Recurrent cerebellar ischemic infarctions and stereotyped peri-ictal sympathetic responses in a near-SUDEP patient with cardiovascular risk factors

We report a 60-year-old woman who presented to the emergency department after experiencing a witnessed unknown onset bilateral tonic clonic seizure (GTCS) that culminated in cardiac arrest. A neurology consultant uncovered a years-long history of frequent episodic staring followed by confusion and expressive aphasia, which strongly suggested that she suffered from epilepsy. Thus, her cardiac arrest and subsequent resuscitation met criteria for a near-sudden unexpected death in epilepsy (SUDEP) diagnosis. Serial bloodwork demonstrated transient troponin I elevations and leukocytoses, while a brain MRI revealed global cerebral anoxic injury and a small acute right cerebellar ischemic infarction. A review of her medical record uncovered a hospitalization sixteen months earlier for a likely GTCS whose workup showed similar troponin I elevations and leukocytoses, and surprisingly, a different small acute right cerebellar ischemic infarction in the same vascular territory. To our knowledge, this is the first report of subcortical ischemic infarctions occurring concurrently with GTCSs in a near-SUDEP patient. Aside from illustrating the key role of inpatient neurologists in the diagnosis of near-SUDEP, this manuscript discusses the potential significance of postictal ischemic infarctions, transient asymptomatic troponin elevations, and transient non-infectious leukocytoses in epilepsy patients with cardiovascular risk factors.

Initial experience with a rapid access blackouts triage clinic

Transient loss of consciousness (T-LOC), or blackout, is common in acute medicine. Clinical skills are not done well, with at least 74,000 patients misdiagnosed and mistreated for epilepsy in England alone. The aim of this study was to provide a rapid, structured assessment and an electrocardiogram (ECG) for patients with blackouts, aiming to identify high risk, reduce misdiagnoses, reduce hospital admission rates for low-risk patients, diagnose and treat where appropriate, and also provide onward specialist referral. The majority of patients had syncope, and very few had epilepsy. A high proportion had an abnormal ECG. A specialist-nurse-led rapid access blackouts triage clinic (RABTC) provided rapid effective triage for risk, a comprehensive assessment format, direct treatment for many patients, and otherwise a prompt appropriate onward referral. Rapid assessment through a RABTC reduced re-admissions with blackouts. Widespread use of the web-based blackouts tool could provide the NHS with a performance map. The U.K. has low rates of pacing compared to Western Europe, which RABTCs might help correct. The RABTC sits between first responders and specialist referral, providing clinical assessment and ECG in all cases, and referral where appropriate.

The dynamics of distance, velocity and acceleration of power output in the 30-s Wingate Anaerobic Test

The purpose of the present study was to analyse the dynamics of distance, velocity and acceleration of the 30-s Wingate Anaerobic Test. Participants were 53 young adult Rugby Union football players of mean age 21.6±2.5 yr, 180.5±7.2 cm height and 89.3±12.7 kg body mass. Measurements of power were obtained using a friction-belt cycle ergometer (Monark 864, Varberg, Sweden). Individual data were aligned according to peak power output, which resulted in a mean value of 1 216±256 W, compared with one of 1 180±256 W when calculated cross-sectionally (p<0.0001). The derivatives of velocity and acceleration were obtained using the mathematical software Mathcad. Distance, velocity and acceleration curves were plotted simultaneously at 1 s intervals before and after peak power output (-4 s to +28 s). The initial rise of the distance curve was the result of a general trend in decreasing positive velocities as far as peak power output, followed thereafter by a gradual deterioration of power, the result of negative velocities from peak power output to +28 s peak power output. The initial values of the acceleration curve showed a fluctuating decelerating trend of negative values to peak power output; subsequently all values remained positive running along the zero acceleration time axis. Coefficients of correlation between peak power output and power values at -1 s to -3 s were 0.80, 0.65 and 0.63 respectively (p<0.001). The relationship between velocity and acceleration was - 0.968 (p<0.01).

ACE ID genotype and leg power in Rugby Union players

AIM

The present study examined the hypothesis that there were no significant differences between forwards and backs in the elements of leg power between the ID and DD genotypes of the ACE (I/D) gene in developing young adult Rugby Union players.

