TPPS News Dec 2006

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Official newsletter of Tamilnadu & Pondicherry chapter of IAPS

Number 2

Executive committee (2006) Chairman Prof. H. R Shanbhogue Chairman - Elect Prof. T. V. Sathappan Immediate-past Chairman Prof. H. Chatterjee Honorary Secretary cum Treasurer Prof. V. Raveenthiran Executive members Dr. S. R. Regunandan (North Zone) Dr V. V. Kannan (South Zone) Prof. R. Mohan (East Zone) Prof. A. Pavai (West Zone) Dr. S. Kumaravel (Pondicherry Zone) Editor of TPPS News Prof. V. Raveenthiran

Address for correspondence Prof. V. Raveenthiran Honorary Secretary & Treasurer, TPPS Editor, TPPS News 7. Medical Faculty Quarters Annamalai Nagar 608002 Chidambaram Tamilnadu, India Email: [email protected] Telephone: +91-04144-239568 Mobile Phone: 09443310182

December 2006

Volume 1

Message of TPPS Chairman-elect Dear Colleagues, I express my sincere gratitude to all my teachers and colleagues for the unanimous selection as Chairmanelect. It gives me great pleasure to speak to you through this column. This is made possible by our proactive secretary Prof. Raveenthiran. Kudos to him! We are in the midst of critical period of renaissance. I think it is the time that we should make an honest introspection on the status of our specialty and the benefits and the recognition available to the pediatric surgeons and pediatric surgical patients with complicated malformations. Our forefathers have sown the seed and it is we, the younger generation, should re-orient to the needs with practical reality and make efforts for the accelerated growth of the specialty and subspecialty. Age-related specialties would have limited recognition and few takers in the ensuing years! Present day population is more “organ specialist” conscious. The proposal submitted by Prof. Raveenthiran and Prof Yogesh Sarin needs thorough debate and an acceptable decision. If united, we can achieve everything! Wish you a very happy New Year!! With regards Yours sincerely Dr. T. V. Sathappan, Chairman-elect, TPPS

M.S., M.Ch. FACS.

For private circulation only; Not for sale

TPPS News Dec 2006

Editorial The year 1966-67 is an important milestone in the history of Indian pediatric surgery. It is the year when the University of Madras started the first formal M.Ch training program in pediatric surgery. The first M.Ch program of India was started at Institute of Child Health by Prof. M.S. Ramakrishnan. Within a couple of months Prof. T. Dorairajan started the country’s second M.Ch program at Madurai Medical College. It is to be noted that at the same time our American counterpart were struggling to get recognition for pediatric surgical residency program in their country. The American Board and American College of surgeons did not recognize pediatric surgery until 1972. Every member of TPPS shall be proud, as our state had been the leader for the rest of India and perhaps to the world. This year (2007) marks the 40th Anniversary year of starting M.Ch program in India. I am happy to be the secretary of TPPS during this important year and on behalf of TPPS I salute Prof MSR and Prof TDR for their unique achievements. At the same time I am pained that our glory has largely remained unsung. I call for some knowledgeable members to write the history of pediatric surgery in India and particularly Tamilnadu and Pondicherry. I am willing to co-ordinate the project. Members possessing historical documents may kindly reposit them with me to aid this venture. Although the past is glorious, the future appears meek to many younger generation pediatric surgeons. This indicates that the 40-year-old model of surgical training requires revision to suit the need of the day. In the present era of internet, the public is more knowledgeable and they decide what they want! Therefore, change is inevitable. Change is the essence of life and without it things will perish. Hence, I seriously solicit active, unbiased debate on the alternate models of training in pediatric surgery. Tamilnadu (TPPS) being the forerunner of pediatric surgical training in India is the right body to initiate the debate on training reforms too. The year 2006 marks another milestone in the history of IAPS. Our specialty can be made more visible to general public only when we mingle with them by serving the downtrodden people. With this aim Community Pediatric Surgery (COPS) section has been created in IAPS. Among the signatories of the request, I am proud that a majority are from TPPS. I cordially invite every one of you to experience and support the new dimension of IAPS. Wish you a very happy New Year

