Biomedical subjects

Michael Temple

Publications and source records attributed to Michael Temple.

11 recordsLinked to original sources

PubMed2006

Influence of arm movement on central tip location of peripherally inserted central catheters (PICCs).

BACKGROUND: PICCs are increasingly employed in children. Some of their risks relate to the location of the central tip. Despite care when placing lines, they sometimes move. OBJECTIVE: To evaluate the influence of arm movement on the central tip location of PICCs placed in children. MATERIALS AND METHODS: The central tip location of PICCs was studied in 85 children, with the arm placed in six positions. The variables of side, vein, site and arm position were examined to measure the direction and range of tip movement. RESULTS: The side, site or vein used did not influence the range of movement of the central tip. Change in position of the arm had a significant influence on the central tip location, moving it an average of 2.2 rib spaces, a maximum of 3.5 ribs. Elbow bending and adduction of the arm caused the central tip to move deeper into the chest, compared to when the arm was straight and abducted 90 degrees . CONCLUSION: Arm position is the significant variable influencing PICC movement. Side, site and vein do not influence the range of movement significantly. Most PICCs descend deeper into the chest with arm adduction and elbow bending.

Adolescent↗

PubMed2006

Percutaneous US-guided biopsies of peripheral pulmonary lesions in children.

BACKGROUND: A wide variety of diseases in children can present with peripheral lung lesions. Minimally invasive percutaneous techniques are preferred diagnostic tools when thoracoscopic resection is not indicated. Significant improvements in US resolution have increased the range of its applications for many diagnostic and therapeutic purposes. OBJECTIVE: To determine the adequacy and safety of US-guided biopsy of peripheral pulmonary lesions in children. MATERIALS AND METHODS: A retrospective review was performed of the clinical, imaging and pathology records of 33 children (13 females and 20 males) in whom 38 US-guided percutaneous lung lesion biopsies had been performed between January 1996 and March 2004. Their mean age was 8.3 years (range 1-19 years, median 6.6 years). All procedures were done under general anesthesia and controlled respiration. Two techniques were used: a single-needle technique and a coaxial-needle technique. In each case, the data recorded included age, sex, lesion's location and size, number of cores, pathology results (adequate, inadequate and indeterminate), and complications. In order to categorize the sample, the lesions were divided into four groups based on the size of the pleural surface: group 1 1-5 mm, group 2 6-10 mm, group 3 11-20 mm, and group 4 21 mm or more. RESULTS: The mean pleural surface size of the lesions was 12 mm (range 2.3-24 mm). The coaxial-needle technique was used for 13 biopsies and the single-needle technique for 25 biopsies. Of the 38 biopsies, 32 were considered adequate (technical success 84%), 4 were truly inadequate, and 2 were indeterminate at the time of the biopsy, requiring surgical biopsy for confirmation. Minor complications occurred following 44% of the procedures, including: pain (n=5), small pneumothorax (n=4), pulmonary hematoma (n=4), atelectasis (n=4), small hemothorax (n=3), respiratory distress (n=1) and hemoptysis (n=1). No major complications occurred. No significant correlation was found between the size of the pleural surface and technical success (P=0.106) or the incidence of complications (P=0.23). Minor complications occurred following 6 out of 13 procedures using the coaxial-needle technique (16% of total) and following 11 out of 25 procedures using the single-needle technique (28% of total), with no statistically significant difference (P=0.1081). CONCLUSION: This small retrospective study suggests that US-guided lung biopsies are a safe and adequate method to sample peripheral pulmonary lesions in children, with a high rate of technical success and low morbidity, even for lesions with a small pleural surface (<5 mm).

Adolescent↗

PubMed2006

Exercise-induced deep vein thrombosis of the upper extremity. 1. Literature review.

Paget-Schroetter syndrome or effort-related upper extremity deep vein thrombosis is a rare condition that usually afflicts young healthy individuals, most commonly males. The cause is multifactorial but almost always involves extrinsic compression of the subclavian vein at the thoracic inlet, causing venous stenosis from repetitive trauma. The diagnosis of this condition may be difficult, and its delay may contribute to potential complications including thrombosis progression, pulmonary embolism, thrombosis recurrence, and post-thrombotic syndrome. Similarly, the best therapeutic option has not been established and in the lack of evidence-based guidelines, treatment may be extremely challenging especially in children, in whom long-term complications can be particularly disabling.

Adolescent↗

PubMed2006

Exercise-induced deep vein thrombosis of the upper extremity. 2. A case series in children.

