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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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   2005| April-June  | Volume 10 | Issue 2  
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Isolated hepatic tuberculosis
AK Bangroo, Amit Singh Malhotra
April-June 2005, 10(2):105-107
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 10,623 335
Preputial retraction in children
Abhinav Agarwal, Anup Mohta, Ritesh K Anand
April-June 2005, 10(2):89-91
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 29,680 388
Role of laparoscopic cholecystectomy in children
Sanjay N Oak, SV Parelkar, T Akhtar, R Pathak, N Vishwanath
April-June 2005, 10(2):92-94
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 7,622 219
Anorectal malformations - Wingspread to Krickenbeck
Devendra K Gupta
April-June 2005, 10(2):75-77
  4 13,336 524
Laparoscopic repair of a Morgagni diaphragmatic hernia in a child, using a trans-sternal technique
Amar Shah, Girish Jawaheer
April-June 2005, 10(2):97-99
Laparoscopic repair of Morgagni hernia has been described in adults and children. In the published reports, the crux of the repair consists of suturing the posterior part of the diaphragmatic defect to the undersurface of the sternum or the posterior rectus sheath. The tissue on the undersurface of the sternum is variable is in its nature and may be inadequate for suturing, hence compromising the strength of the repair. A technique that circumvents this problem and offers a strong anatomical repair is described. A Morgagni hernia was diagnosed in a 2-year-old girl with trisomy 21, who presented with recurrent chest infections. She underwent laparoscopic repair of the hernia using three ports. The tissue on the undersurface of the sternum was inadequate for a conventional repair. The procedure was modified as follows: a small transverse incision was made over the lower end of the sternum. Three nonabsorbable mattress sutures were inserted through the sternum, the anterior edge of the diaphragmatic defect, and back through the sternum and tied with extracorporeal knots. The child was discharged home on the second postoperative day. At 6-month follow up, the child was asymptomatic, and had been infection free. A chest radiograph was normal. This is a simple, novel, noninvasive method, which offers a secure anatomical repair and it is not dependent on the adequacy of the tissue on the undersurface of the sternum.
  3 7,472 189
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
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.
  3 14,725 316
Glucagon augmented Tc99m-pertechnetate scintigraphy for detection of ectopic gastric mucosa in Meckel's diverticulum
R Kumar, T Mohapatra, SA Shamim, M Pathak, S Agarwala, V Bhatnagar
April-June 2005, 10(2):114-115
  3 5,867 134
Biliary ductal and vascular anomalies associated with choledochal cyst
YK Sarin
April-June 2005, 10(2):86-88
Nineteen patients operated for choledochal cyst over a 7-year period were reviewed retrospectively. Cyst excision and Roux -en -Y hepaticojejunostomy was done in all patients but one; one patient was managed with cyst excision and an antiperistaltic hepatico-appendico-duodenostomy. About one-third of patients (6/19) had biliary ductal/vascular anomalies identified at surgery. These included anomalous right hepatic artery (n = 3), primary ductal stricture (n = 2), and aberrant right hepatic duct (n = 1). A high degree of awareness of biliary ductal and vascular anomalies is required on the part of the operating surgeon to facilitate accurate intraoperative diagnosis as well as successful reconstructive surgery.
  3 7,851 249
Laparoscopic management of CSF pseudocyst abdomen
Rakesh Handa, MM Harjai, R Kale
April-June 2005, 10(2):95-96
Cerebrospinal fluid (CSF) pseudocyst formation is an uncommon cause of ventriculoperitoneal shunt malfunction in children. Standard management consisted of laparotomy with repositioning of the shunt and drainage of the pseudocyst. Recurrence of pseudocyst in these patients is well known and resulted in multiple laparotomies and eventually a ventriculo-atrial shunt. We managed a patient laparoscopically with drainage of the pseudocyst and repositioning of the shunt. The patient experienced no complications from the procedure, and there has been no recurrence of the pseudocyst in 2 years of follow-up. This technique has proven to be safe, with results comparable to the conventional open technique.
  2 6,827 161
Unilateral ureteral triplication with duplex kidney and megaureter
S Bhattacharyya, KS Basu, N Samanta
April-June 2005, 10(2):108-111
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.
  1 10,692 206
Penetrating diaphragmatic injury caused by a pencil
AK Singal, B Jindal, V Bhatnagar
April-June 2005, 10(2):112-113
Penetrating injuries caused by a pencil are not commonly reported, although they can lead to serious complications and sequelae. This report describes the case of a 6-year-old girl who accidentally sustained a penetrating injury to the left flank due to a pencil. The intra-abdominal, retroperitoneal and thoracic organs were spared but the diaphragm was penetrated. Surgical exploration and repair of the diaphragm were performed under general anesthesia and the patient could be discharged a few hours later.
  1 7,931 124
Assessment of postoperative results in anorectal malformations
V Bhatnagar
April-June 2005, 10(2):80-85
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.
  1 13,465 584
Cystic neuroblastoma in an older child
S Agarwala, V Bhatnagar
April-June 2005, 10(2):103-104
Cystic neuroblastoma presenting beyond the neonatal period is rare and seems to have a different presentation and outcome as compared to those diagnosed in the antenatal and perinatal period. Presented herein is a case of cystic neuroblastoma diagnosed in a 9-year-old girl who had a poor outcome despite complete excision, aggressive chemotherapy and radiation therapy.
  - 5,724 174
JIAPS- A welcome Change
SS Deshmukh
April-June 2005, 10(2):78-79
  - 4,209 123
Editorial comments
DK Gupta
April-June 2005, 10(2):116-116
  - 2,725 102
Plastic pens as substitutes for metallic dilators
SR Choudhury, P Sahu, D Singh, R Chadha
April-June 2005, 10(2):116-116
  - 6,523 122
Selected Summaries
M Raghvan, Manish Pathak, Gautam S Agarwal
April-June 2005, 10(2):117-119
  - 5,006 135
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  2005 - Journal of Indian Association of Pediatric Surgeons | Published by Wolters Kluwer - Medknow 

Online since 1st May '05