Simmi K. Ratan

Predictors of Posttraumatic Convulsions in Head-Injured Children

The purpose of this study was to determine predictors of posttraumatic convulsions in children. Study subjects included children under 12 years of age, who were admitted to the Safdarjang Hospital, New Delhi, during the year 1997 (January to December) after suffering head trauma. The occurrence of first convulsion after head injury was taken as the outcome variable in the study. Medical records were reviewed for data about clinical, radiological and epidemiological features of such children. The study revealed that children younger than 2 years of age (odds ratio, OR 2.96; 95% confidence interval, CI 1.42–6.21), those suffering severe head injuries, i.e. with low Glasgow Coma Score (OR 3.07; 95% CI 1.40–6.77), and those with longer period of unconsciousness after head trauma, especially longer than 12 h (OR 1.71; 95% CI 0.69–4.19) have higher likelihood of suffering convulsions after head injury. However, none of the radiological findings were found to be significantly associated with posttraumatic convulsions.

Evaluation of the levels of folate, vitamin B12, homocysteine and fluoride in the parents and the affected neonates with neural tube defect and their matched controls

The aim of this study is to evaluate the folate, vitamin B12, fluoride and homocysteine levels in newborns with neural tube defect (NTD) and their parents. The study included 35 neonates with NTD and their parents, 31 neonates with congenital anomalies other than NTD formed control 1, 24 neonates with no anomalies, with the highest birth order and normal siblings formed control 2. These groups matched for socio-economic and nutritional status. Demographic, antenatal history, parental habits, folate (RBC, whole blood and serum), serum vitamin B12 and homocysteine levels were estimated using chemiluminescence technology. Chi-square test was used to assess association between factors and the outcome. One-way ANOVA was used to compare means in the three groups. To determine the risk factors for NTD, odds ratios (95% CI) was computed using bivariate and multivariate logistic regression analysis (STATA 9.0). No difference was found between NTD group and ‘control 1’ group. The fathers in NTD group had significantly lower folate and vitamin B12 and a higher homocysteine, in comparison to ‘control 2’ group (i.e. with normal babies). The babies with NTD had higher homocysteine while their mothers had significantly low folate levels in comparison to ‘control 2’ mothers. Low RBC folate, low serum vitamin B12 and high plasma homocysteine in both the parents had an association with NTD. Multivariate logistic regression revealed high homocysteine of father as the only independent significant risk factor [OR(95% CI):2.6(2.6, 226)] for NTD and also for other anomalies. NTD (and other congenital anomalies) may not only be due to nutritional deficiency in the mothers but also due to more intricate gene–nutrient interaction defects in the affected families, probably some abnormal folate-homocysteine metabolism. These defects seem to be affect the fathers more severely and in all likelihood, get transmitted to the babies from either or both the parents. The emergence of father’s serum homocysteine levels as an independent risk factor for NTD and also other congenital anomalies calls for further studies to evaluate if this can be taken as a marker for congenital anomalies in the fetus during antenatal screening.

Cystic Duplication of the Cecum with Segmental Dilatation of the Ileum: Report of a Case

Abstract Duplication cyst and segmental dilatation are rare congenital anomalies of the gastrointestinal tract, both of which are known to result in intestinal obstruction. We describe herein a case of intestinal obstruction in a neonate, caused by a duplication cyst in the cecum. A small dilated segment of ileum was also present at the site where Meckels diverticulum would be expected, which was not causing obstruction to the luminal contents. Although it is well known that either of these conditions may coexist with a number of congenital malformations, their concurrent occurrence has never been reported before.

A case of chronic renal dysfunction following treatment with oral acyclovir.

Nephrotoxicity is a well-known side effect of intravenous acyclovir treatment but occurs rarely by oral treatment. A 76-y-old healthy male, with normal baseline renal functions (blood creatinine 0.6 mg%), received oral acyclovir at a dose of 800 mg five times daily for 10 days for treatment of herpes zoster ophthalmicus. He developed renal failure with blood creatinine levels of 3 mg% and his renal function failed to improve within eight months of end of treatment. Affection of renal function has to be considered also in relation to oral acyclovir treatment, especially in elderly subjects.

