Factors affecting blood glucose and serum sodium level with intraoperative infusion of 1% dextrose in ringer's lactate in neonates undergoing surgery.

CONTEXT: Under anesthesia, blood glucose level in term neonates varies widely due to stress induced glucose mobilisation due to various factors. Postoperative hyponatremia occurs with intraoperative infusion of large volume of hypotonic fluid. There is a growing consensus on the intraoperative use of 1-4% glucose containing isotonic fluid in them. AIMS: To know the relation of duration of surgery, infusion rate, fluid bolus, blood transfusion with blood glucose level and effect on serum sodium level with intraoperative 1% dextrose ringer's lactate (1% DRL) in neonates undergoing surgery. SETTINGS AND DESIGN: Prospective single-center study in tertiary institute. SUBJECTS AND METHODS: A total of 100 neonates undergoing various surgeries under general anesthesia with or without caudal anaesthesia were included. 1% DRL was used as maintenance and replacement fluid intraoperatively. Blood glucose level at hourly interval throughout surgery and serum sodium concentration before and after infusion was documented. STATISTICAL ANALYSIS USED: Student's t test (two tailed, independent) has been used for statistical analysis. RESULTS: After the infusion of 1% DRL during surgery, mean blood sugar levels were increased above the base line in all neonates at successive hourly interval. Serum sodium levels remained within physiological range in all neonates. CONCLUSION: Intraoperative hyperglycemia is more obvious with higher intravenous fluid infusion rate, prolonged duration of surgery, and requirement of fluid bolus as well as blood transfusion intraoperatively. Use of 1% DRL in neonates undergoing surgery is effective in preventing dysnatremia.

Delayed presentation of jejunal atresia.

Type I intestinal atresias (webs) are rare causes of gastrointestinal obstruction in infants, the most common site being the second portion of the duodenum. According to the Louw and Barnard classification, type 1 atresia has been defined as an intra-luminal web which results in either complete (web with no perforation) or incomplete (web with central perforation) intestinal obstruction. The jejunum is a rare site of such webs. Diagnosis of an incompletely obstructing web due to central perforation is usually difficult and challenging. We present two cases of jejunal web with a central perforation in which the presentation was delayed. Both were managed by excision of the web.

Anovestibular fistula in an infant with retroviral infection - case report.

A vestibular fistula with a normal anus is a rare subtype of anorectal malformation seen more often in East Asia and India. Though mostly congenital, some authors have suggested acquired etiologies for this condition. Infants with retroviral infection have been reported to develop acquired rectovestibular fistulas. We report a case of an infant anovestibular fistula in a patient with retroviral infection.

Neonatal Gartner Duct Cyst: Two Case Reports and Literature Review.

Vaginal cysts are rare, particularly in the newborn. They usually present as one of these three entities in the newborn: paraurethral cysts (Skene duct cysts), Gartner duct cysts (mesonephric ductal remnants) or a covered ectopic ureter. Abdominal ultrasound should always be included in the clinical evaluation in search of renal anomalies. We report two cases of Gartner cysts in neonates.

Desmosis coli - a case report and review of the literature.

Desmosis coli is a rare pathology presenting as slow transit constipation. In this case we would like to discuss the presentation and management of desmosis coli. A 14-month-old female hailing from western India with a history of chronic constipation presented with acute massive abdominal distension and vomiting. At laparotomy, a hugely dilated transverse and sigmoid colon with a transition zone at the lower sigmoid was found. A transverse stoma was done after taking multiple sero-muscular biopsies. The patient underwent re-exploration on day 14 because of the non-functioning of the stoma and a fixed bowel loop. The histopathology report was suggestive of normal ganglion cells. Unfortunately, the stoma continued not to function. A dye study showed dye in the colon after 24 hours ruling out any anatomical obstruction. Histopathology slides were reviewed multiple times and reported lack of connective tissue of the colonic wall leading to the diagnosis of desmosis coli. The patient was started on gradual feeds and pro-kinetics and over the next 2 weeks the stoma started functioning slowly. Desmosis coli is a rare cause of constipation which should be suspected in cases where aganglionosis has been ruled out and the constipation is refractory to conventional therapy.

