Publications by authors named "Veerabhadra Radhakrishna"

15 Publications

  • Page 1 of 1

External Jugular Venous Cutdown versus Percutaneous Technique for Chemoport Insertion in Children: A Comparative Study.

J Indian Assoc Pediatr Surg 2022 Mar-Apr;27(2):140-146. Epub 2022 Mar 1.

Department of Paediatric Surgery, Manipal Hospital, Bengaluru, Karnataka, India.

Aims: We aimed to compare the external jugular vein (EJV) cutdown technique with the percutaneous technique for difficulties in insertion, maintenance, and other complications of chemoport placement in children.

Materials And Methods: A retrospective study was carried out in children who underwent chemoport insertion between January 2007 and December 2019 either by EJV cutdown or percutaneous technique in the department of pediatric surgery at a tertiary center. All children aged <18 years undergoing chemoport insertion by EJV cutdown or percutaneous technique were included in the study. Data collected included the indication, procedure time, early and late complications, and the time to removal of chemoport.

Results: There was no significant difference between the EJV group and the percutaneous group in terms of the time taken for chemoport placement (40.9 ± 7.6 min vs. 37.6 ± 18.9 min; = 0.14), failure to cannulate (one vs. six; = 0.05), and the mean chemoport indwelling days (816.8 ± 729.2 days vs. 854.5 ± 705.1 days; = 0.73). The chemoport placement by EJV cutdown method was found to have significantly fewer overall complications (4 vs. 14; = 0.01) and a lesser rate of premature chemoport removal (4 vs. 12; = 0.04) compared to the percutaneous group.

Conclusions: Chemoport placement by the EJV cutdown was found to have fewer port-related complications and a lesser rate of premature chemoport removal compared to the percutaneous technique. The time taken for port placement and the mean chemoport-indwelling days were similar in both techniques.
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http://dx.doi.org/10.4103/jiaps.JIAPS_346_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9350643PMC
March 2022

The Management of Perineal Trauma in Children.

J Indian Assoc Pediatr Surg 2022 Jan-Feb;27(1):65-70. Epub 2022 Jan 11.

Department of Pediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India.

Aims: This study aimed to evaluate the outcome of perineal trauma in children and to a define protocol for their management.

Methods: It is a retrospective study of children who presented with perineal injury between August 2012 and December 2020. The patients were classified into three groups: Group-1 included children with perineal and genitourinary injuries; Group-2 included patients with perineal and anorectal injuries; and Group-3 included patients with perineal, genitourinary, and anorectal injuries. All patients underwent primary repair. Those with full-thickness anorectal injury underwent an additional covering colostomy, while urethral disruption was initially managed by a diverting suprapubic cystostomy (SPC).

Results: A total of 41 patients were studied. Impalement injury ( = 11; 27%) and sexual abuse ( = 11; 27%) were the most common mechanisms of injury. Twenty (49%) patients had anorectal injuries with 10 (24%) each of partial-thickness and full-thickness injury. There were 24 (59%) genital injuries and five (12%) urethral injuries. One patient each developed anal and vaginal stenosis, both were managed with dilatation. One patient developed a rectovaginal fistula repaired surgically at a later date.

Conclusion: Perineal injuries with resultant anorectal or genital damage require a careful primary survey. Following stabilization, an examination under anesthesia as a set protocol will help determine the treatment strategy. A colostomy is essential in the acute management of severe anorectal injuries to reduce local complications and preserve continence. Urethral injuries may warrant an initial diverting SPC in selected cases.
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http://dx.doi.org/10.4103/jiaps.JIAPS_322_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8853604PMC
January 2022

Wilms tumor in horseshoe kidney in case of WAGR syndrome with multiple congenital anomalies: A cytologic diagnosis.

Indian J Pathol Microbiol 2022 Jan-Mar;65(1):230-232

Department of Pathology, Jawaharlal Institute of Post graduate Medical Education and Research, Puducherry; Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.

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http://dx.doi.org/10.4103/IJPM.IJPM_127_20DOI Listing
February 2022

Factors Associated with a Failed Nonoperative Reduction of Intussusception in Children.

J Indian Assoc Pediatr Surg 2021 Nov-Dec;26(6):421-426. Epub 2021 Nov 12.

Department of Paediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India.

Aims: The aim of this study was to evaluate the factors associated with the failure of nonoperative reduction of intussusception in children.

