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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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   2012| July-September  | Volume 17 | Issue 3  
    Online since July 6, 2012

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Urethral duplication: Experience of four cases
Raghu S Ramareddy, Anand Alladi, OS Siddappa
July-September 2012, 17(3):111-115
DOI:10.4103/0971-9261.98127  PMID:22869976
Aim: Our experience of 4 cases of urethral duplication is reported here. Materials and Methods: A retrospective chart review. Results: The age at presentation varied from newborn to 10 years. The clinical presentation ranged from prepubic sinus to diphallus urethra. There were 2 each incomplete duplication with only external openings (Type IA) and complete duplication of Effmann Type IIA2. All underwent complete excision of accessory urethra and corrections of associated anomalies. Conclusions: Urethral duplications have a varied presentation. At follow up, all are asymptomatic with good cosmetic result.
  7,458 180 1
Surgical complications of Ascaris lumbricoides in children
Raghu S Ramareddy, Anand Alladi, OS Siddapa, V Deepti, Tanveer Akthar, B Mamata
July-September 2012, 17(3):116-119
DOI:10.4103/0971-9261.98130  PMID:22869977
Aim : To report the surgical complications of Ascaris lumbricoides infestation in children. Materials and Methods : This is a retrospective study and cases of intestinal ascariasis managed conservatively were excluded. Results : Sixteen children presented with Ascariasis sequelae, which included ileal volvulus (n=5), perforations (n=4), intussusception (n=1), biliary ascariasis (n-1) and impacted multiple worm boluses (n=5). Plain abdominal radiographs showed pneumoperitoneum (3), cigar bundle appearance (3) and multiple air and fluid levels (13). Sonography showed floating worms with free fluid (2), sluggish peristalsis and moderate free fluid (7) and intestinal worm bolus (11). The surgical procedures included milking of worms (in all), bowel resection (6), closure of perforation (3) and manual reduction of intussusception (1). Biliary ascariasis was managed conservatively and the progress monitored with sonography. There were 3 deaths all of whom had intestinal volvulus, bowel necrosis and toxemia. Conclusion : Sonography can be helpful in diagnosing the presence of worms, its complications and in evaluating response to treatment. Early surgical intervention in those with worm bolus, peritonism, and volvulus may salvage bowel and reduce mortality.
  6,129 215 -
Persistent hyperinsulinemic hypoglycemia of infancy: An overview of current concepts
Prabudh Goel, Subhasis Roy Choudhury
July-September 2012, 17(3):99-103
DOI:10.4103/0971-9261.98119  PMID:22869973
Persistent hyperinsulinemic hypoglycemia of infancy (PHHI) is relatively rare but one of the most important causes of severe neonatal hypoglycemia. Recognition of this entity becomes important due to the fact that the hypoglycemia is so severe and frequent that it may lead to severe neurological damage in the infant manifesting as mental or psychomotor retardation or even a life-threatening event if not recognized and treated effectively in time. Near-total pancreatectomy may be required for patients with intractable hypoglycemia despite medical treatment; however, that may result in diabetes mellitus or recurrent postoperative hypoglycemia. This review aims to consolidate the traditional concepts and current information related to the pathogenesis and management of PHHI.
  4,427 447 3
Amyand's hernia presenting as chronic scrotal sinus
Prashant Jain, Ashwani Mishra
July-September 2012, 17(3):128-129
DOI:10.4103/0971-9261.98134  PMID:22869981
A rare case of Amyand's hernia in an infant who presented with chronic discharging scrotal sinus is reported.
  4,326 96 3
Malrotation and volvulus associated with heterotaxy syndrome
Santosh K Mahalik, Sanat Khanna, Prema Menon
July-September 2012, 17(3):138-140
DOI:10.4103/0971-9261.98138  PMID:22869985
A 2-year-old boy with heterotaxy syndrome with associated polysplenia, ventricular septal defect, and malrotation of gut with volvulus is presented. There was delay in diagnosis due to the unusual plain abdominal radiography findings. At laparotomy, the midgut was also found to be enclosed in a thin transparent cocoon.
