Microwave ablation of osteoid osteoma: initial experience and efficacy.

BACKGROUND: Image-guided percutaneous microwave ablation has been used to treat adult osteoid osteomas but has not been thoroughly evaluated in the pediatric population. OBJECTIVE: To evaluate the technical feasibility and clinical efficacy of microwave ablation to treat osteoid osteomas in pediatric patients. MATERIALS AND METHODS: The electronic medical record and imaging archive were reviewed for 24 consecutive patients who had undergone microwave ablation of osteoid osteomas between January 1, 2015, and May 31, 2018, at a single tertiary care pediatric hospital. All patients were diagnosed by clinical and imaging criteria, and referred by a pediatric orthopedic surgeon after failing conservative management with pain medication. The average age of the patients was 13.3 years (range: 3-18 years), and the average size of the osteoid osteoma nidus was 8.8 mm (range: 5-22 mm). Technical success was defined as placement of the microwave antenna at the distal margin of the lesion nidus and achievement of the target ablation temperature. Clinical findings were assessed pre- and post-ablation and clinical success was defined as complete relief of pain without pain medication at 1-month follow-up. The number and severity of complications were also documented. RESULTS: Clinical success was achieved in 100% of patients (24/24), with all reporting complete cessation of pain medication use 1 week after treatment and 0/10 pain at 1 month. There were 4 minor complications (17%) including access site numbness and a minor soft-tissue infection. There were no major complications. CONCLUSION: Microwave ablation is a technically feasible and clinically effective treatment for pediatric osteoid osteomas.

Updated guidance for efficacy and safety outcomes for clinical trials in venous thromboembolism in children: communication from the ISTH SSC Subcommittee on Pediatric and Neonatal Thrombosis and Hemostasis.

Despite the growing number of pediatric antithrombotic clinical trials, standardized safety and efficacy outcome definitions for pediatric venous thromboembolism (VTE) clinical trials have not been updated since 2011. Many recent trials have adapted the recommended definitions, leading to heterogeneity in outcomes and limiting our ability to compare studies. The International Society on Thrombosis and Haemostasis Scientific and Standardization Subcommittee (SSC) on Pediatric and Neonatal Thrombosis and Hemostasis organized a Task Force to update the efficacy and safety outcome definitions for pediatric VTE clinical trials. The outcome definitions used in the recent pediatric antithrombotic trials, definitions recommended for adult studies, and regulatory guidelines were summarized and reviewed by the Task Force as the basis for this updated guidance. Major updates to the efficacy outcomes include the removal of VTE-related mortality as a part of a composite primary outcome and explicit inclusion of all deep venous anatomic sites. Safety outcomes were updated to include a new bleeding severity category: patient important bleeding, no intervention, which encompasses bleeding for which a patient seeks care but there is no change in management. Menstrual bleeding can now be included in any bleeding category when the criteria are met. We hope that these updated outcome definitions will allow the investigators to focus on clinically relevant and patient-important outcomes and provide standardization to facilitate continued high-quality evidence for the use of antithrombotic therapies in children.

Aneurysmal dilation of bowel mimicking an abscess in pediatric primary gastrointestinal lymphoma.

Primary gastrointestinal lymphoma, though rare, is the most common gastrointestinal malignancy in children. Signs and symptoms are nonspecific, and include abdominal pain, nausea, emesis, and a palpable abdominal mass. Imaging is therefore typically required to differentiate gastrointestinal lymphoma from other abdominal conditions. We present a pediatric case of primary gastrointestinal lymphoma involving the distal bowel that was initially misdiagnosed as an intra-abdominal abscess. This case highlights the imaging findings of primary gastrointestinal lymphoma, potential pitfalls in imaging diagnosis, and the role of accurate imaging diagnosis in expediting patient management to reduce associated morbidity and mortality.

What Radiologists Can Learn From Fighter Pilots.

Many principles of aviation safety have already been adopted into the field of health care. In this article, the author describes some of the core methodologies that contribute to the success of US Air Force fighter pilots and offers examples as to how these could be adapted to meet the challenges facing the practice of radiology. Key principles include "big picture" tactical training, the use of checklists, teamwork, safety, and performance improvement concepts. The need for cultural support of change is emphasized.

Seeding of a high-grade papillary urothelial carcinoma of the bladder along a nephroureterostomy tract.

Percutaneous nephrostomy placement is a common treatment for obstructive uropathy of various causes. Although rare in the literature, tumor seeding along the nephrostomy tract is a potential risk of percutaneous nephrostomy in the treatment of obstructive symptoms secondary to urothelial carcinoma. In this case report, we present one such unusual outcome where urinary bladder urothelial cancer cells metastasized to the paravertebral soft tissues through apparent seeding along a nephroureterostomy tract.

The management of keloids: hands-on versus hands-off.

Keloids are benign fibrous growths that appear in scar tissue. The lesions can be severely disfiguring and early recognition of genetic lesions is crucial. This case report outlines and reviews the important management strategies for these lesions and the requirement for extensive counseling for the patient and their family. Many potential medical and surgical interventions exist. Unfortunately, these lesions tend to recur and overall outcomes remain poor. Given patient susceptibility to disfiguring results, surgical intervention should be used with extreme caution.