Gs Arul

Gs Arul
Birmingham Children's Hospital NHS Foundation Trust · Dept. of Surgery

MD, FRCS(Paeds)

About

74
Publications
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1,354
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Publications

Publications (74)
Article
Full-text available
Background Children are frequently injured during major incidents (MI), including terrorist attacks, conflict and natural disasters. Triage facilitates healthcare resource allocation in order to maximise overall survival. A critical function of MI triage tools is to identify patients needing time-critical major resuscitative and surgical interventi...
Article
Aim Cystic ovarian masses in children may be physiological or neoplastic. It is mandatory that suspected neoplastic lesions are resected without tumour spillage. However, a large midline incision is cosmetically unappealing incision to young women. Here we describe our experience of using controlled drainage without spillage that allows a cosmetic...
Article
Full-text available
Purpose Minimally invasive surgery (MIS) in pediatric oncology remains controversial. Our unit aims to surgically stratify patients for MIS and here we present our data. Methods Oncology patients who had undergone surgery were identified from prospectively collected databases and retrospectively analyzed. Results Between 04/2004 and 12/2019, 905...
Article
Introduction Laparoscopic pyloromyotomy is now an accepted procedure for the treatment of pyloric stenosis. However, it is clear that during the implementation period there are significantly higher incidences of mucosal perforation and incomplete pyloromyotomy. We describe how we introduced a new laparoscopic procedure without the complications ass...
Article
Introduction: Controversy exists over the best dressing for conservative management of exomphalos major. Here we describe our experience of using Manuka Honey. Method: Our regimen involved covering the sac with Manuka honey (Advancis Medical™) wrapped with gauze and crepe bandage. Initially, dressings were changed 3 times a week and then twice week...
Article
Introduction Minimally invasive nephrectomy (MIN)for the resection of pediatric renal tumors is controversial. We compared patients who underwent laparoscopic MIN according to our unit protocol with matched patients who underwent open surgery (ON). Method A single centre retrospective analysis of prospectively collected data for MIN. Tumor volume...
Article
Full-text available
Background: Congenital mesoblastic nephroma is a rare disease. Treatment is surgical in the first instance. Chemotherapy has traditionally been thought not to have a role. Recent literature suggests a 50% mortality rate for recurrent/metastatic disease. Materials and methods: This study is a retrospective case review of prospectively collected d...
Article
Introduction: Mortality for neonates requiring surgery for serious pathology such as NEC, remains high. Damage control surgery (DCS) has evolved as an operative strategy in battlefield trauma that sacrifices the completeness of the initial surgery to address the deadly triad of acidosis, hypothermia and coagulopathy. This approach is now used rout...
Article
In the second instalment in the Psychology of Surgery series, we look at how to prevent the negative spiral of panic in critical surgical situations.
Article
Objective: Dysgerminoma is the most common malignant ovarian germ cell tumor (GCT) with peak incidence during adolescence and young adulthood. Current standard of care for patients with disease that has spread outside of the ovary (advanced-stage) utilizes platin-based chemotherapy regimens. The study objective was to compare clinical outcomes bet...
Article
Full-text available
Totally implantable vascular access devices (TIVADs) are commonly used in conjunction with enzyme replacement therapy (ERT) for lysosomal storage disorders (LSDs). This case series describes potential complications associated with long-term TIVAD use, such as compromise of skin integrity, infection, or port failures. Best practices and skilled spec...
Article
Permanent central venous access has become one of the cornerstones of modern hospital medicine. It is of particular importance in pediatrics as many treatments cannot start without reliable central access. For this reason using the optimal technique for central venous access is crucial. The decision about approach is based both on the local experti...
Chapter
The Uppsala Conflict Data Programme held by Uppsala university reported 149 state and non-state conflicts worldwide in 2015, with over 118,000 deaths [1]. By inference, humanitarian, training, and peacekeeping missions are necessary to provide medical support to those injured in these conflicts. The presence of such military medical facilities will...
Article
Aim: A small proportion of infants with oesophageal atresia (OA) are thought to have a proximal tracheoesophageal fistula (TOF). Failure to recognize these can hamper mobilization of the upper pouch and lead to life-threatening episodes of aspiration once oral feeding starts. We reviewed our experience of upper pouch fistulae to identify character...
Chapter
Most childhood tumors will first present to a physician; some tumors will present in an atypical manner and may mimic a surgical condition. The diagnosis may be missed if the surgeon is not aware of the possibility of cancer. A very great number of rare presentations of childhood cancer have been described in the literature. It is important that th...
Article
Background: There is a debate regarding the management of ovarian immature teratomas (ITs). In adult women, postoperative chemotherapy is standard except for stage I, grade 1 disease, whereas surgery alone is standard in pediatric patients. To determine the role of chemotherapy, a pooled analysis of pediatric and adult clinical trials was conducte...
Article
Background: There is debate regarding optimum management of ovarian immature teratomas (IT). In adult women, postoperative chemotherapy is standard, except for Stage I, grade 1 disease, whereas surgery alone is standard in pediatric patients. To determine the role of chemotherapy, we conducted a pooled analysis of pediatric and adult clinical trial...
Article
