Extensive Surgical Emphysema in a Child after Primary Closure of Tracheocutaneous Fistula.

A 4-year-old child had closure of tracheocutaneous fistula under general anaesthesia. He developed extensive surgical emphysema over the face, chest, and upper abdomen immediately in the recovery room. We gave him oxygen supplementation, removed surgical stitch, and inserted a 4 mm tracheostomy tube to secure airway. Chest X-ray ruled out pneumothorax or pneumomediastinum. After a week, a tight bandage was applied which approximated the tissue and helped in the closure of stoma; no suture was applied. The patient was discharged home on the fourth postoperative day. The patient needs close observation in the postoperative period with likely complication in mind. Recognizing early signs and symptoms of respiratory distress with quick intervention is lifesaving during the complication of tracheocutaneous fistula surgery. In absence of pneumothorax or pneumomediastinum, extensive surgical emphysema occurring during primary closure of tracheocutaneous fistula can be treated without inserting any drainage tube.

Statistical deferred weighted [Formula: see text]-summability and its applications to associated approximation theorems.

The notion of statistical weighted [Formula: see text]-summability was introduced very recently (Kadak et al. in Appl. Math. Comput. 302:80-96, 2017). In the paper, we study the concept of statistical deferred weighted [Formula: see text]-summability and deferred weighted [Formula: see text]-statistical convergence and then establish an inclusion relation between them. In particular, based on our proposed methods, we establish a new Korovkin-type approximation theorem for the functions of two variables defined on a Banach space [Formula: see text] and then present an illustrative example to show that our result is a non-trivial extension of some traditional and statistical versions of Korovkin-type approximation theorems which were demonstrated in the earlier works. Furthermore, we establish another result for the rate of deferred weighted [Formula: see text]-statistical convergence for the same set of functions via modulus of continuity. Finally, we consider a number of interesting special cases and illustrative examples in support of our findings of this paper.

Fetus in fetu in a neonate: report of a case.

Fetus in fetu (FIF) is a rare condition in which a malformed fetus resides in the body of its host. The presence of a well-formed vertebral column secures the diagnosis of FIF and differentiates this entity from a teratoma. Although more than 100 cases of FIF have been reported in the literature, the presence of a well-formed vertebral column is not documented in many cases. We herein report the case of a 19-day-old female who presented with a lump in the abdomen. Plain radiograph of the abdomen showed the presence of a well-formed vertebral column with long bones, and the results were confirmed with ultrasonogram and CT scans. Therefore, a preoperative diagnosis of FIF was made, and the mass was successfully excised. Upon opening the sac of the mass, a malformed anencephalic fetus was found.

Effect of mitomycin C-aided trabeculectomy on conjunctival goblet cell density.

INTRODUCTION: Mitomycin C is gaining widespread popularity as an adjunctive with trabeculectomy, as it significantly increases the success rate of the procedure. But it is associated with serious sight-threatening complications. MATERIALS AND METHODS: Twenty eyes planned for trabeculectomy from the glaucoma clinic were enrolled for the study after obtaining an informed consent. The baseline impression cytology was taken. Ten eyes underwent trabeculectomy with mitomycin C (Group A) and the rest underwent trabeculectomy without any antimetabolites (Group B). Impression cytology samples were taken on months 1, 3, 6, 9 and 12. RESULTS: In Group A, the difference between goblet cell density preoperatively and 12 month postoperatively was statistically significant (p less than 0.0001). In Group B, the difference was not statistically significant. (p = 0.27). CONCLUSION: Mitomycin C, though used to augment the success rate of trabeculectomy, has deleterious effect on the conjunctival goblet cell population as is evident from the conjunctival impression cytology.

Diazinon-induced endocrine disruption in bluegill sunfish, Lepomis macrochirus.

