Papers by Dr. Chiranjiv Kumar
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH
Introduction: The sacral mass in infancy can be sacrococcygeal teratoma (SCT), meningocele, myelo... more Introduction: The sacral mass in infancy can be sacrococcygeal teratoma (SCT), meningocele, myelomeningocele, rectal abscess, lymphangioma, hemangioma, lipoma, perineal cyst. This case report describes the presentation, clinical ndings, imaging characteristics and treatment of a benign lipomatous lesion in the sacrococcygeal region of a 1.5-year-old girl mimicking SCT. The patient presented Case Report: with a gradually increasing swelling over the sacral region, primarily located towards the left buttock. Local examination revealed a rm, immobile mass, measuring approximately 10 * 10 cm with no signs of inammation. Imaging reported the lump as lipomatous lesion. Tumor markers were normal. The mass was excised with primary skin closure. The patient was discharged on the fth post-operative day with minimal wound infection and ap necrosis. There was complete healing and skin closure in two months, following dressings and debridement. Fibrolipoma is a Conclusion: rare variant of l...
INDIAN JOURNAL OF APPLIED RESEARCH
Aim: Serum Matrix metalloproteinase-7 as a diagnostic and prognostic biomarker for extrahepatic b... more Aim: Serum Matrix metalloproteinase-7 as a diagnostic and prognostic biomarker for extrahepatic biliary atresia Methods: This was a prospective, single center, case control study where consecutive infants less than 6 months of age with obstructive jaundice (n=20) at MAMC from April 2021 to March 2023 were enrolled. Age and sex-matched controls (n=20) were also taken. Serum MMP-7 were tested in all 40 infants. In Case group, additional tests performed were, CBC, LFT to derive APRI and FIB-4 scores, Ultrasound Abdomen, Hepatobiliary scintigraphy, Per-operative cholangiogram, Pre and/or intraoperative liver biopsy. The Results: participants were substratied into EHBA (n = 11) and NH (n = 9) based on post priming hepatobiliary scintigraphy and Per-operative cholangiogram. Median serum MMP-7 level in EHBA was 23 ng/ml that was found to be 6 times higher than Neonatal hepatitis and 13 times higher than in normal infants. Median serum MMP-7 levels in NH group and normal infants were 4ng/m...
Journal of Indian Association of Pediatric Surgeons, 2020
Choledocholithiasis (CDL) in neonates and infants is <1 in 5000. There is no gold standard for... more Choledocholithiasis (CDL) in neonates and infants is <1 in 5000. There is no gold standard for the management of CDL in the pediatric population. In English literature, this is the first case report of a baby born with esophageal atresia and tracheoesophageal fistula (Type C) with cholangitis, who underwent percutaneous transhepatic biliary drainage and peroral extraction of a large calculus in the common bile duct after primary repair of esophagus.
The present clinical study on treatment of unstable long bone fractures was performed on fifteen ... more The present clinical study on treatment of unstable long bone fractures was performed on fifteen dogs with radius-ulna, femoral and tibial fractures, presented for treatment at Department of Surgery, College of Veterinary Science, Rajendranagar, Hyderabad and Teaching Veterinary Hospital, Bhoiguda, Secunderabad. Routine clinical and orthopaedic examinations were conducted followed by radiography for diagnosis. After confirming the diagnosis of unstable fractures which included long oblique, short oblique, comminuted, non-union and open fractures, fifteen cases irrespective of breed, sex or age were selected for the study. In the fifteen dogs selected for the study, sixteen unstable fractures (one dog had a bilateral tibial fracture) were repaired by locking compression plating (LCP) in five dogs, external skeletal fixators (ESF) in five dogs with 6 fractures, cross pinning in three dogs, stack pinning in one dog and intramedullary pinning combined with full cerclage wiring in one dog. The selection of the technique was based on its suitability of the technique for the type of fracture encountered. Three 6 hole and two 8 hole 3.5 mm locking compression plates and locking compression screws 14 mm to 28 mm in length were used. At least one to three screws were inserted into each fracture fragment. The results indicated that the use of LCPs for treatment of unstable fractures of long bones in five dogs resulted in good healing of the fracture site with complete restoration of the functional limb usage in four dogs by 45 days after surgery. The lameness grades increased from V pre-operatively to grade I by the end of 45 post-operative day. In the fifth dog that had suffered non-union of the radius-ulna fracture in spite of being surgically treated at other hospitals again had non-union even