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BACKGROUND: Slide tracheoplasty (STP) is the procedure of choice for treatment of long segmental congenital tracheal stenosis (LSCTS). Few studies predict factors leading to reintervention or mortality after STP. We analyzed a pediatric population to identify such factors and compared the outcome between 2 eras (1995-2012 and 2013-2017). METHODS: We analyzed 150 consecutive children who underwent STP from February 1995 to December 2017 in our hospital. RESULTS: Median age and weight were 6.9 months and 6.1 kg. Average tracheal diameter of LSCTS was 2.3 mm. Tracheal stenosis extended into bronchus in 36 patients and distal malacia in 38. Median follow-up was 67 months; mortality was 12.7%. Balloon dilatation was required in 81 patients (54%), stents in 29 (19%), and reoperation in 4 (3%). The presence of malacia, preoperative extracorporeal membrane oxygenation, congenital anomalies, and single lung anatomy increased the risk for reintervention. Cox regression analysis revealed preoperative ventilation to be an independent factor predicting reintervention and single lung tracheal anatomy for mortality. In the current era (after 2013), survival improved from 88% to 97% and stent requirement was reduced from 25% to 11%. CONCLUSIONS: Slide tracheoplasty can be applied to various airway conï¬gurations seen in LSCTS. The requirement for reintervention such as balloon dilatation and stenting is high in the group requiring preoperative ventilation. Mortality is highest in the single lung anatomy group. Centralization of care allowed us to develop the multidisciplinary team expertise to manage this and other rare airway conditions with acceptable outcomes.
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Procedimientos de Cirugía Plástica , Estenosis Traqueal , Niño , Constricción Patológica/cirugía , Humanos , Lactante , Procedimientos de Cirugía Plástica/métodos , Estudios Retrospectivos , Medición de Riesgo , Tráquea/anomalías , Tráquea/cirugía , Estenosis Traqueal/congénito , Estenosis Traqueal/cirugía , Resultado del TratamientoRESUMEN
Dieulafoy's disease is a rare vascular lesion characterized by presence of large aberrant arteries within the submucosa of gastrointestinal tract or respiratory tract with a potential to cause life-threatening hemorrhage. Treatment includes bronchoscopy ablation, angiographic embolization or surgery. We report management of 7-year old girl with Dieulafoy's disease in the airway who presented with recurrent hemoptysis. Bronchial angiography revealed multiple feeding vessels to the lesion. Considering the potential risk of recurrence with embolization, sleeve resection of bronchus offered complete resolution. This case demonstrates the usefulness of bronchial angiography as part of multi-faceted approach before surgery in the management of Dieulafoy's disease.
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PURPOSE: Radiologically inserted gastrojejunal tubes (RGJ) and surgical jejunostomy (SJ) are established modes of jejunal feeding. The aim of the study is to review nutritional outcomes, complications and the practical consideration to enable patients and carers to make informed choice. METHODS: Retrospective review of patient notes with a RGJ or SJ in 2010, with detailed follow-up and review of the literature. RESULTS: Both RGJ and SJ are reliable modes to provide stable enteral nutrition. Both have complications and their own associated limitations. CONCLUSIONS: The choice has to be tailored to the individual patient, the social care available, the inherent medical disease and risk/benefit of repeated anaesthetic and radiation exposure. RGJ and SJ are important tools for nutritional management that achieve and maintain growth in a complex group of children. The risk and benefits should be reviewed for each individual patient.
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Nutrición Enteral , Gastrostomía , Yeyunostomía , Niño , Trastornos de la Nutrición del Niño/prevención & control , Preescolar , Femenino , Gastrostomía/efectos adversos , Trastornos del Crecimiento/prevención & control , Humanos , Lactante , Yeyunostomía/efectos adversos , Masculino , Estudios Retrospectivos , Medición de RiesgoRESUMEN
As in adult practice, there is a growing role for paediatric interventional radiology expertise in the management of paediatric pathologies. This review is targeted for clinicians who may refer their patients to paediatric interventional radiology services, or who are responsible for patients who are undergoing paediatric interventional radiology procedures. The article includes a brief overview of the indications for intervention, techniques involved and the commonest complications. Although some of the procedures described are most commonly performed in a tertiary paediatric centre, many are performed in most Children's hospitals.
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Enfermedades Gastrointestinales/diagnóstico por imagen , Enfermedades Musculoesqueléticas/diagnóstico por imagen , Neoplasias/diagnóstico por imagen , Radiología Intervencionista , Enfermedades Torácicas/diagnóstico por imagen , Enfermedades Urológicas/diagnóstico por imagen , Enfermedades Vasculares/diagnóstico por imagen , Actitud del Personal de Salud , Niño , Preescolar , Toma de Decisiones , Enfermedades Gastrointestinales/terapia , Humanos , Lactante , Consentimiento Informado , Enfermedades Musculoesqueléticas/terapia , Neoplasias/terapia , Padres , Pediatría , Guías de Práctica Clínica como Asunto , Traumatismos por Radiación/prevención & control , Protección Radiológica , Radiografía , Radiología Intervencionista/métodos , Enfermedades Torácicas/terapia , Enfermedades Urológicas/terapia , Enfermedades Vasculares/terapiaRESUMEN
PURPOSE: To determine whether fluoroscopic balloon dilation (FBD) is a safe and effective method of treating esophageal anastomotic stricture after surgical repair in an unselected patient population. MATERIALS AND METHODS: With ethics committee approval, records for 103 consecutive patients who underwent FBD with our interventional radiology service (1999-2011) were reviewed retrospectively. Patients underwent diagnostic contrast material-enhanced study prior to the first dilation. Dilations were performed by using general anesthesia. Outcomes were number and/or frequency of dilations, clinical effectiveness and response to dilations, esophageal perforation, requirement for surgery, and mortality. Data were expressed as mean ± standard deviation (with range). Comparisons were conducted by using the Fisher exact test and log-rank test. The significance level was set at P < .05. RESULTS: One hundred three patients (61 male patients, 59%) underwent 378 FBD sessions (median, two dilations per patient; range, 1-40 dilations). The median age at first FBD was 2.2 years (range, 0.1-19.5 years). The balloon catheter diameters ranged from 4 to 20 mm. FBD was successful in 93 patients (90%): 44 (47%) after single dilation and 49 (53%) after multiple dilations. There was no difference in the proportion of patients who required one dilation and were younger than 1 year versus those who were 1 year of age and older (P > .99; odds ratio, 1.07 [range, 0.43-2.66]). Ten patients (10%) required further procedures: Three underwent stent placement, three underwent esophageal stricture resection, and four underwent esophageal reconstruction. Four esophageal perforations (1%) developed after FBD. Antireflux surgery was performed in 18 patients (17%). There were no deaths. CONCLUSION: FBD for anastomotic strictures after esophageal atresia repair is feasible and acceptably safe and provides relief of symptoms in most patients (90%); however, about half require more than one dilation, and surgery is best predicted if more than 10 dilations are required.
