An institutional series and literature review of pial arteriovenous fistulas in the pediatric population

2013 ◽  
Vol 12 (4) ◽  
pp. 344-350 ◽  
Author(s):  
Peter J. Madsen ◽  
Shih-Shan Lang ◽  
Jared M. Pisapia ◽  
Phillip B. Storm ◽  
Robert W. Hurst ◽  
...  
Keyword(s):  
Heart Failure ◽  
Literature Review ◽  
Cerebrovascular Disease ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Rare Form ◽  
Excellent Outcome ◽  
Arteriovenous Fistulas ◽  
Presenting Symptoms ◽  
Worse Prognosis

Object Pial arteriovenous fistulas (PAVFs) are a rare form of cerebrovascular disease that tend to be overrepresented in the pediatric population. There have been limited studies of the clinical features and outcomes in this group of patients. Here, the authors attempt to better delineate this clinical entity with institutional cases and a review of the literature. Methods A retrospective review of cases at our institution was performed to identify all pediatric patients treated for a PAVF between 2000 and 2012. Results Five patients treated for a PAVF were identified. Patients had a mean age of 1.9 years at diagnosis, and the most common presenting symptoms were seizure and macrocephaly. Patients were treated primarily with embolization, and 3 patients required both N-butyl cyanoacrylate (NBCA) glue and coiling. Four of the patients had complete obliteration of the PAVF and had a pediatric overall performance category score of either 1 (n = 3) or 2 (n = 1) at follow-up. There was 1 death due to heart failure. Analysis of the literature review suggested that a younger age or presence of intracerebral hemorrhage (ICH) or congestive heart failure (CHF) at presentation likely predicts a worse prognosis. Older patients presented more often with ICH, whereas younger patients presented significantly more often in CHF. The majority of pediatric patients reported on in the literature were treated with endovascular embolization, most commonly with NBCA glue alone. Most patients (65.4%) in the literature had an excellent outcome without neurological deficit. Conclusions Pial AVFs represent a serious yet rare form of cerebrovascular disease. Pediatric patients with ICH or CHF at presentation or those who are very young are likely to have a worse prognosis. Endovascular management of these patients has greatly changed the natural history of this disease, but the complication and mortality rates suggest the need for continued insights and advances in treatment.

scholarly journals Rathke cleft cysts in pediatric patients: presentation, surgical management, and postoperative outcomes

2011 ◽  
Vol 31 (1) ◽  
pp. E3 ◽  
Author(s):  
Arman Jahangiri ◽  
Annette M. Molinaro ◽  
Phiroz E. Tarapore ◽  
Lewis Blevins ◽  
Kurtis I. Auguste ◽  
...  
Keyword(s):  
San Francisco ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Growth Delay ◽  
Common Symptom ◽  
Imaging Findings ◽  
Presenting Symptoms ◽  
Sellar Lesions ◽  
Kaplan Meier ◽  
Study Results

Object Rathke cleft cysts (RCC) are benign sellar lesions most often found in adults, and more infrequently in children. They are generally asymptomatic but sometimes require surgical treatment through a transsphenoidal corridor. The purpose of this study was to compare adult versus pediatric cases of RCC. Methods The authors retrospectively reviewed presenting symptoms, MR imaging findings, laboratory study results, and pathological findings in 147 adult and 14 pediatric patients who underwent surgery for treatment of RCCs at the University of Californial at San Francisco between 1996 and 2008. Results In both the adult and pediatric groups, most patients were female (78% of adults, 79% of pediatric patients, p = 0.9). Headache was the most common symptom in both groups (reported by 50% of pediatric patients and 33% of adults, p = 0.2). Preoperative hypopituitarism occurred in 41% of adults and 45% of pediatric patients (p = 0.8). Growth delay, a uniquely pediatric finding, was a presenting sign in 29% of pediatric patients. Visual complaints were a presenting symptom in 16% of adult and 7% of pediatric patients (p = 0.4). There was no difference between median cyst size in adults versus pediatric patients (1.2 cm in both, p = 0.7). Temporary or permanent postoperative diabetes insipidus occurred in 12% of adults and 21% of pediatric patients (p = 0.4). Kaplan-Meier analysis revealed an 8% RCC recurrence rate at 2 years for each group (p = 0.5). Conclusions The incidence of RCCs is much lower in the pediatric population; however, symptoms, imaging findings, and outcomes are similar, suggesting that pediatric RCCs arise from growth of remnants of the embryonic Rathke pouch earlier in life than adult RCCs but do not differ in any other way. It is important to consider RCCs in the differential diagnosis when pediatric patients present with visual impairment, unexplained headache, or hypopituitarism including growth delay. Although the average RCC size was similar in our pediatric and adult patient groups, the smaller size of the pituitary gland in pediatric patients suggests an increased relative RCC size.