Methods: A retrospective study was conducted in a tertiary care pediatric surgery hospital. The children admitted to the department of pediatric surgery between November 2013 and February 2020 with the diagnosis of Intussusception were included.

Results: A total of 106 (67%) children underwent pneumatic reduction. Eighty-nine (84%) children had a successful reduction. A higher rate of failed reduction was found in children who presented at or after 48 h of the onset of symptoms ( = 0.03) and abdominal distension at presentation ( < 0.002). On multiple logistic regression analysis, the children presenting at or after 48 h of the onset of symptoms (odds ratio [OR] = 11.3; = 0.039) and abdominal distension at presentation (OR = 4.46; = 0.021) were found to be associated with increased risk of failure of nonoperative reduction. The variables age <1 year, weight <10 kg, pain abdomen, vomiting, bilious vomiting, fever, bleeding per rectum, and palpable mass were not associated with the failed nonoperative reduction. The variables, presentation at or after 48 h of the onset of symptoms (OR = 2.812; = 0.045) and abdominal distension at presentation (OR = 8.758; = 0.000) were found to be associated with an increased need for surgery.

Conclusion: The risk factors for failed nonoperative reduction of intussusception include a presentation at or after 48 h of the onset of symptoms and the presence of abdominal distension at presentation. The delayed presentation was associated with the increased need for surgery and increased chances of intestinal nonviability.
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http://dx.doi.org/10.4103/jiaps.JIAPS_297_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8637975PMC
November 2021

Transureteroureterostomy in children: a retrospective study.

Am J Clin Exp Urol 2021 15;9(2):163-169. Epub 2021 Apr 15.

Department of Pediatric Surgery, Bangalore Medical College and Research Institute Bengaluru, India.

Transureteroureterostomy (TUU) is a urinary reconstructive procedure seldom used but has a role when conventional reconstructive techniques are not possible. However, the concern is whether it places the opposite, non-diseased ureter and kidney at risk. Hence a retrospective study was conducted to evaluate indications, methods, and outcomes of transureteroureterostomy in children. The study included seven children who underwent TUU between January 2011 and December 2015. The mean age of the study group was 4.5 ± 2.9 years. Six (86%) patients were males. Two patients had primary bladder diverticulum, two posterior urethral valves, two cases of vesico-ureteric reflux, and one had a persistent urogenital sinus. All patients presented with recurrent urinary tract infections. Three (43%) patients had bladder outlet obstruction. Four (57%) patients underwent left to right TUU with right ureteric reimplantation. Two (29%) patients underwent an additional procedure. No complications were found. The key to a good outcome in TUU is case selection. Surgical technique plays a very important role in ensuring good long-term outcome without compromising the normal moiety.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8165706PMC
April 2021

Repair of Recurrent Eventration of the Diaphragm by Latissimus Dorsi Flap: A Novel Technique.

J Indian Assoc Pediatr Surg 2020 Sep-Oct;25(5):326-327. Epub 2020 Sep 1.

Department of Plastic Surgery, Manipal Hospitals, Bengaluru, Karnataka, India.

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http://dx.doi.org/10.4103/jiaps.JIAPS_140_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7732014PMC
September 2020

Limb Salvage in an Extensive, Complicated Vascular Lesion of the Arm in an Infant.

J Indian Assoc Pediatr Surg 2020 Mar-Apr;25(2):121-125. Epub 2020 Jan 28.

Department of Plastic Surgery, Manipal Hospital, Bengaluru, Karnataka, India.

When a vascular lesion involving a limb poses a hazard to the life, treatment options are excision or amputation of the limb. Although excision can be hazardous, limb salvage with vascular control is the best treatment option. We report limb salvage in an infant with an extensive infected congenital hemangioma complicated with consumptive coagulopathy.
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http://dx.doi.org/10.4103/jiaps.JIAPS_16_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7020671PMC
January 2020

Chemoport-A Savior in Children Who Require Chronic Venous Access: An Observational Study.

Vasc Specialist Int 2019 Sep 30;35(3):145-151. Epub 2019 Sep 30.

Department of Paediatric Surgery, Manipal Hospital, Bengaluru, India.

Purpose: Long-term venous access is cumbersome in children because of their thin caliber veins, less cooperative nature, and easy compromise of venous integrity. Hence, a study was conducted to evaluate the indication, efficacy, and safety of chemoport in children who require chronic venous access.

