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Kotb MA, Fawaz LA, Zeitoun RA, Shaalan YM, Aly N, Abd El Kader H, El Tagy G, Esmat H, Hamza AF, Abd El Baky H. Bone demineralization in a cohort of Egyptian pediatric liver transplant recipients: Single center pilot study. Medicine (Baltimore) 2022; 101:e31156. [PMID: 36397404 PMCID: PMC10662835 DOI: 10.1097/md.0000000000031156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 09/14/2022] [Indexed: 11/19/2022] Open
Abstract
Liver transplantation (LT) is the definitive treatment of end-stage liver disease. The long-term survival following LT spurred more interest in improving the quality of life of patients. This was a cohort study that included 23 pediatric liver transplant recipients who underwent LT due to hereditary or metabolic liver diseases. Bone health assessment was performed at their last follow up clinically (anthropometric measures), biochemically and radiologically (Dual Energy X-ray Absorptiometry [DEXA] scans). Poor bone health was defined as z-score <-1. Mean age at LT was 5.77 years (standard deviation [SD] 3.64) and 43% were males. Biliary atresia was the most common cause of end stage liver disease (35%). Mean age at follow up was 14 years (SD 5.48) and mean follow up was 8 years (SD 4.12 years). Eleven patients (48%) had poor bone health (osteopenia 22% and osteoporosis 26%). On univariate analysis, being on steroids at last follow up (odds ratio [OR] 13.2, 95% confidence interval [CI] 1.23-140.67, P = .03), weight at last follow up (OR 0.45, 95% CI 0.20-0.99, P = .04), platelets at last follow up (OR 0.98, 95% CI 0.96-s0.99, P = .02), hemoglobin at last follow up (OR 0.33, 95% CI 0.12-0.89, P = .03) were significantly associated with poor bone health. None of the variables were significant on multivariate analysis. At most recent follow up, 48% of patients demonstrated poor bone health by DEXA scans. More studies are required to evaluate predictors of poor bone health after LT in children.
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Affiliation(s)
- Magd A. Kotb
- Department of Pediatrics, Cairo University, Cairo, Egypt
| | - Lubna A. Fawaz
- Department of Pediatrics, Cairo University, Cairo, Egypt
| | | | | | - Nazira Aly
- Department of Pediatrics, Cairo University, Cairo, Egypt
| | | | - Gamal El Tagy
- Department of Pediatric Surgery, Cairo University, Cairo, Egypt
| | - Haytham Esmat
- Department of Pediatric Surgery, Cairo University, Cairo, Egypt
| | - Alaa F. Hamza
- Department of Pediatric Surgery, Ain Shams University, Cairo, Egypt
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Kotb MA, Hamza AF, Abd El Kader H, El Monayeri M, Mosallam DS, Ali N, Basanti CWS, Bazaraa H, Abdelrahman H, Nabhan MM, Abd El Baky H, El Sorogy STM, Kamel IEM, Ismail H, Ramadan Y, Abd El Rahman SM, Soliman NA. Combined liver-kidney transplantation for primary hyperoxaluria type I in children: Single Center Experience. Pediatr Transplant 2019; 23:e13313. [PMID: 30475440 DOI: 10.1111/petr.13313] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/31/2018] [Accepted: 10/02/2018] [Indexed: 12/11/2022]
Abstract
Primary hyperoxalurias are rare inborn errors of metabolism with deficiency of hepatic enzymes that lead to excessive urinary oxalate excretion and overproduction of oxalate which is deposited in various organs. Hyperoxaluria results in serious morbid-ity, end stage kidney disease (ESKD), and mortality if left untreated. Combined liver kidney transplantation (CLKT) is recognized as a management of ESKD for children with hyperoxaluria type 1 (PH1). This study aimed to report outcome of CLKT in a pediatric cohort of PH1 patients, through retrospective analysis of data of 8 children (2 girls and 6 boys) who presented by PH1 to Wadi El Nil Pediatric Living Related Liver Transplant Unit during 2001-2017. Mean age at transplant was 8.2 ± 4 years. Only three of the children underwent confirmatory genotyping. Three patients died prior to surgery on waiting list. The first attempt at CLKT was consecutive, and despite initial successful liver transplant, the girl died of biliary peritonitis prior to scheduled renal transplant. Of the four who underwent simultaneous CLKT, only two survived and are well, one with insignificant complications, and other suffered from abdominal Burkitt lymphoma managed by excision and resection anastomosis, four cycles of rituximab, cyclophosphamide, vincristine, and prednisone. The other two died, one due to uncontrollable bleeding within 36 hours of procedure, while the other died awaiting renal transplant after loss of renal graft to recurrent renal oxalosis 6 months post-transplant. PH1 with ESKD is a rare disease; simultaneous CLKT offers good quality of life for afflicted children. Graft shortage and renal graft loss to oxalosis challenge the outcome.