V. Raveenthiran

Editor, TPPS News

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Message from IAPS Secretary General Greetings from IAPS Secretariat. I repeat what I had mention during the General Body meeting of IAPS in Goa. “The Tamilnadu and Pondicherry chapter of IAPS is the most vibrant and dynamic chapter of IAPS and if we had an award for the best regional chapter, TPPS would have bagged it year after year.” Unquote. The region has produced stalwarts like MSR, TDR and Ravikumar among others who gave a new direction to the super specialty. TPPS has managed to bring out its Newsletter, a feat unparalleled by any other regional chapter; thanks to its young and energetic Secretary Prof. V. Raveenthiran. TPPS holds its 2-day Annual Conference cum Workshop that has been praised by one and all. TPPS is the only regional chapter that paid part of the registration subscription for the Annual conference as its dues to the parent body IAPS. TPPS has raised and maintained finances that may make the parent body IAPS go envious. I am impressed that a city chapter - Chennai Chapter - affiliated to TPPS not only holds monthly meetings, but also its website. I could only wish that the other regional chapters could learn a lesson or two from TPPS. I close with best wishes to the chapter. Regards Prof. Yogesh Kumar Sarin M.S., M.Ch. Secretary General, IAPS

Our Chairman, Prof H.R. Shanbhogue extends his warm New Year greetings to all the members of TPPS.

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SUPERANNUATION Prof K. Seeniraj (Professor and Head) and Dr G. Ilango (Associate Professor) of the Department of Pediatric surgery at Institute of Child Health and Hospital for Children of Chennai were superannuated in December 2006. TPPS wishes both these eminent Pediatric surgeons a happy, prosperous and healthy retired life. Prof K. Seeniraj

Dr. G. Ilango

Dr. Abul Hassan of TPPS (Left extreme) was instrumental in starting a hospice care center at Erode for terminally ill cancer patients. This charity center was inaugurated on 18th December 2006 by His Excellency Dr A.P.J. Abdul Kalam, the President of India. Also seen are Drs Balasubramanian and Jeevanandam (IMA officials). TPPS is proud of Dr Abul Hassan.

At the Quiz competition held at Goa during the 32nd Annual Conference of IAPS the team of Dr. Zaffer Khanday (TPPS) won the first prize. Seen in this picture are (left to right) Raveenthiran* (TPPS), Gowri Shankar*, Yogesh Sarin, Zaffer Khanday, Bala Saheb Santhosh, Mrs. Ramesh$ and Ramesh*. (*Quiz masters; $ scorer). TPPS congratulates Dr. Zaffer Khanday.

Obituary TPPS records with great pain the sudden demise of its eminent member - Prof. V. Thiagarajan. Prof. Thiagarajan is fondly called as “Annachi” (Big brother) by his friends and colleagues. He was qualified M.Ch in 1979 from Madurai Medical College. He was trained by the renowned Pediatric surgeon Prof T. Dorairajan. He steadily ascended in the career ladder and reached the prestigious position of Professor and Head of Pediatric Surgery at Stanley Medical College, Chennai. He was a perfect gentleman. He was good at heart and never spoke ill about others. He always maintained simplicity in his life. He held several important posts such as Chairman of Chennai City Chapter of Pediatric surgeons (CCPS). He died on 12th December 2006 following a brief illness resembling septicemia and hyperpyrexia. He is survived by his wife, a son and a daughter. TPPS shares the grief of his friends and relatives. May his soul rest in peace!

