PubMed Health⌕ Search

Biomedical subjects

Kamal Nain Rattan

Publications and source records attributed to Kamal Nain Rattan.

14 recordsLinked to original sources
PubMed2006

Cystogastrostomy: a valid option for treating pancreatic pseudocysts of children in developing countries.

Twelve children with pancreatic pseudocysts were managed for over 10 years at our institute that is a tertiary referral center of our country. A majority of them had posttraumatic pancreatic pseudocysts. Six of them were early referrals and presented within 1-2 weeks of pancreatic injury while the remaining six were referred later than 6 weeks with thick cyst walls. An initial conservative management and observation (with serial ultrasounds) led to a resolution of the pseudocysts in three patients (25% resolution rate). All the remaining subjects were treated using surgical modality (cystogastrostomy). In all the subjects where cystogastrostomy was done, the pseudocysts resolved completely, except in one child, who required the procedure to be repeated. The authors encountered no complications of the pancreatic pseudocyst disease in children i.e. infection, rupture, etc, that have been frequently described for adults. The authors conclude that pancreatic pseudocyst is a comparatively benign entity in children with a better outcome than in adults. Though various sophisticated treatment modalities are in vogue in the developed countries for managing pancreatic pseudocysts in children, cystogastrostomy is still a valid option for this purpose in the developing countries with suboptimal infrastructure and gives good results.

Adolescent↗
PubMed2006

Catheterless and drainless open suprapubic cystolithotomy in children: a safe procedure.

The objective of this study is to compare the outcome of the children with vesical stones undergoing conventional open suprapubic cystolithotomy with those undergoing catheterless and drainless suprapubic cystolithotomy. The study included 176 children aged 1-15 years with bladder stones. It was a prospective study stretching over 14 years (1991-2003). In the initial years (1991-1994), 40 patients were used to put a urethral catheter for 5 days and retropubic drain for 48 h post-operatively, as has been recommended conventionally. From 1995 onwards we resorted to a catheterless-drainless (no suprapubic drain) suprapubic cystolithotomy in children with bladder stones. In all the patients, two-layered closure of bladder with absorbable sutures was done. The results of both protocols with regards to duration of hospitilisation and complications were compared. We observed that if the bladder is closed meticulously in two layers and complete haemostasis is achieved, bladder drainage by means of a catheter and drainage of retropubic space is not required. This approach allowed an early post-operative recovery without increasing the risks of complications. However, the catheterisation was required for patients with infected urine, recurrent stones and those operated earlier for ano-rectal malformations. The authors feel that for vesical stones, the catheterless-drainless suprapubic cystolithotomy in children is a safe procedure barring a few above-stated situations. The advantages of this procedure are a shorter hospital stay, early mobility and decreased morbidity.

Adolescent↗
PubMed2005

Second branchial cleft fistula: is fistulogram necessary for complete excision.

We present our 10 years experience (1995-2005) of second branchial cleft fistulas and sinuses in the pediatric age group by retrospective analysis of records of 52 patients (with 63 fistulas) whose sinuses or fistulas were excised. It was found to be thrice as common in males as compared to females and was predominantly unilateral. The role of fistulogram and methylene blue dye injection in delineation and complete surgical excision of the tract was evaluated. Twenty-five cases were managed by pre-operative fistulogram and intra-operative dye injections for excision, whereas 38 cases of branchial fistulas and sinuses were excised without fistulogram and dye injection. Fistulogram and dye injection were found to be of no extra help during excision of the tract. There were two recurrences.

Adolescent↗
PubMed2005

A neonate with anorectal malformation with rare limb defects report of a case.

A 2-day-old male infant, born of a non-consanguineous marriage and uneventful pregnancy was found to have anomalies of vertebral, anal, cardiac, tracheo-esophageal, radial and limb (VACTERL) association. The striking feature was the simultaneous occurrence of two rare limb defects of right upper and lower limb in the baby who also had imperforate anus and ventricular septal defect. These limb defects were-meromelia of the right upper limb (due to transverse deficiency of right humerus and absence of all the bony elements distally), and a short right lower limb due to co-existence of proximal femoral hypoplasia and fibular hemimelia. We could not trace the co-existence of these rare skeletal defects in any case with VACTERL association in the existing English literature, as was observed by us. The simultaneous occurrence of the defects involving distant anatomic sites supports the hypothesis of 'axial mesodermal dysplasia' in our patient, rather than 'caudal regression syndrome', as is popularly held in patients with anorectal malformation (ARM). Further, it points to occurrence of an early embryonic insult, probably taking place at blastogenic stage, when the developing embryo can be considered a polytopic development field. However, in absence of antenatal history suggestive of exposure to a known teratogen and a chromosomal analysis, it appears that the spectrum of anomalies in this neonate might have resulted secondary to early amniotic leak and temporary oligohydramnios.

