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Biomedical subjects

N Zachariah

Publications and source records attributed to N Zachariah.

17 recordsLinked to original sources
PubMed2001

Temporal dermoid--an unusual presentation.

It is rare for a frontotemporal dermoid cyst to present as a discharging sinus, and even more rare for it to have intracranial extensions. Only a few cases of intraorbital extension have been reported. We report a 14-month-old girl who presented with all the aforementioned features. She had a temporal dermoid with three discharging sinuses over the temporal area, lower lid, and cheek. It also had an intraorbital extension through the lateral orbital wall and an intracranial extension through the temporal bone. Preoperative computed tomography was done as there was a history of "orbital cellulitis". Excision of the cyst was done using a hemicoronal-preauricular incision. A lateral orbitotomy was required to remove the orbital component in continuity with the rest of the cyst.

Brain Neoplasms↗
PubMed2001

Pneumonostomy in the surgical management of bilateral hydatid cysts of the lung.

During the period 1994-1998, three patients with bilateral hydatid cysts of the lung (HCL) underwent operative removal of the cysts. In three of the six lungs operated upon the conventional technique was used: after removal of the cyst and suture closure of bronchial leaks, the chest was closed with an intercostal drainage tube. Two of these patients developed bronchopleural fistulae requiring rethoracotomy and prolonged hospital stays. The other three lungs were operated upon using the pneumonostomy technique: after excision of the cyst a separate catheter is fixed within the residual lung cavity and brought out through the adjacent chest wall, effectively marsupialising the residual cavity to the atmosphere. All these patients had an uneventful postoperative recovery. We conclude that the pneumonostomy technique is a very useful method of treating HCL surgically, especially when the cysts are bilateral and complicated.

Child↗
PubMed2001

Bilateral high loop ureterostomy in the primary management of posterior urethral valves in a developing country.

Of 200 consecutive cases of posterior urethral valves (PUV) managed in a single institution, 26 underwent bilateral high loop ureterostomy (BU) as their first operative intervention. Indications for BU were persistently raised serum creatinine levels after bladder drainage, severe urosepsis, and urinary ascites, especially in a neonate or infant. After a median period of 1 year of diversion, the serum creatinine fell from a median value of 2.5 to 0.6 mg%. Twelve cases have been fully undiverted without deleterious effects (median serum creatinine level 0.5 mg%). Three patients died. Of the 14 renal units with documented persistent vesicoureteric reflux at the time of undiversion, only 1 has been reimplanted. One child has undergone bladder augmentation.

Child, Preschool↗
PubMed2001

Pulmonary lipoblastoma: a case report.

We report a case of pulmonary lipoblastoma in a 2-year-old child. This pathology has not been previously reported in the English literature.

Child, Preschool↗
PubMed1999

External laryngotracheal trauma in children.

External laryngotracheal trauma in the paediatric population, although rare, presents a diagnostic and therapeutic dilemma for the attending surgeon. The purpose of this study was to evaluate the clinical profile, treatment and outcome and to establish a simple, effective management protocol in this emergency. A retrospective case series was studied. There were 12 patients aged 2-14 years in this series, eight of them (67%) having closed injuries. Their clinical presentation was correlated to conservative management, tracheostomy and surgical intervention. In the open injury group all the patients (100%) underwent tracheostomy, upper endoscopy and neck exploration. One patient (25%) in this group developed subglottic stenosis. In the closed injury group, seven patients (88%) had tracheostomy with upper endoscopy, and two of them (25%) had neck exploration in addition. One patient (13%), however, developed glottic stenosis. The patients with stenosis underwent multiple surgical interventions prior to final decannulation. There was no mortality. Breathing difficulty/stridor were the commonest clinical presentations in children with acute external laryngotracheal trauma. Tracheostomy and early surgical intervention appeared to be the treatment of choice. A protocol with major and minor criteria of clinical presentation is suggested for effective management.

Acute Disease↗
PubMed1999

Torted ovarian cyst with lethal bleeding diathesis in an infant.

We report a 9-month-old infant with a torted ovarian cyst who presented with an acute consumptive coagulopathy (CC) with lethal outcome. That ischemic tissue can act as a trigger for a CC is well-known, but we did not find any report of a torted ovarian cyst causing a coagulopathy in the pediatric literature. This potential complication constitutes one more reason for the prompt surgical removal of torted ovarian cysts in infants.

Disseminated Intravascular Coagulation↗
PubMed1998

Varied presentations of unilateral lung hypoplasia and agenesis: a report of four cases.