TPPS News Dec 2006

Laurels Dr. V. Sripathi has become the chairman - elect of Pediatric Urology section of IAPS. Dr. S. Namasivayam has been elected to the post of executive committee member of pediatric Urology section of IAPS. Dr. V. Raveenthiran is appointed as convener of Community Pediatric Surgery (COPS) section of IAPS

Report on the 32nd annual conference of IAPS at Goa The annual conference of IAPS was held at Hotel Cidade of Goa between 28th September and 1st October of 2006. About 150 scientific papers were presented in the conference of which 18 were presented by members of our chapter. Abstracts of all these papers have been published in the September issue of JIAPS. The conference venue was truly picturesque on the shore of Arabian sea. The present secretary general of IAPS Prof Yogesh Kumar Sarin introduced several reforms in the program. Meet the professor, problem solving and postgraduate quiz were some of the novel additions to routine paper presentations. All posters, in addition to being displayed, were allowed to be presented at the podium as “e-posters”. All scientific programs were ended with lunch on all days and the evenings were reserved for business meetings and sight seeing. At the general body meeting newly elected office bearers took charge of their office. Prof K. R. Srimurthy adorned Prof B. Mukhopadhyay with the IAPS president medallion. Prof Anirudh Shah has taken over as president - elect. IAPS made a milestone in the history by forming many subchapters and sections. The sections of Pediatric Urology, Pediatric surgical Research and PESI held their executive meetings during the conference. Prof Narendra Kumar proposed the formation of Pediatric Thoracic Chapter, Dr Shusmitha Bhatnagar proposed Pediatric surgical Oncology Chapter and Prof Raveenthiran proposed Community Pediatric Surgery Section. All the proposals were unanimously approved by the general body which appointed the Proposers as conveners of the respective subchapters. Although unanimously approved, formation of so many chapters left an undeniable concern in the minds of many whether such subchapters are going to weaken

4 or strengthen the IAPS. Several members expressed anxiety that it may lead to fragmen tation of IAPS. It remains to be seen if this worry is justified or unwarranted. This would depend upon the effective functioning of various subchapters in the forthcoming years. The venue of 2007 and 2008 annual conference were selected as Jaipur and Guwahati respectively. The new constitution submitted by the secretary was not implemented for technical reasons. It was sent to a review committee for fine tuning. The team of Dr Dinesh Kittur deserves congratula tions for successful organization.

Report on the 20th congress of Asian Association of Pediatric Surgeons at New Delhi This mega event spanned 11th to 17th of November. It began with two-day live operative demonstration of anorectal malformations by Prof Alberto Pena. Nearly 438 papers and posters were presented in the ensuing 3 days; of which 17 were from our chapter. The last two days were devoted for pediatric Urology and Intersex workshop. Several renowned surgeons such as Prem Puri, John Hutson, Arnold Coran, Warren Snodgrass, Bracka, Pippi Salie and Hari Asopa demonstrated various operations. Dr V. Sripathi of TPPS was on of the panelists in the discussion on Vesicoureteric Reflux and Urinary tract infection. During the conference the executive committee of World Federation of Associations of Pediatric Surgeons (WOFAPS) met at the conference venue. Prof DK Gupta of New Delhi assumed the office of the President of Asian Association of Pediatric surgeons. Several VIPs including the Health Minister of India participated in the evening functions. A book on pediatric surgical oncology, written by Indian authors, was released at the inaugural function. Live Operative workshop was telecasted at the JL Auditorium of AIIMS and conference was held at Hotel Taj Palace. Both the venues were elegant and comfortable. It was truly a rare opportunity to meet many who’s who in pediatric surgery at the venue and interact with them. Absolutely the congress was a grand success. It is not an exaggeration to say that the congress has upheld the pride of India in the world arena. For this the organizers surely deserve kudos. The only demerit was the high cost of delegation which was prohibitive to many Indian surgeons; but the educa tive value well compensated the financial burden.