Abnormalities, Multiple↗
PubMed2005

Temporary transgastric fistula occlusion as salvage procedure in neonates with esophageal atresia with wide distal fistula and moderate to severe pneumonia.

A method to achieve distal fistula occlusion by inflating the balloon of a catheter placed at the gastroesophageal junction via a transgastric route was tried in seven consecutive neonates with esophageal atresia and wide distal fistula. Due to associated moderate or severe pneumonia, these infants were at poor anesthetic risk for the definitive repair. The procedure was done under local anesthesia with mild sedation and took an average of half an hour for completion. Another feeding tube was negotiated through another gastrotomy across the pylorus to allow early enteral feeds. Temporary transgastric fistula occlusion (TTFO) allowed better ventilation of the hypocompliant lungs (by increasing resistance at the fistulous end), prevented lung injury due to aspiration of the refluxing gastric juices, and facilitated optimal ventilation by preventing epigastric distension. All study subjects survived this procedure except for one of our earlier study subjects who died of massive pneumothorax that was a procedure-related complication. None of the remaining subjects required mechanical ventilation either after TTFO or after the definitive esophageal repair that was carried out 5-7 days subsequent to TTFO, except for one other neonate with right lung aplasia who began deteriorating 48 h after thoracotomy and died of cardiac failure. There were no anastomosis-related problems among the survivors over a 12-month follow-up. The gratifying results of our study prompt us to suggest that this procedure deserves attention, and its role should be explored for salvaging neonates with type C esophageal atresia with wide fistula and pneumonia in developing countries with few neonatal intensive care services.

Balloon Occlusion↗
PubMed2005

Traumatic diaphragmatic herniation.

Traumatic diaphragmatic hernia is rare in children. Left-sided Herniations are seen in 90%. The diagnosis is often delayed for months to years because of its rarity and overshadowing injuries. Chest/abdominal radiographs and, in particular cases, computed tomography and ultrasound improve the accuracy of diagnosis. We report two cases of traumatic diaphragmatic rupture in children. The history of trauma along with plain X-rays/barium study was diagnostic in both the cases.

Accidents, Traffic↗
PubMed2004

Associated anomalies with anorectal malformation (ARM).

OBJECTIVE: To find the prevalence of associated anomalies in children with anorectal malformation (ARM). METHODS: One hundred and forty patients (80 males and 60 females) with expand were studied to detect associated anomalies and to find their prevalence. High and low type of ARM was seen in 52.14% and 47.86% of patients respectively. Associated anomalies were more common with high type of ARM (78.08%) than in patients with low type of ARM (37.31%). 58.57% patients had associated anomalies which included those of urinary system (37.14%), vertebral system (34.28%), skeletal system other than vertebral (15.17%), genital system (14.29%), cardiovascular system (12.14%), gastrointestinal tract (10.7%) and spinal cord (10%). RESULTS: 37.43% patients had 3 or more than 3 components of VACTERL association. Two patients had all six components of VACTERL. Most common association was vertebral, anal and renal anomalies seen in 16 patients. CONCLUSION: Patients with ARM should undergo a detailed general physical, systemic and radiological examination (infanto-gram, echocardiography, US of urogenital system) in neonatal period to detect associated anomalies in early period.

Anal Canal↗
PubMed2004

Mediastinal foregut duplication cysts.

Foregut duplication cysts are rare congenital anomalies of enteric origin. In majority of the patients, the diagnosis is made in infancy. The authors report 4 cases of mediastinal foregut duplication cyst in children diagnosed on CT/MRI and confirmed on histopathology. In none of the cases the cysts had intraspinal extension nor heterotopic gastric mucosa.

Child↗
PubMed2004

Ileal duplication cyst associated with type-3 ileal atresia: report of a case.