after being treated with LCP. However, weight bearing on the affected limb was noticed after 120 day despite non-union in this dog. The results also indicated that in all the five dogs with six fractures treated by linear ESF in 4 dogs and free form ESF in the fifth dog with compound bilateral unstable fractures of the tibia healed well with minimal callus formation. The three dogs where cross pinning was performed for supracondylar femoral fractures showed evidence of good fracture healing with minimal callus formation. Similarly the dog treated with intramedullary pinning with full cerclage wiring and the St. Bernard dog treated with stack pinning also depicted good radiographic union and these dogs recovered completely with full functional limb usage. It was concluded from the results of the present study that locking compression plating was successful in treatment of unstable fractures of long bones in four out of the five dogs. In one dog operated thrice elsewhere with other techniques and led to non-union again resulted in non-union even with the use of the LCP. It was concluded that the use of LCPs resulted in good healing of closed unstable fractures in four of the five cases treated. It was also concluded that ESF resulted in good healing in both open and closed unstable fractures of radius-ulna and tibia. Cross pinning technique resulted in good healing of the supracondylar fractures of the femur with pain free and complete restoration of the normal range of movement of the stifle joint following fracture healing. The use of intramedullary pinning with full cerclage wiring and stack pinning in one dog each also resulted in good healing of the fractures of femur and tibia respectively.
Journal of Indian Association of Pediatric Surgeons, 2021
Context: Adnexal masses in girls represent a wide pathological spectrum. We performed a retrospec... more Context: Adnexal masses in girls represent a wide pathological spectrum. We performed a retrospective analysis of clinical and diagnostic aspects of adnexal masses in girls. Aims: To analyze the clinical characteristics and surgical management of adnexal masses in children and adolescents. Settings and Design: Retrospective observational analysis from 2000 to 2020. Subjects and Methods: This analysis was performed on 28 children under the age of 17 years with adnexal masses who were managed by us at tertiary care centers of Delhi-NCR. Patients were analyzed based on their age at the time of admission, their presenting complaints, clinical and radiological findings, tumor markers, management, and follow-up. Results: The age ranged between newborn and 17 years. Abdominal pain, nausea with vomiting, and abdominal lump was the most common presenting complaints. Pelvic ultrasound with or without color Doppler done in all patients and computed tomography, magnetic resonance imaging was performed in seven patients preoperatively. Adnexal masses were unilateral in 26 (92.85%) patients and bilateral in 2 (7.15%) patients. Five babies had antenatal diagnosis of ovarian cysts. Serum alpha fetoprotein (AFP) and beta-human chorionic gonadotropin (b-HCG) were normal in all 19 tested patients. Cancer antigen 125 (CA-125) was raised in three ovarian tumors out of 9 tested patients. Laparoscopy was performed in 23 out of 28 patients (30 ovaries). Ovarian cyst torsion was present in 50% patients. Ovarian cystectomy was done in 10 (33.3%) patients. Six (20%) ovaries were saved by detorsion of the ovary and deroofing of the cyst with or without ovarian biopsy. Oophorectomy was done in five (16.7%) patients. Salpingo-oopherectomy had to be done in seven (23.3%) patients. Histopathology revealed functional nonneoplastic lesions in 18 cases (66.7%), benign neoplastic lesions in 8 cases (29.6%), and malignant neoplastic lesion in 1 case (3.7%). Conclusions: Adnexal masses in children are generally benign. AFP, b-HCG, and CA-125 in ovarian torsion are within normal limits. Urgent surgery is required if torsion is established. The ovary should be preserved wherever possible.
Journal of Indian Association of Pediatric Surgeons, 2018
Colonic stenosis/atresias account for only 5%-15% of all atresias. Colonic stenosis is rarer than... more Colonic stenosis/atresias account for only 5%-15% of all atresias. Colonic stenosis is rarer than atresia and mostly occurs in ascending and transverse colon. Gastrointestinal sequelae of cytomegalovirus (CMV) are rare, frequently requires surgical intervention for diagnosis and management. We describe a 5-month-old female child with complaints of recurrent abdominal distension, vomiting, and constipation for 2 months simulating Hirschsprung's disease. After barium enema, the baby was taken up for surgery. Intraoperatively, we found a colonic stricture in the descending colon. The biopsy showed localized CMV infection.
