European Journal of Gastroenterology & Hepatology, 1999
Iron studies are difficult to interpret in patients with chronic inflammatory states such as infl... more Iron studies are difficult to interpret in patients with chronic inflammatory states such as inflammatory bowel disease (IBD). Serum transferrin receptor (TfR) has been reported to be a reliable tool for the diagnosis of iron deficiency in adults. Our aim was to evaluate the role of serum TfR in diagnosing iron deficiency in children and adolescents with IBD. A total of 63 consecutive patients with IBD, aged 9 to 22 years (median 15 years), were tested for serum haemoglobin level, mean corpuscular volume (MCV), and serum iron, transferrin, ferritin and serum TfR levels. Those found to be anaemic were compared with seven age-matched subjects with iron deficiency anaemia (IDA) and 24 age-matched children without signs of anaemia or inflammation. Of the 63 patients with IBD, 26 had anaemia. Based on ferritin levels and MCV indices, anaemia was classified as IDA in 11 patients and as anaemia of chronic disease (ACD) in 15 patients. Mean serum TfR level in normal controls was 3.5 mg/l (range 1.2-8.2 mg/l). Mean (+/-SD) serum TfR levels were significantly lower in the IBD patients with ACD (5.3 +/- 2.3 mg/l) than in the IBD patients with IDA (8.2 +/- 3.1 mg/l) (P < 0.05). Serum TfR levels above 5 mg/l identified 10/11 IBD patients with IDA. The calculated TfR/ferritin ratio was 84 (range 17-367) for controls and 133 (range 6.4-1840) for IBD patients. A cut-off level of 350 (91% sensitivity, 100% specificity, 100% positive predictive value, 98% negative predictive value) was established for the diagnosis of IDA in IBD. The results suggest that serum transferrin receptor is a useful parameter for the diagnosis of iron deficiency in inflammatory bowel disease, in particular, the transferrin receptor/ferritin ratio with a cut-off level > or = 350.
The Israel Medical Association journal : IMAJ, 2008
... Am J Gastroenterol 2002;97 (Suppl 1):S190. 4. Akbulut S, Yavuz B, Koseoglu T, Gokoz A, Sarita... more ... Am J Gastroenterol 2002;97 (Suppl 1):S190. 4. Akbulut S, Yavuz B, Koseoglu T, Gokoz A, Saritas U. Crohn's disease with isolated esophagus and gastric involvement. Turk J Gastroenterol 2004;15:196200. 5. Wagtmans MJ, Verspaget HW, Lamers CB, van Hogezand RA. ...
Our experience with living-related liver transplantation is described. In 2 boys and 1 girl, aged... more Our experience with living-related liver transplantation is described. In 2 boys and 1 girl, aged 4-4.5 years with acute, fulminating hepatitis A, the presence of very severe jaundice (bilirubin levels > 18 mg%) associated with severe coagulopathy (INR > 10) and encephalopathy indicated the need for urgent liver transplantation. In all 3 cases the left lateral hepatic segment of a matched blood type parent was transplanted. None of the donors suffered a serious complication postoperatively and all returned to full activity in 6-16 weeks. The post-transplantation course was uneventful in 1 child, but in the other 2 there was hepatic arterial thrombosis in 1 at 1 day and in the other at 8 days post-transplantation. Early detection of arterial thrombosis by Doppler sonography permitted salvage of the 2 hepatic grafts after thrombectomy and re-anastomosis. In 1 of these 2 children an anastomotic biliary stricture was found 2 months after transplantation. It was corrected at surger...
The pathogenesis of the Shigella-associated neurological symptoms is unclear. We examined the pot... more The pathogenesis of the Shigella-associated neurological symptoms is unclear. We examined the potential role of host factors. Sonicates of Shigella strains isolated from children with and without neurologic disturbances were compared regarding their ability to induce tumor necrosis factor (TNF) and nitric oxide (NO) in vitro, in mouse macrophage J744 cell line. The mean concentrations of TNF (14.6 vs. 4.4 ng/ml) and NO (7.4 vs. 3.7 microM) induced were higher in response to strains isolated from children with neurologic complications; the differences were not statistically significant. TNF was also measured in plasma of children with shigellosis, and was found to be elevated in all patients. The mean concentration of TNF in plasma of children with neurologic manifestations was higher than that of children with no neurologic symptoms (450 vs. 138 pg/ml, P <0.05). It is concluded that TNF and NO may play a role in the development of neurologic manifestations of shigellosis.
