Indian Journal of Neonatal Medicine & Research

Analytic Study of Laparoscopic Cholecystectomy

Mahesh M. Pukar, Jigar Vipulbhai Shah, Sohank G. Mewada, Hrydaynath desai

Introduction: Gall bladder disease is one of the most common problems affecting the digestive tract. The prevalence of gall stone is related to many factors. Women are three times more likely to develop gall stone than men and first degree relatives of patients with gall stone have a twofold greater prevalence. Materials and Methods: Patients attending Dhiraj hospital and clinically diagnosed for gall stone disease were admitted and treated laparoscopically. 50 cases were studied from May 2009 to Oct 2011. Results: Calculus cholecystitis has its peak incidence in 4th and 5th decade. Female have a higher incidence. Right hypochondriac pain, nausea/vomiting were common complaints. Discussion: Laparoscopic cholecystectomy is associated with early post operative recovery, less post operative stay, early return to work. Except for the common bile duct injury, Laparoscopic cholecystectomy is a safe procedure and has no significant complication. Laparoscopic cholecystectomy major extra biliary complication are as frequent as biliary complications and can be life threatening. An early prevention is critical to their management. Laparoscopic cholecystectomy is preferable treatment for gall bladder disease.

A Prospective Study of Post- operative Surgical Site Infection

Introduction: Organ specific surgical site infections are those that involve any part of the anatomy other than the incised body wall layer opened or manipulated during an operation. The proper understanding of bacteriology and mode of infections has surely reduced the incidence of wound infection, but it is not totally controlled. Hence the efforts are still concentrated upon various factors which play important role in wound infection. Materials and Methods: A total of 582 consecutive patient undergoing major and minor surgeries between March 2010 and October 2011 were included in the study. Detail history, physical examination, laboratory and radiological investigation according to Performa with special reference to any factor that could lead to postoperative infection – Age, sex, socioeconomic status, nutrition was recorded. Initial assessment of intra operative findings divided these cases into clean, clean contaminated, contaminated and dirty SSI. Result: A total of 582 patients out of these, 100 have SSI, SSI rate in our hospital was found to be 17.18% including all classes of wounds. Coagulase positive staphylococci were responsible for a majority of SSIs and mixed infections were quite common. The other microorganism responsible for SSIs were E.coli, Coagulase negative staphylococci, Pseudomonas and Proteus etc. Conclusion: The data from our study suggests a need to control modifiable risk factor responsible for development of SSI. Though we may not have a full control on the patient related factors it is essential that the associated health conditions like Diabetes. The anemia should be controlled as far as possible before surgical procedures.

G-6PD Screening in Neonatal Hyperbilirubinemia

Suvitha Thilakarajan, S.R Niveditha, Keshavamurthy

Glucose-6-Phosphate Dehydrogenase deficiency (G6PDD), is one of the commonest X-linked inherited erythroenzymopathy affecting 10% of the world population with a frequency of 0-27% in India. Children with G6PDD can develop acute haemolytic crises precipitated by particular foods or drugs causing significant morbidity. As primary prevention is not available, the only way to avoid morbidity is to recognize such children early in life and prevent exposure to triggering agents and drugs. Aims/ Objectives: 1. To screen and determine the frequency of G6PDD in cases of neonatal hyperbilirubinemia ( > 12.9 mg/dl). 2. To assess the usefulness of methaemoglobin reduction (MR) test in neonatal screening for G6PDD. Results: This observational study conducted in the department of pathology, at Kempegowda Institute of Medical Sciences, Bengaluru included 310 neonates with hyperbilirubinemia (12.9gm%). The male: female ratio was 1.3:1 with 80.3% of neonates presenting between 3-5 days post-birth with jaundice. Majority of the neonates were from non-consanguineous marriages (91.65%). Birth weight of 83.7% of the neonates was found to be > 2.5 kgs. Frequency of G6PDD was 1% ( 3 females) by MR test. All the G6PD deficient neonates (3/310 cases) were females (P=0.045), from non-consanguineous marriages. Conclusion: Frequency of G6PDD in neonatal hyperbilirubinemia was 1% (3/310 cases) suggesting low prevalence in south India. MR test appeared to be a good screening test as it was effective in picking up heterozygotes (all three were females, P=0.045).

