Papers by Jegadeesh Sundaram
Journal of Indian Association of Pediatric Surgeons, 2016
Autism, 2013
The health-related quality of life of school-aged children with high-functioning autism is poorly... more The health-related quality of life of school-aged children with high-functioning autism is poorly understood. The objectives of this study were to compare the health-related quality of life of children with high-functioning autism to that of typically developing peers and to compare child-self and parent-proxy reports of health-related quality of life of children. A cross-sectional study of children with high-functioning autism ( n = 30) and peers ( n = 31) was conducted using the Pediatric Quality of Life Inventory 4.0 Generic Core Scales. Children with high-functioning autism had significantly poorer health-related quality of life than peers whether reported by themselves ( p < .001) or their parents ( p < .001), although disagreement (intra-class coefficient = −.075) between children and parental scores suggested variance in points of view. This study specifically investigated health-related quality of life in children with high-functioning autism as compared to a sample of...
Nigerian Journal of Clinical Practice
Sri Ramachandra Journal of Health Sciences
Castleman disease (CD) is a rare lymphoproliferative disorder characterized by enlarged lymph nod... more Castleman disease (CD) is a rare lymphoproliferative disorder characterized by enlarged lymph nodes involving the neck, mediastinum, and retroperitoneum. Due to its varied presentations, it is often misdiagnosed or underdiagnosed. We present one such case which posed a great diagnostic challenge. An 18-year-old girl presented with fever on and off for 1 year. She was treated for COVID positivity during this time but had persistent evening rise of temperature even after 21 days of COVID negativity. Computed tomography chest done revealed a posterior mediastinal mass on the right side. Biopsy showed features of granulomatous inflammation. She was subsequently started on anti-tuberculous therapy. Repeat imaging showed no significant interval change in the mass and biopsy showed features of cavernous hemangioma. She underwent right posterolateral thoracotomy and excision of posterior mediastinal mass. Histopathology of the mass revealed it to be a hyaline variant of CD. CD is rare in ch...
A 55 year old male patient presented with a swelling with ulceroproliferative lesion over left th... more A 55 year old male patient presented with a swelling with ulceroproliferative lesion over left thigh with left inguinal lymphadenopathy for 8 months. Clinically it appeared to be squamous cell carci-noma. Fine needle aspiration cytology surprisingly revealed a malignant adnexal tumor which was confirmed by wedge biopsy. Metastatic work up done and the Patient was treated with wide local excision and left ilio-inguinal block dissection with post operative Radiother-apy. Post operative histopathology revealed an Eccrine hidradenocarcinoma. The case is presented for its rarity, as Eccrine carcinoma accounts for only 0.005 percent of all skin cancers. Keyword :Squamouscell carcinoma, Malignant adnexal tumor, Eccrine Hidrade-noma PATIENT DETAILS A 55 year old male patient presented with a swelling with ulceroproliferative lesion over the left thigh with left inguinal lymphadenopathy Clinically it was suspected to be squamous cell carcinoma with inguinal lymphnode metastasis. Fine needle ...
Surgical Case Reports, 2021
A 26-week-old extreme preterm boy presented with a right hemiscrotal abscess. An ultrasound of th... more A 26-week-old extreme preterm boy presented with a right hemiscrotal abscess. An ultrasound of the scrotum suggested right epididymo-orchitis. The abscess was drained and appropriate intravenous antibiotics were initiated. One month later, he was diagnosed with a right sided irreducible inguino-scrotal swelling, confirmed as bilateral inguinal hernia with herniating bowel loop on ultrasonography. With this diagnosis, he was planned to undergo a bilateral herniotomy. Intraoperatively, an inflamed and perforated appendix was found herniating into the right sac. The tip of the appendix was adherent to the scrotal wall, where the pus was extruding out. Appendicectomy and bilateral herniotomy was done successfully and histopathology revealed acute appendicitis. Baby recovered well postoperatively. Owing to the fragile nature of tissues in neonates, accession of planes was challenging. Amyand’s hernia presenting as a scrotal abscess is extremely rare in newborn infants, and less than 5 ca...
BMJ Case Reports, 2021
Gastric volvulus (GV) and wandering spleen (WS) associated with eventration of diaphragm share a ... more Gastric volvulus (GV) and wandering spleen (WS) associated with eventration of diaphragm share a common pathological cause of absence or laxity of intraperitoneal ligaments. We herein report a rare case of a 13-year-old child presenting with an acute GV, WS, diaphragmatic eventration and an ectopic ascended kidney managed with a laparoscopic approach.
BMJ Case Reports, 2021
Implantable venous access devices are routinely used, but they are not without complications. A 4... more Implantable venous access devices are routinely used, but they are not without complications. A 4-year-old male child with B cell acute lymphoblastic leukaemia was planned for chemotherapy. Chemo port was accessed through the right internal jugular vein. Check X-ray was done, which showed the correct placement of the catheter. Two months after chemo port insertion when the patient underwent chemotherapy, he developed a fever and he was started on intravenous antibiotics. On the next two admissions, the patient had a fever with chamber site oedema for which culture was done, which revealed Pseudomonas and Candida, which responded to antibiotic and antifungal therapies. In the successive admission, the patient had immediate local oedema on injecting chemotherapy. Exploration was done, which revealed chamber base perforation. It is an infrequent complication and has been reported in only three studies.
