bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pneumothorax in lung metastasis of advanced soft tissue sarcoma patients treated with oral pazopanib
Authors: Sarkar Sayan , Mishra Pradipta Kumar , Mukhopadhyay Sumit , Sen Saugata , Biswas Bivas 
Published: September 2023

Aim:
Data on occurrence of pneumothorax after the use of oral pazopanib in advanced soft tissue sarcoma (STS) with lung metastases are scarce in literature. We aimed to evaluate those in our patients.

Methods:
This was a single center retrospective study of incidence of pneumothorax in patients with lung metastases in advanced STS treated with oral pazopanib between July, 2016 and December, 2020. Patients were treated with pazopanib usually from 2nd line onwards with a dose ranging from 400 mg to 800 mg once daily.

Results:
Total of 34 patients with lung metastasis in a setting of advanced STS were treated with oral pazopanib during the study period. The setting of pazopanib use was 2nd line in four and 1st line in one of them. The starting dose was 600 mg once daily in three patients, 400 mg OD in one patient, and 800 mg OD in one patient. Five patients developed pneumothorax with duration on pazopanib of 6, 7, 24, 6, and 2.5 months, respectively. Three patients had symptoms and required chest tube drainage. None of them were smokers or had any other underlying lung disease. The disease response of those patients was stable disease in four and partial response in one during treatment with pazopanib. One patient had a rechallenge with further pazopanib course without any recurrence of pneumothorax.

Conclusions:
Pneumothorax is a rare pulmonary complication after pazopanib use in patients with lung metastasis. Clinicians should be aware of this rare complication as literature is scarce. Rechallenge with pazopanib is feasible after pneumothorax.
Comparison of psychosocial impact of strabismus on pediatric and adult patients in India
Authors: Bandhu Seema Dutt , Raje Swati S. , Kaur Barinder , Moudgil Tania , Bansal Yashi 
Published: September 2023

Purpose:
The purpose of this study was to compare the psychosocial impact of squint on children with that on adult patients in India.

Materials and Methods:
In this descriptive cross-sectional study, a twenty-question quality-of-life instrument ASO-20 was administered to patients with strabismus to study the psychosocial impact of strabismus on them. The results were compiled in an Excel sheet and analyzed statistically.

Results:
Thirty-two children (5–18 years) and 24 adults (>18 years) were included in the study. It was observed that all the adults responded that they always noticed that they have strabismus as against significantly less (81.25%) number of children who did so. Similarly, 75% of adults responded that strabismus affected their relations with other people, whereas only 37.5% of children felt that strabismus affected their relations with other people. While 95.83% of adults felt that opportunities (social interaction or at work) were fewer because of strabismus, only 37.5% of the children felt so. Similarly, while all the adults responded that they frequently imagined that other people were thinking about their eyes, only half of the children (56.25%) felt so. The difference is statistically significant. Significantly more (83.3%) adults responded that they had more difficulty in making friends because of strabismus, as against this, only one-fourth (25%) of the children felt so. The difference is statistically significant. Both the groups felt that strabismus bothered them, people noticed strabismus while interacting with them and they felt different (inferior) because of strabismus. Although the percentage who felt so was more in adults as compared to children, the difference was not statistically significant. Similarly, more children (75%) said that strabismus never hindered their performance as compared to adults (66.67%), however, the difference was not statistically significant.

Conclusions:
Strabismus has negative psychosocial effects on the affected individual which intensify with age.
A comparative study to assess the accuracy of the SRK T and HOFFER Q formulas in the intraocular lens calculation of long eyes undergoing phacoemulsification with posterior chamber intraocular lens in a tertiary care center
Authors: Kumar H. Mohan , Apoorva N. , Shreya  , Rachana B. , Rasheed Sana , Soni Jyotsana 
Published: September 2023

Aims and Objectives:
The aim is to compare the accuracy of the SRK T and HOFFER Q formulas in intraocular lens (IOL) power calculation in long eyes by noting the postoperative visual outcome.

Introduction:
Senile cataract is a leading cause of blindness in India. Cataracts are managed by cataract extraction with implantation IOL. Before surgery, IOL power is calculated by biometry. IOL power calculation is the main key to obtaining a good refractive outcome after cataract surgery.

