are broadly three types of diphallus,viz. true diphallus with two independent penises, bifid phallus that may be glandular or complete and pseudodiphallus having a rudimentary phallus in addition to the normal penis. Numerous associated genitourinary and gastrointestinal anomalies have been described with diphallus. We encountered a complete bifid phallus in a 2 year old boy, with epispadias and a yentral preputial hoo, making the diphallic organ completely buried within it. In our exhaustive review of the literature, we did not come across any other case of this variety of the penile duplication that we termed the 'concealed or buried diphallus'. We did the corrective surgery in one stage with a good result.
[ABSTRACT]   Full text not available   
  27,461 0 -
REVIEW ARTICLE
Voiding dysfunction - A review
V Sripathi
October-December 2005, 10(4):229-236
DOI:10.4103/0971-9261.19272  
In a child who is toilet trained the sudden onset of daytime wetting with frequency or urgency is alarming to the parents. Initially this subject was subdivided into a number of descriptive clinical conditions which led to a lot of confusion in recognition and management. Subsequently, the term elimination dysfunction was coined by Stephen Koff to emphasise the association between recurrent urinary infection, wetting, constipation and bladder overactivity. From a urodynamic point of view, in voiding dysfunction, there is either detrusor overactivity during bladder filling or dyssynergic action between the detrusor and the external sphincter during voiding. Identifying a given condition as a 'filling phase dysfunction' or 'voiding phase dysfunction' helps to provide appropriate therapy. Objective clinical criteria should be used to define voiding dysfunction. These include bladder wall thickening, large capacity bladder and infrequent voiding, bladder trabeculation and spinning top deformity of the urethra and a clinically demonstrated Vincent's curtsy. The recognition and treatment of constipation is central to the adequate treatment of voiding dysfunction. Transcutaneous electric nerve stimuation for the treatment of detrusor overactivity, biofeedback with uroflow EMG to correct dyssynergic voiding, and behavioral therapy all serve to correct voiding dysfunction in its early stages. In established neurogenic bladder disease the use of Botulinum Toxin A injections into the detrusor or the external sphincter may help in restoring continence especially in those refractory to drug therapy. However in those children in whom the upper tracts are threatened, augmentation of the bladder may still be needed.
  23,782 687 -
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.
  19,980 348 8
CASE REPORT
Giant pseudocyst of the spleen: A case report and review of the literature
K Kalinova
July-September 2005, 10(3):176-178
DOI:10.4103/0971-9261.16971  
Splenic cysts are rare lesions. Primary cysts have a cellular lining that can be caused by congenital events or parasitic infection (Echinococcus). Secondary cysts have no cellular lining and may be of hemorrhagic, serous, inflammatory, or degenerative origin. We report a case of pseudocyst treated successfully by splenectomy, and we review the literature.
  18,165 340 4
ORIGINAL ARTICLES
Congenital pouch colon in girls: Genitourinary abnormalities and their management
Rajiv Chadha, Niyaz Ahmed Khan, Shalu Shah, Nitin Pant, Amit Gupta, Subhasis Roy Choudhury, Pinaki Ranjan Debnath, Archana Puri
July-September 2015, 20(3):105-115
DOI:10.4103/0971-9261.159015  PMID:26166979
Aims: To discuss the assessment and management of genitourinary (GU) tract abnormalities in 21 girls with Types I-III congenital pouch colon (CPC), studied over a period of 10 years. Materials and Methods: Assessment included clinical and radiological assessment, examination under anesthesia (EUA), endoscopy of the lower GU tract, and evaluation of the surgical findings, operative procedures for the GU anomalies, and the results of management. Results: Initial examination of the external genitalia showed a "clover-leaf" appearance (n = 6) and a single perineal opening (n = 6). In 9 patients, the openings of the urethra and double vagina were seen, of which a vestibular fistula was seen in 5 and an anterior perineal fistula in 1. Seventeen patients (81%) had urinary incontinence (UI) - partial in 10, and complete in 7. Renal function tests, X-ray sacrum, and abdominal US were normal in all patients. Micturating cystourethrogram (n = 9) showed a wide, bladder neck incompetence (BNI) with reduced bladder capacity in seven patients. EUA and endoscopy revealed a septate vagina in all patients and the urethral opening at a "high" position (n = 14) or at a relatively normal or "low" position (n = 7). In 8 patients, the intervaginal septum was thick and fleshy. Endoscopy showed a short, wide urethra, an open incompetent bladder neck, poorly developed trigone, and reduced bladder capacity in the patients with UI. The fistula from