Browsing by Author "Ajay Narayan Gangopadhyay"

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Acute gastric volvulus in neonates - A diagnostic dilemma
(2008) V.D. Upadhyaya; Ajay Narayan Gangopadhyay; A. Pandey; V. Kumar; S.P. Sharma; D.K. Gupta
Introduction: Gastric volvulus is a rare, potentially life-threatening condition, which is difficult to diagnose. This study presents a series of acute gastric volvulus in neonates with the aim of describing this rare disease and its varied clinical manifestations. Material and Methods: The data of all neonates presenting with acute gastric volvulus between January 2001 and January 2007 was retrospectively reviewed. Diagnosis was made on suspicion and was documented by a barium study. All patients were operated by open anterior gastropexy with or without a feeding gastrostomy. Results: Four patients were male and 1 was female. All were treated with gastropexy with or without feeding gastrostomy. Four patients recovered well after surgery. There was one postoperative death. Conclusion: Gastric volvulus is extremely rare in neonates but it should be considered in the differential diagnosis after sudden onset or recurrent vomiting in the pediatric age group. Early diagnosis and treatment gives excellent results. © Georg Thieme Verlag KG Stuttgart.
Anorectal malformations
(Medknow Publications, 2014) Ajay Narayan Gangopadhyay; Vaibhav Pandey
Anorectal malformations (ARMs) are among the more frequent congenital anomalies encountered in paediatric surgery, with an estimated incidence ranging between 1 in 2000 and 1 in 5000 live births. Antenatal diagnosis of an isolated ARM is rare. Most cases are diagnosed in the early neonatal period. There is a wide spectrum of presentation ranging from low anomalies with perineal fistula having simple management to high anomalies with complex management. Advances in the imaging techniques with improvement in knowledge of the embryology, anatomy and physiology of ARM cases have refined diagnosis and initial management. There has been marked improvement in survival of such patient over the last century. The management of ARM has moved forward from classical procedures to PSARP to minimal invasive procedures. But still the fecal and urinary incontinence can occur even with an excellent anatomic repair, mainly due to associated problems. There has been a paradigm shift in approach to these patients which involves holistic approach to the syndrome of Anorectal malformations with a long term goal of achievement of complete fecal and urinary continence with excellent quality of life.
Capillary Malformation
(Springer Singapore, 2021) Ajay Narayan Gangopadhyay; Preeti Tiwari
Capillary malformations (CM), are the most common type of vascular malformations that have been usually referred by multiple confusing terminologies in past like port-wine stain or nevus flammeus. The International Society for the Study of Vascular Anomalies (ISSVA) classified capillary malformations as simple, low flow malformation on the basis of lack of endothelial proliferation, type of vessels, and the type of flow. Capillary malformations are further divided into different subtypes with a distinct clinical presentation, associated anomalies, and etiopathogenesis. The lesions are always congenital, presenting at birth as flat (macular) pink patch which most commonly involves the head and neck region. The lesions vary in color, consistency and undergo changes with age, but never involute with time and persist throughout the life. Different genetic mutations have been identified in association with capillary malformations which may be syndromic or non-syndromic depending upon the time of mutation during the developmental process. The non-syndromic lesions which are cosmetically insignificant do not require any intervention. The decision to treat a patient of CM depends on multiple factors like the site of involvement, associated syndromes, and complication. The modality and timing of treatment also depend on the size and location of the lesion. Flashlamp-pumped pulsed-dye laser (PDL) is the treatment modality of choice for patients with capillary malformations. Other medical and surgical modalities have also shown variable therapeutic efficacy in the lesions. © Springer Nature Singapore Pte Ltd. 2021.
Clinical spectrum of neural tube defects with special reference to karyotyping study
(2012) Vijayendra Kumar; Anutosh Singh; Shiv Prasad Sharma; Arvind Srivastava; Ajit Saxena; Ajay Narayan Gangopadhyay
Background: Neural tube defects are common congenital malformations of the central nervous system. Despite years of intensive epidemiological, clinical, and experimental research, the exact etiology of NTD remains rather complex and poorly understood. The present study attempted to look into the association of occurrence of NTD with reference to folic acid levels, along with karyotyping status. Materials and Methods: Detailed history was taken with emphasis on age of the baby and mother, parity, antenatal folic acid intake. Five milliliters of blood was drawn from all the babies and their mothers and divided equally in preheparinized vials (for karyotyping) and plain vials (for folic acid estimation). The total duration was 2 years. Results: The total number (n) in the study group was 75. The folic acid level was less in affected babies and their mother when compared to matched controls. Chromosomal defect was observed in nine of the 75 patients. Karyotyping defects were higher in children born to mothers of the age group 31-40 years and when their birth order was second. Conclusion: Folic acid supplementation needs to be continued to prevent the occurrence of NTD, and the perinatal identification of NTD should alert one to the possibility of chromosomal abnormalities and prompt a thorough cytogenetic investigation and genetic counseling.