  3,161 127 1
Posterior urethral valves and Cowper's syringocele: A rare association causing voiding dysfunction
KV Satish Kumar, Abraham Mammen, Aneez A Ratani, Karthikeya K Varma
July-September 2012, 17(3):126-127
DOI:10.4103/0971-9261.98133  PMID:22869980
Urethral syringoceles are cystic dilatations of paired bulbourethral glands of Cowper. They can cause voiding dysfunction in male children and usually occur in isolation. We report a rare association of Cowper's syringocele with posterior urethral valves in a 4-year-old child, which was successfully managed endoscopically.
  3,076 96 1
Anorectal malformations: Definitive management during and beyond adolescence
Minakshi Sham, Dasmit Singh, Dileep Phadke
July-September 2012, 17(3):120-123
DOI:10.4103/0971-9261.98131  PMID:22869978
Aim: To evaluate our results of definitive repair of anorectal malformations in patients with delayed presentation, during and beyond adolescence. Material and Methods: It is a retrospective analysis of all adolescent patients presenting for the first time for definitive repairs and innate patients - colostomy performed during the neonatal period, but who had lost to follow-up. It includes 15 patients (2 male and 13 female) aged from 13 to 32 years. Three well-decompressed female patients were managed by primary anterior sagittal anorectoplasty (ASARP). Twelve patients underwent staged procedures. Five patients (two male and three female) underwent posterior sagittal anorectoplasty (PSARP). The oldest male patient underwent abdominal-PSARP. Results: All of them attained socially acceptable fecal continence at follow-up of 1-4½ years. They are satisfied with the functional and cosmetic outcome of repair of their anomalies. Conclusions: Prospects of fecal continence are good when definitive repair of anorectal malformations is done by an expert, even in the adolescent age group and beyond.
  2,898 205 -
Esophageal atresia associated with anorectal malformation: Is the outcome better after surgery in two stages in a limited resources scenario?
Sunita Singh, Ashish Wakhlu, Anand Pandey, Anita Singh, Shiv N Kureel, Jiledar Rawat, Payal Mishra Srivastava
July-September 2012, 17(3):107-110
DOI:10.4103/0971-9261.98123  PMID:22869975
Aims: To analyze whether outcome of neonates having esophageal atresia with or without tracheoesophageal fistula (EA±TEF) associated with anorectal malformation (ARM) can be improved by doing surgery in 2 stages. Materials and Methods : A prospective study of neonates having both EA±TEF and ARM from 2004 to 2011. The patients with favorable parameters were operated in a single stage, whereas others underwent first-stage decompression surgery for ARM. Thereafter, once septicemia was under control and ventilator care available, second-stage surgery for EA±TEF was performed. Results: Total 70 neonates (single stage = 20, 2 stages = 30, expired after colostomy = 9, only EA±TEF repair needed = 11) were enrolled. The admission rate for this association was 1 per 290. Forty-one percent (24/70) neonates had VACTERL association and 8.6% (6/70) neonates had multiple gastrointestinal atresias. Sepsis screen was positive in 71.4% (50/70). The survival was 45% (9/20) in neonates operated in a single stage and 53.3% (16/30) when operated in 2 stages (P = 0.04). Data analysis of 50 patients revealed that the survived neonates had significantly better birth weight, better gestational age, negative sepsis screen, no cardiac diseases, no pneumonia, and 2-stage surgery (P value 0.002, 0.003, 0.02, 0.02, 0.04, and 0.04, respectively). The day of presentation and abdominal distension had no significant effect (P value 0.06 and 0.06, respectively). This was further supported by stepwise logistic regression analysis. Conclusions: In a limited resources scenario, the survival rate of babies with this association can be improved by treating ARM first and then for EA±TEF in second stage, once mechanical ventilator care became available and sepsis was under control.