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Affiliation(s)
- Magd A Kotb
- Pediatric Hepatology Unit, Faculty of Medicine, Department of Pediatrics, Cairo University, Cairo, Egypt.,Wadi El Nil Hospital, Pediatric Living-Related Liver Transplantation Team, Cairo, Egypt
| | - Alaa F Hamza
- Wadi El Nil Hospital, Pediatric Living-Related Liver Transplantation Team, Cairo, Egypt.,Faculty of Medicine, Department of Pediatric Surgery, Ain Shams University, Cairo, Egypt
| | - Hesham Abd El Kader
- Wadi El Nil Hospital, Pediatric Living-Related Liver Transplantation Team, Cairo, Egypt.,Faculty of Medicine, Department of Pediatric Surgery, Ain Shams University, Cairo, Egypt
| | - Magda El Monayeri
- Wadi El Nil Hospital, Pediatric Living-Related Liver Transplantation Team, Cairo, Egypt.,Faculty of Medicine, Department of Pathology, Ain Shams University, Cairo, Egypt
| | - Dalia S Mosallam
- Pediatric Hepatology Unit, Faculty of Medicine, Department of Pediatrics, Cairo University, Cairo, Egypt
| | - Nazira Ali
- Pediatric Hepatology Unit, Faculty of Medicine, Department of Pediatrics, Cairo University, Cairo, Egypt.,Wadi El Nil Hospital, Pediatric Living-Related Liver Transplantation Team, Cairo, Egypt
| | | | - Hafez Bazaraa
- Pediatric Hepatology Unit, Faculty of Medicine, Department of Pediatrics, Cairo University, Cairo, Egypt.,Department of Pediatrics, Center of Pediatric Nephrology & Transplantation, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt.,Egyptian Group for Orphan Renal Diseases (EGORD), Cairo, Egypt
| | - Hany Abdelrahman
- Pediatric Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Marwa M Nabhan
- Pediatric Hepatology Unit, Faculty of Medicine, Department of Pediatrics, Cairo University, Cairo, Egypt.,Department of Pediatrics, Center of Pediatric Nephrology & Transplantation, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt.,Egyptian Group for Orphan Renal Diseases (EGORD), Cairo, Egypt
| | - Hend Abd El Baky
- Pediatric Hepatology Unit, Faculty of Medicine, Department of Pediatrics, Cairo University, Cairo, Egypt.,Wadi El Nil Hospital, Pediatric Living-Related Liver Transplantation Team, Cairo, Egypt
| | | | - Inas E M Kamel
- Department of Pediatrics, National Research Center, Cairo, Egypt
| | - Hoda Ismail
- Wadi El Nil Hospital, Pediatric Living-Related Liver Transplantation Team, Cairo, Egypt.,Department of Pediatrics, Wadi El Nil Hospital, Cairo, Egypt
| | - Yasmin Ramadan
- Pediatric Hepatology Unit, Faculty of Medicine, Department of Pediatrics, Cairo University, Cairo, Egypt.,Department of Pediatrics, Center of Pediatric Nephrology & Transplantation, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt.,Egyptian Group for Orphan Renal Diseases (EGORD), Cairo, Egypt
| | - Safaa M Abd El Rahman
- Pediatric Hepatology Unit, Faculty of Medicine, Department of Pediatrics, Cairo University, Cairo, Egypt.,Department of Pediatrics, Center of Pediatric Nephrology & Transplantation, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt.,Pediatric Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Neveen A Soliman
- Pediatric Hepatology Unit, Faculty of Medicine, Department of Pediatrics, Cairo University, Cairo, Egypt.,Department of Pediatrics, Center of Pediatric Nephrology & Transplantation, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt.,Egyptian Group for Orphan Renal Diseases (EGORD), Cairo, Egypt
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Kotb MA, Abd El Satar I, Badr AM, Anis NH, Abd El Rahman Ismail H, Hamza AF, Abdelkader HM. Pulmonary hypertension and cardiac hypertrophy in children recipients of orthotopic living related liver transplantation. J Adv Res 2017; 8:663-668. [PMID: 28879059 PMCID: PMC5581852 DOI: 10.1016/j.jare.2017.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 07/25/2017] [Accepted: 07/26/2017] [Indexed: 12/17/2022] Open
Abstract