Upper-extremity deep venous thrombosis (UEDVT) is an increasingly important clinical problem in children. These events are classified as primary or secondary, with the latter being the most common and usually associated with the presence of a central venous line. Among primary UEDVT, the so-called Paget-Schroetter syndrome, effort-related or exercise-induced upper-extremity thrombotic event represents an extremely rare finding that has never been described in a pediatric series. The objective of the second part of this two-part article is to report the first pediatric series in a group of adolescents with this condition from a single center, describing their clinical features, management, and outcome. A retrospective chart review of 6 patients seen between December 2003 and April 2005 was conducted, with a median follow-up of 9 months (range 2-17). Four females and two males, all Caucasian, were enrolled with a median age of 16 years (range 14-17). In all cases, strenuous exercise was present in the month preceding diagnosis and mild trauma was present in only one case (weight lifting). At presentation, all patients had objective swelling of the affected limb for a median of 4 days (range 2-14), and 4 patients had UEDVT of the dominant arm. Thrombophilia investigation revealed that 50% had a combined prothrombotic state at presentation, and all patients were/are being treated with anticoagulation for 6 months (low-molecular-weight heparin followed by warfarin). Continuation of the initial symptoms was present in all cases but one at the 3-month clinic follow-up (last case has yet to reach 3 months of follow-up), and residual moderate to severe postthrombotic syndrome was present in all 3 cases followed for more than 12 months. Of those 3 patients followed for more than 1 year, 2 patients recurred despite having complete resolution of the thrombus after 6 months of anticoagulation, and the third patient underwent surgery with clinical improvement. Adolescents with UEDVT treated only with anticoagulation seem to have a poor outcome.

Adolescent↗

PubMed2006

Sonographically guided percutaneous liver biopsy in infants: a retrospective review.

OBJECTIVE: The purpose of our study was to assess the technical success and complication rate of sonographically guided percutaneous liver biopsies performed in infants under 1 year old at a tertiary pediatric center. MATERIALS AND METHODS: Retrospective analysis of 65 biopsies performed in 61 infants between January 1999 and December 2003 was conducted. Data collected included patient demographics; details of the biopsy procedure including indication, needle type and size, number of passes, and samples; pathology results; and procedure-related complications. RESULTS: The 61 infants studied included 37 males and 24 females with a mean age of 119 days (age range, 7-348 days; median age, 83 days) and a mean weight of 4.5 kg (1.9-8.3 kg). A total of 65 biopsies were performed in these 61 infants. General anesthesia was used in 66.1% of procedures. An 18-gauge needle was used in 47 (72.3%) procedures. Coaxial technique was used in seven procedures, and five biopsy tracts were embolized. In 63 of 65 procedures, the mean number of passes was 1.8. In two procedures, using a coaxial technique, 11 and 12 passes were made. One biopsy was considered technically unsuccessful, and 64 of 65 (98.5%) of the biopsies provided adequate tissue for pathologic analysis. There were three (4.6%) major complications related to bleeding: one requiring a blood transfusion, one requiring surgery, and one arteriobiliary fistula requiring transarterial embolization. Three (4.6%) minor complications also occurred. There were no deaths. CONCLUSION: Sonographically guided percutaneous liver biopsy in infants is a good and effective diagnostic tool. The complication rate, however, even when performed by an experienced physician, is not insignificant in this age group of patients.

Biopsy, Needle↗

PubMed2005

Percutaneous treatment of pediatric thrombosis.

While rare, thrombosis in the pediatric population can result serious sequelae including death. The best treatment options have not yet been firmly established for this age group. During childhood, there are age-related changes in components of the coagulation system that can affect treatment choices. This review article gives an overview of pediatric coagulation and describes the current state of percutaneous treatment options including local thrombolysis and thrombectomy.

Child↗

PubMed2005

Gas distribution in intraabdominal and pelvic abscesses on CT is associated with drainability.

OBJECTIVE: Intraabdominal and pelvic abscesses are treated by percutaneous image-guided drainage, under sedation or general anesthesia. This study attempts to determine if the CT features of gas distribution are associated with "drainability." Our premise was that gas may be trapped deep in a collection as bubbles, if the material is thick. Gas may rise to the surface if the material is thin, forming either an air-fluid level or superficial bubbles. MATERIALS AND METHODS: Patients with intraabdominal and pelvic abscesses were identified by the interventional radiology database, after research ethics board approval. Patients without prior CT were excluded. The imaging and clinical records were analyzed retrospectively. Intracollection gas distribution was recorded as superficial bubbles, deep bubbles, or air-fluid levels. Collections were classified accordingly: type 1, air-fluid levels; type 2, superficial or deep bubbles and air-fluid levels; type 3, superficial bubbles; type 4, deep bubbles; and type 5, no gas. RESULTS: One hundred five abscesses were examined in 61 patients, ranging in age from 2-17 years. Eight of 8 of type 1, 16 of 16 of type 2, 19 of 21 of type 3, 8 of 13 of type 4, and 43 of 47 of type 5 were drainable. The abscesses of all patients with an air-fluid level were drainable. Of abscesses with deep bubbles, 61.5% were drainable, versus 90.5% of those with superficial bubbles. Of those with superficial gas (superficial bubbles or air-fluid levels), 95.6% were drainable. In comparison with superficial gas, abscesses with deep trapped gas were associated with a longer duration of drainage, longer hospital stay, lower percentage of successful drainage, and higher percentage of residual collections. The difference is significant for drainability (p = 0.0048; p = 0.0331 after statistical adjustment for multiple testing). CONCLUSION: Distribution of gas in an intraabdominal or pelvic abscess is associated with drainability. Abscesses with superficial gas (superficial bubbles or air-fluid levels) have a greater chance of being drained successfully than do abscesses with deep trapped gas.

