Hepaticojejunostomy is a standard biliary reconstruction method for infantile living donor liver transplantation (LDLT), but choledochocholedochostomy for infants is not generally accepted yet. Ten pediatric recipients weighing no more than 10 kg underwent duct-to-duct choledochocholedochostomy (DD) for biliary reconstruction for LDLT. Patients were followed up for a median period of 26.8 months (range: 4.0-79.0 months). The incidence of posttransplant biliary complications for DD was compared with that for Roux-en-Y hepaticojejunostomy (RY). No DD patients and 1 RY patient (5%) developed biliary leakage (P Ͼ 0.05), and biliary stricture occurred in 1 DD patient (10%) and none of the RY patients (P Ͼ 0.05); none of the DD patients and 5 RY patients (25%) suffered from uncomplicated cholangitis after LDLT (P Ͼ 0.05), and 1 DD patient (10%) and 2 RY patients (10%) died of causes unrelated to biliary complications. In conclusion, both hepaticojejunostomy and choledochocholedochostomy resulted in satisfactory outcome in terms of biliary complications, including leakage and stricture, for recipients weighing no more than 10 kg. Liver Transpl 14: [1761][1762][1763][1764][1765] 2008 Liver transplantation is an established curative therapy for children with end-stage chronic liver disease or acute liver failure. Outcomes following liver transplantation for children have significantly improved over the past 2 decades because of advances in surgical procedures, preservation technology, immunosuppressants, and perioperative management. 1 However, despite refinements in surgical techniques for living donor liver transplantation (LDLT), biliary complications are still associated with significant morbidity and mortality. 2 Duct-to-duct choledochocholedochostomy (DD) and Roux-en-Y hepaticojejunostomy (RY) are now generally accepted procedures for biliary reconstruction in adult-to-adult LDLT. 3,4 However, RY has remained the standard method for pediatric LDLT because of the dominance of biliary atresia and technical difficulties related to the size and fragility of recipients' bile ducts. Only a few reports can be found in the literature on pediatric LDLT using DD, 5,6 and to the best of our knowledge, there have been no studies focused on DD for infantile LDLT. This is therefore the first report to investigate the viability of DD in LDLT for infants weighing no more than 10 kg.
PATIENTS AND METHODS
PatientsBetween February 2001 and January 2008, 57 pediatric patients (less than 15 years old) underwent 60 LDLTs at Kumamoto University Hospital. Thirty-four of these pediatric recipients (59.6%) weighed no more
Slide tracheoplasty is a standard treatment for long-segment congenital tracheal stenosis (LCTS). However, in severe cases of LCTS, aggressive divisions of inferior constrictor muscle from the thyroid cartilage and extensive circumferential dissection of the upper tracheal segment are often necessary to mobilize the upper tracheal segment enough to make an anastomosis, but they increase the risks of anastomotic dehiscence, recurrent nerve injury, and impaired deglutition. Alternatively, laryngeal release provides safe mobilization of the upper tracheal segment, minimizing dissection of the inferior constrictor muscle and preserving the lateral tissue pedicle without circumferential dissection. We successfully performed laryngeal release with slide tracheoplasty on six patients with severe LCTS, and report our findings.
A case of conversion disorder caused by traffic accident mimicking cervical cord injury is reported. The patient was a 42year-old male. He was transferred to our emergency center by ambulance after a traffic accident while riding a 400cc motorcycle. He exhibited abdominal breathing, and motor and sensory function of the bilateral upper and lower extremities had been completely lost. There was no anal reflex, though other neurological reflexes were normal. Severe lower cervical injury was suspected, but cervical vertebral radiographs, head CT, and cervical, thoracic, and lumbar magnetic resonance imaging revealed no abnormalities. Finally, it became clear that he had suffered an episode of acute transient psychological disorder 6 years previously, and was therefore admitted to our hospital with the diagnosis of conversion disorder. His symptoms gradually improved, and on the 13th hospital day he was transferred to another hospital for rehabilitation. Psychological disorder should be considered in the differential diagnosis when detailed physical examination indicates the presence of dissociative symptoms.
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