ORCID Profile
0000-0003-1734-2536
Current Organisations
Perth Children's Hospital
,
University of Tasmania
,
University of Western Australia
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: SAGE Publications
Date: 05-2005
Abstract: Image-guided central venous access is forming an increasingly large proportion of the workload in interventional radiology following recognition that such techniques are less invasive and often quicker than traditional surgical techniques, with clear benefit in subjects with multiple previous attempts at venous access. Venous access sites are generally superficial in children, allowing excellent quality images during ultrasound-guided puncture and providing a greater number of options when considering the approach to catheter placement. Methods of ultrasound-guided puncture are described and the varieties of catheter devices available are discussed. Other advantages of ultrasound, such as in the assessment of thrombosed vessels and collateral veins, as well as the localization of catheter cuffs within the subcutaneous tissues, are also discussed.
Publisher: Georg Thieme Verlag KG
Date: 10-2006
Abstract: A 15-month-old male presented with severe gastrointestinal bleeding and heart failure. Imaging revealed a superior mesenteric artery arteriovenous malformation, associated with a congenital portosystemic shunt. The heart failure was cured by resection of the arteriovenous malformation.
Publisher: Springer Science and Business Media LLC
Date: 23-09-1999
Abstract: To determine the nature of the imaging findings following reconstructive surgery using massive allografts in children with malignant bone tumours. A retrospective review of the imaging studies and medical charts of 25 consecutive children who received an allograft as part of the management of a malignant bone tumour. Uncomplicated allografts were sclerotic relative to native bone on radiographs and showed a typical 'tramline' appearance on bone scintigraphy. On MR, the medullary canal of the allograft showed low signal, similar to or greater than skeletal muscle, but less than subcutaneous fat, on 91 % of T1-weighted images. On short-tau inversion recovery images, the medullary canal was inhomogeneous and hyperintense to subcutaneous fat in 70 % and hyperintense to muscle in the remainder. Complications occurred in 68 % of patients and included allograft fractures (36 %), recurrent tumour (20 %), infection (8 %), and non-union or delayed union (8 %). The radiographic findings alone permitted accurate diagnosis of most serious complications. Infection and rejection were difficult to distinguish with any technique. All complications were suspected on clinical and/or radiological grounds before being shown by MR or scintigraphy. Allografts, whether normal or complicated, have characteristic imaging findings, except that infection and bone resorption related to rejection and revascularisation are difficult to distinguish. Routine MR and bone scintigraphy appear to contribute little to the management of these patients.
Publisher: Springer Science and Business Media LLC
Date: 11-01-2006
DOI: 10.1007/S00247-005-0064-3
Abstract: The treatment of hepatoblastoma is an ex le of the great advances made in paediatric oncology over the past few decades. Formerly a disease with a dreadful prognosis, children now have a 5-year survival rate of over 70%. This has been achieved by advances in surgical techniques and the use of chemotherapy. In future, we hope to be able to improve survival for children with high-risk tumours, and decrease the morbidity associated with treatment in the others.
Publisher: Elsevier BV
Date: 2005
DOI: 10.1016/J.EJRAD.2004.07.022
Abstract: Disorders of the major airways in children are often difficult to treat. Recent advances in interventional radiology are proving useful, for both assessment of the severity of the problem and treatment. Flexible bronchoscopy and bronchography are essential tools for diagnosis, intervention and follow-up. Echocardiography, computed tomography and magnetic resonance imaging may also be important for the evaluation of cardiovascular anomalies, which are often associated with airway obstruction. Surgery remains the first line of treatment for most congenital abnormalities of the airway and for cardiac anomalies that cause airway compression. Balloon dilatation and stenting are helpful in certain other conditions, as well as in children whose airway problem is not fully corrected by surgery. A multidisciplinary approach is required, with input from pediatric cardiothoracic surgeons, radiologists, radiographers, otolaryngologists, pulmonologists, anesthesiologists, intensivists, physiotherapists and liaison nurses.
Publisher: Elsevier BV
Date: 04-2008
Publisher: Springer Science and Business Media LLC
Date: 19-11-1998
Abstract: We present a patient with neurocysticercosis with spinal subarachnoid spread who presented with lower back pain and progressive numbness and weakness of the left leg. MRI of the spine simulated metastasis. MRI of the brain demonstrated a "bunch of grapes" appearance in the basal cisterns, characteristic of cysticercosis.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 20-05-2010
Abstract: The primary objective was to determine the efficacy of a newly designed preoperative chemotherapy regimen in an attempt to improve the cure rate of children with high-risk hepatoblastoma. High risk was defined as follows: tumor in all liver sections (ie, Pretreatment Extension IV [PRETEXT-IV]), or vascular invasion (portal vein [P+], three hepatic veins [V+]), or intra-abdominal extrahepatic extension (E+), or metastatic disease, or α-fetoprotein less than 100 ng/mL at diagnosis. Patients were treated with alternating cycles of cisplatin and carboplatin plus doxorubicin (preoperatively, n = 7 postoperatively, n = 3) and delayed tumor resection. Of the 151 patients (150 evaluable for response) 118 (78.7%) achieved a partial response to chemotherapy. Complete resection of the liver tumor could be achieved in 115 patients (76.2%) either by partial hepatectomy (55.6%) or by liver transplantation (20.6%). In 106 children (70.2%), complete resection of all tumor lesions (including metastases) was achieved. Among the patients with initial lung metastases, 52.2% achieved complete remission of the lung lesions with chemotherapy alone. In half of the patients with initial PRETEXT-IV tumor as the only high-risk feature, the tumor could be completely resected with partial hepatectomy. Event-free (EFS) and overall survival (OS) estimates at 3 years were 65% (95% CI, 57% to 73%) and 69% (95% CI, 62% to 77%) for the whole group. EFS and OS for all patients with PRETEXT-IV tumor were 68% and 69%, respectively, and they were 56% and 62%, respectively, for patients with metastasis. The applied treatment rendered a great proportion of tumors resectable, and, in comparison with previously published results, led to an improved survival in patients with high-risk hepatoblastoma.
Publisher: Springer Science and Business Media LLC
Date: 15-07-2009
DOI: 10.1007/S00467-009-1242-6
Abstract: The clinical characteristics and outcomes of children with mid-aortic syndrome (MAS) and the effectiveness of different therapeutic approaches in reducing hypertension are still debated. We conducted a single-centre retrospective review of the records of children with MAS over 30 years. Children with angiographic evidence of a narrowed abdominal aorta were included. Therapeutic approaches included medical management, percutaneous transluminal angioplasty and/or surgical intervention. Thirty-six children had presented at a median age of 2.7 years (10 days-10 years). Thirteen (36%) patients had associated syndromes, and 44% had been diagnosed with cerebrovascular disease. All patients had involvement of multiple arteries. The mortality rate was 8% after a median follow-up period of 4.5 (range 1.1-19.7) years. Among the children who survived, 90% had obtained a reduction in their blood pressure (BP). Of the patients, 76% had had a normal estimated glomerular filtration rate (eGFR) at the last follow-up examination. Seventeen percent (six of 36) had renal dysfunction at presentation. Although MAS is a severe and widespread disease, in most cases it can be effectively treated with a combination of medical, angioplasty and surgical interventions.
Publisher: Springer Science and Business Media LLC
Date: 22-04-2009
DOI: 10.1007/S00247-009-1275-9
Abstract: Rhabdomyosarcoma is a soft-tissue malignancy that represents approximately 4-8% of all solid tumours in children and commonly arises from the head and neck and genitourinary system. Intraperitoneal rhabdomyosarcoma, in particular with omental involvement, has been rarely reported in the literature. Furthermore, reports of omental rhabdomyosarcoma of embryonal origin do not exist, to our knowledge. We report two cases of omental embryonal rhabdomyosarcoma affecting children and illustrate the imaging characteristics of this rare tumour.
Publisher: Elsevier BV
Date: 09-2012
Publisher: Elsevier BV
Date: 03-2006
Publisher: Oxford University Press (OUP)
Date: 06-2011
DOI: 10.1016/J.EJCTS.2011.01.075
Abstract: The aim of the study is to assess the surgical outcome of slide tracheoplasty in patients with congenital tracheal stenosis and single lung. Pre, intra- and postoperative data were collected. Anatomy and associated anomalies were described. Seven patients (median age 5 months range 39 days-1 year) with single lung underwent slide tracheoplasty. Single right lung was present in four patients. Associated anomalies were present in four patients (56%) including vascular ring, left pulmonary artery (LPA) sling, VACTERL (abnormalities of the vertebrae, anus, cardiovascular tree, trachea, oesophagus, renal system, and limb buds) syndrome, atrial septal defect (ASD) and aberrant left subclavian artery. Six patients (85%) needed preoperative ventilation and two (28%) needed preoperative extracorporeal membrane oxygenation (ECMO). Median postoperative ventilation was 7 days (6-35 days). Two patients needed postoperative ECMO, one of whom required preoperative ECMO. Complications occurred in five patients (71%): reintubation due to pneumothorax, pneumonia and several tracheal dilatations due to recurrent tracheal stenosis, which was eventually stented. There was one hospital death in a patient, who could not be weaned off ECMO due to severe distal malacia. At a median follow-up of 16 months (7 days-7 years), all survivors are in good clinical condition and without additional stenting. Slide tracheoplasty can be performed in patients with single lung and tracheal stenosis with a good surgical outcome.
Publisher: Springer Science and Business Media LLC
Date: 06-10-2011
Publisher: Wiley
Date: 03-2020
DOI: 10.1111/PAN.13821
Abstract: Interventional procedures in the airway can be performed in interventional radiology suites or the operating room, by radiologists or other specialists. The most common therapeutic interventions carried out by radiologists are balloon dilatation, stenting, and the treatment of certain airway fistulas. These operations can be very challenging for anesthetists in terms of planning, airway management, the identification and treatment of procedural complications and postoperative care. In particular, a multidisciplinary approach to decision-making and planning is important to obtain the best results.
Publisher: Wiley
Date: 08-1996
DOI: 10.1111/J.1440-1673.1996.TB00409.X
Abstract: Rhabdoid tumour of the kidney is an uncommon malignancy with a poor prognosis that usually occurs in childhood. Certain imaging features may help distinguish this lesion from the much more common Wilms' tumour. Extra-renal rhabdoid tumours appear to have no specific imaging characteristics.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2008
Publisher: Springer Science and Business Media LLC
Date: 11-01-2011
DOI: 10.1007/S00247-010-1952-8
Abstract: Narrowing of the abdominal aorta and renal arteries (mid-aortic syndrome) after treatment for neuroblastoma has been attributed to radiation therapy. We present a child with neuroblastoma, successfully treated without radiation therapy, who developed mid-aortic syndrome and hypertension. MR imaging demonstrated encasement of the aorta at presentation. Following successful treatment, long-segment aortic narrowing and narrowing of the proximal renal arteries were present. Hypertension has improved during a 5-year period although renal artery stenosis persists. The incidence of mid-aortic syndrome in children with neuroblastoma is unknown. Etiologies include vascular injury from radiation or chemotherapy, the effect of catecholamines secreted by the tumor on arterial growth, arterial injury at the time of surgery or a constitutional predisposition to the development of both neuroblastoma and mid-aortic syndrome.
Publisher: Elsevier BV
Date: 2011
DOI: 10.1016/J.ATHORACSUR.2010.09.048
Abstract: Aortopexy is the treatment of choice for clinically significant tracheobronchomalacia from external vascular compression. When a marked chest depression is present, aortopexy may be less effective. We report 2 patients with pectus excavatum and vascular compression of the trachea who, despite their young age, benefited from combined Nuss bar insertion and aortopexy.
