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1.
J Pediatr Hematol Oncol ; 45(2): e279-e284, 2023 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-36716049

RESUMO

Angiomatoid fibrous histiocytoma (AFH) is a soft tissue neoplasm of intermediate biological potential. Typically a slow-growing tumor, it can recur locally. Rarely, it manifests as a soft tissue sarcoma capable of metastasis. When metastases are nonamenable to local therapy, it is believed uniformly fatal. We present 3 patients with metastatic AFH who demonstrated a sustained response to chemotherapy; including one who achieved complete remission with cryoablation. These cases reinforce the potential value of chemotherapy in some patients with unresectable metastatic AFH and provide the first case in the literature of cryoablation in AFH.


Assuntos
Histiocitoma Fibroso Benigno , Histiocitoma Fibroso Maligno , Neoplasias de Tecidos Moles , Humanos , Neoplasias de Tecidos Moles/patologia , Histiocitoma Fibroso Maligno/patologia , Histiocitoma Fibroso Maligno/cirurgia , Indução de Remissão
2.
Pediatr Radiol ; 53(9): 1903-1910, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37052631

RESUMO

BACKGROUND: Traditionally, testicular biopsy is performed using an open surgical approach. Ultrasound-guided percutaneous biopsy is a less invasive alternative and can be performed in children. OBJECTIVE: The aim of this study is to report our technique and to assess the diagnostic accuracy and safety of ultrasound-guided percutaneous biopsy of testicular masses in children. MATERIALS AND METHODS: This is a 16-year retrospective review of ultrasound-guided percutaneous testicular biopsies at a single pediatric hospital. RESULTS: We performed nine ultrasound-guided testicular biopsies in 9 patients (median age: 3 years, range: 4 months-11 years; median weight: 20.9 kg, range: 8.4-35 kg; median volume of testicular lesion biopsied: 4.4 mL, range: 1.2-17 mL). A percutaneous co-axial technique was used for 5/9 biopsies with absorbable gelatin sponge tract embolization performed in 4 of those biopsies. A non-co-axial technique was used in 4/9 biopsies. A median of three cores, range 2-6, were obtained. The diagnostic yield was 89% with one biopsy yielding material suggestive of, but insufficient for, a definitive diagnosis. The most common histological diagnosis was leukemic infiltration, occurring in 6/9 biopsies. Of the remaining three biopsies, one biopsy was suggestive of, but not confirmatory for, juvenile granulosa cell tumor and two biopsies confirmed normal testicular tissue; the long-term follow-up of which demonstrated normal growth and no lasting damage. There was one (clinically insignificant) complication out of nine biopsies (11%, 95% confidence interval 0-44%): a mild, self-resolving scrotal hematoma. CONCLUSION: Ultrasound-guided testicular biopsy can be performed safely in children as an alternative to open surgical biopsy, with a high diagnostic yield and low complication rate.


Assuntos
Hospitais Pediátricos , Biópsia Guiada por Imagem , Humanos , Criança , Pré-Escolar , Biópsia Guiada por Imagem/métodos , Ultrassonografia , Estudos Retrospectivos , Ultrassonografia de Intervenção
3.
Pediatr Radiol ; 53(11): 2245-2252, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37568041

RESUMO

BACKGROUND: Due to the rarity of pediatric diseases, collaborative research is the key to maximizing the impact of research studies. A research needs assessment survey was created to support initiatives to foster pediatric interventional radiology research. OBJECTIVE: To assess the status of pediatric interventional radiology research, identify perceived barriers, obtain community input on areas of research/education/support, and create metrics for evaluating changes/responses to programmatic initiatives. MATERIALS AND METHODS: A survey link was sent to approximately 275 members of the Society for Pediatric Interventional Radiology (SPIR) between May and October 2020. Data was collected using a web-based interface. Data collected included practice setting, clinical role, research experience, research barriers, and suggestions for future initiatives. RESULTS: Fifty-nine surveys were analyzed with a staff physician survey response rate of 28% (56/198). A wide range of practice sizes from 15 countries were represented. Respondents were predominantly staff physicians (95%; 56/59) with an average of 11 years (range: 1-25 years) of clinical experience working at academic or freestanding children's hospitals. A total of 100% (59/59) had research experience, and 70% (41/58) had published research with a mean of 30 peer-reviewed publications (range: 1-200). For job security, 56% (33/59) of respondents were expected or required to publish, but only 19% (11/58) had research support staff, and 42% (25/59) had protected research time, but of those, 36% (9/25) got the time "sometimes or never." Lack of support staff, established collaborative processes, and education were identified as top barriers to performing research. CONCLUSIONS: The needs assessment survey demonstrated active research output despite several identified barriers. There is a widespread interest within the pediatric interventional radiology community for collaborative research.

