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Biomedical subjects

Peter G Chait

Publications and source records attributed to Peter G Chait.

11 recordsLinked to original sources
PubMed2006

Percutaneous thoracic drainage in neonates: catheter drainage versus treatment with aspiration alone.

PURPOSE: To retrospectively compare thoracic drainage in neonates by using catheter and aspiration techniques. MATERIALS AND METHODS: Approval was obtained from the institutional research ethics board; informed consent from parents was waived. Retrospective review of 21 neonates (19 boys, two girls; mean gestational age, 39.3 weeks) who underwent percutaneous thoracic drainage during a 9-year period was performed. Data such as indication for drainage, type of drainage, age and weight at birth, corrected age and weight at the time of drainage, use of mechanical ventilation at the time of drainage, and outcomes were collected. Drainage was considered successful if the collection was treated without additional surgical or radiologic intervention. Fisher exact test and two-tailed unpaired student t test with a confidence level of 95% (unequal variances assumed) were used to compare neonates treated with a catheter and those treated with aspiration. RESULTS: Image-guided therapy was used to treat pleural effusion (29%, n = 6), chylothorax (24%, n = 5), empyema (19%, n = 4), pneumothorax (14%, n = 3), mediastinal seroma (10%, n = 3), and congenital cystic adenomatoid malformation (5%, n = 1). Sixteen (76%) infants were treated with catheter placement, with a success rate of 81% (13 of 16). Five (24%) infants were treated with simple aspiration with no success. The difference in success rates was significant (P = .003). There was no significant difference between the catheter placement and aspiration groups in terms of average age, average weight, and percentage dependent on mechanical ventilation. One complication (cellulitis) was directly related to catheter drainage. In cases where treatment was successful, the mean length of the chest tube placement was 13.5 days, and there were no deaths at follow-up. In cases where treatment failed, the long-term mortality rate was 50% (four of eight). CONCLUSION: Image-guided percutaneous thoracic drainage success rates are improved if drainage catheters are placed rather than if aspiration alone is performed.

Catheterization↗
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

Image-guided therapy and minimally invasive surgery in children: a merging future.

Minimally invasive image-guided therapy for children, also known as pediatric interventional radiology (PIR), is a new and exciting field of medicine. Two key elements that helped the rapid evolution and dissemination of this specialty were the creation of devices appropriate for the pediatric population and the development of more cost-effective and minimally invasive techniques. Despite its clear advantages to children, many questions are raised regarding who should be performing these procedures. Unfortunately, this is a gray zone with no clear answer. Surgeons fear that interventional radiologists will take over additional aspects of the surgical/procedural spectrum. Interventional radiologists, on the other hand, struggle to avoid becoming highly specialized technicians rather than physicians who are responsible for complete care of their patients. In this article, we briefly discuss some of the current aspects of minimally invasive image-guided therapy in children and innovations that are expected to be incorporated into clinical practice in the near future. Then, we approach the current interspecialty battles over the control of this field and suggest some solutions to these issues. Finally, we propose the development of a generation of physicians with both surgical and imaging skills.

Child↗
PubMed2005

The antegrade continence enema successfully treats idiopathic slow-transit constipation.

BACKGROUND: Antegrade continence enemas (ACEs) are successful for constipation and/or fecal incontinence caused by anorectal malformations or spina bifida but have been thought to be less successful in the treatment for patients with colonic dysmotility. We studied the long-term efficacy of ACE in a large group of patients with idiopathic slow-transit constipation (STC). METHODS: We identified 56 children with an appendicostomy for ACE with radiologically proven STC. An independent investigator (SKK) performed confidential telephone interviews. RESULTS: We assessed 42 of 56 children (31 boys) of mean age 13.1 years (range, 6.9-25). Mean follow-up was at 48 months (range, 3-118). Mean symptom duration before appendicostomy was 7.5 years (range, 1.4-17.4). Indications for appendicostomy were soiling (29/42), inadequate stool evacuation (7/42), and recurrent hospital admissions for nasogastric washouts (6/42). Both quality of life (Templeton quality of life [P < .0001]) and continence (modified Holschneider continence score [P < .0001]) improved with ACE. Soiling frequency decreased in 32 of 42 (11/32 completely continent). Thirty-seven of 42 children had reduced abdominal pain severity (P < .0001) and frequency (P < .0001). Complications included granulation tissue (33/42), stomal infection (18/42), and washout leakage (16/42). Fifteen of 42 children ceased using the appendicostomy (7/15 symptoms resolved). Thirty-five of 42 families felt that their aspirations had been met. CONCLUSIONS: Antegrade continence enemas were successful in 34 (81%) of 42 children with STC, contradicting views that ACEs are less effective in patients with colonic dysmotility.

