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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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   2013| October-December  | Volume 18 | Issue 4  
    Online since November 8, 2013

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Plasma renin activity: An early marker of progressive renal disease in posterior urethral valves
Minu Bajpai, Amit Singh
October-December 2013, 18(4):143-146
DOI:10.4103/0971-9261.121114  PMID:24347867
Introduction: A significant number of children with posterior urethral valves (PUV) develop chronic renal failure (CRF) due to activation of the renin angiotensin system (RAS). We investigated the role of plasma renin activity (PRA) in these cases and sought to establish a relationship between the accepted criteria of renal damage and PRA. Aims and Objectives: The aim of this study is to establish the relationship between PRA and CRF. Materials and Methods: The records of 250 patients with PUV were reviewed. Multiple linear regression analysis was used to assess correlations between PRA, grade of reflux, presence of scars and raised creatinine and decrease in glomerular filtration rates (GFR). A P < 0.5 was considered as significant. Results: A total of 58 patients were included. Their mean age was 16 years, range 5.3-24.2 years, mean follow-up period was 12.6 ± 3.6 years. At diagnosis, 22/58 (38%) patients were in CRF and 36/58 (62%) patients had normal renal function (RF). The mean PRA after treatment was higher in those who developed CRF than in those with normal RF (12.6 ± 10.2 vs. 34.6 ± 14.2 ng/ml/24 h, P = 0.02). Mean GFR at 1 year of age were 48 ± 9.8 ml/min/1.73 m 2 and 86 ± 12.5 ml/min/1.73 m 2 respectively (P = 0.005). PRA correlated negatively with GFR, t = -2.816, Confidence Interval: P = 0. 007. In the temporal plot over a period of 14 years, a rise in PRA preceded the fall in GFR in patients who developed CRF. Conclusions: This study shows that RAS is activated earlier in kidneys susceptible to damage. PRA could be investigated as a marker for the early detection and prevention of ongoing renal damage.
  5 3,372 153
Mediastinal hemangioma: Masquerading as pleural effusion
J Deepak, M Narendra Babu, BC Gowrishankar, S Ramesh
October-December 2013, 18(4):162-164
DOI:10.4103/0971-9261.121125  PMID:24347874
We present a rare case of mediastinal hemangioma in a 4-year-old child. The child presented with cough and fever and the chest radiograph revealed right pleural effusion. On further work-up with chest computed tomography mediastinal cystic mass occupying the right hemithorax was identified. The cystic mass was resected completely through a right thoracotomy. Histopathological examination established the final diagnosis of mediastinal capillary hemangioma.
  4 3,141 86
Multiple magnet ingestion: An uncommon cause of peritonitis
Shraddha Verma, Sunil Shinde, Chhabi Ranu Gupta
October-December 2013, 18(4):160-161
DOI:10.4103/0971-9261.121126  PMID:24347873
Foreign body ingestion is common in infants and young children and they pass spontaneously in most of the cases. Magnetic foreign bodies, though not very common, require early intervention to avoid severe gastrointestinal complications. We report a case of multiple magnet ingestion who presented with peritonitis.
  3 3,598 94
A survey of musculoskeletal and aesthetic abnormalities after thoracotomy in pediatric patients
Shasanka Shekhar Panda, Sandeep Agarwala, Veereshwar Bhatnagar, Sushil Kumar Kabra, Arvind Jayaswal, Ashu Seith Bhalla
October-December 2013, 18(4):136-142
DOI:10.4103/0971-9261.121113  PMID:24347866
Objective: To study the incidence and type of musculoskeletal and aesthetic abnormalities after thoracotomy in children. Materials and Methods: Children below 12 years of age who had undergone thoracotomy for any condition and have at least 2 years follow up were included in the study. Detailed assessment of the patients included: history and general examination, clinical examination of chest and musculoskeletal system, X-ray chest including bilateral shoulders [antero-posterior (AP), lateral, oblique], X-ray whole spine (AP, lateral, right and left side bending AP view). Results: Fifty-two pateints were recruited.The incidences of various clinically and radiologically assessed musculoskeletal and aesthetic abnormalities observed were: winging of scapula (5.7%), ipsilateral elevation of shoulder (5.7%), fixation of skin cicatrix to bony thorax (7.7%), maldevelopment of pectoral muscles (11.5%), asymmetry of the level of nipples (1.9%), rib fusion (5.7%), crowding of ribs (9.6%), mediastinal shift (3.8%), decreased space available for lungs (3.8%), Scoliosis with Cobb's angle >10 0 (1.9%). Conclusions: The incidences of musculoskeletal and aesthetic abnormalities after posterolateral thoracotomies in children were low. Longer follow up of patients after thoracotomy is needed to pick up these abnormalities as the children grow.
  3 5,783 133
Congenital double duodenal diaphragms in an infant
Shilpa Sharma, Sukhjeet Singh, Amita Sen
October-December 2013, 18(4):147-148
DOI:10.4103/0971-9261.121116  PMID:24347868
Duodenal stenosis usually occurs in isolation and has a variable presentation in infancy due to partial obstruction.An unusual case of congenital double duodenal diaphragms in an infant presenting as failure to thrive has been described and pertinent literature has been reviewed herein. Excision of webs with double Heineke-Mikulicz closure was performed.