During the past 35 years, survival rates for children with extracranial malignant germ cell tumors (GCTs) have increased significantly. Success has been achieved primarily through the application of platinum-based chemotherapy regimens; however, clinical challenges in GCTs remain. Excellent outcomes are not distributed uniformly across the heteroge...
Article
Full-text available
Introduction The concentration of major trauma experience at Camp Bastion has allowed continuous improvements to occur in the patient pathway from the point of wounding to surgical treatment. These changes have involved clinical management as well as alterations to the physical layout of the hospital, training and decision making. Consideration of...
Article
Full-text available
The British Military Hospital in Camp Bastion, Afghanistan, has been responsible for pushing forwards the limits of care for severe injury; less well known, it has also pioneered amateur bread making in a war zone While Dr William Brydon may have been the only survivor of the British deployment on the first Afghan war in 1842, the Defence Medical...
Article
Full-text available
To risk stratify malignant extracranial pediatric germ cell tumors (GCTs). Data from seven GCT trials conducted by the Children's Oncology Group (United States) or the Children's Cancer and Leukemia Group (United Kingdom) between 1985 and 2009 were merged to create a data set of patients with stage II to IV disease treated with platinum-based thera...
Article
The paradigm of Damage Control Surgery (DCS) has radically improved the management of abdominal trauma, but less well described are the options for managing the abdominal wall itself in an austere environment. This article describes a series of patients with complex abdominal wall problems managed at the UK-led Role 3 Medical Treatment Facility (MT...
Article
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Tongue tie is an increasingly common cause for referral of infants to our general paediatric surgery service. In this article, we will explore the indications for tongue tie division in the newborn child, the practicalities of the procedure and the supporting evidence.
Article
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Human factors or non-technical skills are now commonplace in the medical literature, having taken the lead from the airline and nuclear industries and more recently Formula One motor racing. They have been suggested as playing a vital role in the success of the trauma teams in recent conflicts. This article outlines the background to human factors,...
Article
Full-text available
The deployed Intensive Therapy Unit (ITU) in the British military field hospital in Camp Bastion, Afghanistan, admits both adults and children. The purpose of this paper is to review the paediatric workload in the deployed ITU and to describe how the unit copes with the challenge of looking after critically injured and ill children. Retrospective r...
Article
Venous occlusion following permanent central venous catheter (CVC) insertion by open cutdown or the landmark percutaneous technique has been reported between up to 25 %. However, there are no published data on the equivalent rate following ultrasound-guided percutaneous CVC insertion. The purpose of this study was to document the rate of venous occ...
Article
Left-sided superior vena cava (LSVC) is a congenital venous anomaly with an incidence of about 0.3%, and which is sometimes discovered during vascular intervention [Le Cat. Histoire de l'acadroyale des sciences .Paris 1738:62, I Steinberg, W Dubilier, D Lucas. Persistence of left superior vena cava. Dis Chest 1953;24:479-88]. There is little clear...
Article
Purpose: Wilms' tumours (WT) with retrohepatic vascular extension traditionally requires cardiac bypass for complete excision. We share our experience of these complex cases. Methods: A retrospective review was performed of children with WT with retrohepatic vascular extension presenting to two UK children's hospitals. Tumour stage, chemotherapy...
Chapter
Children differ from adults in both pathology and presentation when suffering from abdominal disease. The abdominal pathology seen in sick children admitted to the ICU can either be the cause of their deterioration or a consequence of the hypotension and sepsis that results from their main pathology.This chapter aims to discuss common abdominal pat...
Article
Haemorrhage from severe pelvic fractures can be associated with significant mortality. Modern civilian trauma centres may manage these injuries with a combination of external pelvic fixation, extra-peritoneal packing and/or selective angiography; however, military patterns of wounding are different and deployed medical facilities may be resource co...
Article
Addition of glutamine to parenteral nutrition in surgical infants remains controversial. The aim of this trial was to determine whether glutamine supplementation of parenteral nutrition in infants requiring surgery would reduce the time to full enteral feeding and/or decrease the incidence of sepsis and septicaemia. A prospective double-blind multi...
Article
We report a case of a neonate presenting with the rare vascular tumor, Kaposiform hemangioendothelioma. She had a lesion arising from the left ovary with multiple intraperitoneal metastases causing small bowel obstruction. We managed this case with primary surgical resection followed by laparoscopic surveillance of the peritoneal cavity and metaste...
Article
Damage Control Resuscitation and Damage Control Surgery (DCR-DCS) is an approach to managing severely injured patients according to their physiological needs, in order to optimise outcome. Key to delivering DCR-DCS is effective communication between members of the clinical team and in particular between the surgeon and anaesthetist, in order to seq...
Article
Full-text available
International humanitarian law requires emergency medical support for both military personnel and civilians, including children. Here we present a detailed review of paediatric admissions with the pattern of injury and the resources they consume. All paediatric admissions to the hospital at Camp Bastion between 1 January and 29 April 2011 were anal...
Article
There remains a significant paediatric workload through the military hospital in Camp Bastion. In this paper the authors review and discuss particular problems with resuscitation, investigation, anaesthetic and surgical issues in dealing with children suffering from ballistic injuries. Personal experience and recent papers are used for a qualitativ...