scholarly journals Transitional Cell Carcinoma of the Bladder in Pediatric Patients: Where Do We Stand?

2020 ◽  
Vol 29 (02) ◽  
pp. 091-095
Author(s):  
Jaime Perez ◽  
Julián Chavarriaga ◽  
Paula Peña ◽  
Gustavo Ramos ◽  
Lynda Torres ◽  
...  
Keyword(s):  
Transitional Cell Carcinoma ◽  
Cell Carcinoma ◽  
Pediatric Patients ◽  
Incidental Finding ◽  
Pediatric Population ◽  
Transitional Cell ◽  
Early Presentation ◽  
Presenting Symptoms ◽  
Carcinoma Of The Bladder

Abstract Introduction Transitional cell carcinoma of the bladder (TCCB) is uncommon in the pediatric population, and its etiology, natural history and epigenetics remain poorly understood. We aim to describe six cases of TCCB in pediatric patients and discuss the state of the art in the management and follow-up of the patients with this uncommon early presentation. Methods The clinicopathological data of 6 patients with TCCB who underwent transurethral resection of bladder tumor (TURBT) were obtained from our institutional database. The patient data were collected retrospectively. A review of the literature was performed, and the most relevant and trending data were analyzed. Results A total of 6 patients (4 female, 2 male) were treated at our institution between 2004 and 2019. The mean age of the sample was 12 years, and the presenting symptoms were macroscopic hematuria (3 cases), suprapubic pain (2 cases), and 1 case was an incidental finding during pelvic ultrasonography. The long-term follow-up (median follow-up of 61 months) did not reveal recurrence. Conclusion Transitional cell carcinoma of the bladder rarely presents in the pediatric population. Genetic and epigenetic anomalies have been proposed as causes, as well as carcinogenic exposure. The reported cases tend to have a good prognosis, and most are non-invasive at the diagnosis. Follow-up protocols are still lacking, as well as molecular insights on tumor development and prognostic markers.

Design of an Implantable Blood Pump for Mechanical Circulatory Support in Pediatric Patients

2017 ◽  
Author(s):  
Trevor A. Snyder ◽  
Phillip Coghill ◽  
Kooroush Azartash-Namin ◽  
Jingchun Wu ◽  
J. Ryan Stanfield ◽  
...  
Keyword(s):  
Heart Failure ◽  
Continuous Flow ◽  
Mechanical Circulatory Support ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Right Heart Failure ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Hydrodynamic Characteristics ◽  
Vaned Diffuser

While the use of pulsatile- and continuous-flow ventricular assist devices (VADs) has become widely accepted as an acceptable treatment for end-stage heart failure in adults over the last three decades, the technology development for pediatric-specific patients is lagging behind that of adult devices. Only one pulsatile-flow VAD has been approved for use in pediatric patients in the U.S., just five years ago [1]. One continuous-flow device was approved specific to this population under Humanitarian Device Exemption (HDE), but is not in clinical use today [2]. As continuous-flow rotary blood pumps (RBPs) have become commonplace for mechanical circulatory support (MCS) in adults due to smaller size and greater reliability, significant resources have gone into the development of RBPs for pediatric use [3]. Further, RBPs designed for adult MCS have been used off-label in pediatric patients [4]. Development of an implantable device specific to a pediatric population includes challenges of anatomic placement and fixation. We have developed a RBP for adult MCS specific to right heart failure using computational fluid dynamics (CFD) and flow visualization [5]. The miniaturized device includes a rotating impeller and a vaned-diffuser in a 7 mm axial hydraulic diameter. As seen in Figure 1, the hydrodynamic characteristics suitable for a right-VAD (RVAD) may also be suitable for pediatric patients. Currently, the only approved device is placed extracorporeal due to size constraints in the intended population [1]. This report shows results of computational simulations for anatomic fit and fluid flow studies of our device geometry in pediatric patients.

