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Harvey JJ, Vrazas JI, Bekhit E, Barnes C, Robinson PJ. Catheter-related superior vena cava syndrome: an increasing problem. Med J Aust 2024; 220:238-240. [PMID: 38357991 DOI: 10.5694/mja2.52233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/14/2023] [Indexed: 02/16/2024]
Affiliation(s)
- John J Harvey
- Royal Children's Hospital Melbourne, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
| | - John I Vrazas
- Royal Children's Hospital Melbourne, Melbourne, VIC
- St Vincent's Private Hospital, Melbourne, VIC
| | | | - Chris Barnes
- Royal Children's Hospital Melbourne, Melbourne, VIC
| | - Philip J Robinson
- Royal Children's Hospital Melbourne, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
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2
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Shanthikumar S, Bekhit E, Bracken J. MRI as screening for pulmonary arteriovenous malformations in hereditary hemorrhagic telangiectasia. Pediatr Pulmonol 2023; 58:1281-1282. [PMID: 36588473 DOI: 10.1002/ppul.26297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023]
Affiliation(s)
- Shivanthan Shanthikumar
- Respiratory Diseases, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Respiratory and Sleep Medicine, Royal Children's Hospital, Victoria, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Elhamy Bekhit
- Department of Medical Imaging, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Jenny Bracken
- Department of Medical Imaging, Royal Children's Hospital, Parkville, Victoria, Australia
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Choshen S, Turner D, Pratt LT, Precel R, Greer ML, Castro DA, Assa A, Martínez-León MI, Herman-Sucharska I, Coppenrath E, Konen O, Davila J, Bekhit E, Alsabban Z, Focht G, Gavish M, Griffiths A, Cytter-Kuint R. Development and Validation of a Pediatric MRI-Based Perianal Crohn Disease (PEMPAC) Index-A Report from the ImageKids Study. Inflamm Bowel Dis 2022; 28:700-709. [PMID: 34151950 DOI: 10.1093/ibd/izab147] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND As part of the prospective multicenter ImageKids study, we aimed to develop and validate the pediatric MRI-based perianal Crohn disease (PEMPAC) index. METHODS Children with Crohn disease with any clinical perianal findings underwent pelvic magnetic resonance imaging at 21 sites globally. The site radiologist and 2 central radiologists provided a radiologist global assessment (RGA) on a 100 mm visual analog scale and scored the items selected by a Delphi group of 35 international radiologists and a review of the literature. Two weighted multivariable statistical models were constructed against the RGA. RESULTS Eighty children underwent 95 pelvic magnetic resonance imaging scans; 64 were used for derivation and 31 for validation. The following items were included: fistula number, location, length and T2 hyperintensity; abscesses; rectal wall involvement; and fistula branching. The last 2 items had negative beta scores and thus were excluded in a contending basic model. In the validation cohort, the full and the basic models had the same strong correlation with the RGA (r = 0.75; P < 0.01) and with the adult Van Assche index (VAI; r = 0.93 and 0.92; P < 0.001). The correlation of the VAI with the RGA was similar (r = 0.77; P < 0.01). The 2 models and the VAI had a similar ability to differentiate remission from active disease (area under the receiver operating characteristic curve, 0.91-0.94). The PEMPAC index had good responsiveness to change (area under the receiver operating characteristic curve, 0.89; 95% confidence interval, 0.69-1.00). CONCLUSIONS Using a blended judgmental and mathematical approach, we developed and validated an index for quantifying the severity of perianal disease in children with CD. The adult VAI may also be used with confidence in children.
