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Biological and Histological Assessment of the Hepatoportoenterostomy Role in Biliary Atresia As a Stand-Alone Procedure Or As a Bridge Toward Liver Transplantation
medicina Article Biological and Histological Assessment of the Hepatoportoenterostomy Role in Biliary Atresia as a Stand-Alone Procedure or as a Bridge toward Liver Transplantation Raluca-Cristina Apostu 1, Vlad Fagarasan 1 , Catalin C. Ciuce 1, Radu Drasovean 1 , Dan Gheban 2, Radu Razvan Scurtu 1,*, Alina Grama 3, Ana Cristina Stefanescu 3, Constantin Ciuce 1 and Tudor Lucian Pop 3 1 Department of Surgery, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, 8 Victor Babes Street, 400000 Cluj-Napoca; First Surgical Clinic, Emergency County Hospital, 3-5 Clinicilor Street, 400006 Cluj-Napoca, Romania; [email protected] or [email protected] (R.-C.A.); [email protected] (V.F.); [email protected] (C.C.C.); [email protected] (R.D.); [email protected] (C.C.) 2 Department of Pathology, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, 8 Victor Babes Street, 400000 Cluj-Napoca; 4 th Pediatric Clinic, Emergency Clinical Hospital for Children, 68 Motilor Street, 400000 Cluj-Napoca, Romania; [email protected] 3 Department of Pediatrics, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, 8 Victor Babes Street, 400000 Cluj-Napoca; 2nd Pediatric Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania; [email protected] (A.G.); [email protected] (A.C.S.); [email protected] (T.L.P.) * Correspondence: [email protected]; Tel.: +40-744-704-012 Abstract: Background and objectives: In patients with biliary atresia (BA), hepatoportoenterostomy (HPE) is still a valuable therapeutic tool for prolonged survival or a safer transition to liver transplantation. Citation: Apostu, R.-C.; Fagarasan, V.; The main focus today is towards efficient screening programs, a faster diagnostic, and prompt treatment. -
Intrahepatic Cysts in Biliary Atresia Aftersuccessful
Arch Dis Child: first published as 10.1136/adc.59.3.274 on 1 March 1984. Downloaded from 274 Sinaasappel, den Ouden, Luyendijk, and Degenhart The reason for the patient's persistent vomiting in 3 Menke JA, Stallworth RE, Bindstadt DH, Strano AJ, the first five months of life may well have been Wallace SE. Medication bezoar in a neonate. Am J Dis Child 1982;136:72-3. a slower development of his antireflux mechanism, 4 Metlay LA, Klionsky BC. An unusual gastric bezoar in a but we have not been able to confirm this newborn: polystyrene resin and candida albicans. J Pediatr hypothesis. 1983;102:121-3. 5 Portuguez-Malavasi A, Aranda JV. Antacid bezoar in a newborn. Pediatrics 1979;63:679- 80. References 6 Hewitt GJ, Benham ES. A complication of gaviscon in' a neonate-'the gavisconoma'. Aust Paediatr J 1976;12:47-8. O'Brien D, Rodgerson DO, Ibbott FA. Laboratory manual of pediatric micro- and ultramicro biochemical techniques. 4th ed. Correspondence to Dr M Sinaasappel, Department of Paediatrics, New York: Harper & Row, 1968:231. Gastro-enterological Division, Erasmus University and University 2 Schreiner RL, Lemons JA, Gresham EL. A new complication Hospital, Rotterdam, The Netherlands. of nutritial management of the low-birth-weight infant. Pediat- rics 1979;63:683-4. Received 7 November 1983 Intrahepatic cysts in biliary atresia after successful hepatoportoenterostomy S SAITO, T NISHINA, AND Y TSUCHIDA Department ofPaediatric Surgery, University of Tokyo, Japan SUMMARY A patient with an unusual association of dilated and cord like portions of the extrahepatic biliary atresia and two intrahepatic cysts is reported. -
American Surgical Association
