Is paracetamol responsible for fatal acute liver failure in pediatric patients after hip dysplasia surgery?

OBJECTIVE: It is well known that local complications, such as avascular necrosis and arthrosis can develop after surgery for developmental dysplasia of the hip (DDH). Thus far, systemic complications that may develop in such cases have not been identified in the literature. This study is the first case series to evaluate acute liver failure (ALF) development after DDH surgery in pediatric patients. PATIENTS AND METHODS: Six patients, five female and one male, who underwent DDH surgery were selected for this study. Perioperative fasting time, laboratory values, treatments, histopathological evaluations, and prognoses after ALF in these patients were evaluated retrospectively. RESULTS: All the patients were administered paracetamol and sevoflurane in therapeutic doses. The patients were referred postoperatively to our pediatric emergency department after 5 ± 1.67 days (range = 3-7 days) on average. The average perioperative fasting time was 9.3 ± 0.82 hours (range = 8-10 hours). Due to the very high aminotransferases and use of paracetamol, intravenous N-acetylcysteine was administered alongside supportive treatments to all the patients. After liver transplantation, two of three patients with grade 3 encephalopathy, died in the early postoperative period. Histopathological evaluations of the three patients' explants were compatible with toxic hepatitis due to paracetamol. CONCLUSIONS: Paracetamol is a commonly used analgesic after pediatric surgery. The therapeutic dose of paracetamol remains uncertain in children who have been fasting for a long time and have been exposed to hepatotoxic drugs due to previous surgery. In conclusion, caution should be exercised in the use of paracetamol in children with DDH who will undergo surgery, and careful perioperative clinical and laboratory monitoring for ALF is essential.

The incidence of non-proliferative and precancerous lesions of reduction mammoplasty: evaluation of 273 cases.

BACKGROUND: Reduction mammoplasty (RM) is one of the most commonly performed plastic surgery procedures to treat symptomatic macromasty or to correct asymmetry. Occult breast carcinomas were rarely defined in RM specimens. There are few studies aiming to define the incidence of non-proliferative and precancerous lesions. MATERIAL AND METHODS: We evaluated the pathological findings of the RM specimens that have been submitted to our Center for the last 6 years (2005-2011). RESULTS: A total of 273 cases with bilateral RM were enrolled to the study. Of them, 229 cases had pathological changes. Eight cases (2.9%) had atypical ductal/lobular hyperplasia. One case (0.3%) had lobular carcinoma in situ; however, no invasive breast carcinoma was detected. Other pathological findings included fibrocystic changes, fibrosis, adenosis, fibroadenoma (without complex features), mastitis and duct ectasia. CONCLUSIONS: Pathological examination of the RM specimens is quite important to define the lesions precancerous of breast carcinoma. Unknown occult breast lesions could be identified and early interventions may be taken into account.