4.
Eur J Pediatr ; 181(9): 3367-3375, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35792951

RESUMO

Renovascular hypertension in most cases requires endovascular treatment and/or surgery. This is technically much more difficult in small children and there is very limited published knowledge in this age group. We here present treatment and outcome of young children with renovascular hypertension at our institution. Children below 2 years of age, with renovascular hypertension between January 1998 and March 2020 were retrospectively reviewed. Demographics and treatment modalities were noted. Primary outcome was blood pressure within a week after the procedures and at last available visit. Sixty-six angiographies were performed in 34 patients. Median age at time of first angiography was 1.03 (interquartile range (IQR) 0.4-1.4) years and systolic blood pressure at presentation 130 (IQR 130-150) mm Hg. Thirty-eight percent (13/34) of children were incidentally diagnosed and 18% (6/34) presented with heart failure. Twenty-six (76%) children had main renal artery stenosis and 17 (50%) mid-aortic syndrome. Seventeen (50%) children showed intrarenal, six (18%) mesenteric, and three (9%) cerebrovascular involvement. Twenty patients underwent 45 percutaneous transluminal angioplasty procedures and seven children surgeries. In 44% of the 16 patients who underwent only percutaneous transluminal angioplasty blood pressure was normalized, 38% had improvement on same or decreased treatment and 19% showed no improvement. Complications were seen in 7.5% (5/66) of angiographies. In four of the seven (57%) children who underwent surgery blood pressure was normalized, two had improved (29%) and one unchanged (14%) blood pressure. CONCLUSION: In small children with renovascular hypertension below the age of 2 years, percutaneous transluminal angioplasty caused significant improvement in blood pressure with low complication profile. Surgery can be recommended where percutaneous transluminal angioplasty and medical treatments failed. WHAT IS KNOWN: • Renovascular hypertension is diagnosed in all age groups from a few weeks of life until adulthood. • Both angioplasty and surgery are significantly more difficult to perform in small children and the published information on short and long-term outcome in these children is very scarce. WHAT IS NEW: • Children below the age of two years can safely and successfully undergo selective renal angiography and also safely be treated with angioplasty. • We here present a large group of babies and infants where angioplasty and in some cases surgery effectively and safely improved their blood pressure.


Assuntos
Angioplastia com Balão , Hipertensão Renovascular , Obstrução da Artéria Renal , Adulto , Angioplastia com Balão/efeitos adversos , Pressão Sanguínea , Criança , Pré-Escolar , Humanos , Hipertensão Renovascular/diagnóstico , Hipertensão Renovascular/etiologia , Hipertensão Renovascular/terapia , Lactente , Obstrução da Artéria Renal/complicações , Obstrução da Artéria Renal/diagnóstico , Obstrução da Artéria Renal/terapia , Estudos Retrospectivos , Resultado do Tratamento
5.
Pediatr Surg Int ; 38(5): 707-712, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35220458