scholarly journals Lethality by COVID-19 in children: an integrative review

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Márcia Andrade ◽  
Joel Lamounier ◽  
Taynara Paiva ◽  
Priscila Leite ◽  
Emylle Silva
Keyword(s):  
Heart Disease ◽  
Literature Review ◽  
Full Text ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Publication Date ◽  
Age Group ◽  
Inclusion Criteria ◽  
Keywords Children ◽  
Epidemiological Characteristics

OBJECTIVES: To characterize the clinical and epidemiological characteristics of deceased pediatric patients with COVID-19. METHODS: It was performed an integrative literature review with the keywords “children”, “COVID-19” and “death” and the boolean “AND” on the databases SciELO, PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Embase and ScienceDirect. The results were filtered by publication date (January 1st to June 30th) and by language (Portuguese, English and Spanish). The inclusion criteria were: articles with proven or probable pediatric COVID-19 cases and full text in Portuguese, English or Spanish. Articles with no full text available in the above-mentioned languages, non-pediatric population and editorials were excluded. Brazilian data were analyzed based on epidemiological reports from each state of the country. RESULTS: 24 articles were analyzed, with a total of 17 deaths among pediatric COVID-19 patients. There was no data available about age of 9 patients and about comorbidities of 14 patients. Brazil had 357 pediatric deaths and 182 of them were on the age group 0-9 years. The most frequent comorbidities were heart disease and diabetes. CONCLUSIONS: Despite the low distribution of deaths among pediatric COVID-19 patients, it is important to point out that they are still carriers of the disease.

Spinal arachnoid cysts in the pediatric population: report of 31 cases and a review of the literature

2012 ◽  
Vol 9 (4) ◽  
pp. 432-441 ◽  
Author(s):  
Aaron E. Bond ◽  
Gabriel Zada ◽  
Ira Bowen ◽  
J. Gordon McComb ◽  
Mark D. Krieger
Keyword(s):  
Spinal Cord ◽  
General Population ◽  
Complete Remission ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Arachnoid Cysts ◽  
Sensory Loss ◽  
Csf Leak ◽  
Lower Extremity Weakness ◽  
Presenting Symptoms

Object The goal of this study was to review all cases of pediatric spinal arachnoid cysts (SACs) surgically treated at the authors' institution between 1992 and 2008 and to compare these cases to the published literature for the general population. Methods The charts of all pediatric patients with SACs were reviewed for demographics, medical history, presenting symptoms, imaging findings, operative procedure(s), complications, and outcomes. Following a complete literature review, the pediatric data were compared with data from the general population and unique findings associated with pediatric patients were identified. Results Thirty-one pediatric patients (median age 6.9 years) underwent operative intervention for SACs between 1992 and 2008 (median duration of follow-up 4.2 years). There were 17 female patients (55%) and 14 male patients (45%). Twenty-one patients (68%) presented with symptoms of radiculopathy or myelopathy. The most common presenting symptoms were pain (42%), lower-extremity weakness (39%), gait instability (32%), spasticity (19%), sensory loss (10%), and bladder dysfunction (7%). In 3 patients (10%) SACs were incidental findings. Intradural SACs were more common (18 patients, 58%) than extradural SACs (11 patients, 36%). One patient (3%) had extradural and intradural components. One patient (3%) had a purely intramedullary cyst, and 1 patient (3%) had both an intradural and intramedullary component. Of the 18 intradural SACs, 9 (50%) were located ventral to the spinal cord and 9 (50%) were dorsally situated. One dorsal intradural SAC had an intramedullary component. All extradural SACs were located dorsal to the spinal cord. Intradural SACs were primarily concentrated in the cervical and thoracic regions (67%), whereas extradural cysts were more evenly distributed between the thoracic, lumbar, and sacral regions. Of the 18 patients with intradural SACs, 13 (72%) had significant previous CNS abnormalities, compared with 3 (27%) of 11 patients with extradural SACs. There were 2 operative complications. One patient had a CSF leak treated with a lumbar drain, and the second patient had a pseudomeningocele. No patients had neurological deterioration as a result of surgical intervention. Twenty-one patients (68%) had complete remission of symptoms, 6 (19%) had improvement, 3 (10%) were stable, and 1 (3%) has worsening of symptoms with recurrence that ultimately required cystoperitoneal shunting, despite multiple failed attempts at fenestration. Conclusions Spinal arachnoid cysts are rare lesions in the pediatric population. Affected patients present with back pain, weakness, and/or gait instability. In children, SACs predominantly develop in the thoracic region and are more likely to occur intradurally, compared with SACs in the general population. Overall outcomes following surgical fenestration or excision of SACs are excellent, with complete remission or improvement of symptoms achieved in 87% of cases.

