PubMed Health⌕ Search

Biomedical subjects

K L Narasimhan

Publications and source records attributed to K L Narasimhan.

At least 19 recordsLinked to original sources
PubMed2005

The vesicoureteral reflux dysplasia syndrome in patients with posterior urethral valves.

PURPOSE: We retrospectively reviewed outcomes in children followed for posterior urethral valves and the vesicoureteral reflux dysplasia (VURD) syndrome. MATERIALS AND METHODS: Of 65 patients with posterior urethral valves 13 fulfilled the criteria for the VURD syndrome. Patients were assessed with diethylenetriamine pentaacetic acid and dimercapto-succinic acid scans at followup to evaluate stability of renal function, presence of renal scarring and drainage of the contralateral kidney. Student's t test and the chi-square test were used for statistical analysis, with p < or = 0.05 considered significant. RESULTS: Based on the dimercapto-succinic acid scan reports, patients were classified into group 1 (6 patients), in which the contralateral kidney had no evidence of scarring, and group 2 (7 patients), in which the contralateral kidney had evidence of scars. Patients in group 1 had no breakthrough urinary tract infections or history of urinary incontinence. There was no dilatation of the contralateral upper urinary tract, and 5 of 6 patients had prompt ureteral drainage on scans. They also attained a long-term serum creatinine of 0.6 +/- 0.0 mg/dl. Patients in group 2 had a significant incidence of breakthrough urinary tract infections (p < or = 0.03) and diurnal incontinence (p < or = 0.01). Hydroureteronephrosis and slow drainage were seen in 6 of 7 patients on scans. The long-term mean serum creatinine attained in this group was 0.9 +/- 0.3 mg/dl. CONCLUSIONS: About half of the patients with the VURD syndrome had renal scarring in the contralateral kidney. These patients had evidence of hydroureteronephrosis, slow drainage of the ureter in association with breakthrough urinary tract infections and diurnal incontinence. Although serum creatinine in patients with the VURD syndrome and renal scarring in the contralateral kidney was not statistically different from that in children with a normal contralateral kidney in the short term, in the long term the deleterious effects of renal scarring, viz hypertension, proteinuria and renal failure, are likely to manifest. The presence of the VURD syndrome may not always be as good a prognostic indicator as believed previously.

Child↗
PubMed2005

Anterior urethral valves.

Posterior urethral valves (PUV) are the most frequent cause of obstructive uropathy in boys. Rarer causes of obstructive uropathy include bladder diverticulae, meatal stenosis and urethral or bladder stones. Anterior urethral valves are rare causes of urinary obstruction in boys and are ten times less frequent than PUV in the literature(1-6). This paper highlights our experience with 5 patients with anterior urethral valves.

Endoscopy↗
PubMed2004

Extrahepatic portal hypertension in children: observations on three surgical procedures.

This paper presents a comparative prospective study of three modalities of surgical treatment for extrahepatic portal hypertension in children: central splenorenal shunt after splenectomy (CSS), side-to-side lienorenal shunt (SSLR) without splenectomy, and splenectomy and gastroesophageal devascularization (SGD). In an 18-month period, 27 procedures were performed: 10 CSS, 10 SSLR, and seven SGD. The outcomes were evaluated by fall in portal pressures, hematological parameters, shunt patency, splenic regression, and disappearance of esophageal varices. All three procedures were comparable in the fall of portal pressure after surgery. The average blood loss and operating time were statistically significant in favor of SSLR compared with CSS. At 3-month follow-up, shunt patency was confirmed by duplex Doppler study in all the patients in the SSLR group and in nine out of 10 patients in the CSS group. In the CSS and SGD groups, hypersplenism resolved in all the patients. In the SSLR group, blood counts improved in only five out of eight affected children. No patient re-bled during a follow-up of 3-5 years. There were no cases of hepatic encephalopathy or overwhelming postsplenectomy sepsis. In conclusion, CSS is useful when there is a large spleen, severe hypersplenism, and a shuntable splenic vein. SSLR is suitable when there is only mild splenomegaly, mild hypersplenism, and a shuntable splenic vein. Splenectomy and devascularization is the choice when there is no shuntable splenic vein.

