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Biomedical subjects

U Poddar

Publications and source records attributed to U Poddar.

At least 19 recordsLinked to original sources
PubMed2003

Renal lymphangiomatosis: a rare cause of bilateral nephromegaly.

We report the ultrasound, excretory urography and MR findings in a young child with renal lymphangiomatosis who presented with gradually progressive bilateral flank swelling but who was otherwise asymptomatic. The typical perirenal and parapelvic cysts are visualized as hypoechoic lesions on sonography and hyperintense on T2-weighted HASTE images. T1-weighted image could not delineate the cysts clearly. The renal parenchyma was hyperechoic on sonography, and MRI showed reversal of the normal corticomedullary signal intensity, and confirmed the diagnosis by suggesting the non-parenchymal origin of the cysts.

Child↗
PubMed2002

Crohn's disease: disastrous consequences of late diagnosis.

Chronic and recurrent perianal abscess is an uncommon condition in children. Tuberculosis is thought to be the common etiology for such a presentation in India. We report a case of a child with colonic and perianal disease due to Crohn's disease and emphasize the disastrous complication due to delayed diagnosis.

Child↗
PubMed2002

Natural history and risk factors in fulminant hepatic failure.

BACKGROUND: The natural history of fulminant hepatic failure (FHF) without liver transplantation is not well known. AIMS: To study the natural history and prognostic factors, especially the presence of ascites and spontaneous bacterial peritonitis (SBP), in children with FHF. METHODS: FHF was defined by the onset of encephalopathy within 12 weeks of onset of jaundice. From August 1997 to December 2000, 67 children (< or =12 years) were diagnosed with FHF. Their clinical features, investigations and outcome were noted. Viral markers A to E (IgM, anti-HAV; IgM, anti-HEV, HBsAg, and anti-HCV) were determined by ELISA. SBP was defined by the presence of > or =250 neutrophils with or without a positive culture in ascitic fluid. RESULTS: Mean age of the children was 5.8 years with an almost equal sex distribution. Viral markers were positive in 63 (94%) cases: hepatitis A in 34 (54%), E in 17 (27%), A+E in seven (11%), and B in five (8%). Thirty one children presented with grade I or II encephalopathy and all recovered, whereas 17 of 36 children who had grade III or IV encephalopathy died. Ascites was detected (both clinically and ultrasonically) in 34 (51%) cases, nine (26%) of which had SBP. Overall mortality was 25%. Mortality was higher in those who had ascites than in those who did not (32% v 18%); among those with ascites it was maximum in those who had SBP (78% v 16%). Total serum bilirubin and grade of encephalopathy were significantly higher, serum albumin was significantly lower, and prothrombin time was significantly prolonged in those who died than in those who recovered. CONCLUSION: The natural history of FHF in Indian children depends on age, grade of encephalopathy, ascites, and SBP. SBP depicts worse outcome. In all cases of FHF with ascites, the presence of SBP should be investigated.

Ascites↗
PubMed2001

Endoscopic retrograde cholangiopancreatography in the management of pancreaticobiliary disorders in children.

BACKGROUND AND AIM: The role of endoscopic retrograde cholangiopancreatography (ERCP) is not yet fully established in children. The purpose of this study was to assess the use of ERCP in the diagnosis and management of various pancreaticobiliary disorders in children. METHODS: Eighty-four ERCPs were performed over 5.5 years in 72 children with suspected pancreaticobiliary tract disorders with an adult-type duodenoscope. In all cases, indications, procedure time, ERCP findings, complications, patients course and therapeutic intervention (if any) were recorded. RESULTS: The mean (+/- SD) age of these children was 8.8 +/- 3.3 years. Successful cannulation was possible in 70 (97%) cases. Of the 44 cases with suspected biliary tract disease, 14 had a choledochal cyst, 13 had portal biliopathy, two each had CBD stones, primary sclerosing cholangitis and a bile leak, one had biliary ascariasis, eight had a normal cholangiogram, and CBD cannulation failed in two. Eight of the 28 children with suspected pancreatic disorders had chronic pancreatitis, five had pancreatic duct disruption, three had pancreas divisum and the rest had a normal pancreatogram (including all eight children with unexplained abdominal pain). Therapeutic ERCP was performed in 22 children, endoscopic nasobiliary or a nasocystic drain was placed in 16, biliary stenting was conducted in two, pancreatic duct stenting was conducted in three, and minor papilla dilation was conducted in one child. Six children had mild procedure-related complications. CONCLUSION: Endoscopic retrograde cholangiopancreatography is very useful in the treatment of cholangitis, bile leak, pseudocyst and pancreatic fistulae in children. However, its role in unexplained abdominal pain is doubtful.