Large Benign Cystic Teratoma of the Mesosigmoid Causing Intestinal Obstruction: Report of a Case

Abstract.We report the case of a large benign cystic teratoma of the mesosigmoid in a 2-year-old child. To the best of our knowledge, this type of lesion has never been described in the English literature, although there are a few reports of teratomas arising from the greater and lesser omentum. There was diagnostic confusion due to the rarity of a teratoma arising from the peritoneal folds and also because calcification was not detected radiologically. A brief review of the literature on the diagnosis and treatment of similar lesions is presented.

Thoracolumbar rachipagus parasite

A rare example of rachipagus conjoint parasitic twinning in a newborn girl is described. A lipomatous mass with an attached hind limb (with fused feet) and a rudimentary vertebral arch were found adherent to the dorsal vertebral arches of the autosite in the thoracolumbar region. There was a clear cleavage plane between the autosite and the parasite. Microscopic sections of the excised specimen showed gut only. The autosite had no other congenital anomalies except for spina bifida in the thoracolumbar region with unfolding of the underlying cord. In the absence of underlying life-threatening anomalies, surgical excision of the parasite and treatment of the associated anomalies of the autosite is known to offer gratifying results.

Association Among Duration of Unconsciousness, Glasgow Coma Scale, and Cranial Computed Tomography Abnormalities in Head-Injured Children

The impact of head trauma leads to generation of forces that cause both the intracranial injuries and loss of consciousness. Glasgow Coma Score (GCS) and cranial CT scan are widely used to gauge the severity of head injury. Milder cranial impacts insufficient to cause intracranial injuries generally cause no or minimal loss of consciousness. Nevertheless, cases with contradictory findings are also seen. This study was undertaken to find out the association among the three above-stated variables. A knowledge of such an association can enable the attending clinician in prognosticating a cranial injury and selecting out those patients with mild head injuries who deserve closer observation. While a significant positive association was found between duration of unconsciousness and GCS, no signifficant association of either of these variables with CT scan findings was noted.

Comparison between the Role of Intraoperative Mitomycin C and Doxorubicin in Preventing the Recurrence of Primary Pterygium

Purpose: The purpose of this study was to compare the role of intraoperative mitomycin C (MMC) and doxorubicin in preventing the recurrence of primary pterygium. Materials and Methods: Fifty-six patients including 22 males and 34 females in the age range of 22–55 years (mean age 38.1 years ± 10.7) having primary pterygium of progressive type were randomly divided into two groups. The first group of patients was treated with intraoperative MMC (0.02% for 3 min) and in the second group intraoperative doxorubicin (0.02% for 3 min) was used. The patients were regularly followed until 1 year postoperatively for examining visual acuity, wound condition, adverse events and recurrence of pterygium. Results: The mean age of patients of MMC group was 37.4 ± 11.0 years and of doxorubicin group was 38.8 ± 10.8 years (difference statistically not significant). All these patients had pterygium on the medial side of cornea. The side effects experienced by our patients from the use of these agents were conjunctival hyperemia, conjunctival necrosis, corneal epithelial defect, subconjunctival hemorrhage, episcleritis, increased pain, foreign body sensation, lacrimation, irritation, diminution of vision and photophobia. Recurrence was seen in 4 patients of MMC group (14.3%) and 3 patients of doxorubicin group (10.7%) (difference statistically not significant; χ2 = 0.16, p = 0.68). The recurrence of pterygium was not associated with age of patients, laterality of eye involved, amount of encroachment of pterygium over cornea, width of pterygium, preoperative complaints and postoperative adverse events. Conclusions: The two antimitotic agents, MMC and doxorubicin, when used intraoperatively along with primary pterygium excision, had a comparable role both in terms of adverse events and prevention of recurrence of pterygium.

Giant chylolymphatic cyst of the jejunal mesentry in a child: report of a case.

Abstract.A giant chylolymphatic cyst from the jejunal mesentery in a 4-year-old boy is herein described. The child presented with an acute intestinal obstruction and the etiology of the obstruction was only discovered at surgery, even though preoperative abdominal sonography had hinted at the presence of a mesenteric lesion. An excision of the cyst, along with part of the involved bowel, was performed and was curative. The literature regarding the origin, presentation, complications, and particularly, the diagnosis of this rare lesion is also reviewed.

Lipoblastoma of the neck.

Lipoblastoma and lipoblastomatosis are benign tumours arising from embryonal fat cells. These rare tumours essentially occur in infancy and early childhood. The males are affected more than females often in the ratio of 3∶1. These tumours usually arise in extremities. The involvement of neck is rare with only 10 cases reported so far in English literature. We herein report lipoblastoma of the neck in a 3 year old girl.