Clinico-immunological response to intratumoral versus intravenous neoadjuvant chemotherapy in advanced pediatric solid malignancies
(Georg Thieme Verlag, 2013) Vijayendra Kumar; Nandini Ramaswami; Anand Pandey; Ram Chandra Shukla; Maloy Ranjan Sen; Shiv Prasad Sharma; Dinesh Kumar Gupta; Ajay Narayan Gangopadhyay
Background: There is minimal literature on the use of intralesional chemotherapy in the pediatric age group. We undertook this present study to evaluate the two modalities (intratumoral and intravenous) of giving chemotherapy in terms of toxicity of chemotherapy, hematological parameters, efficacy of chemotherapy in reduction in volume of the tumor as well as resectability of tumor with special emphasis on immunological parameters. Materials and Methods: Advanced cases of Wilms′ tumor and Neuroblastoma were included in the study. Intratumoral chemotherapy was given through 25 G spinal needle under aseptic precautions and ultrasound guidance in the same dose as in systemic chemotherapy. Intravenous group was given chemotherapy in the usual way. Reassessment was carried out after every course of chemotherapy. Results: Group A included 16 cases of Wilms′ tumor and 6 cases of neuroblastoma. In group B, there were 14 cases of Wilms′ tumor and 8 of neuroblastoma. Vomiting, diarrhea, mucositis, and thrombophlebitis were more common in the intravenous group (P<0.05). The fall in Immunoglobulin A, Immunogloblulin G, Immunoglobulin M, and T-cell rosetting was more common in the intravenous group (P<0.05). Seventy percent of patients had completely resectable tumor at the end of 6 doses of intratumoral chemotherapy as compared to 50% resectability in the intravenous group (P<0.05). Conclusion: Intratumoral chemotherapy, besides causing less of the adverse effects and increasing the resecability rate, also causes less suppression of the immune system. This may be offered as an alternative safe and effective modality of treatment for advanced solid tumors.
Congenital pouch colon associated with anorectal malformation-histopathologic evaluation
(2009) Ajay Narayan Gangopadhyay; Shashikant Chandrakant Urmila Patne; Anand Pandey; Nakul Chandra Aryya; Vijai Dutt Upadhyaya
Background: Although enough literature is available on the descriptive and the management aspects of congenital pouch colon (CPC) associated with anorectal malformation (ARM), there is paucity of its detailed histopathologic studies. The present article details the histopathologic observations in the excised specimens of CPC in the neonates operated on for ARM. Material and Methods: Formalin-fixed specimens of CPC were evaluated both grossly and microscopically. They were stained by H&E stain and Masson trichrome stain. Results: Haustrations and tenia coli were uniformly absent in all the CPC specimens. Mucosa showed focal erosion, hemorrhage, and disruption in the muscularis mucosae. Submucosa showed congested blood vessels, hemorrhage, and thrombosis. Both the circular and the longitudinal muscle layers showed hypertrophic and atrophic appearance. Both the muscle layers also showed disruption. There was presence of fibrosis in all the muscular layers on Masson trichrome stain. There was presence of unique constriction bands in the muscularis propria. These were seen as focal dipping and narrowing of the muscular layers at intermittent intervals. They were more prominent in the circular muscle layers. Conclusion: Congenital pouch colon seen in association with ARM is an abnormally developed tissue and needs to be resected for better functional outcome of the remaining gut. However, further physiologic and immunohistochemical studies are warranted to observe the contractile and innervation pattern of CPC. © 2009 Elsevier Inc. All rights reserved.