Surgical stress, liberation of cytokines associated with re-perfusion injury, and long standing use of immune suppressive medications in children recipients of orthotopic living related liver transplantation (OLRLT) pose cardiovascular risk. Reported cardiovascular adverse effects vary from left ventricular wall thickening, hypertrophic cardiomyopathy to resting ECG abnormalities, asymptomatic ST depression following increased heart rate and ventricular arrhythmias. Twenty-five consecutive children recipients of OLRLT were assessed by conventional 2-D, M-mode echocardiography and Doppler. The mean age ± SD at transplantation and at enrollment in study was 6.3 ± 4.5 and 13.5 ± 5.6 years respectively. All children were on immunosuppressive medications, with tacrolimus being constant among all. Long-term post-transplant echocardiography revealed statistically significant interventricular septal hypertrophy among all (mean thickness 0.89 ± 0.16 cm), (P = 0.0001) in comparison to reference range for age, 24 had pulmonary hypertension (mean mPAP 36.43 ± 5.60 mm Hg, P = 0.0001), and early diastolic dysfunction with a mean Tei index of 0.40 ± 0.10. However cardiac function was generally preserved. Children recipients of OLRLT have cardiac structural and functional abnormalities that can be asymptomatic. Pulmonary hypertension, increased cardiac mass, de novo aortic stenosis and diastolic heart failure were among abnormalities encountered in the studied population. Echocardiography is indispensible in follow-up of children recipients of OLRLT.
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Affiliation(s)
- Magd A Kotb
- Department of Pediatrics, Faculty of Medicine, Cairo University, P.O. Box: 11461, Cairo, Egypt
| | - Inas Abd El Satar
- Department of Pediatrics, Faculty of Medicine, Cairo University, P.O. Box: 11461, Cairo, Egypt
| | - Ahmed M Badr
- Department of Pediatrics, Faculty of Medicine, Cairo University, P.O. Box: 11461, Cairo, Egypt
| | - Nancy H Anis
- Ghamra Military Hospital, P.O. Box: 11674, Cairo, Egypt
| | | | - Alaa F Hamza
- Pediatric Surgery Department, Ain Shams University, P.O. Box: 11588, Cairo, Egypt
| | - Hesham M Abdelkader
- Pediatric Surgery Department, Ain Shams University, P.O. Box: 11588, Cairo, Egypt
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Aly MMD, Hamza AF, Abdel Kader HM, Saafan HA, Ghazy MS, Ragab IA. Therapeutic superiority of combined propranolol with short steroids course over propranolol monotherapy in infantile hemangioma. Eur J Pediatr 2015; 174:1503-9. [PMID: 25982338 DOI: 10.1007/s00431-015-2561-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 05/03/2015] [Accepted: 05/06/2015] [Indexed: 12/14/2022]
Abstract
UNLABELLED Infantile hemangiomas are the most common benign childhood tumor that may have functional and/or cosmetic complications. We aimed to compare the clinical efficacy of propranolol alone and propranolol primed with systemic corticosteroids on the outcome of infantile hemangioma. A prospective randomized study included 40 infants aged less than 9 months with cutaneous hemangiomas. Patients were randomly assigned into two groups: group A were given oral prednisolone for the initial 2 weeks combined with oral propranolol, while group B were given oral propranolol alone for 6 months. The median age of the studied patients was 4.5 months (ranged 4 weeks-8 months). Sequential determination of the dimensions of the hemangiomas based on direct measurement and photographic analysis were performed. A significant reduction in the size of the lesions was found in group A in the 2-, 4-, and 8-week evaluation compared to group B (p < 0.001) with no statistical difference in the ultimate 6 month response (p = 0.134). Multiple logistic regression showed that early treatment before 6 months of age (OR 9.82, p = 0.007) and combined treatment with propranolol and prednisolone (OR 10.71, p = 0.006) were the predictors of best response. CONCLUSION Combining propranolol with corticosteroids gives a faster response and should be considered in treating life- or function-threatening hemangiomas.