Cholestasis is a frequent problem in patients on total parenteral nutrition (TPN) therapy. Nonste... more Cholestasis is a frequent problem in patients on total parenteral nutrition (TPN) therapy. Nonsteroidal anti-inflammatory drugs (NSAIDs), especially aspirin, cause choleresis in animals. We studied the effect of aspirin on bile flow and bile salt secretion in TPN-associated cholestasis in rats. Four groups of 6-10 animals each received either 154 mM NaCl (saline) or 2.5% amino acid solution (TRAVASOL, Travenol, Israel) and 10% glucose i.v. (TPN) for 3 h. During the second and third hours, taurocholate, the main bile salt in rats, was infused at a rate of 10 micromol/min per kg to prevent bile salt pool depletion. Aspirin, one of the main NSAIDs, was infused during the last 2 h into animals with or without TPN treatment at a rate of 100 mg/kg. Bile was directly collected from the common bile duct for 3 h. Rats given TPN showed a significant reduction in bile flow and bile salt secretion rate compared to control groups: 20.89 vs. 29.60 microl/min per kg (P <0.02) and 0.37 vs. 0.65 ...
Ketotifen is an anti-allergic agent that was recently shown to prevent experimental gastric and c... more Ketotifen is an anti-allergic agent that was recently shown to prevent experimental gastric and colonic mucosal injury. We studied the effect of ketotifen on indomethacin-induced small intestinal ulceration in the rat. Ulceration was produced by s.c. injection of 30 mg/kg indomethacin, 30 min after refeeding 24 h fasted rats. Total ulcer area (mm2), prostaglandin E2 (PGE2) and leukotriene B4 (LTB4) were measured 24 h after indomethacin administration. Study groups received ketotifen 100 micrograms/ 100 g body weight 30 min before and 5 h after indomethacin administration, either i.p. or orally. There were 7-9 animals in each group. Ulcer area was significantly reduced by oral administration of ketotifen from 229 +/- 26 to 146 +/- 28 mm2. PGE2 level was reduced by ketotifen from 505 +/- 73 to 228 +/- 68 ng/mg protein, and LTB4 was reduced from 289 +/- 68 to 59 +/- 26 ng/mg protein. Intraperitoneal administration of ketotifen had no effect on any of the measured parameters. Ketotifen ...
During a 4 year period (January 1988 to December 1991), 237 pediatric patients (mean age +/- SD, ... more During a 4 year period (January 1988 to December 1991), 237 pediatric patients (mean age +/- SD, 9.75 +/- 5.17 years) underwent 289 upper gastrointestinal endoscopies. Premedication was used in only 102 of the endoscopic examinations, mostly in children between 2 and 10 years of age. Patients who were examined without sedation tolerated the procedure well. Abdominal pain was the most frequent indication, accounting for 57.4% of all procedures. Gastritis, esophagitis, duodenitis and duodenal ulcer were the most common endoscopic findings. Seventy-five endoscopies were performed to obtain small bowel biopsies. We found this procedure to be easy and safe and preferable to capsule biopsies. In our experience, upper gastrointestinal endoscopy with or without sedation is a safe and effective diagnostic procedure in the pediatric age group.
Celiac disease in children has been occasionally reported to be associated with various disorders... more Celiac disease in children has been occasionally reported to be associated with various disorders such as arthritis, cutaneous vasculitis and diabetes mellitus. We report on a 12-year-old girl with celiac disease, diagnosed at 1 year of age, who developed systemic lupus erythematosus. This association has not yet been reported in children.
