prospective study of the predictors of the clinical outcome after Kasai portoenterostomy done for cases with biliary atresia

Objectives: The purpose of this study was to determine the predictors of the clinical outcome after Kasai portoenterostomy done for cases with biliary atresia [BA]

Study design: a prospective clinical study involving twenty patients with billay atresia that underwent Kasai operation. All patients underwent a detailed history taking, clinical examination and were investigated for liver function tests. US abdomen was also done in addition to preoperative liver biopsy and intra-operative cholangiogram. Patients were followed up for a period of 6 months post operatively and complications such as cholangitis, progress to liver failure and cirrhosis was noted. The schedule and indications for liver transplantation were also followed

Results: There were no mortalities within the 6 months of follow up, 11 patients showed gradual reduction of serum bilirubin [<2mg/dI] as well as liver enzymes [Non-icteric] and 9 patients' maintained high levels of serum bilirubin [>2mg/d1] and liver enzymes [Icteric].There was statistically significant difference between the two groups regarding age at operation, presence of preoperative ascites, hepatomegaly and patients' child-Pugh score. Preoperative total serum bilirubin and its direct fraction, preoperative liver enzymes [AST-ALT-GGT-alkaline phosphatase], preoperative serum albumin and total proteins, advanced pathological changes in preoperative liver biopsy showed statistically significant difference between the two groups. However; sex, splenomegaly, associated anomalies, bleeding profile, presence of preoperative TC sign and operative duration didn't show statistically significant difference between the two groups

Conclusion: Kasai portoenterostomy showed better results with short term follow up if done at an early age. Presence of ascites, hepatomegaly and advanced Child-Pugh score adversely affect the clinical outcome, Better outcome is predicted also by lower preoperative serum bilirubin with its direct fraction, lower levels of liver function tests and higher levels of plasma proteins and serum albumin. Advanced liver fibrosis and pathological changes in preoperative liver biopsy are predictors of bad outcome after Kasai portoenterostomy

Study of prevalance of possible cow's milk protein allergy among infants receving raw cow's milk

Objectives: although medical experts and legislation in many countries are prohibiting or strongly discouraging raw milk consumption, here in Egypt certain areas and as a result to cultural and financial reasons, raw cow's milk is introduced to infants very early from the age of two months or even and acceptability of the products, traditionally used, are further motivations for their use. This study aimed to verify the prevalence of possible cow's milk protein allergy [CMPA] among infants receiving raw cow's milk. Study design: One hundred healthy full term infants from two to six months were included in this study. They were divided into two groups; group I [cases group] which included fifty infants who were raw cow's milk consumers besides being breast fed infants. Special forms describing history and clinical examination and clinical examination were completed for each infant. Complete blood count was done in both groups while total iron binding capacity [TIBC], serum ferrtin stool analysis and occult blood in stool was requested for group I. Oral food challenge [OFC] was done to confirm the diagnosis in infants with suspected CMPA. Result: Out of 13 infants [26%] who were suspected to have CMPA in group I [raw milk consumers], only 4 infants [8%] were diagnosed as CMPA after OFC, and while none of group II [exclusively breast fed] was suspected to have CMPA three out of the four infants diagnosed as CMPA in group I were breast fed. Hence breast feeding is only protective if it's excusive. Conclusion: CMPA prevalence is much greater in the public's belief than it has ever been reported by OFC studies. OFC is the gold st and ard in diagnosis of CMPA. It is recommended to be done in infants with suspected CMPA before subjecting those infants to unnecessary dietary restrictions which may provoke nutritional unbalances, especially in the first year of life.