Publisher: Radiological Society of North America (RSNA)
Date: 12-2003
Publisher: Elsevier BV
Date: 10-2008
DOI: 10.1016/J.JPEDSURG.2008.04.025
Abstract: We report our experience of the management of arterial occlusion in the newborn. A case note review was carried out after ethical approval. Doppler ultrasonography confirmed the occlusion. Thrombolysis was the primary intervention. Surgery was used selectively. A good outcome was one without tissue loss or functional impairment or minimal tissue loss without functional impairment. Data are presented as medians with ranges. Ten patients (9 male median gestational age, 35.5 weeks [range, 28-39 weeks]) presented on day 1 (range, 1-8 days). Initial management included systemic tissue plasminogen activator (8 patients) and surgery (2 infants in whom thrombolysis was contraindicated). Improvement was noted in 7 of 8 infants treated medically and in both who underwent surgery. Three infants had significant tissue loss. Outcome at 29 months (range, 1.3-95.4 months) was good in the remaining 7. A multidisciplinary approach, thrombolysis and selective surgery achieved tissue preservation and function in the majority while minimizing complications. Early referral to centers with multidisciplinary teams is recommended.
Publisher: Springer Science and Business Media LLC
Date: 03-02-2006
Publisher: Elsevier BV
Date: 10-1998
Publisher: Elsevier BV
Date: 12-2003
DOI: 10.1016/J.IJPORL.2003.08.023
Abstract: This paper reviews current concepts and results in the management of congenital tracheal stenosis (CTS). Diagnostic options are considered and the requirements for successful management defined. Chief amongst these is a multi-disciplinary approach with in idualised patient management. Severe long-segment CTS represents the biggest challenge to clinicians and the worst problems for affected families. Near-death episodes are frequent in affected infants and some cannot be ventilated and require ECMO. Associated cardiovascular anomalies are frequent. Patients require immediate resuscitation and transfer to a specialist unit. After careful assessment, accurate diagnosis and discussion, primary resection and end-to-end repair with a slide technique should always be the first option, with concomitant repair of associated cardiac anomalies. If this is impossible because of the severity of the lesion, some form of patch tracheoplasty will be indicated. Cardiopulmonary bypass is often required. Patches include pericardium, autograft trachea, carotid artery, cartilage, and allograft trachea. Mortality ranges from 0 to 30% in the literature, which largely comprises single-centre long-term experience. Recurrence is common and can be managed by stenting and tracheal homograft implantation. Long-term quality of life of survivors is little reported but seems good. Physiological data are lacking. To improve results, we suggest a treatment algorithm to rationalise care.
Publisher: Elsevier BV
Date: 11-2011
DOI: 10.1016/J.ATHORACSUR.2011.07.042
Abstract: We here report our experience with biodegradable polydioxanone stents for tracheal narrowing in children. Eleven custom-made polydioxanone stents were implanted in 4 patients with airway narrowing due to external compression or intrinsic collapse. The median stent diameter was 9 mm (range, 6 to 14 mm) and median length was 15 mm (range, 13 to 70 mm). Narrowing was relieved initially in all cases. There was no bleeding or perforation after polydioxanone stent implantation. Size mismatching was a problem in 2 cases. Three patients needed repeat stenting after stent absorption. There was 1 death, unrelated to the stent implantation. All 3 survivors are in good clinical condition up to 12 months after first stenting. This pilot study shows that polydioxanone stents offer an alternative to metallic or silastic stents for collapse or external compression of the trachea in children. They may avoid the need for permanent stenting and allow subsequent growth of the airway.
Publisher: Springer Science and Business Media LLC
Date: 12-10-2007
Publisher: Springer Science and Business Media LLC
Date: 07-05-2009
Publisher: Wiley
Date: 30-10-2023
DOI: 10.1111/PBI.14209
Publisher: Springer Science and Business Media LLC
Date: 08-2001
Abstract: Medulloepithelioma is a rare tumour with a very poor prognosis. The most frequent site in the central nervous system is the cerebral hemispheres. Appearances on MRI are very variable, possibly reflecting the ergent forms of differentiation seen at histological examination. We report a rare case of sellar and suprasellar medulloepithelioma in a 2-year-old boy and discuss the imaging, differential diagnosis and pathologic findings.
Publisher: Elsevier BV
Date: 05-2005
DOI: 10.1016/J.EJCA.2005.02.004
Abstract: Cisplatin-containing chemotherapy and complete surgical resection are both crucial in the cure of hepatoblastoma. Radical resection can be obtained either conventionally by partial hepatectomy or with orthotopic liver transplant, but the surgical approach to hepatoblastoma differs considerably across the world. Our main aim in this paper is to present the surgical recommendations of the Childhood Liver Tumour Strategy Group of the International Society of Paediatric Oncology (SIOPEL), as well as to stimulate international debate on this issue. We discuss biopsy, verification of resectability, resection principles, indications and potential contraindications for orthotopic liver transplant, as well as thoracic surgery for pulmonary metastases. We suggest that heroic liver resections with a high probability of leaving residual tumour should be avoided whenever possible. In such cases primary orthotopic liver transplant should be considered. Superior survival rates in hepatoblastoma patients who have received a primary transplant after a good response to chemotherapy support the strategy of avoiding partial hepatectomy in cases where radical resection appears difficult and doubtful. We recommend early referral to a transplant surgeon in cases of: (i) multifocal or large solitary PRETEXT IV (PRE Treatment EXTent of disease scoring system) hepatoblastoma involving all four sectors of the liver and (ii) unifocal, centrally located tumours involving main hilar structures or main hepatic veins. Because complete tumour resection is a prerequisite for cure, any strategy leading to an increased resection rate will result in improved survival. We advise the more frequent use of orthotopic liver transplant, as well as the standardisation of techniques for partial liver resection. These guidelines should not be seen as final, but rather as a starting point for further discussion between the various national and international liver tumour study groups.
Publisher: Wiley
Date: 19-06-2003
DOI: 10.1002/MPO.10037
Publisher: Wiley
Date: 16-05-2003
DOI: 10.1002/MPO.10038
Publisher: Elsevier BV
Date: 12-2012
DOI: 10.1016/J.EJCA.2012.06.023
Abstract: To assess the clinical activity of irinotecan as single drug in children with refractory or recurrent hepatoblastoma. Four cycles of irinotecan were administered (20mg/m(2)/day intravenous (i.v.) infusion on days 1-5 and 8-12, every 21days) unless tumour progression occurred or resectability was achieved earlier. Tumour response was assessed according to modified SIOPEL and Response Evaluation Criteria In Solid Tumours (RECIST) criteria. Main end-points were best overall response rate (RR), early progression rate (EPR) and progression free survival (PFS). Twenty-four eligible patients (median age 58.0months 19 boys) were enrolled in the study (11 relapses, 13 refractory diseases). Of the 23 evaluable patients six had an overall partial response, 11 stable disease and six progressive disease, of which four were early progression (RR: 26%, EPR: 17%). In eight patients the residual tumour could be completely resected seven patients became tumour free. At last follow-up 12 patients were alive (six with no evidence of disease, six with disease). PFS at 1year was 24%. Patients with relapse had a higher RR than patients with refractory disease (46% versus 8%) and patients with isolated lung lesions showed a better response than patients with other tumour localisations (50% versus 13%). The main grade 3-4 toxicities, diarrhoea and neutropenia, occurred in half of the patients. Irinotecan has a significant anti-tumour activity and acceptable toxicity in patients with relapsed hepatoblastoma and therefore should be considered for the treatment of these patients. Exploration of the role of irinotecan in the initial treatment of hepatoblastoma is warranted.
Publisher: Oxford University Press (OUP)
Date: 21-10-2009
DOI: 10.1093/NDT/GFP537
Abstract: We retrospectively reviewed the medical records of all patients who underwent surgery as part of the treatment of renovascular hypertension (RVH) at our centre between 1979 and 2008. Patients. Thirty-seven children (65% male) with a median age of 7.6 (0.4-17.9) years were identified with a median systolic blood pressure (SBP) of 140 (105-300) mm Hg prior to surgery. Bilateral renal artery stenosis and intra-renal disease were present in 19 (51%) patients, mid-aortic syndrome in 15 (40%), involvement of visceral arteries in eight out of 35 (23%) and coexisting cerebral disease in eight out of 30 (26%) investigated patients. Surgical procedures (n = 53) included (i) nephrectomy (18, of which two unplanned and two secondary due to technical failure), (ii) renovascular surgery on the renal arteries (28, of which 18 had autologous surgery and 10 synthetic grafts inserted for revascularisation) and (iii) aortic reconstruction with (6) and without (1) a synthetic graft. Post-operative complications were haemorrhage (5), septicaemia (5) and chylous ascites (1). There were no perioperative deaths two children died during follow-up. The SBP post-surgery improved to a median value of 116 (range 90-160) mm Hg. Twelve months after surgery, 16 (43%) children had normal blood pressure without treatment, 15 (41%) normal or improved on one to four antihypertensive drugs and four (11%) unchanged no data were available for two (5%) children. Surgery effectively treated the hypertension of 90% of our children, when performed in conjunction with medical therapy and interventional radiology. In spite of aggressive surgical treatment, RVH is sometimes a progressive disease.
Publisher: Elsevier BV
Date: 04-2012
DOI: 10.1016/J.ATHORACSUR.2011.12.075
Abstract: Slide tracheoplasty has become the surgical technique of choice for repair of congenital tracheal stenosis. Despite the initial reluctance regarding the ability of this "reconstructed" trachea to grow, the reduced morbidity and mortality have allowed slide tracheoplasty to be widely adopted. The aim of this study was to evaluate tracheal growth after slide tracheoplasty. This was a retrospective study. In follow-up bronchography performed 1, 6, 12, 18, and 24 months after slide tracheoplasty, we measured the cross-sectional areas of the midtrachea and distal trachea at each investigation and correlated the measurements with the anthropomorphic factors (body weight, height, and body surface). Fourteen patients were enrolled in this study. The midtracheal and distal tracheal cross-sectional areas significantly increased with time (p ≤ 0.0001). The average rates of midtracheal growth were 21.0 mm(2)year in the first 6 months and 8.0 mm(2)/year in the first 2 years, and the distal trachea grew 18.5 mm(2)/year and 8.4 mm(2)/year, respectively. Regression analysis showed that both the midtrachea and the distal trachea increase significantly with weight (r(2) = 0.257, p ≤ 0.0001), height (r(2) = 0.376, p ≤ 0.0001), and body surface area (r(2) = 0.315, p ≤ 0.0001). Balloon dilation did not significantly alter the tracheal growth in the first 2 years after slide tracheoplasty. Slide tracheoplasty does not inhibit tracheal growth. The reconstructed trachea grows faster in the first 6 months and slows in the following 18 months. There is a positive correlation between tracheal cross-sectional area and weight, height, and body surface area.
Publisher: Elsevier BV
Date: 08-1994
DOI: 10.1016/0720-048X(94)90340-9
Abstract: Colour Doppler ultrasound was used to study the affected lower limbs of a group of patients with the Klippel-Trenaunay syndrome. The abnormal lateral venous channel characteristic of this syndrome was examined, together with its deep venous connections and deep venous patency established if present. Seventeen patients (18 limbs) were studied. Ultrasound demonstrated calf vein patency in 15 out of 17 limbs and deep venous patency from the popliteal vein to the inferior vena cava in 17 out of 17 limbs. Ultrasound was also effective in demarcation of the abnormal lateral venous channel, together with its deep connections (13 out of 16 limbs). We conclude that ultrasound is superior to the more established venographic techniques in the investigations of patients with the Klippel-Trenaunay syndrome. From this study, the deep venous aplasia said to occur in the condition would appear to be less common than previously thought.
Publisher: Springer Science and Business Media LLC
Date: 06-01-2017
Publisher: Springer Science and Business Media LLC
Date: 11-01-2006
DOI: 10.1007/S00247-005-0067-0
Abstract: Hepatoblastoma is the most common liver malignancy in children. With rare exceptions, complete tumour resection is required to cure the patient. Radical tumour resection can be obtained either with standard partial hepatectomy or orthotopic liver transplantation. At present, the surgical approach to hepatoblastoma differs significantly between treatment groups in different parts of the world. Our aim was to review current surgical policy in hepatoblastoma. All aspects of surgery in hepatoblastoma are discussed, including biopsy, tumour resection principles, modern achievements in the field of liver surgery, and the indications and potential contraindications for liver transplantation. Every effort should be made to resect hepatoblastoma completely either by standard partial hepatectomy or by the use of liver transplantation in difficult or clearly unresectable cases.