scholarly journals Pediatric isolated thoracic and/or lumbar transverse and spinous process fractures

2016 ◽  
Vol 17 (6) ◽  
pp. 639-644 ◽  
Author(s):  
Babatunde J. Akinpelu ◽  
Scott L. Zuckerman ◽  
Stephen R. Gannon ◽  
Ashly Westrick ◽  
Chevis Shannon ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Pediatric Population ◽  
Spinous Process ◽  
High Energy ◽  
Neurological Deficits ◽  
Lumbar Region ◽  
Presenting Symptoms ◽  
The Mean

OBJECTIVE Isolated transverse and spinous process fractures (TPFx and SPFx) in the thoracic and/or lumbar region have been deemed clinically insignificant in the adult population. This same rule is often applied to the pediatric population; however, little evidence exists in this younger group. The goal of this study was to describe the clinical, radiographic, and long-term data on isolated TPFx and SPFx in an exclusively pediatric population. METHODS A retrospective chart review at Monroe Carell Jr. Children's Hospital at Vanderbilt University identified 82 pediatric patients with isolated TPFx and/or SPFx following a traumatic event between January 2000 and December 2013. Patient demographic information, presenting symptoms, radiographic characteristics, and follow-up data were collected. Follow-up was used to determine the outcome (presence of neurological deficits) of such injuries via complete physical examination and, when available, radiographic evidence. RESULTS In the 82 identified patients, the mean age was 15.5 ± 3.1 years (mean is expressed ± SD throughout), with 72 injuries (87.8%) resulting from a motor vehicle, motorcycle, or all-terrain vehicle accident. There was a mean of 1.7 ± 1.0 fractured vertebral levels involved and a mean of 1.8 ± 1.1 fractures was identified per patient. Seventy-one patients (86.6%) needed bedside pain control, 7 (8.5%) were prescribed a brace, and 4 patients (4.9%) received a collar. Physical therapy was recommended for 12 patients (14.6%). A total of 84.1% had follow-up, and the mean length of follow-up was 19 ± 37 months. No patients had true neurological deficits at presentation or follow-up as a result of their isolated fractures, whereas 95.1% had other associated system injuries. CONCLUSIONS These data shows that there is no appreciable long-term complication associated with isolated thoracic and/or lumbar TPFx and/or SPFx in an exclusively pediatric population. Because these fractures are, however, associated with high-energy blunt trauma, they often result in associated soft-tissue or other skeletal injury. All pediatric patients in the cohort benefited from conservative management and aggressive treatment of their comorbidities.

scholarly journals Cross-sectional study of the clinical characteristics and outcomes of children hospitalized with COVID-19 in Lima, Peru