We report the case of a neonate with an ileal duplication cyst and type-3 ileal atresia. Although various pathogenetic mechanisms have been suggested to explain the genesis of these separate entities, this case and others previously described lend support to the theory of "vascular pathogenesis" for both of these lesions. The relevant literature pertaining to the causation of these lesions is discussed.

Cysts↗
PubMed2004

Associated congenital anomalies in patients with anorectal malformations--a need for developing a uniform practical approach.

BACKGROUND/PURPOSE: The aim of this study was to compare the incidences of various associated anomalies among subjects with high and low anorectal malformation (ARM), study the coexistence of these anomalies, and compare their frequency with those quoted in the existing literature. METHODS: Ten years of data (from January 1993 through December 2002) on the 416 subjects from our center with anorectal malformations (ARM) were evaluated. The subjects with supra or translevator rectal pouch (radiologic or operative findings) were classified as high ARM and the rest as low ARM. The associated anomalies studied were vertebral, skeletal, renal, cardiac, vesicoureteric reflux (VUR), gastrointestinal, tracheoesophageal fistula, spinal, genital, and miscellaneous. For a detailed comparison, 4 subgroups were made: boys with high ARM, boys with low ARM, girls with high ARM, and girls with low ARM. Statistical methods were used for intergroup comparison. RESULTS: There were 68% male and 32% female subjects. Overall, 58% of subjects had high ARM (supralevator and translevator). Our attempt to compare the incidences of anomalies in our study population with those in other populations was defeated because of nonuniformity of classification and investigation of these anomalies in different studies. We found a frequent clubbing of anomalies affecting distantly developing anatomic regions in patients with ARM in many studies. The highest incidence of associated anomalies was found among boys with high ARM. The male subjects also had significantly more genital anomalies in association with low ARM and gastrointestinal tract anomalies in association with high ARM. On the other hand, girls had more urologic anomalies with high ARM and VUR with low ARM. CONCLUSIONS: Except for a low incidence of spinal anomalies (8%) and of VUR (1.7%), the incidences of most associated anomalies in our study were comparable with those of the earlier studies. Additionally, the girls with high ARM were observed to have significantly more urologic anomalies compared with the boys with high ARM in contrast to the results of the earlier reports. The existence of anomalies in distantly developing anatomic regions in patients with ARM supports the possibility of a "generalized" insult during embryogenesis rather than a ("localized") defect. It was observed that the boys with ARM are more likely to suffer morbidity because of frequent occurrence of multiple associated anomalies, and it may be worthwhile to evaluate of the role of sex chromosome in relation to ARM. The authors are also of the view that there is a need for more uniformity in classification of the anomalies and in their diagnostic approach because various reported studies have differed so widely on these aspects that any interstudy comparison is difficult or not feasible.

Abnormalities, Multiple↗
PubMed2003

Imaging in acute abdomen.

OBJECTIVE: The present study aims at establishing the exact role and limitation of ultrasound in pediatric acute abdomen. METHODS: Fifty children less than 14 years of age presenting with acute abdomen were evaluated by US and other imaging modalities. The mean age of presentation was 3 1/2 years. Maximum number of cases were seen in less than two years of age. There were 17 cases of intussusception with US sensitivity and specificity of 88.2% and 100% respectively and positive and negative predictive values of 100% and 94.5% respectively. There were 13 cases of appendicitis. US was diagnostic in 11 with sensitivity and specificity of 91.6% and 97%; the positive and negative predictive values were 91.6% and 97% respectively. RESULTS: There were two cases each of congenital bands, adhesive intestinal obstruction, malrotation of bowel with volvulus, incarcerated inguinal hernia, hypertrophic pyloric stenosis, duplication cyst and pseudopancreatic cyst, one case each of trichobezoar, Meckel's diverticulum, ureteric calculus and worms as a cause of intestinal obstruction. The sensitivity of US for diagnosing specific cause of acute abdomen was found to be 77.5%. The main limitation of US was in the diagnosis of acute intestinal obstruction such as congenital bands and adhesions. CONCLUSION: US should now be considered as imaging modality of choice in pediatric acute abdomen. However, at times, plain radiography, conventional contrast studies and CT may be vital to reach the true diagnosis.

Abdomen, Acute↗