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Biomedical subjects

V Bhatnagar

Publications and source records attributed to V Bhatnagar.

At least 91 records · Page 5Linked to original sources
PubMed2001

Pediatric extragonadal germ cell tumor of the scalp.

Extragonadal germ cell tumors are relatively rare tumors, accounting for 5% to 10% of all germ cell tumors in adults. In children, approximately two thirds of germ cell tumors are extragonadal. Extragonadal germ cell tumor of the scalp is exceedingly rare. The authors report the case of a 1(1/2)-year-old boy with extragonadal germ cell tumor over the occipital region. Examination of the chest, abdomen, and gonads was normal. Computed tomography scan of the head showed a large, well-defined, lobulated, heterogeneously enhancing soft tissue mass lesion in the occipital region. The underlying bone was normal with no evidence of intracranial extension. Biopsy results of the scalp mass showed features consistent with embroynal carcinoma. Serum alpha-fetoprotein (AFP) level was elevated. The child was started on chemotherapy and received 4 cycles of cisplatin, etoposide, and bleomycin (PEB). There was more than 90% reduction in the size of the mass at the end of the fourth cycle. The residual mass was excised and followed up with 2 cycles of postoperative PEB. Ten months after excision the patient is well, without recurrence, and the AFP level is normal.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2001

Transitional cell carcinoma of the urinary bladder following exposure to cyclophosphamide in childhood.

With the increasing survival of children with malignancies, the long-term effects of chemotherapies are now becoming important and one of these dreadful long-term complications is the development of a second malignancy. Described here is a case of transitional cell carcinoma of the bladder developing 8 years following exposure to cyclophosphamide for the treatment of embryonal rhabdomyosarcoma.

Adolescent↗
PubMed2001

Manometric evaluation of postoperative patients of esophageal atresia and tracheo-esophageal fistula.

Symptoms related to esophageal dysmotility are common following successful repair of esophageal atresia (EA) and tracheo-esophageal fistula (TEF). Esophageal manometry was performed in 27 survivors of EA/TEF at a mean age of 30.5 +/- 30.3 months and in 25 age-matched controls (mean age 36.8 +/- 22.6 months). The patients were also evaluated clinically to grade them into 3 result-oriented groups "Excellent", "Good" and "Fair", depending on pre-existing criteria evaluating the ability and ease of swallowing. Gastroesophageal reflux (GER) was evaluated with the help of a radionuclide scan. The mean esophageal and peak esophageal pressures and therefore also the lower esophageal sphincter (LES) pressure were lower in the patients (12.4 +/- 5.5, 34.9 +/- 20.4 and 12.2 +/- 6.8 mm Hg, respectively) compared to the controls (21.1 +/- 6.9, 62.3 +/- 19.3 and 16.8 +/- 4.3 mm Hg, respectively). The mean body pressures were highest with "Excellent" results and lowest with "Fair" results and the LES pressures followed a similar trend. Likewise, in the patients with GER, LES pressure was 12.0 +/- 7.1, 12.3 +/- 3.7, 11.0 +/- 5.7 and 6.9 +/- 5.6 mm Hg with nil, mild, moderate and severe GER, respectively. The pressure and contractility profile of the esophagus was abnormal in the majority of patients, even in the absence of symptoms.

Case-Control Studies↗
PubMed2000

Measurement of the W-->taunu production cross section in pp collisions at square root s=1.8 TeV.

We report on a measurement of sigma(pp-->W+X)B(W-->taunu) in pp collisions at sqrt[s]=1.8 TeV at the Fermilab Tevatron. The measurement is based on an integrated luminosity (lum) of 18 pb-1 of data collected with the D0 detector during 1994-1995. We find that sigma(pp-->W+X)B(W-->taunu)=2.22+/-0.09 (stat)+/-0. 10 (syst)+/-0.10 (lum) nb. Lepton universality predicts that the ratio of the tau and electron electroweak charged current couplings to the W boson, gWtau/gWe, be unity. We find gWtau/gWe=0.980+/-0.031, in agreement with lepton universality.

Journal Article↗
PubMed2000

Probing Balitsky-Fadin-Kuraev-Lipatov dynamics in the dijet cross section at large rapidity intervals in pp collisions at sqrt[s]=1800 and 630 GeV.