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Management of newborns with posterior urethral valves Dr. V. Sripathi 1 MS, M.Ch, FRACS Dr. N. Prahlad 2 MBBS, DCH, DNB Dr. M. Vijayakumar 2 MD, DCH, DM 1 Consultant Pediatric Urologist, Chennai. 2 Consultant Pediatric Nephrologists, Chennai

Introduction There is a lot of controversy regarding the management of newborn males with posterior urethral valves. This article is written to clarify the situation to some extent and to provide an easy algorithm for management of these children even in small peripheral centers. What is the ideal management in antenatally diagnosed valves? In this situation as soon as the child is born an ultrasound is done to confirm the diagnosis. Catheterization is not attempted to avoid intro duction of sepsis. Under GA the bladder is punctured, urine sent for culture and contrast injected. A micturating cystourethrogram (MCU) is done by compressing the bladder to confirm the diagnosis of posterior urethral valves and under the same anesthetic primary fulguration is attempted. One of the cardinal principles behind newborn valve fulguration is that the scope should not damage the urethra at all. Urethral dilatation and attempts to introduce a resecto scope should be avoided. A 6 – 7.5 scope is avail able from Wolf which can be easily used in children as small as 2kgs in weight without the need for any urethral dilatation. In this scope the valves need to be fulgurated by using a 3 Fr bugbee electrode. Technically the procedure is very demanding. The scope is hard to position and retain in the posterior urethra. The bugbee is used with a low cutting current to make a hole in the membrane in the 12 o’clock position and this hole is slowly enlarged. If by compressing the bladder a good stream can be demonstrated the procedure is stopped. A repeat MCU and refulguration can always be done at three months of age using a resectoscope. Overzealous attempts to fulgurate all remnants of the valves should be avoided at all costs. We have seen several cases of severe posterior urethral strictures from the use of large instruments and from overzealous cauterization.

When doing urethral instrumentation in newborns it is very useful to view the urethra on a TV screen via a camera. If the surgeon does not have access to a newborn scope an MCU is done to confirm the diagnosis and vesicostomy carried out. When a vesicostomy is done, it is customary to identify the urachal insertion and bring this segment of the bladder dome to the skin level. Vesicostomies in thick valve bladders have a tendency to stenose and hence the skin level opening should not be very small. Is an MCU always necessary before valve fulguration? We have seen many older children in whom valves have been fulgurated without a preoperative MCU. Post fulguration MCU often shows a normal urethra. In Posterior urethral valve disease complete normality of the posterior urethra is not obtained immediately. In this context it becomes very difficult to counsel the parents of such a child regarding long term follow up and management. Remember your patient today may migrate elsewhere tomorrow and the other surgeon must have some baseline data to plan treatment. The only convincing evidence of a posterior urethral valve disease is a pre fulguration MCU. Therefore this study is mandatory. What should be the algorithm following a vesicostomy? The vesicostomy can be closed and valves fulgurated at the same sitting at about three months of age when a resectoscope can be easily negotiated into the urethra. It is not advisable to fulgurate the valves and keep the vesicostomy open. A dry urethra can stricture easily. We have seen one child in whom the urethra closed completely following fulguration in a dry urethra.

TPPS News Dec 2006

When should a ureterostomy be done in a newborn with PUV? If the child presents with metabolic acidosis with gross sepsis and tortuous dilated ureters then a ureterostomy offers the quickest way to recovery. We prefer a Sober (or ring) ureterostomy as it enables good drainage and also keeps some urine going into the bladder. We have seen a child with bladder synechiae due to infected urine following bilateral loop cutaneous ureterostomies. Another situation where a ureterostomy is warranted is a child on bladder drainage who does not seem to improve metabolically or whose upper tracts fail to decompress.

