A Review of Management of Congenital Sublobar Hyperinflation at a Single Institution.

There has been an increased recognition of a subset of congenital lobar emphysema (CLE), termed congenital sublobar hyperinflation (CSLH), which may affect only a segment of lung as opposed to an entire lobe. This is an uncommon variant for which there is a paucity of information in published literature. The majority of CLE are managed surgically. Current literature suggests non-operative management for CSLH. However, there has been slow adoption of non-operative management and there is not a well-established observation pathway. A retrospective review of all pediatric patients diagnosed with CSLH at a single institution was performed from 2017 to 2023 to determine if this variant may be safely managed with observation. A total of 10 patients were identified. Of these, three patients had consolidation on cross-sectional imaging; therefore, operative intervention was undertaken given diagnostic uncertainty. All patients managed observationally remained asymptomatic. This case series validates non-operative management for patients with asymptomatic CSLH.

Congenital duodenal obstruction: causes and imaging approach.

Bilious emesis is a common cause for evaluation in pediatric radiology departments. There are several causes of congenital duodenal obstruction, most of which require elective surgical correction, but the potential of malrotation with midgut volvulus demands prompt imaging evaluation. We review the various causes of congenital duodenal obstruction with an emphasis on the approach to imaging evaluation and diagnosis.

Effects of automatic tube potential selection on radiation dose index, image quality, and lesion detectability in pediatric abdominopelvic CT and CTA: a phantom study.

OBJECTIVES: To assess the effect of automatic tube potential selection (ATPS) on radiation dose, image quality, and lesion detectability in paediatric abdominopelvic CT and CT angiography (CTA). METHODS: A paediatric modular phantom with contrast inserts was examined with routine pitch (1.4) and high pitch (3.0) using a standard abdominopelvic protocol with fixed 120 kVp, and ATPS with variable kVp in non-contrast, contrast-enhanced, and CTA mode. The volume CT dose index (CTDIvol), contrast-to-noise ratio (CNR) and lesion detectability index (d') were compared between the standard protocol and ATPS examinations. RESULTS: CTDIvol was reduced in all routine pitch ATPS examinations, with dose reductions of 27-52 % in CTA mode (P < 0.0001), 15-33 % in contrast-enhanced mode (P = 0.0003) and 8-14 % in non-contrast mode (P = 0.03). Iodine and soft tissue insert CNR and d' were improved or maintained in all ATPS examinations. kVp and dose were reduced in 25 % of high pitch ATPS examinations and in none of the full phantom examinations obtained after a single full phantom localizer. CONCLUSIONS: ATPS reduces radiation dose while maintaining image quality and lesion detectability in routine pitch paediatric abdominopelvic CT and CTA, but technical factors such as pitch and imaging range must be considered to optimize ATPS benefits. KEY POINTS: ATPS automatically individualizes CT scan technique for each patient. ATPS lowers radiation dose in routine pitch pediatric abdominopelvic CT and CTA. There is no loss of image quality or lesion detectability with ATPS. Pitch and scan range impact the effectiveness of ATPS dose reduction.

Lumbar fusion in achondroplasia: does fusion to the sacrum affect function?

BACKGROUND: Stenosis and kyphosis are common in achondroplasia, often requiring lumbar fusion, sometimes to the sacrum. The purpose of this study was to determine the functional effect of lumbar fusion to the sacrum in patients with achondroplasia. METHODS: Functional and SF-36 questionnaires were sent to the 66 patients with achondroplasia who underwent instrumented lumbar fusion at our institution from 1991 to 2006. Of the 35 who returned questionnaires, 13 had fusions to the sacrum and 22 did not. Chi-square analysis and a t test were used to evaluate outcomes. Significance was set at P<0.05 or a 95% confidence interval that did not cross 1. RESULTS: There were no statistical differences in SF-36 scores. There was a trend toward more pain in the group fused to the sacrum (P=0.1). There were no statistically significant differences in difficulty with activities, but there was a trend toward increased difficulty with hygiene after toileting in the group with fusion to the sacrum (odds ratio: 3.76, confidence interval: 0.53-26.87, P=0.19). CONCLUSIONS: Fusion to the sacrum did not significantly affect function in patients with achondroplasia, although there was a trend toward increased pain and greater difficulty with hygiene after toileting.

Colonic perforation by a percutaneously displaced biliary stent: report of a case and a review of current practice.

Percutaneous biliary interventions are often performed for biliary obstruction when endoscopic stent placement is not feasible or has failed to provide relief. These secondary percutaneous interventions may be complicated by the presence of a previously placed occluded biliary stent requiring displacement and removal. The authors report a case of colonic perforation by a plastic biliary stent that was purposely displaced into the small bowel for passage at the time of percutaneous intervention and review the current practices concerning biliary stent removal in interventional radiology and gastrointestinal endoscopy.

Poly(vinylpyrrolidone)-doped nitric oxide-releasing xerogels as glucose biosensor membranes.

Nitric oxide (NO)-releasing xerogel membranes were prepared as coatings for an electrochemical glucose biosensor to allow for enhanced biocompatibility while maintaining adequate response times and sensitivity. Formation of the NO-donor species was found to drastically decrease the permeability of the aminosilane-based xerogels to both hydrogen peroxide and glucose. The addition of poly(vinylpyrrolidone) (PVP) polymer enhanced the membrane permeability even after exposure to high pressures of NO (necessary for NO-donor synthesis). The analytical response and NO release of PVP-doped NO-releasing xerogels as glucose sensor membranes were further investigated and found to be enhanced via polymer doping. Doping of the polymer into the xerogel did not compromise the stability of the xerogel as evaluated by silicon leaching studies. Despite the addition of PVP, the NO-releasing xerogels maintained reduced bacterial adhesion characteristics analogous to previous reports for NO-releasing xerogels.

A patient education intervention does not improve satisfaction with emergency care.

STUDY OBJECTIVE: We determine whether a patient education intervention based on a previously validated model increases satisfaction with emergency department (ED) care. METHODS: A single-page patient education form was distributed on alternating 2-week time blocks for 8 weeks at the triage desk of a single academic ED. Alert, discharged patients were administered an exit interview assessing satisfaction on a 5-point ordinal scale. Secondary outcomes included patient satisfaction measured on a bivariate scale, willingness to return, and process of care indicators previously demonstrated to be associated with satisfaction. Exclusion criteria included air or ground transport to the ED, inability to speak English or Spanish, and refusal to participate. Differences in patient satisfaction and other outcomes were adjusted for predefined covariates, including age, sex, triage severity, race, language, location in ED, total ED length of stay, and time to room, using multivariable logistic regression. RESULTS: Of 1,934 patients discharged during study periods, 1,233 (64%) were approached and 860 (44%) were enrolled. There were no important covariate differences between the control and intervention groups. There was no important correlation between intervention and patient satisfaction on univariate (odds ratio [OR] 0.840; 95% confidence interval [CI] 0.650 to 1.086) and multivariate analysis (OR 0.874; 95% CI 0.672 to 1.136). There were no important correlations between the intervention and secondary outcomes on multivariate analysis. CONCLUSION: A triage-based, patient education intervention did not significantly improve patient satisfaction or performance on predictors of satisfaction at the study site.