Article
Children being investigated for gastroesophageal reflux (GOR) have a high incidence of malrotation. Current literature suggests these patients should be managed with a combined antireflux and Ladd's procedure. We review our experience, the largest series to date, of performing an elective Ladd's procedure as the first-line intervention. Retrospecti...
Article
Insertion of permanent central venous access (Broviac line) can be a challenge in neonates especially when sites for peripherally inserted central catheters (PICC) have been exhausted. The landmark technique (LT) has been well described for the percutaneous insertion of central lines in neonates but can be associated with significant complications...
Article
The insertion of a permanent central venous access device (PCVAD i.e. Broviac or Hickman lines and vascuports) is often considered a low priority and performed as an emergency. In 2004, a vascular access team (VAT), responsible for all PCVAD insertions, was established in our institution to address this. Data were collected retrospectively on all P...
Article
Objective: The full spectrum and incidence of injuries caused by handlebar impact in children has not been adequately described in the literature. While bicycle handlebars are known to cause significant intra-abdominal injury, there are a number of other vehicle types using handlebars which have not been fully explored for the incidence and severit...
Article
Full-text available
The ultrasound-guided percutaneous technique of Hickman line insertion has not been widely adopted in pediatric surgical practice. We wished to review our own experience of using this technique for insertion into the internal jugular vein. Our vascular access team consists of a consultant surgeon and 2 consultant anesthetists. All procedures were p...
Article
Full-text available
The usual indications for oesophageal replacement in childhood are intractable corrosive strictures and long-gap oesophageal atresia. Generally, paediatric surgeons attempt to preserve the native oesophagus with repeat dilatations. However, when this is not successful, an appropriate conduit must be fashioned to replace the oesophagus. The neo-oeso...
Article
Most childhood tumors will first present to a physician; some tumors will present in an atypical manner and may mimic a surgical condition. The diagnosis may be missed if the surgeon is not aware of the possibility of cancer. A very great number of rare presentations of childhood cancer have been described in the literature. It is important that th...
Article
We report a case of megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS), occurring in association with mydriasis, in a female infant born to consanguineous Asian parents. This association has not previously been reported and is of interest because mydriasis has been found in a murine MMIHS model produced by knockout of the genes codin...
Article
Neuroblastoma is a malignant tumour derived from the sympathetic nervous system. It arises from sympathetic neuroblasts derived from neural crest cells which migrate from the paravertebral ganglia into the adrenal medulla and sympathetic chain during early fetal life. It is highly malignant and was previously usually fatal. It can regress spontaneo...
Article
Wilms' tumour is a common extracranial solid tumour of childhood; it typically presents as a painless abdominal mass, haematuria or fever. In the UK, it is treated according to the European International Society of Paediatric Oncology protocols: initial imaging by CT and Trucut needle biopsy followed by preoperative chemotherapy. Surgery involves r...
Article
Two infants found to have ileal atresia after birth and who had intrauterine laser treatment to interupt twin to twin transfusion are presented. The donor twin in each pregnancy died in utero.
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Neutropaenic patients are at particular risk of developing a pseudomonal fasciitis known as ecthyma gangraenosum. Despite the similarities with necrotising fasciitis, Fournier's gangrene has a very different aetiology and management.
Article
Full-text available
Mucin genes are expressed in a site specific manner throughout the gastrointestinal tract. Little is known about the expression pattern in the oesophagus. In this study we have investigated MUC gene expression in both the normal oesophagus and specialised intestinal metaplasia (Barrett's oesophagus). Archived paraffin embedded material from eight s...
Article
Bone marrow transplantation (BMT) patients frequently develop life-threatening problems that have similar clinical presentations but differing aetiologies. Despite intensive investigation by haematological, biochemical, and microbiological means, accurate diagnosis is not always possible. Histological and microbiological examination of biopsies fro...
Article
One reason why many surgeons do not attempt laparoscopic cholangiography is that it is considered to be technically difficult and to produce poor-quality images. A retrospective comparison was made of twenty randomly selected intraoperative cholangiograms taken during laparoscopic cholecystectomy for each year from 1991 to 1994 (n = 80) by assignin...
Article
We have tried to review the evidence for the organisation of paediatric surgical care. Difficulties arise because of the lack of published data from district general hospitals concerning paediatric surgical conditions. Hence much of the debate about the surgical management of children is based on anecdotal evidence. However, at a time when the prov...
Article
“The aim of paediatric surgery is to set a standard, not to create a monopoly”—Dennis Browne In 1959 the Platt report made a number of recommendations about caring for children in hospital.1The six main principles were identified as: child and family centred care, specially skilled staff, separate facilities, effective treatments, appropriate hos...
Article
We report a case of coeliac axis thrombosis and splenic infarction presenting in a girl of 14 years who had been on the oral contraceptive pill (OCP), Marvelon (ethinyloestradiol 30 microg plus desogestrel 150 microg, Organon, Cambridge, UK), for 3 weeks. She had no other risk factors for thrombo-embolism. Diagnosis was made with duplex Doppler ult...

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