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Objective:To study the clinical outcomes of children with extrahepatic portal venous obstruction who underwent balloon venoplasties for anastomotic stenosis after Meso-Rex bypass.Methods:The data of 60 patients who underwent Meso-Rex bypass at Guangzhou Women and Children’s Medical Center between October 2014 and November 2018 were retrospectively analyzed. Four patients were shown by transhepatic portal venography to have graft stenosis in the left portal vein anastomosis. There were 2 males and 2 famales, the age of patients were 11 years, 5 years, 5 years and 8 years. Four patients underwent balloon dilation. The pressure, anastomotic diameter and blood flow velocity of the anterior portal vein were compared before and after balloon dilation. The patients were followed-up on the postoperative status.Results:Three of 4 patients who had anastomotic stenosis were successfully treated by balloon venoplasties. On postoperative follow-up for 6 months, the bridging vessels remained unobtrusive and there was no gastrointestinal bleeding. The pressures of the anterior hepatic portal vein before balloon dilation were 19, 15 and 25 mmHg (1 mmHg=0.133 kPa). They were 8, 11 and 20 mmHg after balloon dilation. The preoperative anastomotic diameters were 2.6, 3.0 and 3.0 cm. They were 6.0, 4.5 and 5.5 cm, respectively 6 months after surgery. The preoperative anastomotic blood flow velocities were 138, 107 and 94 cm/s. They were 96, 91 and 90 cm/s, respectively 6 months after surgery. The preoperative three-dimensional CT reconstruction of spleen volumes were 793.24, 192.25, and 318.05 cm 3, respectively. They were 681.84, 190.30, and 310.65 cm 3, respectively 6 months after surgery. In the remaining patient, balloon dilation failed because of the small diameter of the anastomotic stenosis segment. Conclusion:Balloon venoplasties is an optional procedure for patients with anastomotic stenosis after Meso-Rex bypass.
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Objective To investigate the efficacy and safety of transcather arterial embolization (TAE) plus sirolimus for the treatment of refractory Kasabach-Merritt syndrome (KMS) in infants. Methods Clinical data of twelve infants with refractory KMS treated between December 2015 and October 2016 in a single hospital were retrospectively analyzed. TAE were performed in all patients after failed traditional multiple therapies, followed by oral sirolimus administration. The dose of sirolimus was modulated according to the level of sirolimus, the count of platelet, the shrinkage of the lesion and the side effects, which were monitored regularly during the study. Results All 12 patients were treated with TAE plus sirolimus therapies successfully. The platelet count for all patients increased to≥100×109/L for the first time at (7±5) days. Stabilization of platelet level was obtained in (15±7) days averagely. Before the treatment, two infants had a normal fibrinogen level and the fibrinogen level in the other 10 infants was found to be increased to≥2.0 g/L at (9 ± 4)days for the first time and was then stabilized at levels>2.0 g/L at (19 ± 7)days after treatment. One patient showed skin fester (GradeⅡ), one patient had a fever with acute pulmonary infection (Grade Ⅲ) and both patients improved well after symptomatic treatment. There were no serious complications in the other ten patients. Conclusions TAE plus sirolimus can rapidly improve levels of platelets and fibrinogen, and it is a safe, useful and effective method for treatment of refractory KMS in infants.
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Objective To evaluate the application value of MSCT in preoperative diagnosis and postoperative evaluation in children with cavernous transformation of the portal vein (CTPV).Methods 11 children diagnosed with CTPV by surgery were included in this study in our hospital.All patients underwent both plain and enhanced MSCT scans before surgery,and ultrasound or MSCT scan after surgery.Results In all 11 cases,preoperative CT showed different degrees of splenomegaly and the plain CT showed abnormal soft tissue mass in the hepatic hilar area.Enhanced CT showed stenosis or occlusion of portal vein trunk,earthworm-like blood vessels in the hilar region,and that the left and/or right branch of intrahepatic portal vein were replaced by multiple densely-distributed blood vessels (typeⅡ). Superior mesenteric-intrahepatic left portal shunt (Rex surgery)was performed in all 11 cases with successful results.All patients were followed up for 2-20 months after surgery.Imaging examinations showed anastomotic patency in 9 cases and stenosis in 2 cases.Conclusion MSCT findings of CTPV in children have certain characteristics.MSCT plays an important role in preoperative diagnosis and postoperative evaluation of CTPV in children.