The growth charts of 15 patients with anorexia nervosa during the prepubertal and pubertal period... more The growth charts of 15 patients with anorexia nervosa during the prepubertal and pubertal period were carefully reconstructed. All 15 (13 females, 2 males) had been suffering from anorexia nervosa for at least 6 months prior to referral. Mean age at referral was 13.3 +/- 1.3 years and mean duration of anorectic symptoms was 17 +/- 8 months. In all 15 cases growth arrest had been present for 13 +/- 8.5 months prior to admission. During the follow-up period, catch-up growth to different degrees was observed in the 13 patients (11 females, 2 males) who remained under treatment for at least 1 year. On the assumption that stunting of growth during the prepubertal and pubertal period is a very frequent, if not a constant, sign of anorexia nervosa of 6 months duration or more, it could be considered an additional criterion for diagnosis of the disease. The projected height should be included in the calculation of ideal weight. Since patients with growth arrest are usually referred first t...
3 infants wih the acute neuronopathic form of Niemann-Pick disease had prominent gastrointestinal... more 3 infants wih the acute neuronopathic form of Niemann-Pick disease had prominent gastrointestinal manifestations. These included chronic diarrhea, malnutrition, failure to thrive, radiologic intestinal abnormalities, xylose malabsorption, abnormal liver function, and infiltration of the liver, lamina propria and autonomic ganglia by lipid-laden cells. Possible pathogenetic mechanisms are discussed, and it is suggested that gastrointestinal disturbances play a larger part in the clinical manifestations of Niemann-Pick disease than is usually appreciated.
American journal of diseases of children (1960), 1983
We studied 158 children with culture-proven shigellosis, 37 (23.4%) of whom had convulsions. Hist... more We studied 158 children with culture-proven shigellosis, 37 (23.4%) of whom had convulsions. Historical, clinical, and laboratory data were compared between patients with and without convulsions to define risk factors for the development of seizures. Age was the most important predisposing factor. The highest incidence of shigellosis associated with convulsions was found in children between 6 months and 4 years of age. Peak body temperature and a family history of convulsions also independently affected the development of seizures. Sex and Shigella strain showed differences between the groups but failed to reach statistical significance.
The appropriate use of liver transplantation in children with type-1 primary hyperoxaluria (PH-1)... more The appropriate use of liver transplantation in children with type-1 primary hyperoxaluria (PH-1) is not well established. We reviewed our experience with 36 children with PH-1, including 12 who underwent liver transplantation. From 1989-1998, 36 children from 10 families in northern Israel were diagnosed with PH-1. Eight children presented with renal failure; seven of these eight had the severe infantile form of the disease. One child was treated with kidney transplantation alone. Combined liver-kidney transplantation has been performed in nine children and preemptive liver transplantation in three children. A review of the patients&amp;amp;amp;amp;amp;amp;#39; charts for the following parameters was performed: age, clinical signs, and renal sonographic findings at diagnosis, age at onset of dialysis, and current status. Type of transplant, pre- and posttransplant urine oxalate excretion, current renal function, survival, and complications were recorded in liver recipients. Of the 23 nontransplanted children, 9 died of complications related to severe systemic oxalosis and 14 are alive (mean follow-up, 7.4 years), including 2 who are candidates for transplantation. The child who underwent only kidney transplantation died of unrelated causes. Of the 12 liver recipients, 2 died within the first 3 months posttransplant and another child underwent retransplantation due to hepatic arterial thrombosis. At intervals after transplant ranging from 6-54 months, 10 recipients are alive (7 of the 9 recipients of combined liver-kidney transplants and all 3 recipients of preemptive liver transplants). Mean GFR in the 10 survivors is 77 ml/min/m2. In 9 of these 10, daily urinary oxalate excretion normalized. Renal function has improved (mean GFR 86 vs. 58 ml/min/m2) but renal oxalate deposits remain in the three recipients of isolated liver grafts. Our decade-long experience with children with PH-1 supports strategies for early diagnosis and timely liver transplantation. Preemptive isolated liver transplantation should be considered in children who develop the disease during infancy or in those with slowly progressive disease when significant symptoms develop. Combined liver-kidney transplantation is suggested for children with end-stage renal disease.
