Biomedical subjects

E A Roberts

Publications and source records attributed to E A Roberts.

111 records · Page 7Linked to original sources

PubMedDate not supplied

Distal splenorenal shunts for the treatment of severe thrombocytopenia from portal hypertension in children.

Profound thrombocytopenia resulting from portal hypertension may exacerbate gastrointestinal bleeding, precipitate spontaneous bleeding, preclude surgical intervention for associated disorders, and severely limit life-style because of the danger of splenic injury. Although splenectomy can reverse the thrombocytopenia, the procedure should be avoided in children. We reviewed our experience with distal splenorenal shunting (DSRS) in children, particularly when performed for the sole purpose of reversing severe thrombocytopenia resulting from portal hypertension. DSRS was performed in 11 children between the ages of 7 and 15 years: five for severe thrombocytopenia (group 1), four for advanced hypersplenism and congenital hepatic fibrosis prior to renal transplantation (group 2), and two for esophageal bleeding (group 3). One child in group 1 with severe heart disease and Child's class C cirrhosis due to hepatitis C died of progressive cardiac failure and was excluded from further analysis. Of the eight remaining patients in groups 1 and 2, four children had congenital hepatic fibrosis, two had portal vein thrombosis, one had hepatitis B, and one had Wilson's disease. After DSRS, the mean platelet count increased from 37,000 +/- 18,000 to 137,600 +/- 81,000 (P = 0.01). The platelet count improved significantly in all seven children with presinusoidal portal hypertension or stable cirrhosis but did not increase in the child with hepatitis B and Child's class B cirrhosis. The white blood cell count increased from an average of 3.3 +/- 1.1 to 5.4 +/- 2.6 (P= 0.02). There were no postoperative complications in this group. The improved platelet count allowed the four children with congenital hepatic fibrosis and renal failure to undergo renal transplantation with full posttransplant immunosuppression including azathioprine. Postoperative Doppler ultrasound examination demonstrated shunt patency at 6 months in all cases. Spleen size decreased appreciably in all children in groups 1 and 2. All children were able to resume full activity including contact sports. In summary, DSRS effectively controls profound thrombocytopenia resulting from presinusoidal portal hypertension or stable cirrhosis without sacrificing the spleen and should be the treatment of choice for this condition.

Adolescent↗

PubMedDate not supplied

Inducibility of enzyme activities associated with the cytochrome P-450 1A family, ethoxyresorufin O-deethylase, and methoxyresorufin O-demethylase in human hepatocyte lines derived from normal liver tissue.

Three human hepatocyte cultures have been developed from specimens of normal human liver, in each case from an infant or child, by coculture with liver epithelial cells from 6-day-old rat pups in a complex growth medium. In the established cultures hepatocytes predominate and maintain typical hepatocellular morphology by light microscopy and albumin secretion into supernatant medium. The activity of ethoxyresorufin O-deethylase (EROD) and methoxyresorufin O-demethylase (MROD) basally and after treatment with polycyclic aromatic hydrocarbons was measured spectrofluorometrically in cell homogenates from each culture. Very low levels of EROD and MROD activity were found in each culture without induction [EROD: 1.78 +/- 0.71 (mean +/- SE) pmol/min/mg protein; MROD: 1.33 +/- 0.10 pmol/min/mg protein]. After treatment with 10 microM dibenz (a,h)anthracene x 48 hr, EROD and MROD activities rose approximately 20- to 50-fold. When the basal and induced enzyme activities were remeasured 2 months later, results were essentially the same. Incubation with 10 microM benz(a)anthracene x 48 hr also led to induction of EROD and MROD activities. We believe that these cultures can be regarded as human hepatocyte lines, which conserve human hepatic polycyclic aromatic hydrocarbon-inducible P-450s, most likely including P-450 1A2.

Adolescent↗

PubMedDate not supplied

Hepatitis C in children after transfusion: assessment by look-back studies.

Look-back studies to identify paediatric patients with post-transfusion hepatitis C have been conducted at several tertiary-care hospitals in Canada. A general look-back study was conducted at the Hospital for Sick Children in Toronto for the time period December 1985 to May 1990. All patients transfused at the Hospital for Sick Children during this time period were identified from hospital Blood Bank records. Letters of notification were sent by registered mail to all recipients excluding those known to have died. In the letter anti-HCV testing was recommended. Letters were mailed to 6332 transfusion recipients; 4496 letters were delivered. Of these 146 anti-HCV-positive transfusion recipients (92 pts < 18 yrs old; 54 pts > 18 yrs old) were identified. Sixty-four of these patients were definitely transfused only during this time period. Assuming that all notified patients were tested, the minimum prevalence of new infection in this time period was 1.4%. When possible, identified patients were tested for presence of HCV RNA in the serum by RT-PCR. The proportion of patients anti-HCV positive but HCV RNA negative on one or more occasions was similar in both whole cohort and subset: approximately one-third. These data suggest that chronic hepatitis C may be less likely to develop after transfusion in children than in adults.

Blood Transfusion↗