AMERICAN SURGICAL ASSOCIATION Program of the 131st Annual Meeting Boca Raton Resort & Club Boca Raton, Florida Thursday, April 14th Friday, April 15th Saturday, April 16th 2011 Table of Contents Officers and Council ....................................................................2 Committees ..................................................................................3 Foundation Trustees.....................................................................5 Representatives ............................................................................6 Future Meetings ...........................................................................7 General Information.....................................................................8 Continuing Medical Education Accreditation Information........10 AMERICAN Program Committee Disclosure List..........................................13* SURGICAL Faculty Disclosure List...............................................................13* Author Disclosure List...............................................................14* ASSOCIATION Discussant Disclosure List.........................................................22* Schedule-at-a-Glance.................................................................24 Program Outline.........................................................................26 Program Program Detail and Abstracts.....................................................41 of the Alphabetical Directory of Fellows.............................................94* 131st Annual -
Copyright © ESPGHAN and NASPGHAN. All Rights Reserved
Journal of Pediatric Gastroenterology and Nutrition, Publish Ahead of Print DOI : 10.1097/MPG.0000000000002836 Cholangitis in Patients with Biliary Atresia Receiving Hepatoportoenterostomy: A National Database Study Katherine Cheng, M.D.1 Jean P. Molleston, M.D.2 William E. Bennett, Jr., M.D., M.S.2,3 1. Department of Pediatrics, 2. Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 3. Section of Pediatric and Adolescent Comparative Effectiveness Research, Indiana University School of Medicine, Indianapolis, IN, USA Abstract: Introduction: Biliary atresia (BA) is a progressive form of liver disease in the neonatal period usually requiring hepatoportoenterostomy (HPE). Cholangitis is a common sequelae of HPE, but data about which patients are at risk for this complication are limited. Objective: To determine risk factors associated with cholangitis in a large retrospective cohort after HPE. Methods: The Pediatric Health Information System (PHIS) was queried for BA (ICD-9 975.61) and HPE (ICD-9-CM 51.37) admissions from 2004-2013. We performed univariate Copyright © ESPGHAN and NASPGHAN. All rights reserved. analysis and linear regression with dependent variables of ≥ 2 or ≥ 5 episodes of cholangitis, and independent variables of age at time of HPE, race, ethnicity, gender, insurance, ursodeoxycholic acid (UDCA) use, steroid use, presence of esophageal varices (EV), and portal hypertension (PH). Results: We identified 1,112 subjects with a median age at HPE of 63 days and median number of cholangitis episodes of 2 within 2 years. On multiple regression analysis, black race (OR 1.51, p = 0.044) and presence of PH (OR 2.24, p < 0.001) were associated with increased risk of ≥ 2 episodes of cholangitis, while HPE at > 90 days was associated with less risk (OR 0.46, p = 0.001). -
Fy 2020 Acs Ipps
June 24, 2019 Seema Verma, Administrator Centers for Medicare & Medicaid Services Attention: CMS-1716-P P.O. Box 8013 Baltimore, MD 21244-1850 RE: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Proposed Policy Changes and Fiscal Year 2020 Rates; Proposed Quality Reporting Requirements for Specific Providers; Medicare and Medicaid Promoting Interoperability Programs Proposed Requirements for Eligible Hospitals and Critical Access Hospitals Dear Ms. Verma: On behalf of the over 80,000 members of the American College of Surgeons (ACS), we appreciate the opportunity to submit comments to the Centers for Medicare & Medicaid Services’ (CMS) proposed rule, Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Proposed Policy Changes and Fiscal Year 2020 Rates; Proposed Quality Reporting Requirements for Specific Providers; Medicare and Medicaid Promoting Interoperability Programs Proposed Requirements for Eligible Hospitals and Critical Access Hospitals, published in the Federal Register on May 3, 2019. The ACS is a scientific and educational association of surgeons founded in 1913 to improve the quality of care for patients by setting high standards for surgical education and practice. Since a large portion of surgical care is provided in the inpatient hospital setting, the College has a vested interest in CMS’ Inpatient Prospective Payment System (IPPS) and related hospital quality improvement efforts, and we believe that we can offer insight to CMS’ proposed modifications to these policies for fiscal year (FY) 2020. Our comments below are presented in the order in which they appear in the proposed rule. -