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Affiliation(s)
- Mohamed M D Aly
- Pediatric Surgery Department, Ain Shams University, Cairo, Egypt.
| | - Alaa F Hamza
- Pediatric Surgery Department, Ain Shams University, Cairo, Egypt.
| | | | - Hatem A Saafan
- Pediatric Surgery Department, Ain Shams University, Cairo, Egypt.
| | - Mohamed S Ghazy
- Radiodiagnosis Department, Ain Shams University, Cairo, Egypt.
| | - Iman A Ragab
- Hematology-Oncology Unit, Pediatric Department, Ain Shams University, Abbasseya Square, Cairo, Egypt.
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El-Asmar KM, Hassan MA, Abdelkader HM, Hamza AF. Topical mitomycin C can effectively alleviate dysphagia in children with long-segment caustic esophageal strictures. Dis Esophagus 2015; 28:422-7. [PMID: 24708423 DOI: 10.1111/dote.12218] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Caustic ingestion in children and the resulting long esophageal strictures are usually difficult to be managed, and eventually, esophageal replacement was required for cases refractory to frequent dilatation sessions. Topical mitomycin C (MMC) application has been used recently to improve the results of endoscopic dilatation for short esophageal strictures. The study aims to assess the role of MMC application in management of long-segment caustic esophageal strictures. From January 2009 to June December 2013, patients presented with long caustic esophageal stricture (>3 cm in length) were included in this study and subjected to topical MMC application after endoscopic esophageal dilatation on multiple sessions. Regular follow-up and re-evaluation were done. A dysphagia score was used for close follow-up clinically; verification was done radiologically and endoscopically. During the specified follow-up period, 21 patients with long caustic esophageal stricture were subjected to topical MMC application sessions. Clinical, radiological, and endoscopic resolution of strictures occurred in 18 patients (85.7% cure rate). Number of dilatation sessions to achieve resolution of dysphagia was (n = 14.3 ± 5.7) with application of mitomycin two to six times. There was no recurrence in short- and mid-term follow-up. No complications were encountered related to topical MMC application. MMC is a promising agent in management of long-segment caustic esophageal strictures. Long-term follow-up is needed to prove its efficacy and to evaluate potential long-term side-effects of MMC application.
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Affiliation(s)
- K M El-Asmar
- Department of Pediatric Surgery, Ain Shams University, Cairo, Egypt
| | - M A Hassan
- Department of Otolaryngology, Ain Shams University, Cairo, Egypt
| | - H M Abdelkader
- Department of Pediatric Surgery, Ain Shams University, Cairo, Egypt
| | - A F Hamza
- Department of Pediatric Surgery, Ain Shams University, Cairo, Egypt
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Abstract
Liver disease in children in the developing world is a frequent occurrence, which is generally inadequately managed because of lack of resources. However, increasingly, there has been a demand for liver transplantation, where primary medical or surgical therapies have failed. The expertise and infrastructure required for a successful outcome are no different from those in more developed countries; if anything, the challenges are greater. Lack of deceased donors because of cultural and religious factors has driven the use of living donors. Short-term survival has generally been good, but long-term outcomes have rarely been reported. In this article, we review the experience of 2 centers at opposite ends of the continent and share our experience of slightly different settings and show that success can be achieved even in resource-reduced environments.