Publisher: Elsevier BV
Date: 06-2007
DOI: 10.1016/J.EJVS.2006.12.014
Abstract: A 12-day-old term male neonate presented with septic arthritis, multiple skin and intrabdominal abscesses and a mycotic aneurysm of the right internal iliac artery. He was diagnosed as having methicillin resistant staphylococcus aureus (MRSA) septicaemia and deemed unsuitable for surgical treatment of the aneurysm. Coil embolisation of the internal iliac artery was performed, followed by a successful recovery and with no evidence of residual or recurrent infection. The authors describe a method of treating internal iliac mycotic aneurysms in high-risk patients by endovascular means, which we believe has not been attempted in this precise scenario before.
Publisher: Wiley
Date: 18-12-2012
DOI: 10.1111/DMCN.12050
Abstract: To describe the frequency of renovascular abnormalities and hypertension in an opportunistic cohort of children with complex cerebrovascular disease from a single tertiary/quaternary referral centre. This was a retrospective case note and imaging review of children who had had cerebral and renal angiography, with a diagnosis of moyamoya or other occlusive cerebrovascular disease (OCVD). Hypertension was defined as at least three systolic blood pressure readings of the 95th centile or above. Of 34 children (12 males, 22 females median age 5y 11mo, range 2mo-15y 3mo 20 with moyamoya, 14 with OCVD), primary presentation was neurological in 29 (arterial ischaemic stroke, transient ischaemic attack, or headache) and with hypertension in five. Renovascular abnormalities were identified in 17, of whom 10 had main renal artery stenosis. Renovascular involvement was not predictable according to arteriopathy diagnosis. Blood pressure was rarely plotted on centile charts. Using the 50th height centile for blood pressure, and based on a median of five systolic blood pressure readings per patient, 20 out of 34 met the definition for hypertension (15/29 patients with primary neurological presentation). Renovascular abnormalities were common in this group of children with complex cerebrovascular disease. Blood pressure was frequently abnormal but rarely measured and infrequently plotted on centile charts. Neurologists should be alert to potential systemic vascular involvement and its sequelae in children with complex cerebrovascular disease.
Publisher: Springer Science and Business Media LLC
Date: 11-03-2006
DOI: 10.1007/S00247-006-0123-4
Abstract: Image-guided core needle biopsy is widely used in paediatric oncology, but many protocols continue to discourage this practice. No published randomized studies compare image-guided needle biopsy with surgical techniques. To perform a systematic review of the literature on image-guided core needle biopsy in paediatric oncology. Several computerized databases were searched using the terms [(needle OR core) AND (biops*[ti]) AND (paediatric OR pediatric OR child OR children OR childhood OR boy OR girl)[ti]] to identify series of more than five cases of needle core biopsy for tumour diagnosis in children. Data from included studies were combined to calculate pooled estimates of adequacy, accuracy and complication rates. Thirteen studies fulfilled the inclusion criteria. Overall biopsy adequacy rate (defined as sufficient to make a diagnosis) was 94% (95% CI 92-96%). The diagnostic accuracy rate in cases with adequate material (defined as achieving the correct specific diagnosis) was 94% (95% CI 92-96%). Complications requiring treatment occurred in 1%. Available pooled data suggest that about 95% of image-guided needle core biopsies provide an adequate s le for diagnosis of malignant disease in childhood. In such cases, the pathological diagnosis is correct in about 95%. Complications are rare.
Publisher: Springer Science and Business Media LLC
Date: 10-05-2008
Publisher: Wiley
Date: 04-2012
Publisher: Elsevier BV
Date: 06-2010
DOI: 10.1016/J.JPEDSURG.2010.02.081
Abstract: Gastrostomy insertion in children can be performed in many ways, but which is the best technique remains uncertain. This study evaluates the outcome of percutaneous endoscopic gastrostomy (PEG) and image-guided gastrostomy (IG). We reviewed children who had either PEG (n = 136) inserted by pediatric surgeons or IG (n = 195) inserted by interventional radiologists in our hospital between May 2004 and July 2008. Gastrostomy-related complications were given scores ranging from 20 for major complications (eg, peritonitis, gastrointestinal bleed, and visceral injury) to 1 for minor (eg, site infection and tube migration), and total score per month of follow-up was calculated per patient. Conversion to laparoscopic or open gastrostomy was more frequent in PEG versus IG (P = .001). Fewer PEG patients (28%) had complications than did IG (47%) (P = .001). One PEG patient developed a gastrocolic fistula. In the IG group, 2 patients had transverse colon puncture, 1 had intraperitoneal tube detachment, and 1 had upper gastrointestinal bleeding. When scored and adjusted by length of follow-up, PEG had lower scores compared with IG, indicating a better outcome (P = .03). These findings were supported by zero-inflated Poisson regression analysis. Major complications were rare and observed more frequently after IG. Minor complications were observed in both procedures but were significantly less common in PEG.
Publisher: Elsevier BV
Date: 05-2012
DOI: 10.1016/J.JPEDSURG.2012.01.077
Abstract: Tracheomalacia associated with esophageal atresia (EA) is a well-known condition. However, complete absence of tracheal rings (TRs) is extremely rare. Our aim is to describe a novel triad of conditions and to discuss the best treatment. An expremature male operated for EA presented with severe respiratory distress. The diagnosis of absent cartilage rings, suspected on bronchoscopy, was confirmed by optical coherence tomography. The absence of TRs was localized to a short tracheal segment, and the carina trifurcated into right upper lobe, right intermediate, and left main bronchus. The patient was treated with resection and anastomosis with a completely satisfactory course. Absence of TRs was previously reported by us in 2 other cases, both with associated EA and trifurcation of the carina. One child was treated with tracheostomy and the other with a stent, but the outcome was far from optimal. The patient with tracheostomy eventually underwent resection and anastomosis with tracheostomy closure. Congenital absence of TRs is extremely rare. Although localized, it is responsible for severe symptoms owing to complete tracheal collapse and may be misdiagnosed as tracheomalacia. In our experience, it has been associated with EA and trifurcated carina. Our limited experience suggests resection of the abnormal segment and tracheal anastomosis as the best treatment.
Publisher: Springer Science and Business Media LLC
Date: 29-05-2010
DOI: 10.1007/S00247-010-1699-2
Abstract: Interventional radiology is a rapidly growing discipline in paediatrics. Many non-vascular interventional techniques may be used in the gastrointestinal tract in children. The technically simpler and more common of these may be adopted by any paediatric radiologist with an interest in interventional radiology. Other rarer and more complex techniques are currently restricted to specialist centres with a higher overall caseload. This review emphasizes the common procedures such as oesophageal dilatation, gastrostomy, insertion of transgastric jejunal feeding tubes and biopsy. Less common salivary, hepatobiliary, pancreatic and intestinal interventions are also described.
Publisher: Wiley
Date: 03-07-2012
DOI: 10.1002/CNCR.26714
Publisher: Springer Science and Business Media LLC
Date: 12-02-2011
DOI: 10.1007/S00270-010-0090-X
Abstract: Paediatric interventional uroradiology lies at the intersection of the disciplines of paediatric interventional radiology and paediatric endourology. Interdisciplinary collaboration has led to the development of new techniques and refinement of procedures adopted from adult practice. This article reviews the major procedures used in paediatric interventional uroradiology, with emphasis on nephrostomy, percutaneous nephrolithotomy, balloon-burst pyeloplasty, and antegrade ureteric stenting.
Publisher: Springer Science and Business Media LLC
Date: 21-05-1999
Abstract: We evaluated retrospectively the outcome of artery-sparing (AS) versus non-artery-sparing (NAS) laparoscopic varicocelectomy and measured any reversal of testicular growth. Twenty patients (13 left and 7 bilateral varicoceles) were evaluated after surgery. A total of 27 varicocelectomies (20 AS and 7 NAS) were performed. The indication for surgery was smaller testicular size on the affected side in all patients and discomfort ain in 3. The mean age was 12.9 years (range 8-15 years) at surgery. The testicular volumes were determined clinically and by color Doppler sonography (US). The follow-up time was 6-48 months after surgery. There were 4 recurrences out of 27 varicocelectomies (15%), of which 1 has been reoperated. Testicular volumes were equal in both groups after surgery, indicating catch-up growth except in the cases with minor recurrences (2 AS and 2 NAS varicocelectomies). In 12 testes, dilated veins in the p iniform plexus were revealed by US. No severe intraoperative complications occurred. Three patients had a hydrocele after surgery (11%). These data show that there is testicular catch-up growth after varicocelectomy, but some questions remain unanswered: (1) should the remaining dilated veins detected by Doppler US be tackled and (2) is an AS operation worthwhile?
Publisher: Elsevier BV
Date: 03-2009
DOI: 10.1016/J.JPEDSURG.2008.10.105
Abstract: Long segment congenital tracheal stenosis (LSCTS), associated with complete tracheal rings, is a rare condition, difficult to manage and historically associated with high mortality rate. We report two pairs of identical twins all affected by LSCTS successfully treated by sliding tracheoplasty. All had severe respiratory distress. Three infants had left pulmonary artery (LPA) sling and one intra-cardiac malformation. Slide tracheoplasty was done under cardiopulmonary bypass, and cardiovascular malformations were corrected at the same time. One child needed plication of paralyzed right hemi-diaphragm and another distal tracheal Palmaz stent insertion due severe tracheobronchomalacia. All children are doing well during 6 months follow-up. Slide tracheoplasty seems to produce the same good early results in twins as for singletons with LSCTS.
Publisher: Springer Science and Business Media LLC
Date: 10-12-2005
DOI: 10.1007/S00247-005-0029-6
Abstract: Hepatoblastoma is the most common malignant liver tumour of childhood. Accurate radiological staging is very important, especially in children who are treated according to the protocols of the International Childhood Liver Tumor Strategy Group (SIOPEL). These protocols use risk stratification, based almost entirely on imaging findings, to minimize the treatment for localized tumours and to intensify treatment for extensive tumours and those with extrahepatic spread.
Publisher: Informa UK Limited
Date: 2004
DOI: 10.1080/15227950490952460
Abstract: Histologically benign soft-tissue chondromas have been reported at many anatomical sites but are an uncommon cause of soft tissue mass lesions in childhood, accounting for less than 1% of cases. The most frequent sites for extraosseous soft-tissue chondromas are the hands and feet. For the extremely rare visceral chondromas, the site can be lung, where they may represent a component of Carney's syndrome of extra-adrenal paraganglioma, pulmonary chondroma, and epithelioid leiomyosarcoma of the gastrointestinal tract. Primary cardiac chondromas are exceptionally rare in patients of any age although cardiac chondrosarcoma, both primary and metastatic, is well reported. We present a case of a teenage boy with a fatal cardiac chondroma
Publisher: Elsevier BV
Date: 2010
Publisher: Elsevier BV
Date: 12-2011
Publisher: Informa UK Limited
Date: 2000
DOI: 10.1080/003655900750016733
Abstract: The present study, conducted in Hong Kong, was designed to evaluate the clinical assessment and interobserver variation between doctors with different levels of training in the assessment of recurrent varicoceles, and to compare their findings with those made by ultrasound. Fifteen patients, previously operated for left varicocele testis, were evaluated clinically by four observers. The mean age was 12.9 years (range 8-15 years) at surgery. The testicular texture, size and flow with and without the Valsalva manoeuvre were determined by colour Doppler sonography. The follow-up time was 6-48 months after surgery. The echotexture of the testes was normal in all patients. The mean volumes of the left and right testes were equal after surgery (left 9.0 ml [range 2.4-15.2 ml and right 8.7 ml [range 3.4-15.6 ml]). There was large variation between observers in the predictability of both positive and negative clinical findings of varicocele testis when compared with ultrasound. Objective assessment in grading varicocele testis and testicular volume using ultrasound is required for both clinical management and scientific research.