METHODS

Sixty-eight players were recruited to identify the distribution of genotypes between forwards and backs. Fifty-eight players were investigated for leg power. Forwards (n=28) comprised 15 ID and 13 DD genotypes, and backs (n=30) 19 ID and 11 DD genotypes. Leg power was measured on a force platform using a counter movement jump; the parameters of interest were peak and relative force, peak and relative power, displacement and velocity. The three-primer polymerase chain reaction was used to assay the region of interest for I and D variants of the ACE gene. The distribution of genotypes was determined by chi-square and comparisons between forwards and backs made using the independent t-test.

RESULTS

No significant differences were identified in the distribution of genotypes between forwards and backs (χ2=2.2, P=0.336). However, significant differences were identified between forwards and backs in a number of components of leg power. Backs had significantly larger values than forwards for relative force (1.50 vs. 1.30 Wt%, P=0.001) and relative power (27.1 vs. 24.3 W.kg-1, P=0.034) for the ID genotype, whereas backs had significantly larger values than forwards for displacement (0.42 vs. 0.38 m, P=0.049) and velocity (2.76 vs. 2.55 m.s.(-1), P=0.007) for the DD genotype.

CONCLUSION

The characteristics of leg power identified will enhance the functional requirements of players according to playing position and commitment.

Perception of effort at low and moderate intensity exercise in survivors of childhood acute lymphoblastic leukaemia

OBJECTIVE

The study examined the degree to which male and female survivors of acute lymphoblastic leukaemia (ALL) perceive effort at low and moderate intensity exercise in association with related physiological variables.

MATERIALS AND METHODS

Participants were 67 children. Thirty-five (14 boys and 21 girls) were long-time survivors of ALL and 32 (18 boys and 14 girls) were control subjects. The Children's Effort Rating Table (CERT) was used to measure whole-body perceived exertion at low and moderate intensity exercise. Peak oxygen uptake was measured using a motorized treadmill. CERT and physiological data were analysed using 2 x 2 mixed analyses of variance, appropriate t-tests and coefficients of correlation.

RESULTS

In absolute terms, boys treated for ALL found perception of effort to be more strenuous at both low (3.9 vs. 3.5 units) and moderate (6.1 vs. 5.3 units) intensity exercise than control subjects, although differences were not significant (p > 0.05); girls treated for ALL found perception of effort to be the same as controls at low intensity exercise (3.1 vs. 3.1 units) but slightly higher than controls at moderate intensity exercise (5.6 vs. 5.2 units); neither of these differences were significant (p > 0.05). When CERT values were adjusted for (.-)VO(2) peak (%) and heart rate (HR) peak (%) differences remained non-significant. There were no significant interactions (Intensity x Group) in males, but the interaction for (.-)VO(2) peak (%) was significant in females (p < 0.05). The main effect for Intensity (low and moderate) was significant for all variables in boys and girls (p < 0.0001). The main effect for Group (ALL and controls) identified significantly greater absolute (b.p.m.) and relative (%) HR values in ALL boys at low and moderate intensity exercise. In female ALL and control subjects the interaction (Intensity x Group) distinguished between (.-)VO(2) peak (%) at moderate intensity exercise and HR peak (%) at low and moderate intensity exercise. Coefficients of correlation between perceived effort and (.-)VO(2) peak (%) in boys and girls were low to high (0.28-0.76), and between absolute and relative HR were also low to high (0.33-0.73). There were low correlations between time 'off therapy' and perceived effort, (.-)VO(2) peak (%) and HR peak (%) (-0.003 to -0.49).

CONCLUSION

It was concluded that perception of effort in survivors of ALL at low and moderate intensity exercise was the same as that of control subjects. Correlations between perceived effort and physiological variables at moderate exercise were low to high, while those between perceived effort and time from treatment were generally weak.

Effect of Individual Time to Peak Power Output on the Expression of Peak Power Output in the 30-s Wingate Anaerobic Test

The objective of the present investigation was to examine a proposal which stated that individual power values should be aligned according to peak power output (PPO) before calculating the mean value of PPO. This procedure removes the variation in time it takes for individuals to reach PPO. Participants were forty-one University Rugby Union Football players of mean age 21.7 +/- 2.6 years, height 181.4 +/- 6.9 cm and body mass 88.9 +/- 12.7 kg. Data were collected using a friction-belt cycle ergometer (Monark 864, Varberg, Sweden). A significantly larger mean value for PPO was found when results were calculated from time-aligned rather than cross-sectional data (1154 +/- 246 vs. 1121 +/- 254 W, p < 0.0001); the mean difference was approximately 3 %. Additionally, the average profile of the power output curve was more reflective of individual power curves. The negative correlation between PPO and the time taken to reach PPO was - 0.32 (p < 0.05), confirming the view that the earlier the time taken to reach PPO the larger the PPO. It was concluded that the mean value of PPO and the corresponding profile for power output curves are best represented by the analysis of time-aligned rather than cross-sectional data.