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Affiliation(s)
- Alastair J W Millar
- Department of Paediatric Surgery, School of Child and Adolescent Health, University of Cape Town and Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
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Naguib NN, Hamza AF, Kiberu S, Vali A, Davies DJ, McGowan BA, Izzidien AY. Heterotopic salivary gland presenting as a supra-clavicular swelling. Pediatr Surg Int 2009; 25:529-30. [PMID: 19404650 DOI: 10.1007/s00383-009-2366-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2009] [Indexed: 11/30/2022]
Abstract
A 5-month-old female was referred to the paediatric surgery clinic with a neck swelling in the right supra-clavicular region. This was thought clinically to be cystic hygroma. Pathology showed an ectopic salivary gland. This should be added to the list of differential diagnoses of neck swelling in childhood.
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Affiliation(s)
- Nader N Naguib
- Department of Surgery, Prince Charles Hospital, Merthyr Tydfil, UK.
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Abstract
Replacement of the esophagus in children is still a challenging problem; one of the major indications is failed esophageal atresia repair or long-gap ones. The colon is one of the best alternatives for replacement; long-term follow up has shown satisfactory results. In cases of complicated repair receiving frequent dilation and multiple operations, colon could be an alternative choice for these children to achieve normal swallowing.
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Affiliation(s)
- Alaa F Hamza
- Department of Pediatric Surgery, Ain-Shams University, Cairo, Egypt.
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Abstract
Congenital esophageal stenosis (CES) is suspected by a fixed intrinsic narrowing of the esophagus that affects the normal swallowing mechanism. The diagnosis is only confirmed by histopathologic picture, which may show fibromuscular disease (FMD) or tracheobronchial remnants (TBR). The latter involves ciliated pseudo stratified columnar epithelium, seromucous glands or cartilage each alone or in combination. The aim of this study is to document the usefulness of histologic picture of surgical specimens obtained from the lower esophageal pouch (LEP) during primary repair in detecting cases of CES associated with esophageal atresia (EA) with or without tracheoesophageal fistula (TEF). Over an 8-year period, 57 consecutive cases operated upon for EA with or without TEF were subjected for histologic examination of surgical specimens obtained from the tip of the LEP. Cases that histologically showed FMD or TBR were included. The usefulness of this histologic picture as a diagnostic and therapeutic aid is assessed. Methods of treatment and outcome were also reviewed. Eight patients out of 57 (14%) had a histologic picture suggestive of CES, two with FMD, four with TBR without cartilage and two with cartilage. Out of 57 patients, 23 developed strictures, six of them had positive biopsies suggestive of CES. One patient with TBR without cartilage did not have stricture. Another case of pure atresia had LEP resection and gastric pull up showed cartilage involving the whole lower esophagus. Excluding the case of pure EA with gastric pull up, all patients suffered from feeding problems and recurrent aspiration. Fluoroscopic barium studies showed late onset minor dysmotility in five patients and late onset major dysmotility in two. All cases studied showed significant gastro-esophageal reflux (GER). Stricture was seen at the anastomotic site extending distally in the two fibromuscular cases and one case with cartilage, at the anastomotic site in three cases with TBR without cartilage. Anti reflux surgical procedures were performed in four patients without benefit in two patients with major dysmotility. Dilatation was successful in the three patients with TBR without cartilage. One patient with cartilage had resection of the anastomotic site and required frequent dilatations and is now doing well. A case of FMD did not improve after frequent dilatations and myotomy together with Nissen's fundoplication and required resection while the other case of FMD responded partially to dilatations. Cartilage in cases of CES requires surgical resection. Those with TBR without cartilage may not develop stricture. If stricture develops, it responds well to dilatation and patients have good clinical outcomes. Unlike isolated CES, GER is a significant feature in CES with EA. Anti reflux procedures should be avoided before definitive surgery for the stricture and if necessary a partial wrap with gastrostomy is recommended. CES should be considered in the etiology of anastomotic stricture. Taking a surgical specimen routinely from the tip of the LEP during primary esophageal repair for histologic studies is highly recommended.
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Affiliation(s)
- Ashraf H M Ibrahim
- Armed Forces Hospital, Southern Region, King Faisal Military City, P. O. Box: 5062, Khamis Mushait, Kingdom of Saudi Arabia.
