دکتر امیرحسین حسینی

Gallstones are relatively uncommon in children. Postoperative changes in liver function tests (LFTs) after abdominal surgeries, such as cholecystectomy, can lead to complications. There are mixed findings regarding the effect of cholecystectomy on LFTs.

The aim of this research was to investigate the changes in LFTs after cholecystectomy in children with gallstones.

This cross-sectional study, conducted at Mofid Children’s Hospital (2012 - 2021), included children under 18 who underwent cholecystectomy for gallstones. Patients with alternative indications or underlying diseases affecting the liver, such as cystic fibrosis and Wilson’s disease, and those with non-gallstone-related conditions were excluded. Patients were categorized into two groups: (1) Open surgery, and (2) laparoscopic surgery. Preoperative and postoperative liver enzyme levels, along with demographic information, were recorded and analyzed using SPSS.22 software.

The study included 66 patients, comprising 32 boys and 34 girls. Among these, 27 patients underwent open cholecystectomy, and 39 underwent laparoscopic cholecystectomy. The most prevalent clinical symptom was abdominal pain (72.7%), followed by vomiting (37.8%). The decreases in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels following cholecystectomy were not statistically significant, with P-values of 0.65 and 0.36, respectively. However, alkaline phosphatase (ALP) levels significantly decreased post-intervention (P-value = 0.003), indicating a notable improvement in liver function after surgery.

Cholecystectomy does not substantially alter ALT and AST levels, suggesting that routine monitoring of these liver enzymes post-surgery may be unnecessary. In contrast, the significant decrease in ALP levels suggests a resolution of cholestatic conditions, potentially reducing healthcare costs associated with unnecessary testing.

Constipation is one of the most common complaints in children. Guidelines on functional constipation recommend digital rectal examination (DRE) when constipation is suspected. However, diagnosis of megarectum by ultrasonography would differentiate children with constipation from those with dysfunctional defecation.

In this research, we evaluated the utilization of ultrasonography to measure the diameter of rectal ampulla for the diagnosis of functional constipation.

In this study, 94 patients < 14 years old diagnosed with functional constipation were included. Patients were examined by both DRE and ultrasonography before and after a conventional stool softener treatment.

The diameter of the rectal ampulla was significantly wider in patients with large stool mass in DRE than in patients with normal digital rectal exams. There was a significant relationship between fecal incontinence and pre-treatment DRA. By increasing the severity of fecal incontinence, the average DRA in patients increased significantly. Additionally, there was a significant statistical difference between the patient’s DRA before and after treatment. Finally, the relationship between constipation and DRA adjusted model showed that the risk of abnormal DRA was 3.1 times larger in patients with three and four symptoms than in patients with two symptoms and this relationship was statistically significant.

Ultrasonography can be a suitable replacement for DRE; however, further investigations are required.

Right-sided aortic arch with aberrant left subclavian artery is a rare congenital anomaly of the aorta that occurs in less than 0.1% of the population. Patients are asymptomatic in most cases, and the anomaly is found incidentally; however, symptoms can occur due to the compression of other structures, mostly the trachea and esophagus. In this report, we present a case of esophageal compression by a right-sided aortic arch with aberrant left subclavian artery that mimicked gastro-esophageal reflux in a 3-month-old (87-day-old) infant with complaint of regurgitation, vomiting, and failure to gain weight who was diagnosed through a barium meal study.

We report a 22-month-old boy who referred due to nausea, vomiting, abdominal pain and watery non-bloody diarrhea and after thorough evaluation, a large defect in the left postero-lateral side of diaphragm and presence of bowel loops, spleen, stomach and left lobe of liver in the left hemi-thorax were detected. So, he was operated and managed with the impression of Bochdalek hernia. We have also reviewed the similar case reports in the past 10 years, briefly, in order to map the presentations and clinical course of cases with Bochdalek hernia which were diagnosed late, for giving physi-cians a better insight on this issue.