Abdominal Abscess↗

PubMed2004

Effectiveness and safety of tissue plasminogen activator in the management of complicated parapneumonic effusions.

OBJECTIVE: The management of parapneumonic effusions in children is controversial. The objective of this study was to evaluate the effectiveness and safety of intrapleural tissue plasminogen activator (tPA) in children who require tube thoracostomy for drainage of a complicated parapneumonic effusion. METHODS: An observational cohort study was used to compare children who were treated with intrapleural tPA (either early or late administration) with children who were treated with thoracostomy tube drainage alone. RESULTS: Over a 6-year period, 12 children received early tPA (within 24 hours of diagnosis), 18 children received late tPA (>24 hours after diagnosis), and 23 children received thoracostomy tube drainage alone for the management of a complicated parapneumonic effusion. Total pleural fluid drainage was highest for the late tPA group (691 mL vs 360 mL in the control group); however, the rate of pleural fluid drainage was highest for the early tPA group (7 mL/h vs 3 mL/h in the control group). The duration of chest tube placement was 84 hours for the early tPA group, 209 hours for the late tPA group, and 130 hours for the control group. There was a significant difference in duration of chest tube placement between the early and late tPA groups. No child who was treated with tPA developed local or systemic bleeding. CONCLUSIONS: Early administration of intrapleural tPA seems to be a safe and potentially effective treatment in children with complicated parapneumonic effusions. Randomized controlled trial evidence is needed to confirm this finding.

Chest Tubes↗

PubMed2003

Image-guided percutaneous approach is superior to the thoracoscopic approach in the diagnosis of pulmonary nodules in children.

BACKGROUND/PURPOSE: Image-guided, percutaneous techniques are increasingly used in diagnosis of pulmonary disease in children. The aim of this study was to determine the diagnostic accuracy and clinical outcomes of thoracoscopic versus percutaneous lung biopsy in children. METHODS: Sixty-three consecutive patients from January 1996 to December 2000 who had a thoracoscopic lung biopsy, a percutaneous ultrasound scan, or computed tomography (CT)-guided lung biopsy for well-defined and ill-defined lesions were analyzed. RESULTS: Twenty-eight patients had a thoracoscopic lung biopsy (TLB), and 35 patients had a percutaneous image-guided lung biopsy (PLB). Age ranged from 6 months to 17 years (median, 8 years). There was no significant difference between groups with regard to age, depth of lung nodule biopsied, or prebiopsy diagnoses. Seventeen patients (60%) of TLB and 23 (65%) of PLB had well-defined pulmonary nodules suspicious for malignancy at the time of biopsy. Adequate tissue for pathologic diagnosis was obtained in 28 (100%) of TLB versus 26 (80%) of PLB patients. However, 8 (28%) thoracoscopic cases needed to be converted to an open procedure. In 3 (8.5%) PLB cases the percutaneous biopsy was insufficient, and a thoracoscopic or open biopsy was required. The median hospital stay was 3 days for TLB and 4 to 6 hours for PLB (P =.023). There were no complications in the PLB group. Five (18%) of TLB patients suffered a persistent air leak treated with continued chest tube drainage, and one patient died of other causes with a persistent air leak. CONCLUSIONS: Percutaneous lung biopsy has a significantly shorter hospital stay and a lower complication rate than thoracoscopic lung biopsy. The authors propose that the percutaneous technique should be considered as the initial approach for children with pulmonary nodules.

Adolescent↗

PubMed2003

Peripherally inserted central catheter (PICC) fracture and embolization in the pediatric population.

OBJECTIVES: To document and characterize fracture and embolization of peripherally inserted central catheters (PICCs) in the pediatric population and define predisposing features for these complications. STUDY DESIGN: A case series was assembled by examining the records of PICC insertions in a single tertiary care pediatric hospital over a 6-year period. A control group was selected by simple random sampling of eligible PICC insertions. RESULTS: Among approximately 1650 PICCs, 11 children were identified with a fractured line, requiring invasive retrieval. Patient characteristics did not reveal any specific risk factors compared with the control group. Likewise, catheter size, site, and medications infused through the line were not significant predisposing factors for fracture. However, duration of placement and a line complication (blockage of the line or leaking at the insertion site) were significantly associated with catheter fractures. In all cases, the embolized line fragment was successfully retrieved by percutaneously inserted catheters and snares. No major complications arose from these fractured catheters. CONCLUSIONS: Fracture and embolization of PICCs occur and may pose a potential risk of serious consequences. It is prudent to list PICC fracture as a rare but potentially serious complication of this device when obtaining informed consent for its insertion.

Adolescent↗

PubMed2002

Pediatric interventional venous access.

Venous access for therapy in sick children is very important, but sometimes also extremely challenging. With several advances in imaging modalities, the interventional radiologist can certainly help in these situations. This article reviews the indications, technique, and complications related to short- (peripherally inserted central catheter) and long-term (central venous lines, Port-a-catheters) venous accesses in children. A brief commentary is also made about retrieval of fragmented lines.

Catheterization, Central Venous↗