S. C. Gopal

Esophageal achalasia of unknown etiology in infants

BackgroundAchalasia cardia is an uncommon disease in children particularly in infants. We present 8 cases of achalasia who were encountered over a 12-year period. In infantile achalasia, respiratory symptoms predominate and vomiting may easily be mistaken for gastroesophageal reflux (GER). Vomiting of uncurdled milk is characteristic of achalasia.MethodsIn this retrospective study, the data were obtained from records of the Department of Pediatric Surgery IMS, BHU Varanasi, India. The patients were diagnosed by clinical examination and barium study. Any other associated anomalies were noted in these patients. The patients underwent esophagocardiomyotomy with antireflux procedure via the abdominal route.ResultsIn the present series, 7 patients survived. The follow-up study after operation showed remarkable relief of symptoms with satisfactory weight gain. No post-operative death occurred in the patients. Achalasia associated with alacrimia was noted in one infant who was lost to follow up. One infant was initially diagnosed as having gastric volvulus, but exploration revealed achalasia cardia.ConclusionsEsophageal achalasia is a rare disease in children and its origin is generally indeterminable. Achalasia cardia should be emphasized in the differential diagnosis of an infant presenting with signs and symptoms of esophageal obstruction.

Single system ectopic ureter in females: A single center study

The purpose of this study was to inquire into the clinical features and methods for the diagnosis and management of single-system ectopic ureters associated with renal dysplasia. Materials and Methods: A total of 13 female patients were studied. Main stay of diagnosis was ultrasonography of KUB region and intravenous urography and renal scan was used to confirm the diagnosis. Histopathological evaluation was done in all cases for documentation of renal dysplasia. Result: In eight cases ectopic ureter with dysplastic kidney was seen on left side and in five it was on right side. All the patients were treated with nephroureterectomy of the affected side because of poor functioning of ipsilateral dysplastic kidney. Conclusion: Continuous urinary incontinence in females with a normal voiding pattern should prompt an evaluation for ureteric ectopia and when initial evaluation yields diagnosis of solitary kidney the clinician should be aware of the possibility of a hypoplastic and/or dysplastic on one side and normally functioning kidney on opposite side. Nephroureterectomy is the treatment of choice for unilateral single system ectopic ureter with renal dysplasia of affected side.

Prevalence of Gastrointestinal Parasites in Gaur (Bos gaurus) and Domestic Cattle at Interface Zones of the Nilgiri Hills, Tamil Nadu, India

Little is known about gastrointestinal parasite infections in wild ruminants. Faecal survey of parasitic prevalence plays an important role in wildlife management. The Wildlife interface regions, adjoining regions of forests serve as potential marker zones that serve to intermediate buffer zones that provide the viable ecology for the transit of various parasites between domestic and wild animals sharing the same landscape. Parasitic infections can cause disease and death in wild animals and can become a source of infection for domestic animals. Epidemiological studies are important to know about the status and transmission of these diseases. Parasitic diseases are best controlled by preventing the contact and parasite transmission between wild and domestic animals and by manipulating the factors involved in the disease transmission. The aim of this paper was to find out the prevalence of gastrointestinal parasites in gaur (bos gaurus) and domestic cattle at interface zones of the nilgiri hills. Qualitative examination of faecal samples from wild gaur (n=30) sharing ecosystem with domestic cattle (n=20) in the Nilgiri hills was done by Centrifugal sedimentation method and Floatation method. The prevalence was 63.3% and 80.0% in wild gaur and domestic cattle respectively with overall prevalence of 70.0%. The helminthes observed were trematodes (13.3%) include Fasciola sp. (3.3%), Amphistome sp. (6.7%) and Schistosoma sp. (3.3%), cestodes (20.0%) include Moniezia sp. nematodes (43.3%) include Toxocara sp. (6.7%), Strongyle sp. (23.3%), Oesophagostomum sp. (3.3%), Trichuris sp. (6.7%) and Mecistocirrus sp. (3.3%) and unsporulated Coccidia oocysts (13.3%) in wild gaur. It was concluded that, parasitic prevalence survey is vital in monitoring the impact on the health and maintenance of wild gaur population, and the prevalence of GI parasites recorded in the wild gaur and domestic cattle in the study areas shows the need to design and implement a control policy of helminth parasites in the Nilgiri hills.