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Objective To investigate the efficacy and safety of transcather arterial embolization (TAE) plus sirolimus for the treatment of refractory Kasabach-Merritt syndrome (KMS) in infants. Methods Clinical data of twelve infants with refractory KMS treated between December 2015 and October 2016 in a single hospital were retrospectively analyzed. TAE were performed in all patients after failed traditional multiple therapies, followed by oral sirolimus administration. The dose of sirolimus was modulated according to the level of sirolimus, the count of platelet, the shrinkage of the lesion and the side effects, which were monitored regularly during the study. Results All 12 patients were treated with TAE plus sirolimus therapies successfully. The platelet count for all patients increased to≥100×109/L for the first time at (7±5) days. Stabilization of platelet level was obtained in (15±7) days averagely. Before the treatment, two infants had a normal fibrinogen level and the fibrinogen level in the other 10 infants was found to be increased to≥2.0 g/L at (9 ± 4)days for the first time and was then stabilized at levels>2.0 g/L at (19 ± 7)days after treatment. One patient showed skin fester (GradeⅡ), one patient had a fever with acute pulmonary infection (Grade Ⅲ) and both patients improved well after symptomatic treatment. There were no serious complications in the other ten patients. Conclusions TAE plus sirolimus can rapidly improve levels of platelets and fibrinogen, and it is a safe, useful and effective method for treatment of refractory KMS in infants.
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Objective To evaluate the therapeutic effects and safety of transcatheter arterial sclerosing embolization (TASE) combined with oral Propranolol in infantile huge hemangiomas.Methods A total of 76 infants with huge hemangioma were treated by TASE.All patients received oral Propranolol based on their weight.The follow-up and efficacy evaluation were performed from the last treatment.And the complications were analyzed.Results Seventy-six cases underwent 95 case-times of TASE totally.The success rate of puncture technique was 100％ (95/95).All patients were divided into 5 levels (0-Ⅳ levels) based on the curative effect of the follow-up,including 6 cases (6/76,7.90％) of level Ⅰ,19 cases (19/76,25.00％) of level Ⅱ,23 cases (23/76,30.26％) of level l,and 28 cases (28/76,36.84％) of level Ⅳ.The total effective rate was 100％ (76/76).There was no serious complications,and the curative effect was stable during the follow-up.Conclusion TASE combined with oral Propranolol in infantile huge hemangiomas is effective with less invasiveness and fewer complications.
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Objective To evaluate the application value of MSCT in preoperative diagnosis and postoperative evaluation in children with cavernous transformation of the portal vein (CTPV).Methods 11 children diagnosed with CTPV by surgery were included in this study in our hospital.All patients underwent both plain and enhanced MSCT scans before surgery,and ultrasound or MSCT scan after surgery.Results In all 11 cases,preoperative CT showed different degrees of splenomegaly and the plain CT showed abnormal soft tissue mass in the hepatic hilar area.Enhanced CT showed stenosis or occlusion of portal vein trunk,earthworm-like blood vessels in the hilar region,and that the left and/or right branch of intrahepatic portal vein were replaced by multiple densely-distributed blood vessels (typeⅡ). Superior mesenteric-intrahepatic left portal shunt (Rex surgery)was performed in all 11 cases with successful results.All patients were followed up for 2-20 months after surgery.Imaging examinations showed anastomotic patency in 9 cases and stenosis in 2 cases.Conclusion MSCT findings of CTPV in children have certain characteristics.MSCT plays an important role in preoperative diagnosis and postoperative evaluation of CTPV in children.
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Objective To evaluate the therapeutic effects and safety of transcatheter arterial sclerosing embolization (TASE) combined with oral Propranolol in infantile huge hemangiomas.Methods A total of 76 infants with huge hemangioma were treated by TASE.All patients received oral Propranolol based on their weight.The follow-up and efficacy evaluation were performed from the last treatment.And the complications were analyzed.Results Seventy-six cases underwent 95 case-times of TASE totally.The success rate of puncture technique was 100％ (95/95).All patients were divided into 5 levels (0-Ⅳ levels) based on the curative effect of the follow-up,including 6 cases (6/76,7.90％) of level Ⅰ,19 cases (19/76,25.00％) of level Ⅱ,23 cases (23/76,30.26％) of level l,and 28 cases (28/76,36.84％) of level Ⅳ.The total effective rate was 100％ (76/76).There was no serious complications,and the curative effect was stable during the follow-up.Conclusion TASE combined with oral Propranolol in infantile huge hemangiomas is effective with less invasiveness and fewer complications.
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Objective To evaluate the safety and efficacy of percutaneous ethanol embolization (PEE) in treating arteriovenous malformation (AVM) of foot in children.Methods The clinical data of 11 sick children with arteriovenous malformation of foot,who were treated with PEE in authors' department during the period from January 2007 to January 2016,were retrospectively analyzed.The clinical symptoms,the type of tumor nidus,the therapeutic effect and the postoperative complications were analyzed.Results The 11 sick children included 6 boys and 5 girls,with a mean age of 9 years.Foot mass was seen in 8 children,pain in 8 children,claudication in 3 children and ischemic skin ulcer in one child.Cho Ⅲ b type was observed in 10 children and Cho Ⅱ type in one child;Yakes Ⅳ type was found in 10 children and Ⅱa type in one child.A total of 30 PEE procedures were performed,with an average of 2.7 times per case.The children were followed up for 6-48 months,with a mean of 24 months.Evaluation of curative effect showed that complete cure was achieved in 7 children and partial remission in 3 children,the effective rate was 90.9％.Treatment failure (showing no remission) was seen in one child,and no deterioration of disease was observed.Complications included transient blood oxygen decrease in operation (n=1),toe ischemia (n=1),postoperativeblister (n=1) and local skin ulcer (n=l),no severe complications were observed.Conclusion PEE is a safe and effective treatment for arteriovenous malformation of foot in children.