Materials And Methods: Children who underwent chemoport insertion between January 2008 and December 2017 were retrospectively evaluated.

Results: A total of 159 children (169 chemoports) were included in the study. The most common indication for chemoport insertion was acute lymphoblastic leukemia (51.5%). The mean chemoport days were 832±666 days. Among the 169 chemoports, 55.0% were removed after treatment completion. The chemoport was not removed in 35.5% of the patients, as 28.4% of the patients were still under treatment and 7.1% died during the treatment. Sixteen patients (0.1 per 1,000 chemoport days) had a premature chemoport removal. The indications were port-related bloodstream infection (12 patients), port pocket infection (1 patient), exposed chemoport (1 patient), and blocked chemoport catheter (2 patients). Twenty-two patients (0.15 per 1,000 chemoport days) had complications of port-related bloodstream infection (0.09 per 1,000 chemoport days), making it the most common. Other complications include block, fracture, arrhythmias, avulsion, bleeding, decubitus-over-port, and port pocket infection.

Conclusion: Owing to the safe, reliable, and low complication rate of chemoports, more children can be saved from deadly illnesses. Chemoport is the best option for children who require chronic venous access.
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http://dx.doi.org/10.5758/vsi.2019.35.3.145DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6774434PMC
September 2019

Case 2: Dilated Stomach in an Infant with Failure to Thrive.

Neoreviews 2019 07;20(7):e412-e414

Department of Paediatric Surgery, Indira Gandhi Institute of Child Health, Bengaluru, India.

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http://dx.doi.org/10.1542/neo.20-7-e412DOI Listing
July 2019

Clinico-Biochemical Profile of Children with Congenital Anomalies of the Kidney and Urinary Tract: A Cross-Sectional Study.

Kidney Dis (Basel) 2019 Feb 16;5(1):51-57. Epub 2018 Oct 16.

Department of Pediatric Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.

Background: Congenital anomalies of the kidney and urinary tract (CAKUT) are a group of disorders responsible for the majority of pediatric end-stage renal disease cases. There are only a few studies on CAKUT.

Objectives: A study was conducted to determine the clinical and biochemical profile of children with CAKUT and to estimate the prevalence and the factors associated with hypertension in CAKUT.

Methods: A cross-sectional study was conducted in a tertiary center for 18 months from March 2014 to August 2015. Demographic data were recorded, and clinical examination including blood pressure measurement was performed. Various biochemical parameters including plasma renin activity (PRA), urinary beta-2-microglobulin (B2M), and microalbuminuria were evaluated.

Results: A total of 81 patients with CAKUT were studied. Twenty-two (27%) patients were underweight, 4 (5%) patients were stunted, and 26 (32%) were both underweight and stunted. Children with bilateral disease had a higher incidence of underweight (21/44 vs. 8/37; = 0.04; 95% CI; Fisher exact test), and both underweight and stunted (25/44 vs. 10/37; = 0.006; 95% CI; Fisher exact test) compared to children with unilateral disease. Hypertension was found in 27% cases. No association was found between hypertension and PRA, BM2, or microalbuminuria in our study. PRA was inversely proportional to the estimated glomerular filtration rate (eGFR) (Pearson test; 95% CI; = 0.006).

Conclusions: Bilateral disease in CAKUT was significantly associated with poor somatic growth. PRA was inversely proportional to eGFR. The prevalence of hypertension was higher in children with CAKUT than in normal children and is possibly multifactorial as it was not associated with elevated PRA, B2M, or microalbuminuria.
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http://dx.doi.org/10.1159/000493683DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6388434PMC
February 2019

Squamous papilloma of the renal pelvis mimicking transitional cell carcinoma.

Turk J Urol 2019 11 28;45(Supp. 1):S128-S130. Epub 2018 Aug 28.

Department of Surgery, Basaveshwar Hospital, Gulbarga, Karnataka, India.

Squamous papilloma of the renal pelvis is an extremely rare entity. To the best of our knowledge, no case has been reported till date. A 45-year-old female presented to us with flank pain for two months. She had undergone left-sided percutaneous nephrolithotomy three years ago. Preoperative evaluation suggested the presence of a transitional cell tumor arising from the left renal pelvis. Diethylene-triamine-pentaacetic acid renogram showed a non-functional left kidney. She underwent left nephroureterectomy. Histopathology showed squamous papilloma of the renal pelvis. Subsequent follow-ups have been uneventful.
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http://dx.doi.org/10.5152/tud.2018.03295DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6922045PMC
November 2019

Cecal duplication: A mimicker of intussusception: A case report and review.