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH
Background: Gastric perforation among neonates is a rare but frequently fatal condition of uncert... more Background: Gastric perforation among neonates is a rare but frequently fatal condition of uncertain etiology. Although historically gastric perforation has often been described as “spontaneous'', some cases are non-spontaneous. The aim of this study was to review the clinical course of neonatal gastric perforation in a tertiary care center over the last ve years. Aim: Neonatal Gastric Perforation: Review of 5 Years' Experience in a tertiary care center. Material And Methods: It is a retrospective study where we obtained 5 years (2016-2021) data of neonates who were diagnosed with gastric perforation. Data of total 13 neonates were reviewed and tabulated. Factors were noted including age, sex, term or preterm (Gestational age), birth weight, mode of delivery, sign & symptoms, associated anomalies, respiratory distress at birth, mechanical ventilation before the development of signs & symptoms, site of perforation, Total leukocyte count and clinical outcome in terms of s...
Journal of Indian Association of Pediatric Surgeons
We report a case of urethral duplication with high anorectal malformation (ARM). A 12-year-old bo... more We report a case of urethral duplication with high anorectal malformation (ARM). A 12-year-old boy who had undergone transverse colostomy on day 2 of life and posterior sagittal anorectoplasty (PSARP) for ARM (rectobulbar fistula) at 8 years and also had urinary dribbling from a midscrotal opening in addition to normal voiding, presented with recurrent urinary tract infections and dysuria. Midscrotal dribbling had continued postoperatively. Colostomy had been closed 3 months after PSARP. Investigations revealed a large urethral diverticulum at the site of rectourethral fistula due to a segment of the gut being left behind during fistula closure. In addition, he had a sagittal urethral duplication originating at bulbar urethra and opening externally at midscrotum. The highlight of this report is successful endoscopic management of both the urethral duplication and the diverticulum.
Journal of Indian Association of Pediatric Surgeons
Context: Adnexal masses in girls represent a wide pathological spectrum. We performed a retrospec... more Context: Adnexal masses in girls represent a wide pathological spectrum. We performed a retrospective analysis of clinical and diagnostic aspects of adnexal masses in girls. Aims: To analyze the clinical characteristics and surgical management of adnexal masses in children and adolescents. Settings and Design: Retrospective observational analysis from 2000 to 2020. Subjects and Methods: This analysis was performed on 28 children under the age of 17 years with adnexal masses who were managed by us at tertiary care centers of Delhi-NCR. Patients were analyzed based on their age at the time of admission, their presenting complaints, clinical and radiological findings, tumor markers, management, and follow-up. Results: The age ranged between newborn and 17 years. Abdominal pain, nausea with vomiting, and abdominal lump was the most common presenting complaints. Pelvic ultrasound with or without color Doppler done in all patients and computed tomography, magnetic resonance imaging was performed in seven patients preoperatively. Adnexal masses were unilateral in 26 (92.85%) patients and bilateral in 2 (7.15%) patients. Five babies had antenatal diagnosis of ovarian cysts. Serum alpha fetoprotein (AFP) and beta-human chorionic gonadotropin (b-HCG) were normal in all 19 tested patients. Cancer antigen 125 (CA-125) was raised in three ovarian tumors out of 9 tested patients. Laparoscopy was performed in 23 out of 28 patients (30 ovaries). Ovarian cyst torsion was present in 50% patients. Ovarian cystectomy was done in 10 (33.3%) patients. Six (20%) ovaries were saved by detorsion of the ovary and deroofing of the cyst with or without ovarian biopsy. Oophorectomy was done in five (16.7%) patients. Salpingo-oopherectomy had to be done in seven (23.3%) patients. Histopathology revealed functional nonneoplastic lesions in 18 cases (66.7%), benign neoplastic lesions in 8 cases (29.6%), and malignant neoplastic lesion in 1 case (3.7%). Conclusions: Adnexal masses in children are generally benign. AFP, b-HCG, and CA-125 in ovarian torsion are within normal limits. Urgent surgery is required if torsion is established. The ovary should be preserved wherever possible.