Inclusive dijet production at large pseudorapidity intervals (Deltaeta) between the two jets has been suggested as a regime for observing Balitsky-Fadin-Kuraev-Lipatov (BFKL) dynamics. We have measured the dijet cross section for large Deltaeta in pp collisions at sqrt[s]=1800 and 630 GeV using the D0 detector. The partonic cross section increases strongly with the size of Deltaeta. The observed growth is even stronger than expected on the basis of BFKL resummation in the leading logarithmic approximation. The growth of the partonic cross section can be accommodated with an effective BFKL intercept of alphaBFKL(20 GeV)=1.65+/-0.07.

Journal Article↗
PubMed2000

Cineradiographic evaluation of postoperative patients with esophageal atresia and tracheoesophageal fistula.

Esophageal dysmotility is a common occurrence after successful repair of esophageal atresia (EA) and tracheoesophageal fistula (TEF). The etiology of this motility disorder, however, remains controversial. Cine-barium esophagograms were performed in 25 survivors of EA/TEF at a mean age of 30.5 months. A clinical evaluation was done at the same time and the results were classified as "excellent", "good", and "fair". The study revealed that 88% of patients had dysmotile esophageal segments and segmental contractions. Normal peristalsis was seen in only 16% of patients and 64% showed to-and-fro movements. The bolus transit time was delayed in 60%. The clinical status of these patients correlated well with the cine-radiographic findings. Thus, abnormal motility of the esophagus, which may be inherent, exists in postoperative survivors of EA/TEF and may be responsible for the clinical status of these patients.

Barium Sulfate↗
PubMed2000

Postnatal outcome and natural history of antenatally-detected hydronephrosis.

Routine maternal ultrasonography (US) has revealed a very high incidence of fetal hydronephrosis (HDN), the postnatal outcome and management protocols of which are replete with controversies. Pelviureteric junction (PUJ) obstruction is the commonest postnatal diagnosis, and its management has no consensus to date. This study was carried out to define the postnatal outcome and natural history of fetal HDN and to identify the mode of management to be adopted to the best advantage. All patients were subjected to US 48 h postnatally or at first presentation and isotope renography (DTPA) with nuclear glomerular filtration rate (GFR) was carried out at 3-4 weeks of age or at presentation. Micturating cystourethrography (MCU) and/or direct radionuclide cystography (DRCG) were done in cases with bilateral HDN, nonobstructive HDN, dilated ureter on US, and recurrent urinary tract infection. Patients were then grouped for surgical intervention or conservative follow-up. Investigations were repeated periodically. A total of 56 patients were registered for the study (78 renal units) with a mean follow-up period of 14.6 months; 37 renal units were operated upon or scheduled for surgery and 67 had some organic pathology, of which PUJ obstruction was the commonest. Among patients with PUJ obstruction, indications for surgery included symptoms, a palpable mass, poor or deteriorating function, and a solitary functioning kidney. Patients operated upon showed improvement in function and/or drainage, while those followed conservatively remained stable or improved. Controversy still exists as to the optimal management of PUJ obstruction detected antenatally. While it is the commonest postnatal diagnosis, many other pathologies are now being encountered. In antenatally-diagnosed HDN, there is a good scope for conservative management provided rigid follow-up can be ensured, especially because a good recovery potential exists followed surgery whenever indicated.

Female↗
PubMed2000

Fulguration of posterior urethral valves using the Nd:YAG laser.

Endoscopic management is the accepted form of treatment for posterior urethral valves (PUV). The Nd:YAG laser has been in clinical use for many decades, but has been used only sporadically for ablating PUV. In this study, PUV were diagnosed by micturating cystourethrogram (MCU). In the 9-month period beginning March 1997, 23 boys 3 months to 9 years of age underwent endoscopic Nd:YAG laser surgery for PUV using a 600 quartz bare fibre through the catheter channel of an 8.5 F cystoscope. The laser power and total energy delivered ranged from 20 to 50 W and 50-1085 J, respectively. Type I PUV were present in 20 boys; 1 had type III, and in 1 boy each there were residual valves and a urethral stricture from a previous electrocautery ablation. All operations were done with the patient under general anaesthesia supplemented by caudal morphine. Routine postoperative cystoscopy was done in the first 5 cases only. All patients had a good stream of urine without bleeding or any other complication after valve ablation. Mucosal tags seen on follow-up cystoscopy in 5 patients were fulgurated by laser. In 4 other patients recystoscopy was required for deterioration of the urinary stream and persistent posterior urethral dilatation on MCU; residual valves were refulgurated by laser. An indwelling catheter was left in only 4 patients, 2 of whom were primarily operated and 2 following refulguration. All except the first 2 were treated as out-patients. Application of the Nd:YAG laser has added a new dimension for treating PUV. The initial experience has been very encouraging: the destruction of valves is precise, there are no complications, and it can be practised on a day-care basis without indwelling catheterisation. The bare fibre can be used repeatedly, thus reducing the cost of treatment.