Congenital urethrocutaneous fistula is an extremely rare but easily manageable anomaly that can e... more Congenital urethrocutaneous fistula is an extremely rare but easily manageable anomaly that can either be present in an isolated fashion or in association with other abnormalities of the genitourinary tract like hypospadias or chordee or anorectal malformations. A case of isolated congenital urethrocutaneous fistula at the penoscrotal junction which was managed surgically by primary tubularisation of exposed urethral plate with tunica vaginalis reinforcement has been reported along with review of literature. Surgical principles will be similar to any hypospadias repair. Treatment of this rare condition is decided according to the site of the fistula, associated anomalies and condition of the distal urethra. A meticulous clinical examination will yield the diagnosis and to rule out other associated anomalies.
Journal of Indian Association of Pediatric Surgeons, 2021
Journal of minimal access surgery
To retrospectively analyse the results of laparoscopically-assisted anorectal pull-through (LAARP... more To retrospectively analyse the results of laparoscopically-assisted anorectal pull-through (LAARP) for high anorectal malformation (ARM) in male children in our institution. We analysed the hospital records of patients who had undergone LAARP from October 2010 to December 2015 in terms of age, operative time, length of hospital stay and post-operative complications. Of 17 cases, 13 (76%) were in 6-12 months age group, whereas rest of them were in 12-18 months age group. The recto-prostatic urethral fistula was encountered in 82% (n = 14) of patients and rectovesical type in two cases (12%). The mean operative time was 132 min with mean length of hospital stay being 4 days. Rectal mucosal prolapse was the most common complication noted. LAARP is a feasible approach to male children with high ARMs with less post-operative morbidity.
University Journal of Surgery and Surgical Specialities, 2017
A 55 year old male patient presented with a swelling with ulceroproliferative lesion over left th... more A 55 year old male patient presented with a swelling with ulceroproliferative lesion over left thigh with left inguinal lymphadenopathy for 8 months. Clinically it appeared to be squamous cell carcinoma. Fine needle aspiration cytology surprisingly revealed a malignant adnexal tumor which was confirmed by wedge biopsy. Metastatic work up done and the Patient was treated with wide local excision and left ilio-inguinal block dissection with post operative Radiotherapy. Post operative histopathology revealed an Eccrine hidradenocarcinoma. The case is presented for its rarity, as Eccrine carcinoma accounts for only 0.005 percent of all skin cancers.
Journal of Pediatric Neurosciences, 2017
Purpose: To analyze quality of life of children operated for congenital hydrocephalus and the con... more Purpose: To analyze quality of life of children operated for congenital hydrocephalus and the concern of parents in taking care of these children. Methods: Thirty patients who underwent ventriculo-peritoneal shunt were randomly selected with minimum gap of 1 year between surgery and study. Canadian validated questionnaire was used. Overall health score (OHS) and parental concern score (PCS) were correlated with gender, family type and number of surgeries. Results: Mean OHS was 159.43 which was summation of physical health (mean 45.76), social-emotional (mean 80.03) and cognitive health scores (mean 33.66). Mean OHS was 151.57 for males and 177.77 for females (p-value 0.233). Nuclear and joint families had mean OHS of 160.36 and 158.89 respectively (p-value 0.944). Those who underwent one surgery had mean OHS of 167.48 and PCS of 23.10 whereas mean OHS was 140.66 and PCS was 27.78 for those with multiple procedures. Mean PCS for males was 26.71 and for females was 19.33 (p-value 0.036 statistically significant). This was not statistically significant between nuclear (24.73) and joint families (24.26). Conclusions: Quality of life of survivors of hydrocephalus is reasonably good even in developing countries due to keen parental involvement irrespective of gender, family type and number of surgeries.
Journal of Pediatric Neurosciences, 2017
Purpose: To analyze quality of life of children operated for congenital hydrocephalus and the con... more Purpose: To analyze quality of life of children operated for congenital hydrocephalus and the concern of parents in taking care of these children. Methods: Thirty patients who underwent ventriculo-peritoneal shunt were randomly selected with minimum gap of 1 year between surgery and study. Canadian validated questionnaire was used. Overall health score (OHS) and parental concern score (PCS) were correlated with gender, family type and number of surgeries. Results: Mean OHS was 159.43 which was summation of physical health (mean 45.76), social-emotional (mean 80.03) and cognitive health scores (mean 33.66). Mean OHS was 151.57 for males and 177.77 for females (p-value 0.233). Nuclear and joint families had mean OHS of 160.36 and 158.89 respectively (p-value 0.944). Those who underwent one surgery had mean OHS of 167.48 and PCS of 23.10 whereas mean OHS was 140.66 and PCS was 27.78 for those with multiple procedures. Mean PCS for males was 26.71 and for females was 19.33 (p-value 0.036 statistically significant). This was not statistically significant between nuclear (24.73) and joint families (24.26). Conclusions: Quality of life of survivors of hydrocephalus is reasonably good even in developing countries due to keen parental involvement irrespective of gender, family type and number of surgeries.