Conservative management of ulcerated haemangioma - Twenty years experience
(2009) Anand Pandey; Ajay Narayan Gangopadhyay; Shiv Prasad Sharma; Vijayendra Kumar; Saroj Chooramani Gopal; Dinesh Kumar Gupta
Ulceration is the most common complication of haemangioma and occurs in 5-15% of cases. The present study was carried out to evaluate the clinical features of ulcerated haemangioma and efficacy of the management protocol adopted by us over a period of 20 years. All patients with ulcerated haemangioma were evaluated on the basis of age at presentation, sex, rural or urban distribution and site of haemangioma. Treatment included application of topical antibiotic and systemic antibiotic and analgesic for pain. The total number of patients was 608. The male to female ratio was 1: 2·28. The rural:urban distribution was 2·43:1. The most common site of involvement was head and neck. Mean age of patients was 5·60 ± 2·44 months. Mean size of haemangioma and ulceration was 47·30 ± 20·67 cm2 and 7·49 ± 4·52 cm2, respectively. The mean time for ulcer healing was 40·06 ± 19·41 days. Ulcer size of more than 10 cm2 took more time to heal. Response to treatment was satisfactory. Ulcerated haemangioma usually occurs before completion of 1 year of age; hence, every patient with haemangioma needs careful attention. Adequate treatment and regular follow up brings satisfactory response in the patients. © 2009 Blackwell Publishing Ltd and Medicalhelplines.com Inc.
Controversy of Single versus Staged Management of Anorectal Malformations
(Springer India, 2017) Ajay Narayan Gangopadhyay; Vaibhav Pandey
Anorectal malformations’ (ARMs) management has taken strides over the past few decades. The advent of Posterior sagittal anorectoplasty (PSARP) and its acceptance by most people across the globe as standard procedure has given way to a debate of single vs. three-staged repair. After initial hesitancy and lot of skepticism, single-staged repair has very well established its role because of its advantages over the staged procedure. There is enough evidence which suggests that single-staged repair has got equally good outcome as that of staged repair (if not better). Further, one-staged repair offers advantages of lesser morbidity, lesser cost, and lesser burden to the family. The initially thought disadvantages of higher chances of injuries, wound infection and stress to neonates have been countered by growing evidences. The authors agree that staged procedure will continue to stay around for few specific indications like perforation peritonitis, extreme prematurity and special anatomical entities. Further, it can have more important role with advent of laparoscopy and better health infrastructure in future. But with new developments in imaging, scopes and neonatal care, single-staged repair is a feasible and safe modality for treatment of these anomalies. © 2017, Dr. K C Chaudhuri Foundation.
Covered exstrophy: A rare variant of classical bladder exstrophy
(Informa Healthcare, 1997) Sakti Prasad Sahoo; Ajay Narayan Gangopadhyay; Chandrasen Kumar Sinha; Dinesh Kumar Gupta; Saroj Chooramani Gopal
Covered exstrophy is an extremely rare variant of exstrophy-epispadias complex. It is less distressing and easier to manage than classical exstrophy of the bladder. We report three cases of this entity, two associated with anorectal malformation and one with unilateral renal agenesis, along with a review of the literature.
Decortication through muscle-sparing axillary skin crease incision (MSASCI) in late paediatric empyema thoracic
(Springer India, 2015) Vaibhav Pandey; Ajay Narayan Gangopadhyay; Dinesh Kumar Gupta; Shiv Prasad Sharma; Vijayendar Kumar
Introduction: Video-assisted thoracoscopic surgery (VATS) is a less invasive and preferred modality for early stages of empyema (American Thoracic Society, Am Rev Respir Dis 85:935–6, 1962). Still, in the late organising phase, thoracotomy and decortication is the treatment of choice (American Thoracic Society, Am Rev Respir Dis 85:935–6, 1962). We aimed to evaluate the results of decortications through muscle-sparing axillary skin crease incision (MSASCI) in paediatric empyema thoracic. Methods: A prospective study was conducted between July 2011 and June 2013 including 28 patients of empyema thoracic in late organising phase. Decortication was performed through MSASCI in all cases. Utility of incision was assessed in terms of intra-operative exposure, access to all the lobes, size and visibility of scar. Result: Adequate exposure was possible in all cases. Complete excision of thickened parietal pleura with stripping of visceral peel was possible in all the cases with the release of entrapped lung. A chest tube was removed after a mean of 6.67 ± 4.62 days (5–14 days). Three patients had air leak. There were no other complications. All children had good lung expansion on chest radiography at 4 weeks. Scar was hardly visible in normal position in follow up. Conclusion: Muscle-sparing axillary skin crease incision is a good alternative to classical thoracotomy for decortication in paediatric age group for patients with organised empyema. © 2015, Indian Association of Cardiovascular-Thoracic Surgeons.