Context:

 Necrotizing enterocolitis (NEC), as a life-threatening gastrointestinal tract disease, is associated with high rates of morbidity and mortality. Extensive inflammation, progressive hemorrhagic necrosis, and overwhelming infection of the gut are reasons why NEC is known as a devastating disease in premature infants. Almost 45% of affected preterm infants die, and those who survive suffer from multiple complications. Human milk, the best food for newborns, plays a significant role in supporting the immune system. Both mother’s own milk (MOM) and donor human milk (DHM) are particularly important in the prevention and lessening of the severity of NEC. Evidence Acquisition: We searched PubMed, Elsevier, and Google Scholar databases for articles that investigated the correlation between NEC and human milk. Then all data were accessed about their relevancy to this current subject.

In summary, the purpose of this article is to firstly review the protective role of breast milk components against NEC, and secondly discussing the correlation between human milk and NEC in clinical studies. Human milk bio-components, including Lactoferrin, oligosaccharides, maternal soluble IgA, epidermal growth factor, transforming growth factor, prebiotic, probiotics, and antioxidants, have a protective effect against NEC. However, the importance of these components in donor human milk and the formula is underestimated.

Human milk, as the first-choice of nutritional source, comprises a wide diversity of copious bio-components, which dwindle the risk and severity of NEC in many ways. The exact mechanisms are still unclear, the evidence strongly point out that human milk is superior to any other nutrition concerning protecting the gastrointestinal tract from NEC.

Hepatic involvement in Wilson disease consists of isolated elevated liver enzyme, asymptomatic hepatomegaly, cirrhosis and acute liver failure. Here, we report three patients with unexplained elevated liver enzymes. By considering the level of urinary excretion of copper after penicillamine challenge test, we had some problems in the process of diagnosis. Therefore, we thought of cautiously applying the diagnostic cut-off in the mentioned challenge test.

Here is a case of a 6-year-old female with a diagnosis of Duodenal Adenocarcinoma presented by the authors, in which 24 months subsequent to radiation therapy for a Cerebellar Medulloblastomas the mentioned diagnosis has been confirmed. Although the chance of a secondary malignancy has been confirmed to become elevated in children formerly undergone radiation therapy, the incidence of duodenal adenocar-cinoma is a highly infrequent condition. As a consideration, observing manifestations like weight loss, vomiting, and icterus in a pediatric patient, who has been administered earlier on with radiation therapy, must alert physicians that the risk of a gastrointestinal malignancy exists.

Autoimmune pancreatitis as chronic inflammation of the pancreas due to an autoim-mune mechanism is a rare type of pancreatitis. A 14 years old girl presented with mul-tiple episodes of abdominal pain, nausea with elevation of amylase and lipase sus-picions of acute recurrent pancreatitis since 3 years of age. After through evaluation about secondary causes of recurrent and familial pancreatitis finally she responded to corticosteroid treatment. Although very rare but autoimmune processes should be considered in teenagers with recurrent pancreatitis.

Malnutrition is one of the most common disorders among children with Cystic Fibrosis (CF). The present study aimed to investigate the effect of nutritional consultation on the type and severity of malnutrition in children with CF. This quasi-experimental study was conducted on 78 children with CF referred to Mofid Pediatric Hospital, Tehran, Iran, in 2017-2018. Their parents filled the demographic questionnaire. Participants with malnutrition were undergoing the assessment on growth indices, including weight, height, ideal body weight, mid-upper arm circumference, and Z-score. Moreover, the nutritional consultations were considered for them (30-45 minutes). Children and their parents were consulted and trained about total daily calorie acquirement, type, number of the meal, amount of food intake, drinks, and avoided eating of any low-calorie food like snacks, during the consultation. All patients were reassessed three months later for growth indices. The data were analyzed using SPSS software version 22.0. We assessed 78 children with CF, 21 (26%) of them had mild, 26 (34%) moderate malnutrition, and 31 (40%) severe malnutrition. The result showed that nutritional intervention was effective. Consequently, 1 (3.8%) of the moderately malnourished child was improved to mild malnutrition and 5 (27.8%) children under five years old were improved from severe to moderate malnutrition. Moreover, 1 (5.6%) child were improved from severe to mild, and 2 (15.4%) of children over five years old were improved from severe to moderate malnutrition. According to the results, the early growth assessment in hospitalized and outpatient, diagnosis of malnutrition and nutritional interventionwill be useful in improving the severity of malnutrition and growth indices in children with CF.