Diagnostic evaluation of infantile cholestasis.

OBJECTIVE: To evaluate diagnostic accuracy of some important clinical manifestations and different investigations in infantile cholestasis. MATERIAL AND METHOD: Infants diagnosed with prolong conjugated hyperbilirubinemia and admitted to Chiang Mai University Hospital between Jan 1999 and Feb 2003. Demographic and clinical data were recorded Routine biochemical tests, and serology for TORCHS infections were carried out. An abdominal ultrasonography, DISIDA scan and percutaneous/open liver biopsy were performed. Hyperechoic band at the level of portal bifurcation, named triangular cord (TC) sign was blindly assessed on ultrasonography by the same radiologist. The patients were diagnosed as BA if either operative findings of atretic common bile duct/ gallbladder or evidence of bile duct obstruction demonstrated by intraoperative cholangiography was noted RESULTS: Sixty-one patients were diagnosed as BA (n = 31) and NH (n = 30) with an average age at diagnosis of 88.6 and 63.1 days respectively. Concerning clinical presentations, only the presence of acholic stool was significantly different between BA and NH (p = 0.006). The GGT level of greater than 500 IU/L was significantly found in BA (p < 0.001). The acholic stool and GGT level more than 500 IU/L were highly specific for BA at 100 and 96.6% respectively. In addition, the sensitivity and specificity of US-TC and DISIDA scan were 87.4, 100 and 89. 7, 92.0% respectively. The accuracy for diagnosis of BA were highest by DISIDA scan (96.3) followed by US-TC (86.9), GGT level of > 500 IU/L(81.0) and acholic stool (80.3) in order CONCLUSION: There was no single laboratory investigation that could precisely make a definite diagnosis of BA. The acholic stool and GGT level of higher than 500 IU/L were highly specific for BA. The TC in ultrasound is noninvasive and easily available tests when combined with acholic stool and the GGT level is suggested plan of management.

Clinical characteristics of colorectal polyp in Thai children: a retrospective study.

BACKGROUND: It was believed that more than 90 per cent of children with colorectal polyp had a single lesion, located in the rectosigmoid colon, therefore, sigmoidoscopy with polypectomy was the treatment of choice. After a wide use of pediatric colonoscopy, this concept has been changed. MATERIAL AND METHOD: This study was aimed to describe clinical characteristics of colorectal polyp in Thai children. Medical records of children with colorectal polyp were retrospectively reviewed. Comparison between polyposis coli and children with less than 5 polyps were also analyzed. RESULTS: There were 93 patients, 43 females and 50 males. The average age was 5.1 years. Lower GI bleeding and prolapse of rectal polyp comprised the two most common presentations, 93.5 and 39.8 per cent, respectively. The mean duration of symptoms was 5.6 months. Only 50.6 per cent had rectal polyp noted by digital examination. Investigations included sigmoidoscopy (n = 77), colonoscopy (n = 16), and barium enema (n = 16). Eight per cent of the cases had more than 5 polyps. Location of the polyps was noted in the rectosigmoid colon (88.2%), descending colon (4.3%), right-sided colon (4.3%), and pancolonic (3.2%). Of all the patients, 11.8 per cent had the polyp above the rectosigmoid region, whereas 50 per cent of those who underwent colonoscopy (n = 16) had the polyps noted proximal to this region. Older age, lower hematocrit, and more frequent right-sided polyps were significantly associated with polyposis coli (p < 0.05). Only 2 patients with polyposis coli were treated by colectomy. Histopathology included juvenile polyp (95%), inflammatory pseudopolyp (2.5%), and hyperplastic polyp (2.5%). CONCLUSION: Most of the children with colorectal polyp had juvenile polyp that is commonly found in the rectosigmoid colon. However, a significant number of patients had carrying polyps proximal to the rectosigmoid region, which would be easily missed by sigmoidoscopy. With the concern of malignancy change particularly in children with polyposis coli, routine colonoscopy should be considered as an initial investigation in children with colorectal polyp.