the colonic pouch opened in the proximal urethra (n = 4), high in the vestibule (n = 3), low in the vestibule (n = 8), perineum just posterior to the vestibule (n = 1), and undetermined (n = 5). Vaginoscopy (n = 8) showed normal cervices in all and cervical mucus in 4 patients. The subtypes of CPC were Type I CPC (n = 4), Type II CPC (n = 16), and Type III CPC (n = 1). All 21 patients had uterus didelphys. In four patients with UI, during tubular colorraphy, a segment of the colonic pouch was preserved for later bladder augmentation if required. A Young-Dees bladder-neck repair (BNR) was performed in four older girls for treatment of UI, with marked improvement in urinary continence in two girls, some improvement in one girl with complete urinary incontinence, and minimal improvement in one child. Division of the intervaginal septum was performed in three girls. Conclusions: GU abnormalities in girls with CPC need to be assessed and managed by a tailored protocol. UI is frequent, and its correction may require BNR. A segment of the colonic pouch can be preserved for possible future bladder augmentation. All girls have a septate vagina, often widely separated, and uterus didelphys. Gynecologic assessment and monitoring is required throughout adult life. Considering the wide opening of the vestibule, surgical management of the urogenital component by division of the intervaginal septum and if required, the vagino-fistula septum on each side results in a normal or a hypospadiac urethral opening and an adequate vaginal inlet.
  17,886 189 -
REVIEW ARTICLE
Saga of Wilms' tumor: Lessons learnt from the past
Devendra K Gupta, Shilpa Sharma, Sandeep Agarwala, Robert Carachi
October-December 2005, 10(4):217-228
DOI:10.4103/0971-9261.19271  
Wilms' tumor (WT) represents 6% of childhood cancers. Recent advances in molecular biology have significant implications for the clinical management. A dramatic improvement in overall cure has resulted from the adoption of multimodality treatment during the past few decades. National Wilms' Tumor Study (NWTS), and the Sociιtι Internationale d'Oncologie Pιdiatrique (SIOP) have laid down the guidelines for standardized treatment of WT, though differing in the diagnostic and therapeutic approach. Both these groups currently aim at intensifying treatment for patients with poor prognosticators while appropriating the therapy to reduce long-term complications for those with favorable prognostic features. Challenges faced in developing nations include poverty, malnutrition, ignorance, and presentation in advanced stages coupled with limited facilities that are necessary for total management of these cases. In this article, we have discussed our approach to deal with patients with nephroblastoma, reviewed the literature on the current management strategies and the long-term outcome. Most countries have adopted the NWTS protocols, while others especially in Europe, South America and some Asian countries follow the SIOP regimen. Both have their advantages and weaknesses and maynot necessarily be suitable to the setup in developing countries. We have discussed the controversial issues in the management of WT including the timing of biopsy, type of biopsy, investigative approach, role of chemotherapy / radiotherapy, management of bilateral Wilms' tumor and parenchymal sparing renal surgery. Despite deviating from NWTS at various points, the overall results have remained satisfactory. Thus, developing countries might adopt their own protocols depending on the prevalent situations and facilities available to them to treat such patients.
  16,698 474 5
Stem cell therapy - Hope and scope in pediatric surgery
Devendra K Gupta, Shilpa Sharma
July-September 2005, 10(3):138-141
DOI:10.4103/0971-9261.16962  
A stem cell is an undifferentiated cell in the body with undetermined function capable of forming various tissues under definite signals received from the body. Stem cell research in animals using embryonal stem cells has been an ongoing program in the west with fruitful results. However, only limited information is available with the use of stem cells in human beings. Of the various sources of stem cells, umbilical cord blood stem cell research has shown potential for future treatment in Alzheimer's, Parkinson's, heart attack, stroke and spinal cord injuries. Human trials have been done in diseases like spinal cord injury and chronic liver cirrhosis. Cord blood stem cells have already been effectively used in the treatment of sickle cell, leukemia, non-Hodgkin's lymphoma and some other cancers, life threatening anemias and auto-immune diseases. Current challenges with the use of stem cells in clinical practice include the provisions to direct the differentiation of embryonic stem cells into specialized cell populations, and also devise ways to guard their development or proliferation once placed in vivo. Only further research and its clinical application will solve the many unanswered queries.