Publisher: SAGE Publications
Date: 03-2004
Publisher: BMJ
Date: 06-07-2010
Abstract: To describe our experience of treating children with vein of Galen aneurysmal malformation (VGM) in a single UK centre between 2003 and 2008. Retrospective review of case notes and neuroimaging. 33 children were seen (26 neonates, seven infants), of whom 28 underwent endovascular treatment. Four were not offered treatment as they had evidence of severe diffuse brain injury at presentation treatment was deferred in another who subsequently died. Seven children died (two of whom had endovascular treatment). Of the survivors (all treated), 13 (39%) are neurodevelopmentally intact, seven (21%) have mild neurodevelopmental impairment and the remaining six (18%) have significant neurological impairment. The authors were not able to identify clinical or radiological parameters which strongly predicted outcome. Of note, two children with initially low Bicêtre scores were neurologically intact after successful embolisation. The outlook for children with VGM is significantly better since the advent of endovascular treatment. Decisions about the appropriateness and timing of treatment should be taken by an experienced multidisciplinary team.
Publisher: BMJ
Date: 06-02-2007
Publisher: Springer Science and Business Media LLC
Date: 11-01-2002
DOI: 10.1007/S00247-001-0585-3
Abstract: Hodgkin's disease (HD) usually presents with lymphadenopathy. At the time of diagnosis, mediastinal involvement is present in most patients, and purely extranodal disease is rare. We present a case of HD with disease apparently limited to the liver and spleen, and imaging and biopsy findings compatible with sclerosing cholangitis.
Publisher: Wiley
Date: 2004
DOI: 10.1002/CNCR.20220
Abstract: Vincristine (VCR) is widely used to treat patients with malignant disease among the patients treated with VCR are children with brain tumors. In vitro studies have demonstrated that the cytotoxic activity of VCR is related to both extracellular concentration and duration of exposure. The attainment of higher plasma concentrations by injecting larger bolus doses of VCR has been limited by concerns about neurotoxicity. One possible alternative strategy for enhancing the antitumor efficacy of VCR involves prolonging the duration of in vivo exposure. Therefore, the authors explored the neurotoxicity and pharmacokinetics of VCR administered via a 96-hour continuous infusion after administration of a conventional bolus dose in a pediatric population. The current study included 16 patients, 11 of whom were males. The median age of the study population was 4.8 years (range, 1.7-15.8 years). The diagnoses included intrinsic pontine glioma (n = 4), ependymoma (n = 5), astrocytoma (n = 3), medulloblastoma rimitive neuroectodermal tumor (PNET n = 2), ganglioglioma (n = 1), and choroid plexus carcinoma (n = 1). Of the 16 patients, 5 were newly diagnosed, and the remaining 11 had disease recurrences, 8 of which arose after radiotherapy. Treatment included cyclophosphamide 65 mg/kg administered intravenously over 1 hour on Day 1, a bolus of VCR 1.5 mg/m(2) administered intravenously on Day 2, and VCR 0.5 mg/m(2) per 24 hours administered via continuous intravenous infusion on Days 2-5. Thus, a total VCR dose of 3.5 mg/m(2) was administered via infusion over 4 days. Fifteen patients received 2 courses of treatment at 21-28-day intervals, and a total of 31 treatment courses were administered. VCR concentrations in plasma s les were measured using high-performance liquid chromatography. Jaw pain, constipation, mild abdominal pain, and depressed reflexes were common. However, only 1 of 31 courses was associated with Grade III toxicity, and no Grade IV toxicity (e.g., cranial nerve palsy, ileus, inappropriate antidiuretic hormone secretion, seizures, hallucinations, etc.) was noted. The steady-state plasma concentration of VCR during continuous infusion ranged from 1 to 3 microg/L in all patients. Responses after 2 courses were evaluated in 14 of 16 patients. A complete response was noted in one patient (astrocytoma), a partial response in three patients (one each with astrocytoma, ependymoma, and PNET), stable disease in seven patients, and disease progression in three patients. Continuous infusion of VCR after a conventional bolus dose plus cyclophosphamide for children with tumors of the central nervous system did not result in significant neurotoxicity and appeared to be a safe strategy for achieving increased systemic exposure.
Publisher: Cold Spring Harbor Laboratory
Date: 29-05-2023
DOI: 10.1101/2023.05.29.541874
Abstract: Crop protection strategies relying on the improvement of the natural plant immune system via genetic engineering are sustainable solutions against the pathogen thread on food security. Here we describe a novel way to improve the plant immune system by immune protease engineering. As proof of concept, we increased resistance against the late blight pathogen Phytopththora infestans by rendering the tomato secreted immune protease Pip1 insensitive to the P. infestans -secreted inhibitor Epic2B. This concept can be applied to secreted immune proteases in crops by precision breeding.
Publisher: Elsevier BV
Date: 10-1997
DOI: 10.1016/S0009-9260(97)80166-3
Abstract: Of approximately 9 million patients with cancer in China in 2020, more than half were diagnosed with late-stage cancers. Recent regulatory reforms in China have focused on improving the availability of new cancer drugs. However, evidence on the clinical benefits of new cancer therapies authorized in China is not available. To characterize the clinical benefits of cancer drugs approved in China, as defined by the availability and magnitude of statistically significant overall survival (OS) results. This mixed-methods study comprising a systematic review and cross-sectional analysis identified antineoplastic agents approved in China between January 1, 2005, and December 31, 2020, using publicly available data and regulatory review documents issued by the National Medical Products Administration. The literature published up to June 30, 2021, was reviewed to collect results on end points used in pivotal trials supporting cancer drug approvals. The primary outcome measure was a documented statistically significant positive OS difference between a new cancer therapy and a comparator treatment. Secondary outcome measures were the magnitude of OS benefit and other primary efficacy measures in pivotal trials. Between 2005 and 2020, 78 cancer drugs corresponding to 141 indications were authorized in China, including 20 drugs (25.6%) (for 30 indications) approved in China only. Of all indications, 26 (18.4%) were evaluated in single-arm or dose-optimization trials, most of which were authorized after 2017. By June 30, 2021, 34 drug indications (24.1%) had a documented lack of OS gain. For 68 indications (48.2%) that had documented evidence of OS benefit, the median magnitude of OS improvement was 4.1 (range, 1.0-35.0) months. After a median follow-up of 1.9 (range, 1.0-11.1) years from approval, OS data for 13 indications (9.2%) were either not reported or were still not mature. Fewer than one-third of cancer drug indications approved in China only had documented evidence of OS benefits (9 of 30 [30.0%]), whereas more than one-half of the cancer drug indications also available in the US or Europe had OS benefits (59 of 111 [53.1%]). In this study, almost half of cancer drug indications approved in China had demonstrated OS gain. With the increase of cancer drug approvals based on single-arm trials or immature survival data in recent years, these findings highlight the need to routinely monitor the clinical benefits of new cancer therapies in China.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2008
Publisher: Elsevier BV
Date: 03-2011
DOI: 10.1053/J.TVIR.2010.07.004
Abstract: The scope for image-guided intervention in the chest is very wide and encompasses procedures in the heart, pulmonary and systemic vasculature, lungs and pleural cavities, airway, and esophagus. This review describes the most important procedures that are usually performed by radiologists. Percutaneous drainage is now the most common method of treating both empyemas and lung abscesses in children. Although most lung biopsies are carried out by other means, percutaneous biopsy and localization are important alternatives for the diagnosis of focal lung lesions. Esophageal strictures are common in children and are usually best treated by balloon dilatation. The use of retrievable or biodegradable stents has recently been introduced for refractory esophageal strictures. Similarly, balloon dilatation and stenting are now increasingly used in children with stenosis or extrinsic compression of the trachea or bronchi.
Publisher: American Medical Association (AMA)
Date: 15-03-2010
Abstract: To describe a multimodality approach to the management of pediatric head and neck lymphatic malformations using surgery, sclerotherapy, or both and to review the outcomes of these approaches. Retrospective case series. A single pediatric tertiary care referral center. Ninety-seven pediatric patients (aged 1 month to 16 years) diagnosed as having lymphatic malformations of the head and neck during a 7-year period. Follow-up ranged from 3 months to 7 years. All of the patients underwent clinical and radiologic (magnetic resonance imaging) assessment. Treatment modality was selected according to disease location, cyst size, and parental preference. Treatments included surgery (open excision, tongue reduction, electrocautery, and laser treatment), sclerotherapy with OK-432 (Picibanil) or a fibrosing agent (Ethibloc), and a combination of modalities. Clinically determined responses to treatment, complications, and number of treatments required. All isolated neck disease had complete or near-complete responses, with no nerve palsies sustained. Although most patients achieved complete or near-complete responses, disease with parotid, laryngopharyngeal, or oral components had poorer outcomes and frequently required multiple treatments. Significant long-term neural injury was sustained in 3 of 6 surgical patients for mediastinal disease and in only 4% (n = 4) of other surgical procedures. Surgery retains an important role in the treatment of pediatric head and neck lymphatic malformations despite the advent of sclerotherapy. Isolated neck disease has an excellent outcome with either modality. Treatment decisions were made via a problem-based approach and were in idualized according to anatomical location and disease classification.
Publisher: Wiley
Date: 09-2002
DOI: 10.1046/J.1460-9592.2002.00843.X
Abstract: We present a case of a 3-year-old child who underwent hepatic artery chemoembolization. The anaesthetic management, prophylaxis of tumour lysis syndrome, nausea and vomiting and the management of perioperative pain relief are all discussed.
Publisher: Elsevier BV
Date: 03-1998
DOI: 10.1016/S0009-9260(98)80102-5
Abstract: The thyroid is remarkably resistant to infection. Hence, when an infection does occur, the presence of a pyriform fossa sinus must be considered, particularly if it is recurrent and left sided. The aim of this paper is to alert radiologists to the existence, clinical presentation, and ultrasonographic and oesophagographic appearances of a pyriform fossa sinus. We present the role of ultrasound and oesophagography in five children with pyriform fossa sinus associated with suppurative thyroiditis. In four children the abnormality was on the left and on the right in one.
Publisher: Springer Science and Business Media LLC
Date: 03-06-2010
DOI: 10.1007/S00247-010-1691-X
Abstract: The role of interventional radiology in paediatric nephrology and urology is gradually increasing. Some procedures (such as renal biopsy) are best performed using radiological techniques, some (such as ureteric stenting) by either radiologists or urologists, depending on clinical circumstances, and some (such as percutaneous nephrolithotomy) are usually performed jointly by urologists and interventional radiologists. This paper briefly reviews the main non-vascular interventional radiology techniques used in the genitourinary tract in children. Common procedures such as renal biopsy and nephrostomy and related procedures are emphasised.
Publisher: Wiley
Date: 23-09-1998
DOI: 10.1002/(SICI)1096-8628(19980923)79:3<168::AID-AJMG3>3.0.CO;2-J
Abstract: We describe a 2-year-old girl with clinical and radiological findings of Burton skeletal dysplasia. This rare disorder shows some similarities to Kniest dysplasia. Short stature, joint stiffness, microstomia, and pursed lips are characteristic clinical findings. Platyspondyly with cervical kyphosis, but no coronal clefts, and bowing of the long bones are distinctive radiographic findings.