Evaluating the Impact of Elective Endotracheal Tube Replacement on Postoperative Outcomes in Esophageal Atresia: A STROBE‑guided Study
(Wolters Kluwer Medknow Publications, 2024) Ruchira Nandan; Ram Badan Singh; Arvind Bhalekar; Bhanumurthy Kaushik Marripati; Ajay Narayan Gangopadhyay; Vaibhav Pandey
Background: Elective ventilation and paralysis have been shown to decrease the anastomosis‑related complications following primary repair of esophageal atresia (EA). Repeated endotracheal tube (ETT) block and replacement can increase these complications. We evaluated the results of our strategy of electively changing the ETT just before shifting the patient to the postoperative ward for elective ventilation. Materials and Methods: A retrospective study was conducted using the case records of patients from July 2015 to February 2024 including all the patients of EA with tracheoesophageal fistula who underwent primary repair with end‑to‑end esophageal anastomosis. The patients were divided into two groups Group A: ETT was changed and Group B: ETT was not changed immediately before shifting. The groups were compared for anastomotic leak and ETT tube block in the first 48 h. Results: Ninety‑one patients were included in the study, 36 in Group A and 55 in Group B. Elective replacement of ETT decreased the tube block rates in the first 48 h following surgery (P = 0.032). Tension in the anastomosis was associated with a higher leak rate. The leak was present in 58.3% and 3.6% in cases with and without tension in the anastomosis (P = 0.001). Overall, the anastomotic leak was similar in both groups. In the subgroup of patients with anastomosis under tension, the rate of anastomotic leak was higher in patients with ETT block (P = 0.028). Conclusion: Elective replacement of EET decreases the tube block rates and anastomotic leak rates in cases with anastomosis under tension. © 2024 Journal of Indian Association of Pediatric Surgeons.
Letters to the Editor
(2009) Anand Pandey; Ajay Narayan Gangopadhyay; Vijai Dutt Upadhyay
[No abstract available]
Minimizing the postoperative complications of severe hypospadias using a simple technique
(2012) Vijayendra Kumar; Ram Avtar Rathore; Ajay Narayan Gangopadhyay; Dinesh Kumar Gupta; Shiv Prasad Sharma
Background The aim of this study was to decrease complication rates in proximal hypospadias surgery. Methods A simple method of stenting using a polypropylene stent has been developed for the most severe form of hypospadias during the period from January 2008 to January 2011 in the Department of Pediatric Surgery. The total number of patients was 46. The patients were classified into group 1 (n= 23), in which a polypropylene stent was used, and group 2 (n= 23), in which a polypropylene stent was not used. Results In group 1, complications occurred in three patients (13.04%), whereas in group 2 it occurred in 12 patients (52.2%). The difference in the total number of complications between groups was highly significant (< 0.001). In group 1, no patient needed redo surgery, and in group 2 four patients (17.39%) needed redo surgery (< 0.05). All other patients responded to repeated dilatation in the follow-up. Conclusion Although the sample size was small, this simple modification can decrease the complication rate significantly in the most severe form of hypospadias. Ann Pediatr Surg 8:32-34 © 2012 Annals of Pediatric Surgery.
Neonatal necrotising fasciitis - Varanasi experience
(2008) Ajay Narayan Gangopadhyay; Anand Pandey; Vijay Dutt Upadhyay; Shiv Prasad Sharma; Dinesh Kumar Gupta; Vijayendra Kumar
Neonatal necrotising fasciitis (NNF) is a rare and fatal disorder. Successful outcome depends on timely intervention. This paper presents single-centre experience of presentation, management and outcome of the condition. Fifteen patients of NNF were managed during the study period of 5 years. Parameters studied were age, sex, site of involvement and treatment. Treatment included intravenous (i.v.) antibiotics and conservative surgery. Age of presentation was 10-28 days. Male to female ratio was 2:1. Neck and scalp were the commonest site (53.3%). Culture reports were unimicrobial in 66% with predominance of Staphylococcus species. Predisposing factors included rural environment (100%), malnourishment (60%), boils (40%) and scratch injury (13%). Forty per cent had idiopathic NNF. Wound healing was by secondary intention in 46.6% and skin grafting in 53.3%. Overall survival was 80%, while the premature had poorer outcome. NNF is a serious disorder. Early treatment with i.v. antibiotics and supportive measures followed by debridement improves survival. © 2007 Blackwell Publishing Ltd and Medicalhelplines.com Inc.