Phase II trial of iboctadekin (rhIL-18) on a daily X 5 schedule in metastatic melanoma (MM)

10043

Background: Interleukin-18 (IL-18) is an immunostimulatory cytokine with potent antitumor activity in preclinical models. Two phase I studies of recombinant human (rh) IL-18 explored a wide dose range (0.03–1.0 mg/kg) without reaching a maximum tolerated dose (MTD) on the daily × 5 schedule. Pharmacodynamic data including inflammatory cytokine production and activation of lymphocyte subsets revealed optimal biologic activity at the lower end of the dose range (0.01–0.2 mg/kg) as did 2 unconfirmed partial responses (PRs) in a MM and a renal cancer patient (pt) at 0.1 mg/kg. Methods: An open-label, randomized, phase II trial in 60 adult pts with previously untreated MM was conducted to evaluate the efficacy and safety of rhIL-18 administered as a 2-hour IV infusion daily × 5 every 28 days for 6 cycles. Pts with PS ≤ 1, without known CNS involvement, and with adequate end organ function were randomized in stage 1 to 3 dose levels of IL-18 stratified according to AJCC M stage 1a/b vs. 1c. Two confirmed responses for a given dose level in Stage 1 were required to enroll 20 additional pts/level in Stage 2. The 1° objective was determination of overall response rate (ORR) for each dose level. Progression-free survival (PFS), tolerability, and immunogenicity were 2° endpoints. Results: 64 pts were treated at 3 dose levels. Nine pts remain on study. One pt experienced a confirmed PR. Based on preliminary data, the difference in PFS 6 months (mos) was significant (p=0.03) for 0.01 vs 0.1 mg/kg. Most common toxicities were mild to moderate fever, rigors, chills, n/v, and headache. Anti-IL18 antibody (Ab) development correlated with dose level. No clinically significant adverse events were associated with Ab development. Conclusion: Iboctadekin has an acceptable tolerability profile and has activity in MM but insufficient confirmed responses have been observed at this time to initiate Stage 2. Preliminary PFS 6 months indicates an advantage for pts treated at the lowest dose.

[Table: see text]

[Table: see text]

Fatty acids differentially affect serotonin receptor and transporter binding in the rat brain

The aim of this study was to examine the influence of different fat diets on serotonin receptor and transporter binding. Male Sprague-Dawley rats were fed a diet of either high saturated fat, omega-6 polyunsaturated fatty acid, omega-3 polyunsaturated fatty acid or low fat (control) for eight weeks. Using Beta-Imager quantification techniques, [(3)H]ketanserin, [(3)H]mesulergine and [(3)H]paroxetine binding to serotonin (5-HT)(2A), 5-HT(2C) receptors and 5-HT transporters (5-HTT) was measured throughout the brain in all four groups. All three high fatty acid diets influenced serotonin receptor binding, however the most pronounced effects were that compared with the low fat control group, i) 5-HT(2A) receptor binding was increased in the caudate putamen, but reduced in the mammillary nucleus in high saturated fat and high omega-6 polyunsaturated fatty acid diet groups; ii) 5-HT(2C) receptor binding was reduced in the mamillary nucleus of saturated fat group and reduced in prefrontal cortex of the omega-6 polyunsaturated fatty acid and omega-3 polyunsaturated fatty acid groups; and iii) 5-HTT binding was reduced in the hippocampus in the omega-6 polyunsaturated fatty acid group. Overall, the omega-6 polyunsaturated fatty acid diet exerted the most influence on serotonin receptor and transporter binding. These results may be of importance in relation to neuropsychiatric diseases such as schizophrenia, where associations between altered fatty acid levels and the serotonergic system have been made.

