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1.
Semin Intervent Radiol ; 36(2): 97-103, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31123379

RESUMO

Percutaneous renal biopsy is widely used for diagnosis, prognosis, and management of nephropathies. Complications may arise after renal biopsy, most commonly in the form of bleeding. Efforts should be taken to optimize modifiable risk factors such as hypertension, thrombocytopenia, and coagulopathy prior to the procedure. Unmodifiable risk factors such as poor renal function, gender, and underlying histologic diagnosis may be used to identify high-risk patients. Delayed presentation of bleeding complications is common, and close clinical follow-up is crucial.

2.
J Surg Res ; 233: 256-261, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30502256

RESUMO

BACKGROUND: Lymphatic malformations (LMs) are congenital and arise from errors in vascular embryogenesis. LMs are categorized by cyst size as microcystic, macrocystic, or combined. Abdominal LMs are rare. Surgical resection of abdominal LMs has been the mainstay of therapy, but recurrence and morbidity are high. We sought to determine the effectiveness of sclerotherapy treatment for abdominal LM. METHODS: A single-center, retrospective review from 2014 to 2018 was conducted evaluating pediatric patients with abdominal LM. RESULTS: Ten patients were included, n = 9 had macrocystic LM and one patient had combined disease. The average age at first treatment was 6.8 y. The most common presenting symptoms were abdominal distention, pain, infection, and anemia. Preprocedural imaging was performed for all patients; median pretreatment volume was 1572.9 cm3 (range, 67.2-13,226.4). LMs were accessed using ultrasound guidance and injected with opacified doxycycline. Patients received a mean of 7.1 sclerotherapy injections. Complications included intraperitoneal doxycycline extravasation (n = 1), managed conservatively, and LM infection (n = 1), treated with intravenous antibiotics and drainage. One patient went on to surgical resection due to inability gain stable intracystic access; follow-up ultrasonography showed no recurrence. Postprocedural imaging was available in n = 8. Volume decreased by 96.7% after sclerotherapy. The median remaining volume was 0 cm3 (range, 0-599.7) (P = 0.016). Postsclerotherapy magnetic resonance imaging was obtained in n = 6, with complete resolution in 83.3%. All patients had resolution of presenting symptoms. Follow-up duration was 12.3 mo. CONCLUSIONS: Initial results demonstrate that sclerotherapy is an effective and durable treatment for symptom resolution and volume reduction of abdominal LM.


Assuntos
Doxiciclina/administração & dosagem , Anormalidades Linfáticas/terapia , Escleroterapia/métodos , Prevenção Secundária/métodos , Cavidade Abdominal/diagnóstico por imagem , Adolescente , Criança , Pré-Escolar , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Extravasamento de Materiais Terapêuticos e Diagnósticos/etnologia , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Anormalidades Linfáticas/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Recidiva , Estudos Retrospectivos , Escleroterapia/efeitos adversos , Resultado do Tratamento , Ultrassonografia de Intervenção
3.
Pediatrics ; 143(1)2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30584062

RESUMO

Infantile hemangiomas (IHs) occur in as many as 5% of infants, making them the most common benign tumor of infancy. Most IHs are small, innocuous, self-resolving, and require no treatment. However, because of their size or location, a significant minority of IHs are potentially problematic. These include IHs that may cause permanent scarring and disfigurement (eg, facial IHs), hepatic or airway IHs, and IHs with the potential for functional impairment (eg, periorbital IHs), ulceration (that may cause pain or scarring), and associated underlying abnormalities (eg, intracranial and aortic arch vascular abnormalities accompanying a large facial IH). This clinical practice guideline for the management of IHs emphasizes several key concepts. It defines those IHs that are potentially higher risk and should prompt concern, and emphasizes increased vigilance, consideration of active treatment and, when appropriate, specialty consultation. It discusses the specific growth characteristics of IHs, that is, that the most rapid and significant growth occurs between 1 and 3 months of age and that growth is completed by 5 months of age in most cases. Because many IHs leave behind permanent skin changes, there is a window of opportunity to treat higher-risk IHs and optimize outcomes. Early intervention and/or referral (ideally by 1 month of age) is recommended for infants who have potentially problematic IHs. When systemic treatment is indicated, propranolol is the drug of choice at a dose of 2 to 3 mg/kg per day. Treatment typically is continued for at least 6 months and often is maintained until 12 months of age (occasionally longer). Topical timolol may be used to treat select small, thin, superficial IHs. Surgery and/or laser treatment are most useful for the treatment of residual skin changes after involution and, less commonly, may be considered earlier to treat some IHs.


