2010-Q4 Literature Summary
Akinci et al. (Hacettepe, Ankara, Turkey) reviewed 91 percutaneous GI tubes (77 gastrostomies and 14 gastrojejunostomies) (4 mo-16 yr) to answer the question: single or double gastropexy?. No difference found. Single gastropexy should be performed with two different punctures for each retention suture and the tube. Major complications 4.4% (2 aspiration pneumonia, 2 site infection).
Cantasdemir et al. reported treating high-flow priapism with autologous blood clot embolization in 7 kids. Complete detumescence in 6, second session needed in 2, eventually complete detumescence was achieved and no recurrence of priapism. It is worth considering!
Zanjani et al. (Tehran, Iran) reported stenting in aortic coarctation in 10 patients with the Turner syndrome (9 to 24 yr) with bare metal 7 patients and covered 3. Gradient reduced from 46 to 2 mmHg. No procedure-related complications. No restenosis in 30 mo follow up. Though I dout the longevity of these stents compared to the more radical surgical repair.
Tzifa et al. reported on MRI guided intervention (first-in-man) on a child and an adult with pulmonary stenosis.
Awasthy et al. reported embolization with a plug for congenital aortocaval fistula in a 4 mo infant.
The December issue of Techniques in Vascular & Interventional Radiology edited by Dr. Sidhu (Pediatric Interventions: Part I) contains excellent review articles on Biopsy and Drainage (Hogan & Hoffer), Musculoskeletal Interventions (Vo, Hoffer & Shaw), Upper Gastrointestinal Connolly, Krishnamurthy & Amaral), GU Interventions (Barnacle, Roebuck & Racadio), Arterial Interventions (Marshalleck), Biliary Interventions (Racadio & Kukreja), Central Venous Access (Vo, Hoffer & Shaw). Unfortunately, our electronic access to the Techniques expired but I think I will buy the hard copy and keep it as a reference and encourage the fellows to read it.
1. Angioplasty for renal artery stenosis in pediatric patients: an 11-year retrospective experience.
Srinivasan A, Krishnamurthy G, Fontalvo-Herazo L, Nijs E, Keller MS, Meyers K, Kaplan B, Cahill AM. J Vasc Interv Radiol. 2010 Nov;21(11):1672-80.
A very good study which reflects the real practice in PIR. 7 kids with NF1 and 12 with FMD with hypertension. Hypertension “cured” by PTA in 7 (39%), improved (17%) & failed in 8 (44%). None stented. Repeat PTA in 5; all failed. NF1 response > FMD. Interestingly, the authors noted that aneurysms, midaortic and osteal narrowing did not predict the outcome. One may argue that midaortic syndrome is notorious for being difficult to plasty with higher risk of renal failure claudication and heart failure. The conclusion is that PTA provided a clinical benefit in a smaller majority of children.
2. Pediatric enteric feeding techniques: insertion, maintenance, and management of problems.
Nijs EL, Cahill AM. Cardiovasc Intervent Radiol. 2010 Dec;33(6):1101-10.