Child Surgery In India

 

Children aren’t simply miniature people who suffer the same diseases adults do, but on a smaller scale. Rather, they have their own specific afflictions and abnormalities.

Diagnosing and treating children’s heart diseases requires specialized knowledge and a dedicated approach to care…..

 

Understanding Child Surgery

Child / Pediatric Surgeons are medical doctors who specialize in the surgical treatment of conditions affecting children. Pediatric surgeons operate on children whose development ranges from the newborn stage through the teenage years. In addition to completing training and achieving board certification, pediatric surgeons complete two additional years of training exclusively in children’s surgery. They then receive special certification in the subspecialty of child surgery….

 

Variety of Surgical Procedures

A ] Trauma

The ChildSurgery service is consulted immediately for any pediatric trauma victim with serious and/or multiple injuries. The service will coordinate the trauma work-up, consult the appropriate subspecialty services, perform any necessary general surgical procedures, and coordinate care in the hospital. The service maintains a constant presence and therefore, an easily recognizable source of information for families and caretakers……

 

B ] Tumors/Oncology

 

The Child Surgery service is intimately involved with the management and performs surgery for surgical childhood malignancies. These include Wilms’ tumor, neuroblastoma, hepatoblastoma, hepatocellular carcinoma, rhabdomyosarcoma, teratomas, adrenal tumors, ovarian tumors, and testicular tumors. In addition, the service is involved in performing biopsies….

 

C ] Transplantation

The Child Surgery service, in conjunction with Pediatric Urology, performs kidney transplants and participates in the comprehensive care of these pediatric patients. The service provides necessary vascular access for children requiring bone marrow transplantation…..

 

D ] Airway

The Child Surgery service utilizes laryngoscopy, bronchoscopy, and appropriate surgical techniques to evaluate and treat a variety of congenital and acquired airway disorders. These include stridor, laryngomalacia, tracheomalacia, subglottic stenosis, tracheal stenosis, laryngeal or tracheal clefts, and aspirated foreign bodies…..

 

E ] Head and Neck

 

The Child Surgery service addresses a variety of conditions in the head and neck including branchial cleft anomalies and remnants, thyroglossal duct cysts, cystic hygroma/lymphangioma, abnormal/enlarged lymph nodes, neck masses, dermoid and sebaceous cysts, torticollis, disorders of the thyroid and parathyroid glands, and “tongue-tie”……

 

F ] Lymph Node

The Child Surgery service evaluates and surgically treats enlarged and infected lymph nodes when appropriate from a variety of conditions which include infections (cat scratch, atypical mycobacteria, tuberculosis, staphylococcus, streptococcus, and a variety of other bacteria) , tumors (Hodgkin and non-Hodgkin lymphoma, metastases from other primary tumors), and idiopathic enlargement…..

 

G ] Endocrine

The Child Surgery service evaluates and treats disorders of the thyroid gland, parathyroid glands, adrenal glands (adrenal tumors, hyperfunctioning and hypofunctioning gland, pheochromacytoma), pancreas (cysts and pseudocysts, hyperinsulinism, islet cell adenoma, tumors)…..

 

H ] Breast

The Child Surgery service evaluates and treats benign lesions of the breast in males (gynecomastia, breast enlargement, infection, congenital anomalies) and females (fibroadenoma, infection, inflammation, cysts, congenital anomalies). Endocrine evaluation is obtained when needed……

 

I ] Chest Wall

The Child Surgery service evaluates and treats disorders of the chest wall including pectus excavatum, pectus carinatum, sternal defects, Poland’s syndrome, and other congenital and acquired deformities. Cardiac and pulmonary evaluation is obtained when appropriate…..

 

J ] Thoracic

The Child Surgery service evaluates and treats a variety of congenital and acquired thoracic disorders. These include congenital diaphragmatic hernia, diaphragmatic eventration, mediastinal cysts and tumors, bronchogenic cysts, enlarged lymph nodes, pulmonary sequestration, cystic adenomatoid malformation……

 

K ] Abdominal Wall

 

The Child Surgery service evaluates and treats a variety of congenital abdominal wall defects including gastroschisis, omphalocele, and Prune Belly syndrome……

 

L ] Hernias

The Child Surgery service evaluates and treats a variety of hernias including inguinal, umbilical, epigastric, ventral, and epiploceles…..

 

M ] Gastrointestinal

The Child Surgery service evaluates and treats a wide variety of congenital and acquired gastrointestinal disorders. Conditions include pyloric stenosis, esophageal reflux, peptic ulcer, congenital duodenal obstruction (duodenal atresia, stenosis, web, annular pancreas), atresia and stenosis of small and large intestine, meconium ileus, Meckel diverticulum, intussusception, malrotation, intestinal obstruction…..

