Liver transplantation and the management of progressive familial intrahepatic cholestasis in children

Progressive familial intrahepatic cholestasis(PFIC) is a constellation of inherited disorders that result in the impairment of bile flow through the liver that predominantly affects children. The accumulation of bile results in progressive liver damage, and if left untreated leads to end stage liver disease and death. Patients often present with worsening jaundice and pruritis within the first few years of life. Many of these patients will progress to end stage liver disease and require liver transplantation. The role and timing of liver transplantation still remains debated especially in the management of PFIC1. In those patients who are appropriately selected, liver transplantation offers an excellent survival benefit. Appropriate timing and selection of patients for liver transplantation will be discussed, and the short and long term management of patients post liver transplantation will also be described.

Advances in lower extremity peripheral nerve surgery

Peripheral nerve injury(PNI)is a common source of pain and disability in patients.While many patients are affected by PNI,peripheral nerve surgery advancements in the lower extremity have lagged behind the upper extremity.Subsequently,principles that have demonstrated success in the upper extremity have been implemented in the lower extremity.Interventions with recent advances include the advent of novel nerve transfers in the lower extremity and using stem cells and electrical stimulation(ES)for nerve regeneration.This article focuses on advances in nerve transfers for lower extremity PNI and provides details on the basic science and clinical applications of newer interventions.

Management of vascular complications following calcium hydroxylapatite filler injections:a systemic review of cases and experimental studies

Aim:Dermal fillers are increasingly popular procedures.Inadvertent intraarterial injection of fillers,particularly with calcium hydroxylapatite(CaHA),can result in devastating consequences.A systemic review was performed to summarize management strategies to treat CaHA-associated vascular complications.Methods:The methodology of this review was derived from The Preferred Reporting Items for Systematic Reviews and Meta-analyses(PRISMA).In addition,this paper presents a previously unreported case of a CaHA-associated vascular complication.Results:There were 32 articles describing 42 cases,plus our case included in this review.There were 15 cases of vision complications,23 cases of non-vision complications,and 5 experimental studies.The most common injection sites reported were nasal region for vision complications(45%)and nasolabial folds for non-vision complications(40%).Of the 38 human cases,the most prevalent treatment choice was steroids(24 cases,63%).Complete or near complete improvement was reported in 83%of non-vision complications and 40%of vision complications.There was no noticeable homogeneity in the management strategies and outcomes of the patients.Of the 5 experimental studies,no clear consensus on treatments was found.Conclusion:Vascular complications of CaHA are seemingly uncommon,but it is widely suspected that this is due to underreporting.While best management is prevention,preparation for a potential complication is equally important.Derived from CaHA literature,hyaluronic acid filler complication protocols,findings of this review,and personal experiences,this report proposes management strategies for CaHA-associated vascular complications.We hope these strategies provide a much-needed framework for injectors to refer to and utilize as needed.