Total Serum Bilirubin Within 3&Nbsp
Total Serum Bilirubin within 3 Months of Hepatoportoenterostomy Predicts Short-Term Outcomes in Biliary Atresia Benjamin L. Shneider, MD1, John C. Magee, MD2, Saul J. Karpen, MD, PhD3, Elizabeth B. Rand, MD4, Michael R. Narkewicz, MD5, Lee M. Bass, MD6, Kathleen Schwarz, MD7, Peter F. Whitington, MD6, Jorge A. Bezerra, MD8, Nanda Kerkar, MD9, Barbara Haber, MD10, Philip Rosenthal, MD11, Yumirle P. Turmelle, MD12, Jean P. Molleston, MD13, Karen F. Murray, MD14, Vicky L. Ng, MD15, Kasper S. Wang, MD16, Rene Romero, MD17, Robert H. Squires, MD18, Ronen Arnon, MD19, Averell H. Sherker, MD20, Jeffrey Moore, MS21, Wen Ye, PhD21, and Ronald J. Sokol, MD5, on behalf of the Childhood Liver Disease Research Network (ChiLDReN)* Objectives To prospectively assess the value of serum total bilirubin (TB) within 3 months of hepatoportoenter- ostomy (HPE) in infants with biliary atresia as a biomarker predictive of clinical sequelae of liver disease in the first 2 years of life. Study design Infants with biliary atresia undergoing HPE between June 2004 and January 2011 were enrolled in a prospective, multicenter study. Complications were monitored until 2 years of age or the earliest of liver transplan- tation (LT), death, or study withdrawal. TB below 2 mg/dL (34.2 mM) at any time in the first 3 months (TB <2.0, all others TB $2) after HPE was examined as a biomarker, using Kaplan-Meier survival and logistic regression. Results Fifty percent (68/137) of infants had TB <2.0 in the first 3 months after HPE. Transplant-free survival at 2 years was significantly higher in the TB <2.0 group vs TB $2 (86% vs 20%, P < .0001). -
Biliary Atresia and Liver Transplant
www.GIKids.org Biliary Atresia and Liver Transplant What is Biliary Atresia? Biliary Atresia (BA) is an inflammatory process of unknown cause that affects the bile ducts (the tubes that carry digestive juices from the liver to the intestine. Bile ducts are part of the “plumbing system” (or the network of tubes and passageways) that carry bile from the liver to the small intestine to help us to digest fats in our food (see figure). Biliary atresia means that bile and other compounds made by the liver (such as bilirubin, a breakdown product of red blood cells) can’t go into the intestine, and build up in the liver, causing liver damage. What causes Biliary Atresia? • jaundice (yellowing of the skin and eyes) Nobody knows yet why BA happens. It is most likely related to genetic and environmental influences, but we don’t • dark, tea-colored urine know enough about this yet. Lots of research is happening • pale, clay colored stool (that does not contain to try to find more answers. brown, yellow or green color) How common is Biliary Atresia? How is Biliary Atresia diagnosed? BA occurs in one in 8,000-20,000 live births. It is the It is important to make the diagnosis of BA early (ideally most common reason for young children needing liver before 60 days of life). This is because the long-term transplantation. BA most commonly occurs as an isolated outcome depends on the age when the first surgery to problem, meaning that the infant just has this problem treat BA is performed. -
LIVER DISEASE in CHILDREN a Number of Liver Diseases Affect Children