Single-Stage Repair versus Traditional Repair of High Anorectal Malformations, Functional Results’ Correlation with Kelly’s Score and Postoperative Magnetic Resonance Imaging Findings

IntroductionPosterior sagittal anorectoplasty (PSARP) is the standard treatment for anorectal malformations. In the present study, the clinical evaluation of anal continence was carried out using Kelly’s scoring system and the results of primary PSARP or abdomino-PSARP were compared with the traditional three-stage procedure and the functional outcome was correlated with the findings of MRI, which was used as an objective method of evaluation. Patients and methodsA total of 40 patients with intermediate and high anorectal malformations were studied and were divided into two groups on the basis of a random number table. The patients in group A were treated with a single-stage operation, whereas the patients in group B were treated with a standard staged operation (either PSARP or abdominoperineal pull-through). After clinical evaluation using the Kelly score, patients were divided into three clinical groups irrespective of whether they were operated in one stage or in three stages. All patients were subjected to MRI at the age of 3 years and the findings were correlated with the clinical scoring system. ResultPatients were categorized according to their Kelly’s scores as follows: group 1: clinically good (score 5–6); group 2: clinically fair (score 3–4); and group 3: clinically poor (score 0–2). The proportions of good development of the muscles (puborectalis, external sphincter muscle, and levator muscle hammock) were 78.9% in group 1, 40% in group 2, and none in group 3. Development of muscles was found to be a significant factor for anal continence. Other significant factors for anal continence are rectal diameter and anorectal angle. ConclusionClinical assessment using the Kelly score was similar for the single-stage operation and the staged procedure, and this was supported by MRI findings. Therefore, we recommend the single-stage procedure to achieve a better outcome in intermediate and high anorectal malformation.

The Wild Pig (Sus scrofa) Behavior A Retrospective Study

Wild pigs are the most prolific, very intelligent and secretive species that over the recent past has been in a lot of conflict terms with the humans. These animals are adaptive generalists and survive in wide range of habitats worldwide. The reproductive traits of wild pigs are extraordinary showing high prolificacy so it becomes impossible to control their population. These animals have adapted to become nocturnal proving it difficult to know about their behavior. However in order in spite of these challenges the main objectives of this study was to understand the behavior and ecology of this particular species to come up the control strategies. Thus basis for documenting and understanding the wild pig behavior has dramatically evolved, contributing significantly to our understanding of these animals. In general, however, the lack of intensive field studies was attributed to the fact that wild pigs were regarded everywhere as a pest. The wild pig groups usually known as sounder’s were tracked and all findings were documented. The study period was about a year and the wild pigs were tracked and observed at the adjoining regions of the Eastern Ghats (Sathyamangalam region) and the Western Ghats (Mudumalai tiger reserve, Anaimalai tiger reserve) and of Tamil Nadu state during November, 2012 to October, 2014. A variety of behaviors were documented such as social unit organization, Habitat utilization, Daily activity patterns, Movement patterns, Modes of mobility, Home range, Male-male competition, Maternal behavior, Resting/loafing beds, Mannerism and attitudes, Vigilance behavior, Vocalizations, Wallowing, Rubbing, Symbiotic grooming behavior, Scent marking, Senses. At the end of the study we were able to precisely outlay the above the entire behavior attributes of wild pigs. These findings are necessary to understand the wild pigs and their vermin nature to combat crop raiding, eventually cutting down Human-Wild pig conflict, that will a more scientific method of conservation to avoid conflicts ending in tragic outcomes.

