Blind liver biopsy: a 17-year experience / Biopsia hepática a ciegas: experiencia de 17 años

ABSTRACT Objectives: Liver biopsy is the gold standard for assessing liver inflammation, necrosis and fibrosis. The aim of the study is to evaluate clinical indications and histopathological results of percutaneus liver biopsy. Materials and methods: A total of 516 children who underwent blind liver biopsy were evaluated retrospectively. Results: Blind liver biopsy was performed for chronic active hepatitis B in 50% of the cases (n=260), neonatal cholestasis in 14% (n=68), autoimmune hepatitis in 7.7% (n=40), Wilson disease in 7.3% (n=38), isolated elevation of the liver enzymes in 5% (n=26), chronic active hepatitis C in 4.2% (n=22), metabolic disease in 3.4% (n=17), malignancies in 2.2% (n=11) and the others in 3.4% (n=17). Major complications were observed in 0.19% of the cases (n=1) and minor complications such as pain at the biopsy site in 13.5% of the cases (n=70), hypotension and tachycardia in 1.9% (n=10). Conclusions: Blind liver biopsy is a safe method in diagnosing liver diseases in childhood.

RESUMEN Objetivos: La biopsia de hígado es el estándar de oro para evaluar la inflamación, necrosis y fibrosis del hígado. El objetivo del estudio es evaluar las indicaciones clínicas y los resultados histopatológicos de la biopsia hepática percutánea. Materiales y métodos: Se evaluó retrospectivamente a un total de 516 niños a los que se les realizó una biopsia hepática a ciegas. Resultados: Se realizó biopsia hepática a ciegas por hepatitis B crónica activa en el 50% de los casos (n = 260), colestasis neonatal en el 14% (n = 68), hepatitis autoinmune en el 7,7% (n = 40), enfermedad de Wilson en el 7,3%. % (n = 38), elevación aislada de las enzimas hepáticas en el 5% (n = 26), hepatitis C crónica activa en el 4,2% (n = 22), enfermedad metabólica en el 3,4% (n = 17), neoplasias en el 2,2% (n = 11) y los demás en un 3,4% (n = 17). Se observaron complicaciones mayores en el 0,19% de los casos (n = 1) y complicaciones menores como dolor en el sitio de la biopsia en el 13,5% de los casos (n = 70), hipotensión y taquicardia en el 1,9% (n = 10). Conclusiones: La biopsia hepática a ciegas es un método seguro en el diagnóstico de enfermedades hepáticas en la infancia.

Does gluten-free diet protect children with celiac disease from low bone density?

We aimed to assess the effect and duration of gluten-free diet on bone health in children with celiac disease in our study. Sixty three patients with celiac disease [CD] formed the study group. They were divided into two subgroups according to their dietary compliance. Bone mineral density [BMD] values of the patients at two and five years of gluten-free diet [GFD] were determined. The relationship between BMD and compliance to GFD was found to be statistically significant [P<0.01]. BMD z-scores were increased [0.12 +/- 0.15 and 0.10 +/- 0.14 units respectively] [P<0.01]. The patients in group 1 and 2 had mean -1.18 +/- 0.83 and -2.06 +/- 0.73 z-scores in the first DXA. In the second DXA, these values were -1.10 +/- 0.73 and-1.94 +/- 0.93 respectively. Dietary compliance is important for bone health, and the time needed to normalize the BMD is not known. Patients with positive anti-endomysium antibody [EMA], poor dietary history and history of bone pain should be evaluated with DXA during follow-up

case report of malignant infantile osteopetrosis

Malignant infantile osteopetrosis [MIOP] presents early in life with extreme sclerosis of the skeleton and reduction of bone marrow spaces. Since there is a defect in the bone marrow, the disease can cause anemia, extramedullary hematopoiesis secondary to anemia leading to hepatosplenomegaly, cranial nerves compression and severe growth failure. This disorder is often lethal within the first decade of life because of secondary infections. Stem cell transplantation [SCT] remains the only curative therapy. We report a two-month old male infant, diagnosed as MIOP while investigating the cause of hepatosplenomegaly. The patient was referred for stem cell transplantation. Malignant infantile osteopetrosis should be kept in mind as a rare cause of hepatosplenomegaly and the patient should be referred for stem cell transplantation before neurologic or visual impairment develops

Assessment of hepatitis B immunization status after antineoplastic therapy in children with cancer

Hepatitis B is a disease that is preventable with vaccination. Antibody levels after vaccination may be affected by suppression of the immune system due to cancer therapy. Children with cancer have a high risk of hepatitis B virus [HBV] infection. We aimed to assess the pretreatment immunization status against HBV infection and the rate of continuity of immunization after therapy in children with cancer. Retrospective case review of patients treated from 2004 to 2008. We reviewed the medical records of patients treated in the departments of pediatric hematology and oncology and collected data on immunization history and hepatitis B serology. Anti-HBs antibody titers were compared before and after treatment. This study included 159 [99 males, 60 females] children who had a serologic examination. Antineoplastic therapy had been given for acute leukemia [n=66], non-Hodgkin lymphoma [n=27], Hodgkin lymphoma [n=20], and solid tumors [n=46]. Fifty-one patients had not been immunized against HBV prior to the therapy; HBV serology was negative in 49 of these patients and HBsAg was positive in 2 patients. Anti-HBs antibody positivity was present in 99 of 108 patients with an immunization history, whereas no vaccination response was present in 9 patients. The titer of anti-HBs antibody was decreased below the protection level in 33 [33%] patients with positive anti-HBs antibody, whereas the protection level was found to be maintained in 66 [67%] patients. The most significant decrease [63.6%] was observed in leukemia patients. Posttreatment HBsAg and HBV DMA positivity was detected in two of the patients with negative pretreatment serology, whereas no HBV infection developed in the group with positive anti-HBs antibody. This study demonstrated the importance of routine childhood vaccination in reducing the risk of HBV infection in patients with cancer