Study of upper and lower endoscopic findings in children with chronic diarrhea attending Alexandria university children's hospital

Objectives: Chronic diarrhea is a major problem worldwide with high morbidity and mortality. Study design: it is a retrospective study. The medical records of the patients with chronic diarrhea who were subjected to endoscopic evaluation were revised. The study was conducted on patients who attended the pediatric Gastroenterology and Endoscopy unit of Alex and ria Children's University Hospital along two years from January 2012 to December 2013. Methodology: The medical records were revised for: history, clinical examination, laboratory investigation and endoscopic findings. Results: forty patients were included in this study. The age range of the patients was from three months to eleven years. Patients from rural areas more than from urban regions, sixty five percent of the patients were males. Mucoid diarrhea was the most common type of diarrhea. Failure to thrive was evident in abetalipoproteinemiaandinflammatory bowel disease. Fecal calprotectin above 150mg/kg is highly specific and sensitive f or inflammatory bowel disease. Esinophilic enteroclolitis was the most common disease [57.5%] followed by celiac disease [15%] then ulcerative colitis [12.5%]. Conclusion: Management of patients with chronic diarrhea should be initiated and followed in a specialized Pediatric GIT unit since it requires experience and close clinical endoscopic and pathological assessment.

Study of upper and lower endoscopic findings in children with chronic diarrhea attending Alexandria university children's hospital

Objectives: Chronic diarrhea is a major problem worldwide with high morbidity and mortality. Study design: it is a retrospective study. The medical records of the patients with chronic diarrhea who were subjected to endoscopic evaluation were revised. The study was conducted on patients who attended the pediatric Gastroenterology and Endoscopy unit of Alex and ria Children's University Hospital along two years from January 2012 to December 2013. Methodology: The medical records were revised for: history, clinical examination, laboratory investigation and endoscopic findings. Results: forty patients were included in this study. The age range of the patients was from three months to eleven years. Patients from rural areas more than from urban regions, sixty five percent of the patients were males. Mucoid diarrhea was the most common type of diarrhea. Failure to thrive was evident in abetalipoproteinemiaandinflammatory bowel disease. Fecal calprotectin above 150 mg/kg is highly specific and sensitive for inflammatory bowel disease. Esinophilic enteroclolitis was the most common disease [57.5%] followed by celiac disease [15%] then ulcerative colitis [12.5%]. Conclusion: Management of patients with chronic diarrhea should be initiated and followed in a specialized Pediatric GIT unit since it requires experience and close clinical endoscopic and pathological assessment.

Role of laparoscopy in management of unexplained chronic abdominal pain

Objective: Patients with chronic abdominal pain [CAP] can undergo numerous diagnostic tests with failure to detect any structural or biochemical abnormality. This study was undertaken to assess the diagnostic and therapeutic role of laparoscopy in patients with unexplained chronic abdominal pain [UCAP]

Patients and Methods: Diagnostic laparoscopy was performed for 56 patients with UCAP not diagnosed by usual clinical examination and investigations. Their mean age was 27.8 years. In 36 patients [64.3%] the diagnostic procedures was extended to operative laparoscopy

Results: UCAP represent 22.6% of the patients complaining of CAP and it is common in females [71.3%] than in males. The most frequent Iaparoscopic findings detected were abdominal adhesions [26.8%], endometriosis [14.2%], chronic appendicitis [12.5%], pelvic varicosities [8.9%], internal ring for clinically undiagnosed indirect inguinal hernia [5.4%], uterine myoma [3.6%] and abdominal-pelvic tuberculosis [1.8%]. In 21.4% of patients with UCAP, laparoscopy did not reveal any pathologic findings in the abdomen. Laparoscopic Operative interventions were in the form of adhesiolysis in 26.8%, ablation of drainage and cauterization of endometriotic tissue in 12.5%, laparoscopic appendectomy in 12.5%, laparoscopic transabdominal preperitoneal hernioplasty in 5.4% and salpingostomy for chronic tubal ectopic in 3.6%. Other lines of treatment were given for 9 patients [16.1%] with pathologic findings. Follow up for 6 months revealed, pain relief in 53.5%, [mitt reduction in 26.7% and persistent pain in 19.8%

Conclusions: Diagnostic laparoscopy in UCAP is a significant procedure, which increase our understanding of many underlying abdominal disorders. However, it should be undertaken only after complete diagnostic evaluation has been carried out. It permits the effective surgical treatment of many conditions encountered at time of diagnostic laparoscopy