Browsing by Author "Dinesh Kumar Gupta"

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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.
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.
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.
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.
Role of color Doppler ultrasound in the diagnosis of nonpalpable testes
(Lippincott Williams and Wilkins, 2011) Zaheer Hasan; Ajay Narain Gangopadhyay; Dinesh Kumar Gupta; Bindey Kumar
Purpose Color Doppler ultrasound has been used for the diagnosis of torsion of testes. The purpose of this study was to evaluate the sensitivity of this noninvasive tool in detecting impalpable testes. Patients and methods Twenty-five children with nonpalpable testes were treated at the Department of Pediatric Surgery, Institute of Medical Science, Banaras, between 2007 and 2009. Color Doppler ultrasound was used for detecting the position, size, and vascularity of nonpalpable testes. These patients were subsequently revaluated by laparoscopy. Results Out of 25 cases, 15 cases were unilateral and 10 cases were bilateral (a total of 35 nonpalpable testes). The color Doppler ultrasound study successfully localized 30 of the 35 nonpalpable testes, which were confirmed by subsequent laparoscopic examination. The sensitivity of color Doppler in locating testes was 85.71% (95% confidence interval = 0.64-0.97). Conclusion Color Doppler ultrasound is an effective noninvasive method for the initial diagnosis of impalpable testes and for planning its subsequent management. Ann Pediatr Surg 7:146-147 © 2011 Annals of Pediatric Surgery.
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.
Synthesis of superparamagnetic bare Fe 3O 4 nanostructures and core/shell (Fe 3O 4/alginate) nanocomposites
(2012) Manish Srivastava; Jay Singh; Madhu Yashpal; Dinesh Kumar Gupta; R.K. Mishra; Shipra Tripathi; Animesh K. Ojha
In this article we report about the synthesis of superparamagnetic bare Fe 3O 4 nanostructures and core/shell (Fe 3O 4/alginate) nanocomposites by simple low-temperature based method at pH values 5, 9, and 14. The structural morphology and magnetic behavior of Fe 3O 4 nanostructures and core/shell (Fe 3O 4/alginate) nanocomposites (Fe 3O 4/alg NCs) have been investigated by X-ray diffractometer (XRD), Fourier transform infrared spectroscopy (FT-IR), Raman spectroscopy (RS), ultraviolet-visible (UV-vis) spectroscopy, transmission electron microscopy (TEM), energy dispersive X-ray spectroscopy (EDX) and vibrating sample magnetometer (VSM). The particle size was calculated by TEM measurements and it turns out to be ∼10 nm and ∼14 nm for bare Fe 3O 4 nanoparticle and Fe 3O 4/alg NCs with core/shell structure, respectively. The magnetic properties of the synthesized products were found to be function of pH at which the synthesis has been done. The synthesized Fe 3O 4 nanoparticle and Fe 3O 4/alg NCs were found to be superparmagnetic in nature at room temperature. We observed that the value of saturation magnetization in case of Fe 3O 4/alg NCs decreases by increasing the pH value. © 2012 Elsevier Ltd. 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.