RESUMO

PURPOSE: To determine the management and outcomes of patients with gastro-oesophageal reflux (GOR) that requires further intervention following failure of Nissen fundoplication (NF). METHODS: After institutional audit department approval, a retrospective review of paediatric patients who had further intervention following failure of primary NF between January 2006 and December 2015 for GOR at our centre was performed. Data are presented as median (range). RESULTS: Of 820 patients who underwent NF, 190 (23%) received further procedures for GOR management at a median of 21 months of age (6-186); 90/190 (47%) had gastro-jejunal feeding (GJ). Of these, 67 (74%) remained on GJ feeds up to a median of 48 months and 23/90 (26%) had a second NF after GJ feeding. 97/190 (51%) had a redo fundoplication without having had a GJ; thus, 120/190 (63%) of patients having a further procedure went on to have a second NF after a median period of 15 months (1-70 months). Three patients (2%) had early emergency wrap revision 4 days after first fundoplication (we classed this as an 'early complication'). Of the seven patients who failed a 3rd NF, 4 continued GJ feeding, 2 of had oesophagogastric dissociation; 2 had 4th NF of which 1 was successful and 1 patient had gastric pacemaker and is successfully feeding orally. Patients who were finally successfully managed with GJ underwent 2 (2-5) tube changes/year. We found patients who had a previous GJ were more likely to have failure of the redo fundoplication than those who had not to have the GJ (16/24 vs. 30/90, p = 0.005). CONCLUSION: The chance of success decreases with every further attempt at fundoplication. The only factor significantly associated with failure of redo fundoplication was whether the patient previously had a GJ tube. In patients with failed fundoplications, when symptom free on jejunal feedings, further anti-reflux surgical intervention should be avoided. A randomized prospective study is needed for patient selection.


Assuntos
Refluxo Gastroesofágico , Laparoscopia , Criança , Fundoplicatura/métodos , Refluxo Gastroesofágico/etiologia , Refluxo Gastroesofágico/cirurgia , Humanos , Laparoscopia/métodos , Recidiva , Reoperação , Estudos Retrospectivos
6.
J Pediatr Hematol Oncol ; 43(1): e130-e135, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-31815883

RESUMO

BACKGROUND: Nodular ganglioneuroblastoma is a rare peripheral neuroblastic tumor of variable prognosis. Accurate diagnosis, staging, and risk categorization can be particularly challenging in patients with nodular ganglioneuroblastoma due to the inherent heterogeneity of these lesions. CASE PRESENTATION: We illustrate the use of diffusion-weighted magnetic resonance imaging to identify tumor nodules and guide tumor biopsy in an almost 5-year-old boy with a large abdominal tumor. CONCLUSIONS: Diffusion-weighted magnetic resonance imaging was successful in detecting and guiding biopsy of a poorly differentiated neuroblastoma nodule within the context of a well-differentiated ganglioneuroma, allowing the diagnosis and characterization of a ganglioneuroblastoma nodular, thus influencing the child's prognosis and treatment.


Assuntos
Neoplasias Abdominais/diagnóstico , Imagem de Difusão por Ressonância Magnética/métodos , Ganglioneuroblastoma/diagnóstico , Ganglioneuroma/diagnóstico , Biópsia Guiada por Imagem/métodos , Neoplasias Abdominais/cirurgia , Pré-Escolar , Diagnóstico Diferencial , Ganglioneuroblastoma/cirurgia , Ganglioneuroma/cirurgia , Humanos , Masculino , Prognóstico
7.
Pediatr Radiol ; 51(13): 2492-2497, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34435223

RESUMO

BACKGROUND: Gastrojejunal tubes are important feeding devices for children with gastro-esophageal reflux, allowing medication and feeding into the small bowel, and allowing gastric venting to prevent reflux. As with many medical devices, there are multiple manufacturers and designs, including balloon-retained tubes and disc-retained tubes. OBJECTIVE: This study evaluated the cost difference between these two types of gastrojejunal tube. MATERIALS AND METHODS: We conducted a 3.5-year retrospective cost evaluation for all pediatric patients undergoing an insertion or change of gastrojejunal tube using a bottom-up micro-costing analysis. We calculated days between encounters and a subsequent cost per day for each patient. RESULTS: A total of 187 children and adolescents were included, with an average age of 9.2 years. They underwent a total of 1,240 encounters, an average of 6.6 encounters per patient during the study period. A total of 82% of these encounters were related to balloon-retained tubes and 18% to disc-retained tubes. The most common reason for an encounter was a routine change (57%), with mechanical complications accounting for 31%. Disc-retained tubes had a longer period between encounters (117.5 days) than balloon-retained tubes (95 days; P=0.038). However, disc-retained tubes cost 6.9 British pound sterling (GBP) per day, which was significantly higher than balloon-retained tubes at 5.2 GBP per day (P<0.0001). CONCLUSION: Despite being more expensive to purchase, balloon-retained tubes were noted to be the least costly device in a cost-per-day analysis.