Role of Colour and Spectral Doppler in the Diagnosis of Intra Uterine Growth Restriction (IUGR) and its Prediction of Adverse Perinatal Outcome

Introduction and Aim: The aim of this study was to evaluate the diagnostic accuracy of the pulsatility index (PI) and resistive index (RI) in umbilical artery (UA) and middle cerebral artery (MCA) in the diagnosis of IUGR and its role in averting or minimising adverse perinatal outcome. Materials and Methods: A total of 100 cases of clinically suspected IUGR were enrolled in to the study. The patient usually had an adverse factor in the current or previous pregnancy which was a contributing factor for developing Intra Uterine Growth Restriction (IUGR). All such cases underwent colour and spectral Doppler between 28 to 30 weeks in serial intervals and till delivery. Standardized cut off values were taken from previous studies for the data analysis. Diagnostic accuracy of Doppler indices for prediction of IUGR was done by assessing the newborn parameters for growth restriction and perinatal outcome. Results: For UA PI overall diagnostic accuracy was higher at 70% and UA RI at 54%. For MCA overall diagnostic accuracy of PI was 76.6% and for RI, it was marginally low at 70.3%. In both the vessels the PI was having higher sensitivity and specificity from an early gestational age (GA). Further the sensitivity and specificity increased for both vessels with advancing GA. Conclusion: We conclude that colour and spectral Doppler is an effective and non invasive tool which can predict and detect the cases of IUGR early in gestation and help in timely management thereby producing a favourable perinatal outcome.

Edward Syndrome with Aplasia Cutis Congenita: A Rare Case Report

Aplasia cutis congenita (ACC) is a rare developmental malformation characterized by the absence of skin, extending to bone or dura in a localized or widespread area at birth. Mostly it’s seen in the scalp with an autosomal dominant inheritance and slight female predisposition. Generally, it is found as a solitary lesion without other anomalies, but sometimes it is reported associated with other syndromes. The association is much appreciated in case of malformations like Patau syndrome, Wolf-Hirschhorn Syndrome, Johanson-Blizzard Syndrome etc. It is not commonly seen with Edward Syndrome. Normally Edward syndrome is a rare entity and its association with ACC makes it very rare. As the survival rate of Edward syndrome is very low, these types of associations are unavailable in the literature. We present this very rare association and which was never reported before in my country.

Carcinoid Tumour of the Vermiform Appendix Mimicking Acute Appendicitis: A Case Report and Review of Literature

Although carcinoid tumours are relatively rare, they are the most common neoplasms of the vermiform appendix where they are often discovered incidentally. In symptomatic patients, however, these tumours may produce signs and symptoms that closely mimic those of acute appendicitis and thus require adequate histopathological assessment to resolve the diagnostic challenges. We review the case of a 21-year-old Nigerian male university undergraduate who presented with right-sided lower abdominal pain and vomiting a few hours before coming to the hospital. Clinical evaluation suggested a diagnosis of acute appendicitis for which an emergency appendicectomy was performed. The patient recovered and was subsequently discharged home. Histopathological examination of the appendiceal specimen, however, revealed a carcinoid tumour at the tip of the specimen. It, therefore, becomes imperative that all appendicectomy specimens be subjected to appropriate histopathological assessment even if the sample appears innocuous to the naked eye.

A Rare Case of Uterine Lipoleiomyoma

Arunthathy Thangarajah

Lipoleiomyomas are uncommon benign tumours of the uterus and are considered variants of uterine myomas. Their reported incidence varies from 0.03 to 0.2%. Signs and symptoms of lipoleiomyomas are similar to leiomyomas of similar size. Lipoleiomyomas are usually asymptomatic. They can present with pain, hypermenorrhoea, menstrual irregularities and palpable mass. Lipoleiomyomas when asymptomatic require no treatment. However, it is important to differentiate these tumours from ovarian teratomas, which requires surgical excision.

Vitamin A Supplementation in Preterm Very Low Birth Weight Neonates

Kamaldeep Arora, Anu Thukral, Rashmi Ranjan Das

Vitamin A is involved in regulation of fetal lung growth. It protects the preterm lung from oxidative damage. It maintains the integrity of respiratory tract epithelium and helps in differentiation of epithelial cells. In addition, it is necessary for the formation of photosensitive visual pigment in the retina. Preterm neonates, especially very low birth weight (VLBW) have lower concentrations of plasma retinol binding protein (RBP) and plasma vitamin A concentrations than term infants. The plasma vitamin A concentrations in preterm infants with bronchopulmonary dysplasia (BPD) are still lower. Inadequate provision and delivery of vitamin A during postnatal period exacerbates this deficiency and makes these infants prone to multisystem diseases. We review here the current evidence regarding vitamin A supplementation in VLBW and extremely low birth weight (ELBW) infants, and hypothesize important research priorities in this regard.