An attempt to reveal endocrine disruption in bluegill fish (Lepomis macrochirus) upon exposure to diazinon was made. Fish blood serum was collected and estradiol levels were measured following times of exposure to 60 microg/L of diazinon. Samples were drawn from the fish during each exposure period of 24, 48, 72 and 96 h and 1 and 2 weeks. The sample estradiol levels were compared to those of a control. Ovarian tissue was examined. As necrosis increased within the ovaries, estradiol blood serum levels altered from those of the control sample (101 pg/mL). Histopathology within the follicles became apparent as exposure time to diazinon increased. The changes in the ovarian follicles can be correlated to the estradiol levels in the blood. Mean estradiol level for the control group was 101.53 pg/mL. Estradiol levels from the trial groups varied from those of the control (24 h, undetectable; 48 h, 74.04 pg/mL; 72 h, 57.16 pg/mL; 96 h; 39.15 pg/mL; 1 week, 66.50 pg/mL; 2 weeks, undetectable). It seems that the initial shock experienced by the fish after 24 h of exposure resulted in an undetectable level of estradiol. The level of estradiol initially ascended, but it began to decline and after 1 week of exposure it ascended a little and became undetectable after 2 weeks. Nevertheless, throughout the exposure period the level of estradiol was lower than normal. Severe damage to the mature oocytes may be the reason for undetectable levels of estradiol after 2 weeks of exposure.

Sublethal effects of diazinon on the structure of the testis of bluegill, Lepomis macrochirus: a microscopic analysis.

A histopathological analysis of the testis exposed to diazinon, an organophosphorus pesticide was conducted. The testis from the control fish exhibited a normal histological structure with a round, oval or somewhat rectangular shaped with closely associated seminiferous tubules. The seminiferous tubules were surrounded by a layer of connective tissue with myoid cells, Leydig cells, blood vessels, lymph vessels and nerves. Upon exposure for 24 h, the overall structure of the testis looked disrupted and more often the sperm cells appeared to be somewhat larger, but spermatid were smaller than that of the control group. The 48 h exposure caused more dense and closely associated seminiferous tubules. The 72 h exposure induced dilation of the seminiferous tubules and their lumen. Ninety-six hours exposure induced more loose and disrupted structures. In this group (96 h), there was a significant reduction in both lumen and seminiferous tubule size in comparison with the control, 24, 48, and 72 h groups. After 2 weeks of exposure hardly any lumen was seen, which imparted more dense and compacted structures. The biometric analysis gave a highly significant increase in the diameter of the seminiferous lumen. After 48 h of exposure a significant reduction was seen in diameter in comparison with that of the control group. Seventy-two hour exposure indicated an increase in diameter, whereas 96 h exhibited another decrease. One week caused the diameter to increase whereas 2 weeks of exposure caused them to decrease again. The increase in diameter of the seminiferous tabule may be caused by weakening of the surrounding connective tissue and myoid cells, due to exposure to diazinon. The change in the diameters of the seminiferous tabules was very irregular. No apparent co-relation was found between the size of the fish, body weight and weight of the testis after they have been subjected to different exposure periods. There was significant change in the germ cells' diameters. As the germ cells are the essential first step in the process of spermatogenesis, their size reduction may hinder the production of viable spermatozoa, endangering the population dynamics. In order to find out the pathways of this pesticide effects, we propose to study the histopathology of pituitary gland a vital organ of the reproductive axis.

Manometric evaluation of postoperative patients of esophageal atresia and tracheo-esophageal fistula.

Symptoms related to esophageal dysmotility are common following successful repair of esophageal atresia (EA) and tracheo-esophageal fistula (TEF). Esophageal manometry was performed in 27 survivors of EA/TEF at a mean age of 30.5 +/- 30.3 months and in 25 age-matched controls (mean age 36.8 +/- 22.6 months). The patients were also evaluated clinically to grade them into 3 result-oriented groups "Excellent", "Good" and "Fair", depending on pre-existing criteria evaluating the ability and ease of swallowing. Gastroesophageal reflux (GER) was evaluated with the help of a radionuclide scan. The mean esophageal and peak esophageal pressures and therefore also the lower esophageal sphincter (LES) pressure were lower in the patients (12.4 +/- 5.5, 34.9 +/- 20.4 and 12.2 +/- 6.8 mm Hg, respectively) compared to the controls (21.1 +/- 6.9, 62.3 +/- 19.3 and 16.8 +/- 4.3 mm Hg, respectively). The mean body pressures were highest with "Excellent" results and lowest with "Fair" results and the LES pressures followed a similar trend. Likewise, in the patients with GER, LES pressure was 12.0 +/- 7.1, 12.3 +/- 3.7, 11.0 +/- 5.7 and 6.9 +/- 5.6 mm Hg with nil, mild, moderate and severe GER, respectively. The pressure and contractility profile of the esophagus was abnormal in the majority of patients, even in the absence of symptoms.