Assuntos
Nutrição Enteral , Refluxo Gastroesofágico , Adolescente , Criança , Gastrostomia , Humanos , Intubação Gastrointestinal , Estudos Retrospectivos , Estômago
8.
Neuroimage ; 206: 116324, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31704293

RESUMO

High-resolution volume reconstruction from multiple motion-corrupted stacks of 2D slices plays an increasing role for fetal brain Magnetic Resonance Imaging (MRI) studies. Currently existing reconstruction methods are time-consuming and often require user interactions to localize and extract the brain from several stacks of 2D slices. We propose a fully automatic framework for fetal brain reconstruction that consists of four stages: 1) fetal brain localization based on a coarse segmentation by a Convolutional Neural Network (CNN), 2) fine segmentation by another CNN trained with a multi-scale loss function, 3) novel, single-parameter outlier-robust super-resolution reconstruction, and 4) fast and automatic high-resolution visualization in standard anatomical space suitable for pathological brains. We validated our framework with images from fetuses with normal brains and with variable degrees of ventriculomegaly associated with open spina bifida, a congenital malformation affecting also the brain. Experiments show that each step of our proposed pipeline outperforms state-of-the-art methods in both segmentation and reconstruction comparisons including expert-reader quality assessments. The reconstruction results of our proposed method compare favorably with those obtained by manual, labor-intensive brain segmentation, which unlocks the potential use of automatic fetal brain reconstruction studies in clinical practice.


Assuntos
Encéfalo/diagnóstico por imagem , Feto/diagnóstico por imagem , Hidrocefalia/diagnóstico por imagem , Processamento de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética , Espinha Bífida Cística/diagnóstico por imagem , Aprendizado Profundo , Feminino , Terapias Fetais , Idade Gestacional , Humanos , Redes Neurais de Computação , Gravidez , Espinha Bífida Cística/cirurgia
9.
Magn Reson Med ; 82(5): 1905-1919, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31264270

RESUMO

PURPOSE: Magnetic resonance (MR) cholangiopancreatography (MRCP) is an established specialist method for imaging the upper abdomen and biliary/pancreatic ducts. Due to limitations of either MR image contrast or low through-plane resolution, patients may require further evaluation with contrast-enhanced computed tomography (CT) images. However, CT fails to offer the high tissue-ductal-vessel contrast-to-noise ratio available on T2-weighted MR imaging. METHODS: MR super-resolution reconstruction (SRR) frameworks have the potential to provide high-resolution visualizations from multiple low through-plane resolution single-shot T2-weighted (SST2W) images as currently used during MRCP studies. Here, we (i) optimize the source image acquisition protocols by establishing the ideal number and orientation of SST2W series for MRCP SRR generation, (ii) optimize post-processing protocols for two motion correction candidate frameworks for MRCP SRR, and (iii) perform an extensive validation of the overall potential of upper abdominal SRR, using four expert readers with subspeciality interest in hepato-pancreatico-biliary imaging. RESULTS: Obtained SRRs show demonstrable advantages over traditional SST2W MRCP data in terms of anatomical clarity and subjective radiologists' preference scores for a range of anatomical regions that are especially critical for the management of cancer patients. CONCLUSIONS: Our results underline the potential of using SRR alongside traditional MRCP data for improved clinical diagnosis.


Assuntos
Abdome/diagnóstico por imagem , Colangiopancreatografia por Ressonância Magnética/métodos , Interpretação de Imagem Assistida por Computador/métodos , Adulto , Encéfalo/diagnóstico por imagem , Feminino , Voluntários Saudáveis , Humanos , Aumento da Imagem/métodos , Imageamento Tridimensional/métodos , Masculino , Projetos Piloto
10.
Childs Nerv Syst ; 35(12): 2399-2403, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31280353

RESUMO

BACKGROUND: Several complex pediatric neurovascular conditions are amenable to endovascular treatment. Given the unique anatomical and physiological challenges in children, there is an ongoing need for tools and techniques that provide accurate information for treatment planning, while minimizing exposure to ionizing radiation and contrast. This is more so for neonates and infants with high-flow arteriovenous (AV) shunts that are challenging to assess using conventional techniques. OBJECTIVE: In this brief report, we describe, through representative cases, the potential role of quantitative color-coded digital subtraction angiography (qDSA) in neuroendovascular procedures in children with high-flow AV shunting lesions. METHODS: Images were obtained using an ArtisQ biplane system (Siemens Healthineers, Erlangen, Germany). Post-processing was performed at a dedicated workstation (Syngo, Siemens) using the iFlow module to generate color-coded maps of individual digital subtraction angiography runs. CONCLUSION: Color-coded qDSA provides real-time quantitative information in high-flow AV shunting neurovascular lesions. This can potentially help direct treatment choices, optimize endovascular treatment protocols, monitor outcomes, and determine treatment end points.


