Raman Kataria

Gastric pneumatosis associated with preduodenal portal vein, duodenal atresia, and asplenia

Abstract An 8-day-old newborn presented with non-bilious vomiting, upper abdominal fullness, and failure to pass meconium. Plain radiographs revealed gastric pneumatosis (GP). At operation, he was found to have a non-obstructive preduodenal portal vein, preampullary duodenal atresia, asplenia, and malrotation. The baby was treated by duodeno-duodenostomy without mobilizing the portal vein and correction of the malrotation according to Ladds procedure. He made an uneventful recovery and the GP resolved spontaneously. The malformative process was believed to have occurred at or soon after the 5th week of gestation, and the GP probably resulted from intramural air tracking through mucosal tears caused by high intragastric pressure.

Intra-pancreatic splenic artery pseudoaneurysm: A rare complication of chronic calcific pancreatitis

Abstract The authors present the case of a 12-year-old boy with a history of chronic upper abdominal pain. Based on ultrasonography, endoscopic retrograde cholangiopancreatography, and computerized tomography, a diagnosis of chronic calcific pancreatitis with dilation of the main pancreatic duct and a pseudocyst of the proximal pancreas was made. At surgery, in addition to confirmation of the above findings, a pseudoaneurysm arising from the splenic artery was found in the head and body of the pancreas. Pancreaticoduodenal resection including the pseudoaneurysm was performed. Postoperatively the child developed diabetes, which is easily managed with small doses of insulin.

Mesenteric neurofibroma in von Recklinghausen's disease

The authors report the case of a 6-year-old boy admitted for surgical removal of a 5- x 4-cm neurofibroma over the left wrist. On routine clinical examination a mobile firm, nodular, central abdominal mass was discovered. At laparotomy a tumor (measuring 7 x 5 x 3 cm) arising from the ileal mesentery was found. Complete excision of the mass together with a segment of ileum, followed by end-to-end bowel anastomosis was performed. Histological examination showed that the main elements of the mass consisted of wavy, long-spindled cells that crossed irregularly (pallisading negative). Special stains and immunocytochemistry for S-100 protein confirmed the mass to be a neurofibroma of the mesentery. The patient had an uneventful postoperative course and no signs of recurrence or fresh tumor have been recognized in the 4 years since his operation.

Spectrum of congenital anomalies associated with biliary atresia

Several congenital anomalies have been reported in association with biliary atresia. We have analysed the type and frequency of anomalies observed over a 10-year period in consecutive patients operated for extrahepatic biliary atresia at our institution. Of the 107 infants who underwent a laparotomy and surgical correction of biliary atresia, 9 (8.4%) showed significant associated anomalies. Among them, 5 (55.5%) had splenic malformations, 6 (66.6%) had digestive anomalies in the form of malrotation, Meckel’s diverticulum and jejunal atresia. One patient had the classical polysplenia syndrome. Our follow-up period was limited (i.e. 5 months) during which time 3 of the 9 (33.3%) patients with associated anomalies became jaundice-free. A higher incidence of malformations found in association with biliary atresia supports the congenital theory and a more thorough search for these anomalies is recommeded.

burden & pattern of illnesses among the tribal communities in central India : a report from a community health programme

Tribals are the most marginalised social category in the country and there is little and scattered information on the actual burden and pattern of illnesses they suffer from. This study provides information on burden and pattern of diseases among tribals, and whether these can be linked to their nutritional status, especially in particularly vulnerable tribal groups (PVTG) seen at a community health programme being run in the tribal areas of Chhattisgarh and Madhya Pradesh States of India. This community based programme, known as Jan Swasthya Sahyog (JSS) has been serving people in over 2500 villages in rural central India. It was found that the tribals had significantly higher proportion of all tuberculosis, sputum positive tuberculosis, severe hypertension, illnesses that require major surgery as a primary therapeutic intervention and cancers than non tribals. The proportions of people with rheumatic heart disease, sickle cell disease and epilepsy were not significantly different between different social groups. Nutritional levels of tribals were poor. Tribals in central India suffer a disproportionate burden of both communicable and non communicable diseases amidst worrisome levels of undernutrition. There is a need for universal health coverage with preferential care for the tribals, especially those belonging to the PVTG. Further, the high level of undernutrition demands a more augmented and universal Public Distribution System.

Mediastinal Lymphangiomyoma in a Child : Report of a Case

Lymphangiomas and lymphangiomyomas are benign abnormal collections of lymphatic vessels which form a cystic mass. The mediastinum is an uncommon location for these hamartomas in children, but may be life-threatening. We report herein the case of a 23-month-old boy who presented with stridor and a history of recurrent respiratory tract infections. Soon after his admission he suddenly developed respiratory failure and was found to have a multiloculated cystic mediastinal mass which was initially thought to be a lymphangioma. The mass was extensively infiltrative, and histological examination showed prominent smooth muscle proliferation in the walls of the cysts, confirming a diagnosis of lymphangiomyoma. The terminology and relevant literature on the topic are reviewed following the presentation of this case.

Colonic mucormycosis in the neonate

Mucormycosis of the neonatal gut is a rare disease, and most cases have been fatal. Three such cases were seen in quick succession; their detailed clinical and pathological findings are discussed. Experience in managing the first two fatal cases was successfully utilized in the management of the third baby, with gratifying results. A high index of suspicion and characteristic distinguishing features from necrotizing enterocolitis can facilitate an early diagnosis followed by specific therapy.

Congenital diaphragmatic hernia with ipsilateral eventration: A report of two cases

We report herein the cases of two patients in whom the unusual association of a diaphragmatic hernia with eventration of the diaphragm on the same side were confirmed. Although various recognized patterns of malformations have been described in children with diaphragmatic defects or eventration, to the best of our knowledge, this association has never been reported before. Following our case reports, the literature on this unusual topic is reviewed and a discussion on the possible pathogenesis is presented.

Primary hyperparathyroidism in children.

Primary hyperparathyroidism is an uncommon condition in childhood that is easily amenable to surgical treatment with excellent results. Pathologically, the parathyroid glands may show generalized hyperplasia or, more commonly, adenoma formation, the latter frequently being seen in adolescence. Two girls with solitary parathyroid adenomas and predominantly skeletal manifestations resembling rickets are reported, underlining the need to suspect and appropriately investigate these children. The literature on the subject is reviewed.

Complete pelviureteric junction obstruction following a diuretic renal scan

A 13-day-old neonate with a single functioning, hydronephrotic kidney developed complete pelviureteric junction (PUJ) obstruction and anuria following a diuretic radionuclide renal scan. Urgent pyeloplasty resulted in a favourable outcome. Possible dynamics of the obstruction are discussed. Monitoring urine output after diuretic renal scans, especially in infants with a single functioning kidney and PUJ obstruction, is of paramount importance.