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Biliary atresia (BA) is a progressive, idiopathic, fibro-obliterative disease of the extrahepatic biliary tree that presents with biliary obstruction exclusively in the neonatal period. It has been listed as a rare disease by the Office of Rare Diseases (ORD) of the National Institutes of Health (NIH) - the incidence is as low as only 1 patient in 10,000 to 20,000 live births. However, Biliary Atresia is the most common surgical cause of neonatal jaundice for which Liver Transplantation is indicated. We report a rare case of Biliary Atresia in a 6 months old female child who presented with jaundice and abdominal distension.
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Background: Mandibular incisors are the smallest among the permanent dentition, with thin enamel and dentin. Intact teeth do not fracture easily while mastication. Objectives: To evaluate the fracture resistance of mandibular incisors after endodontic treatment and metal ceramic crown placement. Materials and methods: Eighty recently extracted intact mandibular incisors were divided into four groups of twenty each based on root canal treatment and crowns, intact natural tooth without RCT and crown preparation was used as control group. Each tooth was mounted separately in acrylic block and subjected to loading in universal load testing machine until fracture, results were analyzed by one-way ANOVA and Turkey’s multiple post hoc procedures. N Sandeep, G. Ramaswamy Reddy, Kancham Kalyan Kumar Reddy, K Subash Chander, Vasanthi Bondugula, Ram B. Basany. Evaluation of fracture resistance of mandibular incisors before and after endodontic treatment and metal ceramic crown placement. IAIM, 2017; 4(11): 18-26. Page 19 Results: The results showed that Fracture resistance of teeth restored with metal ceramic crowns was very high when compared to the teeth without crowns (p<0.05).There was no statistically significant difference between intact and endodontically treated teeth (p>0.05). Conclusion: The study concluded that endodontic treatment and tooth preparation followed by metal ceramic restoration increased the fracture resistance of mandibular incisors.
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Background: Biliary dyskinesia is a condition where the gallbladder motility is seen as abnormal. Diagnostic imaging studies for biliary dyskinesia usually include a negative or inconclusive abdominal ultrasound or computed tomography followed by a hepatobiliary iminodiacetic acid (HIDA) scan. The HIDA scan is used to visualize the gallbladder and access its motility. The motility is reported in the form of an ejection fraction (EF). Billiary dyskinesia is diagnosed if the EF is less than 35%. However, there are many patients with an EF of greater than 35% but are exhibiting all the signs and symptoms for biliary dyskinesia. Aim: This study evaluated the efficacy of laparoscopic cholecystectomy as a treatment modality in symptomatic patients diagnosed with biliary dyskinesia with three distinct HIDA scan EF results. Materials and methods: They were a total of 654 verified case of laparoscopic Cholecystectomy done between January, 2013 and December 2016 at Westlake and West Suburban Hospital. A total of 163 cases out of the 654 had HIDA scan with calculated EF, therefore meeting the criteria to be included in this study. The patients pre and post-operative course was reviewed from their medical records and resolution of symptoms was determined by in phone interview. Results: A total of 29 (18%) patients were lost to follow up. Out of the 99 cases interviewed in the first group (EF <35%) 91 (92%) cases reported complete symptom resolution post cholecystectomy. Out of the 18 cases interviewed in the second group (EF between 35%-50%) 13 (72%) cases reported Lincey Alexida, Frederick M. Tiesenga. Laparoscopic cholecystectomy for biliary dyskinesia in patient with an extended spectrum of ejection fraction on hepatobiliary iminodiacetic acid scan. IAIM, 2017; 4(11): 14-17. Page 15 complete resolution post cholecystectomy. Out of the 17 cases interviewed in the last group (EF> 75%) 11 (65%) cases reported complete resolution of their symptoms Conclusion: Our study indicates that patient suffering with symptomatic biliary dyskinesia and has a HIDA with EF less than 50% or EF greater than 75% will most likely benefit from laparoscopic Cholecystectomy and could be a reasonable option to offer symptomatic patients.