Assuntos
Angiografia Digital/métodos , Fístula Arteriovenosa/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Fístula Arteriovenosa/cirurgia , Criança , Pré-Escolar , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Feminino , Humanos , Lactente , Malformações Arteriovenosas Intracranianas/cirurgia , Masculino
11.
Pediatr Radiol ; 49(13): 1809-1815, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31302738

RESUMO

BACKGROUND: Traditionally, ultrasound (US)-guided bowel mass biopsies are avoided in favour of endoscopic or surgical biopsies. However, endoscopy cannot easily reach lesions between the duodenojejunal flexure and the terminal ileum and lesions not involving the mucosa may not be accessible via an endoscopic route. OBJECTIVE: The aim of this study was to report our technique and to assess the diagnostic accuracy and safety of US-guided biopsy of bowel masses in children. MATERIALS AND METHODS: We conducted a 14-year retrospective review of US-guided bowel mass biopsies at a single paediatric hospital. RESULTS: Twenty US-guided bowel mass biopsies were performed in 19 patients (median age: 6 years and 6 months, range: 22 months-17 years, median weight: 22 kg, range: 10.2-48.4 kg). For 14 biopsies, there was no other lesion that could potentially be biopsied. A percutaneous coaxial technique was used for 19 biopsies and a transanal non-coaxial biopsy was performed in 1. A median of 9 (range: 2-15) cores of tissue was obtained at each biopsy. The technical success rate and adequacy of diagnostic yield were 100%. The most common diagnosis was lymphoma, which occurred in 16 biopsies. Three biopsies contained mucosa. There was one complication out of 20 biopsies (5%, 95% confidence interval 0-15%): a self-limiting, post biopsy pyrexia. Nineteen procedures were accompanied by a bone marrow aspirate and/or trephine within 2 weeks of the bowel biopsy, only one of which was diagnostic. CONCLUSION: US-guided bowel mass biopsy can be performed safely in children, with a high diagnostic yield and low complication rate.


Assuntos
Linfoma de Burkitt/patologia , Colo/patologia , Biópsia Guiada por Imagem/métodos , Linfoma de Células B/patologia , Segurança do Paciente , Ultrassonografia de Intervenção/métodos , Adolescente , Biópsia por Agulha/métodos , Linfoma de Burkitt/diagnóstico por imagem , Criança , Pré-Escolar , Estudos de Coortes , Colo/diagnóstico por imagem , Bases de Dados Factuais , Feminino , Hospitais Pediátricos , Humanos , Imuno-Histoquímica , Lactente , Linfoma de Células B/diagnóstico por imagem , Masculino , Estudos Retrospectivos , Medição de Risco , Estados Unidos
12.
Pediatr Radiol ; 49(13): 1816-1822, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31342130

RESUMO

BACKGROUND: Endoscopic ultrasound is seldom available at paediatric centres; therefore drainage of pancreatic pseudocysts in children has traditionally been achieved by surgery. OBJECTIVE: This study assessed the feasibility and safety of performing image-guided internal drainage of pancreatic pseudocysts with a flanged self-expanding covered nitinol pancreatic pseudocyst drainage stent. MATERIALS AND METHODS: We conducted a retrospective case note review of children undergoing image-guided cystogastrostomy at two paediatric hospitals. Percutaneous access to the stomach was achieved via an existing gastrostomy tract or image-guided formation of a new tract. Under combined ultrasound, fluoroscopic or cone-beam CT guidance the pancreatic pseudocysts were punctured through the posterior wall of the stomach. A self-expanding covered nitinol stent was deployed to create a cystogastrostomy opening. RESULTS: Image-guided cystogastrostomy was performed in 6 children (4 male; median age 6 years, range 46 months to 15 years; median weight 18 kg, range 13.8-47 kg). Two children had prior failed attempts at surgical or endoscopic drainage. Median maximum cyst diameter was 11.5 cm (range 4.7-15.5 cm) pre-procedure. Technical success was 100%. There were no complications. There was complete pseudocyst resolution in five children and a small (2.1-cm) residual pseudocyst in one. Pseudocyst-related symptoms resolved in all children. CONCLUSION: Pancreatic pseudocyst drainage can be successfully performed in children by image-guided placement of a cystogastrostomy stent. In this cohort of six children there were no complications.


