Parkash Mandhan

Surgical closure of patent ductus arteriosus in preterm low birth weight infants.

BACKGROUND AND AIM OF THE STUDY In many preterm low-birth-weight infants, ductus arteriosus fails to close spontaneously. This study evaluates the results of surgical ligation of symptomatic patent ductus arteriosus (PDA) in preterm low birth weight infants. METHODS We reviewed the medical records of all infants undergoing surgical closure of PDA from January 1987 to December 2005. Demographic data, age and weight at operation, surgical technique to close PDA and outcome were analyzed. RESULTS One hundred and forty-five infants underwent surgical closure of PDA in which either indomethacin treatment had failed or was contraindicated. The mean gestational age was 25.5 +/- 2.3 (range 24-36 weeks) and the mean birth weight was 837.7 +/- 277.2 g (450-1000 g). The average age and weight at operation were 14.1 (+/-1.8) days and 881.7 g (+/-338.1), respectively. PDA was surgically closed by left thoracotomy using either nonabsorbable suture (73%) or hemoclips (27%). Postoperative complications occurred in 10 patients, which included intraoperative bleeding (6), pneumothorax (1), left vocal cord paralysis (1), lymphatic leak (1), and injury to left phrenic nerve (1). There was no mortality related to surgical closure of PDA. CONCLUSION We conclude that surgical closure of hemodynamically significant PDA is safe and effective in preterm low birth weight infants when pharmacological treatment is ineffective or contraindicated. The associated morbidity is minimal and no surgery-related mortality was observed.

Rising incidence of gastroschisis and exomphalos in New Zealand.

BACKGROUND An apparent increase in the incidence of gastroschisis and exomphalos has been reported from several parts of the world. The exact mechanism of this trend is unknown. The aim of this study was to determine the regional and national trends in the incidence of gastroschisis and exomphalos in New Zealand. MATERIAL AND METHODS This retrospective multicenter study involved collection of data from all 4 tertiary care pediatric surgical centers in New Zealand. The incidence was calculated per 10,000 live births. Data were analyzed to determine the regional and national trends. The statistical analysis was done using linear regression model and Poisson distribution. RESULTS The incidence of gastroschisis has increased from 2.96 per 10,000 live births to 5.16 per 10,000 live births between 1996 and 2004. During the same period, the incidence of exomphalos has increased from 0.69 per 10,000 live births to 3.27 per 10,000 live births. Gastroschisis was observed more in younger mothers, whereas exomphalos was associated with older mothers. CONCLUSION The incidence of gastroschisis and exomphalos is increasing in New Zealand, which is consistent with worldwide trends in showing the increasing incidence of anterior abdominal wall defects.

Laparoendoscopic removal of peroral extrusion of a ventriculoperitoneal shunt

Ventriculoperitoneal shunts for hydrocephalic children are known to cause serious complications such as GI perforation. Peroral extrusion of the peritoneal part of a ventriculoperitoneal shunt is very rare, and management could be a challenge.

Counterstaining Improves Visualization of the Myenteric Plexus in Immunolabelled Whole-Mount Preparations

Immunocytochemistry has emerged as a powerful research tool in neurobiology. One of the widely used methods is an indirect fluorescence technique that uses FITC- conjugated IgG to visualise protein expression within tissues, but a major drawback of this technique is the high background fluorescence due to non-specific antibody binding. Gut innervation is complex and best visualized in three-dimensions in whole mount preparations. We describe a simple and easy to use counterstaining procedure in conjunction with an indirect immunofluorescence technique in gut whole mount preparations that largely eliminates background fluorescence and creates a contrasting background against the bright antigen-antibody complexes. Furthermore, this technique allows the detailed qualitative and quantitative study of myenteric plexuses in whole-mount preparations.