Adolescent↗
PubMed2004

Risk factors in the primary management of anorectal malformations in Northern India.

The purpose of this study was to determine the major factors influencing the survival of babies with anorectal malformation (ARM) during the primary management in the neonatal period in a tertiary referral center. The outcome of 125 neonates with ARM, treated in a single hospital during a 2-year period, was analyzed retrospectively with particular reference to birth weight, time of arrival, and the type of ARM, including pouch colon and major associated anomalies, to see whether any of them had a significant effect on initial survival. High ARM (HARM) was present in 75, low ARM (LARM) in 36, and pouch colon in 14 babies. There were a total of 28 deaths (22%). In babies with isolated HARM weighing >2.5 kg and brought to the hospital within the first 48 h of life, the survival was 100%, which dropped to 80% when brought later than 48 h. Of the babies with birth weight <2.5 kg and isolated HARM but who were brought to the hospital within the first 48 h of life, 80% survived, whereas of those reaching the hospital after 48 h, only 55% survived. Two babies with pouch colon and two of the four babies with LARM and associated anomalies died. In the HARM group, of the 31 babies with major associated anomalies, only 37% with birth weight <2.5 kg and 58% with birth weight >2.5 kg survived. Low birth weight, major associated anomalies, and delay in referral were the three important factors that influenced the outcomes of babies with ARM during the neonatal period.

Anal Canal↗
PubMed2004

An audit of neonatal colostomy for high anorectal malformation: the developing world perspective.

A high divided sigmoid colostomy has been recommended for staged management of high anorectal malformation. We audited our cases of neonatal colostomy for high anorectal malformation to assess its effectiveness. A retrospective study was carried out of all surgical newborns admitted with high imperforate anus as the single diagnosis at our centre between December 1998 and December 2000. Morbidity and mortality were analysed after retrospective stratification into two groups (group A: birth weight >2.5 kg; group B: birth weight <2.5 kg). The chi square test was used to test the statistical significance in terms of outcome in the two groups. Overall mortality was 16%. Group A consisted of 34 babies: 30 with divided sigmoid colostomy and four with transverse loop colostomy. One baby with a divided sigmoid colostomy died from wound complications and septicaemia (mortality 2.9%). All four babies with transverse loop colostomy done under local anaesthesia survived, despite being sick on arrival. Group B consisted of 16 babies: 15 with sigmoid colostomy and one with transverse loop colostomy, with seven deaths (44%). None of the five babies with transverse loop colostomy done under local anaesthesia died, despite being sick on arrival, whereas all eight babies who died had undergone sigmoid colostomy under general anaesthesia. The difference in the outcomes of babies in groups A and B is highly significant ( p <.01). Sick, small (<2.5 kg) and septic babies arriving late to the unit do not appear to tolerate general anaesthesia and divided sigmoid colostomy well, despite that procedure's long-term advantages. Divided sigmoid colostomy has produced excellent results in babies >2.5 kg, but in the context of the developing world and limited critical care availability, transverse loop colostomy under local anaesthesia may save lives.

Colostomy↗
PubMed2003

Adrenocortical tumors in childhood.