Assuntos
Gerenciamento Clínico , Hemangioma/terapia , Guias de Prática Clínica como Assunto , Neoplasias Cutâneas/terapia , Terapia Combinada/normas , Humanos , Lactente
4.
J Pediatr Surg ; 2019 Dec 30.
Artigo em Inglês | MEDLINE | ID: mdl-31973927

RESUMO

BACKGROUND: The management of childhood empyemas has transformed over the past decade, with current trends favoring chest tube placement and intrapleural fibrinolytic therapy. Although this strategy often avoids the need for video-assisted thoracoscopic surgery (VATS), hospital length of stay can be long. METHODS: To characterize national trends and outcomes associated with empyema management, the Pediatric Health Information System (PHIS) database was queried to identify children (2 months-18 years) treated for an empyema between January 2010 and December 2017. The cohort was divided into those treated with primary VATS and those treated with chest tube and intrapleural fibrinolysis. Number of chest radiographic studies obtained, frequency of pediatric intensive care unit (PICU) admission, mechanical ventilation requirements, and length of hospitalization were compared between groups. RESULTS: A total of 3,365 otherwise healthy children met inclusion criteria. Among them, 523 (16%) were managed with primary VATS and 2,842 (84%) were managed with chest tube and fibrinolytic therapy. Of those who were treated with chest tube and fibrinolysis, 193 (6.8%) subsequently underwent VATS. The percentage of children treated with chest tube and fibrinolysis increased from 65% in 2010 to 95% in 2017 (p<0.001). After adjusting for age, race, ethnicity, payer, and region, children who underwent primary VATS received fewer chest radiographic studies, were less likely to be admitted to the PICU or require mechanical ventilation and had a shorter PICU and hospital length of stay compared to those who were treated with chest tube and fibrinolytic therapy (p<0.001 for all analyses). DISCUSSION: Although national trends favor chest tube and fibrinolysis, primary VATS are associated with a shorter hospital and PICU length of stay and a lower requirement for mechanical ventilation. Future studies should aim to risk stratify children who may suffer from a protracted course with the goal to offer primary VATS to this subset of children and return them to normal life more expeditiously. LEVEL OF EVIDENCE: III.

5.
Semin Intervent Radiol ; 35(1): 62-68, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29628618

RESUMO

Vascular malformations are classified primarily according to their flow characteristics, slow flow (lymphatic and venous) or fast flow (arteriovenous). They can occur anywhere in the body but have a unique presentation when affecting the female pelvis. With a detailed clinical history and the proper imaging studies, the correct diagnosis can be made and the best treatment can be initiated. Lymphatic and venous malformations are often treated with sclerotherapy while arteriovenous malformations usually require embolization. At times, surgical intervention of vascular malformations or medical management of lymphatic malformations has been implemented in a multidisciplinary approach to patient care. This review presents an overview of vascular malformations of the female pelvis, their clinical course, diagnostic studies, and treatment options.

6.
Pediatr Pulmonol ; 52(11): E97-E101, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28869334

RESUMO

Plastic bronchitis is a life-threatening condition of airway obstructive cast formation. This pediatric case series from a high altitude center details the course of three patients after percutaneous thoracic duct interventions for refractory plastic bronchitis, with a follow-up interval of 3.5 years. In two patients, where cisterna chyli maceration (patients 2) or thoracic duct embolization (patient 3) was performed, a sustained clinical improvement is shown, with no subsequent cast recurrence. In patient 1, cisterna chyli maceration resulted in partial improvement. Herein, a favorable outcome is shown in pediatric patients with percutaneous thoracic duct interventions for plastic bronchitis at altitude.


