D. K. Mitra

Portal hypertension in north Indian children

Etiological factors associated with portal hypertension in children influence the decision about therapy and the prognosis. This cross-sectional observational study was performed at a tertiary care centre in northern India from January, 1990 to December, 1994. Children below the age of 14 years with suspected portal hypertension were prospectively assembled into a cohort to determine the etiology and clinical profile of portal hypertension. Of the 115 patients with portal hypertension, 76.5% had extrahepatic portal hypertension (EHPH). Remaining 23.5% of the cases had intrahepatic and post-hepatic causes of portal hypertension. Children with EHPH had a significantly earlier onset of symptoms as compared to those with intrahepatic portal hypertension (p = 0.002) and bled significantly more frequently (p = 0.00). Forty per cent of patients with chronic liver disease (CLD) never had jaundice. History suggestive of potential etiological factors could be elicited in only 7% of EHPH patients. The commonest site of block in splenoportal axis was at the formation of the portal vein. An inverse relation of bleeding rates with duration of illness was seen in EHPH. Of the 10 CLD patients in whom liver biopsy could be done, cirrhosis was present in 6 patients.Understanding the natural history of EHPH and portal hypertension due to other etiologies may have significant implications in choosing the appropriate intervention and predicting the outcome.

Primary tubercular abscess of the spleen

A 12-year-old boy with localized tubercular abscess of the spleen is presented. The diagnosis was established on histopathologic examination. Treatment consisted of splenectomy and postoperative antitubercular therapy.

Pulmonary blastoma in a neonate

A rare case of pulmonary blastoma in a neonate is reported. Only one other neonate has been documented in the available English literature. The treatment consisted of surgical excision only.

Hemangiolymphangioma of the urinary bladder in a child

A rare case of hemangiolymphangioma of the urinary bladder with associated cutaneous hemangiomas of the shaft and glans penis and the scrotum is presented. Unusual features of clinical presentation, noninvasive diagnosis, and the surgical management are discussed.

Factors contributing to poor results of treatment of esophageal atresia in developing countries

The results of treatment of 341 consecutive cases of esophageal atresia/tracheoesophageal fistula over an 11-year period have been analyzed to determine the factors resulting in a poorer prognosis of these cases in a developing country; 121 neonates in the first 6-year period are compared with 220 in the last 5 years. In the latter group only 8% were in Waterstons group A; 46% reached the hospital within 24 h of birth, 13% were normothermic on presentation, 70% had a chest infection, and 28% had major associated malformations. This was similar to the preceding 6-year period. In the last 5 years the overall mortality was 58%, compared to 67% in the preceding 6 years. Despite improvement in survival in the last 5 years, the overall survival is far inferior to that reported from the developed countries. The factors resulting in poorer results have been analyzed and remedial actions suggested.

Conservative surgery for splenic hydatid cyst

Splenectomy has been the treatment of choice for hydatid cyst of the spleen. By successful enucleation of a deep-seated splenic hydatid cyst and preservation of the spleen, the authors show the technical feasibility of such a procedure and recommend it as the treatment of choice.

T-lymphocyte subsets in the contralateral testis after unilateral blunt testicular trauma in pre-pubertal mice

Abstract Although spermatozoa express antigens, they normally do not produce an immunological response because of the blood-testis barrier and the predominance of CD8+ T-lymphocytes in the rete testis. Unilateral blunt testicular trauma (UBTT) has been reported to decrease fertility. The present study was designed to evaluate the sub-populations of T-lymphocytes in mice with testicular trauma. Twenty male mice aged 20 days were randomized into control and test groups. At about 70 days of age the contralateral testis was harvested, cell suspensions were prepared, and immunofluorescence staining was performed for detection of CD4+ and CD8+ T-lymphocytes by flow-cytometry. The ratio of CD8+ and CD4+ lymphocytes was significantly higher (P < 0.001) in the control mice compared to the UBTT group (1.3 ± 0.3 vs 0.5 ± 0.01). The results suggest that UBTT alters the CD8+/CD4+ ratio in the contralateral testis, which may have an important bearing on the pathogenesis of infertility in cases of testicular injury.

Gastric duplication cyst in children: Report of two cases

Gastric duplication cysts (GDCs) in children are rare and are difficult to diagnose. They usually present as an epigastric mass but may be a chance finding. We report two cases and our experience with establishing the diagnosis.

Upper-tract changes after treatment of posterior urethral valves

Abstract This paper discusses the long-term sequelae in the upper urinary tract with respect to hydroureteronephrosis (HUN), vesicoureteral reflux (VUR), renal parenchymal disease, and their correlation with renal function in 84 boys with posterior urethral valves followed for 1 to 21 years. Thirty-one boys (39.3%) were adolescents or older at the time of review. The incidence of high-grade VUR (grade III or more) was 47.6% at presentation, and resolution following decompression of the lower urinary tract occurred in 38.7% of refluxing units. VUR was associated with a high incidence of chronic renal failure (CRF) (30%) on long-term follow up; however, 16% of non-refluxing patients also progressed to CRF. The incidences of renal parenchymal disease and persistent upper-tract dilatation in the non-refluxing group were 25% and 50% of renal units respectively. Gross HUN persisted in 12.3% of patients despite decompression and reconstructive surgery, with vesicoureteral junction (VUJ) obstruction being documented in 1 patient only. Moderate and mild upper-tract dilatation persisted in 31.6% and 43.9% of patients, respectively. Persistent gross HUN was associated with a very high incidence of CRF (92.3%), while 88.4% of those with persistent mild/moderate dilatation maintained normal renal function over a follow-up period ranging from 1 to 21 years. This study emphasizes the need for systematic evaluation to exclude VUJ obstruction and abnormal urodynamics as a cause of persistent HUN so that effective therapy can be instituted early to relieve back-pressure and to provide a low-pressure reservoir with effective emptying. In the absence of either of these causes, persistent ureterectasis after treatment is presumably due to secondary peristaltic failure as a consequence of ureteral fibrosis, ureteral tortuosity, or developmental dysplasia.

Anterior abdominal wall closure in bladder exstrophy

Anterior abdominal wall closure without pelvic osteotomy for bladder exstrophy can be very diffecult and more often than not calls for various reconstructive measures. A technique is described that involves bilateral detachment of the rectus abdominis from the pubic ramus, midline vertical closure, and refixation to the pubic rami after medial and caudal advancement. A relaxing fascial incision may be required. This technique has been used in 15 patients and has obviated the need for pelvic osteotomy, thereby decreasing the postoperative morbidity. It has resulted in good cosmetic repair in all patients in addition to the ease of abdominal wall closure. The healing has been remarkably good. This technique is particularly useful in children coming for primary surgery after the neonatal period.