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Biomedical subjects

V T Joseph

Publications and source records attributed to V T Joseph.

At least 37 records · Page 2Linked to original sources
PubMed1990

Surgical techniques and long-term results in the treatment of choledochal cyst.

A personal follow-up of 52 cases of choledochal cyst managed over a 28-year period has provided a unique opportunity to review the long-term problems and outcome. Eleven patients had internal drainage procedures and at least four have developed cholangitis more than 10 years later, with three requiring reoperation and cyst excision. Of the 41 patients who had cyst excision, 34 were performed personally by the author; 33 have remained completely well, whereas one died subsequently of cholangiocarcinoma. Complete cyst excision can be successfully achieved provided the dissection of the distal part of the cyst is carried out in a clear, bloodless field obtained by working directly on the cyst wall beneath the overlying loose areolar tissue. Partial excision, mucosectomy, and operative cholangiograms have not been found necessary. This study provides conclusive evidence that any anastomosis of cyst wall to the gastrointestinal tract will ultimately result in stricture and cholangitis.

Adenoma, Bile Duct↗
PubMed1990

Chemotherapy for hepatoblastoma in children.

Hepatoblastoma is an uncommon but highly malignant liver tumour found in childhood. It is associated with high mortality with overall survival of only 35%. Two cases of hepatoblastoma are described. Both had surgical excision of tumour with microscopic residual tumour at the resected margins. They were given adjuvant chemotherapy. Both patients are living well, disease-free and off treatment six years and two years since diagnosis.

Carcinoma, Hepatocellular↗
PubMed1989

Accuracy of anorectal manometry in the diagnosis of Hirschsprung's disease.

The value of anorectal manometry as a diagnostic tool for Hirschsprung's disease (HD) was assessed in 50 children presenting with chronic constipation. Anorectal manometric studies and rectal biopsy were performed on all children. Biopsy specimens were stained with hematoxylin and eosin and serial sections were examined for ganglion cells. Forty-five children had concordant manometric and histologic results, 15 of whom were positive for HD and 30 negative. In five children, the results were discordant. Using histologic aganglionosis as the reference point for the final diagnosis of HD, the overall accuracy of anorectal manometry as a discriminative test was 90.0%. The sensitivity, specificity, and positive and negative predictive values of manometric studies for the diagnosis of HD were 0.79, 0.97, 0.94, and 0.88, respectively. Factors responsible for the inaccuracies of manometric studies are discussed.

Anal Canal↗
PubMed1989

A new technique of vaginal reconstruction using neurovascular pudendal-thigh flaps: a preliminary report.

The blood supply to the skin of the perineum, medial groin, and upper thigh was studied in fresh female cadavers. The pudendal-thigh flap was designed as a result to reconstruct the vagina. The flaps are raised bilaterally in the groin crease just lateral to the labia majora and then are transposed toward the midline and sutured together to form a skin-lined cul-de-sac which opens at the introitus. The technique has been used successfully in three patients to reconstruct the vagina. The first patient, an adult, was reconstructed after total pelvic exenteration for malignancy, while two children had reconstructions for congenital vaginal anomalies. This technique is superior to currently available methods because it is simple and reliable. No stents or dilators are needed. It is safe technique without complications in our hands. The reconstructed vagina has a natural angle for intercourse and is sensate. The donor scars in the groin are well hidden.

Adult↗
PubMed1989

Acute appendicitis in Singapore children--some clinical aspects.

This retrospective study of 132 patients less than 12 years of age with Appendectomy done for Acute Appendicitis showed histological confirmation in 106 patients (80.3%) and a "negative appendix" rate of 19.7%. The appendix was perforated in 31 patients (23.5%). In those patients with confirmed Acute Appendicitis, males predominate (1.7 males: 1 female) and the peak incidence was in those 9 years of age or more. Abdominal pain was present in all patients except a 13 month old infant. Abdominal tenderness was also elicited in all patients except one. Fever was present in 83 patients (78.3%), vomiting in 82 patients (77.4%) and diarrhoea in 19 patients (17.9%). There were 2 deaths in this review, giving a mortality rate of 1.9%. Postoperative complications include wound infection (13.2%), pelvic abscess (0.9%), ileus (0.9%) and adhesion obstruction (0.9%).

Acute Disease↗
PubMed1988

Problems and pitfalls in the management of Hirschsprung's disease.

A study of 126 patients with histologically proven Hirschsprung's disease revealed various problems associated with the surgical management of these cases. Complications such as prolapse, stricture, and cuff abscess were noted in patients undergoing endorectal pull-through (ERPT). These complications were not always obvious, and in some cases, the diagnosis became apparent only several years after definitive surgery. Specific technical aspects of the procedure probably play an important role in the pathogenesis of these problems. Ultrashort-segment Hirschsprung's disease remains a problem in treatment. Rectal myectomy gives good results in some cases and unsatisfactory results in others.

Child, Preschool↗
PubMed1988

Experiences in the treatment of neuroblastoma.

The clinical presentation, diagnosis and treatment of a series of 18 cases of neuroblastoma is reviewed. About half the patients were below the age of 2 years. Fever, loss of weight and appetite appeared to be the common manifestations, underscoring the vague and non-specific symptomatology of such a grave childhood disorder. Unusual presentations included paraplegia, chronic diarrhoea, lower limb edema and respiratory distress. Management consisted of radical surgery with adjunctive chemotherapy where indicated. It is emphasised that in resectable lesions every attempt must be made to remove tumour involved tissue as thoroughly as possible. With this approach 50% of patients followed up to 4 years have survived. Comparison of characteristics of survivors against non-survivors showed that the only significant difference was in the state of the disease--survivors having generally earlier state tumours.

Adrenal Gland Neoplasms↗
PubMed1987

Experience in the surgical management of Hirschsprung's disease.

