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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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   2009| January-March  | Volume 14 | Issue 1  
    Online since July 31, 2009

 
 
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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 8,708 1,298
ORIGINAL ARTICLES
Surgical considerations in pediatric necrotizing fasciitis
A Pandey, AN Gangopadhyay, SP Sharma, V Kumar, SC Gopal, DK Gupta
January-March 2009, 14(1):19-23
DOI:10.4103/0971-9261.54816  PMID:20177439
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.
  5 3,219 291
CASE REPORTS
Congenital diaphragmatic hernia: Misdiagnosis in adolescence
Yogender Singh Kadian, Kamal Nain Rattan, Manish Verma, Pradep Kajal
January-March 2009, 14(1):31-33
DOI:10.4103/0971-9261.44775  PMID:20177443
We report 3 cases of congenital diaphragmatic hernia (CDH) in the second decade of life which were misdiagnosed on initial presentation. The first case had an iatrogenic gastric injury because of intercostal tube drainage for suspected pleural effusion. The second case was treated for pulmonary tuberculosis for 6 months before being diagnosed as a case of CDH. The third case presented as acute chest pain on the left side. It was treated accordingly for 1 month and was diagnosed as a CDH on a CT scan of the chest when seen by a surgeon.
  4 4,146 244
ORIGINAL ARTICLES
Surgical treatment of biliary atresia with patent distal extra hepatic bile ducts: Is hepatic portocholecystostomy the right choice?
V.V.S Chandrasekharam
January-March 2009, 14(1):24-26
DOI:10.4103/0971-9261.54817  PMID:20177440
Purpose : To report the results of surgical treatment of biliary atresia with patent distal extra hepatic bile ducts (BA with PDEBD) with special reference to hepatic portocholecystostomy (HPC) operation. Materials and Methods : The study reviews records of children operated for BA with PDEBD. The type of operation, results of surgery, postoperative course and complications during follow-up are noted. Results : Five children (mean age 83 days) underwent surgery for biliary atresia with patent extra hepatic bile ducts. The diagnosis was confirmed by intraoperative cholangiography in each case. Three children underwent HPC and two had standard hepatic portoenterostomy (HPE) as HPC was not technically feasible. The operation was considered successful in three of five children (60%, two HPC and one HPE), partially successful in one. The mean follow-up was 22 months. None of the children with HPC had cholangitis at follow-up; one child with HPE had recurrent cholangitis. Conclusions : Biliary atresia (BA) with PDEBD may be a variant with a fair chance for surgical success. When feasible, HPC may be a good treatment option in this group with acceptable results and practically no risk of postoperative cholangitis.
  3 2,511 274
LETTERS TO EDITOR
Sacrococcygeal teratoma: Excision aided by laparocopic ligation of the median sacral artery in a premature neonate
AP Desai, R Wragg, M Kulkarni, T Tsang
January-March 2009, 14(1):39-39
DOI:10.4103/0971-9261.54807  PMID:20177446
  1 1,923 177
Is primary chemotherapy effective in large hydatid cyst of liver?
AN Gangopadhyay, Punit Srivastava, Vijai D Upadhyaya, Zaheer Hasan
January-March 2009, 14(1):40-40
DOI:10.4103/0971-9261.54806  PMID:20177447
  1 1,971 178
CASE REPORTS
Rectal diaphragm in a patient with imperforate anus and rectoprostatic fistula
Ashokanand Thakur, NP Dhende, SB Mane, Himanshu Acharya
January-March 2009, 14(1):27-28
DOI:10.4103/0971-9261.54814  PMID:20177441
The association of rectal diaphragm in an imperforate anus has not been reported until now. A 1-year-old male presented with right transverse colostomy for high anorectal malformation. The patient had imperforate anus and a recto-prostatic fistula with rectal diaphragm. We managed the case by an ano-rectal pull through with excision of the diaphragm.
