Experience with Compressed Gelfoam Plugs in Children during Liver Biopsies and Other IR Procedures: A Retrospective Single-Center Case Series.

PURPOSE: To analyze the experience using compressed gelfoam plugs (CGPs) in children during liver biopsies and other interventional procedures. MATERIALS AND METHODS: This was a single-center, retrospective, consecutive case series of 477 various pediatric interventional radiology procedures using CGPs (January 2012 to December 2016) performed on 397 children (209 males, 188 females; median age, 7 years [range, 9 days-17.8 years]; median weight, 18 kg [range, 2.7-141 kg]). Of 477 procedures, most (n = 371) were liver biopsies, 98 were biopsies of other organs, and 8 were non-biopsy procedures. Analysis focused on liver biopsies. RESULTS: Of liver biopsies, a median of 2 CGPs were used per procedure, and the mean drop in hemoglobin was -0.36 g/dl (-3.0% change). Thirty-seven mild, 8 moderate, 2 severe, and 1 life-threatening (an anaphylaxis to CGP) adverse events (AEs) occurred. Analysis of liver biopsies with AEs showed significant association between number of passes, cores, and focal-type lesions (unadjusted logistic regression: P = .007, P = .022, P = .028, respectively) and age, weight, and number of passes (adjusted multiple logistic regression: P = .006, P = .032, P = .046, respectively). Technical problems relating to CGP deployment were noted in 5 (1%), without any AEs. CONCLUSIONS: CGPs were used in a wide variety of procedures and organs in children. There was 1 life-threatening AE resulting from the rare risk of anaphylaxis caused by the gelfoam-containing plug. After liver biopsies, transfusion was required in 2/371 (0.5%) procedures, 1 related to pre-biopsy anemia (0.25%).

Diagnosis and Management of Conjunctivitis for the Dermatologist.

Atopic dermatitis is a chronic, sometimes relapsing inflammatory skin condition that presents with pruritus and characteristic skin manifestations. Conjunctivitis is a common ocular comorbidity affecting almost half of patients with the risk increasing with atopic dermatitis severity. Recent targeted biologic therapies that successfully treat atopic skin disease, including dupilumab, which blocks interleukin (IL)-4 and IL-13, as well as agents that block IL-13 alone, have been associated with an increased rate of conjunctivitis in clinical trials. Because conjunctivitis commonly occurs in patients with atopic dermatitis and as the treatment with targeted biologic agents may increase the risk or severity of conjunctivitis, it is important that dermatologists recognize symptoms, appreciate treatment options, and know when referral to an ophthalmologist is appropriate.