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Background: Pediatrics liver transplantations have been accepted as definitive treatment for end stage liver disease. Pleural effusion is the most common of pulmonary complications following liver transplantation in children. It can affect high morbidity including prolong oxygen dependence and hospitalization. Objectives: To identify the risk factors associated with posttransplant pleural effusion and patients' outcomes in Ramathibodi hospital in order to predict the prognosis after liver transplantations. Materials & Methods: This is a retrospective review of 140 patients who underwent pediatrics liver transplantations between March 2001 and June 2018 in Ramathibodi hospital. The medical records were missed in 31 patients, so 107 patients were included to this study. Then they were categorized into pleural effusion and no pleural effusion group. Pre and perioperative data including age, body weight at transplantation, etiology, pre-operative albumin level, lung disease, Pediatric End-Stage Liver Disease score (PELD)/Model For End-Stage Liver Disease score (MELD), intraoperative ascites, liver graft characteristics, length of stay in ICU/hospital and O2 dependence time were compared between 2 groups by multivariable logistic regression analysis. Results: Post-transplant pleural effusion occurred in 64 (59.8%) patients. PELD score ≥ 25, presence of intraoperative ascites, LDLT (left lateral segment donor grafts) were significant factors for postoperative pleural effusion. Prolonged length of stay in ICU (p = 0.013) / hospital (p = 0.018) and oxygen dependence time (p = 0.001) were significant outcomes in pleural effusion group following liver transplantations. Conclusions: Pleural effusion following Pediatrics liver transplantations incidence is high. Pre-operative risk factor assessment can use to predict the prognosis of post-transplant pleural effusion. Consequently, this may diminish morbidity and length of stay in hospital. [ABSTRACT FROM AUTHOR]

Diffuse oesophageal leiomyomatosis is a rare benign disease in the paediatric population. This report highlights a recent clinical case, together with a narrative review of current world literature.An early middle childhood girl with recurrent lower respiratory tract infections for 2 years was noted to have a retrocardiac lesion on chest X-ray, later confirmed to be an oesophageal mass on CT imaging. She underwent an Ivor-Lewis oesophagogastrectomy and a Heineke-Mikulicz pyloroplasty. Pathology examination revealed type I diffuse oesophageal leiomyomatosis. Alport syndrome was later confirmed following an episode of postoperative haematuria, which was corroborated by electron microscopy examination following renal biopsy.With an oesophageal mass lesion and Alport syndrome, oesophageal leiomyomatosis should be suspected in any patient with a clinical history of dysphagia and/or respiratory symptoms. Endoscopic ultrasound-guided tissue biopsy is valuable for diagnosis of all suspected lesions. Surgical resection is mandatory to effect cure., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Many children respond to medical treatment for gastroesophageal reflux disease (GERD). However, some may require invasive intervention for refractory disease. Due to the lack of prognostic tools in children, this study aimed to develop a predictive model for refractory GERD., Methods: A retrospective review was performed in children with symptoms of GERD at a university hospital. Refractory GERD was defined as an unresponsive disease after optimal treatment with medication for >8 weeks. The predictive model was constructed based on clinical features and 24-h multichannel intraluminal impedance-pH (MII-pH) monitoring results., Results: A total of 205 children were included with a median (IQR) age of 0.6 (0.3, 2.0) years. Over half of the patients (59.5%) had motor disabilities. Forty-four children (21.5%) were diagnosed with refractory GERD and subsequently underwent fundoplication. Multivariable analysis suggested that the refractory disease was associated with motor disabilities (OR: 5.35; 95% CI: 2.06-13.91), recurrent aspiration pneumonia (OR: 2.78; 95% CI: 1.24-6.26), prematurity with an onset of GERD at a post-conceptual age <40 weeks (OR: 6.76; 95% CI: 1.96-23.33), and abnormal total reflux episodes according to age (OR: 2.78; 95% CI: 1.24-6.19), but not the acid exposure time or symptom association analysis. The predictive model for refractory GERD based on associated factors revealed an area under the ROC curve of 76.8% (95% CI: 69.2%-84.3%) with a sensitivity of 77.3% and a specificity of 64% when applying a cutoff score of ≥2.5., Conclusions: The predictive model, using clinical features and MII-pH, may be an additional tool to predict refractory GERD in young children., (© 2023 Japan Pediatric Society.)

Henoch-Schönlein purpura (HSP) is generally a self-limited vasculitis disease and has a good prognosis. We report a 4-year-old Thai boy who presented with palpable purpura, abdominal colicky pain, seizure, and eventually developed intestinal ischemia and perforation despite adequate treatment, including corticosteroid and intravenous immunoglobulin therapy. Imaging modalities, including ultrasonography and contrast-enhanced computed tomography, could not detect intestinal ischemia prior to perforation. In this patient, we also postulated that vasculitis-induced mucosal ischemia was a cause of the ulcer, leading to intestinal perforation, and high-dose corticosteroid could have been a contributing factor since the histopathology revealed depletion of lymphoid follicles. Intestinal perforation in HSP is rare, but life-threatening. Close monitoring and thorough clinical evaluation are essential to detect bowel ischemia before perforation, particularly in HSP patients who have hematochezia, persistent localized abdominal tenderness and guarding. In highly suspicious cases, exploratory laparotomy may be needed for the definite diagnosis and prevention of further complications.