Publisher: Springer Science and Business Media LLC
Date: 07-2005
DOI: 10.1007/S00383-005-1478-6
Abstract: Static electricity within sterile packaging may result in bacterial contamination of central venous catheters (CVCs) prior to insertion. To prevent this, some surgeons inject saline into the pack before opening it. This trial was designed to determine the effect of this procedure. A double blind randomised controlled trial of 47 CVCs comparing injection of 2 ml of sterile saline into the pack prior to opening with no injection was performed. Five centimetre lengths cut from the tip of the catheter before and after subcutaneous tunnelling were sent for microbiological culture. Eight catheters (17%) showed evidence of bacterial contamination prior to insertion into the vein. Two (4.2%) were contaminated prior to tunnelling and seven (14.9%) afterwards. One catheter was contaminated before and after tunnelling. All but one of the contaminating bacteria were coagulase negative staphylococci. There was no significant difference in the contamination rate between catheters from packs that had been injected (5/25) and those that had not (3/22), P = 0.56. Just under one-fifth of the catheters were contaminated with bacteria prior to insertion into the vein but this was not influenced by prior injection of saline into the pack. We conclude that there is no evidence to support the practice of injecting the catheter pack prior to opening.
Publisher: Springer Science and Business Media LLC
Date: 12-11-2006
Publisher: Springer Science and Business Media LLC
Date: 16-02-2023
Publisher: Springer Science and Business Media LLC
Date: 22-09-2004
DOI: 10.1007/S00247-004-1311-8
Abstract: Peliosis hepatis is a rare benign condition characterized by oval or irregular, multiple blood-filled spaces within the liver parenchyma. It is most commonly seen in adults and may be idiopathic, but has various associations including malignancy, infection and drugs. The imaging findings are often non-specific and the condition may be mistaken for multiple abscesses, metastases or vascular malformations. Peliosis hepatis is an especially rare condition in children and to our knowledge only six cases have been described in the literature. Our case describes and illustrates peliosis in a 3-year-old girl and is the first described in any age group to cause complete IVC obstruction. The patient subsequently made a full recovery.
Publisher: Springer Science and Business Media LLC
Date: 03-03-2013
Publisher: Springer Science and Business Media LLC
Date: 03-02-2012
DOI: 10.1007/S00247-011-2268-Z
Abstract: Rapidly involuting congenital haemangioma (RICH) is a benign neoplasm that may occur in many locations in the body. When RICH occurs in the liver, it may be confused with other lesions. To present a case series from a single institution. Retrospective review of pathological and imaging findings in infants with biopsy-proven hepatic RICH treated at a single hospital. Four children (2 days to 6 weeks of age) presented between 2002 and 2007 with a solitary hepatic lesion. Needle biopsy excluded the alternative possibility of infantile haemangioma by showing negativity for GLUT1. Serial imaging confirmed rapid involution in each child. RICH should be suspected in neonates who present with a solitary liver lesion and normal-for-age serum alpha-fetoprotein. Serial US scans should be used to confirm a progressive shrinkage of the lesion. Corticosteroids and β2-adrenergic antagonists have no proven effect in treating RICH. If the lesion grows, percutaneous needle biopsy is recommended to exclude a malignant tumour and to direct further management. Infants with cardiac failure should be treated medically. Embolization (with or without needle biopsy) should only be performed when this strategy fails.
Publisher: Elsevier BV
Date: 07-2012
DOI: 10.1016/J.EJCA.2011.12.011
Abstract: To identify factors relevant to long-term outcome in newly diagnosed hepatoblastoma, and define subgroups for clinical research on tailoring treatment to the in idual patient. Between 1995 and 2006 the SIOPEL group conducted two clinical trials which established risk-adapted therapy for hepatoblastoma patients. Patients were stratified into high-risk (AFP 1,200,000 ng/mL, patient age, platelet count and histology were further explored. The outcome measure was event-free survival (EFS). In 541 patients, reduced EFS correlated significantly with AFP 5 years (2.76, 1.68-4.53) borderline with small cell undifferentiated (SCU) histology (2.29, 95% confidence interval 0.91-5.77) but not with PRETEXT III, age 30-60 months, platelet count or V+/P+/E+. By using the significant factors and SCU to stratify the population, we have identified three distinct prognostic groups: PRETEXT I/II/III, and no other factors, have 3 year EFS of 90%, PRETEXT IV and/or multifocal tumour and/or age> 5 years and/or AFP > 1.2 × 10(6) have 3 year EFS of 71% and SCU and/or AFP < 100 ng/mL and/or metastatic have a 3year EFS of 49%. Prognostic stratification for clinical research on newly diagnosed hepatoblastoma should take into consideration PRETEXT, metastatic disease, AFP, multifocality, age and SCU histology.
Publisher: Springer Science and Business Media LLC
Date: 21-12-2006
Publisher: American Academy of Pediatrics (AAP)
Date: 07-2006
Abstract: OBJECTIVE. Our aim was to evaluate the clinical outcomes, safety, and efficacy of percutaneous transluminal angioplasty for renovascular hypertension in children. METHODS. A retrospective review of data for all children with renovascular hypertension who underwent percutaneous transluminal angioplasty at a single center between 1984 and 2003 was performed. Patients with renal transplants and inflammatory multisystem diseases were excluded. RESULTS. Thirty-three children, 1.9 to 17.9 years of age (median: 10.3 years), underwent renal angioplasty and/or stenting. Underlying syndromes were present in 10. On angiograms, 16 had bilateral renal artery stenosis, 15 intrarenal disease, 8 aortic stenosis, and 7 cerebrovascular disease. Forty-eight percutaneous transluminal angioplasty procedures were performed, including 15 stenting procedures. There was a high rate of restenosis after stenting (7 of 19 cases, compared with 2 of 27 cases after balloon dilation). Outcomes were cured (ie, blood pressure normal without treatment) for 9 patients, improved blood pressure with same or reduced treatment for 7, blood pressure maintained in & th percentile because of cerebrovascular disease for 2, no change in blood pressure despite technical success for 10, and technical failure for 5. Blood pressure control improved in 11 of 13 children who had main renal artery disease alone and in 6 of 20 with associated intrarenal disease or stenoses in other vascular beds. There was 1 procedure-related death and 5 minor complications. CONCLUSIONS. Angioplasty produced clinically worthwhile improvement for ∼50% of patients. High incidence rates of extrarenal involvement and intrarenal disease and a high restenosis rate after stenting accounted for poor blood pressure control in the rest.
Publisher: Springer Science and Business Media LLC
Date: 12-1998
Publisher: Elsevier BV
Date: 03-2003
DOI: 10.1067/MSY.2003.62
Publisher: Springer Science and Business Media LLC
Date: 20-03-2021
Publisher: Wiley
Date: 04-08-2016
Abstract: During barley germination, the aleurone layer secretes most of the enzymes required to degrade the endosperm, many of which are yet to be characterized. We used activity-based protein profiling (ABPP) to detect a range of active enzymes extracted from aleurone layers isolated from grains of a commercial malting barley variety incubated with or without gibberellic acid (GA). Enzymes found to be induced by GA were putative aleurains, cathepsin-B-like proteases and serine hydrolases. By using an inhibitory sugar panel, a specific active retaining β-glycosidase in the barley aleurone was identified as a putative xylanase. Our results show that ABPP can be used rapidly to identify a variety of active enzyme isoforms in cereal aleurone without the need for enzyme purification.
Publisher: Springer Science and Business Media LLC
Date: 10-05-2008
Publisher: Springer Science and Business Media LLC
Date: 1998
Abstract: A self-expanding metallic stent (Wallstent) was used to relieve obstruction of the common bile duct in a young male with a desmoplastic small cell tumor of the abdomen. Two months after insertion and following a course of chemotherapy the lower end of the stent eroded the mucosa of the second part of the duodenum causing severe gastrointestinal hemorrhage which necessitated laparotomy and trimming of the stent. This complication may have been due to shrinking of the tumor as well as thrombocytopenia following chemotherapy.
Publisher: Cambridge University Press (CUP)
Date: 04-2004
DOI: 10.1017/S1047951104002185
Abstract: Aortic coarctation is a recognized arteriopathy in patients with Williams’ syndrome. We present an adolescent with Williams’ syndrome who developed rapid restenosis after primary stenting of coarctation of the aorta. We believe such restenosis within the stent is due to a proliferative response of the abnormal aortic wall. Attention should be paid to the potential for restenosis during follow-up after stenting of aortic coarctation in patients with Williams’ syndrome.
Publisher: Wiley
Date: 05-1998
DOI: 10.1002/(SICI)1096-911X(199805)30:5<297::AID-MPO7>3.0.CO;2-A
Publisher: Elsevier BV
Date: 07-2001
DOI: 10.1016/S0360-3016(01)01513-9
Abstract: To evaluate the long-term brain metabolite changes on (1)H-MRS in acute lymphoblastic leukemia (ALL) patients who had intrathecal methotrexate (ITMTX) and cranial irradiation (CRT) for central nervous system (CNS) prophylaxis against CNS relapse. Thirty-seven ALL patients (12 females, 25 males) with history of ITMTX and CRT for CNS prophylaxis were studied. Age ranges at the time of diagnosis and at magnetic resonance examination were 0.8-13 years and 12-27 years, respectively. The interval since diagnosis was 5.6-19 years. T2-weighted and gradient-recalled echo (GRE) magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy ((1)H-MRS) were performed to assess brain injury. On MRI, 3 leukoencephalopathy (LEP) and 1 infarct were detected. Twenty-two patients had evidence of hemosiderin. On (1)H-MRS no statistically significant difference in choline (Cho)/creatine (Cr) and N-acetylaspartate (NAA)/Cr was associated with LEP. A lower Cho/Cr (p = 0.006) and NAA/Cr (p = 0.078) was observed in brains with hemosiderin. Linear-regression analysis showed no statistically significant relationship between NAA/Cr or Cho/Cr with age at diagnosis, but there was a statistically significant decreasing trend of NAA/Cr and Cho/Cr with the interval since diagnosis. Long-term brain injury in ALL survivors after CNS prophylaxis with ITMTX and CRT was reflected by decreasing NAA/Cr and Cho/Cr with the interval since diagnosis. The lower Cho/Cr associated with hemosiderin but not LEP suggested a different pathophysiology for these brain lesions.
Publisher: Wiley
Date: 09-1998
DOI: 10.1002/(SICI)1096-911X(199809)31:3<187::AID-MPO15>3.0.CO;2-J
Publisher: Elsevier BV
Date: 2024
Publisher: Elsevier BV
Date: 11-1992
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2011
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2001
Publisher: Springer Science and Business Media LLC
Date: 28-04-2005
DOI: 10.1007/S00247-005-1461-3
Abstract: We report two cases to demonstrate the imaging features of solid-pseudopapillary neoplasm of the pancreas (SPNP) in children. The SPNP is heterogeneous and often shows evidence of a pseudocapsule and haemorrhage, reflecting the pathology of this tumour. In an appropriate clinical context an accurate preoperative diagnosis can be made without the need for biopsy. This is important because tumour seeding may be more important in chemoresistant tumours such as SPNP than in the more common paediatric neoplasms.
Publisher: Springer Science and Business Media LLC
Date: 02-2010
DOI: 10.1007/S00467-009-1304-9
Abstract: We studied the ability of pre- and postcaptopril renal scintigraphy to predict renovascular disease (RVD) in children. Retrospective review of medical notes and radiology reports of all hypertensive children who had had both pre- and postcaptopril renal scintigraphy with [(99m)Tc] dimercaptosuccinic acid (DMSA) and/or [(99m)Tc] mercaptoacetyltriglycine (MAG3) and digital subtraction angiography (DSA). 81 children aged 1-18 (median 10) years were studied with 62% (51) having a diagnosis of RVD. Main renal artery disease, intrarenal disease, and both main and intrarenal artery disease were present in 25, 14, and 12 patients respectively. The isotope study accurately diagnosed RVD, confirmed by DSA, in 47% (24 of 51) children, with eight false positive studies. The sensitivity, specificity, and positive and negative predictive values of the isotope study to predict RVD were 48%, 73%, 76%, and 51%, respectively. Pre- and postcaptopril renal scintigraphy was unable to predict RVD in children.