Assuntos
Bronquite/terapia , Altitude , Criança , Pré-Escolar , Embolização Terapêutica/métodos , Feminino , Humanos , Masculino , Ducto Torácico
7.
Pediatr Radiol ; 45(9): 1382-91, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25786605

RESUMO

Extratesticular cystic and solid scrotal masses are commonly encountered in pediatrics. The most common extratesticular malignancy is paratesticular rhabdomyosarcoma. The remainder of the common pathologies encountered -- appendage torsion, epididymitis and varicoceles -- are mostly benign. These frequently encountered benign lesions are confidently differentiated from paratesticular rhadbomyosarcoma using high-frequency scrotal sonography in combination with clinical features. Less commonly encountered extratesticular masses may not be as easily classified; however, these also have distinguishing features that can enable differentiation from malignancy. This review discusses the sonographic findings, and relevant clinical and pathological manifestations of the more unusual extratesticular masses encountered in two tertiary pediatric institutions during a 10-year period. While these extratesticular pathologies are encountered relatively infrequently, recognition of their manifestations enables appropriate management.


Assuntos
Escroto/diagnóstico por imagem , Espermatocele/diagnóstico por imagem , Neoplasias Testiculares/diagnóstico por imagem , Testículo/anormalidades , Testículo/diagnóstico por imagem , Ultrassonografia/métodos , Adolescente , Criança , Pré-Escolar , Diagnóstico Diferencial , Humanos , Lactente , Recém-Nascido , Masculino
8.
Radiology ; 274(3): 871-8, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25325323

RESUMO

PURPOSE: To describe a dynamic magnetic resonance (MR) lymphangiography technique after intranodal injection of gadolinium-based contrast agent and to assess its feasibility for evaluation of the central conducting lymphatics (CCL) in patients with pathologic disorders that involve the CCL. MATERIALS AND METHODS: A retrospective evaluation of experience with the dynamic MR lymphangiographic technique in six consecutive patients was performed after institutional review board approval. Written informed consent for the percutaneous procedure was obtained from the patient, parent, or the legally responsible guardian. The dynamic MR lymphangiographic technique involves ultrasonographically guided intranodal injection of gadolinium-based contrast material into the inguinal lymph nodes, combined with sequential imaging of the chest and abdomen with a three-dimensional sequence optimized for soft tissue with high spatial resolution that provides time-resolved imaging of lymphatic transit through the CCL. Qualitative assessment of the images was performed for reliability of CCL visualization and for associated findings that could explain the clinical symptoms, including lymphangiectasia, chylolymphatic reflux, and chylous leak. RESULTS: The procedure was technically successful in all six patients. The dynamic MR lymphangiographic findings confirmed the presence of normal CCL morphologic structure in two patients and provided a possible explanation for clinical manifestations in the remaining four patients. The dynamic MR lymphangiographic procedure led to a change in management in two patients, continuation of conservative treatment in three patients, and confirmation of an alternative nonlymphatic diagnosis in one patient. Image quality for visualization of the CCL was considered good in all cases by the two readers. There were no known adverse effects related to the procedure. CONCLUSION: The dynamic MR lymphangiographic technique with intranodal injection of gadolinium-based contrast material is feasible and can provide useful information in a variety of lymphatic flow abnormalities involving the CCL.


Assuntos
Doenças Linfáticas/diagnóstico , Vasos Linfáticos/diagnóstico por imagem , Linfografia/métodos , Imagem por Ressonância Magnética , Adolescente , Adulto , Criança , Pré-Escolar , Meios de Contraste/administração & dosagem , Estudos de Viabilidade , Feminino , Gadolínio DTPA/administração & dosagem , Humanos , Injeções Intralesionais , Imagem por Ressonância Magnética/métodos , Masculino , Estudos Retrospectivos , Adulto Jovem
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