Cost analysis in the management of esophageal coins: endoscopy versus bougienage.
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Catheterization↗
Biomedical subjects
V Bhatnagar
Publications and source records attributed to V Bhatnagar.
Endoscopic treatment of tracheoesophageal fistula using electrocautery and the Nd:YAG laser.
BACKGROUND: Endoscopy is a well-established means of diagnosis in recurrent and congenital H-type tracheoesophageal fistulas. There is only limited knowledge of its role in the treatment using either electrocautery or laser. Laser application has not yet been reported in the treatment of recurrent tracheoesophageal fistula. METHODS: From 1993 to 1997 five patients with tracheoesophageal fistula (two congenital H-type and three recurrent) were treated endoscopically using a rigid ventilating bronchoscope. The final diagnosis was made on bronchoscopic examination. In two of the patients with recurrent fistulas and one with congenital fistula, the mucosal lining was fulgurated with electrocautery via an insulated wire. In one patient each with recurrent and congenital fistula, the mucosal lining was vaporized with the Nd:YAG laser via a 600 microm bare quartz fiber. RESULTS: Obliteration of the fistula was achieved in both the patients in whom laser was used, but it was unsuccessful in two of the three children in whom electrocautery was used. The obliquity of the congenital H-type fistula renders it more amenable to obliteration compared with the short and direct recurrent fistula. There was significant respiratory distress in the postoperative period after use of electrocautery. However, it was uneventful with the use of laser. CONCLUSIONS: Endoscopic treatment of recurrent and congenital H-type tracheoesophageal fistula is technically easier than open surgical procedures and helps avoid the risks associated with the latter. The Nd:YAG laser is qualitatively better than electrocautery for the obliteration of the fistula.
Adolescent↗
Hypertension in the elderly with coexisting benign prostatic hyperplasia.
The treatment of hypertension in the elderly can be safely achieved with low-dose diuretic therapy. Men with prostatism may benefit from peripheral alpha-blocking drugs. However, drugs such as doxazosin or terazosin may further lower blood pressure and at times may be associated with orthostatic hypotension, especially if diuretics are given concomitantly. Tamsulosin achieves relaxation of the smooth muscle of the prostate, as do terazosin and doxazosin, but without provoking changes in blood pressure, especially orthostatic hypotension. There appears to be no adverse interaction with any other antihypertensive medication or with low-dose diuretics. To manage such patients with hypertension and prostatism, hydrochlorothiazide 6.25 to 12.5 mg/day and tamsulosin 0.4 mg/day would be an adequate combination. Low-dose diuretics have been shown to be effective in both isolated systolic hypertension as well as fixed diastolic hypertension in the elderly. If other antihypertensives need to be added, then a low dose of a long-acting calcium-entry blocker, a central alpha-agonist (a transdermal clonidine for better compliance), an angiotensin-converting enzyme inhibitor (if renal vascular disease has been ruled out), or an angiotensin II receptor blocker, e.g., losartan or valsartan, should be considered.
Age Factors↗
Long-term prognosis of renal function in boys treated for posterior urethral valves.
This paper discusses the long-term prognosis of renal function in 84 boys treated for posterior urethral valves and followed up for a period ranging from 1-21 years. Thirty-one of the 84 patients (39.3%) were either adolescents or had crossed adolescence and this study highlights the changes through adolescence and puberty. Serum creatinine was found to be raised in 53% patients at presentation and 22.5% patients eventually progressed to chronic renal failure. Serum creatinine value 1 year after appropriate decompression of the urinary tract was a more accurate predictor of the eventual renal outcome rather than serum creatinine at presentation. Decompensation at puberty was detected in 3 patients in this study. The predisposing factors identified were the persistence of gross hydroureteronephrosis with voiding dysfunction after treatment in one patient and renal parenchymal disease in the other 2 patients. The "risk factors" for predicting a poor eventual renal function were persistently raised serum creatinine 1 year after decompression by diversion or fulguration, bilateral high grade vesicoureteral reflux, persistent severe upper tract dilatation after treatment, voiding dysfunction and delayed presentation. This study emphasizes the need to diagnose and intervene early, to investigate post-treatment persistent upper tract dilatation for vesicoureteral junction obstruction and for detrusor dysfunction by a complete urodynamic evaluation and to follow up these patients carefully through adolescence and adulthood.
