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Lojanatorn P, Ruangwattanapaisarn N, Klaisuban W, Tanpowpong P. Primary pancreatic lymphoma in a child presenting with rapidly progressive obstructive jaundice. Pediatr Neonatol 2024; 65:87-88. [PMID: 37953103 DOI: 10.1016/j.pedneo.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/07/2023] [Accepted: 09/08/2023] [Indexed: 11/14/2023] Open
Affiliation(s)
- Ponlakit Lojanatorn
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nichanan Ruangwattanapaisarn
- Department of Diagnostic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wipawi Klaisuban
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pornthep Tanpowpong
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Tanaanantarak P, Kritsaneepaiboon S, Charoonratana V, Chittchang C, Chutiwongthanaphat K, Pacharn P, Iemsawatdikul K, Amornsitthiwat R, Ruangwattanapaisarn N, Eng-Chuan S, Junhasavasdikul T, Mahayosnond A, Tewattanarat N, Kitpraphasiri P, Phewplung T, Tangsiwong T, Sangsupawanich P. Cranial ultrasound performance assessment tool: development and validation. Med Ultrason 2023. [PMID: 38150694 DOI: 10.11152/mu-4307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
AIM A standard assessment tool for direct evaluation of procedural skills to ensure proficiency of trainees is necessary for cranial ultrasound (US) in clinical practice. This study created and validated an assessment tool for cranial US performance by radiologists. MATERIAL AND METHODS An initial evaluation tool for cranial US using criteria was developed based on existing literature. The assessment form was modified using a three-round Delphi process by an expert panel, conducted between January 2021 and April 2021. Rubric scales for grading were added once consensus regarding generated items was reached. Experts confirmed the final assessment tool using a rubric scale. Two raters evaluated cranial US performance of 27 residents in video clips using the tool. Reliability and percent agreement were assessed. RESULTS Seventeen pediatric radiologists working in different settings participated in the expert panel. The content validation of the proposed evaluation tool was enabled by expert pediatric radiologists. Following three rounds of the Delphi process, the initial 14-item assessment form became a final 15-item form. A three-part rubric scale was used in the final form (preparation, US machine operation, and cranial US performance). Interrater reliability was evaluated with Cohen's Kappa. The Kappa value and percent interrater agreement for most items was moderate to almost perfect (0.42-0.93 and 77.8-100%, respectively). The Cronbach's alpha values for both raters were 0.856 and 0.891. CONCLUSIONS This study produced the first validated cranial US assessment tool using a modified Delphi method. The final assessment form is a simple and reliable tool.
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Affiliation(s)
- Pattama Tanaanantarak
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla
| | | | - Vorawan Charoonratana
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla
| | - Chomanad Chittchang
- Department of Radiology, Queen Sirikit National Institute of Child Health, Bangko
| | | | - Preeyacha Pacharn
- Department of Radiology, Siriraj Hospital, Faculty of Medicine, Mahidol University, Bangkok
| | | | - Ramida Amornsitthiwat
- Department of Radiology, Siriraj Hospital, Faculty of Medicine, Mahidol University, Bangkok
| | - Nichanan Ruangwattanapaisarn
- Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok
| | - Suwadee Eng-Chuan
- Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok
| | - Thitiporn Junhasavasdikul
- Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok
| | - Atchara Mahayosnond
- Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok
| | | | | | - Teerasak Phewplung
- Department of Radiology, Faculty of Medicine, King Chulalongkorn Memorial Hospital and Chulalongkorn University, Bangkok
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Ketsuwan S, Tanpowpong P, Ruangwattanapaisarn N, Phaopant S, Suppalarkbunlue N, Kooanantkul C, Anantasit N, Vaewpanich J. Intravenous Metoclopramide to Improve the Success Rate of Blind Bedside Post-pyloric Placement of Feeding Tube in Critically Ill Children: A Randomized, Double-Blind, Placebo-Controlled Study. Front Pediatr 2021; 9:739247. [PMID: 35004534 PMCID: PMC8727866 DOI: 10.3389/fped.2021.739247] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 11/15/2021] [Indexed: 11/14/2022] Open
Abstract