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Affiliation(s)
- Sapir Choshen
- Pediatric Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Dan Turner
- The Juliet Keidan Institute of Pediatric Gastroenterology, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Li-Tal Pratt
- Pediatric Imaging Unit, Imaging Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronit Precel
- Pediatric Imaging Unit, Imaging Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Mary-Louise Greer
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Denise A Castro
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada.,Department of Diagnostic Radiology, Kingston Health Science Centre, Queen's University, Kingston, Canada
| | - Amit Assa
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Diagnostic Imaging, Schneider Children's Hospital, Petach-Tikva, Israel
| | | | | | | | - Osnat Konen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Diagnostic Imaging, Schneider Children's Hospital, Petach-Tikva, Israel
| | - Jorge Davila
- Department of Medical Imaging, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Elhamy Bekhit
- Department of Medicine and Radiology, The Royal Children's Hospital, Melbourne, Australia
| | - Zehour Alsabban
- Department of Radiology, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Gili Focht
- The Juliet Keidan Institute of Pediatric Gastroenterology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Matan Gavish
- School of Computer Science and Engineering, The Hebrew University, Jerusalem, Israel
| | - Anne Griffiths
- Department of Gastroenterology, Hospital for Sick Children, University of Toronto, Canada
| | - Ruth Cytter-Kuint
- Radiology Department, Shaare Zedek Medical Center, Jerusalem, Israel
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4
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Anderson R, Cusack B, Bekhit E, Troncoso Solar B, Quinlan C, Kausman J. Taking a multidisciplinary approach to maintaining haemodialysis vascular access: a challenging case in an infant: Answers. Pediatr Nephrol 2021; 36:1161-1163. [PMID: 32875405 DOI: 10.1007/s00467-020-04728-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 07/24/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Rebecca Anderson
- Department of Nephrology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Brendan Cusack
- Department of Nephrology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Elhamy Bekhit
- Department of Medical Imaging, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | | | - Cathy Quinlan
- Department of Nephrology, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | - Joshua Kausman
- Department of Nephrology, The Royal Children's Hospital, Melbourne, Victoria, Australia. .,Department of Paediatrics, University of Melbourne, Melbourne, Australia. .,Murdoch Children's Research Institute, Melbourne, Australia.
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5
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Campos J, Tan Tanny SP, Kuyruk S, Sekaran P, Hawley A, Brooks JA, Bekhit E, Hutson JM, Crameri J, McLeod E, Teague WJ, King SK. The burden of esophageal dilatations following repair of esophageal atresia. J Pediatr Surg 2020; 55:2329-2334. [PMID: 32143903 DOI: 10.1016/j.jpedsurg.2020.02.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/02/2020] [Accepted: 02/06/2020] [Indexed: 02/07/2023]
Abstract
AIM To describe the burden of esophageal dilatations in patients following esophageal atresia (EA) repair. METHOD A retrospective review was performed at The Royal Children's Hospital, Melbourne, of all neonates undergoing operative repair for EA over a 17-year period (1999-2015). Stricture was defined by radiological and/or intra-operative findings of narrowing at the esophageal anastomosis. Data recorded included EA type, perinatal details, operative approach, esophageal anastomosis outcome, dilatation requirement, and survival. Key endpoints were anastomotic leakage and tension, esophageal dilatation technique, dilatation frequency, fundoplication, and complications. RESULTS During the study period, 287 newborn EA patients were admitted, of which 258 underwent operative repair and survived to primary discharge. Excluding 11 patients with isolated tracheoesophageal fistula, 247 patients were included in the final analysis. Intra-operative anastomotic tension was documented in 41/247 (16.6%), anastomotic leak occurred in 48/247 (19.4%), and fundoplication was performed in 37/247 (15.0%). Dilatations were performed in 149/247 (60.3%). Techniques included bougie-alone (92/149, 61.7%), combination of bougie and balloon (51/149, 34.2%), and balloon-alone (6/149, 4.0%). These patients underwent 1128 dilatations; median number of dilatations per patient was 4 (interquartile range 2-8). Long-gap EA and anastomotic tension were risk factors (p < 0.01) for multiple dilatations. Complications occurred in 13/1128 (1.2%) dilatation episodes: 11/13 esophageal perforation, 2/13 clinically significant aspiration. Perforations were rare events in both balloon (6/287, 2.1%) and bougie dilatations (4/841, 0.5%); one patient had a perforation from guidewire insertion. CONCLUSIONS Esophageal dilatation occurred in a majority of EA patients. Long-gap EA was associated with an increased burden of esophageal dilatation. Perforations were rare events in balloon and bougie dilatations. TYPE OF STUDY Original article - retrospective review. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Jose Campos
- Department of Paediatric Surgery, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia
| | - Sharman P Tan Tanny
- Department of Paediatric Surgery, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia; F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC 3052, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC 3010, Australia.