Regional placement of bone mineral mass, fat mass, and lean soft tissue mass in young adult rugby union players

The purpose of the present study was to ascertain whether differences existed in the regional placement of bone mineral mass (BMM), fat mass (FM) and lean soft tissue mass (LSTM) between playing units in Rugby Union Football and between players and control subjects. Thirty young adult rugby players and 21 controls participated in the study. Players were assigned to groups as either forwards (n = 15) or backs (n = 15). Control subjects were matched (n = 15) to rugby players using the mean BMI of forwards and backs. BMM, FM and LSTM were measured using dual-energy X-ray absorptiometry. The digital image of each subject was partitioned into regional anatomical segments comprising the head, right and left arms, trunk, and right and left legs. Measurements were summed for the arms and legs respectively. One-way ANOVA was used to differentiate between- and within-groups; Tukey's post-hoc test was applied to identify pairwise differences. The alpha level was set throughout at p = 0.01. Principal components analysis was utilized to contrast the regional segments of each tissue in each of the groups. Forwards exhibited larger absolute (kg) amounts of BMM, FM and LSTM than backs or controls. In relative terms (%) there were no significant differences in BMM(%) between forwards, backs and controls in the arms and legs, but differences did occur between backs and controls at the trunk (2.9 vs. 2.5%). Backs had a significantly larger LSTM(%) than forwards at the arms (84.4 vs. 76.5%), legs (80.0 vs. 71.9%) and trunk (89.2 vs. 79.0%), whereas forwards had a greater FM(%) than backs at the arms (18.7 vs. 10.6%), legs (23.1 vs. 14.7%), and trunk (18.4 vs. 8.0%). The distribution of BMM showed a lower body-upper body contrast in forwards, a trunk-extremity contrast in backs and an arm-lower body contrast in controls. FM exhibited a trunk-extremity contrast in all three groups, while LSTM displayed an arm-lower body contrast in all three groups. It is concluded that there are significant regional tissue differences between forwards and backs, which may be related to playing function, and also differences between rugby players and controls.

Somatic characteristics and cardiovascular risk factors in growth hormone deficiency: A randomized, double-blind, placebo-controlled study of the effect of treatment with recombinant human growth hormone

The purpose of the present study was to identify the effect of treatment with recombinant human growth hormone (rhGH) on seven somatic characteristics and eight clinical cardiovascular risk factors. Twenty-seven male and 24 female patients between the ages of 21 and 60 years were examined. The investigation was a double-blind, placebo-controlled study of 12 months duration. Patients were assigned randomly to treatment (T) and placebo (P) groups. In the first 6 months group T received rhGH and group P placebo. In the second 6 months both groups received rhGH. Complete data were available for 23 males and 20 females. Increments were calculated between 6 months -BL (increment 1) and 12-6 months (increment 2) in both T and P groups. Apart from the somatotype, data were analysed with a 2 x 2 mixed analysis of variance (ANOVA) using treatment (rhGH and placebo) and time (increments 1 and 2). Somatotype data were analysed using a 2 x 3 multivariate ANOVA. Three significant interactions were identified in males: waist circumference (P = 0.006), trunk fat (P = 0.0001), and conicity index (P = 0.001). The only significant interaction in females was trunk fat (P = 0.006). In general, treatment and placebo groups responded differently by time and treatment. Responses were similar in males and females. In the first 6 months when group P was on placebo, waist circumference, trunk fat, and conicity index increased slightly; with group T on rhGH somatic variables declined markedly. In the second 6 months when both groups received rhGH there was a marked decline in group P and a continued decline (but less steeply) in group T. In males there were significant decreases in endomorphy in group T and increases in mesomorphy in group P. In females the somatotype remained stable. There were no significant interactions in clinical cardiovascular risk factors in either males or females. Favourable responses occurred in male and female lipid profiles, although these were not significant. It was concluded that in males waist circumference, trunk fat, conicity index, and somatotype responded significantly to treatment with rhGH; in females the only significant response was trunk fat.

Comprehensive cardiac rehabilitation programme for implantable cardioverter-defibrillator patients: a randomised controlled trial

OBJECTIVE

To investigate the effects of a 12 week comprehensive cardiac rehabilitation (CCR) programme on patients who have undergone implantation of an implantable cardioverter-defibrillator (ICD).

DESIGN

Sixteen patients with ICDs (14 (88%) male, mean (SD) age 58 (10) years, range 34-74 years) were randomised to either attend an individually tailored CCR programme or receive usual care. They then changed to the alternative regimen for a further 12 weeks. Exercise capacity was assessed using a treadmill exercise test at baseline, after usual care, after CCR and 12 weeks after CCR to assess maintenance effects. Hospital anxiety and depression (HAD) scores were recorded at each stage.

