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AIM: Although intestinal obstruction following living donor liver transplantation (LDLT) is relatively common, diaphragmatic hernia (DH) as the attributing cause is rarely reported. The study aimed to find out the incidence, clinical presentation, and management of DH after liver transplant in pediatric patients. MATERIALS AND METHODS: A retrospective review of all cases of pediatric liver transplants was performed. Case sheets, operation records, and investigations including radiology were studied. RESULTS: Out of 79 cases of pediatric liver transplants, two cases of posttransplant DH were identified. The first case is a 2-year-old male child who was transplanted for progressive familial intrahepatic cholestasis, and the second one is a 4-year-old boy who underwent LDLT for hepatitis A-induced acute liver failure. The first child presented abdominal symptoms and the second one with pulmonary symptoms. The DHs were diagnosed at 132 and 70 days, respectively, posttransplant by chest radiographs and computed tomography scan. The defects were located at the posteromedial aspect of the diaphragm in both the cases and were closed by primary closure with mesh reinforcement. Both the children are doing well with no recurrence. CONCLUSION: High index of clinical suspicion is mandated in pediatric patients after liver transplant and once the diagnosis is confirmed, urgent surgical exploration is mandatory.
RESUMO
BACKGROUND: Bone morphogenic proteins (BMP) have shown tremendous potential in bone formation at fracture sites and at non-union sites. Animal studies and limited human studies have proven their efficacy as an alternative or enhancer of autologus bone graft in bone regeneration. The action of BMP is mediated through receptor kinases and transcription factors called Smads that regulate the expression of target genes. In preclinical studies, it was observed that BMP is relatively devoid of adverse effects and carcinogenicity but further studies are needed to clarify the issue of ectopic bone formation before its extensive use in humans. MATERIALS AND METHODS: This review article intends to give brief information on biology and basic science of BMP and provide an overview on the current research data on clinical application of BMP in the treatment of fractures and difficult non-unions. RESULTS: Various studies have shown that BMP holds promise in the management of delayed unions and recalcitrant non-unions. It has also been observed to initiate faster healing resulting in less pain and infection at the fracture site in open fractures. However the role of BMP in fresh fractures is debatable. CONCLUSION: Judicious use of BMP in certain clinical scenarios may revolutionise management of non-unions and delayed unions. The major constraints for routine use of BMP are inadequate clinical trials in humans and the need to comprehensively assess the cost-effectiveness and budget impact of BMP.