Perforated meckel's diverticulum in a 3-day-old neonate; a case report

Perforation of Meckel's diverticulum is a rare complication in neonatal period. A 3-day-old term male neonate was transferred to our emergency room due to bowel perforation. Surgical exploration was done and perforated Meckel's diverticulum was detected. Pathological reportofthe tissue showed inflamed diverticulum withheterotopic gastric muco-sa. This is the first report of Meckel's diverticulum perforation inaneonate in our country

Living related donor liver transplantation in Iranian children: a 12- year experience

The aim of this study was to describe our results and investigate the survival of below-18-year-old patients undergoing LRDLT and the factors affecting this. Living Related Donor Liver Transplantation [LRDLT] has become a good option to provide suitable grafts for children with liver diseases. Using this method, children who have no chance for life can live a much longer life. The present study is a historical cohort study carried on 191 patients below-18-years-old who had undergone LRDLT for the first time in the Namazi hospital liver transplantation center. Survival rate of the patients was assessed using Kaplan-Meier method. The effect of factors related to the recipients, donors, and the transplantation process on the patients' survival was also investigated. 1, 3, 5 and 11-year survival of patients was 71%, 66%, 65%, and 65%, respectively. In the univariate analysis, age, weight at transplantation, PELD/MELD score, existence of post-transplant complications were found to be effective factors on the patients' survival. In the multivariate analysis, weight at transplantation, PELD/MELD score, and existence of post-transplant complications were the prognostic variables. LRDLT is now well established with satisfactory results in our center. Although the survival rate of the patients is lower than the survival rate reported in other studies, but the survival of the patients who had survived 1 month after the transplantation was comparable to other studies

Evaluation of quality of life in children six months after liver transplantation

Liver transplantation [LT] is now performed as a cure for numerous untreatable pediatric liver diseases. Quality of life [QoL] can be affected in pediatric patients with LT. Many factors are responsible for lower scores of QoL. This article aims to detail QoL in liver recipients six months following LT in children.We assessed QoLwith the following questionnaires: Child Health Quality-Parent Form 50 [CHQ-PF 50] for parents and Child Health Quality-Child Form 87 [CHQ-CF 87] for children >/= 10 years of age in 50 children with LT and their parents. According to the CHQ-PF 50 questionnaire, QoL was found to be significantly lower in LT children compared with healthy children. According to the CHQ-CF 87 questionnaire, QoL was similar in pediatric liver recipients and the normal population. According to parents' judgments, childhood liver recipients have impaired QoL. This may be due to multiple factors that include concern about the long term outcome of LT, comparing their child with other children, and complications of LT. On the other hand, older children and adolescents believe their QoL is similar to healthy children. It seems that by decreasing risk factors, we can reduce stress on families and improve QoL

Outcomes of kidney transplantation in patients with systemic lupus erythematosus: a single-center study

This study aimed to compare outcomes of kidney transplantation in patients with systemic lupus erythematosus [SLE] and a matched control group of non-SLE kidney recipients. In a case-control study, 33 patients with kidney transplantation due to end-stage renal disease caused by SLE were matched to a control group consisted of 33 non-SLE patients who had been transplanted during the same period of time in our center. The clinical characteristics, complications, and patient and graft survival were compared between the two groups. In each group, 12 patients [36.4%] received a kidney from a deceased donor, 15 [45.4%] from a living unrelated donor, and 6 [18.2%] from a living related donor. There was no significant difference between the outcome in SLE patients and duration of dialysis before transplantation. The mean duration of hospital stay was 23.4 +/- 18.1 days in the SLE group, while it was 13.0 +/- 7.3 days in the controls [P = .006]. One-year graft survival was 79.0% in patients with SLE and 90.9% in non-SLE patients [P = .17]. One-year patient survival was 93.9% in patients with SLE versus 81.8% in the controls [P = .26]. Nine patients in the SLE group versus 11 patients in the control group developed posttransplant complications [P = .59]. Although hospital stay after transplantation was longer in the SLE kidney recipients than controls, safety of kidney transplantation was comparable. Graft failure in the SLE patients was not significantly different between patients with different sources of kidneys