Materials and Methods:
A hospital-based study was conducted prospectively to evaluate IOL power using SRK T and HOFFER Q formulae in patients undergoing phacoemulsification with posterior chamber intraocular lens in long eyes over a period of 18 months. Thirty patients were studied based on inclusion criteria. A detailed clinical examination, pre- and postoperative visual acuity, anterior chamber depth (ACD), and refraction were done on day 30 postsurgery.

Results:
The study included 30 cases with 15 patients in either group, of which 63% were male and 37% were female; 95% of the patients were aged above 50 years; the maximum number of patients in either group had an axial length in the range of 24.5–25 mm; the maximum preoperative ACD was between 3 and 4.5 mm and the maximum postoperative ACD was between 4 and 4.5 mm in both groups; 40% of the patients in either group had 6/6 vision; spherical refractive error postoperative was seen in 73% in the SRK T group and 68% in the HOFFER Q group; and cylindrical refractive error was seen in 27% in SRK T group and 32% in HOFFER Q group.

Conclusion:
Either formula can be used for IOL power calculation in eyes up to 26.5 mm, as not much difference in postoperative refractive error was observed. Both formulas had a lesser degree of spherical error and an equally good visual outcome postoperatively. Careful biometry is important to prevent postoperative surprises.
Correlation of diabetic retinopathy with thyroid status
Authors: Sachdeva Lalit , Srivastava Neha , Yadav Vishal , Srivastava Anil Kumar 
Published: September 2023

Background:
Several studies have demonstrated a correlation between subclinical hypothyroidism (SCH) and diabetic retinopathy (DR) with conflicting results. The study is aimed to find out the correlation and severity of DR with thyroid status.

Materials and Methods:
A cross-sectional study was conducted taking up 59 patients of DR and categorized them according to the severity of DR as per early treatment DR study classification. Thyroid stimulating hormone (TSH), free thyroxine (FT4), and FT3 concentration were measured in all 59 patients. Patients with normal TSH and FT4 values are euthyroid patients and those with normal FT4 but TSH >4.12 mIU/L is considered having SCH and those with FT4 <0.93 ng/dL and TSH >4.12 mIU/L are considered having hypothyroidism. The severity of DR is compared between the euthyroid, subclinical hypothyroid, and hypothyroid groups.

Results:
Out of the 59 patients included in the study, 23 (38.98%) were females and 36 (61.01%) were males. Out of 59 cases of DR, 51 (86.44) cases were diagnosed with nonproliferative DR (NPDR) and 8 (13.56%) were diagnosed with PDR. Fifteen had thyroid dysfunction, SCH were seen in 13 patients, two patients had hypothyroidism, and 44 had euthyroid. Fifty-one patients of NPDR and SCH were seen in seven patients, and hypothyroid was present in two patients. In eight patients of PDR, six had SCH.

Conclusions:
In the present study, the prevalence of SCH among the patients of DR with type 2 diabetes mellitus (DM) was found to be 20.33%. The prevalence of severe NPDR and PDR was higher in patients with SCH compared to euthyroid patients. Therefore, SCH is associated with the severity of DR.
Characteristics, Surgical Management, and Outcomes of Parotid Gland Masses in the Pediatric Age Group
Authors: Murugan Raghunath Sambandam , Maniam Raghul , Dhanasekarapandiyan Vembar , Hariharan G. 
Published: September 2023

Context:
Parotid gland lesions in children requiring surgical management are not common. Neoplastic lesions of the parotid glands are also less common. Parotid tumors in children have different characteristics from those that occur in adults. When they occur in the pediatric age group, malignancy has to be ruled out.

Subjects and Methods:
This is a retrospective study of children who presented to our institute, a tertiary care referral hospital for children <12 years, with parotid swellings during the 5-year period between April 2018 and March 2023. The children who underwent surgical management for parotid lesions, in the form of parotidectomy, were included in the study. Children who were treated by nonoperative management were excluded from the study.