Journal of pediatric surgery, 2016
Phlebectasia affecting the internal jugular vein is a rare cause of a benign neck swelling in chi... more Phlebectasia affecting the internal jugular vein is a rare cause of a benign neck swelling in children. They are mostly asymptomatic and therefore managed conservatively. Ligation of the vein and excision is usually avoided owing to the worry of raised intracranial pressure. We report a case of a large right internal jugular vein phlebectasia, causing dysphagia in a 7month old male child. Contrast enhanced computed tomography with 3-D reconstruction helped in pre-operative anatomical delineation, especially of the lower extent. It was excised through a cervico-thoracic approach with postoperative amelioration of symptoms. Contrary to expectation, the ectasia was not friable and was covered with a pseudocapsule of fibrofatty tissue, making excision easy.
Journal of Pain & Palliative Care Pharmacotherapy, 2015
The appropriate pain management in neonates and children is lacking. Factors that prevent the exe... more The appropriate pain management in neonates and children is lacking. Factors that prevent the execution of proper pain relief vary from center to center. We studied the factors responsible for it in a surgical unit. We conducted a survey at a tertiary-level institute among the resident doctors and nursing staff by means of an informal questionnaire analyzing their basic knowledge. The questions pertained mainly to pain assessment, analgesic usage, role of opioids, and formal training, and the responses so obtained were analyzed under these four headings. Seventy-three percent (22/30) of the residents and 74% (26/35) of the nursing staff knew about pain assessment scoring system in pediatric patients. However, assessment of pain in emergency cases was always done by only 6.6% of the residents. Effect of analgesia on severity of pain was never recorded by 33% (10/30) of the residents. Eighty-six percent (26/30) of the residents and 91% (32/35) of the nursing staff had adequate knowledge about analgesic dosage and interval for routine use. Ten of the 30 (33%) residents believed that analgesic administration in an acute abdomen, before definitive diagnosis, will always mask the symptoms. During a minor procedure, 56% (17/30) of the residents always used analgesia. Only 3.3% (1/30) of residents and 2.8% (1/35) of the nursing staff had received a structured training for pain management. Although, 93% (28/30) of the residents claimed to know about the safety of use of opioids, only 46% (14/30) used them routinely as analgesics. Pain management in surgical neonates and children is often ignored. Lack of formal training, inadequate knowledge, and standard protocols are the barriers in our setup, which may in turn be due to overwhelming attention given to the surgical condition.
Journal of the Korean Association of Pediatric Surgeons, 2015
Although Meckel's diverticulum is the most common vitellointestinal duct (VID) anomaly, patent vi... more Although Meckel's diverticulum is the most common vitellointestinal duct (VID) anomaly, patent vitellointestinal duct (PVID) is the most common symptomatic embryological defect. Patient may present with the anomaly itself or due to complications like intestinal obstruction secondary to volvulus, intussusception or adhesions. Prolapse occurs if the diverticulum is wide-mouthed enough to allow bowel to come out or due to increased intra-abdominal pressure like cry or cough. Bowel prolapse through PVID is rare and double prolapse of proximal as well as distal loop in a newborn is extremely rare. Omphalocele with prolapsing bowel through PVID as found in our index case is even rarer in literature. The pediatric surgeon should be familiar with these varied manifestations in the newborn because the prolapsed bowel can progress to gangrene and complications if not identified and operated upon early.
Fetal and pediatric pathology, Jan 24, 2015
Isolated ileal heterotopic pancreatic tissue as a lead point of intussusception in children is ex... more Isolated ileal heterotopic pancreatic tissue as a lead point of intussusception in children is extremely rare. We report a 6-month-old female with ileoileal intussusception and a 4-year-old female with ileocolic intussusception both associated with gangrene. A review of literature suggests a higher prevalence of gangrene probably secondary to the pancreatic exocrine tissue.
BMJ Case Reports, 2021
An 8-month-old male child presented with the complaint of two separate urinary streams from the p... more An 8-month-old male child presented with the complaint of two separate urinary streams from the penis. The child had no complaints of incontinence or recurrent UTI (urinary tract infection). Initial diagnosis of urethrocutaneous fistula was made and proceeded to micturating cystourethrography (MCU) and found to be having a urethral duplication. The duplicated urethra was excised and accessory urethra closed. Postoperatively, the child was followed up for 1 year and had no complaints of recurrence or incontinence. Through this case report, we learn about different classification systems and types of urethral duplication and their associated anomalies, and mode of management, which is mainly surgical. Further, management should be individualised to each patient based on their complaints and intraoperative findings.
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Papers by Jegadeesh Sundaram