... Auteur(s) / Author(s). MOR E. (1) ; BAR-NATHAN N. (1) ; SHMUELI D. (1) ; SHAHARABANI E. (1) ;... more ... Auteur(s) / Author(s). MOR E. (1) ; BAR-NATHAN N. (1) ; SHMUELI D. (1) ; SHAHARABANI E. (1) ; YUSSIM A. (1) ; ZEHAVI I. (2) ; SHAPIRA R. (2) ; SHEINFELD T. (3) ; BEN-ARI Y. (3) ; DINARI G. (2) ; SHAPIRA Z. (1) ; Affiliation(s) du ou des auteurs / Author(s) Affiliation(s). ...
There is at present very little information about hepatitis B virus (HBV) infection in children a... more There is at present very little information about hepatitis B virus (HBV) infection in children after liver transplantation. This is the first study to assess the safety and efficacy of lamivudine in this patient population. We describe three children aged 5-14 years who underwent liver transplantation for fulminant hepatitis A, hyperoxaluria, and cystic fibrosis. Despite adequate immunoprophylaxis, two of the children who were serum hepatitis B surface antigen-positive before transplantation (HBV DNA-negative by hybridization) had a reactivation of the disease, and one had a de novo HBV infection, at 12-18 months after transplantation. Lamivudine 3 mg/kg was administered on a compassionate-use basis for 14-36 months. After 1 month of therapy, HBV DNA disappeared from the serum in all patients by hybridization and in two patients by polymerase chain reaction. In all three children, alanine transaminase levels normalized. One child developed lamivudine resistance after 22 months with no evidence of hepatic decompensation. Repeated liver histological studies revealed progression of hepatic fibrosis in one child. All children remained serum hepatitis B surface antigen- and hepatitis B e antigen-positive. No adverse effects of the drug were noted. Lamivudine is beneficial and well tolerated in children with HBV infection after liver transplantation.
European Journal of Gastroenterology & Hepatology, 1999
Iron studies are difficult to interpret in patients with chronic inflammatory states such as infl... more Iron studies are difficult to interpret in patients with chronic inflammatory states such as inflammatory bowel disease (IBD). Serum transferrin receptor (TfR) has been reported to be a reliable tool for the diagnosis of iron deficiency in adults. Our aim was to evaluate the role of serum TfR in diagnosing iron deficiency in children and adolescents with IBD. A total of 63 consecutive patients with IBD, aged 9 to 22 years (median 15 years), were tested for serum haemoglobin level, mean corpuscular volume (MCV), and serum iron, transferrin, ferritin and serum TfR levels. Those found to be anaemic were compared with seven age-matched subjects with iron deficiency anaemia (IDA) and 24 age-matched children without signs of anaemia or inflammation. Of the 63 patients with IBD, 26 had anaemia. Based on ferritin levels and MCV indices, anaemia was classified as IDA in 11 patients and as anaemia of chronic disease (ACD) in 15 patients. Mean serum TfR level in normal controls was 3.5 mg/l (range 1.2-8.2 mg/l). Mean (+/-SD) serum TfR levels were significantly lower in the IBD patients with ACD (5.3 +/- 2.3 mg/l) than in the IBD patients with IDA (8.2 +/- 3.1 mg/l) (P &lt; 0.05). Serum TfR levels above 5 mg/l identified 10/11 IBD patients with IDA. The calculated TfR/ferritin ratio was 84 (range 17-367) for controls and 133 (range 6.4-1840) for IBD patients. A cut-off level of 350 (91% sensitivity, 100% specificity, 100% positive predictive value, 98% negative predictive value) was established for the diagnosis of IDA in IBD. The results suggest that serum transferrin receptor is a useful parameter for the diagnosis of iron deficiency in inflammatory bowel disease, in particular, the transferrin receptor/ferritin ratio with a cut-off level &gt; or = 350.