Abdominal Pain↗
PubMed2001

Benign esophageal strictures in infants and children: results of Savary-Gilliard bougie dilation in 107 Indian children.

BACKGROUND: Little information is available regarding the safety and efficacy of dilation of esophageal strictures in children with Savary-Gilliard bougies. This is a report of our experience with this form of dilation in Indian children. METHODS: One hundred seven Indian children age 14 years or younger with benign esophageal strictures underwent dilation. Clinical information including etiology was recorded. Dilation was performed at 2- to 3-week intervals by using Savary-Gilliard bougies under ketamine sedation and was considered adequate if the esophageal lumen could be dilated to 15 mm diameter (12.8 mm in children <5 years of age) with complete relief of symptoms. Subsequently, dilation was performed on an "as needed" basis. RESULTS: Mean age was 4.8 +/- 3.4 years; male to female ratio was 3:1. Fifty-four children had corrosive strictures (acid 34, alkali 20). Noncorrosive strictures were sclerotherapy-induced (23), postsurgical (14), congenital (10), peptic (4), and due to other causes (2). Dilation was successful in all but 3 cases. Corrosive strictures required a significantly higher number of sessions to achieve adequate initial dilation (2.4 +/- 1.9 vs. 1.3 +/- 0.5, p < 0.01). Patients with corrosive strictures also required a higher number of subsequent sessions for recurrence (7.3 +/- 6.5 vs. 0.7 +/- 1.3, p = 0.10). Dilation was also successful in patients with strictures 5 cm or more in length and/or patients with multiple corrosive strictures, although these required a higher number of sessions to achieve adequate dilation (p < 0.05) and also higher number of subsequent sessions for recurrence. Six esophageal perforations occurred during 648 dilation sessions (0.9%); 5 occurred in patients with corrosive strictures. One patient required surgery. CONCLUSIONS: Corrosive injury is the most common cause of benign esophageal strictures in Indian children. Savary-Gilliard bougie dilation is safe and effective, even for long and/or multiple corrosive strictures.

Burns, Chemical↗
PubMed1999

Congenital hepatic fibrosis in Indian children.

BACKGROUND: Congenital hepatic fibrosis (CHF) is an uncommon cause of portal hypertension in children. So far, there is no report of this from the subcontinent. We have studied the clinical spectrum of CHF in North Indian children. METHODS: Fifteen children were diagnosed with CHF on the basis of their liver histology over a period of 6.5 years. Their clinical details were recorded. Oesophagogastroduodenoscopy and abdominal ultrasonography were performed in all cases. All siblings were examined clinically; and ultrasonography, endoscopy and liver biopsy were performed if there was firm hepatomegaly. Children with variceal bleeding were managed by endoscopic sclerotherapy. The median age of these children was 8 years with a male to female ratio of 1.5:1. RESULTS: Only one sibling (of 33) was diagnosed as having CHF. The predominant presentations were variceal bleeding in six, abdominal distension in seven and incidental detection of organomegaly in two. Hepatomegaly was present in all patients and splenomegaly in all but one. Liver function and renal function tests were normal in all children, except for a raised serum alkaline phosphatase in six. Two children had associated renal cysts, two had choledochal cysts, one each had Caroli's disease and biliary atresia and two children had portal vein thrombosis. Variceal obliteration was achieved in five children after an average 4.8 sclerotherapy sessions and one required a mesocaval shunt. On follow up (median 41 months, range 1-80 months) all are doing well. CONCLUSIONS: Congenital hepatic fibrosis is mainly sporadic in India and associated renal lesions are uncommon. Endoscopic sclerotherapy is effective in controlling variceal bleed and the prognosis is universally good in the absence of renal diseases.

Adolescent↗
PubMed1999

Celiac disease: clinical features and diagnostic criteria.

Celiac disease (CD) classically presents between 9-18 months of age but in India there is a significant delay in the onset of symptoms (3-4 years) and the age of presentation (6.8-9.2 years). Failure to thrive, anemia, and muscle wasting are more common in children. Symptomatic CD represents the tip of the iceberg. Clinically there may be overt, silent, latent and potential CD. Modified ESPGAN criteria for diagnosis of CD is based on demonstration of characteristic histological changes in small intestinal biopsy while on gluten, and unequivocal clinical improvement when on gluten free diet. However, in developing countries there are several conditions which can give rise to villous atrophy and using it as a diagnostic criteria may lead to overdiagnosis of CD. IgA antigliadin antibody has a high sensitivity (98%) and specificity (90%) for CD and hence, may be an ideal adjunct to modified ESPGAN criteria in the diagnosis of CD in India.

Age Distribution↗