Massive upper gastrointestinal haemorrhage from a gastric vascular malformation.
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Arteriovenous Malformations↗
Biomedical subjects
V Bhatnagar
Publications and source records attributed to V Bhatnagar.
Management of hydrocephalus.
The present study is an analysis of 747 patients with hydrocephalus, treated and followed up in the Hydrocephalus Clinic run by the department of Paediatric Surgery at the All India Institute of Medical Sciences, New Delhi. The distribution of patients was: congenital-46%, post-meningomyelocoele excision-28%, post-meningitic-21% and others-5% (including post haemorrhagic and post encephalocoele excision hydrocephalus. The average age was 7 months in the shunted group and 10 months in the medical group with overall male to female ratio of 2.3:1. The data were analysed to study the effect of treatment on ventriculomegaly and mental development with special reference to the type of treatment (shunt versus medical) and age at starting treatment. The probability of shunt failure was also studied. A comparison of ventricular size in US/CAT scans between the time of starting treatment and last follow-up revealed improvement in ventriculomegaly in 60% of the shunted patients but only 30% of the medically treated patients. A significant difference was particularly noted in patients with severe hydrocephalus, 72% and 22%, respectively. Comparison of the mean Mental Performance Quotient (MPQ) scores in the shunted & medically treated patients also revealed significantly better MPQ scores in the shunted group (p = < 0.001). Probability of shunt survival, as depicted by the Kaplan-Meier survival curve, revealed that there is a high rate of shunt failure in the first 12 months, followed by a dramatic slowing down. Our observations support the contention that CSF shunt surgery offers better outcome than medical management even when ventriculomegaly is severe at the time of presentation.
Cerebral Ventricles↗
Spontaneous neonatal gall bladder perforation.
A full term neonate was operated for diaphragmatic eventration through the chest. Postoperatively the baby developed gastric outlet obstruction. Ultrasonography and barium meal examination were suggestive of extrinsic compression in the region of the pylorus. At laparotomy a gall bladder perforation was found producing a biloma just abve the pylorus. Drainage of the bilioma and temporary cholecystostomy cured the gastric outlet obstruction.
Female↗
Infantile gastric teratoma.
Gastric teratoma is a rare tumour, comprising less than 1% of all teratomas in children. A 5 month old male child, who presented with an abdominal mass, fever and vomiting was diagnosed to have a gastric teratoma on ultrasonography, CT scan and serum alpha-feto protein. Complete excision of the tumour was performed. No chemotherapy was given. The histological examination revealed immature teratoma. The child is well 1 year after surgery.
Humans↗
Hepatocyte isolation and transplantation in syngenic rats.
Refinement of techniques to isolate viable hepatocytes began in the late 1960's. It was established that perfusion of the intact liver as opposed to incubation of liver slices or chopped tissue increased the yield of cells. The present study aims to establish a simple, two-step, collagenase digestion method for hepatocyte isolation. A single inbred Fisher rat was used for hepatocyte isolation. The liver was perfused in-situ with perfusion buffer containing ethylene glycol bis N, N1, tetra acetic acid (EGTA), followed by the collagenase buffer. The liver was excised and gently minced. The tissue was resuspended in the collagenase buffer to complete dissociation. The cell suspension obtained was washed, centrifuged and filtered to complete the isolation procedure. The trypan blue exclusion test showed 80-85% cell viability. The isolated cells were transplanted into the splenic parenchyma of syngenic rats. Survival of the transplanted hepatocytes was confirmed by histological examination at the end of 90 days. This two step technique of in-situ liver perfusion gives a high yield of viable hepatocytes which show long term survival after transplantation.
Animals↗
Duplications of the alimentary tract in children.
This study was conducted to assess the clinical, diagnostic and therapeutic approach in patients with alimentary tract duplication and review the relevant literature. A retrospective analysis of 28 patients of alimentary tract duplications treated between January 1990-December 1999 was carried out. There was a male preponderance (25:3); 71% of the patients were under 2 years of age. The presenting features were related to the anatomic location. Three patients were diagnosed antenatally. Real time ultrasonography and CT scan was undertaken for preoperative evaluation in the majority of patients. In selected cases a 99m-Tc-pertechnetate scan and barium meal follow through examination were also performed. Majority of duplications were in the jejunum and ileum. Twenty percent of our patients had thoracoabdominal duplication as compared to 2% reported in literature. Four patients required to be operated upon in the emergency for related complications. In the remaining patients complete excision of the cyst was done in 21 and only mucosectomy in 3 patients. Because these lesions are rare and can present with a wide range of clinical manifestations or may even be encountered intraoperatively, the appropriate surgical management requires the surgeon to be familiar with the anatomy and clinical characteristics of these lesions.