The Israel Medical Association journal : IMAJ, 2008
... Am J Gastroenterol 2002;97 (Suppl 1):S190. 4. Akbulut S, Yavuz B, Koseoglu T, Gokoz A, Sarita... more ... Am J Gastroenterol 2002;97 (Suppl 1):S190. 4. Akbulut S, Yavuz B, Koseoglu T, Gokoz A, Saritas U. Crohn&#x27;s disease with isolated esophagus and gastric involvement. Turk J Gastroenterol 2004;15:196200. 5. Wagtmans MJ, Verspaget HW, Lamers CB, van Hogezand RA. ...
Our experience with living-related liver transplantation is described. In 2 boys and 1 girl, aged... more Our experience with living-related liver transplantation is described. In 2 boys and 1 girl, aged 4-4.5 years with acute, fulminating hepatitis A, the presence of very severe jaundice (bilirubin levels > 18 mg%) associated with severe coagulopathy (INR > 10) and encephalopathy indicated the need for urgent liver transplantation. In all 3 cases the left lateral hepatic segment of a matched blood type parent was transplanted. None of the donors suffered a serious complication postoperatively and all returned to full activity in 6-16 weeks. The post-transplantation course was uneventful in 1 child, but in the other 2 there was hepatic arterial thrombosis in 1 at 1 day and in the other at 8 days post-transplantation. Early detection of arterial thrombosis by Doppler sonography permitted salvage of the 2 hepatic grafts after thrombectomy and re-anastomosis. In 1 of these 2 children an anastomotic biliary stricture was found 2 months after transplantation. It was corrected at surger...
The pathogenesis of the Shigella-associated neurological symptoms is unclear. We examined the pot... more The pathogenesis of the Shigella-associated neurological symptoms is unclear. We examined the potential role of host factors. Sonicates of Shigella strains isolated from children with and without neurologic disturbances were compared regarding their ability to induce tumor necrosis factor (TNF) and nitric oxide (NO) in vitro, in mouse macrophage J744 cell line. The mean concentrations of TNF (14.6 vs. 4.4 ng/ml) and NO (7.4 vs. 3.7 microM) induced were higher in response to strains isolated from children with neurologic complications; the differences were not statistically significant. TNF was also measured in plasma of children with shigellosis, and was found to be elevated in all patients. The mean concentration of TNF in plasma of children with neurologic manifestations was higher than that of children with no neurologic symptoms (450 vs. 138 pg/ml, P <0.05). It is concluded that TNF and NO may play a role in the development of neurologic manifestations of shigellosis.
Cholestasis is a frequent problem in patients on total parenteral nutrition (TPN) therapy. Nonste... more Cholestasis is a frequent problem in patients on total parenteral nutrition (TPN) therapy. Nonsteroidal anti-inflammatory drugs (NSAIDs), especially aspirin, cause choleresis in animals. We studied the effect of aspirin on bile flow and bile salt secretion in TPN-associated cholestasis in rats. Four groups of 6-10 animals each received either 154 mM NaCl (saline) or 2.5% amino acid solution (TRAVASOL, Travenol, Israel) and 10% glucose i.v. (TPN) for 3 h. During the second and third hours, taurocholate, the main bile salt in rats, was infused at a rate of 10 micromol/min per kg to prevent bile salt pool depletion. Aspirin, one of the main NSAIDs, was infused during the last 2 h into animals with or without TPN treatment at a rate of 100 mg/kg. Bile was directly collected from the common bile duct for 3 h. Rats given TPN showed a significant reduction in bile flow and bile salt secretion rate compared to control groups: 20.89 vs. 29.60 microl/min per kg (P <0.02) and 0.37 vs. 0.65 ...