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Objective To analyze the angiographic characteristics of Kasabach-Merritt syndrome (KMS) and study the value of transcatheter arterial embolization (TAE) in KMS therapy. Methods The clinical data of 36 infants with KMS treated between June 2010 and June 2016 in our hospital were reviewed retrospectively. All infants performed angiography and TAE therapy. These angiographic characteristics were analyzed by comparing with infantile hemangioma(IH).The times of TAE and the level of platelet after TAE therapy were observed. Results The angiographic characteristics of KMS were as follows: The capillary blush of KMS were ill defined with no-uniform distribution. There were a lot of very fine feeding arteries. The diameter of feeding artery was disproportionate to the volume of tumor blush because the feeding arteries were too small or fine. Normal artery was usually embedded in tumor blush. However, the angiographic characteristics of IH were different as follows:the capillary blush of IH were well defined with uniform distribution.There were about 1-4 feeding arteries.The diameter of feeding artery was proportional to the volume of tumor blush. Normal artery was not embedded in tumor blush. Tumor blush was usually located beside the normal artery. In 36 patients, 107 embolization treatments were performed. The platelet declined for 11 times and increased for 96 times after TAE therapy. The platelet count for these 96 cases increased to ≥100×109/L at(7.1 ± 2.4)days following therapy. However, the platelet level fluctuated thereafter and the average relapse time was(45.9 ± 21.8)days. All cases were followed-up ranging from 6 months to 2 years and finally received other therapies.Eight cases were cured and the other 28 cases were improved. Conclusions The angiographic characteristics of KMS are different from common infantile hemangioma. It is difficult to embolize the feeding arteries of KMS because there are a lot of very fine feeding arteries.TAE may rapidly improve the level of platelets while the long term effect was poor.It might be better to combine TAE with other medical therapies to treat KMS.
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Objective To detect radiation-induced changes of temporal lobe normal-appearing white matter on conventional MRI following radiation therapy (RT) for nasopharyngeal carcinoma (NPC).Methods The clinical and imaging features of 75 patients with nasopharyngeal carcinoma were retrospectively analyzed,all patients were confirmed by biopsy.All patients performed conventional MRI and Diffusion-tensor imaging (DTI) examinations,and there was no abnormal finding on conventional MRI.Eighteen patients without radiotherapy were selected as the control group and fifty-seven patients with radiotherapy were as the experimental group.We divided the experimental group into five subgroups based on completion time of RT:group 1 (less than 3 months,n =16),group 2 (3 to 6 months,n =12),group 3 (6 to 9 months; n =10),group 4 (9 to12 months,n =8),and group 5 ( more than 12 months,n =11 ).The mean diffusivity ( MD),apparent diffusion coefficient ( ADC ),fractional anisotropy ( FA),radial diffusivity ( λ⊥ ) and axial diffusivity ( k ‖ ) were calculated in bilateral temporal lobe.One-way analysis of variance (one-way ANOVA) test was used for comparison among groups.Results The mean λ⊥ values of the control group and experimental groups ( group1-5 ) after radiotherapy were ( 6.075 ± 0.341 ) × 10 -4 (6.700±0.379) × 10-4,(6.976 ±0.527) ×10-4,(6.621 ±0.388) ×10-4,(6.751 ±0.460) ×10-4,(6.222 ±0.256) × 10-4 mm2/s,respectively.The mean λ ‖ values of the control group and experimental groups were (12.524±0.713) ×10-4,(11.764 ±0.574) ×l0-4,(11.842±0.471) ×10-4,(11.569 ± 0.552) × 10-4,( 12.050 ±0.614) × 10-4,( 12.100 ±0.529) × 10-4 mm2/s,respectively.The mean FA values of the control group and experimental groups were 0.452 ± 0.030,0.379 ± 0.028,0.382 ± 0.028,0.389 ± 0.032,0.388 ± 0.022,0.423 ± 0.232,respectively.The three indicators were significantly different among groups ( F =10.485,4.625,16.539,respectively,P ＜ 0.05 ). Multiple comparisons showed that λ⊥ increased significantly in group 1-4 compared with that in the control group.In group 5,λ ⊥ was not significantly different from that in the control group,λ ‖ decreased in group 1-3 compared with that in the control group,but was not significantly different in the control group and group 4-5. In all experimental groups,FA decreased significantly. MD and ADC values in experimental groups were not significantly different from those in the control group. Conclusion Diffusion tensor imaging is a noninvasive and quantitative method to detect the structural changes in WM after RT and can provide scientific evidence for the early diagnosis and intervention treatment of radiation-induced changes.