  2,770 231 1
Splenosis after splenectomy and spleen tissue autoimplantation: Late followup study
Carlos T Brandt, S. C. S. Brandão, A. L. C. Domingues, LA Gondra, RA Viana
July-September 2012, 17(3):104-106
DOI:10.4103/0971-9261.98120  PMID:22869974
Aim : In children suffering from severe hepatosplenic schistosomiasis, the surgical protocol includes splenectomy and autoimplantation of spleen morsels in the major omentum, which has the potential of reducing the overwhelming postsplenectomy infection (OPSI). The purpose of the study was to evaluate the remaining splenosis, with the mean postoperative followup of 12.1 ± 5.6 years; to compare the efficacy of the 2 evaluation tools. Materials and Methods : Nineteen patients underwent, when they were children, portal decompression and autoimplantation of spleen. After a mean age of 23.4 ± 5.3 years, they were investigated regarding the number of infections and OPSI. They had undergone hepatosplenic scintigraphy with labeled colloidal SnTc 99m and abdominal ultrasound. It was considered efficient splenosis when the patients presented with 5 or more spleen nodules. The evaluation was performed by 3 observers. Results : None of the patients had increased infection rate or developed OPSI. Sixteen (84.2%) presented efficient splenosis. Conclusions : The remaining postoperative splenosis was considered efficient in the majority of patients in the long-term followup; and nuclear medicine was considered the gold standard for splenosis evaluation.
  2,729 181 -
Locally invasive pulmonary inflammatory myofibroblastic tumors in children
Prabudh Goel, Veereshwar Bhatnagar, Vishesh Jain, Ajay Verma, Monica Breta, Manoj K Singh
July-September 2012, 17(3):135-137
DOI:10.4103/0971-9261.98137  PMID:22869984
Two uncommon cases of locally invasive pulmonary inflammatory myofibroblastic tumor are reported. Diagnosis was established by a prior thoracotomy and incisional biopsy. Complete excision was curative and both children remain asymptomatic at last follow up.
  2,074 94 1
A rare mode of entry for needles observed in the abdomen of children: Penetration
Unal Bakal, Tugay Tartar, Ahmet Kazez
July-September 2012, 17(3):130-131
DOI:10.4103/0971-9261.98135  PMID:22869982
Report of incidentally detected sewing needles on plain abdominal radiographs in two patients without any prior history of ingestion or of being pierced: one in the liver and the other in the peritoneum encased by omentum. These case reports point out a rare mode of entry of needles into the abdominal cavity by penetration from outside.
  2,074 91 -
Isolated mucormycosis in a post-pyeloplasty kidney in an immuno-competent child
Anjan K Dhua, Shalini Sinha, Yogesh K Sarin, Nita Khurana
July-September 2012, 17(3):132-134
DOI:10.4103/0971-9261.98136  PMID:22869983
A child with isolated renal mucormycosis who was successfully treated with systemic anti-fungal therapy and nephrectomy is reported.
  2,064 80 1
Extrarenal calyces associated with pelviureteric junction obstruction: A case report of a rare anomaly
BV Raghunath, M Narendra Babu, BC Gowrishankar, S Ramesh
July-September 2012, 17(3):124-125
DOI:10.4103/0971-9261.98132  PMID:22869979
Extrarenal calyces are one of the rare renal anomalies associated with the collecting system. Their association with renal ectopia or horse shoe kidney is known. But, here in, we are reporting an intraoperative surprise, where extrarenal calyces were associated with pelviureteric junction obstruction and routine preoperative imaging did not show any light on the diagnosis.
  2,033 95 -
Children's Surgery: A Worldwide History
V Raveenthiran
July-September 2012, 17(3):144-145
  1,823 92 -
Soft tissue covers in hypospadias surgery: Is tunica vaginalis better than dartos flap?
V. V. S. Chandrasekharam, Harish Jayaram
July-September 2012, 17(3):141-141
DOI:10.4103/0971-9261.98139  PMID:22869986
  1,491 121 1
Authors' reply
Anjan K Dhua, Satish K Aggarwal, Shandip Sinha, Simmi K Ratan
July-September 2012, 17(3):142-143
  1,433 93 -
Live operative workshops: Should we do away with them?
Dinesh H Kittur
July-September 2012, 17(3):143-143
DOI:10.4103/0971-9261.98141  PMID:22869988
  1,172 79 1
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