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Biomedical subjects

R D Kaye

Publications and source records attributed to R D Kaye.

13 recordsLinked to original sources
PubMed2001

Non-endoscopic removal of radiologically placed percutaneous primary gastrostomy tubes: a new technique.

PURPOSE: To present a new technique for non-endoscopic removal of radiologically inserted primary percutaneous gastrostomy tubes (PGT) and to assess the utility and safety of this technique in the pediatric population. MATERIALS AND METHODS: Over a 9-year period 172 children (80 F, 92 M) mean age 10 years (range 0.29-24 years) underwent removal of radiologically placed PGTs in the Radiology Department. All procedures were performed with conscious sedation. The procedure time ranged from 20 to 45 min (mean 30 min). The procedures were performed electively at > or = 3 14 months for either gastrostomy button placement (70), balloon gastrostomy and jejunostomy placement (55), or G tube removal at termination of enteral feeding (15). RESULTS: PGT disc retrievals were successful performed in 169 of 173 (98%). No technical failures occurred, but five procedures failed due to PGT disc lodgement in gastric wall (four), and gastrocolic fistula (one). One child had a repeat procedure due to premature removal of the primary PGT necessitating replacement. No deaths occurred. PGT discs retrieval was performed at a mean time interval of 14 months from initial PGT insertion (range 3-40 months). CONCLUSION: Non-endoscopic GT disc removal is a quick and safe procedure. It facilitates easy conversion to a gastrostomy button in the radiology setting and avoids the risk of a retained percutaneous gastrostomy tube remnant and intra/transmural migration of discs.

Adolescent↗
PubMed2001

"Push-pull" gastrostomy: a new technique for percutaneous gastrostomy tube insertion in the neonate and young infant.

OBJECTIVE: To evaluate a newly developed method combining antegrade and retrograde techniques for percutaneous gastrostomy tube (PGT) insertion in the neonate and young infant. MATERIALS AND METHODS: From January 1994 to December 2000, 85 children (47 male, 38 female), mean age 4.5 months (range 0.44-9.13 months) underwent PGT insertion using the "push-pull" technique. With the addition, 57 children had a jejunostomy tube placed as well at or within 24 h of the PGT procedure. The mean weight was 3.74 kg, range 1.5-7.0 kg. The indications for the procedure included failure to thrive in 40 patients (25%), static encephalopathy in 21 (25%), neurological/congenital abnormalities in 12 (14%), aspiration in 7 (8%), and cardiac problems in 5 (6%). RESULTS: Eighty-five PGTs were successfully inserted in 85 children. One procedure was initially unsuccessful due to failed conscious sedation and was completed under general anesthesia. Four of 85 patients initially had attempted antegrade placement that failed, and the procedure was successfully completed using the "push-pull" method. One major complication occurred: a gastrocolic fistula at day 5 post-procedure, which was surgically repaired without sequelae. Tube-related problems included; tube dislodgement (n = 1) and procedure-related stomal infection (n = 3). CONCLUSION: The "push-pull" gastrostomy technique is a safe, effective method of percutaneous gastrostomy tube placement in neonates. It facilitates successful placement of the PGT in patients in whom the classic antegrade method is not possible. It has become the procedure of choice in this group.

Failure to Thrive↗
PubMed2000

Intrahepatic chemoembolization in unresectable pediatric liver malignancies.