 

N ] Liver and Biliary Tract

 

The Child Surgery service evaluates and treats conditions of the biliary tract including jaundice of the newborn, biliary atresia, choledochal cyst, diseases of the gallbladder (gallstones, cholecystitis), common bile duct obstruction, liver cysts and tumors, liver hemangioma, portal hypertension…..

 

O ] Pancreas

The Child Surgery service evaluates and treats conditions of the pancreas including cysts, pseudocysts, pancreatitis, neoplasms, hyperinsulinemia, islet cell adenoma…..

 

P ] Spleen

The Child Surgery service evaluates and treats conditions of the spleen including splenomegaly and hypersplenism from a variety of hematologic disorders (sickle cell anemia, hereditary spherocytosis, Gaucher’s disease, idiopathic thrombocytopenic purpura (ITP), thrombotic thrombocytopenic purpura (TTP), thalessemias, autoimmune hemolytic anemias), cysts, tumors, and abscesses….

 

Q ] Genitourinary

The Child Surgery service evaluates and treats undescended testicles, testicular torsion, epididymitis, phimosis, cloacal extrophy, cloacal anomalies, labial fusion, clitoral hypertrophy, ambiguous genitalia, Prune Belly syndrome. The service regularly performs circumcision procedures as well…..

 

R ] Soft Tissue

The Child Surgery service treats and evaluates congenital and acquired defects of the skin and soft tissue including cysts, nodules, pigmented lesions/nevi, hemangioma, lymphangioma/cystic hygroma…..

 

S ] Vascular

The Child Surgery service treats and evaluates congenital and acquired vascular anomalies. These include vascular rings and slings, and vascular injuries. The service also regularly provides vascular access for nutrition, chemotherapy….

 

T ] Minimally Invasive Surgery (Laparoscopy, Thoracoscopy, Endoscopy)

 

The Child Surgery regularly uses a variety of endoscopic techniques to evaluate and treat conditions of the airway (laryngoscopy, bronchoscopy), the chest (thoracoscopy), abdomen (laparoscopy) and urinary tract (cystoscopy)…..

  

 

 

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First detected in the United States in 1984 the Tracheal mite has caused the loss of tens of thousands of colonies and millions of dollars. The tracheal mite will infest the tracheal system of the adult honey bee, they prefer adult bees less than four days old. Levels seem to be at the highest during the winter and spring. Once they are on the bee, the mites are attracted to the carbon dioxide exhaled and enter the spiracles located on the thorax, which lead to the tracheal system. They will puncture the wall of the trachea and suck the blood of the bee.  Once in the tracheal system the mites live, breed and la eggs. The adult and the eggs plug the tubes of the trachea, which impairs oxygen intact of the bee. Since they puncture the trachea in order to feed, they will spread secondary diseases and pathogens. The bee dies from the disruption to respiration damage to the trachea, and from the loss of blood. Once over 30 percent of the population are infected with tracheal mites, honey production may be reduced. The likelihood of winter survival decreases with increasing infestation of the mite. Mites are transmitted from bee to bee within a colony by robbing or drifting bees.

Infested bees will be seen leaving the colony and crawling on the grass just outside the hive. They will crawl up the blades of grass or the hive, fall back down and try again. The wings will be disjointed and the bees will be unable to fly. If you are unsure about a tracheal mite infestation, send sample bees in alcohol to your local county extension agent for verification.

One method of preventing tracheal mites is an oil extender patty. It consists of two parts sugar to one part vegetable shortening. Make a small patty about four inches in diameter. Sandwich it between was paper. Cut the wax paper around the edges so the bees have access to the patty. Place the patty on top of the frames in the center within the hive body. The bees will be attracted to the sugar and get oil on their body. The oil makes it difficult for the mites to identify suitable bee hosts. The oil patties will not contaminate the honey supply so they can be used for prolonged periods.

There is one other method for controlling tracheal mite infestations. Menthol can be used and is available in most bee supply stores. The temperature must be above 60?F in order for the menthol to work. The bees breathe the vapor, which dehydrates the mites. Menthol must be removed during a nectar flow so that the honey is not contaminated.

When medical professionals enter their career, they have to be careful when diagnosing a patient. Often times, symptoms of one illness can be having symptoms to another illness. It’s because of this that doctors have to be very careful and provide an accurate diagnosis, combine that with the right type of treatment of medicine.

Bronchitis is a condition in which the bronchial tubes are irritated and inflamed. There are three specific categories of bronchitis including acute, chronic and bronchiectasis.