Catheter Ablation↗
PubMed2000

Congenital hepatoportal arteriovenous fistula: report of a case.

Fistulae between the hepatic artery and portal vein, known as hepatoportal arteriovenous fistula (HPAVF), most commonly occur secondary to trauma or malignancy. Congenital HPAVF is an extremely rare anomaly and only 11 pediatric cases have been documented to date HPAVF causes portal hypertension with the reversal of flow in the portal circulation, leading to hyperemia and congestion of the bowel, causing severe ascites, gastrointestinal bleeding, anemia, and malabsorption. The diagnosis is first made by Doppler sonography, then confirmed by angiography. HPAVF is most effectively treated by performing either ligation of the hepatic artery or percutaneous transcatheter embolization. We describe herein the case of an 8-month-old boy diagnosed to have congenital HPAVF by duplex Doppler sonography and confirmed by digital subtraction angiography, who was successfully managed by percutaneous transcatheter embolization of the feeding right hepatic artery. A review of the previously reported 11 cases of infants with this unusual anomaly, examining presentation, management, and outcome, is also presented.

Arteriovenous Fistula↗
PubMed2000

A histopathological study of esophageal atresia and tracheoesophageal fistula.

BACKGROUND/PURPOSE: Histopathologic examination of the esophagus has not been reported often in esophageal atresia (EA) and tracheoesophageal fistula (TEF). Abnormal esophageal motility has been reported after successful repair of EA and TEF, although the exact etiology of this motility disorder remains unclear. Histological evaluation of the fistulous portion of the esophagus has been performed to document any abnormality that may be responsible for the abnormal motility. METHODS: Histopathological study of fistulous segment of esophageal atresia and distal TEF was conducted on 65 patients, which included autopsy material from 3 patients in whom the entire esophagus was examined by serial section. Special stains were administered to each specimen to look for tracheobronchial remnants and the arrangement of muscle fibers. Clinical evaluation was performed in 27 patients who were available for review 6 months to 9 years after successful surgical treatment. These patients were categorized into 3 groups according to their clinical status. RESULTS: These findings showed that the majority of these patients have tracheobronchial remnants in the esophagus in the form of abnormal mucous glands and ducts, abnormal mucin secretion, presence of cartilage, and a disorganized muscle coat. CONCLUSIONS: The presence of abnormal mucous glands and abnormal mucin secretion has not been highlighted before. Although tracheobronchial remnants and a disorganized muscle coat are common findings in the fistulous portion of the esophagus, these may not reflect the structure of the remaining esophagus.

Biopsy↗
PubMed2000

High incidence of adriamycin cardiotoxicity in children even at low cumulative doses: role of radionuclide cardiac angiography.

BACKGROUND/PURPOSE: Adriamycin (doxorubicin), a chemotherapeutic agent commonly used in the treatment of pediatric solid tumors, is known to have a dose-related cardiotoxicity, which is reported to be more common in children. The clinical manifestation of this is congestive cardiac failure (CHF), and this is fatal in 50% of the cases. Various strategies, including prospective multiple gated acquisition (MUGA) scan for early detection of the onset of cardiac damage has been recommended to decrease this fatality caused by cardiotoxicity. METHODS: All children receiving Adriamycin for solid tumors, registered at our pediatric solid tumor clinic from January 1998 through June 1999, were included in the study. Cardiotoxicity was evaluated by using electrocardiogram (ECG)-gated radionuclide cardiac angiography (MUGA scan). RESULTS: MUGA scans were performed on 55 patients in the above-mentioned period of 18 months. Twenty-three patients had only 1 baseline MUGA scan done, 12 of these are awaiting further studies at appropriate time and 11 are either dead or lost to follow-up. Of the remaining 32 patients, 13 have shown evidence of cardiotoxicity on MUGA scan done at a cumulative dose of 180 to 200 mg/m(2), in the form of decrease in left ventricular ejection fraction (LVEF) or abnormality in myocardial movements. Three of these 13 patients had clinical evidence of CHF. In 10 patients, timely discontinuation of Adriamycin, based on the MUGA report, probably has helped avoid the development of CHF. CONCLUSION: Routine monitoring of all children receiving Adriamycin is required to avoid the mortality and morbidity of Adriamycin-related cardiotoxicity, which may develop at relatively low cumulative doses also.

Antineoplastic Agents↗
PubMed2000

Sonography and CT of pancreatoblastoma in children.