Assuntos
Endossonografia/métodos , Pseudocisto Pancreático/diagnóstico por imagem , Pseudocisto Pancreático/cirurgia , Stents Metálicos Autoexpansíveis , Cirurgia Assistida por Computador/métodos , Adolescente , Ligas , Criança , Pré-Escolar , Estudos de Coortes , Meios de Contraste , Drenagem/métodos , Feminino , Seguimentos , Gastrostomia/métodos , Hospitais Pediátricos , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Pâncreas/cirurgia , Estudos Retrospectivos , Medição de Risco , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
13.
J Vasc Interv Radiol ; 29(10): 1410-1414, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30174154

RESUMO

PURPOSE: To assess technical success of arterial recanalization in children requiring repeated arterial access and intervention. MATERIALS AND METHODS: Over 14 years, 41 attempts to cross 30 arterial occlusions were made in 22 patients (13 male, 9 female). Median patient age was 12 months (15 days-14 years), and weight was 7.6 kg (3.0-77.3 kg). Techniques and outcomes were recorded. RESULTS: Twenty-five of 41 (61%) attempts at crossing an arterial occlusion were successful. Nineteen of 30 (63%) first attempts to cross occlusions were successful, and 6 of 11 (55%) repeat attempts were successful. The occluded segments were combinations of common femoral artery (n = 4), external iliac artery (n = 36), common iliac artery (n = 11), and aorta (n = 1). Complications occurred in 5 of 41(12%) attempts: 3 minor complications (hematoma, extravasation, and transient leg ischemia) and 2 major complications (rupture and thrombosis). CONCLUSIONS: Arterial access by recanalization of occluded segments is technically feasible in children, with a low complication rate.


Assuntos
Angiografia Digital/métodos , Arteriopatias Oclusivas/terapia , Cateterismo Periférico/métodos , Procedimentos Endovasculares/métodos , Adolescente , Fatores Etários , Angiografia Digital/efeitos adversos , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/etiologia , Arteriopatias Oclusivas/fisiopatologia , Cateterismo Periférico/efeitos adversos , Criança , Pré-Escolar , Procedimentos Endovasculares/efeitos adversos , Estudos de Viabilidade , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Punções , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Grau de Desobstrução Vascular
14.
Pediatr Radiol ; 53(9): 1971-1973, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37204462
15.
Pediatr Radiol ; 48(5): 708-714, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29396791

RESUMO

BACKGROUND: Patients often use the internet as a source of information about their condition and treatments. However, this information is unregulated and varies in quality. OBJECTIVE: To evaluate the readability and quality of online information for pediatric and adult patients and caregivers regarding sclerotherapy for venous malformations. MATERIALS AND METHODS: "Venous malformation sclerotherapy" was entered into Google, and results were reviewed until 20 sites that satisfied predefined inclusion criteria were identified. Scientific and non-patient-focused web pages were excluded. Readability was assessed using the Flesch Reading Ease Score and American Medical Association reading difficulty recommendations and quality was assessed using Journal of the American Medical Association standards and assessing if the site displayed HONcode (Health on the Net Code) certification. Assessment of the breadth of relevant information was made using a predefined checklist. RESULTS: Forty-nine search engine results were reviewed before 20 sites were identified for analysis. Average Flesch Reading Ease Score was 44 (range: 24.2-70.1), representing a "fairly difficult" reading level. None of the sites had a Flesch Reading Ease Score meeting the American Medical Association recommendation of 80-90. Only one site met all four Journal of the American Medical Association quality criteria (average: 2.1). None of the sites displayed a HONcode seal. The information most frequently found was: sclerotherapy is performed by radiologists, multiple treatments may be needed and surgery is an alternative treatment. CONCLUSION: Online information regarding sclerotherapy for venous malformations is heterogeneous in quality and breadth of information, and does not meet readability recommendations for patient information. Radiologists should be aware of and account for this when meeting patients.


