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Shpanskaya K, Lungren MP, Tulin-Silver S. Pediatric Interventional Oncology: Endovascular, Percutaneous, and Palliative Procedures. Semin Roentgenol 2019; 54:359-366. [PMID: 31706369 DOI: 10.1053/j.ro.2019.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
| | - Matthew P Lungren
- Department of Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA
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2
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Inserra A, Crocoli A. Palliative care: A surgical perspective. Pediatr Blood Cancer 2019; 66:e27817. [PMID: 31081581 DOI: 10.1002/pbc.27817] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Alessandro Inserra
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
| | - Alessandro Crocoli
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
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Pimpalwar A, Iacobas I, Margolin J, Phan-Tran H, Pimpalwar S. Innovative Use of Denver Shunt in a Child with Generalized Lymphatic Anomaly. J Laparoendosc Adv Surg Tech A 2017; 27:1091-1094. [PMID: 28876997 DOI: 10.1089/lap.2016.0667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Denver® shunts have traditionally been used for palliation of refractory malignant and chylous peritoneal and pleural collections. We describe an innovative use of the Denver shunt in a child with generalized lymphatic anomaly. MATERIALS AND METHODS Retrospective chart review of a 6-year-old girl with generalized lymphatic anomaly, who presented with refractory lymphorrhea from the labium majus, was performed. This was managed with innovative placement of the Denver shunt between a large abdominal wall cyst and the peritoneal cavity. RESULTS There was progressive reduction in lymphorrhea with complete cessation at 11 months post shunt placement. At 33-month follow-up, the shunt remains patent with no further lymphorrhea. CONCLUSION Denver shunts can be utilized for the creation of internal drainage pathways besides its traditional uses for draining peritoneal and pleural fluids.
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Affiliation(s)
- Ashwin Pimpalwar
- 1 Division of Pediatric Surgery, Michael E Debakey Department of Surgery, Baylor College of Medicine and Texas Children's Hospital , Houston, Texas
| | - Ionela Iacobas
- 2 Cancer and Hematology Centers, Baylor College of Medicine and Texas Children's Hospital , Houston, Texas
| | - Judith Margolin
- 2 Cancer and Hematology Centers, Baylor College of Medicine and Texas Children's Hospital , Houston, Texas
| | - Holly Phan-Tran
- 3 Division of Interventional Radiology, Department of Radiology, Texas Children's Hospital , Houston, Texas
| | - Sheena Pimpalwar
- 3 Division of Interventional Radiology, Department of Radiology, Texas Children's Hospital , Houston, Texas
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Karkhanis S, Jones R, Willis A, Mccarthy E, Zia Z, Mehrzad H, O'rourke J, Holt A, Tripathi D. Radiological insertion of automated low flow ascitic pump (alfapump ®) system for management of medically refractory ascites. BJR Case Rep 2017; 3:20170025. [PMID: 30363221 PMCID: PMC6159181 DOI: 10.1259/bjrcr.20170025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 05/01/2017] [Indexed: 11/13/2022] Open
Abstract
Ascites is well-documented sequelae of liver cirrhosis with significant impact on survival in this group of patients. Among the many established management strategies for the same is the use of an implantable mechanical device, called alfapump® (Sequana Medical, Zurich, Switzerland), that removes ascitic fluid by pumping it from the peritoneal cavity to the urinary bladder. Until recently, this device has been surgically placed under general anaesthesia. We describe successful interventional radiological implantation under conscious sedation in three patients with minimal complications. This device can serve as an alternative to transjugular intrahepatic portosystemic shunt for the management of refractory ascites; however, further studies are required to understand the device better.
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Affiliation(s)
- Salil Karkhanis
- Department of Interventional Radiology, Queen Elizabeth Hospital, University Hospital Birmingham Trust, Birmingham, UK
| | - Robert Jones
- Department of Interventional Radiology, Queen Elizabeth Hospital, University Hospital Birmingham Trust, Birmingham, UK
| | - Andrew Willis
- Department of Interventional Radiology, Queen Elizabeth Hospital, University Hospital Birmingham Trust, Birmingham, UK
| | - Eoghan Mccarthy
- Department of Interventional Radiology, Queen Elizabeth Hospital, University Hospital Birmingham Trust, Birmingham, UK
| | - Zergham Zia
- Department of Interventional Radiology, Queen Elizabeth Hospital, University Hospital Birmingham Trust, Birmingham, UK
| | - Homoyoon Mehrzad
- Department of Interventional Radiology, Queen Elizabeth Hospital, University Hospital Birmingham Trust, Birmingham, UK
| | - Joanne O'rourke
- Department of Hepatology and Liver Transplant Unit, Queen Elizabeth Hospital, University Hospital Birmingham Trust, Birmingham, UK
| | - Andrew Holt
- Department of Hepatology and Liver Transplant Unit, Queen Elizabeth Hospital, University Hospital Birmingham Trust, Birmingham, UK
| | - Dhiraj Tripathi
- Department of Hepatology and Liver Transplant Unit, Queen Elizabeth Hospital, University Hospital Birmingham Trust, Birmingham, UK
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Inserra A, Narciso A, Paolantonio G, Messina R, Crocoli A. Palliative care and pediatric surgical oncology. Semin Pediatr Surg 2016; 25:323-332. [PMID: 27955737 DOI: 10.1053/j.sempedsurg.2016.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Survival rate for childhood cancer has increased in recent years, reaching as high as 70% in developed countries compared with 54% for all cancers diagnosed in the 1980s. In the remaining 30%, progression or metastatic disease leads to death and in this framework palliative care has an outstanding role though not well settled in all its facets. In this landscape, surgery has a supportive actor role integrated with other welfare aspects from which are not severable. The definition of surgical palliation has moved from the ancient definition of noncurative surgery to a group of practices performed not to cure but to alleviate an organ dysfunction offering the best quality of life possible in all the aspects of life (pain, dysfunctions, caregivers, psychosocial, etc.). To emphasize this aspect a more modern definition has been introduced: palliative therapy in whose context is comprised not only the care assistance but also the plans of care since the onset of illness, teaching the matter to surgeons in training and share paths. Literature is very poor regarding surgical aspects specifically dedicated and all researches (PubMed, Google Scholar, and Cochrane) with various meshing terms result in a more oncologic and psychosocial effort.