6 In a child with valves and reflux is primary fulguration an option or should ureterostomies be done? Primary fulguration is not contradindicated in the presence of reflux. It should be remember ed that bladder function in children with valves will keep changing and reflux very often dis appears when the bladder increases in size and becomes more compliant. (Fig 2]

Is there an optimal age for closure of a ureterostomy? It is easy to create a ureterostomy but very hard to decide when to close it. If the child is thriving well, infection free with normal serum chemistry and the bladder is of reasonable size then ureterostomy closure is safe. In the context of bilateral ureterostomies one is closed followed by the other. If the child deteriorates, closure of the second side can be postponed. In an ideal setting a urodynamic study and demonstration of normal pressures can be helpful before ureteros tomy closure. It is safer to keep the ureterostomy open then to hastily close it only to see the child deteriorate. We have enclosed a urodynamic study of one child with a non complaint bladder in whom the ureterostomy could not be closed and who ultimately required an augment at 3 years of age. (Fig 1)

Figure 2: Compression cystogram in a newborn (A) showing PUV with bilateral reflux. Following fulguration MCU at 3 months of age (B) showed adequate fulguration of valves with persistent left reflux. At 14 months (C)bladder was of good size and no reflux

Should urodynamics necessarily be done in posterior urethral valves in the newborn period? Though a lot has been written about the use of urodynamics in a newborn with valves, practi cally it does not change management very much. It is more in the nature of a baseline study. In a center where it is readily available then it may be an option. Can one prognosticate long term outcome based on sepsis, serum chemistry reflux status etc? Figure 1: Urodynamic study in a 2 year old with PUV prior to closure of left ureterostomy showing severe non compliance of bladder. This child underwent an augmentation cystoplasty with Mitrofanoff at 3 years of age

It appears that renal status at birth and bladder behavior in the long term are the most important factors that determine whether a newborn with PUV will do well in the long term. However in a child with severe sepsis, raised serum chemistry, poorly functioning kidneys and gross reflux it is good to give a guarded prognosis and involve the pediatric nephro logists early on.

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What should be done when newborn with PUV presents with renal failure and type 4 renal tubular acidosis? Managing these newborns is a team effort needing close co-operation between the pediatrician, pediatric nephrologist and pediatric urologist. Continuous bladder drainage should be instituted to reduce back pressure effects on the kidney. Intravenous fluids containing Sodium bicarbonate should be commenced. The volume of fluid and content of sodium bicarbonate depends on age of child, serum level and urine output. Urine output, Serum Creatinine and electrolytes should be monitored on a daily basis. As a general rule 5% Dextrose with 3-5 meq/kg of sodium bicarbonate should be adequate. Serum Calcium needs to be monitored when the baby is on sodium bicarbonate. Hyperkalemia usually settles following iv fluids, sodabicarb and catheterization. If Serum Potassium is >6 mEq/l the neonate is commenced on potassium binding resin as a retention enema given once in six hours.

What drugs should be continued on discharge? If the child has low serum bicarbonate he should be commenced on oral sodium bicarbo nate at 3 mg/kg/day in three divided doses. If the MCU shows reflux, uroprophylaxis is mandatory (e.g Cephalexin 10mg/kg/day as a single daily dose). Oral iron is commenced if the Hb is less than 10g/dl. Anticholinergics like ditropan are commenced to increase bladder capacity and to abolish overactive contractions. What is the followup protocol? These children need to be followed by monthly for first three months and then 3 monthly for one year. Serum Creatinine and electrolytes are monitored during every visit. The stream of urine is watched and persistence of a palpable urinary bladder checked. This will alert us that the fulguration may be incomplete. If this is suspected a repeat MCU and refulguration are done.

Dr. Bagdi’s X-ray Quiz Prof. Raj Kishore Bagdi’s x-ray quiz is becoming increasingly popular. Here are some samples. To view more and for a treasure hunt log on to “Indpedsurgery” group. To become member write email to . Membership is free of any cost.

