Laparoscopic Surgery in Pediatric Age Group – Our 10 Years Experience from a Tertiary Care Centre

Background: To study the role of Laparoscopic surgery in Pediatric age group. Settings: Department of General and Minimal Access Surgery, Government Medical College Srinagar. Methods: Three hundred and sixty four pediatric patients referred to our tertiary care center in the pediatric age group were operated upon laparoscopically for various conditions from January 2009 to January 2019. Results: A total of 364 non-infantile pediatric cases were operated upon laparoscopically which included 107 Non-palpable UDT, 71 Appendectomies, 67 Diagnostic laparoscopies, 31 Cholecystectomies, 5 VATS procedures, 8 Varicocelectomies, 2 Advance urological procedures, 55 Herniotomies, 3 umbilical hernia laparoscopic anatomical repairs, 7 Hepatic Hydatid cyst surgeries, 5 Laparoscopic assisted Soaves procedures, 1 each of Laparoscopic Pyeloplasty, Morgagni hernia repair and Ladd’s procedure for Malrotation of Gut. There were 5 conversions to open procedure and 8 cases were completed by laparoscopic assisted methods. The complication rate including minor complications was approximately 4%. Conclusion: Laparoscopy including Videoassisted Thoracoscopic Surgeries (VATS) in pediatric age group is safe, feasible and rapidly gaining popularity even for advanced and reconstructive procedures. However the threshold for better judgement should be low for decreasing avoidable morbidity in small children.

Classification of Vascular Anomalies Using Clinico- Radiological Parameters – Is It Sufficient?

To classify vascular anomalies using clinico-radiological parameters. Settings: Government Medical College Srinagar and Army Hospital Research and Referral New Delhi. Methods: 129 cases of vascular anomalies were studied and classified using clinical and radiological methods from March 2011 to June 2018. Outcome: Vascular anomalies were broadly classified into vascular tumours and vascular malformations and these anomalies were further sub-classified based on clinical and radiological parameters. Results: Among 129 vascular anomalies studied there were 51 vascular tumours which included 50 hemangiomas (H) and 1 case of pyogenic granuloma (PG). Among Hemangiomas there were 34 Hemangiomas of Infancy (HOI) and 16 Congenital Hemangiomas (CH). Among HOI there were 26 Simple (Localized-17, Segmental-2, Indeterminate-6, Multifocal-1), 8 complex visceral hemangiomas (Liver-2, Subglottic-2, Parotid-4). Among Congenital Hemangiomas there were 4 Rapidly Involuting Congenital Hemangiomas (RICH) and 12 Non involuting congenital hemangiomas (NICH). There were 78 vascular malformations which included 51 slow flow malformations and 27 fast flow malformations based on colour doppler studies. Among slow flow there were 42 Simple {2 Capillary Malformations, 26 Venous Malformations (VM), 14 Lymphatic Malformations (LM), 4 Combined (2 each of Lymphohemangiomas - LH and Lymphovenous Malformations – LVM} and 5 Complex-combined (4 Klipple Trenaunay Syndrome – KTS and 1 case of Blue Rubber Bleb Nevus Syndrome - BRBNS). Among fast flow there were 6 simple (Nasopharyngeal Angiofibromas), 20 combined (Arteriovenous Malformations - AVM) and 1 Complex combined malformation (Sturge Weber Syndrome - SWS). Conclusion: Newborn with birthmark should always be documented by the attending health care provider at birth and referral to an expert for proper evaluation and careful parental/Guardian counseling. Doppler US should be the first line of investigation in broadly classifying vascular anomalies whereas CT Scan, MRI/MRA/MRV, Angiography, Venography help in further sub-classification. Some confusion still persists in classifying few lesions like Lympho-hemangioma (LH), Complex combined Malformations (Syndromes) like Sturge Weber Syndrome (SWS), Blue Rubber Bleb Nevus Syndrome (BRBNS), and Nasopharyngeal Angiofibroma (NPA).

Bilateral Mirror Image Cervical Neurofibroma in an Adult with Neurofibromatosis Type 1

Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder characterised by various phenotypic features like hyperpigmented spots, neurofibromas, Lisch nodules, skeletal abnormalities and tendency to develop neoplasms. Only few cases of Non-Familial Spinal Neurofibromatosis-1 (Non-FSNF1) have been described in literature with tumors involving the spinal roots at every level being even rarer. We reported an interesting case of bilateral symmetrical cervical neurofibroma with multiple spinal neurofibromas appearing as mirror image on CT, associated with non familial NF-1 as a rare presentation in a 25-year-old adult male.

Clinicoradiological and Histopathological Comparative Study of Nodal Metastasis in Head and Neck Cancers.