Objective: Impaired gastric emptying is a common cause of delayed feeding in critically ill children. Post-pyloric feeding may help improve feeding intolerance and nutritional status and, hence, contribute to a better outcome. However, post-pyloric feeding tube insertion is usually delayed due to a technical difficulty. Therefore, prokinetic agents have been used to facilitate blind bedside post-pyloric feeding tube insertion. Metoclopramide is a potent prokinetic agent that has also been used to improve motility in adults and children admitted to intensive care units. The objective of this study was to determine the efficacy of intravenous metoclopramide in promoting the success rate of blind bedside post-pyloric feeding tube placement in critically ill children. Design: The design of this study is randomized, double blind, placebo controlled. Setting: The setting of the study is a single-center pediatric intensive care unit. Patients: Children aged 1 month-18 years admitted to the pediatric intensive care unit with severe illness or feeding intolerance were enrolled in this study. Intervention: Patients were randomly selected to receive intravenous metoclopramide or 0.9% normal saline solution (the placebo) prior to the tube insertion. The study outcome was the success rate of post-pyloric feeding tube placement confirmed by an abdominal radiography 6-8 h after the insertion. Measurements and Main Results: We found that patients receiving metoclopramide had a higher success rate (37/42, 88%) of post-pyloric feeding tube placement than the placebo (28/40, 70%) (p = 0.04). Patients who received sedative drug or narcotic agent showed a tendency of higher success rate (p = 0.08). Conclusion: Intravenous metoclopramide improves the success rate of blind bedside post-pyloric placement of feeding tube in critically ill children. Trial Registration: Thai Clinical Trial Registry TCTR20190821002. Registered 15th August 2019.
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Affiliation(s)
- Sirima Ketsuwan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pornthep Tanpowpong
- Division of Gastroenterology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nichanan Ruangwattanapaisarn
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Supatra Phaopant
- Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nattanicha Suppalarkbunlue
- Clinical Pharmacy Department, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Nattachai Anantasit
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jarin Vaewpanich
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Thirapattaraphan C, Treepongkaruna S, Ruangwattanapaisarn N, Sae-Guay S. Congenital extrahepatic portosystemic shunt (Abernethy malformation) treated with surgical shunt ligation: A case report and literature review. Int J Surg Case Rep 2019; 66:4-7. [PMID: 31783328 PMCID: PMC6889787 DOI: 10.1016/j.ijscr.2019.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/03/2019] [Accepted: 11/06/2019] [Indexed: 11/30/2022] Open
Abstract
Abernethy malformation is a rare congenital abnormality characterized by an extrahepatic portosystemic shunt. Doppler ultrasonography is usually the initial investigation. Computerized tomography (CT) scan or magnetic resonance imaging (MRI) scan is helpful in confirming the diagnosis. Preoperative angiography with balloon occlusion test is highly recommended to determine the most appropriate intervention. We propose guidelines for approaching and management this condition.
Introduction Congenital extrahepatic portosystemic shunt is also known as Abernethy malformation. It is a rare anomaly of the portal venous system where partial or complete portal blood flow drains directly into the systemic vein via this abnormal shunt, bypassing the liver. Occasionally, this condition is incidentally detected on imaging studies performed for other indications. An early diagnosis is challenging due to the lack of specific symptoms—often leading to delayed diagnosis and development of subsequent complications. Presentation of case A 4-year-old boy presented with multiple cutaneous hemangiomas with concomitant splenomegaly. While the diagnostic work-up for the definite cause of splenomegaly was in progress, an Abernethy malformation was incidentally noted by abdominal ultrasonography. After computerized tomography (CT) imaging confirmed the diagnosis, the patient underwent a successful surgical shunt ligation without any complications through a one-year follow-up period. Discussion Various imaging studies, including Doppler ultrasonography, CT imaging, and Magnetic Resonance Imaging (MRI), are useful tools to diagnose an Abernethy malformation. Preoperative angiography with a balloon occlusion of the shunt is highly recommended in order to opt for the most appropriate intervention—including one-or-two-step surgical closure, endovascular occlusion, and liver transplantation. Conclusion An Abernethy malformation should be considered in the differential diagnosis of unexplained portal hypertension or any of its associated complications in pediatric patients. Early diagnosis and proper management of this condition can lead to a favorable prognosis, as in this case. Accordingly, a pre-operative evaluation is important to determine the proper therapeutic method.
