ABSTRACT: Nuclear imaging techniques using Tc-99m iminodiacetic acid derivatives have been employed extensively to differentiate billiary atresia (BA) from other causes of neonatal jaundice (NH). The use of phenobarbital prior to the nuclear scan to increase the accuracy of the study is widely accepted. During 1995-97, 59 patients underwent HIDA scan for obstructive cholangiopathy following phenobarbital therapy for 5-7 days. Only 15 patients (25 percent) showed excretion in the gut and were diagnosed as neonatal hepatitis. On 44 remaining patients with suspected biliary atresia on HIDA scanning, operative cholangiogram was performed on 7 patients; 2 of them showed patent biliary tree. In the remaining 37 patients, the HIDA study was repeated after adding betamethasone to phenobarbital for 5-7 days; 14 (38 percent) of these showed excretion now and were diagnosed again as NH. Surgical exploration was performed on the remaining 23 patients; 2 of them again showed patent biliary tree and were labelled as NH. Thus with the use of PB, a total of 18/33 (54.5 percent) patients with NH were misdiagnosed as BA. However, with the addition of BM to PB, 14/16 patients with NH were correctly diagnosed on HIDA scanning. The remaining 2 patients (2/16-12.5 percent) required operative cholangiogram to rule out BA Both these had severe cholestasis. We advocate the use of betamethasone in addition to phenobarbital in all patients undergoing HIDA scanning for suspected neonatal jaundice to achieve the maximal hepatoenteric clearance rate without delay.

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ABSTRACT: An experimental model of extrahepatic billary obstruction was created by injecting OK-432 into bile ducts of albine rats. Indocyanin Green (ICG) which is a tricarboxylic acid compound, is taken up and excreted solely by the hepatocytes, was used to assess the hepatocyte function. The ICG was injected intravenously at 3 and 6 weeks following OK-432 injection. Serial arterial blood samples were collected and fractional clearance (K-valu) of ICG was calculated. Study revealed that K-value of ICG is a sensitive marker of hepatocyte function,

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ABSTRACT: Extrahepatic biliary atresia remains a challenge to the pediatric surgeons till. The early enthusiasm with the Kasai procedure is now tempered with the realization of significant morbidity and mortality in long term follow up. There is still a controversy regarding the etiology, the ideal investigative modality and also the best possible treatment for this condition. We reviewed our experience with biliary atresia over the last 10 years to assess the clinical presentation and early outcome following Kasai's portoenterostomy.

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ABSTRACT: Study to analyse our experience with surgical management of biliary atresia at the Institute of Child Health (ICH), Calcutta, India. Design: Retrospective study. Setting: Hospital based. Methods: Over the last 4,5 years, 17 cases of neonatal conjugated hyperbilirubinemia diagnosed as biliary atresia were treated. Their clinical presentation, diagnosis, peroperative cholangiograms, and treatment outcome were analyzed. Preoperative workup included biochemical studies. TORCH screening, 99 m Tc Hepatobiliary scan and duodenal intubation (5 cases). Peroperative cholangiogram could be done in 8 cases. There was one case of neonatal hepatitis, and in one case, there was total aplasia of the radicles at the porta. Drainage Procedure-portoenterostomy was done in 12 cases, and in 3 cases the common hepatic duct was anastomosed with the duodenum. Results: Mean age of the study group was 2.3 months with a male : female ratio of 1.42:1.0. Followup period ranges from 4 months to 4.2 years. Two patients died within 10 days of operation and one after 3 months leading to a mortality rate of 17.6 percent . Conclusions: Immediate results in surgically treated biliary atresia is fairly satisfactory.

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ABSTRACT: In countries such as Japan, Taiwan, Hong Kong and Korea, where cadaveric donors for organ transplantation are hardly obtained, live related liver transplantation (LRLT) is an important choice for saving the patients with end stage Biliary atresia. LRLT has been performed in almost 800 patients at 28 institutions in Japan since 1989; 70 percent of those 800 were pediatric patients with advanced biliary atresia. Overall surviving rate of LRLT in Japan is approximately 80 percent which is compatible with cadaveric liver transplantation in western countries. Current status of LRLT at the University of Tokyo (n=53, between January 1996 and February 1999) and in Japan (n=796, between November 1989 and January 1999) will be reported.

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ABSTRACT: Biliary Atresia management has always been an anathema of the pediatric surgeons. But of late the results are not that dismal as it was a decade ago, thanks to new modalities of investigations, early surgery, appropriate technique adopted during surgery and better postoperative management. Radionuclide hepatobiliary scan has made the workup of neonatal cholestasis much easier and paves the way of early surgical invention and can be used for follow up. Inj. Human Albumin in the immediate post operative period facilitates speedy re ovary of liver function.

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