Hepatobiliary Scintigraphy to Evaluate Biliary Complications of Pediatric Liver Transplantation: An Account of an Experience

2020 ◽  
Author(s):  
Claudia Gutierrez-Villamil ◽  
Camila Velez-Gutierrez ◽  
Sinay Arevalo-Leal ◽  
Jairo Rivera-Baquero ◽  
Víctor Marín-Oyaga
Keyword(s):  
Liver Transplantation ◽  
Pediatric Patients ◽  
Clinical Decision Making ◽  
Expectant Management ◽  
Clinical Decision ◽  
Biliary Complications ◽  
Hepatobiliary Scintigraphy ◽  
Transplant Patients ◽  
Course Of Action ◽  
Transplantation Complications

Abstract Introduction Hepatobiliary scintigraphy (HS) is a noninvasive imaging technique whose use in the follow-up of liver transplantation has not been duly documented. The main objective of this study is to describe the experience of using this technique to detect biliary complications in pediatric patients following liver transplantation. Materials and Methods A retrospective, observational, and descriptive study involving 86 pediatric patients who had undergone liver transplantation between 2013 and 2018. Of the 86, 31 had undergone at least one HS during their postoperative period. Results A total of 45 studies were performed on 31 patients (36% of the patients undergoing transplantation during that time period). Patient ages ranged from 5 to 204 months (mean = 50 months). A total of 22 transplants (71%) were from living donors and 9 (29%) were from cadaveric donors. Of the 45 studies, 22 were positive for biliary complications, and all of them had an impact on clinical decision-making. The remaining 23 studies were negative. Of these 23, 19 continued under medical treatment and the other four underwent an additional intervention with positive surgical outcomes in all cases. All scintigraphy studies revealed hepatocellular dysfunction and cholestasis. Conclusion The HS is a useful, noninvasive, and diagnostic procedure for the early diagnosis of biliary complications that may impact the evolution of disease in liver transplant patients. It allows the treating physician to make a more informed decision regarding expectant management, surgical management, or a less invasive course of action for transplantation complications.

Clinical Decision Making in Early Wound Drainage Following Posterior Spine Surgery in Pediatric Patients

2014 ◽  
Vol 2 (2) ◽  
pp. 104-109 ◽  
Author(s):  
Ozgur Dede ◽  
Patrick Bosch ◽  
Austin J. Bowles ◽  
William Timothy Ward ◽  
James W. Roach
Keyword(s):  
Decision Making ◽  
Spine Surgery ◽  
Pediatric Patients ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Wound Drainage ◽  
Posterior Spine ◽  
Posterior Spine Surgery ◽  
Early Wound

Ivy sign: a diagnostic and prognostic biomarker for pediatric moyamoya

2021 ◽  
pp. 1-9
Keyword(s):  
Blood Flow ◽  
Cerebral Artery ◽  
Pediatric Patients ◽  
Clinical Decision Making ◽  
Prognostic Biomarker ◽  
Pediatric Population ◽  
Radiographic Finding ◽  
Clinical Decision ◽  
Stage Iii ◽  
Postoperative Stroke

OBJECTIVE Ivy sign is a radiographic finding on FLAIR MRI sequences and is associated with slow cortical blood flow in moyamoya. Limited data exist on the utility of the ivy sign as a diagnostic and prognostic tool in pediatric patients, particularly outside of Asian populations. The authors aimed to investigate a modified grading scale with which to characterize the prevalence and extent of the ivy sign in children with moyamoya and evaluate its efficacy as a biomarker in predicting postoperative outcomes, including stroke risk. METHODS Pre- and postoperative clinical and radiographic data of all pediatric patients (21 years of age or younger) who underwent surgery for moyamoya disease or moyamoya syndrome at two major tertiary referral centers in the US and Israel, between July 2009 and August 2019, were retrospectively reviewed. Ivy sign scores were correlated to Suzuki stage, Matsushima grade, and postoperative stroke rate to quantify the diagnostic and prognostic utility of ivy sign. RESULTS A total of 171 hemispheres in 107 patients were included. The median age at the time of surgery was 9 years (range 3 months–21 years). The ivy sign was most frequently encountered in association with Suzuki stage III or IV disease in all vascular territories, including the anterior cerebral artery (53.7%), middle cerebral artery (56.3%), and posterior cerebral artery (47.5%) territories. Following surgical revascularization, 85% of hemispheres with Matsushima grade A demonstrated a concomitant, statistically significant reduction in ivy sign scores (OR 5.3, 95% CI 1.4–20.0; p = 0.013). Postoperatively, revascularized hemispheres that exhibited ivy sign score decreases had significantly lower rates of postoperative stroke (3.4%) compared with hemispheres that demonstrated no reversal of the ivy sign (16.1%) (OR 5.5, 95% CI 1.5–21.0; p = 0.008). CONCLUSIONS This is the largest study to date that focuses on the role of the ivy sign in pediatric moyamoya. These data demonstrate that the ivy sign was present in approximately half the pediatric patients with moyamoya with Suzuki stage III or IV disease, when blood flow was most unstable. The authors found that reversal of the ivy sign provided both radiographic and clinical utility as a prognostic biomarker postoperatively, given the statistically significant association with both better Matsushima grades and a fivefold reduction in postoperative stroke rates. These findings can help inform clinical decision-making, and they have particular value in the pediatric population, as the ability to minimize additional radiographic evaluations and tailor radiographic surveillance is requisite.