Adolescent↗
Congenital lung cyst.
This case report describes a congenital lung cyst presenting as a brilliantly transilluminant mass in the left supraclavicular region. Clinically, it was mistakenly thought to be a cervical cystic hygroma with intrathoracic extension. X-ray and CT scan of the neck and chest confirmed the diagnosis. The lung cyst was treated by surgical excision with excellent results.
Child, Preschool↗
Spontaneous perforation of the common bile duct in infancy: role of Tc-99m mebrofenin hepatobiliary imaging.
A 2-month-old infant had jaundice that began 3 days after birth. The clinical features were suggestive of biliary obstruction. Tc-99m mebrofenin hepatobiliary imaging confirmed the diagnosis of spontaneous perforation of the common bile duct, and surgical intervention resulted in progressive recovery.
Aniline Compounds↗
Mediastinal lymphangiomyoma in a child: report of a case.
Lymphangiomas and lymphangiomyomas are benign abnormal collections of lymphatic vessels which form a cystic mass. The mediastinum is an uncommon location for these hamartomas in children, but may be life-threatening. We report herein the case of a 23-month-old boy who presented with stridor and a history of recurrent respiratory tract infections. Soon after his admission he suddenly developed respiratory failure and was found to have a multiloculated, cystic mediastinal mass which was initially thought to be a lymphangioma. The mass was extensively infiltrative, and histological examination showed prominent smooth muscle proliferation in the walls of the cysts, confirming a diagnosis of lymphangiomyoma. The terminology and relevant literature on the topic are reviewed following the presentation of this case.
Humans↗
Intra-pancreatic splenic artery pseudoaneurysm. A rare complication of chronic calcific pancreatitis.
The authors present the case of a 12-year-old boy with a history of chronic upper abdominal pain. Based on ultrasonography, endoscopic retrograde cholangio-pancreatography, and computerized tomography, a diagnosis of chronic calcific pancreatitis with dilation of the main pancreatic duct and a pseudocyst of the proximal pancreas was made. At surgery, in addition to confirmation of the above findings, a pseudoaneurysm arising from the splenic artery was found in the head and body of the pancreas. Pancreaticoduodenal resection including the pseudoaneurysm was performed. Postoperatively the child developed diabetes, which is easily managed with small doses of insulin.
Aneurysm, False↗
Acute renal failure in bilateral urinary tract tuberculosis.
A case of bilateral urinary tract tuberculosis presenting with acute renal failure is reported. It is believed to be the first reported instance of the disease presenting in this form. The patient was managed with preliminary high diversion followed by bilateral replacement of the ureters with ileal loops that were anastomosed end-to-side and then implanted into the bladder.
Acute Kidney Injury↗
Upper-tract changes after treatment of posterior urethral valves.
