Catalina Gómez

Hepatitis A, cardiomyopathy, aplastic anemia, and acute liver failure: A devastating scenario

Hepatitis A virus (HAV) causes an acute infection and is usually asymptomatic in children. When clinical manifestations appear, these include choluria, jaundice, and abdominal pain. Although infrequent, extra‐hepatic manifestations related to HAV have been described, affecting the heart, bone marrow, blood vessels, and other tissues.A 10‐year‐old boy from a rural area presented with a 15‐day history of malaise, fever, and jaundice; laboratory examinations were compatible with HAV infection. The patient turned encephalopathic and was remitted to our center, where laboratory examinations showed a medullary aplasia and fulminant hepatitis requiring a liver transplant that was performed 72 hours after admission. At 24 hours post transplant, the patient developed a cardiomyopathy secondary to HAV, and intravenous immunoglobulin was administered. The patient is still alive and attending his medical check‐ups.Although rare, extra‐hepatic manifestations of HAV infection have been described in 14% of cases. The groups of patients affected are usually aged and present with high bilirubin levels. Acquired aplastic anemia and myocarditis caused by HAV are uncommon, and its pathophysiology has not yet been elucidated.HAV infection is usually asymptomatic in children, although extra‐hepatic manifestations can appear requiring early detection and management.

Hepatoblastoma: Transplant Versus Resection Experience in a Latin American Transplant Center

Background Hepatoblastoma is the most common primary malignant liver tumor in children and is usually diagnosed during the first 3 years of life. Overall survival has increased 50% due to chemotherapeutic schemes, expertise surgery centers, and liver transplantation. Methods A retrospective collection of data was performed from pediatric patients with diagnosis of hepatoblastoma. Variables included demographic, diagnostic tools and histological classification; chemotherapy and surgical treatment; and outcomes and patient survival. The PRETEXT classification was applied, which included the risk evaluation, and according to the medical criterion in an individualized way, underwent resection or transplant. The morbidity of patients was evaluated by the Clavien-Dindo classification. Statistical analysis was performed according to the distribution of data and the survival analysis was carried out using the Kaplan-Meier method. Results The patients (n = 16) were divided in a resection group (n = 8) and a transplant group (n = 8). The median age at the time of diagnosis was 13.5 months. The motive for the initial consultation was the discovery of a mass; all patients had high levels of &agr;-fetoprotein and an imaging study. Ten of 16 patients required chemotherapy before the surgical procedure. In the resection group, 5 of 8 patients were classified as Clavien I and 4 of 8 patients of the transplant group were classified as Clavien II. Patient survival at 30 months was 100% in the resection group and 65% in the liver transplantation group. Conclusions To our knowledge, this is the first case report of pediatric patients with hepatoblastoma and liver resection or transplant in Colombia and Latin America. Our results are comparable with the series worldwide, showing that resection and transplant increase the survival of the pediatric patients with hepatoblastoma. It is important to advocate for an increase of reporting in the scientific literature in Latin America.

Pediatric trauma at a general hospital in Cali, Colombia.

BACKGROUND Trauma is an important cause of morbidity and mortality in children. Blunt trauma is the most common type and falls and road traffic injuries (RTI) are the most frequent mechanisms. METHODS Secondary analysis of institutional data included within the Panamerican Society of Trauma Registry (STP-ITSDP). A total of 581 trauma patients younger than 18years, hospitalized between 2012 and 2014, were included. RESULTS Blunt trauma (BT) (68%) was the most common type, and falls (42.5%) the most common mechanism. Median age was: 14years for penetrating trauma (PT), 8years for BT, and 5.5years for other types of trauma (OT). Of all patients, 8.1% had a Glasgow score<8, 9% had a Glasgow score of 8-13 and 81.1% had a Glasgow score higher than 14. Death occurred in 5.2% of patients: 83.3% as inpatients and 16.7% during initial management in the emergency room (ER). Patients dying in the ER were mostly PT victims, with higher ISS and lower Glasgow scores. CONCLUSIONS Trauma is an important cause of morbidity and mortality in our pediatric population. Fundación Valle de Lili (FVL), a referral hospital, receives a high number of trauma patients from southwestern Colombia. Detailed knowledge of epidemiological data will help us to develop rapid response strategies for patients with trauma and to develop prevention and promotion programs.

Aspergillus hepatic artery thrombosis in liver transplantation

We present the first cirrhotic patient who underwent liver transplantation (LT) and presented a hepatic artery thrombosis of the graft due to Aspergillus fumigatus, within the first month of LT. This culminated in graft loss, re-transplant with multiple biliary and infectious complications. To our knowledge, this is a case report of an early hepatic artery thrombosis due to Aspergillus fumigatus in an infection-free patient.