Publisher: Elsevier BV
Date: 04-2003
DOI: 10.1016/S0003-4975(02)04549-6
Abstract: We describe an unusual case of tracheo-aortic fistula, which occurred after tracheal surgery and tracheal stenting. The management of this complex case and the surgical technique used for repair are discussed and illustrated. Repair of the aortic arch was accomplished using a modified technique of regional low-flow perfusion, similar to that described for neonatal aortic arch reconstruction. This strategy allowed maintenance of cerebral, myocardial, and systemic perfusion during arch repair, thus avoiding total circulatory arrest.
Publisher: Wiley
Date: 07-06-2012
DOI: 10.1002/PBC.24221
Abstract: Imaging plays a pivotal role in the diagnosis and management of children with hepatoblastoma. However, the continuing evolution of imaging technologies and rarity of hepatoblastoma make validation of imaging approaches challenging. In Europe and other parts of the world staging of hepatoblastoma is based on imaging features while in North America it is based on surgical resectability. In this review we discuss the clinical and imaging features that aid in diagnosing and monitoring children with hepatoblastoma. The potential roles of new imaging techniques are presented, and differences between staging systems are addressed.
Publisher: Springer Science and Business Media LLC
Date: 07-2001
Abstract: Pancreatoblastoma is a rare tumour of childhood. Reports of the imaging appearances are limited. To define the imaging features of pancreatoblastoma by analysis of four previously unreported cases and review of the literature. Findings at CT (n = 4), US (n = 3) and MRI (n = 2) were retrospectively reviewed in four patients with pancreatoblastoma. A Medline search was performed to identify relevant literature. Pancreatoblastoma arises most frequently in the body and/or tail, or involves the entire pancreas. Ultrasonography, CT and MRI show variable imaging features, but should in most cases permit preoperative distinction of pancreatoblastoma from other tumours that occur in this region in infancy and childhood. Detection of metastases in the liver, lymph nodes and peritoneal cavity is not significantly better with any one of these three modalities. Preoperative imaging with US, CT and/or MRI will usually suggest a correct diagnosis of pancreatoblastoma. Contrary to previous reports, the tumour arises in the pancreatic head in a minority of cases.
Publisher: Massachusetts Medical Society
Date: 22-10-2009
Publisher: Elsevier BV
Date: 08-2003
DOI: 10.1016/S0009-9260(03)00129-6
Abstract: Paediatric oncology patients are prone to central nervous system (CNS) complications due to multiple factors including disorders of the blood cell counts (which include neutropenia, thrombocytopenia or hyperleukocytosis), immunosuppression, neurotoxicity of the treatment, CNS dysfunction due to failure of other organ systems, disease progression of the primary malignancy or metastases. Imaging plays an important role in the management of paediatric oncology patients presenting with acute neurological symptoms. This pictorial review is from our institutional experience on imaging children who are under the care of the Child Cancer Centre. The review consists of a spectrum of neurological complications in paediatric oncology patients. The complications can be classified as (1) cerebrovascular complications, (2) treatment-elated complications, (3) opportunistic infections and (4) tumoural involvement of the CNS. Computed tomography (CT) is the initial choice of investigation, which is easily available and helps to exclude major intracranial abnormality such as haemorrhage. If the CT is negative, magnetic resonance imaging (MRI) should be performed, which is more sensitive for detection of CNS lesions.
Publisher: Springer Science and Business Media LLC
Date: 30-12-2011
Publisher: Springer Science and Business Media LLC
Date: 29-06-2012
DOI: 10.1007/S00467-012-2235-4
Abstract: Children with renovascular hypertension often present with severe hypertension. Some children have severe obstruction of their renal arteries resulting in <10% relative function on [(99m)Tc]dimercaptosuccinic acid (DMSA) scan. Conventional treatment of these children has been nephrectomy of the poorly functioning kidney to normalise their blood pressure (BP). We describe three children aged 20 months to 9 years with severe renal artery stenosis and severe hypertension who had radionucleotide uptake of 0% in one kidney. In one case, no renal perfusion was demonstrated by duplex ultrasound scan. Significant recovery of relative renal function of 18 to 52% was achieved after revascularisation by percutaneous angioplasty or open surgery of the obstructed renal artery. These cases illustrate that scintigraphy alone cannot be used to predict salvageable function in children with renovascular disease.
Publisher: Springer Science and Business Media LLC
Date: 22-07-1999
Abstract: An investigation requiring the use of ionising radiation can be justified by showing that its benefits are likely to exceed its risks. The risks can be estimated from the effective dose by using the system recommended by the International Commission on Radiological Protection. The benefits of investigations in paediatric radiology are currently unquantified. We can assume that some tests have potential benefits so large that further evaluation is unnecessary. Others have a maximum potential benefit so low that they can be discarded. For most investigations, however, research into the magnitude of benefit to the patient is required in order to establish that it is greater than the magnitude of the radiation risk.
Publisher: Elsevier BV
Date: 05-2011
DOI: 10.1016/J.JPEDSURG.2011.01.027
Abstract: Fetal medicine is developing rapidly and aims to improve the outcome for fetuses with congenital anomalies. Fetal endoscopic tracheal occlusion (FETO) has been developed for fetuses with congenital diaphragmatic hernia to counterbalance the compression of the lung by the abdominal viscera, preserving the pulmonary maturation. Because the perinatal morbidity and mortality of patients treated with FETO have decreased, new complications are emerging in the older survivors. Tracheomegaly has been reported to be a late complication of FETO, sometimes requiring tracheostomy. We report a case of bronchial dilatation after FETO and suggest an alternative surgical treatment.
Publisher: Elsevier BV
Date: 04-2012
DOI: 10.1016/J.IJPORL.2012.01.019
Abstract: Venous vascular malformations in the head and neck region present a difficult management challenge. We describe our experience of using sodium tetradecyl sulphate injection sclerotherapy to treat children presenting with venous malformations of the oral and pharyngeal region. We performed a retrospective case note review of consecutive children treated at our institution between 2004 and 2011. Patient notes were analysed for demographic details, site and size of lesion, number and duration of treatments, treatment response and complications. Twelve patients were included (7 boys and 5 girls, mean age 7 years). Sites of lesions included tongue, floor of mouth, pharynx, tonsillar fossae, parapharyngeal space and soft palate. All patients were treated with 3% sodium tetradecyl sulphate (STS) foam injected trans-orally or percutaneously under ultrasound or fluoroscopic guidance. The lesions had a mean volume of 4 ml (range 2-14 ml). An average of 3 treatments was required (range 1-9). In 4 patients a single treatment was sufficient. For those patients requiring multiple treatments, a mean of 4 treatments were required over an average period of 28 months. The overall response rate was 83% (10/12). Complete resolution was achieved in 4 cases (33%) with a significant reduction in size in a further 6 cases (50%). Larger lesions generally require more treatments than low volume lesions. Two cases recurred despite treatment. One patient suffered minor bleeding following transcutaneous injection. Injection sclerotherapy using STS foam offers an effective treatment option when managing children presenting with venous malformations in the oral and pharyngeal. A single treatment may be adequate for small lesions but the procedure may be safely repeated until a satisfactory result is obtained.
Publisher: Springer Science and Business Media LLC
Date: 08-01-2010
Publisher: Informa UK Limited
Date: 2006
DOI: 10.1080/15513810600908388
Abstract: Primary extrarenal rhabdoid tumors (RT) are now recognized as a specific entity in pediatric oncological pathology practice. We present an unusual case of a small cell myxoid variant of a thoracic RT in an infant and highlight the importance of recent molecular developments in the diagnosis of these tumors. An 8-month-old child presented with a short history of cough and shortness of breath. Imaging demonstrated a large mass occupying the majority of the thoracic cavity on the right side. A percutaneous needle biopsy of the mass showed fragments of tissue composed of malignant tumor with a predominant "small ovoid cell" phenotype and extensive myxoid change, with small nests and islands of tumor cells occasional cells demonstrated open vesicular nuclei, prominent nucleoli, and eosinophilic cytoplasmic inclusions. Immunohistochemical staining revealed focal strong cytoplasmic positivity for cytokeratin, focal strong paranuclear cytoplasmic vimentin positivity, and INI1 staining showed normal nuclear positivity in control tissues but was negative in tumor cell nuclei. Electron microscopy demonstrated characteristic paranuclear whorls of intermediate filaments confirming the diagnosis of extrarenal malignant RT. The diagnosis of malignant rhabdoid tumor may be difficult, particularly in cases, such as the present, with a predominant small-cell myxoid phenotype. The characteristic expression patterns of cytokeratin and vimentin provide strong clues to the diagnosis, and the use of INI1 antibody now makes definitive diagnosis possible even on needle core biopsies.
Publisher: Springer Science and Business Media LLC
Date: 06-11-2011
DOI: 10.1007/S00247-011-2269-Y
Abstract: Central venous catheters (CVC) are now commonly inserted by radiologists. Although complications are infrequent, they must be avoided where possible and recognized when they occur. We present a 10-year-old boy who developed right hemidiaphragmatic paralysis, requiring surgical plication, following US-guided insertion of a tunnelled right internal jugular CVC. The needle trajectory for internal jugular puncture must be planned to avoid the phrenic nerve.
Publisher: Wiley
Date: 02-1999
DOI: 10.1046/J.1440-1673.1999.00598.X
Abstract: A young girl with a history of chondroblastic osteosarcoma of the tibia developed a pulmonary metastasis which was treated by metastasectomy, chemotherapy and lung irradiation. There years later, at the age of 15, she developed a breast mass which was excised and which proved to be a poorly differentiated sarcoma. This was almost certainly a metastasis rather than a radiation-induced second primary tumour, in view of the short interval since radiotherapy. The ultrasonographic features of this lesion are presented here and the differential diagnosis is discussed in this context.
Publisher: Wiley
Date: 05-05-2009
DOI: 10.1002/PBC.22059
Abstract: Most commonly a tissue diagnosis of rhabdomyosarcoma (RMS) in children is made by biopsy as opposed to primary resection. Open surgical procedures are often recommended to obtain sufficient material for accurate and complete diagnostic work up. Our institution has routinely used image-guided needle biopsies for soft tissue tumour diagnosis. We therefore sought to assess diagnostic accuracy and completeness, and procedure safety of consecutive patients diagnosed by needle biopsies in a single institution. A retrospective review of consecutive biopsies of patients who were diagnosed with RMS or undifferentiated sarcoma in a single institution over a 9-year period. There were 24 children diagnosed with RMS or undifferentiated sarcoma who underwent 37 procedures (30 primary site and 7 draining lymph nodes). In the primary site diagnostic procedures, definitive diagnosis was made in all cases. In the majority of cases there was sufficient material for molecular analysis, cytogenetics and freezing. There were no complications of biopsy. In the hands of experienced operators, image-guided needle biopsies of RMSs allow for accurate diagnosis, allow sufficient material to be obtained for supplementary studies and research, and are associated with minimal morbidity.
Publisher: Springer Science and Business Media LLC
Date: 15-06-2006
DOI: 10.1007/S00247-006-0175-5
Abstract: Lipoblastoma and lipoblastomatosis are uncommon benign mesenchymal lesions that predominantly occur in infancy and early childhood. To evaluate the imaging and histological features of lipoblastoma and lipoblastomatosis. Retrospective review of the radiological and pathological findings in children with lipoblastoma and lipoblastomatosis treated at a single centre between 1997 and 2004. Eight children (median age 18 months) had undergone imaging and surgery at our institution. An infiltrative growth pattern was identified at imaging in two children with lipoblastomatosis, and a well-defined mass in six children with lipoblastoma. In all patients, imaging showed a lesion composed mostly, but not entirely, of fat. There were no recurrences at follow-up of between 1 and 91 months. In infancy and early childhood, the identification of a tumour composed mostly of fat should suggest the diagnosis of lipoblastoma or lipoblastomatosis.