Bronchitis remains a large threat to public health, ranking fourth among causes of death. A new strain recently revealed is making treating this disease even harder because of its nature. The newly discovered strain is even nastier in that it can resist conventional medicines. It’s forcing doctors to revise their techniques pertaining to both illness of pneumonia and bronchitis.

Coupled with data that is unusable by the time it’s ready to be tested, doctors rely on patient’s physical examinations to diagnosis the disease. Often they make the diagnosis based on what they see or observe in patients but scientific approaches are still important for the antimicrobial therapy design.

Antibiotics must meet certain criteria including effectiveness in its treatment, the safety of drugs, cost-effectiveness and convenience. Doctors feel the ideal antibiotic would treat all of the following:

Offer action against primary organisms
Pharmacokinetic
best possible pharmacologic
Experimental response rates are soaring
Penetration of tissue
Drug interaction low
Low or no side effects
Bacteria resistance is slow in developing.

Traditional antibiotics include the ever accepted Amoxicillin, macrolides and cephalosporins and greatly used in the antimircobial therapy. Yet, there usefulness fluctuates along with its resistance frequency.

In the late 1990’s, two medicines called gatifloxacin and moxifloxacin were released which offered better options for the respiratory treatments. When new drugs are introduced, others are often removed because of certain dangerous side effects.

Physicians and doctors must have a immense appreciativeness of the organisms so they can know how to manage tracheal bronchitis and many other respiratory illnesses. They must also be acutely aware of all of the therapies effective enough to treat the disease.

Nowadays, there is some controversy with how to treat the disease. Some doctors feel it is in the best interest of the patient to use no medicine treatment therapy especially when a cough does not last for more than five days. Others feel medicinal therapy is the way to go. Patients are typically treated rather quickly. Since most feel that paying for a doctor’s consultation entitles them to antibiotics but it’s the doctor’s job to edify his patients they should not hurry to the doctor if they have a cough for one day or two. Doctors usually say waiting 5 to 7 days is best because then if it is bronchitis, you can tell. This means if you have a viral infection and severe cough. Once the infection goes away and the cough stays, that’s the instance to visit the doctor. If you give viral infections antibiotics, resistance can build up, leaving you with nothing to use for medicine.

If someone has tracheal bronchitis and the cough is in conjunction with sputum; however there is no fever, pneumonia, COPD or emphysema, it is likely the physician will prescribe medicine to knock out the symptoms, getting the patient back on the road to recovery.

Studies are undergoing to develop better treatments and antibiotics to combat the tracheal bronchitis. Here is hoping that before the nasty bacteria settles in the tubes that the new medicines are already out on the market.

Heated Intraoperative Intraperitoneal Chemotherapy Mesothelioma Cancer Treatment

A procedure known as heated intraoperative intraperitoneal chemotherapy was developed by Paul Sugarbaker at the Washington Cancer Institute.The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48°C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained.

This technique permits the administration of high concentrations of selected drugs into the abdominal and pelvic surfaces. Heating the chemotherapy treatment increases the penetration of the drugs into tissues. Also, heating itself damages the malignant cells more than the normal cells.

Dr. Paul Sugarbaker, renowned oncologic surgeon specializing in mesothelioma at the Washington Cancer Institute, developed a leading-edge surgical procedure to treat mesothelioma called heated intraoperative intraperitoneal chemotherapy. In this procedure, as much of the tumor as possible is first removed by the surgeon. Following the removal of the tumor, a chemotherapy agent heated to between 40°C and 48°C is administered into the abdomen. The fluid is perfused for anywhere between one and two hours and then it is drained.

High concentrations of selected drugs can be administered into the abdominal and pelvic surfaces using this technique. The other benefit associated with using this technique to treat peritoneal mesothelioma is that the heated chemotherapy treatment increases the level to which the drugs can penetrate the tissues and damages malignant cells more than normal ones.