A

C

Contributed by

Prof R. K. Bagdi Professor and Head Department of pediatric surgery Sri Ramachandra Medical College Chennai

B

Legends A. 10-year-old child with breathlessness of 1 week duration B. 3-year-old with intermittent cough C. 8-year-old with fever and dysuria (Answers in page 10)

TPPS News Dec 2006

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8

2 7

3

4

8 11

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Compiled by Prof. V. Raveenthiran, Professor of Pediatric Surgery, Annamalai University

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PEDIATRIC SURGICAL CROSS WORD PUZZLE

(Numbers at the end of each question indicate the number of letters in the answer-word)

21 22

(Answers in page 10)

23

Above downwards

Across (Right to left)

[2].

[1].

[3]. [4]. [5]. [6]. [7]. [8]. [9]. [11]. [13]. [14]. [15].

To be remembered as a cause of chronic abdominal pain in children (4) A condition with increased risk of Wilms’ tumor (11) A tool very useful in liver resections (4) The first president of IAPS (4). One of the causative factors of neonatal necrotizing enterocolitis (10) Location of lacuna magna (5) A small subcutaneous swelling (6) A modern synonym (acronym) for posterior urethral valve (5) Tumors of this organ are over-diagnosed by routine neonatal screening (7) Vomiting is an uncommon and late symptom of atresia occurring in this part of intestine (5) Eponym of a para-duodenal fossa (8) Useful adjunct (acronym) in the management of Diaphragmatic hernia. (4)

[5]. [8]. [10].

[12]. [14]. [16]. [17]. [18]. [19]. [20]. [21]. [22]. [23].

The only male organ that is devoid on any androgen receptor (6) A sign of twisted appendix of testis (3) A prognostic indicator of neuroblastoma (4) This agent is used in the treatment of cardiac murmurs that occur after repair of neonatal diaphragmatic hernia (2) Personality remembered with exomphalos and patent ductus arteriosus (5) Name of the laparoscopic operation for malrotated gut (4) A type of pyeloplasty (4) Abbreviation of a tumor marker (3) Name associated with Hepatitis B (4) Syndrome that is commonly associated with duodenal atresia (4) The first Indian University to start formal M.Ch Training program in pediatric surgery (6) A syndrome of congenital double lip and non toxic thyroid enlargement in children (6) A radiological sign of Hirschsprung’s disease. (7) A lung condition that causes opaque hemi thorax in neonates and infants (8)

Feedback of the inaugural issue of “TPPS News” “The newsletter has come out very well. I could understand the tremendous efforts put in” Dr. VR Ravikumar “The article on Intersex was stimulating” - Dr M. Bajpai “Congratulations Ravi” - Dr. YK Sarin “Ardhanari concept is one of the deepest and most difficult concept in Hindu philosophy. It is unfortunate that the author has only looked at the physical nature of the form. The whole concept is not physical at all; it is metaphysical and spiritual” - VVSS Chandrasekaram Author’s reply: Ardhanari was compared with hermaphrodite and Intersex from scientific point of view. The article is never intended to hurt anybody’s fundamentalistic feelings. However, I would like to apologize if someone is hurt by the article which was written in lighter vein.

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Photography MALIGNANT GRAPES! This is a chain of cervical lymph nodes excised from a 9-year-old boy suffering from Hodgkin’s Lymphoma. Non-Hodgkin’s lymphoma spreads indiscriminately while Hodgkin’s disease spread along the chain of contiguous nodes. This fact is well demonstrated in this photograph. Sony 5 Mega pixel digital camera was used with manual settings of f 8, t 1/60. The nodes were hung in air using an artery forceps (The forceps is seen in the picture resembling the pedicle of a grape-bunch). Oblique lighting from artificial source was shine from the right side. Shadow of the nodes cast on an adjacent wall was utilized to produce the effect of black background. Surgeon & Photographer: Prof. V. Raveenthiran, M.S, M.Ch Professor of Pediatric Surgery Annamalai University

For this section the editor TPPS invites submissions based on extra-curricular skills like painting, photography, poetry, short stories and so forth which are relevant to surgery or pediatrics.

