RESUMEN
Initially described in children, cyclic vomiting syndrome (CVS) is an idiopathic disorder that affects patients of all ages and is characterized by recurrent episodes of vomiting separated by symptom-free intervals or baseline health. Frequent misdiagnoses and delays in diagnosis often lead to years of recurrent vomiting. Similarities in the clinical features and symptoms of children and adults with CVS are often linked to migraines. Association with mitochondrial disorders and neuroendocrine dysfunction have been described in the pediatric CVS literature, whereas migraines, anxiety, and panic are common in adults with CVS. Various psychological, infectious, and physical stressors commonly precipitate episodes of CVS. Treatment is mostly empiric, with few controlled therapeutic studies conducted thus far. Associations with migraines have aided in developing pharmacologic treatment strategies for prophylaxis as well as abortive therapy during episodes, including the use of trip-tans. Most children outgrow CVS with time, though some children transition to migraine headaches or continue to have CVS as adults. Improved recognition of CVS in adults, along with the emergence of data in the use of anticonvulsants and antiemetics, may help further delineate pathophysiologic connections and therapeutic options for this debilitating disorder.
RESUMEN
Posttransplantation biliary strictures occur in 5-34% of the pediatric liver transplant patients and are conventionally managed by interventional radiological techniques. The aim of this manuscript is to assess the outcomes of patients with biliary strictures treated by percutaneous dilatation at our institution. Included in the study were 35 children with posttransplant biliary strictures that were treated with percutaneous dilatation and stenting. Initial dilation and biliary stent placement was accomplished in all patients without complications requiring surgical intervention. Recurrent strictures developed in 23 (66%) of 35 patients. The recurrence rate was 45% for anastomotic strictures, 90% for intrahepatic strictures, and 100% for those with both an anastomotic and intrahepatic component. Seven patients required revision of the choledochojejunostomy, 5 of them with a successful outcome and 2 requiring retransplant. Five patients were treated with retransplantation without surgical revision. Patients with an intrahepatic or a "combined" stricture were less likely to have a successful outcome after radiologic treatment. In conclusion, the radiological treatment of biliary strictures with balloon dilation and stenting can be performed successfully with minimal complications avoiding the need for surgical correction in many cases.