  14,947 539 4
Tissue engineering: Present concepts and strategies
Amulya K Saxena
January-March 2005, 10(1):14-19
DOI:10.4103/0971-9261.16069  
  13,605 578 8
Management of empyema - Role of a surgeon
DK Gupta, Shilpa Sharma
July-September 2005, 10(3):142-146
DOI:10.4103/0971-9261.16963  
Postpneumonic empyema still remains quite common in developing countries, especially during the hot and humid months. While most cases would respond to antibiotic therapy, needle aspiration and intercostal drainage, few cases require further surgical management. The most common nontubercular etiological agent is Staphylococcus. Tubercular etiology is not uncommon in India, especially due to delayed presentation, multiresistant strains, mismanaged cases, and noncompliance with antitubercular treatment amidst malnutrition and anemia. Clinical symptoms, a skiagram chest followed by thoracentesis are enough for diagnosis. Pleural fluid is usually diagnostic and helps in choosing the appropriate antibiotics. Further investigations and management depends on the stage of the disease. Thoracentesis alone may be sufficient for the exudative phase. In fibrinopurulent stage, a properly sized and well-placed tube thoracostomy with underwater seal is curative in most cases. Interventional radiologists have placed small-bore catheters, specifically directed to the loculated collection and have used fibrinolytics like urokinase, streptokinase, and tissue plasminogen activator (TPA) to break loculations, ameliorate fibrous peel formation, and fibrin deposition. Thoracoscopic debridement and thoracoscopic decortication is an alternative with distinct advantages over thoracotmy and are indicated if there was no response with intercostal drainage procedure. In the organizing stage, a thoracotomy (for decortication) would be required if there is a loculated empyema, underlying lung disease or persistently symptomatic effusions. Timely institution of proper management prevents the need for any surgical intervention and avoids long-term morbid complications.
  13,622 526 5
CASE REPORTS
Intraperitoneal leech: A rare complication of leech bite
Manoj Saha, Sedengulie Nagi
October-December 2011, 16(4):155-157
DOI:10.4103/0971-9261.86877  PMID:22121316
An intraperitoneal leech, which entered through vagina and uterus in a 2-year-old girl is reported. The child presented with intraperitoneal hemorrhage and shock. A leech inside the peritoneal cavity has never been reported in the literature.
  13,764 122 4
REVIEW ARTICLE
Genetics and management of retinoblastoma
Sameer Bakhshi, Radhika Bakhshi
July-September 2007, 12(3):109-115
DOI:10.4103/0971-9261.34946  
Retinoblastoma is the most common intraocular tumor in childhood. In majority of early stage retinoblastoma, the eyeballs as well as vision can be preserved with chemotherapy and local intraocular therapy with laser or photocoagulation. However, more than half the patients in India and other developing nations present in advanced stage of the disease. This article reviews the genetics, clinical approach, and treatment options for retinoblastoma focussing on advances in chemotherapy for intraocular retinoblastoma (chemoreduction), as well as improvement in survival in advanced retinoblastoma with surgery, chemotherapy, radiotherapy, and bone marrow transplantation.
  12,969 810 5
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.
  13,080 545 20
HOW I DO IT
Laparoscopic management of neonatal ovarian cysts
Sanjay N Oak, SV Parelkar, T Akhtar, R Pathak, N Vishwanath, KV Satish, R Kiran
April-June 2005, 10(2):100-102
DOI:10.4103/0971-9261.16472  
The first prenatal detection of an ovarian cyst was by Valenti in 1975. Since then antenatal and neonatal ovarian cysts are encountered more frequently due to the improvement of imaging techniques as well as routine antenatal ultrasound scanning. We discuss here the laparoscopic management of three cases of neonatal ovarian cysts. This approach is well tolerated by neonates, and it may overcome the controversy between the 'wait and see' policy and early surgical intervention, as laparoscopy has both diagnostic and therapeutic value with minimal morbidity, and ovarian salvage whenever possible.
  13,324 299 3
CASE REPORT
Hair tourniquet syndrome
AK Bangroo, Smita Chauhan
January-March 2005, 10(1):55-56
DOI:10.4103/0971-9261.16080  
A frequently unrecognized and potentially devastating form of penile strangulation is that caused by human hair. Hair tourniquet syndrome frequently occurs during the time period when post partum mothers are experiencing increased hair loss. The majority of cases are thought to be accidental, however possibility of child abuse should be considered in every case.