OBJECTIVE: We reveal the sonography and CT findings of three children with pancreatoblastoma. CONCLUSION: Pancreatoblastomas are invasive tumors that encase adjacent vessels and infiltrate surrounding organs. Original and atypical findings include metastases to the omentum and lymph nodes of the neck and direct extension of the tumor to the portal vein and its branches.

Child↗
PubMed1999

Epithelioid hemangioendothelioma of the greater omentum: report of a case.

We report herein the case of an 11-year-old girl found to have an epithelioid hemangioendothelioma of the greater omentum. The child presented with a 4-month history of vague lower abdominal pain and gradually increasing generalized distension. Her symptoms and signs could not be ascribed to any specific organ system. Ultrasonography and computerized axial tomography revealed a mass lesion anterior to the bowel loops and a laparotomy revealed a huge lobulated mass, arising from the greater omentum, which was completely excised. She has remained well postoperatively without any adjunctive chemotherapy or radiotherapy.

Child↗
PubMed1999

Bladder-neck repair in urinary bladder exstrophy.

A simple modification of an existing technique for bladder-neck reconstruction in exstrophy of the urinary bladder is reported. The technique involves tubularization of the posterior urethra up to just below the ureteric orifices. It differs from other techniques in that no part of the bladder tissue is used for buttressing the repair, but all is utilized for enhancing the bladder volume. Only 2 of 20 patients remained incontinent after bladder-neck reconstruction; the remaining 18 have achieved socially acceptable continence.

Bladder Exstrophy↗
PubMed1999

Primary reconstruction of a congenital anterior urethral diverticulum.

A new technique for primary reconstruction of a congenital anterior urethral diverticulum is described. This operation eliminates the obstruction caused by the distal lip of the diverticulum and at the same time strengthens the unsupported urethral wall using tissue from the walls of the diverticulum. It has been used very effectively in two boys.

Child, Preschool↗
PubMed1999

Urodynamic evaluation in boys treated for posterior urethral valves.

This study describes the urodynamic findings in 22 patients with posterior urethral valves and discusses their association with urinary incontinence, age, mode of primary treatment, renal function, and changes in the upper tracts. The patients' ages ranged from 3 to 26 years and 27% were either adolescents or older. The urodynamic findings were categorized into 5 main patterns, although mixed patterns were also observed; (1) normal capacity and compliance with normal detrusor contractility (2/22 patients, 9.1%); (2) small-capacity, hypocompliant bladder (8/22 patients, 36.4%); (3) unstable bladder (2/22 patients, 9.1%); (4) large-capacity, hypotonic bladder with decreased detrusor contractility (2/22 patients, 9.1%); and (5) normal capacity and compliance but with decreased detrusor contractility (8/22 patients, 36.4%). More than one-half of the patients (57.1%) evacuated their bladders incompletely, and this seemed to be associated with post-treatment episodes of urinary-tract infection. The commonest symptom was daytime frequency, urgency, and leak with nocturnal enuresis, which urodynamically correlated with a small-capacity, hypocompliant or unstable bladder or to incomplete evacuation of the bladder, leading to significant post-void residue. Significant detrusor dysfunction was identified in 2 asymptomatic patients as well, emphasizing the need to perform a routine urodynamic work-up on all valve patients. Urodynamic properties seemed to be associated with age. Small, hypocompliant, and unstable bladders were almost always seen in prepubertal boys and in the first 5 years following undiversion, whereas large, hypotonic bladders with impaired contractility were seen in post-pubertal boys. While the current policy is to avoid high diversion, data in this study suggest that disorders of detrusor capacity, compliance, and contractility exist in children treated by primary valve ablation and vesicostomy and that abnormal detrusor dynamics seem to be a reflection of inherent developmental detrusor dysfunction consequent to congenital infravesical obstruction.

Adolescent↗
PubMed1999

Total colonic aganglionosis: diagnosis and management in a 12-year-old boy.

Total colonic aganglionosis (TCA) is an unusual form of Hirschsprung's disease, and most of these present within the first few weeks and nearly all by the end of the first year of life. Very few cases presenting in older childhood or adulthood have been reported. Without a high index of suspicion these cases can easily be missed and, therefore, patients undergo repeated laparotomies for subacute intestinal obstruction without relief of symptoms. The diagnosis is suspected on operative findings and confirmed by histological evaluation of seromuscular biopsy specimens. Proper diagnosis will prevent loss of bowel length caused by inadvertent resection and will help in performing an optimal procedure to treat these patients. Discussed herein is another case of TCA in a 12-year-old boy with review of relevant literature.

Child↗