Ketotifen is an anti-allergic agent that was recently shown to prevent experimental gastric and c... more Ketotifen is an anti-allergic agent that was recently shown to prevent experimental gastric and colonic mucosal injury. We studied the effect of ketotifen on indomethacin-induced small intestinal ulceration in the rat. Ulceration was produced by s.c. injection of 30 mg/kg indomethacin, 30 min after refeeding 24 h fasted rats. Total ulcer area (mm2), prostaglandin E2 (PGE2) and leukotriene B4 (LTB4) were measured 24 h after indomethacin administration. Study groups received ketotifen 100 micrograms/ 100 g body weight 30 min before and 5 h after indomethacin administration, either i.p. or orally. There were 7-9 animals in each group. Ulcer area was significantly reduced by oral administration of ketotifen from 229 +/- 26 to 146 +/- 28 mm2. PGE2 level was reduced by ketotifen from 505 +/- 73 to 228 +/- 68 ng/mg protein, and LTB4 was reduced from 289 +/- 68 to 59 +/- 26 ng/mg protein. Intraperitoneal administration of ketotifen had no effect on any of the measured parameters. Ketotifen ...
During a 4 year period (January 1988 to December 1991), 237 pediatric patients (mean age +/- SD, ... more During a 4 year period (January 1988 to December 1991), 237 pediatric patients (mean age +/- SD, 9.75 +/- 5.17 years) underwent 289 upper gastrointestinal endoscopies. Premedication was used in only 102 of the endoscopic examinations, mostly in children between 2 and 10 years of age. Patients who were examined without sedation tolerated the procedure well. Abdominal pain was the most frequent indication, accounting for 57.4% of all procedures. Gastritis, esophagitis, duodenitis and duodenal ulcer were the most common endoscopic findings. Seventy-five endoscopies were performed to obtain small bowel biopsies. We found this procedure to be easy and safe and preferable to capsule biopsies. In our experience, upper gastrointestinal endoscopy with or without sedation is a safe and effective diagnostic procedure in the pediatric age group.
Celiac disease in children has been occasionally reported to be associated with various disorders... more Celiac disease in children has been occasionally reported to be associated with various disorders such as arthritis, cutaneous vasculitis and diabetes mellitus. We report on a 12-year-old girl with celiac disease, diagnosed at 1 year of age, who developed systemic lupus erythematosus. This association has not yet been reported in children.
The growth charts of 15 patients with anorexia nervosa during the prepubertal and pubertal period... more The growth charts of 15 patients with anorexia nervosa during the prepubertal and pubertal period were carefully reconstructed. All 15 (13 females, 2 males) had been suffering from anorexia nervosa for at least 6 months prior to referral. Mean age at referral was 13.3 +/- 1.3 years and mean duration of anorectic symptoms was 17 +/- 8 months. In all 15 cases growth arrest had been present for 13 +/- 8.5 months prior to admission. During the follow-up period, catch-up growth to different degrees was observed in the 13 patients (11 females, 2 males) who remained under treatment for at least 1 year. On the assumption that stunting of growth during the prepubertal and pubertal period is a very frequent, if not a constant, sign of anorexia nervosa of 6 months duration or more, it could be considered an additional criterion for diagnosis of the disease. The projected height should be included in the calculation of ideal weight. Since patients with growth arrest are usually referred first t...
3 infants wih the acute neuronopathic form of Niemann-Pick disease had prominent gastrointestinal... more 3 infants wih the acute neuronopathic form of Niemann-Pick disease had prominent gastrointestinal manifestations. These included chronic diarrhea, malnutrition, failure to thrive, radiologic intestinal abnormalities, xylose malabsorption, abnormal liver function, and infiltration of the liver, lamina propria and autonomic ganglia by lipid-laden cells. Possible pathogenetic mechanisms are discussed, and it is suggested that gastrointestinal disturbances play a larger part in the clinical manifestations of Niemann-Pick disease than is usually appreciated.
American journal of diseases of children (1960), 1983
We studied 158 children with culture-proven shigellosis, 37 (23.4%) of whom had convulsions. Hist... more We studied 158 children with culture-proven shigellosis, 37 (23.4%) of whom had convulsions. Historical, clinical, and laboratory data were compared between patients with and without convulsions to define risk factors for the development of seizures. Age was the most important predisposing factor. The highest incidence of shigellosis associated with convulsions was found in children between 6 months and 4 years of age. Peak body temperature and a family history of convulsions also independently affected the development of seizures. Sex and Shigella strain showed differences between the groups but failed to reach statistical significance.