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Affiliation(s)
- Chollasak Thirapattaraphan
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Tung Phayathai, Ratchathewi, Bangkok 10400, Thailand
| | - Suporn Treepongkaruna
- Division of Gastroenterology, Department of Paediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Tung Phayathai, Ratchathewi, Bangkok 10400, Thailand
| | - Nichanan Ruangwattanapaisarn
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Tung Phayathai, Ratchathewi, Bangkok 10400, Thailand
| | - Suthida Sae-Guay
- Division of Pediatric Surgery, Department of Surgery, Phramongkutklao Hospital, 315 Rajavithi Road, Tung Phayathai, Ratchathewi, Bangkok, 10400, Thailand.
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Sriphongphankul H, Tanpowpong P, Ruangwattanapaisarn N, Thirapattaraphan C, Treepongkaruna S. Anaplastic Large Cell Lymphoma of the Duodenum in a Teenage Girl: Misdiagnosed as an Intramural Duodenal Hematoma. Pediatr Gastroenterol Hepatol Nutr 2019; 22:571-575. [PMID: 31777723 PMCID: PMC6856504 DOI: 10.5223/pghn.2019.22.6.571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 08/23/2019] [Indexed: 11/14/2022] Open
Abstract
We report a case of a 13-year-old girl who presented with a 2-month history of intermittent abdominal pain. Laboratory examination showed hepatitis and pancreatitis. Because of persistent vomiting, computed tomography (CT) was performed, which revealed a circumferential soft tissue density in the duodenal wall, causing partial obstruction. Supportive therapy failed. Repeat CT showed no significant change from the initial study. The patient underwent upper endoscopy, which revealed a mass in the second portion of the duodenum, which occluded most parts of the lumen. The histopathological finding was consistent with an anaplastic large cell lymphoma, a rare form of small bowel neoplasm. After the third course of chemotherapy, complete resolution of the mass was noted, and her symptoms were relieved.
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Affiliation(s)
- Hansa Sriphongphankul
- Department of Pediatrics, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand.,Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Pornthep Tanpowpong
- Department of Pediatrics, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand
| | - Nichanan Ruangwattanapaisarn
- Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand
| | - Chollasak Thirapattaraphan
- Division of Pediatric Surgery, Department of Surgery, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand
| | - Suporn Treepongkaruna
- Department of Pediatrics, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand
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Lerkvaleekul B, Treepongkaruna S, Ruangwattanapaisarn N, Treesit T, Vilaiyuk S. Recurrent ruptured abdominal aneurysms in polyarteritis nodosa successfully treated with infliximab. Biologics 2019; 13:111-116. [PMID: 31354239 PMCID: PMC6585408 DOI: 10.2147/btt.s204726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 05/09/2019] [Indexed: 11/23/2022]
Abstract
Systemic polyarteritis nodosa (PAN) is a rare form of necrotizing vasculitis in children. Recurrent episodes of abdominal aneurysm ruptures are uncommon and life-threatening condition in children. Failures of response to immunosuppressive medications and radiological intervention also lead to high mortality. Some reports suggested that tumor necrosis factor (TNF) might have role in the inflammation of this disease. After an English-language literature review, this is the first case report in children of recurrent abdominal-ruptured aneurysms with a failure of conventional therapy but successfully treated with anti-TNF-α monoclonal antibody. We herein describe a 9-year-old girl who presented with chronic abdominal pain, hypertension, and massive lower gastrointestinal bleeding. The disease was refractory to conventional treatment, including administration of a corticosteroid, cyclophosphamide, and intravenous immunoglobulin, and recurrent-ruptured aneurysms developed in the gastrointestinal tract. Arterial embolization during angiography resulted in temporary improvement of the gastrointestinal bleeding. Infliximab, a chimeric anti-tumor necrosis factor-α monoclonal antibody, was initiated and resulted in disease remission with resolution of the gastrointestinal bleeding and abdominal pain. Anti-TNF therapy might be another treatment option for refractory disease to prevent ongoing inflammation that could lead to aneurysmal dilatation or even rupture. However, early recognition of refractory disease and aggressive treatment in the early course of the disease are crucial to reduce morbidity and mortality.