application of a new cyanoacrylate glue in pediatric surgery for fistula closure

Surgical glues have been used in pediatric surgery because of the fragility of tissue, and to prevent major surgeries. The present report describes our experience with using a new cyanoacrylate Glubran 2 [Viareggio, Italy] in the treatment of five cases of tracheoesophageal atresia with fistula [one fistula protection, three recurrent fistula, and one unstable patients], two cases of hypospadias, one case of vesicutanouse fistula after bladder extrophy, and one case of cloacal extrophy from January-December 2008. Three cases of recurrent tracheoesophageal atresia with fistula were treated by bronchoscpic glue injection. The other two cases benefited from glue through its ability to plug the fistula and to act as a protecting layer on anastomosis. In two cases with hypospadias excessive use of the glue caused skin necrosis, which was repaired. The wounds of cloacal extrophy were protected from nearby colostomy contamination and infection, and the vesicocutanouse fistula was closed by deepithelialization and sealing with glue. Based on the outcomes of the cases, it may be possible to suggest that Glubran 2 may be used safely in Pediatric Surgery as a sealant for the prevention and treatment of fistulas

Liver abscess in children: a 10-year single centre experience

Although liver abscess is more prevalent in developing countries than in developed countries, there is scant data about the characteristics of pediatric liver abscess in our region. We aimed to analyze the characteristics of pediatric liver abscess in our region and compare these with those of developed countries. The clinical features, laboratory, imaging, microbiologic findings, management strategy, and final outcome were extracted from the patients' records retrospectively. There were 18 cases of liver abscess including 16 pyogenic liver abscess, one amebic liver abscess and one candida liver abscess. Fever and abdominal pain were the most common clinical findings and leukocytosis was the most common laboratory finding. The most predisposing factors of liver abscess were immune deficiency, minor thalassemia. Origin of liver abscess was appendicitis in two patients, the rest were considered as cryptogenic. While one patient was treated with antibiotics alone, five cases were taken for open drainage, and 12 cases were treated with percutaneous aspiration. Percutaneous aspiration failed in two patients who were later taken for open drainage, with an overall mortality rate of 5.5%. The overall characteristics of liver abscess in children in our society are not so different from developed countries. However, in contradiction to case reported in developed countries, most cases of liver abscess were seen in healthy patients in our centre. Moreover, liver abscess was reported in our patients at a younger age and was more commonly seen in male children. Mortality rate was similar to that of developed countries

Tacrolimus related hypertrophic cardiomyopathy in liver transplant recipients

Recently there are a number of reports on the cardiotoxicity of tacrolimus in post-transplant patients. There is no protocol for cardiovascular evaluation in these patients. This study was performed to evaluate the cardiotoxicity of tacrolimus in liver transplant recipients. We evaluated 63 post-liver transplant patients who received tacrolimus. They were evaluated for cardiovascular complications by physical examination, electrocardiographic and echocardiographic examinations within three and six months following liver transplantation. Serum tacrolimus levels were checked by ELISA. For comparison, we selected 50 post-liver transplant patients who received no tacrolimus and evaluated them for cardiovascular function identically. Among 63 patients, 42 were male [66.7%] and 21 were female [33.3%] 70% of the patients were adults, and 19 [30%] were within the pediatric age group. The cardiovascular examinations, electrocardiogram and echocardiography of all patients three months post-transplantation were normal except for two children who developed tacrolimus related cardiac complications. Both had high serum tacrolimus levels. No adults developed cardiovascular complications. In the control group, the results of the cardiovascular evaluations were normal in all cases. The cardiovascular toxicity of tacrolimus, such as hypertrophic cardiomyopathy, may be observed in pediatric patients. Therefore, we recommend routine regular cardiovascular evaluation of children after liver transplantation

Xerografting as a novel procedure in the management of syngnathia

Congenital fusion of the maxilla and the mandible is a rare condition. The extent of the problem ranges from simple mucosal adhesion [synechia] to severe bony fusion [syngnathia]. Here we present a patient with zygomatico-mandibular fusion who was treated at neonatal and infancy periods at three different stages without tracheostomy. Having had recurrence for two times, porcine grafting was performed as a novel procedure to increase the chance of success. Ultimately the patient had uneventful outcome for 6 months after the last operation

Congenital lobar emphysema. Report of three cases

Congenital lobar emphysema is a rare cause of respiratory distress during infancy which is cured by surgery. We are reporting three cases of congenital lobar emphysema with different presentations of the disease. Chest x-ray was the basis of diagnosis but confirmatory lung computerized tomography was also used. The emphysematous lobe was left upper lobe in two infants and right upper and middle lobes in the third one. Resection of the affected lobes was performed with good results