HOW COVERAGE OF MEDICAL FOODS CAN SAVE LIVES & COSTS LIVER DISEASE IN CHILDREN A number of liver diseases affect children. While some conditions are treatable and potentially reversible, many result in chronic liver disease and require transplantation. The incidence of chronic liver disease in children is unknown but relatively rare. For example, biliary atresia (the most common reason for liver transplantation in children) occurs in roughly one in 10,000 to 20,000 live births. The liver performs a number of important roles in the body, including filtering or detoxifying the blood; producing or digesting nutrients (like fats, proteins, and sugars); and storing those nutrients to release in the body as needed. The liver primarily eliminates toxins and other materials through the production and subsequent release of bile into the intestines. Bile also plays an important role in absorbing certain fats and vitamins (A, D, E and K) from food. Therefore, when bile production is altered or if bile cannot be excreted (like with chronic liver disease), children develop fat and vitamin deficiencies. Possible symptoms or complications of these deficiencies include diarrhea, poor growth, rashes, poor wound healing, a weakened immune system, excessive bleeding, broken bones, and neurologic deficits, among others. These complications can be prevented, however, with vitamin replacement therapy and specialized nutrition. Specific formulas (such as Pregestimil) contain a high percentage of medium chain triglycerides (MCT), a fat that can be absorbed in the intestine without bile. In fact, MCT is the only fat that can be absorbed this way; it is for this reason specialized formulas with high MCT concentrations are used in children with chronic liver disease. -
Case Report a Fragment of Foley Catheter Balloon As a Cause of Bladder Stone in Woman
Open Access Case report A fragment of Foley catheter balloon as a cause of Bladder stone in woman El Majdoub Aziz1,&, Mouad Amrani1, Khallouk Abdelhak1, Farih Moulay Hassan1 1Department of Urology, Hassan II Hospital University Center, Fez, Morocco &Corresponding author: El Majdoub Aziz, Department of Urology, Hassan II Hospital University Center, Fez, Morocco Key words: intravésical, foreign body, catheter balloon, recurrent urinary tract infections Received: 08/04/2015 - Accepted: 22/04/2015 - Published: 13/08/2015 Abstract Urinary bladder calculi are rarely seen in women and any history of previous pelvic surgery must, therefore, raise suspicion of an iatrogenic etiology. According to the literature, fewer than 2% of all bladder calculi occur in female subjects and, thus, their presence should provoke careful assessment of the etiology. We report one case of a fragment of Foley catheter balloon as a cause of Bladder stone in 28 years old woman. Weanalyzed the diagnosis, aspect and therapeutic management of this case which is the first described in literature to our knowledge. Pan African Medical Journal. 2015; 21:284 doi:10.11604/pamj.2015.21.284.6770 This article is available online at: http://www.panafrican-med-journal.com/content/article/21/284/full/ © El Majdoub Aziz et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Pan African Medical Journal – ISSN: 1937- 8688 (www.panafrican-med-journal.com) Published in partnership with the African Field Epidemiology Network (AFENET). -
Serum MMP-7 in the Diagnosis of Biliary Atresia
Serum MMP-7 in the Diagnosis of Biliary Atresia Jingying Jiang, MD, Junfeng Wang, MD, PhD, Zhen Shen, MD, Xuexin Lu, MD, Gong Chen, MD, Yanlei Huang, MD, Rui Dong, MD, PhD, Shan Zheng, MD, PhD BACKGROUND: The overlapping features of biliary atresia (BA) and other neonatal cholestasis with abstract alternative causes (non-BA) have posed challenges for diagnosis. Matrix metalloproteinase-7 (MMP-7) has been reported to be promising in diagnosing BA. We aimed to validate the diagnostic accuracy of MMP-7 for BA in a large population sample. METHODS: We enrolled 288 patients with neonatal obstructive jaundice from March 2017 to October 2018. Serum MMP-7 levels were measured by using an enzyme-linked immunosorbent assay. Receiver operating characteristic curves were constructed, and decision curve analysis was done. A Pearson correlation coefficient test was conducted to assess the correlation between MMP-7 levels and other characteristics. RESULTS: The median serum MMP-7 levels were 38.89 ng/mL (interquartile range: 22.96–56.46) for the BA group and 4.4 ng/mL (interquartile range: 2.73–6.56) for the non-BA group (P , .001). The area under the receiver operating characteristic curve value was 0.9829 for MMP-7, and the sensitivity, specificity, positive predictive value, and negative predictive value were 95.19%, 93.07%, 97.27%, and 91.43%, respectively, at a cutoff value of 10.37 ng/mL. When MMP-7 was combined with g glutamyl transferase, the diagnostic accuracy was slightly improved without significance when compared with MMP-7 alone and had an area under the curve of 0.9880 (P = .08). -