Medwave ◽  
2021 ◽  
Vol 21 (01) ◽  
pp. e8107-e8107
Author(s):  
Jesús Domínguez Rojas ◽  
Matilde Estupiñan Vigil ◽  
Raquel Garcés-Ghilardi ◽  
Giancarlo Alvarado-Gamarra ◽  
Olguita del Águila ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Abdomen ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Cross Sectional Study ◽  
Hospitalized Patients ◽  
Sectional Study ◽  
Cross Sectional ◽  
Presenting Symptoms ◽  
Inflammatory Syndrome

Introduction Coronavirus 2019 (SARS-CoV-2) infection in children occurred in Peru as of March 2020, leading to pediatric patients' hospitalization in areas adapted for this purpose at the Edgardo Rebagliati Martins National Hospital. In the beginning, the demand for hospitalization was low, but it increased gradually. Consistent with international reports, the majority of patients presented mild or moderate symptoms. Nonetheless, there were also severe cases, even fatal ones. Objectives To describe the characteristics and clinical outcome of pediatric patients with COVID-19 hospitalized in a referral hospital in Lima, Peru, between March and August 2020. Methods A descriptive and inferential cross-sectional study was carried out. The population includes all hospitalized patients in the Department of Pediatrics, with clinical and surgical diagnoses associated with COVID-19. Results We included 100 patients, with an average age of 83.4 ± 54 months, with a predominance of male patients (55%). Hospitalized patients were grouped into five categories: respiratory failure (17%), multisystemic inflammatory syndrome (MIS-C) (31%), neurological presentation (19%), acute abdomen (20%), and patients with oncological problems (13%). Most of the patients (74%) had comorbidities. Regarding the presenting symptoms, intestinal pain predominated in the appendicitis group (90%, p < 0.001), fever was present in most patients with respiratory failure (64.7%); multisystemic inflammatory syndrome (90.3%), neurological manifestations (15.8%), acute abdomen (50%) and oncological conditions (61.5%) were also present in these patients. Kawasaki symptoms were found in 38.7% of the patients with multisystemic inflammatory syndrome. Mortality was 4%. Respiratory problems (29.4%) and multisystemic inflammatory syndrome (22.6%) required admission to intensive care, more frequently than the other presentations (p = 0.008). Conclusions We conclude that the vulnerability in the pediatric population is the one that has preexisting conditions. We divided our patients according to presentation, diagnosis, and complications, which were predominantly respiratory. We also had oncological patients with COVID-19.

Successful Use of Argatroban in Pediatric Patients Requiring Anticoagulant Alternatives to Heparin.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 4085-4085 ◽  
Author(s):  
Wendy Y. Tcheng ◽  
Wing-Yen Wong
Keyword(s):  
Heart Failure ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Dilated Cardiomyopathy ◽  
Congenital Heart ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Complex Congenital Heart Disease ◽  
Platelet Factor ◽  
History Of