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Affiliation(s)
- Alessandro Inserra
- General Pediatric and Thoracic Surgery, Bambino Gesù Children׳s Hospital-Research Institute, Rome, Italy.
| | - Alessandra Narciso
- General Pediatric and Thoracic Surgery, Bambino Gesù Children׳s Hospital-Research Institute, Rome, Italy
| | - Guglielmo Paolantonio
- Interventional Radiology Unit, Bambino Gesù Children׳s Hospital-Research Institute, Rome, Italy
| | - Raffaella Messina
- Neurosurgery Unit, Bambino Gesù Children׳s Hospital-Research Institute, Rome, Italy
| | - Alessandro Crocoli
- General Pediatric and Thoracic Surgery, Bambino Gesù Children׳s Hospital-Research Institute, Rome, Italy
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Dayal S, Ghosh D, Moran B. Miscellaneous conditions of the peritoneal cavity--peritoneal tumors, pseudomyxoma, mesothelioma, fibroblastic reaction, cocoon, cystic lymphatic malformations, blue-bleb, and chylous ascites. Semin Pediatr Surg 2014; 23:363-8. [PMID: 25459443 DOI: 10.1053/j.sempedsurg.2014.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The peritoneum is subject to both primary neoplasia and secondary malignancy from direct, trans-coelomic, or hematogenous spread from any cancer. The knowledge base in the pediatric age group is very limited due to the rarity of peritoneal conditions in children, and much of the information is extrapolated from adult literature. There have been few reports in the pediatric population on the diagnosis and management of peritoneal conditions including peritoneal malignancy. In this article, we aim to highlight some of these conditions and the treatments available with a special emphasis on the evolving role of cytoreduction surgery and hyperthermic intraperitoneal chemotherapy in the treatment of certain peritoneal malignancies in children.
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Affiliation(s)
- Sanjeev Dayal
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Dhruv Ghosh
- Children׳s Hospital at Westmead, Westmead, Sydney, New South Wales, Australia
| | - Brendan Moran
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK.
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Roebuck DJ. Interventional radiology in paediatric palliative care. Pediatr Radiol 2014; 44:12-7. [PMID: 24395375 DOI: 10.1007/s00247-013-2815-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 10/03/2013] [Indexed: 02/07/2023]
Abstract
Paediatric palliative care is a distinct subspecialty that offers treatment to children with many types of illness, including oncological, neurological and respiratory problems. Paediatric interventional radiologists can make a useful contribution to symptom management as part of a multidisciplinary team. Interventions for pain management include local ablation or other treatment of painful lesions, image-guided nerve blocks and the insertion of devices for the delivery of analgesic drugs. Various techniques are also available for the management of ascites, pleural effusions and other symptomatic complications of the underlying disease process.
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Affiliation(s)
- Derek J Roebuck
- Department of Radiology, Great Ormond Street Hospital, London, WC1N 3 JH, UK,
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Percutaneous placement and management of the Denver shunt for portal hypertensive ascites. AJR Am J Roentgenol 2012; 199:W449-53. [PMID: 22997394 DOI: 10.2214/ajr.12.9203] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Many patients with cirrhotic effusions in the peritoneal and pleural spaces lead a difficult existence. In addition to their decreased mobility and physical discomfort, they spend hours in the hospital or an outpatient facility undergoing peritoneal and pleural drainage. Liver transplantation is the ultimate solution for those with cirrhotic effusions refractory to medical management; however, most are on a long waiting list, forcing them to undergo a year or more of percutaneous centesis. Transjugular intrahepatic portosystemic shunts offer relief to those with cirrhotic ascites but at the cost of accelerated hepatic failure and hepatic encephalopathy. This article will review the development of the peritoneovenous and pleurovenous shunt, discuss reasons for its loss of favor, and suggest its current role in the armamentarium of the interventional radiologist. CONCLUSION Peritoneovenous and pleurovenous shunt creation is a procedure that has the potential to significantly improve the quality of life of the patient by controlling the fluid collections, reducing dependence on frequent drainage procedures, improving renal function, and reducing protein loss.
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