Assuntos
Malformações Arteriovenosas/terapia , Compreensão , Informação de Saúde ao Consumidor/normas , Internet , Escleroterapia , Humanos , Radiografia Intervencionista , Ferramenta de Busca
16.
Pediatr Radiol ; 47(10): 1353-1363, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28523345

RESUMO

BACKGROUND: Endovenous laser ablation is well recognized as the first-line treatment for superficial venous reflux with varicose veins in adults. It is not widely reported and is not an established practice in pediatric patients. OBJECTIVE: To illustrate a variety of pediatric venous conditions in which endovenous laser ablation can be utilized and to demonstrate its feasibility and safety in children. MATERIALS AND METHODS: We conducted a retrospective review of endovenous laser ablation procedures performed between January 2007 and July 2014 at two large pediatric institutions. RESULTS: We included 35 patients (17 males) who underwent endovenous laser ablation to 43 veins. Median age at first treatment was 14 years (range: 3-18 years). Median weight was 56 kg (range: 19-97 kg). Underlying diagnoses were common venous malformation (15), Klippel-Trenaunay syndrome (8), superficial venous reflux with varicose veins (5), verrucous hemangioma-related phlebectasia (4), venous varix (2) and arteriovenous fistula (1). The most common aim of treatment was to facilitate sclerotherapy. Thirty-four patients had treatment in the lower limbs and one patient in an upper limb. Ten of the veins treated with endovenous laser ablation had an additional procedure performed to close the vein. Complications attributable to endovenous laser ablation occurred in two patients (6%). One patient experienced post-procedural pain and one patient developed a temporary sensory nerve injury. Median clinical follow-up was 13 months (range: 28 days-5.7 years). The aim of the treatment was achieved in 29 of the 35 (83%) patients. CONCLUSION: Endovenous laser ablation is technically feasible and safe in children. It can be used in the management of a range of pediatric venous diseases with good outcomes.


Assuntos
Terapia a Laser/métodos , Varizes/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
17.
Pediatr Radiol ; 46(3): 407-12, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26563298

RESUMO

Lesions only visible on magnetic resonance (MR) imaging cannot easily be targeted for image-guided biopsy using ultrasound or X-rays but instead require MR guidance with MR-compatible needles and long procedure times (acquisition of multiple MR sequences). We developed an alternative method for performing these difficult biopsies in a standard interventional suite, by fusing MR with cone-beam CT images. The MR cone-beam CT fusion image is then used as an overlay to guide a biopsy needle to the target area under live fluoroscopic guidance. Advantages of this technique include (i) the ability for it to be performed in a conventional interventional suite, (ii) three-dimensional planning of the needle trajectory using cross-sectional imaging, (iii) real-time fluoroscopic guidance for needle trajectory correction and (iv) targeting within heterogeneous lesions based on MR signal characteristics to maximize the potential biopsy yield.


Assuntos
Tomografia Computadorizada de Feixe Cônico/métodos , Fluoroscopia/métodos , Biópsia Guiada por Imagem/métodos , Imageamento por Ressonância Magnética/métodos , Neoplasias/diagnóstico por imagem , Neoplasias/patologia , Adolescente , Criança , Feminino , Humanos , Aumento da Imagem/métodos , Interpretação de Imagem Assistida por Computador/métodos , Masculino , Modelos Biológicos , Modelos Estatísticos , Imagem Multimodal/métodos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Técnica de Subtração
18.
Pediatr Radiol ; 44(10): 1281-9, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24821394

