ABSTRACT
Spinal dysraphism can present in various ways in the form of severity. Split cord is one of the presentations where two hemi cords are separated either by a fibrous septum or calcific spur. This may be accompanied with different other vertebral anomalies like block vertebra, hemi vertebra or spina bifida. We present a 8-years old girl who presented with weakness and gait disturbances since she started walking. She also had a tuft of hair on the back in the lumbar region. She underwent computerized tomography (CT) and magnetic resonance imaging (MRI) and was diagnosed as diastematomyelia with other associated anomalies.
ABSTRACT
Need and purpose of review: Biliary atresia is a progressive obstructive cholangiopathy and is fatal if left untreated within 2 years of life. Delay in referral is because of difficulties in differentiating it from physiologic jaundice and identifying an abnormal stool color. This paper presents an overview on the diagnosis and discusses the current strategies in the management of this disease in developing countries. Methods: Articles were retrieved from the PubMed database using the terms ‘biliary atresia’, ‘Kasai portoenterostomy’ and ‘pediatric liver transplantation’. Contents of the article are also based on personal experience of the authors. Conclusion: A national screening program using stool color cards as part of standard care in the neonatal period will greatly improve early detection of biliary atresia. Outcomes will improve if it is diagnosed at the earliest after birth, the child is referred to an experienced pediatric hepatobiliary unit for evaluation, and undergoes an early Kasai procedure. If an early Kasai portoenterostomy is performed, nearly half of all children survive into adolescence, and about one-third are likely to have a long-term, symptom-free life with normal liver biochemistry. Sequential treatment combining Kasai as first line and liver transplantation as second line results in 90% survival for children with biliary atresia.