Abdominal Pain↗
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

Early mediastinal seroma secondary to modified Blalock-Taussig shunts--successful management by percutaneous drainage.

BACKGROUND: Large symptomatic mediastinal seroma following modified-BT shunts, traditionally required revisional thoracotomy. OBJECTIVE: We describe percutaneous image-guided pigtail catheter drainage in the successful treatment of early mediastinal seroma secondary to PTFE Blalock-Taussig shunt, avoiding thoracotomy. MATERIALS AND METHODS: A retrospective review of all relevant clinical and imaging records in five patients was performed. RESULTS: All five presented with intermittent stridor, respiratory distress and/or episodic desaturation within 6 weeks of their surgery. In four of five infants, percutaneous drainage was effective and reoperation was avoided. In one of five, rather than urgent surgical evacuation and BT shunt revision, we were able to perform an elective stage-II bidirectional Glenn SVC-RA anastamosis in a stable infant. There were no complications. CONCLUSIONS: Percutaneous image-guided drainage of mediastinal seroma secondary to PTFE-BT shunt is a safe, minimally invasive, and effective treatment. This may avoid BT shunt revision.

Cardiac Surgical Procedures↗
PubMed2003

Percutaneous cecostomy: updates in technique and patient care.

PURPOSE: To evaluate the authors' 7-year experience with the percutaneous cecostomy procedure and the long-term outcome of the procedure. MATERIALS AND METHODS: Since 1994, 163 tube cecostomies for fecal incontinence were performed in patients aged 2-23 years and who weighed 8-72 kg (mean, 32.2 kg). Underlying conditions included spina bifida (n = 106), imperforate anus (n = 53), Klippel-Feil deformity (n = 1), cerebral palsy (n = 1), Hirschsprung disease (n = 1), and paraplegia (n = 1). Ventriculoperitoneal shunts were present in 85 (52%) of the 163 patients. The authors have followed up 124 (76%) of the 163 cecostomy patients. Information regarding enema technique, satisfaction with the procedure, postprocedure problems, and long-term outcome of the procedure was obtained by interviewing either the patients or the parents. RESULTS: Tube placement was successful in all patients. One hundred ten (89%) of the 124 patients experienced a substantial decrease in the frequency of soiling accidents. The vast majority of patients expressed satisfaction with the procedure; 117 (94%) of the 124 patients rated the cecostomy procedure as better than the bowel control procedure used before. Late complications of the procedure included granulation tissue and accidentally dislodged tubes. Four patients elected to have their tubes removed for aesthetic and tube management reasons. There was no mortality related to the procedure, although one patient died of pneumonia 5 years later. CONCLUSION: The percutaneous cecostomy procedure is a safe and effective method for treating fecal incontinence.

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↗
PubMed2003

Combined sonographic and fluoroscopic guidance during transjugular hepatic biopsies performed in children: a retrospective study of 74 biopsies.

OBJECTIVE: Our aim was to evaluate the safety, effectiveness, and clinical impact of transjugular biopsies of the liver performed in children. MATERIALS AND METHODS: We retrospectively reviewed 74 transjugular hepatic biopsies performed in 64 pediatric patients. The selection criteria for transjugular approach in these children included mainly coagulopathy, thrombocytopenia, or ascites. The last 37 biopsies in our series were performed with combined sonographic and fluoroscopic guidance, which improved visualization of the biopsy tract. RESULTS: Adequate samples for histopathologic analysis were obtained in all except one case (98.6%). In most patients with fulminant hepatic failure, biopsy results allowed patients to be promptly listed for orthotopic liver transplantation; in patients with less severe hepatic failure, biopsy results helped guide medical management. In patients with liver transplants, the biopsy provided information on acute graft rejection; in patients who had undergone bone marrow transplantation, the biopsy helped to determine the status of graft-versus-host disease. One death occurred immediately after the procedure but at autopsy was deemed not to have been caused by the biopsy itself. Overall, procedural complications occurred in 8.1% of patients. Complications included neck hematomas, small subcapsular hematomas, subclavian artery puncture, and extravasation of contrast material into the retroperitoneum. CONCLUSION: Transjugular hepatic biopsy is a relatively safe procedure that has considerable impact on patient treatment. The addition of sonographic guidance during the biopsy improves visualization, increases operator confidence, and allows the performance of biopsies in smaller patients and in children with reduced liver transplants.

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↗