Chronic bilious vomiting in children in developing countries due to high bowel obstruction: not always malrotation or tuberculosis

BackgroundBilious vomiting, in conjunction with abdominal pain is considered to be a surgical problem, unless proved otherwise. In children, besides tuberculosis (TB), we have found jejunal stricture (JS) due to non-specific jejunoileitis (NSJI) to be an important cause of chronic high small bowel obstruction and bilious vomiting.Materials and methodsIn this retrospective study, the records of all children with complaint of intermittent bilious vomiting and failure to thrive were evaluated. Investigations included oral contrast study, ultrasound abdomen, chest X-ray and Mantoux test. Final confirmation was made at laparotomy. Treatment included jejuno-jejunal resection and anastomosis. Histopathology of the specimen was done to look for caseation, granuloma formation and other details.ResultsOut of total 100 patients with the complaint of bilious vomiting, 25 were having JS. Radiologic confirmation was possible in 19 (76%) patients of JS. No patient had evidence of TB as per our protocol. Histopathology revealed non-specific ischemic changes in all specimens.ConclusionJejunal stricture due to NSJI is a common entity in our setup leading to bilious vomiting. Contrast study can provide high index of suspicion in most of the patients. The diagnosis must be confirmed after proper histopathological examination. The results of the surgery are excellent.

Juvenile polyposis syndrome.

Aim: Report of a series of 12 cases of juvenile polyposis coli. Methods: The study period was from 1995 to 2005. All the patients were treated by total colectomy with rectal mucosectomy and endorectal ileoanal pullthrough with or without ileal pouch formation. Covering ileostomy was avoided in all the cases. Time taken for the surgery, postoperative complications and continence were documented. Results: The mean operating time was 4.2 h (range: 4–5 h). The mean duration of hospital stay was 16.3 days (range: 15–18 days). The most common postoperative complication was pouchitis and perianal excoriation. Initially, all the patients were passing stools at an interval of 2 h, and after 3 weeks, the frequency has reduced to 6–8 stools per day. In the follow-up after 3 months, the frequency was 3–5 per day with minimal soiling. Conclusions: Single-stage total colectomy with rectal mucosectomy and endorectal ileoanal pull-through without covering ileostomy and pouch formation is a safe and definitive treatment for juvenile polyposis coli if the patient selection is appropriate.

Assessment of Faecal Cortisol Levels in Free-Ranging Nilgiri Tahrs (Nilgiritragus hylocrius) in Correlation with Meteorological Parameters: A Non-Invasive Study

The faecal glucocorticoid metabolites of a free-ranging small Nilgiri tahr population of Western Ghats, Tamil Nadu was studied to investigate contributing confounding influences of season, ambient temperature, rainfall and water level on the annual secretion pattern. The was done for a period of one year Oct 2013-Sep 2014. Individuals may cope with environmental challenges through the secretion of stress hormones (glucocorticoids) which allows the integration of environmental change as essential life events such as predator stress, food and water availability, resting cover, influence of tourists and life history events such as birth, death, maintenance of an essential population size by means of an adaptive feedback mechanism. Adaptation and eventually acclimatization to cyclic day-to-day activities, short-term environmental stressors or long-term ecological pressures have been observed with these animals. However, being a highly limited population the animals maintained an effective population size. A clear cut seasonal pattern of glucocorticoid metabolites excretion was detected, with increasing levels in summer and winter. The confounding factors such temperature, rainfall, relative humidity, solar radiation, soil temperature were recorded throughout the study period and did not have any correlation with the stress the animals exhibited. The observed pattern might be due to lack of feed availability both during summer and winter, a declining nutritional intake and reduction of metabolism during winter, clearly the animals were not in their “Thermo comfort Zone”. However, broad retrospective studies are essential to identify potential contingent environmental stressors. This study reports the baseline cortisol level in Nilgiri Tahrs, with the relevant confounding factors correlating with their annual variation level.