| | - Sema Kuyruk
- Department of Paediatric Surgery, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia
| | - Prabhu Sekaran
- Department of Paediatric Surgery, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia
| | - Alisa Hawley
- Department of Paediatric Surgery, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia; F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC 3052, Australia; Department of Neonatal Intensive Care, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia
| | - Jo-Anne Brooks
- Department of Paediatric Surgery, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia; F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC 3052, Australia; Department of Neonatal Intensive Care, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia
| | - Elhamy Bekhit
- Department of Medical Imaging, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia
| | - John M Hutson
- Department of Paediatric Surgery, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia; F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC 3052, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Joseph Crameri
- Department of Paediatric Surgery, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia
| | - Elizabeth McLeod
- Department of Paediatric Surgery, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia
| | - Warwick J Teague
- Department of Paediatric Surgery, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia; F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC 3052, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Sebastian K King
- Department of Paediatric Surgery, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia; F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC 3052, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC 3010, Australia; Department of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia
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6
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Fitzpatrick NS, Bartley AC, Bekhit E, Berkowitz RG. Skull base anatomy and surgical safety in isolated and CHARGE-associated bilateral choanal atresia. Int J Pediatr Otorhinolaryngol 2018; 115:61-64. [PMID: 30368396 DOI: 10.1016/j.ijporl.2018.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/11/2018] [Accepted: 09/12/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Bilateral choanal atresia (BCA) is associated with a high incidence of congenital abnormalities that include skull base anomalies and defects. Surgical repair of BCA is necessary in the early neonatal period and any altered anatomy of the adjacent skull base will heighten the risk of intracranial injury. This risk may be further increased in patients with CHARGE syndrome. OBJECTIVES To measure surgically relevant nasal and skull base dimensions in neonates with BCA in order to determine whether any difference exists between isolated and CHARGE syndrome associated subgroups, thereby optimizing the safety of surgical repair. METHODS A retrospective review of medical charts and computed tomography was undertaken at a tertiary pediatric hospital of all neonates diagnosed with BCA between 2004 and 2016. Isolated and CHARGE syndrome subgroups of BCA were identified from clinical records and CT data was analyzed and compared between the two. The skull base parameters measured were choanal width, choanal height, mid-nasal skull base height and skull base slope. RESULTS Of the 13 patients included, 3 had CHARGE syndrome and 10 had isolated BCA. Whilst the difference in mid-nasal height approached significance for the two groups, numbers were too small for a statistical difference to be identified. The mean value for choanal width in the isolated BCA group was significantly less the largest series of normative data available in the literature for comparison (p < 0.001). No skull base anomalies were noted in either group. CONCLUSION While this is a small study with limited numbers, it is the first that has attempted to identify and measure the posterior nasal and skull base anatomy most pertinent to avoiding skull base injury in the surgical management of BCA.
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Affiliation(s)
- Nicholas S Fitzpatrick
- Department of Otolaryngology, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.
| | - Anthony C Bartley
- Medical Imaging Department, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Elhamy Bekhit
- Medical Imaging Department, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Robert G Berkowitz
- Department of Otolaryngology, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; Murdoch Children's Research Institute, University of Melbourne, Victoria, Australia
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7
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Pratt JJ, Connell TG, Bekhit E, Crawford NW. Splenic cyst and its management in a 21-month-old boy: a rare complication of invasive meningococcal disease. BMJ Case Rep 2018; 2018:bcr-2018-224613. [PMID: 29728436 DOI: 10.1136/bcr-2018-224613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Splenic complications of invasive meningococcal disease (IMD) are well recognised, though cyst formation is rare, particularly in paediatric populations. The best approach to their management is not yet established. This case outlines the management of a splenic cyst in a 21-month-old boy following severe IMD. The case took place in the context of an acute emergence of serogroup W prompting significant media attention and subsequent change in vaccination practice at a jurisdictional level in Australia. The patient was critically unwell early in the illness, then later a collection in the left upper quadrant was detected, shown on ultrasound to be a 11.6×7.7 cm splenic cyst. In this case, the cyst was managed by ultrasound-guided drainage tube insertion. The residual collection was small and stable on subsequent imaging.
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Affiliation(s)
- Jeremy John Pratt
- Department of General Medicine, Royal Children's Hospital (RCH), Melbourne, Victoria, Australia
| | - Tom G Connell
- Department of General Medicine, Royal Children's Hospital (RCH), Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Elhamy Bekhit
- Department of Radiology, Royal Children's Hospital (RCH), Melbourne, Victoria, Australia
| | - Nigel W Crawford
- Department of General Medicine, Royal Children's Hospital (RCH), Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Surveillance of Adverse Events Following Vaccination In theCommunity (SAEFVIC), Murdoch Children's Research Institute (MCRI), Melbourne, Victoria, Australia
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8
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Bekhit E, Fink A. Giant cervical teratoma and cerebral arteriovenous malformation: Coincidence or association? J Pediatr Neuroradiol 2015. [DOI: 10.3233/pnr-13079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Elhamy Bekhit
- Department of Medical Imaging, The Royal Children’s Hospital, Melbourne, Australia
| | - A. Fink
- Department of Medical Imaging, The Royal Children’s Hospital, Melbourne, Australia
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Narayanam S, de Oliveira V, Krishnamurthy G, Bekhit E, Sertic M, Cheng HL, Connolly BL. Fate, complications and MRI implications of retention anchor suture placed during gastrostomy in children. Pediatr Radiol 2013; 43:1009-16. [PMID: 23417230 DOI: 10.1007/s00247-013-2627-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 11/15/2012] [Accepted: 11/27/2012] [Indexed: 01/25/2023]
Abstract
Retrograde radiologic gastrostomy is one of several techniques used for placing a gastrostomy and is a common technique used in children. The use of a retention anchor suture (RAS) is an important component of this procedure. This pictorial essay explores the normal course and passage of the RAS, as well as abnormal migration, various complications and the implications of the RAS with regard to MRI safety.
