Hepatic hemodynamic changes during acute viral hepatitis in children: Assessment by color Doppler Sonography

To study the pattern of hemodynamic changes in both portal vein [PV] and hepatic artery [HA] through the different stages of acute viral hepatitis in children and to determine any sonographic correlation with the prognosis or with other studied paprameters including clinical features and liver function tests, we performed color Doppler sonography [after full clinical examination and laboratory investigation] with point spectral analysis in 50 children suffered from acute viral hepatitis for four consequtive weeks and compared the results with those in 20 normal controls. The portal vein diameter and velocity showed no significant changes either during different stages of acute hepatitis or with the control group while during the acute phase, the peak-systolic [PSV] and end-diastolic [EDV] velocity of the hepatic artery were significantly larger than those in normal arteries [P < 0.01]. During the recovery phase, these indexes of the hepatic artery decreased significantly to the control levels [P < 0.01]. The resistive indexes [RI] related to vascular resistance in the hepatic artery during the acute phase were significantly less than those in normal arteries [P < 0.01], and they increased significantly to the control levels during the recovery phase [P < 0.01]. No significant correlation was found between these indexes of the hepatic artery and the parameters of liver function tests. However, the interval between the acute phase and the recovery phase did significantly correlate negatively with the peak-systolic velocity of the hepatic artery in the acute phase [r=-0.341, P < 0.05] and correlate highly significant with the end-diastolic velocity [r=- 0.837, P < 0. 01]. We conclude that Doppler sonography is useful for imaging hepatic hemodynamic changes in patients with acute viral hepatitis. We found that significant changes occur only in hepatic artery while no changes occurred in the portal vein. Also measurement of hepatic arterial flow during acute phase may be a convenental and reliable of determining the prognosis of patients with viral hepatitis where the increased hepatic arterial blood flow during the acute phase may provide a marker for earlier recovery from hepatitis-induced damage and may be considered as a good marker for the prognosis

Interposition jejunal loop with valve for management of biliary atresia

Kasai's operation has changed significantly the prognosis of patients with biliary atersia. However, postoperative ascending cholangitis is still a relatively frequent complication with high morbidity and mortality rates. Several surgical procedures to overcome the high incidence of postoperative ascending cholangitis after Kasai operation have been introduced. The aim of this study is to investigate the effect of the jejunal interposition hepatic portoduodenostomy with an intussusception type intestinal valve on the incidence of the post-operative cholangitis in cases of biliary atresia at our institute. Ten cases of biliary atresia [from June 1995 to January 1997], were included in the study. Seven were females and 3 males, with mean age at the time of operation of 67.8 days and mean body weight of 4.37 Kgm. There was no intraoperative mortality, while hospital mortality was 30%; the cause of death was not related to the surgical procedure. The remaining 7 patients were followed up for a period ranged from 6 to 17 months with a mean of 10.7. Three [42.8%] of the 7 patients did not develop any attacks of cholangitis, the other 3 developed one attack of grade I; cholangitis and the remaining one had 4 attacks of grade II; cholangitis and reoperation for him was considered. Upper GIT study using Gastrografin demonstrated competence of the artificially constructed valve in all survivors. The results obtained in this study demonstrate that interposition jejunal loop with an anti-reflux intestinal valve has prevented the incidence of cholangitis and reduced the number as well as the severity of the attacks of cholangitis in 85.7% of the studied patients with biliary aterisa