Results:
Twelve children were included. Of the 12 children, three (25.0%) children had malignancy, four (33.33%) children had benign tumors, three (25.0%) children had vascular malformations, and the remaining two (16.67%) children had inflammatory etiology. All children underwent superficial/total parotidectomy, depending on the involvement of superficial and/or deep lobe. Of the three malignant parotid tumors, two were of mucoepidermoid carcinoma and one was myoepithelial carcinoma. One of the children with mucoepidermoid carcinoma had recurrence.

Conclusions:
Facial nerve-sparing parotidectomy is the treatment for neoplastic and inflammatory lesions. Initially, lymphovascular tumors were treated aggressively with parotidectomy. Neck node dissection should be performed only in children with fine-needle aspiration cytology-confirmed nodal metastases during primary surgery. Adjuvant treatment may be required in selected cases.
Variation in the Expression of Interstitial Cell of Cajal-like Cell (CD117) Across Congenital Pelvic-ureteric Junction Obstruction and its Renal Sonological and Functional Correlation
Authors: Ashish Kumar , Ratan Simmi K. , Sarin Yogesh Kumar , Khurana Nita , Kumar Jyoti 
Published: September 2023

ABSTRACT

Aims and Objectives:
This study aims to study the variation in the expression of CD117-positive interstitial cells of Cajal-like cells (ICC-LC) across the upper urinary tract region in children presenting with pelvic-ureteric junction obstruction (PUJO) and its association with renal functional and sonological parameters of patients.

Materials and Methods:
A prospective observational study was done on 20 children with congenital PUJO who underwent dismembered pyeloplasty. All children underwent renal sonography (anteroposterior pelvic diameter [APPD], pelvicalyceal ratio [P/C ratio], Mid polar renal parenchymal diameter [MPPD]) and functional imaging scan (LLEC scan or DTPA scan). Three specimens were taken intraoperatively from above PUJ, at the level of PUJ, and below PUJ. Those were examined immunohistochemically using CD117 to count ICC-LC using standard criteria. Variation in the expression of CD117-positive ICC-LC was correlated with the abovestated parameters.

Results:
The number of CD117-positive ICC-LC showed a continuous decreasing trend above downward. P/C ratio and APPD showed a parallel trend with ICC-LC distribution, whereas split renal function (SRF) showed an inverse relationship with the expression of ICC-LC. Children with lesser severity of obstruction (APPD <30 mm and SRF >40%) showed a uniform decreasing trend in the number of CD117-positive ICC-LC across PUJ. Children with more severe obstruction (APPD >30 mm and SRF <40%) showed a decrease in the expression of ICC-LC up to the level of PUJO followed by a sudden relatively increased expression of ICC-LC below the obstruction.

Conclusion:
The expression of ICC-LC shows a uniformly decreasing trend across obstruction when the severity of obstruction is less. Resurgence in the number of ICC-LC below PUJ in subjects with severe obstruction hints at the emergence of a new pacemaker area below severely blocked PUJ akin to that seen in complete heart block patients and deserves early attention.
Preoperative Triple-Phase Three-Dimensional-Multi-Detector Computed Tomography Imaging of the Hepatic Vascular Tree
Authors: Mitra Aparajita , Bhatnagar Veereshwar , Agarwala Sandeep , Gupta Arun Kumar , Jana Manisha , Srinivas M. , Dhua Anjan Kumar 
Published: September 2023

Objective:
To evaluate the hepatic vasculature/tumor relations in hepatoblastoma patients with three-dimensional (3D) reformatted images after triple-phase multi-detector computed tomography (MDCT) and to compare these with the surgical findings to judge the accuracy of this investigation.

Materials and Methods:
The study was carried out in hepatoblastoma patients after appropriate neo-adjuvant chemotherapy, prior to resection. Images were postprocessed at a dedicated workstation for multi-planar reformations, maximum intensity projection, curved planar reformations, and volume-rendered technique reconstructions. The reporting was done as per a specific protocol by both the radiologist and surgeon (per-operative findings) and the accuracy of MDCT ascertained as per concordance between the surgical and imaging findings.

Results:
Fourteen children (13 boys, 1 girl) underwent surgery. Clinically, relevant information regarding vascular, tumor involvement, and interface with vessels was provided by the study in all cases. Although all tumors were deemed resectable on preoperative imaging, one procedure was abandoned due to an unanticipated portal cavernoma. While a few anatomical variations were unexpectedly encountered during surgery, there was good concordance overall between findings on imaging and surgical exploration.

