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Ham PB, Anderson SR, Neff LP, Osei H, Gill AE, Hawkins CM, Jose J, Bhatia AM. Percutaneous Embolization and Laparoscopic Ligation of a Congenital Umbilical Arteriovenous Malformation. Am Surg 2023; 89:6278-6281. [PMID: 36629251 DOI: 10.1177/00031348221148348] [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] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Phillip Benson Ham
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, GA, USA
- Division of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, NY, USA
| | - Spencer R Anderson
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, GA, USA
- Department of Plastics and Reconstructive Surgery, Wright State University School of Medicine, Dayton, OH, USA
| | - Lucas P Neff
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, GA, USA
| | - Hector Osei
- Division of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, NY, USA
| | - Anne E Gill
- Division of Interventional Radiology and Image Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Division of Pediatric Radiology, Emory + Children's Pediatric Institute, Children Healthcare of Atlanta, Atlanta, GA, USA
| | - Clifford M Hawkins
- Division of Interventional Radiology and Image Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Division of Pediatric Radiology, Emory + Children's Pediatric Institute, Children Healthcare of Atlanta, Atlanta, GA, USA
| | - Jeremy Jose
- Philadelphia College of Osteopathic Medicine, Suwanee, GA, USA
| | - Amina M Bhatia
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, GA, USA
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Muhammad H, L'Huillier JC, Benson Ham P, Vali K. Strategies for appropriate positioning and repositioning the Avalon ECMO cannula in a 17-year-old with left hepatic vein malposition. Perfusion 2023; 38:645-650. [PMID: 34927476 DOI: 10.1177/02676591211063829] [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: 11/15/2022]
Abstract
INTRODUCTION Extracorporeal membrane oxygenation (ECMO) is a well-recognized therapy in children with refractory hypoxia. Different cannulas have been used with reported complications with placement, such as cardiac perforation, and multiple reports focusing on avoiding this. However, strategies to avoid hepatic vein cannulation and reposition when it occurs are not well described. CASE REPORT Here, we report a case where a 27-Fr Avalon bicaval double lumen cannula in the left hepatic vein was successfully repositioning using serial chest X-rays (CXR) and transthoracic echocardiography (TTE) in a 17-year-old female. DISCUSSION While venovenous (VV) ECMO is preferred by many, placement of the Avalon catheter, a cannula available for VV ECMO, may be challenging due to migration or positioning issues. Specific techniques of wire and catheter advancement as well as confirming wire position in the infra-hepatic inferior vena cava can help ensure appropriate positioning while avoiding hepatic vein cannulation and enabling successful repositioning when it occurs. CONCLUSION Wire position in the infra-hepatic inferior vena cava helps ensure safe and appropriate Avalon cannula position and placement. The Avalon cannula can be successfully repositioned from the left hepatic vein by retracting the cannula, reinserting the wire and introducer together, and then manipulation techniques using serial CXR and TTE.
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Affiliation(s)
- Haris Muhammad
- Department of Pediatric Surgery, 23561John R. Oishei Children's Hospital Buffalo, NY, USA
| | - Joseph C L'Huillier
- Department of Pediatric Surgery, 23561John R. Oishei Children's Hospital Buffalo, NY, USA.,Department of Surgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Phillip Benson Ham
- Department of Pediatric Surgery, 23561John R. Oishei Children's Hospital Buffalo, NY, USA.,Department of Surgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Kaveh Vali
- Department of Pediatric Surgery, 23561John R. Oishei Children's Hospital Buffalo, NY, USA.,Department of Surgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
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Zhang JF, Umenta J, Ali A, Reynolds R, Ham PB, Thomas RD, Piryani R, Izhar M, Wrotniak B, Swayampakula AK. Cervical spine flexion-extension radiography versus magnetic resonance imaging in pediatric patients following blunt traumatic injury. Trauma Surg Acute Care Open 2023; 8:e001016. [PMID: 36761391 PMCID: PMC9906377 DOI: 10.1136/tsaco-2022-001016] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/22/2023] [Indexed: 02/09/2023] Open
Abstract
Background In pediatric trauma patients, 60-80% of spinal cord injuries involve the cervical vertebrae. While the American College of Radiology offers guidelines for best imaging practices in the setting of acute pediatric trauma, there is a lack of uniformity in imaging-decision protocols across institutions. MRI has been shown to demonstrate high sensitivity for both bony and ligamentous injuries while also avoiding unnecessary radiation exposure in the pediatric patient population. However, the efficacy of flexion-extension (FE) radiography following initial MRI has not been evaluated in children. Our hypothesis is that FE radiography conducted following an initial MRI does not contribute significant diagnostic information or reduce time to cervical collar removal and thus can be removed from institutional protocols in order to avoid unnecessary testing and reduce pediatric radiation exposure. Methods Trauma data were collected for pediatric patients presenting with suspected acute cervical spine injury from 2014 to 2021. A total of 108 patients were subdivided into 41 patients who received "MRI Only" and 67 patients who received both "MRI and FE" diagnostic cervical spine imaging. Chi-square testing and t-tests were performed to determine differences between MRI and FE radiographic detection rates of bony and ligamentous injuries in the subgroups. Results In patients for whom FE did not find any injury, MRI detected bony and ligamentous injuries in 9/63 and 12/65 cases, respectively. In 3/21 (14.3%) cases in which MRI detected a bony and/or ligamentous injury and FE did not, patients eventually required surgical intervention for c-spine stabilization. No patients required surgical fixation when FE radiography showed an abnormality and MRI was normal. Addition of follow-up FE radiography after initial MRI did not have a significant effect on overall hospital length of stay (MRI Only vs MRI+FE: 9.2±12.0 days vs 8.6±13.5 days, p=0.816) or on rates of collar removal at discharge or greater than 48 hours after imaging (MRI Only vs MRI+FE: 41.5% vs 56.7%, p=0.124). Conclusions FE radiography following initial MRI did not have a significant effect on reducing time to cervical collar removal or overall hospital length of stay. In addition, in 3 of 6 cases (50.0%) in which surgical fixation was required, MRI detected ligamentous and/or bony injury while FE radiography was normal. Level of Evidence This study contributes Level 2b scientific evidence consistent with a well-designed cohort or case-control analytic study.