Recent Advances in Understanding Biliary Atresia[Version 1; Peer
F1000Research 2019, 8(F1000 Faculty Rev):218 Last updated: 17 JUL 2019 REVIEW Recent advances in understanding biliary atresia [version 1; peer review: 3 approved] Andrew Wehrman 1, Orith Waisbourd-Zinman1,2, Rebecca G Wells3 1Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA 2Gastroenterology, Hepatology, and Nutrition, Schneider Children's Medical Center of Israel, Petach-Tiqva, Israel 3Medicine and Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA First published: 25 Feb 2019, 8(F1000 Faculty Rev):218 ( Open Peer Review v1 https://doi.org/10.12688/f1000research.16732.1) Latest published: 25 Feb 2019, 8(F1000 Faculty Rev):218 ( https://doi.org/10.12688/f1000research.16732.1) Reviewer Status Abstract Invited Reviewers Biliary atresia (BA) is a neonatal liver disease characterized by progressive 1 2 3 obstruction and fibrosis of the extrahepatic biliary tree as well as fibrosis and inflammation of the liver parenchyma. Recent studies found that infants version 1 who will go on to develop BA have elevated direct bilirubin levels in the first published few days of life, suggesting that the disease starts in utero. The etiology and 25 Feb 2019 pathogenesis of BA, however, remain unknown. Here, we discuss recent studies examining potential pathogenetic mechanisms of BA, including genetic susceptibility, involvement of the immune system, and F1000 Faculty Reviews are written by members of environmental insults such as viruses and toxins, although it is possible that the prestigious F1000 Faculty. They are there is not a single etiological agent but rather a large group of injurious commissioned and are peer reviewed before insults that result in a final common pathway of extrahepatic bile duct publication to ensure that the final, published version obstruction and liver fibrosis. -
Clinical Presentation, Management and Outcome in Diverticular Colovesical Fistulas - Our Experience
Jemds.com Original Research Article Clinical Presentation, Management and Outcome in Diverticular Colovesical Fistulas - Our Experience Gaurav Kalra1, Rajeev Thekke Puthalath2, Suraj Hegde3, Narendra Pai4, Amit Kumar5 1Department of Urology, K.S. Hegde Medical Academy, NITTE (Deemed to Be University), Mangalore, Karnataka, India. 2Department of Urology, K.S. Hegde Medical Academy, NITTE (Deemed to Be University), Mangalore, Karnataka, India. 3Department of Urology, K.S. Hegde Medical Academy, NITTE (Deemed to Be University), Mangalore, Karnataka, India. 4Department of Urology, K.S. Hegde Medical Academy, NITTE (Deemed to Be University), Mangalore, Karnataka, India. 5Department of Urology, K.S. Hegde Medical Academy, NITTE (Deemed to Be University), Mangalore, Karnataka, India. ABSTRACT BACKGROUND Colovesical fistula (CVF) is an abnormal communication between the urinary bladder Corresponding Author: and the large intestine, usually sigmoid colon. Diverticulitis is the most common Dr. Rajeev Thekke Puthalath, cause of CVF in most of the western studies, accounting for approximately 70% of Professor and HOD, cases. Diverticular CVF is uncommon in Asia. This case series shares the experience Department of Urology, K.S. Hegde Medical Academy, of six cases of diverticular CVF in Indian population. NITTE (Deemed to be University) Post Nithyananda Nagar, Deralakatte, METHODS Mangalore-575018, Karnataka, India. Medical records of six patients with diverticular colovesical fistulas during the period E-mail: [email protected] January 2016 - August 2019 were reviewed with regard to symptoms, diagnostic investigations, and management. Various aspects of the disease were analysed to DOI: 10.14260/jemds/2020/466 determine the common features of colovesical fistula in our population. How to Cite This Article: Kalra G, Puthalath RT, Hegde S, et al.