This paper discusses the long-term sequelae in the upper urinary tract with respect to hydroureteronephrosis (HUN), vesicoureteral reflux (VUR), renal parenchymal disease, and their correlation with renal function in 84 boys with posterior urethral valves followed for 1 to 21 years. Thirty-one boys (39.3%) were adolescents or older at the time of review. The incidence of high-grade VUR (grade III or more) was 47.6% at presentation, and resolution following decompression of the lower urinary tract occurred in 38.7% of refluxing units. VUR was associated with a high incidence of chronic renal failure (CRF) (30%) on long-term follow up; however, 16% of non-refluxing patients also progressed to CRF. The incidences of renal parenchymal disease and persistent upper-tract dilatation in the non-refluxing group were 25% and 50% of renal units respectively. Gross HUN persisted in 12.3% of patients despite decompression and reconstructive surgery, with vesicoureteral junction (VUJ) obstruction being documented in 1 patient only. Moderate and mild upper-tract dilatation persisted in 31.6% and 43.9% of patients, respectively. Persistent gross HUN was associated with a very high incidence of CRF (92.3%), while 88.4% of those with persistent mild/moderate dilatation maintained normal renal function over a follow-up period ranging from 1 to 21 years. This study emphasizes the need for systematic evaluation to exclude VUJ obstruction and abnormal urodynamics as a cause of persistent HUN so that effective therapy can be instituted early to relieve back-pressure and to provide a low-pressure reservoir with effective emptying. In the absence of either of these causes, persistent ureterectasis after treatment is presumably due to secondary peristaltic failure as a consequence of ureteral fibrosis, ureteral tortuosity, or developmental dysplasia.
Adolescent↗
Tubed vaginostomy: a new technique for preliminary drainage of neonatal hydrometrocolpos.
The preferred treatment of neonatal hydrometrocolpos has been vaginal drainage onto the perineum. However, in some situations a temporary vaginostomy is required, for which an indwelling catheter is used. This report describes an operative procedure that avoids the use of any indwelling catheter and at the same time provides excellent drainage and an easy access for performing dye studies to outline the pathological anatomy of the condition. This procedure has been performed in two patients, found ready acceptance, and gave gratifying results.
Drainage↗
Gastric pneumatosis associated with preduodenal portal vein, duodenal atresia, and asplenia.
An 8-day-old newborn presented with non-bilious vomiting, upper abdominal fullness, and failure to pass meconium. Plain radiographs revealed gastric pneumatosis (GP). At operation, he was found to have a non-obstructive preduodenal portal vein, preampullary duodenal atresia, asplenia, and malrotation. The baby was treated by duodeno-duodenostomy without mobilizing the portal vein and correction of the malrotation according to Ladd's procedure. He made an uneventful recovery and the GP resolved spontaneously. The malformative process was believed to have occurred at or soon after the 5th week of gestation, and the GP probably resulted from intramural air tracking through mucosal tears caused by high intragastric pressure.
Cysts↗
Somatic growth and renal function after unilateral nephrectomy for Wilms' tumor.
Solitary kidneys in renal donors and patients who have undergone unilateral nephrectomy for malignant disease have been reported to undergo hyperfiltration injury. This study was undertaken to evaluate the somatic growth and development of followed-up patient after Wilms' tumor to evaluate their renal function and identify any evidence of injury in the remaining kidney. The growth and development of all the children was found to be normal, as was DTPA clearance. Microalbuminuria in 24-h urinary collections was detected in 84% of the patients, indicating evidence of hyperfiltration injury. This study highlights the need for close monitoring of the renal function of long-term follow-up patients after Wilms' tumor in addition to the routine monitoring for tumor recurrence.
Albuminuria↗
Multiple urethral calculi in children: report of two cases.
Multiple urethral calculi are rarely found in children. We report herein two unusual cases of children found to have multiple urethral calculi. In one, the calculi formed proximal to a stricture and in the other they formed within a diverticulum. Both patients required urethrotomy for removal of the calculi. A unique cause of urethral stricture is also described in case 1.
Child↗
Exteriorization of the distal esophagus in the abdomen in esophageal atresia.
METHODS: The distal esophagus was exteriorized on to the left upper abdominal wall (abdominal esophagostomy) in 15 babies who had esophageal atresia with or without tracheo-esophageal fistula. The indications for this procedure were long gap atresia with or without tracheoesophageal fistula in which primary anastomosis was not possible and a major anastomotic dehiscence requiring cervical esophagostomy and gastrostomy. In all these patients a decision to replace the esophagus had been made, and a cervical esophagostomy was constructed. The distal esophagus was mobilized either from the thorax if thoracotomy had been done or by a transhiatal abdominal route. CONCLUSIONS: Advantages of the abdominal esophagostomy include absence of gastroesophageal reflux, no indwelling catheter, early institution of enteral feeds, intermittent catheterization for feeding, easy nursing care, and no stomal complications. In addition, this procedure allows the entire stomach to be available for esophageal replacement and retains the natural gastroesophageal junction and the lower esophagus for anastomosis to any bowel segment being used for the esophageal replacement.