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Affiliation(s)
- Surendra Narayanam
- Diagnostic Imaging, Division of Image Guided Therapy, The Hospital for Sick Children, 555 University Ave, Toronto, Canada, M5G 1X8.
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11
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Philpott C, Rosenbaum J, Moon A, Bekhit E, Kumbla S. Paediatric MRCP: 10 year experience with 195 patients. Eur J Radiol 2013; 82:699-706. [DOI: 10.1016/j.ejrad.2012.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 02/03/2012] [Accepted: 08/15/2012] [Indexed: 11/26/2022]
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12
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Haller W, Vrazas J, Bekhit E, Hardikar W. Voice matters: late presentation of an iatrogenic vertebral arteriovenous fistula after liver transplantation in early childhood with successful endovascular treatment. Cardiovasc Intervent Radiol 2011; 34:1109-12. [PMID: 21301844 DOI: 10.1007/s00270-011-0107-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2010] [Accepted: 01/10/2011] [Indexed: 11/25/2022]
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13
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Tibballs J, Fasulakis S, Robertson CF, Berkowitz RG, Massie J, Brizard C, Rose E, Bekhit E, Eyres R, Ragg P. Polyflex stenting of tracheomalacia after surgery for congenital tracheal stenosis. Int J Pediatr Otorhinolaryngol 2007; 71:159-63. [PMID: 17081626 DOI: 10.1016/j.ijporl.2006.07.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2006] [Accepted: 07/31/2006] [Indexed: 11/23/2022]
Abstract
Polyflex self-expanding stents (Rüsch, Germany) were used in three young children who had presented with life-threatening long-segment tracheal stenosis with bronchial stenosis in two cases. Two children had slide tracheoplasties and subsequently aortic homografts and another tracheal resection and autotracheoplasty. However, in all cases persistent lower tracheal malacia necessitated stenting. Complications of granuloma, stent migration or dislodgement occurred in all cases. A fatal tracheo-aortic fistula occurred in one child. Granuloma in one was treated successfully with steroids. One child survives.
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Affiliation(s)
- James Tibballs
- Department of Intensive Care, Royal Children's Hospital, Parkville, Melbourne, Victoria 3052, Australia.
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Abstract
BACKGROUND/PURPOSE Localized intestinal perforation (LP) is thought to be a distinct entity when compared with perforation associated with necrotizing enterocolitis (NEC). Studies have indicated that LP is more amenable to percutaneous drainage and associated with a better outcome. We sought to determine whether LP and NEC could be distinguished based on clinical parameters alone. METHODS A retrospective review of 40 neonates with gastrointestinal perforations between January 1990 and May 1998 was performed. All had undergone laparotomy and had histologic specimens available for evaluation. RESULTS Twenty-one neonates had necrotizing enterocolitis (NEC), and 19 had localized perforation (LP) based on histologic criteria. More neonates with LP were exposed to prenatal indomethacin (37% v 5%; P <.05), received intravenous dexamethasone (42% v 10%; P <.05), had umbilical artery catheters (63% v 14%; P <.05), and had a higher white blood cell (WBC) count (27.1 +/- 23.1 v 14.3 +/- 11.5; P <.05). More neonates with NEC had pneumatosis intestinalis (47% v 11%; P <.05). No significant differences existed in enteral feeding (16% LP v 38% NEC) or overall mortality rate (37% LP v 38% NEC). No statistical differences in the timing of perforation or clinical presentation were found. CONCLUSIONS NEC and LP are difficult to distinguish based on clinical parameters alone. The authors did find associations between LP and prenatal indomethacin, intravenous dexamethasone, umbilical artery catheters, and a higher WBC count. Mortality rate and clinical outcome were nearly identical in both groups. Pneumatosis intestinalis, thought to be pathognomonic for NEC, was seen on abdominal radiograph in 2 babies with histologically proven LP.
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Affiliation(s)
- Hamish Hwang
- Departments of Pediatric Surgery, Pathology, and Radiology, British Columbia's Children's Hospital, Vancouver, British Columbia, Canada
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