OBJECTIVE: To determine the effectiveness of a new multidisciplinary approach using neoadjuvant intrahepatic chemoembolization (IHCE) and liver transplant (OLTx) in patients with unresectable hepatic tumors who have failed systemic chemotherapy. MATERIALS AND METHODS: From November 1989 to April 1998, 14 children (2-15 years old) were treated with 50 courses of intra-arterial chemotherapy. Baseline and post-treatment contrast-enhanced CT and alpha-fetoprotein levels were performed. Seven had hepatoblastoma, and 7 had hepatocellular carcinoma (1 fibrolamellar variant). All patients had subselective hepatic angiography and infusion of cisplatin and/or adriamycin (36 courses were followed by gelfoam embolization). The procedure was repeated every 3-4 weeks based on hepatic function and patency of the hepatic artery. RESULTS: Six of 14 children received orthotopic liver transplants (31 courses of IHC). Pretransplant, 3 of 6 showed a significant decrease in alpha-fetoprotein, while only 1 demonstrated a significant further reduction in tumor size). Three of 6 patients are disease free at this time. Three of 6 patients died of metastatic tumor 6, 38, and 58 months, respectively post-transplant. One of 14 is currently undergoing treatment, has demonstrated a positive response, and is awaiting OLTx. Three of 14 withdrew from the program and died. Four of 14 patients developed an increase in tumor size, developed metastatic disease, and were not transplant candidates. Two hepatic arteries thrombosed, and one child had a small sealed-off gastric ulcer as complications of intrahepatic chemoembolization. CONCLUSION: The results of intrahepatic chemoembolization are promising and suggest that some children who do not respond to systemic therapy can be eventually cured by a combination of intrahepatic chemoembolization orthotopic liver transplant. Alpha-fetoprotein and cross-sectional imaging appear to be complementary in evaluating tumor response. IHCE does not appear to convert an anatomically unresectable lesion to a candidate for partial hepatectomy.

Adolescent↗
PubMed1999

Transhepatic insertion of vascular dialysis catheters in children: a safe, life-prolonging procedure.

INTRODUCTION: Central venous catheters (CVC) have been inserted percutaneously since 1989. This technique has been adapted for transhepatic insertion of large-bore catheters in children with occluded central veins. MATERIALS AND METHODS: Three children aged 5, 11, and 12 years required hemodialysis or plasmaphoresis for treatment of life-threatening conditions. All central veins were occluded, thus transhepatic insertion of a large-bore catheter was necessary. All children underwent successful placement using a combination of ultrasound guidance and fluoroscopy. No complications occurred. DISCUSSION: Transhepatic insertion of large-bore catheters can be performed safely in children. Catheter removal should be accompanied by track embolization to prevent exsanguinating hemorrhage. CONCLUSION: Transhepatic insertion of dialysis catheters is a safe alternative in children with occluded central veins.

Ammonia↗
PubMed1998

Percutaneous gastrostomy tube placement in patients with ventriculoperitoneal shunts.

OBJECTIVE: The purpose of this study is to determine the risk of CNS and/or peritoneal infection in children with ventriculoperitoneal shunts in whom a percutaneous gastrostomy tube is placed. MATERIALS AND METHODS: We placed 205 gastrostomy or gastrojejunostomy tubes from January of 1991 to December 1996. Twenty-three patients (10 boys, 13 girls) had ventriculoperitoneal shunts at the time of placement. All shunts were placed at least 1 month prior to placement of the gastrostomy tube. The patients ranged in age from 8 months to 16 years with a mean age of 6 years, 9 months. Patient weight ranged from 2 kg to 60 kg. All 23 children required long-term nutritional support due to severe neurologic impairment. No prophylactic antibiotics were given prior to the procedure. Of the patients, 21/23 had a 14-F Sacks-Vine gastrostomy tube with a fixed terminal retention device inserted, using percutaneous fluoroscopic antegrade technique. Two of the 23 patients had a Ross 14-F Flexi-flo gastrostomy tube which required a retrograde technique due to a small caliber esophagus in these children. RESULTS: All 23 children had technically successful placements of percutaneous gastrostomy (7) or gastrojejunostomy (16) tubes. Of the children, 21/23 (91%) had no complications from the procedure. Two of 23 (9%) patients demonstrated signs of peritonitis after placement of their gastrostomy tubes and subsequently had shunt infections. In both, children CSF culture grew gram-positive cocci. The antegrade technique was used in both children who developed peritonitis. CONCLUSION: Our study indicates children with ventriculoperitoneal shunts who undergo percutaneous gastrostomy are at greater risk for infection and subsequent shunt malfunction. Therefore, we recommend prophylactic antibiotic therapy to cover for skin and oral flora.