Cineradiographic evaluation of postoperative patients with esophageal atresia and tracheoesophageal fistula.

Esophageal dysmotility is a common occurrence after successful repair of esophageal atresia (EA) and tracheoesophageal fistula (TEF). The etiology of this motility disorder, however, remains controversial. Cine-barium esophagograms were performed in 25 survivors of EA/TEF at a mean age of 30.5 months. A clinical evaluation was done at the same time and the results were classified as "excellent", "good", and "fair". The study revealed that 88% of patients had dysmotile esophageal segments and segmental contractions. Normal peristalsis was seen in only 16% of patients and 64% showed to-and-fro movements. The bolus transit time was delayed in 60%. The clinical status of these patients correlated well with the cine-radiographic findings. Thus, abnormal motility of the esophagus, which may be inherent, exists in postoperative survivors of EA/TEF and may be responsible for the clinical status of these patients.

A histopathological study of esophageal atresia and tracheoesophageal fistula.

BACKGROUND/PURPOSE: Histopathologic examination of the esophagus has not been reported often in esophageal atresia (EA) and tracheoesophageal fistula (TEF). Abnormal esophageal motility has been reported after successful repair of EA and TEF, although the exact etiology of this motility disorder remains unclear. Histological evaluation of the fistulous portion of the esophagus has been performed to document any abnormality that may be responsible for the abnormal motility. METHODS: Histopathological study of fistulous segment of esophageal atresia and distal TEF was conducted on 65 patients, which included autopsy material from 3 patients in whom the entire esophagus was examined by serial section. Special stains were administered to each specimen to look for tracheobronchial remnants and the arrangement of muscle fibers. Clinical evaluation was performed in 27 patients who were available for review 6 months to 9 years after successful surgical treatment. These patients were categorized into 3 groups according to their clinical status. RESULTS: These findings showed that the majority of these patients have tracheobronchial remnants in the esophagus in the form of abnormal mucous glands and ducts, abnormal mucin secretion, presence of cartilage, and a disorganized muscle coat. CONCLUSIONS: The presence of abnormal mucous glands and abnormal mucin secretion has not been highlighted before. Although tracheobronchial remnants and a disorganized muscle coat are common findings in the fistulous portion of the esophagus, these may not reflect the structure of the remaining esophagus.

Congenital hepatoportal arteriovenous fistula: report of a case.

Fistulae between the hepatic artery and portal vein, known as hepatoportal arteriovenous fistula (HPAVF), most commonly occur secondary to trauma or malignancy. Congenital HPAVF is an extremely rare anomaly and only 11 pediatric cases have been documented to date HPAVF causes portal hypertension with the reversal of flow in the portal circulation, leading to hyperemia and congestion of the bowel, causing severe ascites, gastrointestinal bleeding, anemia, and malabsorption. The diagnosis is first made by Doppler sonography, then confirmed by angiography. HPAVF is most effectively treated by performing either ligation of the hepatic artery or percutaneous transcatheter embolization. We describe herein the case of an 8-month-old boy diagnosed to have congenital HPAVF by duplex Doppler sonography and confirmed by digital subtraction angiography, who was successfully managed by percutaneous transcatheter embolization of the feeding right hepatic artery. A review of the previously reported 11 cases of infants with this unusual anomaly, examining presentation, management, and outcome, is also presented.

Effect of malathion, an organophosphorus pesticide, on the serum proteins of Heteropneustes fossilis (BLOCH).