Journal of Indian Association of Pediatric Surgeons, 2022
Conjoined pygopagus accounts for about 17% of all conjoined twins and commonly share the gluteal ... more Conjoined pygopagus accounts for about 17% of all conjoined twins and commonly share the gluteal region, terminal spine, lower gastrointestinal, urological, and reproductive tracts. This makes their separation a very challenging task. We report herein pygopagus twins who had minimal fusion in coccygeal region and could be separated without a complicated procedure. The case is being reported to add to the literature and emphasize that simple fusion in conjoined twins can be relatively easy to manage.
Journal of Indian Association of Pediatric Surgeons, 2019
Journal of Indian Association of Pediatric Surgeons, 2020
Choledocholithiasis (CDL) in neonates and infants is <1 in 5000. There is no gold standard for th... more Choledocholithiasis (CDL) in neonates and infants is <1 in 5000. There is no gold standard for the management of CDL in the pediatric population. In English literature, this is the first case report of a baby born with esophageal atresia and tracheoesophageal fistula (Type C) with cholangitis, who underwent percutaneous transhepatic biliary drainage and peroral extraction of a large calculus in the common bile duct after primary repair of esophagus.
Journal of Indian Association of Pediatric Surgeons, 2018
Colonic stenosis/atresias account for only 5%-15% of all atresias. Colonic stenosis is rarer than... more Colonic stenosis/atresias account for only 5%-15% of all atresias. Colonic stenosis is rarer than atresia and mostly occurs in ascending and transverse colon. Gastrointestinal sequelae of cytomegalovirus (CMV) are rare, frequently requires surgical intervention for diagnosis and management. We describe a 5-month-old female child with complaints of recurrent abdominal distension, vomiting, and constipation for 2 months simulating Hirschsprung's disease. After barium enema, the baby was taken up for surgery. Intraoperatively, we found a colonic stricture in the descending colon. The biopsy showed localized CMV infection.
Journal of Indian Association of Pediatric Surgeons, 2019
Thymic cyst is regarded as a rare anomaly, accounting for about 3% of all anterior mediastinal ma... more Thymic cyst is regarded as a rare anomaly, accounting for about 3% of all anterior mediastinal masses. It can be either congenital or acquired. Congenital thymic cysts are usually asymptomatic, with about 50% found incidentally in childhood or adolescence. We report a case of 1-month 23-day-old male baby who was antenatally diagnosed at 32 weeks' gestation. Spontaneous resolution did not take place in the antenatal or neonatal period; instead, there was an increase in size on follow-up imaging. The baby was successfully managed by surgical excision.
Journal of Neonatal Surgery, 2016
Aim: To study the prevalence of associated anomalies with neonatal duodenal obstruction and facto... more Aim: To study the prevalence of associated anomalies with neonatal duodenal obstruction and factors impacting short-term survival.Material and methods: Records of 31 neonates with neonatal duodenal obstruction could be retrieved and analyzed for a 13.5-year-period (October 2003-May 2016). M:F ratio was 1.58:1. The mean birth weight was 2.15 kg; 12 patients were preterm. Etiologies included duodenal atresia (n=23), duodenal web (n=8) and malrotation of gut (n= 6).Results: Associated anomalies were seen in 19/31: Down’s syndrome (n=6), anorectal malformation (ARM) (n=5), annular pancreas (n=5), cardiac anomalies (n=4), esophageal atresia with trachea-esophageal fistula (EA with TEF) (n=3). Mortality in the series was 22.5%; 5 deaths and 2 patients left against medical advice in moribund state (hidden mortality). Mortality in associated anomalies group was 5/19; and 2/12 in the no anomalies group, though this difference was not statistically significant (p=0.676). Similarly, low birth ...
Journal of Neonatal Surgery, 2017
We report a rare case of large immature retroperitoneal teratoma in a neonate. The diagnostic and... more We report a rare case of large immature retroperitoneal teratoma in a neonate. The diagnostic and therapeutic challenges of dealing with such a case have been discussed and the relevant literature reviewed.
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Papers by Dr. Chiranjiv Kumar