Adrenocortical tumors (ACT) are rare in childhood. Determination of malignant potential is difficult. To assess the presentation, clinical behaviour, and histology of these tumors in our center, the records of nine patients with ACTs between 1989 and 2000 were analyzed. The age, sex, clinical presentation, investigations, treatment, follow-up data, and current status were determined. The pathological features were reanalyzed by our pathologist. The endocrine profile of the tumors was also retrieved from the records. There were two males and seven females; the median age at referral was 2.5 years. Two patients (one male, one female) presented with clinical features of Cushing's syndrome with hypertension. Four girls had features of Cushing's syndrome with associated virilization. One 11-year-old girl presented with hypertension, hypokalemia, and pseudoparalysis due to an aldosterone-secreting tumor. One girl presented with precocious pubic hair and clitoromegaly. One male had evidence of true precocious puberty. The endocrine profile was available in eight cases: cortisol levels were raised in four, testosterone in four, and aldosterone in one. One boy had pubertal levels of follicle-stimulating hormone and testosterone. Surgery was the only modality of therapy used. Histopathology showed capsular invasion in four patients and vascular invasion in two. The median tumor weight was 80 g (15-550 g) and the size ranged from 1.5 x 1.5 to 12 x 12 cm. Five patients are alive without tumor recurrence at a median follow-up time of 2 years. Tumor recurrence was seen in two patients, one with capsular rupture during surgery and another with a tumor weight of 16 g with associated capsular and vascular invasion. Atypical modes of presentation like pseudoparalysis must be kept in mind. Histologic criteria for malignancy in ACT are unreliable. Tumor weight may not always be accurate in predicting tumor behaviour. Complete surgical excision remains the only effective and potentially curative treatment.

Adrenal Cortex Neoplasms↗
PubMed2003

Pelviureteric junction obstruction: how much is the extent of the upper ureter with defective innervation needing resection?

BACKGROUND/PURPOSE: It is well realized that Anderson-Hyne's pyeloplasty fails to improve the drainage pattern and renal functional parameters in a few cases of hydronephrosis because of pelviureteric junction (PUJ) obstruction. The purpose of this study is to delineate the lower extent of the abnormally innervated pelviureteric junction by S-100 immunohistochemistry, which requires surgical removal. METHODS: Thirty pelviureteric junction (PUJ) specimens were analyzed by histology and by S-100 immunohistochemistry after serial sectioning of the resected ureter and compared with the variables age, calyceal separation, parenchymal thickness, differential renal function, glomerular filtration rate (GFR), and the measured constricted ureteral segment on gross examination. RESULTS: No significant correlation was noted (P >.05) when the histology was analyzed to find any association with any of the variables studied. The length of the visible constricted segment ranged from 2 mm to 15 mm (mean, 5.37 mm). The abnormally innervated segment was much longer than the length of the visible constricted segment in 24 and of the same length in 5 specimens. However, in 1 case, the abnormal innervation segment was shorter than the macroscopic constriction by 3 mm. The maximum difference in length between the visible constriction and the lower limit of defective innervation was 8 mm. CONCLUSIONS: The abnormally innervated ureteral segment below the PUJ in hydronephrosis is longer than the visible constricted segment at the time of surgery, and the ureter should be excised at least 8 mm or more beyond the visible lower limit of the constricted segment in cases of Anderson-Hyne's pyeloplasty.

Child↗
PubMed2003

Testosterone therapy in microphallic hypospadias: topical or parenteral?

BACKGROUND/PURPOSE: Local or systemic application of testosterone is reported to stimulate penile growth. Intramuscular testosterone has been found to be effective in 50% of patients; however, variable results have been reported with topical testosterone. The current study is an attempt to compare the efficacy of intramuscular versus topical testosterone application. METHODS: A total of 26 consecutive patients with hypospadias and small penis (<2SD for given age) were studied prospectively. These patients were recruited alternately into group A or group B. Each group consisted of 13 patients. In group A, penile growth was accomplished by topical application of testosterone (Testoviron, oily solution containing testosterone propionate, 25 mg, and testosterone enanthate, 110 mg, equivalent to about 100 mg of testosterone, Schering, Germany) with a dose of 2 mg/kg/wk, for 3 weeks. While in group B, testosterone (same preparation as above) was administered by intramuscular injection weekly for 3 consecutive weeks. Penile length, diameter, and secondary effects were recorded before, during, and 3 weeks after the therapy by a single observer. RESULTS: Significant penile growth (P <.01) was noticed in both the groups of patients when compared with pretherapy with maximum response observed during the third week of therapy (reaching from an average pretherapy length of 2.0 cm and 1.8 cm to 3.18 cm and 3.11 cm posttherapy in group A and B patients, respectively). Seven patients in each group had growth of at least 50% compared with the initial size. The basal serum testosterone was within the normal range in both the groups. During therapy the serum testosterone was elevated above the basal level in all patients, but within the normal range except in 2 patients of group A. In these 2 children the serum testosterone level crossed the normal range. Linear growth did not alter significantly for the chronological age. Two patients of group A went on to have pubic hair, one of them had elevated testosterone level above the normal range. There was a surge in serum testosterone in all children, although significant penile enlargement was observed in 60% children in group A and 75% in group B. CONCLUSIONS: Although the desired therapeutic effect of testosterone was achieved in both the groups, this study failed to show any significant difference between the 2 routes of administration. However, in group A, (topical) serum testosterone crossed the normal range in 15% of patients and was associated with significant reversible side effects.

