Non operative management of blunt bile duct injuries in children.

From the Division of Pediatric Surgery, Department of Surgery, (Mallick, Al-Bassam) and the Department of Radiology (Boukai), King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia.Bile duct injuries after blunt abdominal trauma are rare in children. This report describes 2 cases of blunt bile duct injuries in children, which were managed non-operatively. One patient sustained partial tear in the right hepatic duct, which was managed successfully by passing a stent into the injured duct during endoscopic retrograde cholangio pancreatography. The 2nd patient had intrahepatic bile duct injury associated with liver trauma and was managed with a drain placed in the sub-hepatic area percutaneously. This non-operative management in our patients allowed healing of bile duct injuries without any stricture, at 2 years followup. Both children are symptom free with normal liver function tests and normal liver ultrasound. With the advancement in radiological and endoscopic techniques, some of the bile duct injuries can be managed conservatively. Conservative treatment must be individualized according to the site and extent of injury

Outcome of pulmonary embolism and clinico-radiological predictors of mortality: Experience from a university hospital in Saudi Arabia

Objectives: The objective of this study is to determine the outcome of pulmonary embolism (PE) and the clinico-radiological predictors of mortality in a university hospital setting. Methods: A Prospective observational study conducted at King Khalid University Hospital, Riyadh Saudi Arabia between January 2009 and 2012. A total of 105 consecutive patients (49.9 ± 18.7 years) with PE diagnosed by computed tomography pulmonary angiography were followed until death or hospital discharge. Results: Overall in hospital mortality rate was 8.6%, which is lower than other international reports. Two-thirds of patients developed PE during the hospitalization. The most common risk factors were surgery (35.2%), obesity (34.3%) and immobility (30.5%). The localization of the embolus was central in 32.4%, lobar in 19% and distal in 48.6%. A total of 26 patients (25%) had evidence of right ventricular strain and 14 (13.3%) were hypotensive. Multivariate analysis revealed that heart failure (Beta = −0.53, P < 0.001), palpitation (Beta = −0.24, P = 0.014) and high respiratory rate (Beta = −0.211, P < 0.036) were significant predictors of mortality. There was no significant difference in the localization of the embolus or obstruction score between survivors and non-survivors. Conclusion: The outcome of PE is improving; however, it remains an important risk factor for mortality in hospitalized patients. Congestive heart failure, tachypnea and tachycardia at presentation were associated with higher mortality. These factors need to be considered for risk stratification and management decisions of PE patients. Radiological quantification of clot burden was not a predictor of death

ISSN 2347-954X (Print) Radiologic Imaging in Patients with 46 XY, Disorders of Sex Development (DSD): A 25 Years&apos; Experience from a Major Teaching Hospital

Abstract: Disorders of sex development (DSD), is a group of conditions where the external genitalia appear abnormal. It represents a true medical and social emergency which need a multi-disciplinary team approach for elucidation. The pediatric radiologist plays an important role in defining the genital anatomy which remains one of the most important factors in sex determination, in addition to chromosomal analysis. It was a retrospective hospital-based study, conducted over 25 years between January 1989 and December 2014. Imaging studies (ultrasound, and/or magnetic resonance imaging were retrospectively reviewed in various patients with 46XY, DSD confirmed by chromosomal analysis and appropriate hormonal investigations. Fifty-six patients were diagnosed to have 46 XY, disorders of sex development (DSD), with variable etiological causes with androgen insensitivity and 5--reductase deficiency were among the commonest. In addition to radiological, hormonal and chromosomal studies, laparoscopy studies were needed in four patients. Ultrasound was the primary modality for screening, as it is so sensitive and specific for eliciting the presence or absence of internal organs, but it less sensitive in identifying the testes, only 6 out of 18 (33.3%) patients and operator dependent. However, Magnetic Resonance (MRI) was more sensitive for testicular tissue identification reaching up to 100%, and can detail various internal structures. At the time of diagnosis of 46 XY, DSD, imaging to characterize the pelvic structures should be ordered. Ultrasound continues to remain the first choice for initial evaluation, as it is cheap, easily accessible and has a high sensitivity and specificity for eliciting the presence or absence of female internal organ; however, it is less sensitive in identifying the tests and is operator dependent. Magnetic resonance (MRI) has been used as a helpful modality for difficult cases as it is more sensitive for testicular tissue identification, and can detailed internal structure