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Introducción. El quiste de colédoco es una dilatación quística congénita de la vía biliar. Puede afectar exclusivamente a la vía biliar extrahepática (tipo I, II y III), intrahepática (tipo V) o ambas (tipo IVa). El diagnóstico se realiza principalmente con estudios de imagen, con el ultrasonido (USG) abdominal como primera modalidad. Sin embargo, puede utilizarse la colangiogammagrafía 99mTc-HIDA (ácido iminodiacético hepatobiliar) -la cual tiene una sensibilidad del 100% en los quistes tipo I (sacciformes)- para confirmar el diagnóstico. Puede ser útil para distinguir entre quistes de colédoco y atresia de la vía biliar. Igualmente se ha utilizado la tomografía contrastada como complemento diagnóstico. Caso clínico. Lactante mayor femenino de 2 años de edad que ingresó al Servicio de Urgencias por presentar dolor abdominal. El USG abdominal reportó colecistitis aguda y una imagen quística adyacente al conducto cístico, compatible con un quiste de colédoco. Conclusiones. El tratamiento de elección del quiste de colédoco tipo I es la resección del mismo y una anastomosis hepático-yeyunal en Y de Roux o la anastomosis hepático-duodenal. Esta última se ha considerado una alternativa útil y confiable en nuestro medio, que aunque en un principio se dejó de utilizar por la presentación de colangitis ascendente, actualmente no se ha documentado esta complicación.
Background. Choledochal cyst is a congenital cystic dilatation of the intra- or extrahepatic biliary tree. It may affect only the extrahepatic bile duct (type I, II and III), intrahepatic (type V) or both (type IVa). Diagnosis is primarily made with imaging, abdominal ultrasound being the first modality used. However, in case of a diagnostic doubt using this means, a technectium-99 HIDA scan, which has a sensitivity of 100% for type I cysts (sacciform), may be performed. It may be useful for distinguishing between choledochal cyst and biliary atresia. Computed tomography scan with contrast can also be used. Case report. We present the case of a 2-year-old lactating female who was admitted to the Emergency Department because of abdominal pain. She underwent abdominal USG, which reported acute cholecystitis and a cystic image adjacent to the cystic duct fibrosis consistent with a choledochal cyst. Conclusions. The elective treatment for type I choledochal cyst is resection of the cyst with Roux-en-Y hepaticojejunostomy or hepaticoduodenostomy. The latter is considered a useful and reliable alternative in our context, although initially it fell into disuse due to reports of ascending cholangitis. However, this has not been recently documented.
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Aim: To determine the utility of Tc99m-Mebrofenin hepato-biliary scintigraphy (HIDA scan) for diagnosis of biliary atresia in patients with neonatal cholestasis. Methods: Our study involves the retrospective analysis of 46 patients with neonatal cholestasis who underwent HIDA scans at the Pediatric Hepatobiliary Clinic, BJ Wadia Hospital for Children from May 2005 to July 2007. Biliary atresia (BA) was diagnosed on the basis of intra-operative cholangiogram. Non-BA patients were included in the neonatal hepatitis (NH) group. All patients received phenobarbitone and ursodeoxycholic acid for 5 days, prior to the HIDA scan. The HIDA scan was evaluated on the basis of uptake of the radioactive tracer by the liver at 5 minutes after intravenous injection; retention of radioactive tracer within the liver at 24 hours after injection and visualization of excretion of tracer into the intestine upto 24 hours after administration. The results of the HIDA scans were analyzed and correlated with the final diagnosis, gender and age of the patients. Chi-square test was employed for statistical analysis. Results: The age of presentation of our patients ranged from 5 days to 6 months. The male: female ratio was 37:9. Of the total 46 patients, 28 had BA and 18 had NH. All 28 (100%) patients diagnosed with BA showed persistent radiotracer in the liver at 24 hours whereas 17 (94.4%) of the 18 NH patients showed hepatic radiotracer retention (p=0.207), the difference being statistically insignificant. Twenty two (78.6%) patients of BA showed no excretion of the radiotracer at 24 hours whereas only 7 (38.9%) of the NH group did not excrete the radiotracer (p=0.007), which was statistically significant. Neither the sex nor the age of the child contributed to any difference on the hepatic retention (p=0.618 and 0.235, respectively) or on the intestinal excretion (p=0.307 and 0.9, respectively) of the radiotracer. Conclusion: HIDA scan is a useful tool for screening of biliary atresia in patients with neonatal cholestasis. Non excretion of the radioactive radiotracer into the intestines even after 24 hours of radiotracer administration can suggest biliary atresia in majority of patients.