Background: Detection of regional lymph nodes in head and neck cancers greatly modifies the staging, treatment and prognosis of the patient and helps in planning the management of these patients. Methods: A prospective study was conducted in the Department of E.N.T., S.M.G.S. Hospital, G.M.C. Jammu, in collaboration with the Department of Radio diagnosis and Imaging, G.M.C. Jammu & Department of Radiation Oncology GMC, Srinagar from 2008 to 2012 in which patients attending / admitted in the Department of E.N.T., with cancer of head and neck, were assessed for lymph node metastasis (at different levels). 16 patients, all cases of squamous cell carcinoma head and neck, underwent appropriate neck dissections. The patients were examined clinically as well as with ultrasonography for detection of various enlarged lymph nodes at different levels. Computed tomography and magnetic resonance imaging were done, wherever indicated. Patients were subjected to fine needle aspiration cytology in cases of palpable lymph nodes. The removed lymph nodes were examined histopathologically. Results: The findings of clinical, radiological and histopathological studies were compared. We concluded that clinical palpation should be supplemented by ultrasonography in every case of head and neck cancer. However, since computed tomography picks up lymph nodes missed by ultrasonography in a significant number, is important in imaging primary tumour and picks up necrosis and extracapsular spread at the most, it should be included in each case of head and neck cancer. Conclusion: Magnetic resonance imaging being equivalent to computed tomography in picking up the nodes, but lagging behind the criteria such as picking up of nodal necrosis and extra capsular spread of lymph nodes, and is too costly, so may be included as an imaging modality wherever computed tomography is contraindicated.

New Modified English and Hindi Oswestry Disability Index in Low Back Pain Patients Treated Conservatively in Indian Population

STUDY DESIGN: Prospective cohort study along with questionnaire. PURPOSE: To measure the correlation of the visual analogue score (VAS), with (Oswestry disability Index [ODI], version 2.1a) in English, and modified ODI (English and Hindi version). To validate translated version of the modified ODI in English version to Hindi. OVERVIEW OF LITERATURE: Conflicting evidence in literature regarding the ability for existing ODI score to accurately measure the pain associated disability. METHODS: One hundred and three patients conservatively treated for low back pain were enrolled in the study. The Pearson correlation coefficient for VAS and ODI along with the Cronbach alpha and test-retest reliability for Hindi version using the intraclass correlation coefficient was recorded. The new proposed translated Hindi version of ODI was carried out with established guidelines. RESULTS: The mean age in English and Hindi version of ODI was 53.5 years and 58.5 years, respectively. The gender ration was 21:24 in the English version and 35:23 in the Hindi version. The mean follow-up in English and Hindi version of ODI was 3.4 months and 50.27 months, respectively. The Cronbach coefficient alpha=0.7541 for English ODI and 0.9913 for Hindi ODI was recorded for the both modified versions. CONCLUSIONS: The new modified ODI is time saving and accurate, and it avoids the need to measure other scores and has stronger correlation with VAS score compared to the previous scores. We recommend this version for both English and Hindi speaking population as an assessment tool to measure the disability related to pain.

Nocturnal Cramps in Patients with Lumbar Spinal Canal Stenosis Treated Conservatively: A Prospective Study

STUDY DESIGN: Prospective cohort study with questionnaire. PURPOSE: To compare the treatment outcome of nocturnal leg cramps in lumbar spinal canal stenosis (LSCS) patients on conservative treatment with historical surgical cohorts and to determine the sensitivity and specificity as well as positive predictive value and negative predictive value of knee flexion test suggested for LSCS patient. OVERVIEW OF LITERATURE: True prevalence of nocturnal leg cramps in LSCS patients as well as the clinical outcome of its surgical treatment have been reported. METHODS: A questionnaire suggested from previous study with minor modifications was used in this study. Clinical data was collected. Knee flexion test was performed in two groups. RESULTS: The prevalence of nocturnal leg cramp was higher in the LSCS group compared to the control group (second group). In LSCS patients, 38 (88%) had improved leg cramps after the conservative treatment, 3 (6.97%) remained unchanged, and 2 (4.6%) had worsened leg cramps. Of the 43 patients, 21 (48.8%) had no disturbance to their activities of daily living. In the LSCS group, the sensitivity and specificity of the knee flexion test was 53.5% and 33.3%, respectively. The knee flexion test in the LSCS group had a positive predictive value and a negative predictive value of 65.71% and 23.1%, respectively. CONCLUSIONS: Our study demonstrated that nocturnal leg cramps were significantly more frequent in LSCS patients than in the control group.

Unusual Presentation of a Rare Para Testicular Tumour in a Child.

Adenomatoid tumour epididymis usually present as painless scrotal mass during 2nd or 3rd decade of life. The case presented is a seven years old boy admitted with acute painful swelling of the scrotum. The scrotum was explored on the suspicion of torsion testis but testis was found to be normal and the epididymis enlarged. Biopsy from epididymis showed Adenomatoid tumour. Surgical exploration was performed through the same inguinal incision later and tissue sent for histopathological examination confirmed “adenomatoid tumour with surrounding inflammatory mass”.