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Dilatación/métodos , Atresia Esofágica/terapia , Estenosis Esofágica/terapia , Adolescente , Niño , Preescolar , Medios de Contraste , Femenino , Fluoroscopía , Humanos , Lactante , Masculino , Estudios Retrospectivos , Stents , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: In this video we will demonstrate endo-ureterotomy using a cutting balloon for vesico-ureteric junction (VUJ) dilatation and stenting of the primary obstructive megaureter. METHOD: For the technique, a 0.014 inch guide-wire is endoscopically inserted through the VUJ and allowed to curl in the megaureter. A 3 mm atherotome-bladed cutting balloon is inflated with iohexol contrast solution. Under fluoroscopy or cystoscopically, the stenotic VUJ segment is observed to open and post-dilated with a 4 mm simple balloon before JJ stent placement for six weeks. RESULTS: This video demonstrates the equipment and technique of VUJ endo-ureterotomy using a cutting balloon and stenting of the primary obstructive megaureter. CONCLUSION: Where intervention for the primary obstructive megaureter is indicated, we propose VUJ endo-ureterotomy as the first line treatment.
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Endoscopía/métodos , Uréter/anomalías , Uréter/cirugía , Obstrucción Ureteral/cirugía , Procedimientos Quirúrgicos Urológicos/métodos , Humanos , Stents , Uréter/patología , Vejiga Urinaria , Cateterismo UrinarioRESUMEN
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.
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Cateterismo Venoso Central/efectos adversos , Venas Yugulares/diagnóstico por imagen , Traumatismos de los Nervios Periféricos/diagnóstico por imagen , Traumatismos de los Nervios Periféricos/etiología , Nervio Frénico/diagnóstico por imagen , Nervio Frénico/lesiones , Radiografía Intervencional/efectos adversos , Niño , Resultado Fatal , Humanos , Venas Yugulares/cirugía , Masculino , Traumatismos de los Nervios Periféricos/terapia , Radiografía Torácica/efectos adversosRESUMEN
BACKGROUND: The natural history of focal splenic lesions in paediatric Gaucher disease (GD) is unknown and these lesions are thought to persist despite enzyme replacement therapy (ERT). OBJECTIVE: To assess the prevalence, evolution and resolution of splenic nodules in a cohort of paediatric Gaucher patients treated with ERT. MATERIALS AND METHODS: The US findings in 37 children with GD were retrospectively reviewed. A total of 28 children underwent serial abdominal US examinations as part of their initial assessment and during routine follow-up. All patients received ERT. RESULTS: Six children (21%) had splenic nodules on US examination, either at presentation or on follow-up examination. In all six patients, the nodules had resolved on follow-up imaging, with resolution taking 17 months to 4 years 8 months. Two sets of siblings developed nodules that resolved over a similar time period. CONCLUSION: Disappearance of focal splenic lesions in children with GD during follow-up has not been previously reported. The development of new focal splenic lesions in children with GD whilst on ERT has not been previously documented.
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1-Desoxinojirimicina/análogos & derivados , Enfermedad de Gaucher/tratamiento farmacológico , Glucosilceramidasa/administración & dosificación , Bazo/diagnóstico por imagen , Enfermedades del Bazo/diagnóstico , 1-Desoxinojirimicina/administración & dosificación , Niño , Preescolar , Estudios de Cohortes , Inhibidores Enzimáticos/administración & dosificación , Femenino , Estudios de Seguimiento , Enfermedad de Gaucher/complicaciones , Humanos , Lactante , Masculino , Estudios Retrospectivos , Bazo/patología , Enfermedades del Bazo/etiología , Esplenomegalia/etiología , Esplenomegalia/patología , UltrasonografíaRESUMEN
The aim of imaging in a child with urinary tract infection (UTI) is to detect abnormalities that require appropriate treatment or findings that can be acted on to prevent development of complications (hypertension, chronic renal failure or pregnancy-related complications). Imaging protocols in pediatric urinary tract infections are evolving. From strategies based on extensive investigations in all children younger than 7 years of age, we are slowly moving to imaging strategies focused on children at risk of developing renal damage and possibly long-term complications. The article provides an overview on urinary tract infections, their complications and the use of imaging in their management. The different imaging strategies in children with UTIs (including the recommendation of excluding from imaging certain groups of patients) still needs full evaluation. It is interesting to note, however, a slow move from wide use of cystography in all children with UTI, which has been standard practice for many years but was probably not based on solid scientific evidence, toward a more focused use of cystograms in specific groups of children.