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Khalaf H, El-Meteini M, El-Sefi T, Hamza AF, El-Gazaz G, Saleh SM, Moustafa I, Gad H, Yosry A, El-Hussainy E, Khafaga M, Helmy A. Evolution of living donor liver transplantation in Egypt. Saudi Med J 2005; 26:1394-7. [PMID: 16155655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2022] Open
Abstract
OBJECTIVE To date, cadaveric organ donation is illegal in Egypt. Therefore, Egypt recently introduced living donor liver transplantation (LDLT), aiming to save those who are suffering from end stage liver disease. Herein, we study the evolution of LDLT in Egypt. METHODS In Egypt, between August 2001 and February 2004, we approached all centers performing LDLT through personal communication and sent a questionnaire to each center asking for limited information regarding their LDLT experience. RESULTS We identified and approached 7 LDLT centers, which collectively performed a total of 130 LDLT procedures, however, 3 major centers performed most of the cases (91%). Overseas surgical teams, mainly from Japan, France, Korea, and Germany, either performed or supervised almost all procedures. Out of those 7 LDLT centers, 5 centers agreed to provide complete data on their patients including a total of 73 LDLT procedures. Out of those 73 recipients, 50 (68.5%) survived after a median follow-up period of 305 days (range 15-826 days). They reported single donor mortality. Hepatitis C virus cirrhosis, whether alone or mixed with schistosomiasis, was the main indication for LDLT. CONCLUSION Egypt recently introduced LDLT with reasonable outcomes; yet, it carries considerable risks to healthy donors, it lacks cadaveric back up, and is not feasible for all patients. We hope that the initial success in LDLT will not deter the efforts to legalize cadaveric organ donation in Egypt.
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Affiliation(s)
- Hatem Khalaf
- Department of Liver Transplantation and Hepatobiliary-Pancreatic Surgery MBC-72, King Faisal Specialist Hospital and Research Center, PO Box 3354, Riyadh 11211, Kingdom of Saudi Arabia.
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Elhalaby EA, Hashish A, Elbarbary MM, Soliman HA, Wishahy MK, Elkholy A, Abdelhay S, Elbehery M, Halawa N, Gobran T, Shehata S, Elkhouly N, Hamza AF. Transanal one-stage endorectal pull-through for Hirschsprung's disease: a multicenter study. J Pediatr Surg 2004; 39:345-51; discussion 345-51. [PMID: 15017550 DOI: 10.1016/j.jpedsurg.2003.11.038] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND/PURPOSE Transanal endorectal pull-through (TEPT) is the latest development in treatment of Hirschsprung's disease (HD). This prospective study was designed to evaluate the safety and efficacy of 1 stage TEPT technique in the management of patients with HD. METHODS One hundred forty-nine children (116 boys and 33 girls) aged 8 days to 14 years underwent 1 stage TEPT procedure over an 18-month period at 5 Egyptian academic pediatric surgical centers and affiliated hospitals. Median follow-up was 12 months (range, 3 to 21 months). These patients were evaluated with regard to age, sex, length of the aganglionic segment, intraoperative details, and postoperative functional results or complications. An electromyogram (EMG), endorectal ultrasound scan, and lower gastrointestinal (GI) motility studies were reserved for patients with postoperative problems with bowel control. RESULTS Mean operating time was 120.2 +/- 27.8 minutes (range, 60 to 210 minutes). The average length of resected bowel was 26.8 +/- 12.4 cm (range, 15 to 45 cm). Thirteen patients required laparotomy because of extension of aganglionic segment beyond the sigmoid colon in 9, tear in the mesenteric vessels in 2, and difficulties in getting to the submucosal plane in 2. Three deaths (2%) occurred 3 days, 4 days, and 4 weeks postoperatively, respectively. Postoperative complications included transient perianal excoriation in 48 patients (30 were <3 months of age), enterocolitis (n = 26), anastomotic stricture (n = 7), recurrent constipation (n = 6), hypoganglionosis at distal end of pulled through segment (n = 2), cuff abscess (n = 3), anastomotic leak (n = 1), adhesive bowel obstruction (n = 1), and rectal prolapse (n = 1). Complete anorectal continence was noted in 35 of 42 (83.3%) children older than 3 years, whereas soiling and frequent accidents still occur in 7, who showed a steady improvement in their continence status. CONCLUSIONS One-stage TEPT technique is both feasible and safe technique in properly selected children with rectosigmoid HD in all ages. The technique is easily learned and is associated with excellent clinical results.