Conclusions:
MDCT with 3D reformatting provides accurate virtual representations of the hepatic tumor. This allows simulation of surgical resection with decreased risk of vascular injury and postoperative liver failure.
Long Tubular Duplication of the Small Intestine – Lessons Learnt from a Common Presentation of a Rare Disease
Authors: Vaze Poonam Guha , Acharyya Bhaswati C. , Banerjee Rupa , Biswas Somak Krishna , Chattpopadhyay Anindya , Saha Subhasis 
Published: September 2023

ABSTRACT
Long tubular duplication of the small intestine is one of the most difficult surgical challenges. The presence of heterotopic gastric mucosa necessitates resection of the duplicated bowel, but shared vascularity with the normal adjoining bowel makes the task daunting. We present a case of long tubular small intestinal duplication with certain special surgical and perioperative challenges which were successfully managed.
Management of Umbilical Hernia in African Children
Authors: Ngom Gabriel , Zeng Florent Tshibwid A. , Sagna Aloise , Gueye Doudou , Ndoye Ndeye Aby , Mbaye Papa Alassane , Ndiaye Cheikh , Fall Mbaye , Ndour Oumar 
Published: September 2023

Aims:
Umbilical hernia (UH) is common in African and African-descent children. In high-income countries (HICs), it is considered benign, which is not the case in Sub-Saharan ones. Through this study, we aimed to share our experience.

Materials and Methods:
A descriptive review was conducted from January 01, 2012 to December 31, 2017 at Albert Royer National Children's Hospital Center. Among the 2499 patients, 2146 cases were included in the review.

Results:
UH had a frequency of 6.5%, with patients having a mean age of 2.6 years, with a male preponderance of 63%. Emergency consultation occurred in 37.1%. The symptomatic hernia was present in 90.9%. The congenital type was found in 96%, a history of painful episodes was reported in 46%, and medical and surgical comorbidities were found in 30.1% and 16.4%, respectively. Multimodal anesthesia was used in 93.1%. A lower umbilical crease incision was made in 83.2%, the sac was not empty in 16.3%, and additional umbilicoplasty was performed in 16.3%. During a 14-month follow-up, a complication occurred in 6.5% and mortality in 0.05%.

Conclusion:
In our region, the pediatric UH was predominantly symptomatic, with its natural evolution leading to more complications than in HICs. Its management carried acceptable morbidity.
Propranolol for Vascular Anomalies
Authors: Gupta Rahul 
Published: September 2023

Context:
Congenital vascular anomalies are classically subdivided into vascular tumors and vascular malformations. The role of propranolol in the regression of infantile hemangioma (IH), a vascular tumor, is well establishe.

Aims:
This study aimed to analyze the therapeutic efficacy and complications associated with oral propranolol and adjuvant therapy in the treatment of vascular anomalies.

Settings and Design:
A prospective interventional study was undertaken over 10 years duration extending from 2012 to 2022 at a tertiary care teaching institute.

Materials and Methods:
All children with cutaneous hemangiomas and lymphatic and venous malformations under 12 years of age, except those with contraindications for administration of propranolol, were included in the study.

Results:
Out of 382 patients, there were 159 males and 223 females (male: female = 1:1.4). The majority (53.66%) were between ≥3 months and 1 year. There were 481 lesions in 382 patients. There were 348 patients with IH, and 11 were congenital hemangiomas (CHs). There were 23 patients with vascular malformations; lymphatic malformation (n = 19) and venous malformation (n = 4) were present. The size of the lesions ranged from 5 mm to 20 cm; 50.73% were 2–5 cm in size. Ulceration (>5 mm) was the most common complication present in 20/382 (5.24%) patients. Complications related to oral propranolol were seen in 23 (6.02%) patients. Drugs were given for a mean period of 10 months (range from 5 months to 2 years). At the end of the study, 282 (81.03%) out of 348 patients with IH showed an excellent response; 4 (36.36%) patients in the case of CH (n = 11) and 5 (21.74%) patients with vascular malformation (n = 23) showed excellent response.

