D. Claus

Hepatic artery thrombosis in pediatric liver transplantation

The incidence of hepatic artery thrombosis was analyzed in a series of 59 consecutive liver transplants performed in 52 children less than 15 years of age at the University of Louvain Medical School, Brussels, from March 1984 to March 1987. This incidence was 17% for the whole series; it was increased in small recipients less than 3 years of age and less than 15 kg (23%) in weight, as well as when the liver was harvested from a small donor less than 15 kg in weight (38%). It was also increased when the donor liver was supplied by more than one artery. This incidence was markedly reduced by arterial revascularization from the aorta, either directly or by interposition of an iliac segment; the reduced-size livers had a much lower incidence of arterial thrombosis (5%) than the whole livers (23%). In the present series, we did not find any argument to support the view that poorly controlled rejection could be implicated in the pathogenesis of arterial thrombosis.

Congenital fibrosarcoma. Preoperative chemotherapy and conservative surgery

Three cases of congenital fibrosarcoma are reported. The use of preoperative chemotherapy, a VAC regimen, allowed conservative surgery in two of them. The three children are well, with no evidence of disease and without sequelae after completion of postoperative chemotherapy.

Diverticulum formation after circular myotomy for esophageal atresia

Out of our last 70 cases of esophageal atresia, a circular myotomy of the upper pouch (Livaditis technique) was required in six patients to achieve an end-to-end anastomosis: all had a lower tracheoesophageal fistula. They were operated on between 15 and 96 hours after birth, without any preoperative attempt of elongation of the upper pouch. Follow-up ranged from 14 to 77 months. Three patients had an uneventful postoperative course and late outcome, despite a moderate ballooning at the myotomy site in one. Three babies developed a mild stricture which responded easily to a few dilatations. Asymptomatic ballooning at the myotomy site was observed in one baby; the other two developed a diverticulum responsible for acute respiratory distress in one case and severe dysphagia in the other. both required esophageal replacement. These observations call attention to the fact that patients treated by myotomy should be followed very carefully early and late, especially if an anastomotic stricture develops or in case of associated tracheomalacia.

Parotid gland abnormality found in children seropositive for the human immunodeficiency virus (HIV)

Out of our series of 24 children seropositive for the Human Immunodeficiency Virus (HIV), parotid gland enlargement was noted in 4 children with AIDS-related complex (ARC) presenting also a Lymphocytic Interstitial Pneumonitis (LIP) on their chest radiographs. The ultrasound (US) aspect of the parotid gland suggests acinar enlargement (suggesting the presence of lymphocytic infiltration). The aspect displayed in the parotid mirrors the process developing in other areas (lungs, liver, spleen, lymphnodes), i.e. a syndrome of lymphocytic (CD8) proliferation present at the stage of ARC.

Sonographic evaluation of traumatic spinal cord lesions in the newborn infant

We present a case of spinal cord injury due to birth trauma and assess the value of sonography for diagnosis, lesion characterization, and follow-up. Sonography is a non-invasive and easily reproducible imaging method for examining a ventilated child, and its initial sensitivity is comparable to that of MRI. Sonography is the method of choice for guiding diagnosis in this type of traumatic lesion to the newborn.

Unifocal stricture of the common bile duct in two children: a localized form of primary sclerosing cholangitis.

A 4-year-old boy and a 14-year-old girl referred for a cholestatic syndrome were found to have a unifocal stricture of the extrahepatic bile duct. Both radiological (endoscopic-retrograde-choledocopancreatography) and histological findings were suggestive of primary sclerosing cholangitis. There was no past history of chronic inflammatory bowel disease nor any other disorder. Serum autoimmune markers were negative. Complete remission was observed after surgical drainage, and both patients remained symptom-free after a follow-up of 12 months and 8 years, respectively. Such unifocal form of the disease may have a better prognosis than the plurifocal disease. The absence of associated disorders and autoimmunity may also be an indicator of better prognosis in these patients.

Transient cyst-like cortical defects following fractures in children : medullary fat within the subperiosteal haematoma

Asymptomatic cyst-like cortical defects appearing after fractures in children have been occasionally reported. Typically, these defects appear during fracture consolidation, within the newly formed subperiosteal bone, proximal to the fracture line, do not enlarge, and progressively disappear. We have previously shown a fatty density on CT scan within the early cortical defect. We now present two additional cases in which early CT scans appeared to confirm that these transient cortical defects may consist of fat, and probably result from the inclusion of medullary fat within the subperiosteal haematoma.