RESULTS

Exercise times (min:s; mean (SD)) increased by 16% from a baseline mean of 9:55 (2:33) to 11:11 (2:17) following attendance at CCR (95% confidence interval (CI) 0:34 to 1:58; p = 0.001). This improvement was maintained 12 weeks after attendance at CCR, at 11:20 (2:17) (p = 1.00). HAD scores for anxiety and depression decreased during CCR from a baseline of 13.4 (3.6) to 8.1 (3.6), 95% CI 3.5 to 7.0 (p < 0.001) and 9.9 (3.4) to 6.7 (2.9), 95% CI 1.9 to 4.4 (p = 0.002), respectively. These improvements were maintained at 12 weeks after CCR. No ventricular arrhythmias or ICD discharges occurred during the exercise components of the CCR. The total number of ventricular arrhythmias and ICD discharges was similar 12 weeks before, during, and 12 weeks after CCR.

CONCLUSIONS

CCR appears to be safe for patients with ICDs. It can improve exercising ability and lower the levels of psychological distress. A larger multicentre study is recommended to confirm these findings.

Protease-activated receptor 2, a receptor involved in melanosome transfer, is upregulated in human skin by ultraviolet irradiation

Previous studies have shown that the protease-activated receptor 2 is involved in skin pigmentation through increased phagocytosis of melanosomes by keratinocytes. Ultraviolet irradiation is a potent stimulus for melanosome transfer. We show that protease-activated receptor 2 expression in human skin is upregulated by ultraviolet irradiation. Subjects with skin type I, II, or III were exposed to two or three minimal erythema doses of irradiation from a solar simulator. Biopsies were taken from nonexposed and irradiated skin 24 and 96 h after irradiation and protease-activated receptor 2 expression was detected using immunohistochemical staining. In nonirradiated skin, protease-activated receptor 2 expression was confined to keratinocytes in the lower one-third of the epidermis. After ultraviolet irradiation protease-activated receptor 2 expression was observed in keratinocytes in the upper two-thirds of the epidermis or the entire epidermis at both time points studied. Subjects with skin type I showed delayed upregulation of protease-activated receptor 2 expression, however, compared with subjects with skin types II and III. Irradiated cultured human keratinocytes showed upregulation in protease-activated receptor 2 expression as determined by immunofluorescence microscopy and Western blotting. Cell culture supernatants from irradiated keratinocytes also exhibited a dose-dependent increase in protease-activated receptor-2 cleavage activity. These results suggest an important role for protease-activated receptor-2 in pigmentation in vivo. Differences in protease-activated receptor 2 regulation in type I skin compared with skin types II and III suggest a potential mechanism for differences in tanning in subjects with different skin types.

Reliability of power output measurements during repeated treadmill sprinting in rugby players

The non-motorized treadmill system initially reported by Lakomy in 1984 has been used extensively to assess sprinting performance. However, there has been limited research into the reliability of power output measurement using such systems. The aim of this study was to design a system and protocol capable of measuring treadmill sprinting performance in rugby players and to assess the reliability of this system for measuring power output. Twenty-seven rugby players, all of whom were familiar with treadmill sprinting, performed three maximal 6 s sprints with 2 min recovery between sprints, on two occasions 1 week apart. Both tests were performed on a non-motorized Woodway tramp treadmill, interfaced to a data acquisition system. There were no significant differences (P > 0.05) between power output for repeated trials on the same day (between trials) or for repeated trials on different days (between days). Limits of agreement for maximum average power (the average of 100 readings per second) were 4+/-98 and 30+/-157 W for between trials and between days, respectively. When reported as ratio limits of agreement, these were 1.07 (*/divided 1.12) and 1.03 (*/divided 1.16), respectively. The limits of agreement for maximum instantaneous power (the highest of 100 readings per second) were 51+/-464 and 105+/-588 W for between trials and between days, respectively. When reported as ratio limits of agreement, these were 1.02 (*/divided 1.20) and 1.04 (*/divided 1.21) for between trials and between days, respectively. The coefficients of variation for all measures of power output were less than 9.3%. Hence, the treadmill system and protocol developed in this study provide a reliable measure of power output for rugby players.