Mixed Gonadal Dysgenesis with an unusual "inverted" Y chromosome.

Mixed gonadal dysgenesis is a rare disorder of sex development associated with sex chromosome aneuploidy and mosaicism of the Y chromosome. It is characterized by a unilateral non-palpable (usually intra-abdominal) testis, a contralateral streak gonad and persistent mullerian structures. The clinical presentation can vary from a typical male to female phenotype including all degrees of cryptorchidism, labial fusion, clitoromegaly, epispadias and hypospadias. It is the second most common cause of ambiguous genitalia in the neonatal period. We report a case of Mixed Gonadal Dysgenesis with an inverted Y chromosome.

Mutational and Structural Analysis of Conserved Residues in Ribose-5-Phosphate Isomerase B from Leishmania donovani: Role in Substrate Recognition and Conformational Stability.

Ribose-5-phosphate isomerase B from Leishmania donovani (LdRpiB) is one of the potential drug targets against visceral leishmaniasis. In the present study, we have targeted several conserved amino acids for mutational analysis (i.e. Cys69, His11, His102, His138, Asp45, Tyr46, Pro47 and Glu149) to gain crucial insights into their role in substrate binding, catalysis and conformational stability of the enzyme. All the eight LdRpiB variants were cloned, sequenced, expressed and purified. C69S, H102N, D45N and E149A mutants exhibited complete loss of enzyme activity indicating that they are indispensable for the enzyme activity. Kinetic parameters were altered in case of H138N, H11N and P47A variants; however Y46F exhibited similar kinetic behaviour as wild type. All the mutants except H138N exhibited altered protein structure as determined by CD and fluorescence spectral analysis. This data was supported by the atomic level details of the conformational changes and substrate binding using molecular dynamic simulations. LdRpiB also exhibited activity with D-form of various aldose substrates in the order of D-ribose > D-talose > D-allose > D-arabinose. Our study provides insights for better understanding of substrate enzyme interactions which can rationalize the process of drug design against parasite RpiB.

ERCP with stenting of traumatic pancreatic duct transection: A case report.

Pancreatic injuries, though rare, are associated with high morbidity because of location of pancreas adjacent to the various hollow and solid organs. Difficulty in early diagnosis adds to morbidity. Condition of the pancreatic duct is an important factor in grading the injury and deciding upon course of management. Conservative management is the line of treatment in lower grade injuries. Higher grades of pancreatic injuries are usually managed surgically. Endoscopic retrograde cholangiopancreaticography (ERCP) has recently emerged as an effective diagnostic as well as therapeutic modality for hepatobiliary and pancreatic pathologies. Presently described is case of a 12-year-old boy who presented with post-traumatic complete transection of pancreatic duct, which was successfully managed by ERCP-guided stenting of the duct. Therapeutic advantages of ERCP in trauma setting and difficulties involved are highlighted.

A Case of Biliary Peritonitis following Spontaneous Common Bile Duct Perforation in a Child.

Spontaneous common bile duct (CBD) perforation leading to biliary peritonitis is a rare entity in children. It is an unusual cause of acute abdomen and is potentially fatal. Preoperative diagnosis is rare. A 10-year-old girl was referred from a private hospital after laparotomy for acute abdomen. Intraoperatively, bile was found in the peritoneal cavity which was drained, and the patient was referred to Topiwala National Medical College. Endoscopic retrograde cholangiopancreaticography (ERCP) and stenting was done. The stent was removed after 8 weeks, and the girl is doing well during follow-up. HOW TO CITE THIS ARTICLE: Sharma C, Desale J, Waghmare M, Shah H. A Case of Biliary Peritonitis following Spontaneous Common Bile Duct Perforation in a Child. Euroasian J Hepato-Gastroenterol 2016;6(2):167-169.