  - 2,363 292
Successful treatment of recurrent epididymo-orchitis: Laparoscopic excision of the prostatic utricle
Ashish Jiwane, S.V.S Soundappan, John Pitkin, Daniel T Cass
January-March 2009, 14(1):29-30
DOI:10.4103/0971-9261.54813  PMID:20177442
Prostatic utricle presenting with recurrent epididymo-orchitis is not uncommon. Excision of prostatic utricle is the treatment of choice. The various techniques described in literature suffer from the disadvantages of incomplete excision due to poor view. We report the successful laparoscopic excision of prostatic utricle in childhood.
  - 2,951 252
A rare cause of right iliac fossa pain
Mansoor Khizer, Ram Samujh, Abdul Mannan Khan
January-March 2009, 14(1):34-35
DOI:10.4103/0971-9261.54812  PMID:20177444
A child with torsion of appendix epiploicae presenting as acute right iliac fossa pain in abdomen is reported.
  - 3,928 265
Ischiopagus tetrapus conjoined twins: 22 years after separation
Subir K Chatterjee, Amal K Chakravarty, N Demajumdar, Kalyan K Sarkar, Sukanta Misra
January-March 2009, 14(1):36-38
DOI:10.4103/0971-9261.54809  PMID:20177445
There is no record of both separated ischiopagus tetrapus conjoined twins leading normal lives 22 years after separation. We separated a pair of such twins in 1986 and have followed them up till date. Details regarding the technique of separation and the procedures required to ensure normal defecation and micturition and normal musculoskeletal function have been described by us in earlier communications. In this paper we describe their present status and ability to face the world as independent adult females. The outcome reflects the responsibilities and dedication of pediatric surgeons for infant patients with congenital problems after they have become adults, taking a pivotal role to involve surgeons of other disciplines as and when necessary.
  - 2,873 226
EDITORIAL
President's speech at 34 th Annual Conference of Indian Association of Pediatric Surgeons, Guwahati
Anirudh Shah
January-March 2009, 14(1):1-2
DOI:10.4103/0971-9261.54808  PMID:20177434
  - 1,981 273
EDITORIAL COMMENTS
Editor's comments
Minu Bajpai
January-March 2009, 14(1):18-18
DOI:10.4103/0971-9261.54815  PMID:20177438
  - 1,537 138
GUEST EDITORIAL
Pediatric surgery in India: Then and now
IC Pathak
January-March 2009, 14(1):3-5
DOI:10.4103/0971-9261.54810  PMID:20177435
  - 2,829 252
ORIGINAL ARTICLE
Vesicoureteric reflux: Evaluation by bladder volume graded direct radionuclide cystogram
Vikesh Agrawal, Venkatesh Rangarajan, Tejaswini Kamath, SS Borwankar
January-March 2009, 14(1):15-18
DOI:10.4103/0971-9261.45360  PMID:20177437
Aim : Evaluation of vesicoureteric reflux (VUR) in children by bladder volume graded direct radionuclide cystogram (BVG DRC). This technique allows detection of VUR at different bladder volume grades. Materials and Methods : In this prospective study, 33 patients (66 renal units) with suspected vesicoureteric reflux were subjected to a voiding cystourethrogram (VCUG) and BVG DRC. The patients were assessed further with radioisotope renal scans for renal cortical scars. Results : Twenty-two patients and 36 renal units were found to have VUR in either of the reflux studies. A VCUG was able to detect 20 units (55.50%) and a BVG DRC was able to detect 35 units (97.2%). A VCUG had a test accuracy of 77.8% and a BVG DRC had a test accuracy of 98.6%. There was a positive correlation between bladder volume grades and scarring on a DMSA scan. Conclusions : Like a conventional DRC, BVG DRC is a sensitive and an accurate test. It gives additional information on the reflux phenomenon with respect to bladder filling. The bladder volume graded technique is better than conventional DRC for grading of VUR.
  - 4,197 253
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  2005 - Journal of Indian Association of Pediatric Surgeons | Published by Wolters Kluwer - Medknow 

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