Publisher: E-MED LTD
Date: 2009
Publisher: Elsevier BV
Date: 06-2010
DOI: 10.1016/J.JVIR.2010.02.025
Abstract: Most pediatric arteriograms are obtained from a femoral approach alternative access sites are sometimes needed. Transaxillary arteriography is an established procedure in adults. The purpose of this study was to establish the feasibility and safety of this procedure in children. All children who underwent arteriography involving axillary access during a 10-year period were reviewed for demographic details, indications, technical aspects of the procedure, and complications. Twenty-five procedures were performed in 19 children aged between 7 days and 15 years (median, 4.8 years). The children weighed between 2.6 and 47 kg (median, 15 kg). Indications for use of the axillary artery were absolute (including aortic or bilateral iliac artery occlusion) in 15 (60%) and relative (including more favorable angle for thoracic or abdominal intervention) in 10 (40%). Two procedures (8%) were purely diagnostic arteriography procedures. Transaxillary access was successful in all cases. The largest sheath used (7-F) had an outer diameter of 2.7 mm. One child died of a postoperative complication unrelated to the arterial access. There were no neurologic or bleeding complications related to the access site. Two access site complications (8%) occurred-one pseudoaneurysm and one axillary artery dissection-but neither resulted in permanent adverse sequelae. Ultrasound-guided transaxillary access is feasible for arteriography in children when femoral access is impossible or unfavorable for technical reasons. Although major complications are unlikely, this study does not exclude the possibility of subtle postoperative nerve injury.
Publisher: Springer Science and Business Media LLC
Date: 30-09-2023
Publisher: Informa UK Limited
Date: 2006
DOI: 10.1080/15513810600788715
Abstract: We present a case of a 4-month-old female infant with a maxillary melanotic neuroectodermal tumor of infancy (MNTI) and review the pooled data from previous publications on this entity. The literature to date comprises 378 reported cases from 1918 to the present, from which data on the presence or absence of metastatic disease was available in 311, and on the presence or absence of local recurrence in 165. These pooled data suggest a local recurrence rate of 36% with metastasis occurring in 7% of cases. At present, the optimal management includes complete surgical excision with clear margins, but there are no reliable histopathological or molecular features to predict the biological behavior in in idual cases.
Publisher: Elsevier BV
Date: 03-2012
DOI: 10.1016/J.ATHORACSUR.2011.12.019
Abstract: Congenital tracheal stenoses are rare and life-threatening anomalies, associated with considerable variation in both morphology and prognosis. They have been classified previously according to the length of the stenosis or the severity of the symptoms, but not according to bronchial involvement. Data from patients who underwent slide tracheoplasty for long-segment (>50%) congenital tracheal stenosis were collected. We identified four different types of bronchial arborization (normal, n=52 tracheal right upper lobe bronchus, n=10 carina with "trifurcation," n=14 and unilateral bronchial and lung agenesis, n=8). Each type included congenital tracheal (above the carina) or tracheobronchial (extending below the carina) stenosis. Eighty-four children were enrolled in the study. Preoperative ventilation was necessary in 44 patients (52.4% 75% in patients with a single lung), and preoperative extracorporeal membrane oxygenation was needed in 10 patients (11.9%). Preoperative tracheostomy was present in 3 patients initially treated elsewhere (3.5%), and a left pulmonary artery sling was performed in 44% (37 of 84). The overall mortality was 13% (11 of 84), 7.9% in patients with tracheal stenosis and 28.6% with tracheobronchial stenosis. No deaths occurred in patients with right upper lobe bronchus anatomy. Endoscopic procedures after slide tracheoplasty were required in 34 patients (40.4%). Stents were placed in 18 patients (21.4%), with a higher incidence in those with bronchial trifurcation (42.8%, 6 of 12). This classification appears useful for the morphologic characterization of congenital airway stenosis and could be the benchmark for future prospective studies on the outcome of these patients.
Publisher: Elsevier BV
Date: 12-2004
DOI: 10.1016/J.JTCVS.2004.07.008
Abstract: Long-segment tracheal stenosis is rare, life-threatening, difficult, and expensive to treat. Management remains controversial. A multidisciplinary tracheal team was formed in 2000 to deal with a large number of children with airway problems referred for management. We review the effect of that service, comparing the era before and after the establishment of the multidisciplinary tracheal team. From January 1998 through January 2004, 34 patients with long-segment tracheal stenosis (21 patients with cardiovascular anomalies) underwent surgical intervention. Cardiopulmonary bypass was used in all operations. Before the multidisciplinary tracheal team, pericardial patch tracheoplasty with or without an autograft technique was the preferred method of repair. After the multidisciplinary tracheal team, an integrated care plan preferring slide tracheoplasty was initiated, correcting cardiac lesions simultaneously. Before the establishment of the multidisciplinary tracheal team, pericardial patch tracheoplasty was performed in 15 of 19 patients. Twelve patients had a suspended pericardial patch tracheoplasty, 2 (17%) of whom died late after the operation. Of 3 patients who had had a simple unsuspended patch, 2 (67%) died early after the operation. Four patients were operated on with the tracheal autograft technique, 2 (50%) dying early in the postoperative period. After multidisciplinary tracheal team formation, in the era between 2001 and 2004, 15 patients were operated on with slide tracheoplasty, and there were 2 (13%) early postoperative deaths. A significant reduction in cost and duration of stay has been shown both in the intensive care unit and the hospital. Our data suggest that a formalized multidisciplinary team approach and a policy of primary slide tracheoplasty are beneficial in the management of children with long-segment tracheal stenosis.
Publisher: Springer Science and Business Media LLC
Date: 06-2004
DOI: 10.1007/S00330-003-2217-9
Abstract: The objective of this study is to assess computed tomography (CT) changes, both volume estimates and subjective features, following preoperative chemotherapy for nephroblastoma (Wilms' tumour) in patients treated on the United Kingdom Children's Cancer Study Group Wilms' Tumour Study-3 (UKW-3) protocol and to compare CT changes and histopathological classification. Twenty-one nephroblastomas in 15 patients treated on UKW-3 were included. All patients were examined by CT before and after preoperative chemotherapy treatment. CT images were reviewed (estimated volume change and subjectively assessed features). CT changes were compared to histopathological classification. Of the 21 tumours, all five high-risk tumours decreased in volume following chemotherapy (median -79% range -37 to -91%). The sole low-risk tumour decreased in volume by 98%. Ten intermediate-risk tumours decreased in volume (median -72% range -6 to -98%) and five intermediate-risk tumours increased (median +110% range +11 to +164%). None of the five high-risk tumours, compared to 15/16 intermediate or low-risk tumours, became less dense and/or more homogeneous, or virtually disappeared, following chemotherapy. Volume change following chemotherapy did not relate to histopathological risk group. Changes in subjectively assessed qualitative CT features were more strongly related to histopathological risk group.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2011
Publisher: Springer Science and Business Media LLC
Date: 17-11-2009
Publisher: Elsevier BV
Date: 11-1995
Publisher: Elsevier BV
Date: 07-2011
Publisher: Wiley
Date: 22-10-2010
DOI: 10.1111/J.1460-9592.2010.03422.X
Abstract: To examine the anatomic spread of caudal local anesthetic solution in children aged 1-7 years. To determine whether incremental increases in the volume of caudal injections of 0.5, 0.75, and 1.0 ml·kg(-1) result in reliable (>90%) and potentially clinically significant increases in the number of vertebral segments reached. Caudal block is one of the most frequently performed pediatric regional analgesic techniques. Traditional formulae suggest that changes in the volume of caudal injectate in the range 0.5-1.0 ml·kg(-1) would have clinically useful effects. In a single blind design, 45 children aged 1-7 years undergoing caudal block received one of the three predetermined volumes (0.5, 0.75, and 1 ml·kg(-1) ) of local anesthetic solution containing radio-opaque contrast under controlled conditions. Following X-ray examination, the anatomic spread of the block was reported by a radiologist blinded to the volume of solution received. There were 15 children in each group, and they were similar in terms of age, height, and weight. Spread was observed between the 5th lumbar (L5) and 12th thoracic (T12) vertebral levels. A volume of 1 ml·kg(-1) results in a small but significantly greater spread of solution than 0.5 ml·kg(-1) (P < 0.05), but there was no difference between 0.5 and 0.75 ml or between 0.75 and 1.0 ml. No volume reliably reached a level higher than the second lumbar vertebra (L2). Incrementally increasing the volume of injectate between 0.5 and 1.0 results in a modest increase in the spread of the caudal solution. It is unlikely that volumes of <1 ml will reliably reach a vertebral level that is higher than L2.
Publisher: Elsevier BV
Date: 07-2009
DOI: 10.1016/J.JPEDSURG.2009.03.035
Abstract: Persistent respiratory symptoms often occur after double aortic arch (DAA) repair but rarely require a second operation. We report 4 children with severe respiratory problems (failure to extubate, 2 severe respiratory distress, 2) caused by severe tracheomalacia and tracheal compression after DAA repair, treated by anterior aortopexy. Aortopexy proved effective and safe in improving symptoms and provides a simple treatment option for children with severe malacia or tracheal compression after DAA repair.
Publisher: Springer Science and Business Media LLC
Date: 02-11-2012
Publisher: Springer Science and Business Media LLC
Date: 16-02-1998
Abstract: Rhabdomyosarcoma (RMS) occurs infrequently in the liver and biliary tree. Although the radiological diagnosis may be simple when the tumour involves the extrahepatic bile ducts, no specific imaging features are known for hepatic RMS. We present four cases and discuss the role of diagnostic radiology in the management of this tumour.
Publisher: Springer Science and Business Media LLC
Date: 24-10-2009
Publisher: Springer Science and Business Media LLC
Date: 16-02-2001
Publisher: Elsevier BV
Date: 05-2007
DOI: 10.1016/J.JVIR.2007.02.014
Abstract: Children with systemic hypertension resulting from a renovascular stenosis commonly have fibromuscular dysplasia and respond to percutaneous transluminal renal angioplasty (PTRA). There is a subset of children, however, with conditions that appear to be resistant to PTRA (eg, syndromic renal artery stenosis and arteritis). These patients are often treated surgically. The development of the cutting balloon may provide a minimally invasive alternative to surgery in these in iduals. Associated adverse events may include recurrent stenosis, arterial occlusion with renal loss, and arterial rupture with extravasation and pseudoaneurysm formation. Some of these adverse events can be successfully treated with percutaneous interventional techniques. The authors present four cases of cutting balloon angioplasty performed at two large metropolitan children's hospitals in children with resistant renal artery stenosis.
Publisher: Cambridge University Press (CUP)
Date: 12-07-2007
DOI: 10.1017/S0022215107009590
Abstract: We report a rare case of chronic facial pain following sclerotherapy for intraparotid haemolymphangioma, thereby highlighting an important clinical consideration when advising this treatment option as an alternative to surgery in the head and neck. Case report, with a review of relevant literature. Sclerotherapy of lymphangiomata is well reported in the literature. Unusually, our young patient with an intraparotid haemolymphangioma experienced severe, chronic pain following intralesional injection of sodium tetradecyl sulphate, which required management by a specialist pain service. We discuss the technique of sclerotherapy for such lesions, and also discuss the potential side effects of two agents commonly used in our centre: OK 432 and sodium tetradecyl sulphate. Non-surgical treatments of lymphangiomata and venous vascular malformations are not without complication. Both patient and clinician should be aware of this, and of the other potential side effects of sclerotherapy, prior to its use in the head and neck.
Publisher: Elsevier BV
Date: 03-2020
Publisher: Springer Science and Business Media LLC
Date: 06-11-2009
DOI: 10.1007/S00247-009-1437-9
Abstract: Fetal endoscopic tracheal occlusion (FETO) is a promising treatment for severe congenital diaphragmatic hernia, a condition that carries significant morbidity and mortality. It is hypothesised that balloon occlusion of the fetal trachea leads to an improvement in lung growth and development. The major documented complications of FETO to date are related to preterm delivery. To report a series of five infants who developed tracheomegaly following FETO. Review of all children referred with tracheomegaly to the paediatric intensive care and tracheal service at two referral centres. Five neonates presented with features of respiratory distress shortly after birth and were subsequently found to have marked tracheomegaly. Two neonates had tracheomalacia in addition. There are no previous reports in the literature describing tracheomalacia, or more specifically, tracheomegaly, as a consequence of FETO. We propose that the particularly compliant fetal airway is at risk of mechanical damage from in utero balloon occlusion. This observation of a new problem in this cohort suggests a thorough evaluation of the trachea should be performed in children who have had FETO in utero. It may be that balloon occlusion of the trachea earlier in utero (before 26 weeks' gestation) predisposes to this condition.