Novel technique of repair of large tracheo-esophageal fistula following battery ingestion in children: Review of two cases
(Springer Verlag, 2014) Vaibhav Pandey; Ajay Narayan Gangopadhyay; Dinesh Kumar Gupta; Shiv Prasad Sharma; Vijayendar Kumar
Surgical repair of acquired tracheo-esophageal fistula may result in tracheal stenosis or esophageal stricture. We used fistula with esophageal cuff as flap to repair the tracheal defect. Esophageal repair was performed by rotating ends through 90° in opposite direction. This technique offers excellent repair in a single stage. © Springer-Verlag 2014.
Single stage management of a unique variant of congenital pouch colon with triplet fistula and normal anus
(Wolters Kluwer Medknow Publications, 2015) Vaibhav Pandey; Ajay Narayan Gangopadhyay; Dinesh Kumar Gupta; Shiv Prasad Sharma
Congenital pouch colon (CPC) in the female patient presents with highly variable and anomalous anatomy. We herein report the first case of CPC with uterus didelphys having normal anal opening, H-type vestibular fistula, two other fistulous communications between pouch colon and two vagina managed in a single stage with excellent postoperative outcome.
Small intestinal lymphangioma presenting as an acute abdomen with relevant review of literature
(Journal of Clinical and Diagnostic Research, 2017) Basant Kumar; Ankur Bhatnagar; Vijai Datta Upadhyaya; Ajay Narayan Gangopadhyay
Cystic lymphangioma of small bowel mesentery is rare with clinical features ranging from an asymptomatic abdominal lump to acute intestinal obstruction. We discuss two cases of lymphangioma of small bowel mesentery who presented to us as acute intestinal obstruction. In the first case exploratory laparotomy revealed a large multicystic lesion arising from small bowel mesentery just distal to the duodenojejunal junction having multiple small cysts filled with milky white fluid. The involved region of the bowel was excised. The second case had a large multicystic lesion involving the mesentery of proximal jejunum, dudenojejunal junction, encasing the entire superior mesenteric vessels. For this patient, debulking was done. © 2017, Journal of Clinical and Diagnostic Research. All rights reserved.
Twenty years' experience of steroids in infantile hemangioma-a developing country's perspective
(2009) Anand Pandey; Ajay Narayan Gangopadhyay; Saroj Chooramani Gopal; Vijayendra Kumar; Shiv Prasad Sharma; Dinesh Kumar Gupta; Chandrasen Kumar Sinha
Background: Hemangioma is a common vascular tumor. Though it involutes spontaneously, results are unpredictable. Steroid therapy is an effective mode of its regression. We present our experience of largest series and possible recommendations for treatment. Materials and methods: A total of 2398 patients were treated during the study period of 20 years. They were given oral prednisolone, intralesional triamcinolone, or combination of both as per the protocol and followed for the response. Response to the treatment was graded as excellent, good, poor, or no response. Results: The male-to-female ratio was 1:2.3. In 81% of patients, hemangioma was noticed within first month of life. The commonest site of involvement was head and neck (57%). The commonest clinical presentation was discoloration and swelling. Mean age and size were 8.43 ± 7.04 months and 23.64 ± 20.13 cm2. Response rate was highest for superficial type using any modality of treatment. Patients younger than 1 year showed better response (90.3%) in comparison with children older than 1 year (80.8%). The specific complications occurring were infections in 249 (12.4%), cushingoid facies and growth delay in 62 (3.1%), and hypertension in 51 (2.5%) patients. Conclusion: Steroid therapy either oral or intralesional as per the requirement is an easy and safe modality. Results are good to satisfactory in most patients. The complications are minimal. If treatment is needed, it should be used as a first-line therapy, especially when cost is an important concern. © 2009 Elsevier Inc. All rights reserved.