Vinay Jadhav

Experience with video-assisted thoracoscopic removal of pulmonary hydatid cysts in children.

Pulmonary hydatid disease is prevalent in many parts of world including India. In our small series of 5 pediatric patients, all patients were diagnosed with clinical and radiological findings on plain X-ray chest and CT (Computed Tomography) chest. All of them received oral albendazole 10 mg/kg/day soon after diagnosis except in one patient in which preoperative differential diagnosis was bronchogenic cyst and lung abscess (case 4). All underwent video assisted thoracoscopy. Simple endotracheal intubation was utilized in all cases along with CO(2) insufflation. Complete thoracoscopic removal was successful in 3 cases, while conversion to open thoracotomy was required in 2 cases. All of them showed rapid recovery except for one patient in whom prolonged intercostal drainage was present for 2 weeks. The average duration of procedure was 150 minutes and average length of hospital stay was 4.5 days except case 2, which was discharged on day 15 due to prolonged air leak. Histopathology in all cases was suggestive of hydatid cyst. At mean follow up of 6 months, all patients are asymptomatic and doing well.

Urethral ratio on voiding cystourethrogram: A comparative method to assess success of posterior urethral valve ablation

OBJECTIVE To develop a simple, objective and reproducible quantitative measurement to assess success of posterior urethral valve ablation. METHOD In 30 patients with posterior urethral valves the diagnosis was confirmed by voiding cystourethrogram (VCUG). Our protocol was to perform valve ablation, and repeat VCUG at 12 weeks postoperatively. Urethral ratio was calculated by dividing the posterior urethral diameter by the anterior urethral diameter. Thirty males undergoing VCUG for urinary tract infections were evaluated as normative controls. RESULTS Median age of controls was 12 months (2 days-6 years) and of study group was 13 months (1 day-11 years). Mean urethral ratio in pre-fulguration group was 4.94 (+/-2.97) and in post-fulguration group was 2.134 (+/-1.19) (P<0.001). The mean urethral ratio in the control group of 1.73 (+/-0.577) was significantly different from the pre-fulguration group result (P<0.001), but not significantly different in comparison to the post-fulguration group (P=0.104). CONCLUSION Calculation of urethral ratio on VCUG as a method of assessment of outcome of fulguration is objective, reproducible, and allows preoperative and postoperative VCUG from different facilities to be compared. A post-fulguration urethral ratio of 2.5-3 represents an acceptable result postoperatively.

Congenital alveolar fusion.

Congenital fusion of the jaws is rare. It may be unilateral or bilateral and may involve only the soft tissues or both the hard and soft tissues. This anomaly may be seen separately or in association with other syndromes. Congenital alveolar fusion restricts mouth opening, causing problems with feeding, swallowing, and respiration. Case 1 had membranous bands between the alveoli that required tracheostomy for stabilization, followed by osteotomy for release. Postoperatively, both patients had adequate mouth opening.

Minimal access surgery in children: An initial experience of 28 months

BACKGROUND This study reports our 28 months experience with minimal access surgery (MAS) in children. MATERIALS AND METHODS This was a review of all children who underwent MAS between December 2004 and March 2007 at the Departments of Paediatric Surgery, Seth Gordhandas Sunderdas Medical College (GSMC) and King Edward the VII Memorial (KEM) Hospital, India. Results and observations were tabulated and analysed, comparing with observations by various other authors regarding variety of indications such as, operative time, hospital stay, conversion rate, complications, safety, and feasibility of MAS in neonates, in the appropriate operative groups. RESULTS A total of 199 procedures were performed in 193 children aged between 10 days and 12 years (average age: 5.7 years). One case of each, adrenal mass, retroperitoneoscopic nephrectomy, laparoscopic congenital diaphragmatic hernia (CDH) repair, and abdominoperineal pull-through for anorectal malformation, were converted to open surgeries due to technical difficulty. The overall conversion rate was 3%. Morbidity and mortality were very minimal and the procedures were well tolerated in majority of cases. CONCLUSION We concluded that MAS procedures appear to be safe for a wide range of indications in neonates and children. Further development and expansion of its indications in neonatal and paediatric surgery requires further multi-institutional studies and larger cohort of patients, to compare with standards of open surgery.