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Affiliation(s)
- Jeff F Zhang
- Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Janet Umenta
- Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Adil Ali
- Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Renee Reynolds
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York, USA
| | - Phillip Benson Ham
- Department of Surgery, Division of Pediatric Surgery, John R Oishei Children’s Hospital, Buffalo, New York, USA
| | - Richard D Thomas
- Department of Radiology, John R Oishei Children's Hospital, Buffalo, New York, USA
| | - Ravi Piryani
- Department of Pediatrics, Division of Critical Care Medicine, John R Oishei Children’s Hospital, Buffalo, New York, USA
| | - Muhammad Izhar
- Department of Radiology, John R Oishei Children's Hospital, Buffalo, New York, USA
| | - Brian Wrotniak
- Department of Pediatrics, Division of Critical Care Medicine, John R Oishei Children’s Hospital, Buffalo, New York, USA
| | - Anil K Swayampakula
- Department of Pediatrics, Pediatric Critical Care, Cook Children’s Medical Center, Fort Worth, Texas, USA
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Ham PB, Wise LJ, Wang EJ, Stansfield B, Hatley RM, Walters KC, Pipkin WL, Bhatia J. Venovenous Extracorporeal Membrane Oxygenation for Cardiorespiratory Failure due to Congenital Diaphragmatic Hernia and Ebstein's Anomaly. Am Surg 2015; 81:e322-e324. [PMID: 26350645] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Phillip Benson Ham
- Departments of Surgery and Pediatrics, Children's Hospital of Georgia, Medical College of Georgia, Georgia Regents University, Augusta, Georgia, USA
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Ham PB, Wise LJ, Wang EJ, Stansfield B, Hatley RM, Walters KC, Pipkin WL, Bhatia J. Venovenous Extracorporeal Membrane Oxygenation for Cardiorespiratory Failure due to Congenital Diaphragmatic Hernia and Ebstein's Anomaly. Am Surg 2015. [DOI: 10.1177/000313481508100901] [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: 11/16/2022]
Affiliation(s)
- Phillip Benson Ham
- Departments of Surgery and Pediatrics Children's Hospital of Georgia Medical College of Georgia Georgia Regents University Augusta, Georgia
| | - Linda J. Wise
- Departments of Surgery and Pediatrics Children's Hospital of Georgia Medical College of Georgia Georgia Regents University Augusta, Georgia
| | - Eric J. Wang
- Departments of Surgery and Pediatrics Children's Hospital of Georgia Medical College of Georgia Georgia Regents University Augusta, Georgia
| | - Brian Stansfield
- Departments of Surgery and Pediatrics Children's Hospital of Georgia Medical College of Georgia Georgia Regents University Augusta, Georgia
| | - Robyn M. Hatley
- Departments of Surgery and Pediatrics Children's Hospital of Georgia Medical College of Georgia Georgia Regents University Augusta, Georgia
| | - Kenneth C. Walters
- Departments of Surgery and Pediatrics Children's Hospital of Georgia Medical College of Georgia Georgia Regents University Augusta, Georgia
| | - Walter L. Pipkin
- Departments of Surgery and Pediatrics Children's Hospital of Georgia Medical College of Georgia Georgia Regents University Augusta, Georgia
| | - Jatinder Bhatia
- Departments of Surgery and Pediatrics Children's Hospital of Georgia Medical College of Georgia Georgia Regents University Augusta, Georgia
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