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Affiliation(s)
- Butsabong Lerkvaleekul
- Division of Rheumatology, Department of Paediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suporn Treepongkaruna
- Division of Gastroenterology, Department of Paediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nichanan Ruangwattanapaisarn
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tharintorn Treesit
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Soamarat Vilaiyuk
- Division of Rheumatology, Department of Paediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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7
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Manuyakorn W, Bamrungchaowkasem B, Ruangwattanapaisarn N, Kamchaisatian W, Benjaponpitak S. Needle length for epinephrine prefilled syringes in children and adolescents: Is one inch needle appropriate? Asian Pac J Allergy Immunol 2017; 36:113-119. [PMID: 28938839 DOI: 10.12932/ap-020317-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Intramuscular epinephrine is the first line drug in the treatment of anaphylaxis. This study was to identify the appropriateness of 1 inch needle length for epinephrine prefilled syringes in children. METHODS Children aged 1 month to 18 years were enrolled. Skin to muscle depth (STMD) and skin to bone depth (STBD) were measured using an ultrasonography at the mid-anterolateral thigh. A 1 inch needle was considered as being appropriate if the STBD was more than 1 inch and the STMD was less than 1 inch. RESULTS Seventy five infants, 75 pre-school aged children, 75 school aged children and 147 adolescent were enrolled: 196 (52.7%) children were male. A 1 inch needle length was appropriate for 61% of the infants, for 88% of the preschool children, for 99% of the school aged children and for 95% of the adolescents. Thigh circumference ≥23 cm, BMI ≥16 kg/m2 and BW ≥ 6 kg in infants provided the sensitivity of 74%-96% in predicting the appropriateness of 1 inch needle. In preschool group, thigh circumference ≥25 cm, BMI ≥13.5 kg/m2 and BW ≥ 10 kg provided the sensitivity of 98.5-100% in predicting the appropriateness of 1 inch needle. Thigh circumference ≥ 49 cm in adolescents provided the sensitivity of 75% in predicting that a 1 inch needle was too short. CONCLUSION One inch needle length may not be appropriated for intramuscular injection at thigh in all children. Thigh circumference, BMI and body weight are useful for predictor for using the 1 inch needle.
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Affiliation(s)
- Wiparat Manuyakorn
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Buntita Bamrungchaowkasem
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Wasu Kamchaisatian
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suwat Benjaponpitak
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Junhasavasdikul T, Ruangwattanapaisarn N, Molagool S, Lertudomphonwanit C, Sirachainan N, Larbcharoensub N. Immature gastric teratoma in an infant: a case report and review of the literatures. Clin Case Rep 2016; 4:962-967. [PMID: 27761247 PMCID: PMC5054471 DOI: 10.1002/ccr3.654] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 02/11/2016] [Accepted: 04/08/2016] [Indexed: 11/06/2022] Open
Abstract
Immature gastric teratoma is an uncommon germ cell tumor of the stomach. We report a rare case of immature gastric teratoma in an infant with down syndrome with clinically presenting with hematemesis and severe anemia. Complete surgical resection remains the cornerstone of treatment.