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Abstract
Many children in developing countries continue to sustain caustic esophageal injures. The first line of treatment is dilatation, unless contraindicated, where 60% to 80% success rate is expected. In cases of failure, esophageal replacement is the only hope for achieving normal swallowing. Over the last 30 years, more than 850 cases of esophageal replacement were done in the Pediatric Surgery Department at Ain-Shams University. Three types of replacement were performed, gastric pull-up (75 cases), retrosternal colon replacement (550 cases), and, in the last 12 years, transhiatal esophagectomy with posterior mediastinal colon replacement (225 cases). Complications in the last 475 cases include 10% cervical leakage, 5% proximal strictures, 2% postoperative intestinal obstruction, 1% mortality, and 0.6% late graft stenosis. Colonic replacement of the esophagus is the ideal treatment in cases of caustic esophageal strictures after failure of dilatation. The posterior mediastinal route is shorter, and in long-term follow-up results show improved evacuation and less reflux than with the retrosternal route.
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Affiliation(s)
- Alaa F Hamza
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Hamza AF, Soliman HA, Abdel Hay SA, Kabesh AA, Elbehery MM. Total urogenital sinus mobilization in the repair of cloacal anomalies and congenital adrenal hyperplasia. J Pediatr Surg 2001; 36:1656-8. [PMID: 11685695 DOI: 10.1053/jpsu.2001.27943] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE Urogenital sinus mobilization has facilitated markedly the vaginal reconstruction in cases of cloacal anomalies. Application of the same technique in cases of congenital adrenal hyperplasia has resulted in cosmetic and functional improvement. METHODS Total urogenital sinus mobilization was used as a part of the repair in 9 patients: 6 with congenital adrenal hyperplasia (4 high and 2 mid vaginal confluence), and 3 with cloacal anomalies; sinus mobilization to the level of the symphesis pubis allowed the vagina to reach the perineum in all cases. Their age ranged from 6 to 8 months, and follow-up ranged from 6 months to 2 years. In the former group, the mobilized sinus was split dorsally and used as an anterior vaginal flap. Cases of cloaca needed weekly dilatation early postoperatively. RESULTS All patients are below 3 years of age, so urinary control assessment is not yet objective; however, all mothers reported dry intervals. Examination 6 months postoperatively showed wide vagina and excellent cosmetic appearance in all cases. CONCLUSIONS Total urogenital mobilization provides an easier way for vaginal reconstruction. The improved cosmetic appearance and the absence of vaginal stenosis provided by this technique is a major advantage in the management of these difficult surgical situations.
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Abstract
Spontaneous descent of testes after birth can occur in up to 70% of cases, yet the factors contributing to it are still controversial. This study aims to evaluate factors contributing to spontaneous descent of palpable undescended testes. Eighty-four newborns with 126 palpable undescended testes (42 unilateral and 42 bilateral) were followed up for a period of one year to study the occurrence and time of testicular descent and its relation to gestational age, birth weight, uni- or bilaterality and levels of FSH, LH and testosterone. A total of 58 testes (46%) descended between 3 and 6 months. Spontaneous descent occurred in 10 premature patients (14 testes 63%) compared to 44 testes of full-term patients (43%). Descent occurred in 14 unilateral undescended testes (33%) compared to 44 (52%) in bilateral cases. In patients with spontaneous testicular descent there was postnatal peak of LH and testosterone at 2 to 3 months of age which returned to basal level at 6 months of age. In patients with permanent undescended testes the peak of LH and testosterone was very low and almost absent in some of them; no significant difference was found between the mean values of FSH in both groups. No spontaneous testicular descent occurred after the 4th month in the full-term group, whereas in the pre-term group spontaneous descent occurred up to 6 months of age. This study concluded that spontaneous descent of palpable undescended testes is closely related to the presence of LH and testosterone surge. Therapy of undescended testes should start at 4 months of age in a full-term baby and at 6 months of age in a pre-term baby.