The use of pesticides to control pests and to increase food production is a normal process in this modern age. The objective of this study was to determine changes in different serum protein fractions caused by the action of malathion, a commonly used pesticide. We used Indian catfish, Heteropneustes fossilis. The fish were exposed to a sublethal dose of 4 mg/L of malathion for 24, 48, 72, and 96 hr. The LC50 value at 96 hr was found to be 11.676 mg/L. The results showed the formation of three low and four high mobility fractions and the disappearance of some protein fractions at different periods of exposure. The appearance of fractions A, B, and C (low-mobility proteins) may be due to altered immune responses caused by cellular damage. The appearance of new high-mobility fractions (D, E, F, and G) is possibly due to the breakdown of red blood cells and other cellular components. The findings of this study indicate that the high concentration of malathion (4 mg/L) induced more alterations in serum proteins compared with the low concentration (1.2 mg/L) used in our previous study.

The inhibition of brain acetylcholinesterase activity of juvenile largemouth bass Micropterus salmoides by sublethal concentrations of diazinon.

An effect of diazinon on brain acetylcholinesterase (AChE) activity of juvenile largemouth bass Micropterus salmoides was observed. The exposure concentration started from 1/10 of the 24-h LC50 value, 90 micrograms/liter. The exposure duration was 24 h. Statistically significant and dose-dependent reductions in the mean AChE activities we seen at 90, 180, 270, 360, and 450 micrograms/liter. The results show that juvenile brain acetylcholinesterase activities were significantly inhibited by sublethal doses of diazinon. Inhibition of brain AChE will definitely cause physiological and behavioral modifications that reduce survival ability of the animals at an early stage of growth.

Effect of sublethal levels of malathion on the gills of Heteropneustes fossilis: scanning electron microscopic study.

Scanning electron microscopic studies of the gills of catfish, Heteropneustes fossilis, exposed to sublethal malathion (4 mg/L and 6 mg/L) revealed that 24-hour exposure to 4 mg/L had a mild effect. However, severe damage was found after 48- and 72-hour exposures. After a 24-hour exposure to a 6 mg/L concentration, more severe damage ensued. The microridged epithelial cells of the gill arch became perforated and the central portion of the filament appeared elevated. Numerous mucous gland openings also became visible. After 48- and 72-hour exposures, the damage and structural changes were more pronounced when compared with the 4 mg/L exposure. Enlarged mucous gland openings were found on the gill arch. The lamellar surface had many crevices, elevations and depressions. Broken microridges in the gill arch surface were visible at a 72-hour exposure. At 96 hours of exposure, structural recovery occurred to some extent in both the 4- and 6-mg/L exposures. Corrugation and dissociated epithelium along with some interlamellar bridges were evident after 72 hours of exposure to both concentrations. Such deleterious effects cause reduction in available water supply as well as available respiratory area that may result in decreased oxygen uptake. Consequently, fish may fail to get sufficient oxygen and asphyxiate.

Management of hydrocephalus.

The present study is an analysis of 747 patients with hydrocephalus, treated and followed up in the Hydrocephalus Clinic run by the department of Paediatric Surgery at the All India Institute of Medical Sciences, New Delhi. The distribution of patients was: congenital-46%, post-meningomyelocoele excision-28%, post-meningitic-21% and others-5% (including post haemorrhagic and post encephalocoele excision hydrocephalus. The average age was 7 months in the shunted group and 10 months in the medical group with overall male to female ratio of 2.3:1. The data were analysed to study the effect of treatment on ventriculomegaly and mental development with special reference to the type of treatment (shunt versus medical) and age at starting treatment. The probability of shunt failure was also studied. A comparison of ventricular size in US/CAT scans between the time of starting treatment and last follow-up revealed improvement in ventriculomegaly in 60% of the shunted patients but only 30% of the medically treated patients. A significant difference was particularly noted in patients with severe hydrocephalus, 72% and 22%, respectively. Comparison of the mean Mental Performance Quotient (MPQ) scores in the shunted & medically treated patients also revealed significantly better MPQ scores in the shunted group (p = < 0.001). Probability of shunt survival, as depicted by the Kaplan-Meier survival curve, revealed that there is a high rate of shunt failure in the first 12 months, followed by a dramatic slowing down. Our observations support the contention that CSF shunt surgery offers better outcome than medical management even when ventriculomegaly is severe at the time of presentation.