Ann Med Surg (Lond) 2018 Jul 31;31:17-19. Epub 2018 May 31.

Department of Paediatric Surgery, KEM Hospital, Mumbai, India.

Introduction: is a rare congenital anomaly and to the best of our knowledge, only 43 cases have been reported in the literature till date. Most of them present within the first year of life. They can mimic intussusception, and the delay in diagnosis can lead to high morbidity.

Case Report: A five-year boy presented with pain abdomen for a week. He was found to have ileocolic intussusception. The intussusception could only be partially reduced by the hydrostatic method. On laparotomy, a submucosal solid mass was found in the cecum with multiple enlarged lymph nodes. Mass was resected with clear margins and lymph nodes sampled. Histopathology was conclusive of cecal duplication. Post-operative course was uneventful, and the child is thriving well, last reviewed at three-year follow-up.

Conclusion: Incomplete reduction of intussusception, intussusception with atypical presentation or intussusception in atypical age group should alert to the possibility of cecal duplication.
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http://dx.doi.org/10.1016/j.amsu.2018.05.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6004772PMC
July 2018

Torsion of a Splenule in a Case of Splenogonadal Fusion Mimicking a Strangulated Inguinal Hernia.

J Indian Assoc Pediatr Surg 2018 Apr-Jun;23(2):100-102

Department of Pathology, Manipal Hospital, Bengaluru, Karnataka, India.

Splenogonadal fusion (SGF) is a rare anomaly, and to the best of our knowledge, none have mimicked a strangulated inguinal hernia. A 6-year-old boy presented with a painful left inguinal swelling mimicking a strangulated hernia but turned out to be a SGF, which was managed successfully with an inguinal procedure.
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http://dx.doi.org/10.4103/jiaps.JIAPS_191_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5898199PMC
April 2018

Bartholin's gland abscess in a prepubertal female: A case report.

Ann Med Surg (Lond) 2017 Dec 6;24:1-2. Epub 2017 Oct 6.

Department of Paediatric Surgery, Indira Gandhi Institute of Child Health, Bengaluru, India.

is one of the common inflictions of vulva seen in females of reproductive age group with a recurrence rate of up to 38%. Although it's encountered by many Paediatric Surgeons, it's very rarely reported in prepubertal age. Till date, only six cases have been reported to the best of our knowledge. A seven-year-old female child presented with a recurrent labial abscess. She was found to have Bartholin's gland abscess and was treated with partial excision of cyst wall along with the overlying mucosa and drainage. There has been no recurrence for the past six months at follow-up. Bartholin's gland abscess, although rare in children, should be considered as one of the differential diagnosis of a labial swelling. Adequate drainage is essential to prevent recurrence.
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http://dx.doi.org/10.1016/j.amsu.2017.09.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5643079PMC
December 2017

Lesson learnt from a migrated drain: A case report.

Ann Med Surg (Lond) 2017 Aug 5;20:80-83. Epub 2017 Jul 5.

Department of General Surgery, Mahadevappa Rampure Medical College, Gulbarga, India.

Introduction: Though surgical drainage is used as a safety measure, it's not without complications. Migration of various drains has been described, but very little literature refers to the migration of peritoneal drain.

Presentation Of Case: A 55-year male underwent anterior Gastro-Jejunostomy for inoperable metastatic carcinoma of the Gastric Pylorus. We found the peritoneal drain missing on the third post-operative day. On further evaluation, we found it to have migrated into the peritoneal cavity. We opened the operative wound for a partial length and retrieved the drain.

Discussion: We did research to find why drain migrates and searched literature on migration of peritoneal drains. The possible etiologies for drain migration are (1) Drain hasn't been fixed properly (2) Cutting through of suture material (3) Relatively low abdominal pressure (4) Pressure over the drain by patient's body weight when he lies on the same side as drain.

Conclusion: Every use of drain should be weighed for its needs and risks. Proper precautions during drain placement avoid unnecessary complications, morbidity and prolonged hospital stay.
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http://dx.doi.org/10.1016/j.amsu.2017.07.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5503826PMC
August 2017
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