Ischemic Complications after Liver Transplantation

2018 ◽  
Vol 02 (03) ◽  
pp. 244-248
Author(s):  
Martin Montenovo ◽  
Christopher Ingraham
Keyword(s):  
Liver Transplantation ◽  
Patient Survival ◽  
Vascular Complications ◽  
Biliary Tree ◽  
Biliary Complications ◽  
Surgical Anastomosis ◽  
Biliary Leak ◽  
The Past ◽  
Ischemic Complications ◽  
Transplantation Complications

AbstractDespite major advances in the field of liver transplantation over the past few decades with both increased graft and patient survival, biliary complications still occur in many patients after liver transplantation. Complications can range from a biliary leak or biloma to strictures most commonly involving the surgical anastomosis, or elsewhere in the biliary tree. Etiologies of these complications include surgical technique, rejection, complications secondary to infection, and vascular complications causing ischemia of the bile ducts. Biliary complications, particularly biliary ischemia, can cause significant morbidity to the patient, and may require multiple endoscopic, endovascular, or percutaneous therapies for successful treatment, or even retransplantation in severe cases. This review will provide an overview of common biliary complications with a focus on biliary ischemia.

DECISION MAKING IN PEDIATRIC SPINAL DEFORMITY

Neurosurgery ◽  
2008 ◽  
Vol 63 (suppl_3) ◽  
pp. A54-A68 ◽  
Author(s):  
Justin S. Smith ◽  
Christopher I. Shaffrey ◽  
Mark F. Abel ◽  
Christopher P. Ames
Keyword(s):  
Decision Making ◽  
Spinal Deformity ◽  
Pediatric Patients ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Nonoperative Treatment ◽  
Treatment Modalities ◽  
Decision Making Process ◽  
History Of ◽  
Diagnosis And Classification

ABSTRACT OBJECTIVE To review the concepts involved in the decision-making process for management of pediatric patients with spinal deformity. METHODS The literature was reviewed in reference to pediatric deformity evaluation and management. RESULTS Pediatric spinal deformity includes a broad range of disorders with differing causes, natural histories, and treatments. Appropriate categorization of pediatric deformities is an important first step in the clinical decision-making process. An understanding of both nonoperative and operative treatment modalities and their indications is requisite to providing treatment for pediatric patients with spinal deformity. The primary nonoperative treatment modalities include bracing and casting, and the primary operative treatments include nonfusion instrumentation and fusion with or without instrumentation. In this article, we provide a review of pediatric spinal deformity classification and an overview of general treatment principles. CONCLUSION The decision-making process in pediatric deformity begins with appropriate diagnosis and classification of the deformity. Treatment decisions, both nonoperative and operative, are often predicated on the basis of the age of the patient and the natural history of the disorder.

Differentiation of liver transplantation complications by quantitative analysis of dynamic hepatobiliary scintigraphy

2012 ◽  
Vol 33 (3) ◽  
pp. 255-261 ◽  
Author(s):  
Ji Young Lee ◽  
Wei Hu ◽  
Kyung-Han Lee ◽  
Choon Hyuck Kwon ◽  
Eun Jeong Lee ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Quantitative Analysis ◽  
Hepatobiliary Scintigraphy ◽  
Transplantation Complications

scholarly journals Morphological Characteristics of Biliary Strictures after Liver Transplantation Visualized Using SpyGlass™ Cholangioscopy

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Yathip M. Chokpapone ◽  
Anne R. Murray ◽  
Ashwini P. Mehta ◽  
Vichin C. Puri ◽  
Alejandro Mejia ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Morphological Characteristics ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Biliary Complications ◽  
Direct Visualization ◽  
Biliary Strictures ◽  
Endoscopic Retrograde ◽  
Visualization System ◽  
Transplant Patients

Biliary complications following liver transplant are common. Endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP) are the main techniques used to diagnose and treat biliary complications; however, these techniques have limits to the depth of visualization. In this report, we present five cases of orthotopic liver transplant patients with biliary complications that underwent ERCP- or MRCP-guided cholangioscopy with the SpyGlass™ DS Direct Visualization System (SDDVS). The SDDVS allowed for the visualization of the morphological characteristics of biliary strictures, and images collected using the SDDVS allowed for four of the cases to be treated endoscopically. Our findings suggest that cholangioscopy with the SDDVS is a promising method to guide the endoscopic treatment of biliary complications after liver transplantation.

scholarly journals The Utility of Procalcitonin to Support Clinical Decision Making in Critically Ill Pediatric Patients

2016 ◽  
Vol 3 (suppl_1) ◽  
Author(s):  
David Jacobs ◽  
Maya Holsen ◽  
Shirley Chen ◽  
Nicholas Fusco ◽  
Amanda Hassinger
Keyword(s):  
Decision Making ◽  
Critically Ill ◽  
Pediatric Patients ◽  
Clinical Decision Making ◽  
Clinical Decision

scholarly journals Classic cases revisited: Of hurricanes, cyanide and moral courage

2018 ◽  
Vol 21 (1) ◽  
pp. 2-6
Author(s):  
Piotr Szawarski
Keyword(s):  
Reflective Practice ◽  
Clinical Decision Making ◽  
Moral Distress ◽  
Clinical Decision ◽  
Moral Dimension ◽  
Usual Practice ◽  
Course Of Action ◽  
Burn Out ◽  
Moral Dimensions ◽  
The Individual

All decisions made by doctors have a moral dimension. When a moral judgement demands a different course of action to one that represents the usual practice, many doctors do struggle. The inability to embrace such decisions can represent moral negligence, as often the consequence is greater suffering for the individual in question or loss of utility for the population. On the other hand, it takes courage to make such decisions as the society fails to accept them, even though decisions made are rational and morally valid. Clinical practice that does not conform to moral judgements can result in moral distress, burn out and job-leave. Reflective practice evaluating moral dimensions of clinical decision making is an important aspect of nurturing humanity, empathy and professionalism in the therapeutic endeavour.

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