Coliseum Technique for Hyperthermic Intraoperative Intraperitoneal Chemotherapy

Cytoreductive surgery was attempted to make each patient macroscopically disease-free. At the end of the procedure, four closed suction catheters (Zimmer Inc, Warsaw, IN) were placed through the abdominal wall, using stab incisions, to lie beneath each hemidiaphragm and two within the pelvis (Figure 2). A Tenckhoff catheter (Quinton Inc, Seattle, WA) was placed through the abdominal wall if early postoperative intraperitoneal chemotherapy (EPIC) is planned. Otherwise, the Tenckhoff catheter was placed over the midline abdominal incision for use in HIIC. The Tenckhoff catheter functioned as an in-flow line. The closed suction catheters were used as drainage lines for intraoperative lavage and remained in place for postoperative abdominal drainage. Two temperature probes (Respiratory Support Products Inc. Irvine, CA) were then placed over the edge of the abdominal incision. One temperature probe was tied to the Tenckhoff catheter. The other temperature probe was tied to a closed suction drain at a distant location from the Tenckhoff. All transabdominal tubes were secured to the skin and to the peritoneum with purse string sutures to prevent fluid leakage. The Thompson retractor (Thompson Surgical Instruments, Traverse City, MI) was then repositioned as in Figure 2. The abdomen was left open with the skin edges suspended to the Thompson retractor with a number 2 running nylon suture. To prevent spillage of the chemotherapy and to control potential chemotherapy vapors, a plastic sheet was sutured to the wound edges. A slit incision was then made in the center of the plastic sheet to allow the surgeon access to all intraabdominal surfaces and to manually control the fluid distribution. After the hyperthermic perfusion was complete, bowel anastomoses and other reconstructive procedures were performed.

The hyperthermic perfusion with mitomycin C was carried out for ninety minutes using a HIIC custom tubing pack (Bard Cardiology, Haverhill, MA), two cardiopulmonary bypass pumps (Travenol Labs, Morton Grove, IL) and a Sarns heater/cooler unit (3M Cardiovascular Systems, Ann Arbor, MI). Three liters of 1.5% dextrose peritoneal dialysis solution containing the appropriate cytotoxic drug(s) were heated and infused at approximately 1 liter per minute into the abdominal cavity. The perfusate was heated to approximately 43oC. Temperatures were measured with a Labcraft digital thermometer (Curtin Matheson Scientific, Jessup, MD). The temperature at the In-Flow line was approximately 44oC. The Tenckhoff temperature probe was maintained between 42 and 43oC. The temperature probes and all temporary 3-0 chromic sutures were removed at the end of the hyperthermic perfusion.

Urine output was monitored by the anesthesiologist. At his or her discretion fluid challenge, furosemide, renal dose dopamine or mannitol were instituted to maintain a brisk diuresis. Urine output was measured every 15 minutes. It was maintained at greater than 400 cc per hour during the ninety minutes of the hyperthermic perfusion and for one hour thereafter.

In addition to intraoperative hyperthermic perfusion, patients with high grade tumor or incomplete cytoreduction received five days of early postoperative intraperitoneal chemotherapy. These five days of chemotherapy were given on postoperative days 1-5. Each dose was prepared in 1000 to 2000 cc of 1.5% dextrose peritoneal dialysis solution, depending on body size. Each dose was infused as quickly as possible, allowed to dwell for 23 hours then drained for one hour prior to the next infusion.

Levels of 5-FU were monitored in the peritoneal fluid and plasma of 9 patients on the first postoperative day. Three patients received cytoreductive surgery, HIIC and early postoperative 5-FU. Six patients received only cytoreduction and early postoperative 5-FU. Samples were obtained at regular intervals from 0 to 180 minutes post infusion.

Drug doses were as follows:

For pseudomyxoma peritonei and adenocarcinoma from appendiceal, colonic and rectal cancer:

Drug Day Route Dose Mitomycin C 0 IP 12.5 mg/m2 (max. 25 mg) for males or
10.0 mg/m2 (max 20 mg) for females in 3 liters. 5-Fluorouracil 1-5 IP 15 mg/m2 x 5 days

For gastric, pancreatic and ovarian cancer, mesothelioma, and sarcoma:

Drug Day Route Dose Cisplatin 0 IP 50 mg/m2 (max. 100 mg) Doxorubicin 0 IP 50 mg/m2 (max. 100 mg) Mitomycin C 0 IP 7 mg/m2 (max. 14 mg)

Doxorubicin 1-5 IP 15 mg/m2 x 5 days

Standardized dose reductions occurred as follows:

33% dose reduction for age > 65 years
33% dose reduction for patients with compromised renal function.
50% dose reduction for prior exposure to heavy chemotherapy or radiation therapy
Other dose reductions as deemed necessary by the Principal Investigator.

For patients undergoing pharmacokinetic monitoring, samples of plasma, urine and perfusate were obtained at fifteen minute intervals during the hyperthermic perfusion and at the end of the procedure. These measurements were used for pharmacokinetic calculations and to help relate possible complications to systemic and intraperitoneal drug levels.

Patients were monitored for complications associated with intraperitoneal hyperthermia including: enteral complications (fistulas, anastomotic leaks), wound complications (pancreatitis, bile leaks, wound dehiscence), hematologic toxicities, prolonged ileus and line sepsis.