Adolescent↗
PubMed1997

Aortic and renal artery thrombosis in a neonate: recovery with thrombolytic therapy.

This report describes a neonate with acute renal failure associated with extensive aortic and bilateral renal artery thrombosis attributed to inadequate breastfeeding and severe dehydration. Dialytic and general supportive care, together with concurrent anticoagulation, and continuous aggressive intrathrombic instillation of urokinase for 5 days resulted in near-complete thrombolysis. Renal functional recovery began 11 days after the onset of anuria. Despite ischemic atrophy of the left kidney, renal function and blood pressure were normal on follow-up. Thus, in neonates thrombolytic therapy may positively impact survival and recovery of renal function even in the setting of prolonged ischemic renal injury.

Aortic Diseases↗
PubMed1996

Imaging in liver transplantation.

Thoughtfully planned and skillfully executed diagnostic and interventional imaging is indispensible in preoperative assessment of the pediatric liver transplant candidate and for the detection and management of the myriad postoperative complications that may affect the liver recipient.

Child↗
PubMed1996

Interventional procedures in the gastrointestinal tract in children.

Significant growth and innovation in interventional procedures involving the gastrointestinal tract has occurred over the last 15 years. The authors discuss historical background, procedural planning, sedation, and monitoring during the procedure, technique, postprocedural care, and potential procedural complications in the pediatric population.

Child↗
PubMed1993

Intervention in the thorax in children.

The 1970s and 1980s have been a period of significant growth and innovation in interventional radiology. Interventional procedures that were developed and perfected with adult patients are now being used very successfully in pediatric patients. In comparison with surgical management, interventional procedures generally have lower morbidity and mortality, require shorter hospital stays, and are less expensive. Preprocedural imaging and planning, adequate monitoring and sedation during the procedure, and selection of equipment appropriate for pediatric patients maximizes the chance for a successful outcome.

Child↗
PubMed1984

X-ray diffraction study of the polymorphism of hydrated diacyl- and dialkylphosphatidylethanolamines.

The structure and polymorphism of a homologous series of diacyl- and of dialkylphosphatidylethanolamines have been investigated by X-ray diffraction, calorimetry, and density measurement. The compositional dependence of the repeat spacings of the gel (L beta or L beta'), fluid bilayer (L alpha), and inverted hexagonal (HII) phases has been determined both for the short chain length (di-C12) dialkyl didodecylphosphatidylethanolamine (DDPE) and for the long chain length (di-C20) diacyl diarachinoylphosphatidylethanolamine (DAPE). These data, in conjunction with the measured phase transition temperatures obtained both by X-ray diffraction and by differential scanning calorimetry, have been used to construct phase diagrams for the two lipids. DDPE exhibits metastable behavior in the L beta and L alpha phases below 44 degrees C at all water contents and forms cubic and other nonlamellar phases between the L alpha and HII phases. At low water contents, crystalline and fluid phases coexist at temperatures up to 83 degrees C. For DAPE, the behavior is simpler. In the gel phase, the hydrocarbon chains are tilted at 29 degrees to the bilayer normal, and metastability is only observed at water contents below 3 wt %. The L alpha phase is adopted within a narrow temperature range and then transforms directly to the HII phase. The structural parameters of the L beta (L beta'), L alpha, and HII phases of DDPE and DAPE have been calculated from the X-ray data, in conjunction with the measured values of lipid partial specific volume. In addition, the chain-length dependence of the repeat spacings of the phases has been measured for the homologous series of diacyl and dialkyl lipids. Taken together, the results allow a detailed description of the effects of temperature, hydration, and chain length on the polymorphism of the saturated phosphatidylethanolamines.

Calorimetry↗