Conclusion:
The study validates the use of propranolol hydrochloride as the first-line agent for the treatment of IHs and congenital hemangiomas. It may have an additive role in lymphatic malformations, and venous malformations, as a part of a multimodality treatment approach for vascular malformations.
Assessment of Gastric Residual Volume with Ultrasound in Children at Fasting and after Oral Intake of Carbohydrate-Rich Fluid in the Preoperative Period
Authors: Garg Keshav Kumar , Agarwal Aarti , Goyal Puneet , Lal Hira , Prasad Raghunandan , Dhiraaj Sanjay , Pant Kailash Chandra , Lal Richa 
Published: September 2023

Purpose:
Despite standard preoperative fasting guidelines, children are subjected to prolonged fasting due to various reasons. This does not reduce gastric residual volume (GRV) further, instead causes hypoglycemia, hypovolemia, and unnecessary discomfort. We calculated the cross-sectional area (CSA) of antrum and GRV in children in fasting state and 2 h after intake of oral carbohydrate-rich fluid, using gastric ultrasound.

Methods:
Anteroposterior and craniocaudal gastric antral diameters were measured by ultrasonography in the right lateral decubitus position, at fasting and at 2 h after 8 ml/kg of pulp-free fruit juice ingestion. CSA of antrum and GRV was calculated using validated mathematical models.

Results:
Data of 149 children of age >1–12 years were analyzed. Greater than ninety-nine percent of children emptied ≥95% of the ingested pulp-free fruit juice volume within 2 h. One hundred and seven (71.8%) children had reduced CSA and GRV at 2 h after fruit juice ingestion (2.01 ± 1.00 cm2 and 7.77 ± 6.81 ml) as compared to fasting state (3.18 ± 1.40 cm2 and 11.89 ± 7.80 ml). Fourty-nine (28.2%) children had slightly increased CSA and GRV at 2 h after fruit juice (2.46 ± 1.14 cm2 and 10.61 ± 7.26 ml) than at fasting (1.89 ± 0.92 cm2 and 8.61 ± 6.75 ml), but this increased GRV was grossly lower than limit of risk stomach (26.54 ± 8.95 ml).

Conclusion:
Carbohydrate-rich drink in the form of pulp-free fruit juice may be safely permitted up to 2 h before anesthetic induction, as it promoted gastric emptying in ≈ 72% of children and 28% of children, although GRV was slightly higher at 2 h after fruit juice ingestion than fasting but remained considerably lower than limit of risk stomach.
Role of Partial Splenectomy in Gaucher's Disease in Resource Challenged Nations
Authors: Santanakrishnan Ramesh , Dasaratha Vinupriya , Munianjanappa Narendra Babu , Javaregowda Deepak , Saroja Murali Govindappa 
Published: September 2023

ABSTRACT

Context:
Gaucher's disease (GD) is a rare inherited metabolic disorder caused by the defective activity of glucocerebrosidase. Enzyme replacement therapy (ERT) and substrate reduction therapy are the treatment of choice. Total splenectomy has a role when the child develops complications of massive splenomegaly. There are only a few case series of partial splenectomy in GD in the pediatric age group.

Aims:
To study the role, technical feasibility, and challenges of partial splenectomy in children with GD with hypersplenism.

Materials and Methods:
Retrospective review of children of GD who had partial splenectomy between February 2016 and April 2018. Demographics, clinical findings, laboratory, operative details, transfusion requirements, and perioperative, immediate, and late complications were retrieved. Clinical courses after discharge were obtained from follow-up data.

Results:
Eight children with GD underwent partial splenectomy between 2016 and 2018. The median age at surgery was 3 years and 6 months (range −2 years to 8 years). Five children underwent partial splenectomy successfully, of which one child required postoperative ventilatory support for 48 h owing to lung atelectasis. Three children underwent completion splenectomy due to bleed from the cut surface of the splenic remnant. One of the children who underwent completion splenectomy expired on the postoperative day 5 due to refractory shock with multi-organ dysfunction.

Conclusion:
Partial splenectomy has a definite role in selected children who present with massive splenomegaly with mechanical effects and/or hypersplenism while awaiting ERT.