Ultrasonographic parameters of the liver, spleen and kidneys among a cohort of school children in Sri Lanka.

BACKGROUND: Liver, spleen and kidney dimensions on ultrasonography vary with the age, weight and ethnicity. Reference standards of these parameters for normal Sri Lankan children are not available. Our aim was to establish normative data for longitudinal length of liver, spleen and kidneys in healthy children. METHOD: Three hundred fifty-seven children, 5-13 years of age were selected from two randomly selected schools in the Gampaha district in the western province of Sri Lanka. A questionnaire was administered to the parents after obtaining informed written consent. Participants were screened for risk factors for organomegaly and were examined by a trained officer. Children with a past history of infective, inflammatory, haematological, malignant, congestive, collagenous or congenital conditions that can affect the size of the organs were excluded as well as those with clinically evident malnutrition, anemia, lymphadenopathy or organomegaly. Ultrasonographic assessment was done using a high resolution real-time scanner with a 3.5 MHz convex transducer by a trained officer. Children with ultrasonographic abnormalities of organs were also excluded from the study and referred for further evaluation. RESULTS: The study comprised 332 children comprising 176 girls (53%). There was a significant difference in the longitudinal dimension of the liver between the two sexes with a higher value recorded among females (Mann Whitney U = 11,830.5, p = 0.037). Body weight was correlated with the dimensions of the liver, the spleen and the kidneys. On multiple regression analysis body weight significantly associated with all the organs. (p < 0.01) Percentile graphs for longitudinal length of liver, spleen, right and left kidneys were formed according to the body weight. CONCLUSION: The organ dimensions showed the highest correlation with body weight. We hope the normal ultrasonographic values of healthy Sri Lankan children will assist in interpretation of sonographic examinations in daily clinical practice.

Factors affecting post-embolization fever and liver failure after trans-arterial chemo-embolization in a cohort without background infective hepatitis- a prospective analysis.

BACKGROUND: Transarterial-chemo-embolization (TACE) is used for palliation of unresectable hepatocellular carcinoma (HCC). We studied the tolerability of TACE in a cohort of patients with NASH and alcoholic cirrhosis related HCC. METHODS: Of 290 patients with HCC (July 2011 - December 2014), 84 underwent TACE. They were monitored for post-TACE complications: postembolization fever (PEF), nausea and vomiting (NV), abdominal pain, infection, acute hepatic decompensation (AHD) and acute kidney injury (AKI). RESULTS: 84 patients [90.5% males, 89.2% cirrhotics, 89.2% nodular HCC, median age 63 (34-84) years] underwent 111 TACE sessions. All were Child class A [69.4% sessions (n = 77)] or B; ascites and portal vein invasion was present in 18 (16.2%) and 15 (13.6%), respectively. 42 (38.2%) TACE procedures resulted in complications [PEF 28 (25.2%), NV 4 (3.6%), abdominal pain 9 (8.1%), infection 7 (6.3 %), AHD 13 (11.7%), AKI 3 (2.7 %)]. There were no immediate post-TACE deaths. On univariate analysis elevated serum bilirubin (p = 0.046) and low serum albumin (p = 0.035) predicted PEF while low serum albumin (p = 0.021) and low platelet counts (p = 0.041) predicted AHD. In the multivariate model, factors with p < 0.200 on univariate analysis and factors derived from the previous literature were considered covariates. Female gender (p = 0.029, OR = 1.412), ascites (p = 0.030, OR = 1.212), elevated serum bilirubin (p = 0.007, OR = 4.357) and large tumour size (p = 0.036, OR = 3.603) were independent risk factors for PEF. Tumour diameter >5 cm (p = 0.049, OR = 2.410) and elevated serum bilirubin (p = 0.036, OR = 1.517) predicted AHD. CONCLUSION: In NASH and alcoholic cirrhosis related HCC patients pre-procedure serum bilirubin, ascites, tumour size and female gender predicted PEF post-TACE. Tumours larger 5 cm with elevated bilirubin predicted AHD post-TACE.