The appropriate use of liver transplantation in children with type-1 primary hyperoxaluria (PH-1)... more The appropriate use of liver transplantation in children with type-1 primary hyperoxaluria (PH-1) is not well established. We reviewed our experience with 36 children with PH-1, including 12 who underwent liver transplantation. From 1989-1998, 36 children from 10 families in northern Israel were diagnosed with PH-1. Eight children presented with renal failure; seven of these eight had the severe infantile form of the disease. One child was treated with kidney transplantation alone. Combined liver-kidney transplantation has been performed in nine children and preemptive liver transplantation in three children. A review of the patients&amp;amp;amp;amp;amp;amp;#39; charts for the following parameters was performed: age, clinical signs, and renal sonographic findings at diagnosis, age at onset of dialysis, and current status. Type of transplant, pre- and posttransplant urine oxalate excretion, current renal function, survival, and complications were recorded in liver recipients. Of the 23 nontransplanted children, 9 died of complications related to severe systemic oxalosis and 14 are alive (mean follow-up, 7.4 years), including 2 who are candidates for transplantation. The child who underwent only kidney transplantation died of unrelated causes. Of the 12 liver recipients, 2 died within the first 3 months posttransplant and another child underwent retransplantation due to hepatic arterial thrombosis. At intervals after transplant ranging from 6-54 months, 10 recipients are alive (7 of the 9 recipients of combined liver-kidney transplants and all 3 recipients of preemptive liver transplants). Mean GFR in the 10 survivors is 77 ml/min/m2. In 9 of these 10, daily urinary oxalate excretion normalized. Renal function has improved (mean GFR 86 vs. 58 ml/min/m2) but renal oxalate deposits remain in the three recipients of isolated liver grafts. Our decade-long experience with children with PH-1 supports strategies for early diagnosis and timely liver transplantation. Preemptive isolated liver transplantation should be considered in children who develop the disease during infancy or in those with slowly progressive disease when significant symptoms develop. Combined liver-kidney transplantation is suggested for children with end-stage renal disease.
... Auteur(s) / Author(s). MOR E. (1) ; BAR-NATHAN N. (1) ; SHMUELI D. (1) ; SHAHARABANI E. (1) ;... more ... Auteur(s) / Author(s). MOR E. (1) ; BAR-NATHAN N. (1) ; SHMUELI D. (1) ; SHAHARABANI E. (1) ; YUSSIM A. (1) ; ZEHAVI I. (2) ; SHAPIRA R. (2) ; SHEINFELD T. (3) ; BEN-ARI Y. (3) ; DINARI G. (2) ; SHAPIRA Z. (1) ; Affiliation(s) du ou des auteurs / Author(s) Affiliation(s). ...
There is at present very little information about hepatitis B virus (HBV) infection in children a... more There is at present very little information about hepatitis B virus (HBV) infection in children after liver transplantation. This is the first study to assess the safety and efficacy of lamivudine in this patient population. We describe three children aged 5-14 years who underwent liver transplantation for fulminant hepatitis A, hyperoxaluria, and cystic fibrosis. Despite adequate immunoprophylaxis, two of the children who were serum hepatitis B surface antigen-positive before transplantation (HBV DNA-negative by hybridization) had a reactivation of the disease, and one had a de novo HBV infection, at 12-18 months after transplantation. Lamivudine 3 mg/kg was administered on a compassionate-use basis for 14-36 months. After 1 month of therapy, HBV DNA disappeared from the serum in all patients by hybridization and in two patients by polymerase chain reaction. In all three children, alanine transaminase levels normalized. One child developed lamivudine resistance after 22 months with no evidence of hepatic decompensation. Repeated liver histological studies revealed progression of hepatic fibrosis in one child. All children remained serum hepatitis B surface antigen- and hepatitis B e antigen-positive. No adverse effects of the drug were noted. Lamivudine is beneficial and well tolerated in children with HBV infection after liver transplantation.
Uploads
Papers by G. Dinari