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Affiliation(s)
- Thitiporn Junhasavasdikul
- Department of Radiology Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand
| | | | - Sani Molagool
- Department of Surgery Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand
| | | | - Nongnuch Sirachainan
- Department of Pediatric Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand
| | - Noppadol Larbcharoensub
- Department of Pathology Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand
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9
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Lerkvaleekul B, Treepongkaruna S, Saisawat P, Thanachatchairattana P, Angkathunyakul N, Ruangwattanapaisarn N, Vilaiyuk S. Henoch-Schönlein purpura from vasculitis to intestinal perforation: A case report and literature review. World J Gastroenterol 2016; 22:6089-6094. [PMID: 27468201 PMCID: PMC4948269 DOI: 10.3748/wjg.v22.i26.6089] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 05/07/2016] [Accepted: 05/23/2016] [Indexed: 02/06/2023] Open
Abstract
Henoch-Schönlein purpura (HSP) is generally a self-limited vasculitis disease and has a good prognosis. We report a 4-year-old Thai boy who presented with palpable purpura, abdominal colicky pain, seizure, and eventually developed intestinal ischemia and perforation despite adequate treatment, including corticosteroid and intravenous immunoglobulin therapy. Imaging modalities, including ultrasonography and contrast-enhanced computed tomography, could not detect intestinal ischemia prior to perforation. In this patient, we also postulated that vasculitis-induced mucosal ischemia was a cause of the ulcer, leading to intestinal perforation, and high-dose corticosteroid could have been a contributing factor since the histopathology revealed depletion of lymphoid follicles. Intestinal perforation in HSP is rare, but life-threatening. Close monitoring and thorough clinical evaluation are essential to detect bowel ischemia before perforation, particularly in HSP patients who have hematochezia, persistent localized abdominal tenderness and guarding. In highly suspicious cases, exploratory laparotomy may be needed for the definite diagnosis and prevention of further complications.
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10
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Loening AM, Saranathan M, Ruangwattanapaisarn N, Litwiller DV, Shimakawa A, Vasanawala SS. Increased speed and image quality in single-shot fast spin echo imaging via variable refocusing flip angles. J Magn Reson Imaging 2015; 42:1747-58. [PMID: 26094580 DOI: 10.1002/jmri.24941] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 04/23/2015] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To develop and validate clinically a single-shot fast spin echo (SSFSE) sequence utilizing variable flip angle refocusing pulses to shorten acquisition times via reductions in specific absorption rate (SAR) and improve image quality. MATERIALS AND METHODS A variable refocusing flip angle SSFSE sequence (vrfSSFSE) was designed and implemented, with simulations and volunteer scans performed to determine suitable flip angle modulation parameters. With Institutional Review Board (IRB) approval/informed consent, patients referred for 3T abdominal magnetic resonance imaging (MRI) were scanned with conventional SSFSE and either half-Fourier (n = 25) or full-Fourier vrfSSFSE (n = 50). Two blinded radiologists semiquantitatively scored images on a scale from -2 to 2 for contrast, noise, sharpness, artifacts, cardiac motion-related signal loss, and the ability to evaluate the pancreas and kidneys. RESULTS vrfSSFSE demonstrated significantly increased speed (∼2-fold, P < 0.0001). Significant improvements in image quality parameters with full-Fourier vrfSSFSE included increased contrast, sharpness, and visualization of pancreatic and renal structures with higher bandwidth technique (mean scores 0.37, 0.83, 0.62, and 0.31, respectively, P ≤ 0.001), and decreased image noise and improved visualization of renal structures when used with an equal bandwidth technique (mean scores 0.96 and 0.35, respectively, P < 0.001). Increased cardiac motion-related signal loss with full-Fourier vrfSSFSE was seen in the pancreas but not the kidney. CONCLUSION vrfSSFSE increases speed at 3T over conventional SSFSE via reduced SAR, and when combined with full-Fourier acquisition can improve image quality, although with some increased sensitivity to cardiac motion-related signal loss.
