ABSTRACT
PURPOSE: HBV prophylaxis is necessary to prevent de novo hepatitis B infection from HBcAb positive donors. However, it is somewhat controversial in which protocol is more effective, and whether it is necessary to administer the HBV prophylaxis for HBsAb positive recipients. In this study, we attempted to elucidate whether it is necessary to administer the HBV prophylaxis for HBsAb positive patients and to evaluate the efficacy of HBIG monotherapy protocol. METHODS: From May 1996 to July 2001, 58 donors (45.3%) were HBcAb positive among 128 donors who were examined for HBcAb. Eighteen HBcAb positive grafts were transplanted to HBsAg negative recipients. Four patients died of unrelated causes were excluded. Of 14 study cases, 12 recipients were HbsAb positive, and 2 were negative. Among 12 HBsAb positive recipients, 3 were HbcAb positive simultaneously. In early period (Nov. 1997~Nov. 1998), only HBV vaccination was applied for de novo infection prophylaxis. In late period (since Dec. 1998), regardless of HBsAb positivity in recipients, HBIG was administered from the beginning of liver transplantation. RESULTS: The overall de novo HBV infection from HBcAb positive donors was 21.4 % (3/14). All 3 recipients without HBIG prophylaxis presented de novo HBV infection. Two of them were HBsAb positive postoperatively. No de novo HBV infection occurred in recipients with HBIG prophylaxis. CONCLUSION: It is necessary to administer the HBV prophylaxis even for vaccinated HBsAb positive patients and HBIG monotherapy protocol is effective to prevent de novo hepatitis B infection from HBcAb positive donors in living donor liver transplantation.
Subject(s)
Humans , Hepatitis B Surface Antigens , Hepatitis B , Hepatitis , Liver Transplantation , Liver , Living Donors , Tissue Donors , Transplantation , Transplants , VaccinationABSTRACT
Ulcerative colitis is a chronic relapsing inflammatory disease localized on the colon. This disease is rare in children under 10 years of age. We experienced a case of ulcerative colitis in a 3-year-old male child. He was admitted due to fever, abdominal pain and diarrhea for 5 days, followed by rectal bleeding for 2 days. The diagnosis was established by clinical features, endoscopic and histologic findings. Taking combined medication of prednisolone and sulfasalazine, he achieved symptomatic remission and remained asymptomatic.
Subject(s)
Child , Child, Preschool , Humans , Male , Abdominal Pain , Colitis, Ulcerative , Colon , Diagnosis , Diarrhea , Fever , Hemorrhage , Prednisolone , Sulfasalazine , UlcerABSTRACT
PURPOSE: Although many strides have been made in the radiological and laboratory diagnosis, the liver biopsy is still considered an important tool for the diagnosis of liver disease. We report our experience that histologic investigation of the liver was essential searching for the etiologic diagnosis in eight children with fever of unknowm origin and hepatosplenomegaly, who's diagnosis were not documented by other diagnostic studies. METHODS: Histologic investigation of the liver including Percutanous liver biopsy, open surgical biopsy, necropsy or autopsy was taken at Seoul national university of children's hospital between 1985 and 1995 in twelve children with fever of unknown origin and hepatosplenomegaly. We performed light and electron microscopic examination, culture and PCR of the tissue obtained by liver biopsy. RESULTS: 1) The etiologic diagnoses were possible by histologic investigation of the liver in 9 of 12 Cases; Nine cases were congenital tuberculosis, cryptococcosis, hepatic capillariasis, candidiasis, amoebiasis, neonatal herpes hepatitis, Escherichia. coli abscess and two cases of cytomegalovirus hepatitis. Three cases in which organisms could not be found in tissue obtained from biopsy were suspected clinically as liver abscess and parasite infestation. 2) Three cases were males and 6 were females, ranging in age from 1 days to 6 years; mean age 23.6 months. 3) Clinical manifestations were fever of unknown origin(9 Cases), hepatomegaly(9 Cases), splenomegaly(5 Cases), skin lesions(2 Cases) and jaundice(3 Cases). 4) Laboratory findings were increased AST/ALT(7 Cases), hyperbilirubinemia(3 Cases), leukocytosis(5 Cases), eosinophilia(2 Cases), increased CRP(9 Cases) and increased ESR(5 Cases). 5) In four children, there were underlying diseases which were acute lymphoblastic leukemia, acute myeloid leukemia and two cases of prematures. CONCLUSIONS: In children with fever of unknown origin and hepatosplenomegaly, we recommend liver biopsy for early diagnosis and apropriate management.
Subject(s)
Child , Female , Humans , Male , Abscess , Amebiasis , Autopsy , Biopsy , Candidiasis , Clinical Laboratory Techniques , Cryptococcosis , Cytomegalovirus , Diagnosis , Early Diagnosis , Escherichia , Fever of Unknown Origin , Fever , Hepatitis , Leukemia, Myeloid, Acute , Liver Abscess , Liver Diseases , Liver , Parasites , Polymerase Chain Reaction , Precursor Cell Lymphoblastic Leukemia-Lymphoma , Seoul , Skin , TuberculosisABSTRACT
Esophageal stenosis due to tracheobronchial remnants is a rare cause of congenital esophageal stenosis. The cause is thought to be esophageal sequestration of tracheobronchial remnants during embryonic separation. Errors in diagnosis are common and high index of suspicion is required for accurate diagnosis, and resection of primary site with anastomosis is recommanded. Although a rare entity, esophageal stenosis due to tracheobronchial remnants should be considered in patients with esophageal stenosis, when esophageal stenosis fails to respond to standard therapy including bougienage and balloon dilatation, and esophagoscopy shows normal mucosa on the stenotic segment. Four cases of congenital esophageal stenosis due to tracheobronchial remnants were reported, the first case without accompanied anomaly, the second case accompanied by tracheoesophageal fistula, the third case accompanied by Down syndrome, and the last case accompanied by tracheoesophageal fistula and congenital heart disease.