Female urethral duplication: Rare anomaly with unusual presentation

Urethral duplication (UD) in females is a rare congenital anomaly and requires a high degree of clinical suspicion for diagnosis. The preoperative evaluation requires thorough investigations to delineate anatomy which is imperative for surgical reconstruction to provide excellent functional and cosmetic outcome. We describe the successful management of a 6-year-old girl with UD (presented as ambiguous genitalia and urinary incontinence) along with a review of pertinent literature.

An unusual congenital scrotal lymphatic malformation with absent corpora cavernosa: a case report

Congenital lymphatic malformations of the genitourinary tract are rare. A 2-day-old male child who presented with congenital scrotal swelling extending into the penile shaft was investigated and successfully treated with complete excision. We report this unusual case of congenital scrotal lymphatic malformation with absent corpora cavernosa for its rarity, which is not yet discussed in the medical literature.

Gastric teratoma: An unusual presentation and location

The gastric teratoma is a rare tumor that usually presents as an abdominal mass, with or without features of gastric outlet obstruction. We report two cases of gastric teratoma; one – mature in a male neonate and another – ruptured immature gastric teratoma in a female neonate.

Neonatal brachial plexus injury with diaphragmatic eventration

Our case report describes obstetric right brachial plexus injury leading to Erbs palsy and Klumpkes palsy with ipsilateral paralysis of diaphragm in a 9-month-old baby without Horners syndrome. The baby required initial right brachial plexus root exploration and nerve grafts, later requiring surgical plication of diaphragm. Now, the baby is free of bronchopneumonia and is in recovering phase of upper limb motor and sensory function.

Anesthetic management and perioperative outcome of infants with Biliary atresia: A retrospective review of 40 cases from a tertiary care pediatric institute in India

Background: Biliary atresia (BA) is a progressive and fatal obliterative cholangiopathy affecting 1 in 10,000 infants resulting in biliary cirrhosis and eventually death within the first two years of life. The first line of treatment is a surgical procedure known as Kasai’s portoenterostomy which aims to restore the forward flow of bile into the intestines. There is paucity of literature regarding perioperative anesthetic management of BA and its outcome. This review was thus specifically done to fill in the dearth with regard to anesthetic challenges and complications met during management of infants with BA undergoing Kasai’s procedure. Materials and methods: Retrospective data of all infants diagnosed and operated for EHBA in our institute from 2011 to 2014 was collected. Perioperative data, anesthetic and surgical details including post operative course of these children were collected and analyzed. Results: The highlights of our series were the delayed presentation of infants with BA at an average age of 85 days which indirectly prolonged the operative time. These infants in early stages of cirrhosis had higher requirements of crystalloid and blood component therapy. Intraoperatively, a decrease in blood pressure was also reflected in the R wave amplitude of ECG which signals further research in the direction of non invasive hemodynamic monitoring in infants. Of significance was the finding of normal intraoperative blood glucose values in infants with EHBA and thus inadvertent dextrose supplementation in all infants with liver dysfunction needs to be avoided. Multimodal analgesia in the form of intravenous opioids, paracetamol, tramadol and judicious local anesthetic infiltration can be used to tackle perioperative pain. Conclusions: In conclusion, when faced with anesthetizing infants with EHBA, the anesthesiologist needs to pay attention to the preoperative assessment like age of presentation, severity of the liver dysfunction and associated congenital and co morbid conditions like anemia and coagulopathy. Goals of anesthetic management would include meticulous maintenance of euvolemia, euthermia, euglycemia and provision of adequate perioperative analgesia and anesthesia.