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Answers to Puzzle Above downwards [2].

[3].

[4].

[5]. [6].

[7].

[8].

[9].

[11].

[13].

[14].

[15].

LEAD - Chronic lead poisoning from toys and paint is a well known cause of chronic abdominal pain in children. Hence routinely look for blue lead line of gums in such children. EMG SYNDROME - Exomphalos, Macroglossia and Glucose metabolic abnormality forms the syndrome (Also known as Beckwith Widemann syndrome). The risk of Wilms’ tumor is ten times higher in such children. CUSA - CUSA is an acronym of Cavitating Ultrasonic Suction Apparatus. Bloodless liver resection is possible with the usage of this knife. DeSA - Arthur de Sa of Goa was president of IAPS between 1965 and 1968 TOCOPHEROL - It is another name for Vitamin E. Vitamin E drops given to premature neonates is incriminated as cause of Necrotizing enterocolitis. GLANS - Lacuna magna is a recess on the roof of the fossa navicularis of the penis. In urethrograms sometimes it is mistaken for diverticulum NODULE - It is the standard terminology for any subcutaneous swelling more than 5 mm diameter. Smaller and superficial swellings should be called as papule. COPUM - Stands for Congenital Obstructing Posterior Urethral Membrane. This term was coined and popularized by Dewan as he believes that the lesion does not behave like a valve. ADRENAL - Japanese policy of routine neonatal urine VMA estimation lead to over diagnosis of neuroblastoma. Mismatch of this figure and community incidence of neonatal neuroblastoma lead to the realization that many neonatal neuroblastomas resolve spontaneously. COLON - Like any other colonic obstruction vomiting is an uncommon and late symptom of colonic atresia LANDZERT - He was a 19th century German anatomist who described the inferior duodenal fossa which is a common site of paraduodenal hernia. ECMO - Stands for Extra Corporeal Membrane Oxygenator.

Across (Right to left) [1].

SPLEEN - In male all other organs contain androgen receptors [5]. DOT - Also known as “Blue Dot sign”. It is seen in twisted appendix of testis. When the scrotum is transilluminated, the twisted cyst of Morgagni will be seen as blue dot in the centre of bright light. [8]. NMYC - It is an oncogene and prognostic indicator of neuroblastoma. [10]. NO - The chemical symbol of Nitric Oxide. It is a potent vasodilator that is used to treat pulmonary hypertension occurring in Diaphragmatic hernia (CDH). Sudden onset of murmur in CDH patients should raise the suspicion of pulmonary hypertension.

[12]. GROSS - Robert Gross, the father of pediatric surgery, was the first to successfully ligate Patent Ductus Arteriosus and correction of coarctation of aorta. He advocated conservative management of exomphalos major with delayed repair of residual hernia. [14]. LADD - Stands for Laparoscopy Assisted Duodenal De-rotation [16]. CULP - He was an American urologist who described a pyeloplasty, whereby a spiral flap of renal pelvis is brought down and interposed into a vertical incision in the ureter. [17]. NSE - Stands for Neuron Specific Enolase which is a tumor marker and prognostic indicator of neuroblastoma. [18]. DANE - He was a British Virologist who described the antigenic particle (Dane particles) of Hepatitis B. [19]. DOWN - Every duodenal atresia child should be screened for chromosomal abnormality [20]. MADRAS - University of Madras was the first to start formal M.Ch Training program in pediatric surgery in the year 1967. [21]. ASCHER - The syndrome consist of congenital double lip, blepharochalasis and nontoxic thyroid gland enlargement [22]. MONEREO - This sign is also known as Dunndarmschling’s sign. When rectal irrigation had been given prior to barium enema, then mega colon will collapse and coning of lumen may not be evident. In such cases increased folding of mucosa may be seen in colon leading to “Jejunification of colon” [23]. AGENESIS - Unilateral pulmonary agenesis frequently mimics like empyema in chest radiographs. Absence of fever and constitutional symptoms should raise the suspicion.

