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Biomedical subjects

Simmi K Ratan

Publications and source records attributed to Simmi K Ratan.

At least 19 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

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

Transient recurrence of pressure regurgitation following successful conventional external dacryocystorhinostomy.

PURPOSE: To report a patient with transient recurrence of lacrimal pressure regurgitation following a successful conventional external dacryocystorhinostomy. MATERIAL AND METHODS: A 22-year-old female, who had undergone conventional external dacryocystorhinostomy, presented 3 days later with a recurrence of pressure regurgitation. The patient's symptoms disappeared spontaneously 7 days later. Serial naso-endoscopic examination was used to find the cause. RESULTS: Endoscopic examination showed an oedematous posterior nasal mucosal remnant obstructing the lacrimal drainage pathway. On account of its peculiar location, shape and movements, and the surgically induced tissue oedema, this mucosal remnant misdirected the fluid coming through the canalicular system away from the nasal cavity into the lacrimal pocket. Ten days later, due to healing fibrosis, this flap adhered permanently to the lateral nasal wall and the patient's symptoms disappeared spontaneously. CONCLUSION: Nasal endoscopy is a simple, quick and convenient technique for diagnosing the cause of obstruction in the lacrimal drainage system. The surgeon should aim for large anterior lacrimal and anterior nasal mucosal flaps, and every remnant of posterior flaps should be excised during dacryocystorhinostomy.

Adult↗
PubMed2005

Appraisal of a modified medial canthal plication for treating laxity of the medial lower eyelid.

PURPOSE: The purpose of this study was to evaluate the efficacy of modified medial canthal tendon plication technique for correcting laxity of the medial end of the lower eyelid. MATERIAL AND METHODS: Eleven patients (9 males and 2 females, 21 eyes), with an age range of 31-80 years, having laxity of the medial end of the lower lid of varying degrees were enrolled in this study. These patients presented with complaints of watering, recurrent redness, photophobia and foreign body sensation. After grading the amount of lower lid laxity, plication was performed. In patients in whom laxity was associated with ectropion, the severity of lower lid ectropion was also graded. In patients with ectropion of Grade II or more, additional procedures for its correction were performed before undertaking plication. The patients were followed up 6 months post-operatively and re-assessed for laxity, recurrence of symptoms and complications of plication. RESULTS: All the lids were evaluated for the amount and extent of laxity of lower lid. Twelve (57%) eyes had Grade I, 9 (43%) had Grade II (and none Grade III) laxity of the lower lid. Twelve eyes had laxity restricted to the medial end and 9 eyes had laxity of the entire length of the lower lid. Some eyes also had an associated ectropion. Among the 21 eyes, 4 eyes (22%) had Grade 1, 11 (61%) had Grade 2, 6 (17%) Grade 3 and none Grade 4 ectropion. In the lids with associated ectropion, additional procedures had been performed. In 1 eye, the medial canthus was anchored to the tendon and this patient had poor apposition of the lower lid to the globe. Hence, in the remaining 20 eyes, the medial canthus was anchored to the orbital periosteum. The mean change in eyelid length was 2.6 mm (measured from medial to lateral canthus) from pre-operative status (33+/-3.4 mm) to the post-operative status (30+/-2.9 mm) this being statistically significant. An overriding of the lower lid was seen in 2 eyes (10%), and a residual gap between the lower lid and globe was noticed in 15 (71%) eyes. Some eyes had uncorrected symptoms including epiphora (3 eyes; 14%), redness (2 eyes; 10%), and photophobia (1 eye; 5%). All were those in which the lateral end was lax. None had a recurrence of foreign body sensation. CONCLUSION: Plication is easy, effective and quick for correcting laxity of the lower lid when restricted predominantly to the medial end. Correct identification of anatomical landmarks and appropriate tension of sutures is vital to achieve proper apposition of the lower lid to the globe.

Adult↗
PubMed2005

Acquired ileal atresia in infancy: report of two cases.