Publisher: Springer Science and Business Media LLC
Date: 26-05-2007
DOI: 10.1007/S00247-007-0513-2
Abstract: Imaging is a crucial part of the evaluation of children with primary liver malignancies. In addition to staging the intrahepatic extent of the tumour, the 2005 revision of the PRETEXT system specifies certain criteria for assessment of extrahepatic disease. This article reviews the imaging findings of two of these criteria: direct extrahepatic extension of the tumour (E1, E1a, E2, E2a) and tumour rupture at diagnosis (H1).
Publisher: Springer Science and Business Media LLC
Date: 26-02-2001
Abstract: Alveolar soft-part sarcoma (ASPS) is a rare tumour. Certain distinctive clinical and radiological features suggest the correct diagnosis. There is moderate predilection for young women. ASPS almost always arises in skeletal muscle and occurs most frequently in the lower limbs. There is often a long clinical history and a large mass at presentation. Two young females with ASPS presented with very vascular tumours in the thigh, with prominent intra- and extra-tumoural blood vessels. The imaging findings and the existing literature are reviewed.
Publisher: Wiley
Date: 2005
DOI: 10.1002/PBC.20407
Abstract: Stage 4S metastatic neuroblastoma (NB) has a favorable prognosis due to a high rate of spontaneous regression. Young infants risk lethal complications arising from hepatomegaly, which can develop rapidly despite treatment. MYCN oncogene lification confers a significantly worse prognosis. We describe a 4-week-old neonate with MYCN- lified stage 4S NB complicated by gross hepatomegaly causing rapidly progressive respiratory, hepatic, and renal failure. The child remains in remission 3 years after hepatic artery embolization, radiotherapy, standard, and high-dose chemotherapy. Embolization of the hepatic artery, with classical treatment, is feasible and safe at this age and may contribute substantially to the management of high-risk patients.
Publisher: Springer Science and Business Media LLC
Date: 05-11-2011
DOI: 10.1007/S00467-011-2039-Y
Abstract: Mid aortic syndrome (MAS) is a rare condition often presenting with severe hypertension. It is characterized by narrowing of the abdominal aorta. We here describe a case of complete occlusion of the abdominal aorta presenting in infancy. This child presented at four months of age with heart failure and hypertension. CT angiogram showed total narrowing of the abdominal aorta. This was initially felt to be too severe for surgical treatment and he was planned for palliative care. We were however able to improve his blood pressure with antihypertensive agents and he underwent succesful angioplasty at five and a half months of age. He has required three further angioplasty procedures and still needs two antihypertensive agents to control his blood pressure. His renal function remains normal and at age six years he has excellent quality of life with normal growth and development. This case illustrates that the combination of medical treatment and angioplasty can give an excellent long-term treatment response even in children with extremely severe MAS. This boy now has normal blood pressure and has experienced normal growth, development and quality of life.
Publisher: BMJ
Date: 07-2005
Publisher: Elsevier BV
Date: 12-2010
DOI: 10.1053/J.TVIR.2010.04.005
Abstract: Nephro-urological interventions developed in adult practice are highly transferable to the pediatric setting, and their use has widened the role of interventional radiology in the management of renal tract pathology in spheres such as oncology and urolithiasis. The emerging evidence is that these procedures are safe and effective in children and their use should be encouraged. Many of the techniques are similar to those used in adults. There are, however, subtle but important pediatric tips and tricks available that serve to minimize risk to the child and increase the chances of technical success. This article covers the indications, techniques, aftercare, and complications for renal biopsy, nephrostomy insertion, percutaneous nephrolithomy procedures, and ureteric stent insertion. Renal biopsy and nephrostomy insertion are commonly performed in most pediatric centers. Percutaneous nephrolithomy may be limited to centers with a significant urology workload, but are complex procedures ideally performed as joint cases between urology and interventional radiology.
Publisher: Elsevier BV
Date: 06-2008
DOI: 10.1016/J.PRRV.2007.12.003
Abstract: Haemoptysis varies in significance from trivial to fatal. The most common causes in children are tuberculosis, fungal infections and bronchiectasis of any cause. In populations of European origin, cystic fibrosis is the most common predisposing factor. Chronic or life-threatening haemoptysis requires further investigation. Various forms of treatment are possible, and management is optimized when a multidisciplinary team is available. Bronchial artery embolization (BAE) is effective in controlling haemoptysis in most cases, although recurrent bleeding is not uncommon. BAE is often technically challenging, however, and requires angiographic skills that are not always available in children's hospitals. Although the procedure is usually regarded as relatively safe, complications are not uncommon and may be severe or even fatal.
Publisher: Elsevier BV
Date: 12-2003
DOI: 10.1053/J.TVIR.2003.10.007
Abstract: Pediatric renovascular hypertension is an uncommon but important clinical problem. Atherosclerosis is rare in children, who typically suffer from fibromuscular dysplasia, neurofibromatosis type 1, Williams syndrome, or certain other rare conditions. Children with renovascular disease often have involvement of other arteries including the aorta and mesenteric and cerebral vessels. The pediatric interventional radiology service has a vital role in the diagnosis, evaluation, and treatment of renovascular hypertension. Renal vein renin s ling appears to be more useful in children than in adults, because their arterial disease is more often bilateral and segmental. Diagnostic angiography is still superior to less-invasive methods of imaging the renal arteries, especially the smaller branches. Interventional options include angioplasty, stenting, and ethanol ablation. Angioplasty is almost always technically successful and usually gives a worthwhile clinical improvement. Stenting is only used in children when angioplasty fails. Ethanol embolization may be appropriate in children with focal renin-producing areas that are untreatable by angioplasty.
Publisher: Springer Science and Business Media LLC
Date: 08-06-2006
DOI: 10.1007/S00247-006-0174-6
Abstract: Airway compression is a common problem in children with certain forms of congenital heart disease. Although various surgical approaches are available to overcome this form of airway obstruction, internal stenting is necessary in a minority of patients. It can be difficult to assess the success of stenting at the time of the procedure, and the interval to successful extubation is usually used as an outcome measure. Measurement of relevant parameters of respiratory physiology with flow-volume and volume-pressure loops permits immediate quantitative assessment of the adequacy of stenting. A 3-month-old infant who underwent bronchial stenting and physiological assessment at the time of the procedure is described.
Publisher: Elsevier BV
Date: 12-2003
Publisher: Springer Science and Business Media LLC
Date: 25-10-1999
Abstract: Gadolinium-enhanced MRI has recently been employed in the diagnosis of acute pyelonephritis. Its potential utility in the diagnosis of renal scars in children is unknown. Objective. To evaluate the potential utility of MRI using fat-saturated T1-weighted (T1-W) and post-gadolinium, short-tau inversion-recovery (STIR) sequences in detecting renal scarring by comparison with technetium dimercaptosuccinic acid ((99 m)Tc-DMSA) renal scintigraphy in children at risk of renal scarring. A group of 24 children with spina bifida and neurogenic bladder or anorectal anomaly was studied. No patient had a history of acute pyelonephritis. Documented urinary tract infection (UTI) was present in 10 children (42 %). The remaining 14 (58 %) children had a history of asymptomatic bacteriuria. None had clinical signs or symptoms of acute UTI at the time of the study. (99 m)Tc-DMSA and MRI were performed to detect renal scarring. (99 m)Tc-DMSA scans were supplemented with pinhole imaging. MRI of the kidneys employed a fat-saturated T1-W sequence and a post-gadolinium STIR sequence employing a short echo time. Of the kidneys studied, 33 % (n = 16) had evidence of a renal parenchymal defect suggestive of scarring on (99 m)Tc-DMSA. The concordance in the detection of a scarred kidney by post-gadolinium STIR sequence and (99 m)Tc-DMSA is 94 % that by fat-saturated T1-W sequence and (99 m)Tc-DMSA is 82 % that by both sequences (positive result on either sequence) and (99 m)Tc-DMSA is 100 %. Using (99 m)Tc-DMSA as the gold standard, MRI had a sensitivity of 100 % and a specificity of 78 % in the diagnosis of a scarred kidney. The concordance in the detection of a scarred zone by post-gadolinium STIR sequence and (99 m)Tc-DMSA is 68 % that by fat-saturated T1-W sequence and DMSA is 44 % that by both sequences (positive result on either sequence) and (99 m)Tc-DMSA is 84 %. MRI had a sensitivity of 84 % and a specificity of 86 % in the diagnosis of a scarred zone, using (99 m)Tc-DMSA as the gold standard. The detection rate for renal scarring on MRI using the fat-saturated T1-W and post-gadolinium STIR sequences is comparable to planar (99 m)Tc-DMSA. MRI is of potential utility in the evaluation of children at risk of renal scarring.
Publisher: Elsevier BV
Date: 07-2000
Publisher: Wiley
Date: 12-1998
DOI: 10.1002/(SICI)1096-911X(199812)31:6<534::AID-MPO16>3.0.CO;2-9
Publisher: E-MED LTD
Date: 2010
Publisher: Elsevier BV
Date: 06-2008
DOI: 10.1016/J.PRRV.2007.12.008
Abstract: Congenital heart disease (CHD) is an important clinical problem. Although survival has improved over recent decades, certain children with CHD remain difficult to treat, usually because of severe co-morbidity or uncorrectable defects. Vascular compression of the airway is one such co-morbidity, occurring in approximately 1-2% of children with CHD. It may be caused by congenital anomalies of the configuration of the great vessels, enlargement of otherwise normal structures or as a result of surgery. The anatomical patterns seen in these children may be complex, and as surgical correction is usually required to relieve the compression, the pre-operative imaging assessment should be as complete as possible. Precise diagnosis and therapy are essential because chronic airway compression in childhood carries a significant morbidity and mortality. Airway stenting is currently reserved for rare occasions when surgical correction is not possible.
Publisher: Springer Science and Business Media LLC
Date: 28-03-2013
Publisher: Elsevier BV
Date: 03-2013
DOI: 10.1016/J.EJCA.2012.10.003
Abstract: To analyse the clinical characteristics and outcome of hepatoblastoma (HB) patients who relapsed after enrolment on SIOPEL studies 1-3. Analysis of clinical data of all 59 patients (pts) registered in SIOPEL 1-3 studies, who relapsed after achieving complete remission (CR). The median time from the initial diagnosis to relapse was 12 months (4-115 m). The site of relapse was lung N=27, liver N=21, both liver and lung N=5 and other N=5 (missing data-MD: 1 patient). All but 9 pts had an alpha-fetoprotein level >10 ng/mL at the time of relapse. Treatment of the relapse included chemotherapy and surgery N=25, chemotherapy alone N=21, surgery alone N=7 and only palliative treatment N=5 (MD: 1 pt). Overall, 31 pts (52%) achieved a second CR. With a median follow-up of 83 months, 23 pts are alive, (18 in 2nd CR, 5 after a second relapse) and 36 pts have died (35 from disease and 1 from complications). Three-year event-free survival and overall survival are 34% and 43% respectively (95% confidence interval [CI] 0.28-0.69). The main factors associated with a good outcome were PRETEXT group I-III at diagnosis, a high AFP level at relapse and relapse treatment including both chemotherapy and surgery. Relapses in HB are rare events occurring in less than 12% of pts after CR. Combined treatment with chemotherapy and surgical removal of the tumour is essential for long-term survival.
No related grants have been discovered for Derek Roebuck.