Abstract BACKGROUND: Heparin-induced thrombocytopenia (HIT) is a potentially devastating immune-mediated complication that occurs in 1-2% of heparin-exposed pediatric patients in the ICU. Thrombosis can occur 5-14 days following heparin initiation and may cause significant morbidity and mortality. The thrombotic risk of HIT is mediated by heparin-platelet factor 4 antibody complexes that trigger platelet and endothelium activation, resulting in increased thrombin production. Argatroban is a direct thrombin inhibitor that is currently approved for use in adults for the prophylaxis or treatment of HIT. There is limited argatroban experience in the pediatric population. METHODS: A retrospective review of all pediatric patients (age &lt; 18 years) who received argatroban at our institutions (1,2) was performed. Data collected: age, diagnosis, indication for argatroban use, dose, duration, concurrent medications, measures of coagulation, adverse effects, and outcome. RESULTS: Six pediatric patients who received argatroban anticoagulation were identified (Table 1). Ages ranged from 8 months to 16 years. Indications included HIT or history of HIT on ECMO, HIT with thrombosis, and refractory thrombosis unrelated to HIT. Argatroban was infused at a dosing range of 0.5 to 24 mcg/kg/min with goal PTT at 2X baseline. Duration of therapy ranged from 1–39 days. All cases were successfully anticoagulated on argatroban. Termination of therapy occurred when ECMO was discontinued (cases 1, 2, 4), when HIT was ruled out (case 3), when patient was converted to coumadin (case 5), and at the time of surgery (case 6). There were no significant thrombotic nor bleeding episodes during argatroban therapy. CONCLUSIONS: Our limited experience demonstrates that Argatroban can be an effective means of anticoagulation in pediatric patients who require alternatives to heparin therapy. An ongoing multi-center study to evaluate the safety and efficacy of argatroban in the pediatric population will help to determine appropriate pediatric dosing. Table 1. Argatroban in Pediatrics Case Age/Gender Diagnosis Indication for Argatroban Initial Dose (μ g/kg/min) Dosing Range (μg/kg/min) Therapy Duration (days) Complications ECMO= extracorporeal membrane oxygenation, HPF4= Heparin-Platelet Factor 4, OHT= orthotopic heart transplant, WPW= Wolf-Parkinson-White syndrome, RLE= right lower extremity, DVT= deep vein thrombosis, B-T= Blalock-Taussig. 1 8 yo M Dilated cardiomyopathy, requiring ECMO Thrombus in circuit on day 4 of ECMO, +HPF4 ELISA 0.5 0.5 to 1.5, stabilized at 1.0 6 None 2 16 yo M Complex congenital heart disease, idiopathic cardiomyopathy s/p OHT, acute rejection requiring ECMO History of +HPF4 ELISA 2.0 0.6–2.0, stabilized at 0.6–0.8 10 None 3 8 yo F Complex congenital heart disease, heart failure requiring ECMO Concern for HIT when initiating ECMO, HPF4 ELISA pending 2.0 1.5–2.0 1 None 4 15 mo F Dilated cardiomyopathy,heart failure requiring ECMO Dropping platelets, and +HPF4 ELISA on day #10 ECMO 2.0 2.0–3.5 during 1st week, rate increased to 24 during 2nd week, then stabilized at 13–15 39 None 5 16 yo F History of right femoral osteosarcoma and WPW requiring ablation by cardiac catheterization RLE DVT after cardiac catheterization; DVT refractory to heparin & thrombolytic therapy 2.0 2.0 10 None 6 8 mo F Complex congenital heart disease Thrombosed B-T shunt, +HPF4 ELISA 1.0 0.5–1.0 9 None

Intraorbital Arteriovenous Fistulae Of The Ophthalmic Veins Treated By Transvenous Endovascular Occlusion:Technical Case Report

2006 ◽  
Vol 58 (suppl_1) ◽  
pp. ONS-E170-ONS-E170 ◽  
Author(s):  
Louis P. Caragine ◽  
Van V. Halbach ◽  
Chris F. Dowd ◽  
Randall T. Higashida
Keyword(s):  
Case Report ◽  
Complete Resolution ◽  
Transvenous Embolization ◽  
Carotid Cavernous Fistula ◽  
Rare Form ◽  
Arteriovenous Fistulae ◽  
Cavernous Fistula ◽  
Arteriovenous Fistulas ◽  
Presenting Symptoms ◽  
Facial Vein

Abstract OBJECTIVE AND IMPORTANCE Intraorbital arteriovenous fistulas (AVF) of the ophthalmic veins are an extremely rare phenomenon. This article describes two such cases treated solely by transvenous occlusion and not hitherto described in the literature. METHODS AND RESULTS: Two women, aged 51 and 63 years old, presented with proptosis and chemosis mimicking a carotid-cavernous fistula. In both cases, cerebral angiography revealed an intraorbital dural AVF of the superior and inferior ophthalmic vein, respectively. Both patients underwent transvenous ablation of the dural AVF retrograde via the facial vein and subsequently had complete resolution of the presenting symptoms. METHODS: Ophthalmic vein fistulas are a rare form of AVF with presenting symptoms mimicking those of carotid cavernous fistulae. This report describes two cases of ophthalmic vein fistulas successfully treated and angiographically obliterated via transvenous embolization with resolution of the patient's presenting symptoms.

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