Biomedical subjects

Deepti Vepakomma

Publications and source records attributed to Deepti Vepakomma.

6 recordsLinked to original sources

PubMed2005

Low anorectal malformation associated with 'ano-urethro-cutaneous' fistula.

Anorectal malformations are one of the common congenital anomalies encountered in the newborn period. The plethora of anomalies described makes it a complex subject for embryological explanations. Fistulous communications between the blind rectum and the urinary tract are common in boys with high/intermediate anomalies, but it is uncommon in children with low anorectal malformations, more so a double fistula. We are reporting a case of 'ano-uerthro-cutaneous fistula' associated with a low ano rectal malformation.

Anus, Imperforate↗

PubMed2005

Vaginal endodermal sinus tumor.

Malignant germ cell tumors are rare tumors of childhood accounting less than 3% of pediatric malignancies, and endodermal sinus tumor (EST) is the most common histological subtype. The vagina is an extremely rare site for germ cell tumors (GCT). A one-year female was admitted with history of bleeding per vagina. She had pallor and a mass was palpable anteriorly on rectal examination. Magnetic Resonance Imaging (MRI) showed a tumor mass at the junction of cervix and vagina and biopsy was suggestive of a vaginal EST. The serum alpha fetoprotein (AFP) was elevated. She underwent vaginohysterectomy. The tumor was excised in toto and patient received four courses of cisplatin, etoposide and bleomycin. At one year of follow up, patient was symptom free and serum AFP remained at normal level. EST of the vagina is a rare, highly malignant GCT that exclusively involves children less than 3 years of age. It is both locally aggressive and capable of metastasis. Even though more conservative surgery is advised to maintain sexual and reproductive function, at times, radical surgery is mandatory depending on the infiltration of the tumor to the surrounding structures. Simple tumor excision is not sufficient, as residual cells induce recurrence and make chemotherapy ineffective. The serum AFP level is a useful marker for diagnosis and monitoring the recurrence of vaginal EST in infants.

Endodermal Sinus Tumor↗

PubMed2004

A prospective comparison of two regimes of bowel preparation for pediatric colorectal procedures: normal saline with added potassium vs. polyethylene glycol.

We prospectively evaluated the safety and efficacy of total gut irrigation (TGI) using normal saline with added potassium (NS) and polyethylene glycol (PG) in patients undergoing a variety of colorectal procedures including single-stage pull-through for Hirschsprung's disease (HD). Fifty-four patients were randomly assigned into one of the two groups (NS or PG). Pre- and post-TGI weight, abdominal girth, and serum electrolytes were assessed. Patients were also evaluated for vomiting and abdominal discomfort. At surgery, bowel preparation was evaluated, and postoperative complications were recorded. Both NS and PG are safe and effective agents for TGI. No patient in either group had any clinical or statistically significant change in the evaluated parameters. The amount of NS required for TGI was significantly higher than PG, and PG was better tolerated than NS. All patients with HD completed TGI, although one patient with long segment HD had abdominal distension.

Cathartics↗

PubMed2004

Lingual thyroid gland: clinical evaluation and management.

The authors present three illustrative cases of lingual thyroid gland in paediatric age group with a protocol for diagnosis and management of the condition. Elements in the diagnostic and therapeutic evaluation are outlined with attention to the clinical findings, laboratory tests and radiographic imaging studies employed in confirming the diagnosis and planning appropriate treatment. Presentations varied from swelling noticed on routine evaluation for upper respiratory tract infection in one, to dysphagia in the next and sore throat in the third patient. On examination they had swelling on the tongue just behind the circumvallate line. 99mTc thyroid scan confirmed the swelling as lingual thyroid with no thyroid tissue in the normal location. All three children had raised TSH levels and were put on suppressive L-thyroxine. At follow up patients are asymptomatic.

Child↗

PubMedDate not supplied

Anovestibular fistula in adults: a rare presentation.

Adult presentation of anorectal malformations (ARM) is rare. Most of these anomalies are diagnosed and corrected at birth or shortly thereafter. We will present two cases of anovestibular fistula presenting in adulthood. One case is a woman with a history of passing stools through the vagina after marriage and the other case is a woman with a history of chronic constipation since childhood. Case 1 was treated with limited anterior sagittal anorectoplasty, and case 2 was treated with limited posterior sagittal anorectoplasty. Total correction was achieved both anatomically and physiologically after surgery. The reporting of this information should increase the awareness of this disease among surgeons treating adults.

Adult↗

PubMedDate not supplied

Is gastropexy required for all cases of gastric volvulus in children?

Gastric volvulus (GV) is rare in the pediatric age group. The presentation is varied, and surgery in the form of gastropexy is recommended. We examine the place of gastric fixation in the management of these patients. The authors retrospectively reviewed five cases of gastric volvulus treated at their institute and noted presenting symptoms and signs, studies performed, associated anomalies, surgery done, and outcome. All patients had associated diaphragmatic abnormalities. Two patients had acute volvulus; three had a chronic presentation. Chest X-ray and barium meal were diagnostic. All patients underwent surgical correction of the diaphragmatic anomaly with detorsion of the stomach. Gastropexy was done in only one patient. All patients recovered without any complications and have been well. GV must be suspected in the appropriate clinical setting; chest X-rays and barium meals are the best studies in suspected cases. Gastropexy or gastrostomy is not necessary for a successful outcome in secondary volvulus.

Child, Preschool↗