Unilateral lung hypoplasia or agenesis can be asymptomatic or present with recurrent respiratory symptoms. The latter may be amenable to surgical treatment in selected cases. Of four children in this report, two are being managed without surgery. A third was relieved of his symptoms by pneumonectomy. The fourth presented with acute foreign-body inhalation into the healthy right main bronchus, and coexistent left pulmonary agenesis was discovered at bronchoscopy. Bronchoscopy and computed tomography were found to be the most useful investigations in management.

Child, Preschool↗
PubMed1998

Achalasia cardia in infancy and childhood: an Indian experience.

Seven children with achalasia cardia, six of them infants, were seen over a 10-year period. In infantile achalasia, respiratory symptoms predominate and vomiting may easily be mistaken for gastroesophageal reflux (GER). Vomiting of uncurdled milk is characteristic of achalasia. Six children underwent esophagocardiomyotomy with good results in five. The procedure was transthoracic in two and transabdominal combined with an anterior fundoplication in the others. There was one post-operative death. Achalasia and alacrima were associated in two infants. One baby with this association also had a neurogenic bladder.

Child, Preschool↗
PubMed1997

Ludwig's angina.

A 13 year review of patients diagnosed to have Ludwig's angina admitted to the Christian Medical College and Hospital, Vellore, India, between March 1982 and April 1995 is presented. The patients were either admitted to the ENT or paediatric surgical units. There were 41 patients, 24% being children and 76% adults. The clinical profile and outcome of these two groups were compared. In the paediatric group, none had dental caries while in the adult group, 52% had associated dental caries. In children, 70% were controlled with conservative medical management unlike the adults of whom 81% needed incision and drainage. Tracheostomy was necessary in 10% of the children and in 52% of the adults. The mortality was 10% in both groups.

Adolescent↗
PubMed1987

Renal hemodynamic effects of ketanserin therapy in essential hypertension.

Ketanserin is a novel agent that has been shown to be a specific 5-HT2-serotonergic antagonist. It has useful antihypertensive properties. Owing to its unique mechanism of action, it has been suggested that ketanserin may have a favorable effect on tissue blood flow during chronic therapy for hypertension. This double-blind study was designed to evaluate the acute (1 week) and chronic (8 weeks) effects of ketanserin on renal hemodynamic parameters and renin-aldosterone axis in patients with uncomplicated hypertension. Compared to placebo, ketanserin caused a significant blood pressure reduction at the end of the 8-week study period. Despite the reduction in systematic arterial pressure, glomerular filtration rate and renal plasma flow were preserved. Ketanserin therapy induced a slight reduction in plasma renin activity and a marginal increase in the sodium excretion. Although the results of this study are limited by the small number of patients, it appears that ketanserin may have favorable renal hemodynamic effects in uncomplicated essential hypertension.

Aged↗
PubMedDate not supplied

Choledochal cysts: evaluation with MR cholangiography.

BACKGROUND: To determine where magnetic resonance (MR) cholangiography can accurately demonstrate the presence, extent, and type of choledochal cysts. METHODS: Ten patients with sonographically suspected choledochal cysts were evaluated with a non-breath-hold MR cholangiography technique. The presence, extent, and type of choledochal cyst were determined. Visualization of the pancreatobiliary junction was recorded. MR cholangiographic findings were correlated with the gold standard of surgery in six patients, endoscopic retrograde cholangiography in two, and a 99mTc hepatobiliary scintigram in one. Three patients underwent intraoperative cholangiography. RESULTS: All MR cholangiograms were correlated with findings at surgery, endoscopic retrograde cholangiography, or 99mTc hepatobiliary scintigraphy. There were seven Todani type 1 and two Todani type 5 choledochal cysts (Caroli's disease). The extent of involvement was correctly demonstrated on all MR cholangiograms. The pancreatobiliary junction could not be identified in any of the cases. Calculi and sludge were correctly identified on the MR cross-sectional images in three patients but were not seen on MR cholangiograms in two. In one patient with an initially misinterpreted choledochal cyst, MR sectional images showed the typical appearance of a hydatid cyst, which was confirmed at surgery. CONCLUSION: MR cholangiography can be used to confirm the diagnosis of choledochal cysts and define the extent of involvement preoperatively. The pancreatobiliary junction, however, is difficult to visualize. Non-biliary cysts such as a hydatid cyst can mimic a choledochal cyst on the MR cholangiogram and should be correlated with the MR cross-sectional images to avoid misinterpretation.

Adolescent↗