Prediction and validation of fat-free mass in the lower limbs of young adult male Rugby Union players using dual-energy X-ray absorptiometry as the criterion measure

The aim was to derive and cross-validate prediction equations to estimate fat-free mass (FFM) in the lower limbs of young adult male Rugby Union players. Thirty players of mean +/- SD age of 21.1 +/- 2.1 years were recruited. Bone mineral mass, fat mass and lean tissue mass were measured with a Hologic QDR 1000/W whole-body scanner. Anthropometry included circumferences, segmental leg lengths and skinfold thicknesses. Players were divided randomly into prediction (n = 15) and cross-validation (n = 15) samples. Regression equations were derived from the prediction sample and validated on the cross-validation sample. Seven equations were formulated to predict leg FFM. The two equations providing the lowest standard errors of estimate were leg length with circumferences at the knee (0.7262) and calf (0.7382); the multiple correlation was 0.83 in both instances. Cross-validation statistics found no significant differences (p > 0.05) between measured (12.4 +/-1.5 kg) and predicted leg FFM (12.1-12.4 kg). The smallest mean difference was -0.05 kg, the largest 0.26 kg; these were equivalent to -0.4 and 2.1% of the measured leg FFM respectively. Correlations between measured and predicted leg FFM were reasonably high (0.79-0.90, p < 0.001). The ratio limits of agreement confirmed that there was little bias between measured and predicted leg FFM (1.00-1.02) and a good level of agreement (1.12-1.16). Because prediction equations tend to be age, gender and population specific, unless validated for other athletic groups, the present equations should be applied to male Rugby Union players with characteristics similar to those described.

Effect of recombinant human growth hormone on regional tissue distribution in growth hormone-deficient males

Dual-energy X-ray absorptiometry was used to analyze the regional tissue distribution of bone mineral mass (BMM), fat mass (FM), and lean tissue mass (LTM) in the arms, trunk, and legs of 23 male growth hormone-deficient (GHD) males. Patients were assigned randomly to treatment (n = 11) and control (n = 12) groups. During the first six months, the treatment group received recombinant growth hormone (rhGH) and the control group placebo. During the second six months, both groups received rhGH. Following treatment there was a trend for BMM to be lost in the arms and legs, with gains at the trunk. Fat mass was lost mainly from the trunk. Proportionally more LTM was distributed to the arms and legs than to the trunk. Treatment was more effective in the first six months than the second. The correlation between the waist-hip ratio and trunk fat was poor, suggesting that its use in patients with GHD may be misleading.

Use of telemedicine for children with special health care needs

OBJECTIVE

In 1995, the Children's Medical Services (CMS) of the State of Georgia contracted with the Department of Pediatrics of the Medical College of Georgia (MCG) and the MCG Telemedicine Center to develop telemedicine programs to provide subspecialty care for children with special health care needs. This article presents project statistics and results of client evaluation of services, as well as physician faculty attitudes toward telemedicine.

DESIGN

A demonstration project using telemedicine between a tertiary center and a rural clinic serving children with special health care needs was established. Data were collected and analyzed for December 12, 1995 to May 31, 1997, during which 333 CMS telemedicine consultations were performed.

RESULTS

Most CMS telemedicine consultations (35%) involved pediatric allergy/immunology. Other subspecialties included pulmonology (29%), neurology (19%), and genetics (16%). Overall, patients were satisfied with the services received. Initially, physician faculty members were generally positive but conservative in their attitudes toward using telemedicine for delivering clinical consultation. After a year's exposure and/or experience with telemedicine, 28% were more positive, 66% were the same, and only 4% were more negative about telemedicine. The more physicians used telemedicine, the more positive they were about it (r =.30).

CONCLUSIONS

In terms of family attitudes and individual care, telemedicine is an acceptable means of delivering specific pediatric subspecialty consultation services to children with special health care needs, living in rural areas distant to tertiary centers. Telemedicine is more likely to be successful as part of an integrated health services delivery than when it is the sole mode used for delivery of care.

Carcinoid tumor of the hepatic duct presenting as a Klatskin tumor in an adolescent and review of world literature

This is a case presentation of a 14-year-old boy with the radiological diagnosis of cholangiocarcinoma occluding the hepatic duct bifurcation. His only symptom at presentation was jaundice and further workup confirmed a mass at the porta hepatis. Surgical treatment resulted in a resection of the hepatic bifurcation tumor with a final pathological diagnosis of a carcinoid tumor of the hepatic duct bifurcation. To our knowledge, this is only the second case presented of a resected carcinoid tumor in adolescence. In this communiqué we present the above case and review of the world literature of biliary neuroendocrine tumors.