RESUMO

BACKGROUND: Ablation techniques are widely used for solid malignant tumors in adults. There is no large series assessing the effectiveness of local ablative therapies in the treatment of malignant or aggressive benign lesions in children. OBJECTIVE: To review the existing evidence on the techniques and results of ablation for pediatric solid malignant or aggressive benign tumors. MATERIALS AND METHODS: We searched MEDLINE for papers published between 1995 and 2012 that reported outcomes of radiofrequency, microwave and cryoablation, interstitial laser therapy, irreversible electroporation and percutaneous ethanol injection for patients younger than 18 years old. Data collection included factors related to the patient, tumor biology, ablation technique and cancer-specific endpoints. Additional series of predominantly adults including data on patients younger than 18 years old were also identified. RESULTS: We identified 28 patients treated by ablation in 29 regions: 5 patients undergoing ablation for liver lesions, 9 patients for lung metastases, 11 patients for bone and/or soft tissue and 4 patients for kidney or pancreas. The ablation was performed to treat primary tumors, local recurrences and metastases. The histology of the tumors was osteosarcoma in 6 patients, Wilms tumor in 3, rhabdomyosarcoma in 3, hepatoblastoma in 3, desmoid tumor in 3, adrenocortical carcinoma in 2 and a single case each of leiomyosarcoma, Ewing sarcoma, paraganglioma, solid-pseudopapillary neoplasm, sacrococcygeal teratoma, hepatic adenoma, juxtaglomerular cell tumor and plantar fibromatosis. Eighteen of the patients (64%) experienced a complication, but only 6 (21%) of these needed treatment other than supportive care. CONCLUSIONS: Although ablative techniques are feasible and promising treatments for certain pediatric tumors, large multicenter prospective trials will be needed to establish efficacy.


Assuntos
Técnicas de Ablação/classificação , Técnicas de Ablação/estatística & dados numéricos , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/cirurgia , Padrões de Prática Médica/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Neoplasias Hepáticas/patologia , Masculino , Prevalência
19.
J Vasc Interv Radiol ; 24(8): 1257-62, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23885917

RESUMO

Ablation of exophytic and border-deforming liver tumors may increase risks of tumor seeding or hemorrhage. The present report describes a no-touch wedge ablation technique intended to potentially reduce tumor disruption while achieving technically adequate ablation. The technique involves the use of multiple probe positions tangential to the tumor, and was used to treat eight tumors. Complete ablation was demonstrated in all cases on early posttreatment imaging at an average of 16 days after the procedure. At an average imaging follow-up of 244 days, there was one case of local tumor recurrence. The technique may be useful for the ablation of exophytic, border-deforming liver tumors.


Assuntos
Técnicas de Ablação , Neoplasias Hepáticas/cirurgia , Micro-Ondas/uso terapêutico , Técnicas de Ablação/efeitos adversos , Adulto , Idoso , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Masculino , Micro-Ondas/efeitos adversos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estudos Retrospectivos , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
20.
Cardiovasc Intervent Radiol ; 46(8): 1046-1052, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37311838

RESUMO

AIMS: The development of paediatric specific devices appears to lag behind advancements in our specialty. Children could therefore be limited in the number of procedures available to them unless we continue to use and modify adult devices 'off-label'. This study quantifies the proportion of IR devices in which paediatric use is indicated by the manufacturer. MATERIALS & METHODS: Cross-sectional analysis of device instructions for use (IFU), assessing inclusion of children was performed. Vascular access, biopsy, drainage, and enteral feeding devices, from 28 companies who sponsored BSIR, CIRSE and SIR (2019-2020) as determined by the meeting websites, were included. Devices for which the IFU was not available were excluded. RESULTS: 190 (106 vascular access, 40 biopsy, 39 drainage and 5 feeding) devices with IFU's from 18 medical device manufacturers were assessed. 49/190 (26%) IFU's referenced children. 6/190 (3%) explicitly stated the device could be used in children and 1/190 (0.5%) explicitly stated the device was not for use in children. 55/190 (29%) implied they could be used in children through caution notes. The most common caution was a reference to the size of the device that could be accommodated in a child (26/190, 14%). CONCLUSIONS: This data identifies an unmet need for paediatric IR devices and could be used to support the future development of devices intended for the children we treat. There is potentially a larger proportion (29%) of devices suitable for paediatric use, but which lack manufacturer explicit support. LEVEL OF EVIDENCE: Level 2c, Cross-Sectional study.


Assuntos
Nutrição Enteral , Adulto , Criança , Humanos , Estudos Transversais , Nutrição Enteral/métodos
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