The clinical presentation, surgical treatment and results in a group of 126 patients with histologically proven Hirschsprung's disease are presented. This study has enabled the authors to identify various problems and complications associated with the management of this condition. The typical clinical picture in the neonate has been observed in only 45.2% of our cases. In the long segment Hirschsprung's, especially those presenting with bowel perforation, the precise localisation of the aganglionic segment has been difficult. The standard surgical procedure in our department has been the mucosal-stripping endorectal pull-through operation. The problems of prolapse, stricture and cuff abscess associated with this procedure are, related to specific technical aspects of the operation which we believe have not been emphasised previously. Our current experience with this type of procedure has enabled us to carry out definitive surgery in early infancy without preliminary colostomy. The results justify our confidence that this approach to the surgical management of neonatal Hirschsprung's disease will become the standard procedure in our practice. An unusual feature has been the relatively common occurrence of the short segment type of Hirschsprung's disease--30.2% with rectal aganglionosis and 7.1% with ultrashort segment disease. This group has posed a dilemma as to the selection of the most appropriate surgical procedure. Rectal myectomy, which was the operation of choice, has given excellent results in some cases and yet in other cases it has been unsatisfactory, leading to the development of very gross megacolon.

Abscess↗
PubMed1985

Estimation of glomerular filtration rate in children using 99m-technetium DTPA. A comparison with 51-chromium EDTA clearance.

The usefulness of radionuclide imaging studies with 99m-technetium diethylenetriaminepentaacetic acid (Tc-DTPA) for quantitating the glomerular filtration rate (GFR) in children was studied. This was compared to the conventional methods for measuring GFR using 51-chromium-EDTA clearance (Cr-EDTA), creatinine clearance and a height/plasma creatinine formula. In the 22 children studied, the correlation coefficient between renal uptake of DTPA and Cr-EDTA was 0.90 (p less than 0.001). In contrast, there was a poorer correlation between Cr-EDTA and creatinine clearance (r = 0.69) or the derived GFR using height/creatinine formula (r = 0.83). The regression line between Tc-DTPA uptake and Cr-EDTA clearance was used to derive a formula for calculating the predicted GFR. This was tested in 10 additional children, and the correlation between the predicted GFR and measured GFR (using Cr-EDTA clearance studies) was 0.92 (p less than 0.001). Quantitative estimation of the GFR during renal imaging studies is a feasible and convenient method of assessing renal function.

Adolescent↗
PubMed1985

Anorectal malformations and their associated anomalies.

Congenital malformation of the rectum and anus is a problem frequently encountered in the neonatal period. 88 patients presenting with anorectal malformations were analysed and physical, operative, radiological and autopsy findings were reviewed to determine the types and incidence of associated lesions. Genitourinary malformations form the major group of associated lesions and contribute a significant degree of morbidity in the overall management of the anorectal deformities.

Abnormalities, Multiple↗
PubMed1984

Neonatal total gastrectomy.

A 2-day-old, female infant underwent total gastrectomy for spontaneous gastric gangrene and perforation. She developed the following complications: growth retardation, vitamin B12 deficiency, post-gastrectomy dumping syndrome, and occasional bile regurgitation. Nutritional management is described. The two previously reported survivors of total gastrectomy in the neonatal period are reviewed.

Dumping Syndrome↗
PubMed1984

Pelvi-ureteric junction obstruction in Singapore children--a retrospective study.

Thirty-two cases of hydronephrosis caused by pelvi-ureteric junction obstruction, presenting to the Department of Paediatric Surgery in the last 6 years were reviewed. In both infants and older children a palpable abdominal mass was the most common mode of presentation. Anderson-Hynes pyeloplasty was performed in a total of 31 kidneys. In 4 children, whose kidneys were severely hydronephrotic and with hardly any renal parenchyma present a primary nephrectomy was performed. Of the two children who required further operation on the same kidney, a repeat pyeloplasty for persistent obstruction was required in 1 patient, the other patient underwent nephrectomy subsequent to pyeloplasty as a severe pyonephrosis had developed. Twenty-nine of the 31 kidneys were assessed postoperatively by tube nephrogram, intravenous pyelogram (IVP), or diuretic renography. Four kidneys were found to be non-functional or severely damaged.

Child↗
PubMed1984

Vesico-ureteric reflux in Singapore children--a survey of surgically treated children.

A survey of 29 cases of vesico-ureteric reflux treated surgically at the Department of Paediatric Surgery, Singapore General Hospital, between 1974 and 1981 was carried out to assess the Singapore experience with the disease. There was a 2:1 female predominance but proportionately more males presented before 6 months of age (sex ratio 1:1). In contrast to Caucasian children, the peak incidence is below one year of age, and demonstrates the importance of recognising the condition early in infancy. Correspondingly, the most frequently presenting symptom is fever, as a result of urinary tract infection. In contrast, enuresis is uncommon (unlike in Caucasian children, where the peak incidence is at a later age). There is no predilection to unilateral, bilateral or side of involvement. Ectopia lateralis and patulous ureteric orifices were the most commonly identified structural defects. E. Coli and Klebsiella were the most commonly occurring organisms among those with urinary tract infections, and Ampicillin or Bactrim was adequate for most cases.

Age Factors↗
PubMed1984

Endoscopic surgery of posterior urethral valves.

Although posterior urethral valves were described more than sixty years ago, the surgical treatment of this condition has only recently been technically feasible. This paper is a review of 15 cases of posterior urethral valves treated over a 3 year period in the Department of Paediatric Surgery, Singapore General Hospital. The commonest clinical presentation was urinary tract infection. The upper urinary tract was normal in only six cases. In 14 out of the 15 cases primary surgical treatment of the valve was carried out with satisfactory results in 13 patients.

Child↗