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Affiliation(s)
- Andreas M Loening
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Manojkumar Saranathan
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Nichanan Ruangwattanapaisarn
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA.,Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Daniel V Litwiller
- GE Healthcare Global MR Applications and Workflow, Rochester, Minnesota, USA
| | - Ann Shimakawa
- GE Healthcare Global MR Applications and Workflow, Menlo Park, California, USA
| | - Shreyas S Vasanawala
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
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Angkathunyakul N, Treepongkaruna S, Molagool S, Ruangwattanapaisarn N. Abnormal layering of muscularis propria as a cause of chronic intestinal pseudo-obstruction: A case report and literature review. World J Gastroenterol 2015; 21:7059-7064. [PMID: 26078585 PMCID: PMC4462749 DOI: 10.3748/wjg.v21.i22.7059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/09/2015] [Accepted: 03/31/2015] [Indexed: 02/06/2023] Open
Abstract
Visceral myopathy is one of the causes of chronic intestinal pseudo-obstruction. Most cases pathologically reveal degenerative changes of myocytes or muscularis propia atrophy and fibrosis. Abnormal layering of muscularis propria is extremely rare. We report a case of a 9-mo-old Thai male baby who presented with chronic intestinal pseudo-obstruction. Histologic findings showed abnormal layering of small intestinal muscularis propria with an additional oblique layer and aberrant muscularization in serosa. The patient also had a short small bowel without malrotation, brachydactyly, and absence of the 2nd to 4th middle phalanges of both hands. The patient was treated with cisapride and combined parenteral and enteral nutritional support. He had gradual clinical improvement and gained body weight. Subsequently, the parenteral nutrition was discontinued. The previously reported cases are reviewed and discussed.
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12
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Ruangwattanapaisarn N, Hsiao A, Vasanawala SS. Ferumoxytol as an off-label contrast agent in body 3T MR angiography: a pilot study in children. Pediatr Radiol 2015; 45:831-9. [PMID: 25427433 PMCID: PMC4446254 DOI: 10.1007/s00247-014-3226-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 10/07/2014] [Accepted: 10/28/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Ferumoxytol is an ultrasmall superparamagnetic iron oxide (USPIO) nanoparticle agent used to treat iron deficiency anemia in adults with chronic kidney disease. OBJECTIVE We aim to determine the feasibility of using ferumoxytol for clinical pediatric cardiac and vascular imaging. MATERIAL AND METHODS We retrospectively identified 23 consecutive children who underwent MRI with ferumoxytol (11 males; mean age: 7.4 years, range: 3 days-18 years), yielding 12 abdominal MR angiography and 15 cardiac MRI studies. Medical records were reviewed for the clinical indication, ferumoxytol dose, injection rate, sedation and any complication. A two-reader consensus scored the images on a five-point scale for overall image quality and delineation of various anatomical structures. Signal-to-background ratios for abdominal aorta and inferior vena cava for abdominal cases and blood pool-myocardium contrast ratios for cardiac cases were calculated. The confidence intervals for obtaining a score of three or above for each image parameter were calculated by using adjusted Wald method. RESULTS For abdominal MR angiography, average scores for overall image quality, as well as delineation of the hepatic artery, superior mesenteric artery, renal artery and veins were 4.5, 4.3, 4.3, 3.7 and 4.7, respectively. For cardiac exams, the average scores for overall image quality, systemic arteries, pulmonary arteries, pulmonary veins, valves and ventricles were 4.4, 4.6, 4.1, 4.8, 4.1 and 4.7, respectively. For all parameters, the lower bound for the proportion of cases to have a score of 3 or above was 65%. Signal-to-background ratios for aorta and abdominal veins averaged 86 +/- 74 and 86 +/- 77 for full-dose images, and 23 and 18 for half-dose images, respectively. Mean blood pool to myocardium contrast ratio was 3:3. CONCLUSION Ferumoxytol can provide excellent image quality for pediatric body MR angiography/MR venography at a dose of 1.5 or 3 mg Fe/kg. Further investigation should be directed toward understanding the lowest dose that can be administered.