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Affiliation(s)
- A F Hamza
- Pediatric Surgery Unit, Ain-Shams University, Cairo, Egypt.
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15
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Abstract
BACKGROUND When managing neonatal jaundice, despite continual improvement of diagnostic tests and increasing knowledge regarding its pathogenesis, there is no single test or imaging modality that can reliably define biliary atresia. Early diagnosis is essential for a better surgical outcome. In many situations, mini-laparotomy and operative cholangiography may be needed to settle the definitive diagnosis, with the risk of having negative exploration in those high-risk patients with medical etiology. The use of laparoscopy may help in avoiding unnecessary exploration for such group of patients. METHODS Thirty-three patients aged between 1 and 4 months with conjugated hyperbilirubinemia were the subject for this study. All had a HIDA scan result suggestive of biliary atresia. They underwent a diagnostic laparoscopy before surgical exploration. When the gallbladder was not visualized we proceeded to laparotomy. In patients with a good size gallbladder visualized at laparoscopy, a laparoscopic-guided cholangiogram was then performed, and laparoscopic liver biopsy done for those who had patent biliary tree. RESULTS Two groups of patients were identified: the first group (21 patients) showed small atretic gallbladder; 18 patients had biliary atresia with complete intra- and extrahepatic atresia; these patients underwent a Kasai hepatic-portoenterostomy. Two patients showed a patent gallbladder and common bile duct with atresia of the common hepatic and intrahepatic ducts, and they underwent a portocholecystostomy. The last patient showed left-sided gallbladder arising from the left lobe of the liver that was missed during laparoscopy, and operative cholangiogram showed hypoplastic biliary ducts. The second group included 12 patients with good-sized gallbladder, and laparoscopic-guided percutaneous cholangiogram showed normal communicating patent biliary system, hypoplastic in 2, and they underwent laparoscopic liver biopsy. No mortality related to the laparoscopic procedure was encountered in this series, and one patient with hypoplastic gallbladder had adhesive intestinal obstruction on the fifth day after laparoscopy necessitating exploration. CONCLUSION Laparoscopy with laparoscopic-guided cholangiography may be a very useful tool used in accurately diagnosing infants with conjugated hyperbilirubinemia, and in avoiding unnecessary laparotomies performed on these critical babies.
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Affiliation(s)
- S A Hay
- Department of Pediatric Surgery, Ain shams University, Cairo, Egypt
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16
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Abstract
Surgical treatment of cardiac achalasia in children is still the main line of treatment with a success rate of 70-80%. Balloon dilatation is less widely used due to inappropriate size of balloons. The authors report on their experience in 11 children with cardiac achalasia over the last 7 years using balloon dilatation as the treatment of choice, 8 boys and 3 girls with ages ranging from 1.5-14 years (average 7.5 years) were investigated. One family (brother and sister) presented with no glucocorticoid deficiency or other anomalies, one patient had mental retardation, the rest had no associated anomalies. All patients presented with vomiting, 7 with dysphagia, 6 with loss of weight, 5 with recurrent chest infection and 2 with retrosternal pain. Radiological diagnosis was accurate in all patients, endoscopy with biopsy were done to confirm diagnosis and exclude other pathology, manometry yielded positive results in 4 patients. Dilatation was done under general anesthesia with fluoroscopic control, balloons were used over a guide wire (balloon sizes were 18-35 mm). Seven patients had 2 sessions and 4 had 3 sessions with radiological follow-up after the second dilatation. Follow-up ranged from 2-7 years: excellent results were achieved in 8 patients (72.7%) with disappearance of symptoms and marked radiologic improvement, 2 still have mild symptoms with overall success (90.9%), one had mild gastroesophageal reflux, controlled medically, and one had mild dysphagia but his status was improved compared to that before dilatation. One patient had recurrent dysphagia necessitating cardiomyotomy (9.1%). Results were not related to age or sex. The authors recommend balloon dilatation in children with cardiac achalasia as the treatment of choice or even as the only feasible treatment.
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Affiliation(s)
- A F Hamza
- Department of Pediatric Surgery, Ain-Shams University, Cairo, Egypt
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