KK Varma

Government Medical College

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T. Joseph

Government Medical College

M. I. Sreekumaran

Botswana Open University

Douglas Stephens

Royal Children's Hospital

Svs Akbar

Government Medical College

Askar Kukkady

Waikato Hospital

PY Henry

Dr. Somervell Memorial CSI Medical College and Hospital

Tara Joseph

University of California, San Francisco

Kumar Mi Sree

Government Medical College

MG Joy

Medical Trust Hospital

F. Douglas Stephens

Canterbury Christ Church University

Cooperative Institutions

Government Medical College

Royal Children's Hospital

Women's and Children's Hospital

University of Melbourne

Hospital Research Foundation

Waikato Hospital

Starship Children's Health

Government Medical College and Hospital

Dr. Somervell Memorial CSI Medical College and Hospital

Government Medical College

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Acute scrotum in children.

Journal of Indian Association of Pediatric Surgeons (1997)

MG Joy M. I. Sreekumaran T. Joseph KK Varma

ABSTRACT: Acute scrotum is one of the common childhood surgical emergencies. Even if all modern investigative techniques are used an accurate diagnosis may be difficult. A correct diagnosis and prompt intervention can save most of the tests in cases of torsion. A 5-year experience of 236 cases of acute scrotum treated in this institution is reported. Of these 236 cases 34.8 percent were epididymo-orchitis, 13.9 percent were torsion of testis and 29.7 percent were torsion of appendix of testis. There were 33 cases of torsion of testis of which 23 (69.7 percent) were gangrenous. Eight cases were presented within 24 hours of onset of symptoms of which 6 (75 percent) were viable, Twenty-seven cases (81.8 percent) of torsion of testis was on the left side and in 3 cases torsion occurred in undescended testis. Ten per cent of patients with epididymo-orchitis had an underlying primary urinary tract pathology.

Acute scrotum

Spermatic Cord Torsion

Orchitis

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Citations (2)

Life and times of unborn Kamla

KK Varma

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Citations (1)

Experience in the diagnosis of Hirschsprung's disease using the anomanometer

Journal of Pediatric Surgery (1979)

KK Varma

Barium enema

Hirschsprung's disease

Enema

10.1016/s0022-3468(79)80137-2

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Citations (3)

Neuromuscular Reflexes of Rectal Continence

Australian and New Zealand Journal of Surgery (1972)

KK Varma Douglas Stephens

The purpose of this paper is to describe the nerve pathways, reflex arcs and sphincter muscles responsible for the sensory and motor mechanisms of rectal continence. The data from which the reflex arcs were deduced were obtained from anal and rectal pressure profiles in children with normal and malformed rectums, and in children with injuries and deformities of the spinal cord which affect the neuromuscular control. These profiles were correlated with the clinical state of continence and with the known anatomy of both normal and abnormal states.

External anal sphincter

Anal sphincter

Fecal Incontinence

10.1111/j.1445-2197.1969.tb06306.x

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Citations (52)

Long-term continence after surgery for anorectal malformations

Pediatric Surgery International (1991)

KK Varma

Anorectal anomalies

10.1007/bf00174881

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Citations (7)

Congenital diaphragmatic hernia : a clinical study of 256 cases.

Journal of Indian Association of Pediatric Surgeons (1997)

Svs Akbar Kumar Mi Sree T. Joseph KK Varma

ABSTRACT: Two hundred and fifty-six cases of congenital diaphragmatic hernia (CDH) admitted to the department of pediatric surgery from the year 1974 to 1993 were studied. Ninety-one cases were symptomatic within the first 24 hours (CDH less than 24 hours). The incidence of CDH showed a progressive increase during the period of study. The CDH less than 24 hours also showed a progressive increase in incidence with a peak during the third phase of the study (from 1984-88), in spite of a drop in the birth rate at Kerala. Clinical scoring method evolved by us definitely helped in predicting the prognosis. A combination of clinical, radiological and biochemical scoring methods helped in predicting the prognosis in CDH less than 24 hours with reasonable accuracy. Our study has shown an improvement in the survival-overall survival as well as survival of newborns presenting within 24 hours of birth.

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Neuromuscular Reflexes in Hirschsprung's Disease

Australian and New Zealand Journal of Surgery (1973)

KK Varma F. Douglas Stephens

The neuromuscular reflexes before and after the Swenson rectosigmoidectomy procedure and the Duhamel operation for Hirschsprung's disease have been studied to determine and compare the responses of the anal sphincters to “rectal” distension and to evaluate the state of continence.

Hirschsprung's disease

Megacolon

Neuromuscular disease

10.1111/j.1445-2197.1973.tb06806.x

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Citations (5)

The Role of the Voluntary Anal Sphincter in the Maintenance of Fæcal Continence in Normal and Abnormal States

Australian and New Zealand Journal of Surgery (1972)

KK Varma

Manometric studies on normal and abnormal children showed that the voluntary sphincter complex of the anal canal subserved the most important role in the maintenance of continence by three mechanisms‐namely, by providing a resting pressure in the sphincter sone higher than that in the rectum, by reflex contractions in response to rectal distension, with consequent unconscious adjustment of the anal pressure to preserve continence, and by its action as a conscious response to reinforce the anal canal and control defæcation. Furthermore, stretch receptors in the voluntary sphincter complex of the anal canal gave a warning of impending defæcation. After rectoplasty procedures when the only sphincter present was the levator ani complex, the unconscious reflexes were abolished, but the children attained appropriate sensory perception and a high degree of continence provided that the resting tone of the puborectalis muscle was adequate. Summary The voluntary sphincter takes the lion's share of the responsibility of maintaining anorectal continence. Continence in the normal child is dependent on: (1) Resting tone of the sphincters; and (2) Neuromuscular reflexes ‐an unconscious Phase I and a conscious Phase II. After abdomino‐perineal pull‐through operations, these children can achieve a high degree of continence, even in the absence of a Phase T response, provided that the resting tone of the voluntary sphincter is high enough.

External anal sphincter

Urethral sphincter

Internal anal sphincter

Muscle tone

Fecal Incontinence

10.1111/j.1445-2197.1972.tb06741.x

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Citations (7)

Management of Hirschsprung's disease ? an alternate approach

Pediatric Surgery International (1994)

KK Varma Askar Kukkady Tara Joseph M. I. Sreekumaran

Hirschsprung's disease