  12,988 408 5
ORIGINAL ARTICLE
Choledochal cyst associated with extrahepatic bile duct atresia
Arun Kumar, AK Gupta, V Bhatnagar
January-March 2005, 10(1):48-49
DOI:10.4103/0971-9261.16077  
Three infants who presented with clinical features of neonatal cholestasis and clinically suspected to have biliary atresia were found on imaging studies and surgery to have extrahepatic bile duct atresia in association with choledochal cyst. All patients were treated by bilio-enteric bypass procedure. Post operatively jaundice cleared in only two patients. The prognosis of this association depends on the pre-existent liver damage due to biliary atresia.
  11,689 352 5
CASE REPORTS
Colorectal lithobezoar: A rare case report
Muzamil Shafi Sheikh, Rizvi Malla Hilal, Afsheen Malla Misbha, Ahmed Reshi Farooq
April-June 2010, 15(2):62-63
DOI:10.4103/0971-9261.70642  PMID:20975785
We report an unusual case of a giant lithobezoar that was extending from the caecum to the anal canal, and the patient had no features of absolute constipation or peritonitis. It is believed to be the first such giant colonic lithobezoar in the literature.
  11,582 93 2
REVIEW ARTICLE
Assessment of postoperative results in anorectal malformations
V Bhatnagar
April-June 2005, 10(2):80-85
DOI:10.4103/0971-9261.16466  
Surgery for the correction of anorectal malformations (ARM) is performed by almost all pediatric surgeons. A number of operative procedures are practiced. The posterior sagittal anorectoplasty procedure has found wide acceptability and although it provides the most accurate anatomical reconstruction of the neoanorectum and the sphincters, the results are not in keeping with this technical advantage. In addition, there is no uniformity in describing the results of surgery and hence comparative evaluation of different series is difficult. This review describes the various methods that are available for the assessment of postoperative results following surgery for ARM, with a special emphasis on clinical methods keeping in mind the limitations in various parts of the country. Clinical examination and clinical scoring systems hold an important place in the post-operative evaluation of these patients. Imaging modalities are useful in the diagnosis of misplaced bowel and damage to the muscle complex and are necessary before re-do surgery is planned. Objectivity in the evaluation is provided by anorectal manometry combined with electromyography and these corelate well with clinical scoring systems. A consensus is required for uniformity in the methods of assessment.
  10,825 475 1
EDITORIAL
Anorectal malformations - Wingspread to Krickenbeck
Devendra K Gupta
April-June 2005, 10(2):75-77
DOI:10.4103/0971-9261.16464  
  10,801 471 4
CASE REPORT
Recurrent parotitis in children
M Bhattarai, PT Wakode
October-December 2006, 11(4):246-247
DOI:10.4103/0971-9261.29611  
Recurrent parotitis is an uncommon condition in children. Its etiological factors have not been proved till date although causes due to genetic inheritance, local autoimmune manifestation, allergy, viral infection and immunodeficiency have been suggested. The exact management of this disorder is not yet standardized, but a conservative approach is preferred and all affected children should be screened for Sjogren's syndrome and immune deficiency including human immunodeficiency virus. We report a 12 years female child who presented with 12 episodes of non-painful recurrent swellings of the bilateral parotid gland in the past 3 years.
  9,932 287 2
Unilateral ureteral triplication with duplex kidney and megaureter
S Bhattacharyya, KS Basu, N Samanta
April-June 2005, 10(2):108-111
DOI:10.4103/0971-9261.16475  
We report a case of duplex kidney with Type-2 ureteral triplication, with one megaureter having stenosis at its lower end and dysplasia of the upper moiety of the kidney. The child presented with lump abdomen and recurrent attacks of urinary tract infection. The child underwent excision of the dysplastic part of the kidney and megaureter with an ureteroureterostomy connecting the normal caliber lower ureter (U3) draining in trigone with the mildly dilated middle ureter (U2) draining into the megaureter (U1) of the upper moiety. The patient is well 2 months postoperatively with no urinary infection and stable renal function.
  9,622 193 1
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  2005 - Journal of Indian Association of Pediatric Surgeons | Published by Wolters Kluwer - Medknow 

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