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Affiliation(s)
- Nichanan Ruangwattanapaisarn
- Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. LPCH Department of Radiology, Stanford University, Stanford, CA 94305, USA
| | - Albert Hsiao
- LPCH Department of Radiology, Stanford University, Stanford, CA 94305, USA
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Cheng JY, Zhang T, Ruangwattanapaisarn N, Alley MT, Uecker M, Pauly JM, Lustig M, Vasanawala SS. Free-breathing pediatric MRI with nonrigid motion correction and acceleration. J Magn Reson Imaging 2014; 42:407-20. [PMID: 25329325 DOI: 10.1002/jmri.24785] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Accepted: 10/06/2014] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To develop and assess motion correction techniques for high-resolution pediatric abdominal volumetric magnetic resonance images acquired free-breathing with high scan efficiency. MATERIALS AND METHODS First, variable-density sampling and radial-like phase-encode ordering were incorporated into the 3D Cartesian acquisition. Second, intrinsic multichannel butterfly navigators were used to measure respiratory motion. Lastly, these estimates are applied for both motion-weighted data-consistency in a compressed sensing and parallel imaging reconstruction, and for nonrigid motion correction using a localized autofocusing framework. With Institutional Review Board approval and informed consent/assent, studies were performed on 22 consecutive pediatric patients. Two radiologists independently scored the images for overall image quality, degree of motion artifacts, and sharpness of hepatic vessels and the diaphragm. The results were assessed using paired Wilcoxon test and weighted kappa coefficient for interobserver agreements. RESULTS The complete procedure yielded significantly better overall image quality (mean score of 4.7 out of 5) when compared to using no correction (mean score of 3.4, P < 0.05) and to using motion-weighted accelerated imaging (mean score of 3.9, P < 0.05). With an average scan time of 28 seconds, the proposed method resulted in comparable image quality to conventional prospective respiratory-triggered acquisitions with an average scan time of 91 seconds (mean score of 4.5). CONCLUSION With the proposed methods, diagnosable high-resolution abdominal volumetric scans can be obtained from free-breathing data acquisitions.
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Affiliation(s)
- Joseph Y Cheng
- Magnetic Resonance Systems Research Laboratory, Department of Electrical Engineering, Stanford University, Stanford, California, USA.,Department of Radiology, Stanford University, Stanford, California, USA
| | - Tao Zhang
- Magnetic Resonance Systems Research Laboratory, Department of Electrical Engineering, Stanford University, Stanford, California, USA.,Department of Radiology, Stanford University, Stanford, California, USA
| | | | - Marcus T Alley
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Martin Uecker
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, California, USA
| | - John M Pauly
- Magnetic Resonance Systems Research Laboratory, Department of Electrical Engineering, Stanford University, Stanford, California, USA
| | - Michael Lustig
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, California, USA
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Chamadol N, Laopaiboon V, Ruangwattanapaisarn N, Khuntikeo N, Pairojkul C. Computed tomographic appearances of colorectal liver metastases. J Med Assoc Thai 2011; 94:826-832. [PMID: 21774290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND There are various computed tomographic appearances of liver metastases from colorectal cancer, but there is little data in Thailand. MATERIAL AND METHOD This was a retrospective, descriptive study of the CT appearances of 21 patients diagnosed with liver metastasis from colorectal cancer in Srinagarind Hospital, Khon Kaen, between January 2003 and December 2007. All of the patients were examined in the portovenous phases. RESULTS Rim-enhancement was seen in 20 patients (95.2%). Irregular rim-enhancement was seen in 19 patients (90.5%) and smooth rim-enhancement in one (4.8%). Thin rim was seen in 16 patients (76.2%) and thick rim in four (19%). Internal heterogeneous enhancement was seen in 15 patients (71.4%). Irregular, thin rim-enhancement with internal heterogeneous enhancement was the most common combination seen in 12 patients (57.1%). CONCLUSION An enhancing rim could be seen in 95.2% of patients. Internal heterogeneous enhancement was shown in 71.4% of patients. Familiarity with the various CT appearances may help to facilitate the diagnosis of colorectal liver metastases.
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Affiliation(s)
- Nittaya Chamadol
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
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