Abdominal Muscles↗
Urethral strictures after fulguration of posterior urethral valves.
This report discusses the incidence and predisposing factors for postfulguration urethral strictures in 82 boys with posterior urethral valves treated over 20 years and followed up for a period ranging from 1 to 21 years. A urethral stricture developed in three of the 82 patients (3.6%). All newborns and infants with small urethral caliber at presentation were treated on a temporary tubeless diversion, and fulguration of the valves was deferred until 9 to 12 months of age. A 9F resectoscope with a loop electrode was used to fulgurate at 5, 7, and 12 o'clock positions. A definite technical factor leading to a stricture could be identified in one of these three patients. Comparison of the "stricture" group with the "no stricture" group suggested that although dry fulguration did not have a definite correlation with stricture formation, it is best avoided. Refulguration and properly managed preoperative catheterization did not predispose to stricture formation. Meticulous surgical technique and avoiding oversized instrumentation were the most important factors for preventing this complication.
Adolescent↗
Endoscopic treatment of tracheal diverticulum after primary repair of esophageal atresia and tracheoesophageal fistula.
Two cases of recurrent and persistent respiratory symptoms after primary repair of esophageal atresia and tracheoesophageal fistula are described. The diagnostic workup included barium swallow examination, radionuclide study for gastroesophageal reflux, and bronchoscopy. The tracheal diverticulum was detected on bronchoscopy. Treatment consisted of endoscopic cauterization of the mucosa of the diverticulum and its orifice using electrocoagulation in case 1 and the Nd:YAG laser in case 2. Electrocoagulation produced tracheal edema, which caused severe respiratory distress necessitating temporary tracheostomy. Cauterization with the Nd:YAG laser was safe, effective, and uncomplicated.
Bronchoscopy↗
In vitro modulation of proliferation and melanization of melanoma cells by citrate.
B16/F10 murine melanoma cells were grown for 24 and 36 h in Dulbecco's modified Eagle medium in presence of 10-20 mM trisodium citrate. The intracellular melanin concentration and the melanin secreted in the extracellular medium was estimated. It is observed that 20 mM citrate stimulates extracellular melanin secretion in B16/F10 melanoma cells by 200% at 36 h treatment. The intracellular melanin content increased by 90%. This stimulatory effect of citrate was totally abolished when these cells were grown in presence of 1 mM phenyl thiourea, a specific inhibitor of tyrosinase activity. Citrate (0.1-5 mM) had no effect on dopa oxidase activity either at pH 5.0 or at pH 6.8. There was no increase in the tyrosinase specific activity in presence of citrate. The increased melanin synthesis was shown to be due to stimulation of cellular tyrosine hydroxylase activity by citrate. It has been suggested that enhanced melanin synthesis results in an increased production of metabolites that are toxic to the growth of melanoma cells. We have studied the effect of citrate on cellular proliferation. Following 24 and 36 h treatment with citrate, the cells exhibited a dose-dependent decrease in proliferation. In presence of 20 mM citrate the cell number was only up to 50% of the control cultures after 36 h of incubation. The growth retardation was not due to cytotoxicity. Citrate, a natural metabolite, is a unique molecule which may be involved in the regulation of melanin biosynthetic pathway, since it enhances melanogenesis by increasing the hydroxylase activity of tyrosinase which is the regulatory enzyme of this pathway. These observations add further support to the critical role of intramelanosomal pH in regulation of melanogenesis.
Animals↗