Child, Preschool↗
Evaluation of transplanted hepatocytes using HIDA scintigraphy.
BACKGROUND: Hepatocyte transplantation has generated interest because of potential clinical application in enzyme deficiency disorders and acute hepatic failure. Ex-vivo HIDA scintigraphy has been used to assess graft survival after hepatocyte transplantation. The present study evaluates in-vivo99mTc-HIDA scintigraphy to assess graft function after hepatocyte transplantation. METHODS: Rat hepatocytes were isolated by a modified collagenase digestion technique and injected intrasplenically into 6 syngenic rats; 4 control rats received intrasplenic saline injections. In-vivo HIDA scintigraphy and histological evaluation were done 90 days after transplantation. RESULTS: Five of the six rats in the study group showed prompt and progressive accumulation of HIDA in the spleen. Histological examination showed presence of hepatocytes in the splenic red pulp. None of the control group animals had splenic uptake of HIDA. CONCLUSION: HIDA scintigraphy may be a useful modality for assessment of graft function after intrasplenic hepatocyte transplantation.
Animals↗
Sacrococcygeal teratoma with anorectal malformation.
A 7-month-old child presented with imperforate anus, penoscrotal hypospadias and transposition, and a midline mucosa-lined perineal mass. At surgery the mass was found to be supplied by the median sacral artery. It was excised and the anorectal malformation was repaired by posterior sagittal anorectoplasty. Histologically the mass revealed well-differentiated colonic tissue. The final diagnosis was well-differentiated sacrococcygeal teratoma in association with anorectal malformation.
Abnormalities, Multiple↗
Low anorectal malformation associated with sarococcygeal teratoma.
The association of sacrococcygeal teratoma with anorectal malformation is rare event in teratopathogenesis. One such case is described here. The Sacrococcygeal teratoma was excised at birth and the low anorectal anomaly was also treated at the same time.
Anal Canal↗
Bleeding ileal duplication diagnosed by pertechnetate scan.
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Child, Preschool↗
Manometric evaluation of postoperative patients with anorectal anomalies.
AIM: To evaluate the outcome of surgical treatment in patients with anorectal malformations and to correlate the clinical, manometric and electromyographic studies in assessment of postoperative continence in these patients. METHODS: Forty-one patients operated on for anorectal malformations were evaluated retrospectively. These included 13 patients with low anomalies, 24 with high anomalies, and 4 with congenital pouch colon. Functional results after surgical correction were assessed on clinical basis using the Kelley's scoring system and by anorectal manometry. In addition, the electrical activity of contraction of the external sphincter muscle was studied using electromyography. RESULTS: There was direct correlation between anal canal pressures and Kelley's score in patients with both high and low anomalies; Kelley's score of 6, 5, 4, 3 and less had pressures ranging between 60-75, 45-59, 30-44, 15-29 and less than 15 cm H2O, respectively. However, the electromyographic activity did not correlate well with Kelley's score. CONCLUSIONS: Anorectal manometry correlates well with Kelley's scoring system and may be a more objective method of analyzing the results of surgery. Poor correlation between Kelley's score and electromyography may be a reflection of poor compliance with instructions to voluntarily contract the muscles of continence.
Adolescent↗
Prenatal diagnosis of pre-sacral mass, simulated by meconium.
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Diagnosis, Differential↗
Clinical course and management of pancreatoblastoma in children.
Pancreatoblastoma is a rare malignant tumour. Two children with this tumour were managed in the last 2 years. Both presented with progressively increasing abdominal mass. The diagnosis was established only after laparotomy. In the first child, an 8 year old girl, the mass was arising from the body of the pancreas and only incomplete resection was feasible. She received postoperative chemotherapy and went into remission for a few months before presenting with jaundice and abdominal pain due to recurrent, metastatic disease in the liver and porta hepatitis. Further therapy was refused by the patient because of anorexia and social problems. The second patient, a 5-year-old girl, underwent distal pancreatectomy for complete removal of a large mass arising from the tail of the pancreas. Chemotherapy was begun postoperatively but discontinued by the patient. However, she has remained disease free 1 year after diagnosis. Histologic, histochemical and ultrastructural features of the tumour are detailed and the management discussed.
Antineoplastic Combined Chemotherapy Protocols↗