Two infants, aged 3 months and 4 months, with acquired ileal atresia in the distal ileum are described. Both of them presented with features of intestinal obstruction following a diarrhoeal episode. In both patients the time interval between the onset of symptoms and detection of atresia at surgery was very short, i.e. 2 weeks. In our opinion, strangulation with subsequent resorption of gangrenous gut could have been the underlying mechanism in both patients. However, a short interval between initiation of symptomatology and detection of atresia prompted us to postulate a thromboembolic phenomenon as the cause of these lesions. While in one patient intussusception was noted on sonography, in the other there was no clear-cut aetiology present except for a high-lying caecum with a long mesentery that might have led to volvulus. We have reviewed the pertinent literature of this very rare sequela of gut inflammation.

Age of Onset↗
PubMed2005

A rare presentation of abortive epispadiac urethral duplication and vanishing midurethra.

We report a 4-year-old boy with a hitherto undescribed case of abortive epispadiac duplication of the urethra presenting as a blind-ending penopubic sinus proximally and a mucosa-lined groove overlying the glanular corona distally but with absent midurethra. The patient was treated for cosmetic reasons with good results. A plausible embryological genesis of this defect is discussed.

Child, Preschool↗
PubMed2004

Thoracolumbar rachipagus parasite.

A rare example of rachipagus conjoint parasitic twinning in a newborn girl is described. A lipomatous mass with an attached hind limb (with fused feet) and a rudimentary vertebral arch were found adherent to the dorsal vertebral arches of the autosite in the thoracolumbar region. There was a clear cleavage plane between the autosite and the parasite. Microscopic sections of the excised specimen showed gut only. The autosite had no other congenital anomalies except for spina bifida in the thoracolumbar region with unfolding of the underlying cord. In the absence of underlying life-threatening anomalies, surgical excision of the parasite and treatment of the associated anomalies of the autosite is known to offer gratifying results.

Female↗
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

Evaluation of neonates with esophageal atresia using chest CT scan.

Recent literature stresses various factors that influence outcome in neonates with esophageal atresia (EA), including associated congenital anomalies, ventilator dependency, and gap length. Although the existing modalities can fairly accurately assess the first two factors, a comparable modality for assessing the interpouch gap in a natural unstretched position preoperatively is lacking. A technique of direct sagittal computed tomography (CT) scanning of the chest, initially employed by Tam et al. in 1987, was found to provide fairly accurate information on the level of origin of the fistula and the interpouch distance, with pouches in natural, unstretched positions, in two neonates with EA and distal tracheoesophageal fistula (TEF). However, no further studies were reported using this technique. We studied 10 neonates with EA and distal TEF, the most common variant, using this technique. The addition of axial cuts was done in the event of a short upper pouch or suboptimally-clear anatomical details in sagittal chest CT films. The preoperative information in our study subjects was found to corroborate well with operative findings except in the one patient with laryngotracheoesophageal cleft (LTEC). Prior information of a left bronchoesophageal fistula in two of the neonates with dextrocardia greatly helped us in saving operative time and difficulties and postoperative hassles. The chest CT scan proved to be a noninvasive and quick means for investigating neonates with the most common variant of EA. CT scanning could be extended for routine preoperative evaluation of neonates with EA to prepare for intraoperative problems, besides helping prognostication.

Bronchial Fistula↗
PubMed2004

"Pouch colon patch graft"--an alternative treatment for congenital short colon.

A patch graft of the pouch colon over the pulled-through ileum in a patient with long-length pouch colon (in whom the entire colon was replaced by a pouch that communicated with the urinary bladder) was tried with good results for the first time. At follow-up the patient was found to have normal bowel patterns and weight gain. Though colon patch grafts have been widely used in patients with total colonic aganglionosis, they have not been tried for the short colon. The authors discuss the clinical setting in which the procedure may prove useful in patients with pouch colon and why these patch grafts may yield comparable or even better results in patients with pouch colon compared with those with total colonic aganglionosis.

Anastomosis, Surgical↗
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↗