Administration, Topical↗
PubMed2002

Early postoperative feeding and outcome in neonates.

OBJECTIVES: The results of neonatal surgery in the Western world have rapidly improved over the past three decades. Early nutrition support is thought to be one of the key factors. We used transgastric, transanastomotic feeding jejunostomy tubes in every infant undergoing upper gastrointestinal surgery when the expected period of fasting has exceeded 7 d. METHODS: Newborns with duodenal atresia, malrotation, and jejunal atresia were treated consecutively between November 1998 and November 1999. We analyzed the outcome of such a practice. There were 17 consecutive babies recruited into the study. Ten babies had duodenal atresia, one associated with esophageal atresia and tracheo-esophageal fistula, six had malrotation, and one had jejunal atresia. The weights of the babies varied between 1.2 and 3.78 kg (mean = 2.1 kg) and they were referred between the ages of 1 and 23 d. Three babies were younger than 32 wk of gestation and weighed less than 1.5 kg; all had multiple bowel atresia, including one with associated pyloric atresia. None of these three survived. Enteral feeding was started by postoperative day 2 in 14 cases. Period of feeding varied between 3 and 20 d, with a mean of 10.4 d in the surviving babies. Three of the tubes had minor mechanical complications. RESULTS: The weight loss or gain during the period of hospitalization was not significant (P = 0.3) Breast milk was the most common nutrient. Thirteen of the 14 babies weighing more than 1.5 kg were discharged and are being followed; the remaining baby died from neonatal septicemia. Excellent results can be obtained with aggressive enteral nutrition support in newborns undergoing upper intestinal surgery. CONCLUSIONS: Transgastric, transanastomotic feeding jejunostomy was well tolerated by the newborns and is preferable to parenteral nutrition.

Enteral Nutrition↗
PubMed2002

Prospective analysis of renal function and somatic growth in neonatal posterior urethral valves.

AIM: The present prospective study focuses on the effect of transurethral fulguration (TUF) and vesicostomy on the renal functions and somatic growth in posterior urethral valves (PUV). PATIENTS AND METHODS: 37 consecutive neonates were diagnosed and treated for PUV with vesicostomy (18 patients) and TUF (19 patients). Postoperative stable creatinine values, renal function and somatic growth were recorded. Standard anthropometric techniques and standard statistical methods were used to compute distance statistics for body weight and crown-heel length at age intervals of 3 months for the first year. OBSERVATIONS: The distance values of body weight and crown-heel length of these groups of children were less than the 5th percentile of the National Centre For Health Statistics (NCHS) and healthy Punjabi infants showing growth retardation in the first year of life. Pre- and postoperative mean serum creatinine of the fulguration group was 1.5 +/- 1.5 mg/dl and 0.8 +/- 0.3 mg/dl and for vesicostomy it was 2.4 +/- 2.2 mg/dl, and 0.9 +/- 0.7 mg/dl respectively. The babies of the fulguration group showed better growth attainments than the babies of the vesicostomy group at the end of one year. CONCLUSION: At the end of one year, babies of the fulguration group had a similar growth velocity compared to the vesicostomy group, though in general they showed retarded growth compared to healthy counterparts. The modality of treatment chosen did not seem to affect the renal functions or somatic growth in the short-term follow-up.

Body Height↗