Answers to x-ray Quiz A.

Foreign body in the left main bronchus.

B.

Congenital Diaphragmatic hernia of the right side

C.

Incomplete duplication of the right renal pelvis and complete duplication of the left ureter with left ureterocoele. Note the drooping Lilly sign of left kidney with filling defect in the bladder

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PEDIATRIC URODYNAMICS WORKSHOP (Under the aegis of Pediatric Urology Chapter of IAPS, TPPS and Department of pediatric surgery, PSG Hospitals of Coimbatore) Date: 14th January 2007 at 8 am to 4 pm Venue: Auditorium of PSG Hospitals, Coimbatore. Faculty: Drs. V. Sripathy, Sudipta Sen, Mohan Abraham Registration fee: Rs 300 Contact Dr. A. Pavai: Cell Phone - 098430 16171, 09894769919 Dr. G. Lakshmi Devi : Cell Phone – 09444058770

PEDIATRIC ENDOSCOPIC WORKSHOP (Under the aegis of PESI chapter of IAPS and Sri Ramachandra Medical College of Chennai) Venue: Harvard Auditorium, Sri Ramachandra Medical College and Research Institute, Porur, Chennai Date: 16Th & 17Th March 2007 Faculty: Drs Anirudh Shah, Srimurthy, Sanjay Oak, Rasik Shah, Ramesh, Selvarajan, Rajamani Registration fee: Rs 1500 before 31st December (Rs 2000 later) Contact: Prof RK Bagdi: Cell Website: www.srmc.edu

SEPSCON 2007

KGV FELLOWSHIP AWARD Applications are invited from eligible candidates for the award of TPPS - Dr. KGV travel fellowship for the year 2007-08. The candidate must be within 40 years of age and must be a member of TPPS. Applications can be obtained from Dr V. Raveenthiran at email: [email protected] Last date for submission of application is 30th June 2007

Sixth annual conference of TPPS is organized by Salem & Erode Pediatric Surgeons Dates: 14th & 15th July 2007 Venue: Yercaud Contact : Dr S. Prabakaran, cell phone: 9442641878 Email: [email protected] Fax: 0427 - 2477908

MADURAI ALUMNI MEET

COMMUNITY PEDIATRIC SURGERY (COPS) Formation of COPS section of IAPS is approved by the general body of IAPS with an aim to promote pediatric surgery by serving the community. Pediatric surgeons who are interested in social service are invited to become members. Life Membership fee is Rs 1000 only Convener: Dr. V. Raveenthiran Contact: [email protected] Mobile: 9443310182

Alumni of the Department of Pediatric Surgery of Madurai Medical College are invited for a social get together at Yercard. Please put in your suggestions to Dr. V. Raveenthiran. Further details will be mailed in due course.

Disclaimer This newsletter is edited and published by the Honorary secretary cum Treasurer of TPPS. It is meant only for private circulation among TPPS members. The editor is responsible for the accuracy of Secretary’s reports in the OFFICIAL NEWS section. He can not be held responsible for any errors or omissions that occur in the materials contributed by members. Similarly, neither the TPPS nor its office bearers sanction any official approval of opinion expressed by individual contributors. Scientific articles are not peer reviewed. The editor has the right to reject or edit any of the submitted material. Scientific articles are not peer reviewed. There are merely reviewed by the editor for their suitability of publication. Please forward all your submissions to Dr. V. Raveenthiran, Honorary Secretary cum Treasurer TPPS, No 7. Medical Faculty Quarters, Annamalai Nagar 608002, Chidambaram, Tamilnadu, India. Email: [email protected]. Electronic submissions are preferred. Partial reproduction of material from this newsletter for non-commercial purposes is permitted provided the TPPS NEWS is duly acknowledged as the source. Complete duplication and sale of this publication is prohibited. Copyright of individual articles lies with the contributor.

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