  1 3,540 118
Neonatal segmental enteritis due to cow's milk allergy
Pavai Arunachalam, John Mathai
October-December 2013, 18(4):149-151
DOI:10.4103/0971-9261.121118  PMID:24347869
Cow's milk protein allergy (CMPA) typically presents with persistent diarrhea or dysentery, vomiting and bleeding per rectum in young infants. CMPA is reported to mimic Hirschsprung's disease and malrotation. We report, a neonate who presented with recurrent attacks of segmental enteritis due to CMPA and the last episode presented with signs of peritonitis. He improved dramatically after elimination of cow's milk from his diet. CMPA should be considered in artificially fed babies with surgical abdomen and atypical clinical signs and symptoms.
  1 3,377 100
Malrotation with midgut volvulus associated with perforated ileal duplication
Anand Pandey, Shailendra Pal Singh, Vipin Gupta, Jigyasa Pandey, Pradeep Sachan
October-December 2013, 18(4):155-157
DOI:10.4103/0971-9261.121123  PMID:24347871
Duplication of the alimentary tract is an important surgical condition. It may occur anywhere in the gastrointestinal tract. An important complication of this entity is perforation of the normal or abnormal gut. Malrotation with midgut volvulus can be a surgical emergency. We present a patient, who presented as malrotation with midgut volvulus associated with perforated ileal duplication. The patient was successfully managed.
  1 3,405 83
Hydatid cyst within a choledochal cyst
Ruchirendu Sarkar, Ram Mohan Shukla, Sujay Maitra, Malay Bhattacharya, Biswanath Mukhopadhyay
October-December 2013, 18(4):158-159
DOI:10.4103/0971-9261.121128  PMID:24347872
A 5 year 4 months old male child presenting with pain abdomen and jaundice was diagnosed to have type 1 choledochal cyst on ultrasonography and magnetic resonance cholangio pancreatography. On exploration, the cystic dilatation of common bile duct was found to have a hydatid cyst (HC) inside it. The per-operative findings were confirmed by histopathology. Association of HC within a choledochal cyst is extremely rare and has been reported only twice before in the available English literature.
  1 2,913 104
Single piece artificial urinary sphincter for secondary incontinence following successful repair of post traumatic urethral injury
DK Kandpal, SK Rawat, S Kanwar, A Baruha, SK Chowdhary
October-December 2013, 18(4):152-154
DOI:10.4103/0971-9261.121120  PMID:24347870
Post traumatic urethral injury is uncommon in children. The management of this condition is dependent on the severity of injury. Initial suprapubic cystostomy with delayed repair is the conventional treatment. Successful reconstruction of urethral injury may be followed by urethral stricture, incontinence, impotence, and retrograde ejaculation. Successful repair of post traumatic urethral injury followed by secondary incontinence in children has not been well addressed in literature. We report the management of one such child, with satisfactory outcome with implantation of a new model of single piece artificial urinary sphincter in the bulbar urethra by perineal approach.
  - 4,123 102
Research in pediatric surgery: Indian scenario
AN Gangopadhayay
October-December 2013, 18(4):131-132
DOI:10.4103/0971-9261.121111  PMID:24347864
  - 2,836 139
Report of a malignant melanoma arising in a small congenital nevus in a 3-year-old child
Andrea Zangari, Michele Ilari, Fabiano Nino, Martino Ascanio
October-December 2013, 18(4):165-166
DOI:10.4103/0971-9261.121122  PMID:24347875
  - 2,591 69
Bowel perforation due to retained enema nozzle in a patient of anorectal malformation
Abhilasha Tej Handu, KL Aravind, BC Gowrishankar, S Ramesh
October-December 2013, 18(4):166-167
DOI:10.4103/0971-9261.121124  PMID:24347876
  - 3,720 81
Endoscopic treatment of vesico-ureteral reflux: Experience of 99 ureteric moieties
Minu Bajpai, Ajay Verma, Shasanka S Panda
October-December 2013, 18(4):133-135
DOI:10.4103/0971-9261.121112  PMID:24347865
Aims: To study the outcome of endoscopic hyaluronic acid/dextranomer injection in patients with vesico-ureteric reflux (VUR). Materials and Methods: Sixty-three children were evaluated with a median follow up of 18 months (12-55 months) before injecting hyaluronic acid/dextranomer in a total of 99 ureteric moieties. Median age at presentation was 24 months (6-72 months). Primary VUR was the main presenting diagnosis in 60%. Patients were monitored for urinary tract infection (UTI), glomerular filtration rate (GFR), renal scarring, persistence, or appearance of contra-lateral reflux. Results: Grade III VUR was the most common (38%) followed by Grade IV (24%), Grade V (17%), Grade II (14%), and Grade I (7%). Most common cause for VUR was Primary (60%), followed by posterior urethral valve (PUV) (19%), bladder exstrophy (5%), anorectal malformation (ARM), epispadias, and duplex system. Analysis of patients characteristics at presentation revealed renal scarring (40%), split renal functions <35% (35%), recurrent UTI (15%), GFR <50 ml/min/1.73 m 2 (15%), serum creatinine >1.4 mg/dL (10%). Complete resolution (100%) of Grade I and Grade II VUR was achieved after single injection. For Grade III VUR, single injection resolved reflux in 85.5% ureters, 100% resolution was seen after 2 nd injection. In Grade IV VUR, 1 st injection resolved VUR in 83.3% ureters, 95.8% ureters were reflux free after 2 nd injection, and 100% resolution was seen after 3 rd injection. In Grade V VUR, 94% ureters showed absent reflux after three injections. Conclusion: Hyaluronic acid/dextranomer injection holds promise even in higher grades of VUR.
  - 3,684 191
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  2005 - Journal of Indian Association of Pediatric Surgeons | Published by Wolters Kluwer - Medknow 

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