Francis E. Marshalleck

Joint Quality Improvement Guidelines for Pediatric Arterial Access and Arteriography: From the Societies of Interventional Radiology and Pediatric Radiology

Manraj K. S. Heran & Francis Marshalleck & Michael Temple & Clement J. Grassi & Bairbre Connolly & Richard B. Towbin & Kevin M. Baskin & Josee Dubois & Mark J. Hogan & Sanjoy Kundu & Donald L. Miller & Derek J. Roebuck & Steven C. Rose & David Sacks & Manrita Sidhu & Michael J. Wallace & Darryl A. Zuckerman & John F. Cardella & Society of Interventional Radiology Standards of Practice Committee and Society of Pediatric Radiology Interventional Radiology Committee

Pediatric Arterial Interventions

The spectrum of pediatric vascular pathology differs from the adult population and it varies greatly to include congenital and acquired disorders. Although catheter-directed angiography remains the gold standard, most vascular conditions in the child can be adequately diagnosed with magnetic resonance angiography, computed tomographic angiography, or duplex/Doppler ultrasonography with only a few exceptions, such as intrarenal arterial stenosis, small vessel vasculitides, and visceral vascular malformations. The advancement of catheter and wire technology has made it increasingly possible for complex arterial interventions to be performed in children, including embolization, angioplasty with stent insertion, thrombolysis, and endovascular neurological procedures. More angiographic procedures are being performed with the aim of also being therapeutic. Special considerations in children include the use of appropriate equipment and adequate dosing of contrast and of the various medications used during angiography, particularly in patients less than 15 kg in weight. This article will focus on the management of renovascular hypertension, liver transplant hepatic arterial intervention, and the use of carbon dioxide gas as a contrast agent in the child.

Joint quality improvement guidelines for pediatric arterial access and arteriography: From the Societies of Interventional Radiology and Pediatric Radiology

Manraj K. S. Heran & Francis Marshalleck & Michael Temple & Clement J. Grassi & Bairbre Connolly & Richard B. Towbin & Kevin M. Baskin & Josee Dubois & Mark J. Hogan & Sanjoy Kundu & Donald L. Miller & Derek J. Roebuck & Steven C. Rose & David Sacks & Manrita Sidhu & Michael J. Wallace & Darryl A. Zuckerman & John F. Cardella & Society of Interventional Radiology Standards of Practice Committee and Society of Pediatric Radiology Interventional Radiology Committee

NASPGHAN clinical report on the evaluation and treatment of pediatric patients with internal penetrating Crohn disease: intraabdominal abscess with and without fistula.

Natural History of Pediatric Crohn Disease T he natural history of pediatric Crohn disease (CD) remains unpredictable, although some trends are observed that differentiate children from adults. Pediatric CD often presents with more severe disease and more frequent need for immunosuppressive therapy (1). Growth failure, present in 15% to 20% of patients, is a unique characteristic of pediatric CD not seen in adult-onset CD (2). Colonic disease distribution is common in patients younger than 10 years (1). The need for surgical intervention also varies, with 1 study reporting the actuarial risk of having undergone an extensive intestinal resection being 48.6% 5% in a childhood-onset group versus 14.6% 2% in the adult-onset group (P< 0.001) (1). More recently, long-term follow-up of patients enrolled in pediatric registries shows a cumulative surgical rate of 14% to 17% at 5 years and 28% at 10 years (3,4).

Developing a clinical pediatric interventional practice: a joint clinical practice guideline from the Society of Interventional Radiology and the Society for Pediatric Radiology.

Kevin M. Baskin, MD, Mark J. Hogan, MD, Manrita K. Sidhu, MD, Bairbre L. Connolly, MB,Richard B. Towbin, MD, Wael E.A. Saad, MD, Josee Dubois, MD, MSc,Manraj K.S. Heran, MD, FRCPC, Francis E. Marshalleck, MD, Donald L. Miller, MD,Derek Roebuck, MBBS, Michael J. Temple, MD, FRCP, T. Gregory Walker, MD,John F. Cardella, MD, and members from the Society of Interventional Radiology Standards ofPractice Committee and Society for Pediatric Radiology Interventional Radiology Committee

Epstein-Barr-associated leiomyomatosis and T-cell chimerism after haploidentical bone marrow transplantation for severe combined immunodeficiency disease.

Background The clinical course of Epstein-Barr virus (EBV)–associated smooth muscle tumors is variable and there are no reports in patients with mixed T-cell chimerism after bone marrow transplantation (BMT). Observations A child with X-linked severe combined immunodeficiency disease developed multiple renal and pulmonary leiomyomata 8 years after haploidentical BMT. Epstein-Barr viral DNA was detectable in the blood and in situ hybridization for EBV-encoded RNAs was positive in the tumor. The tumors have been radiographically stable, chimerism remains mixed, and plasma EBV DNA has been repeatedly negative for over 2 years after donor lymphocyte infusion. Conclusions EBV-associated smooth muscle tumors may occur in patients who are partially reconstituted after BMT for severe combined immunodeficiency and may not require surgery or chemotherapy.

ACR Appropriateness Criteria Radiologic Management of Hepatic Malignancy

Management of hepatic malignancy is a challenging clinical problem involving several different medical and surgical disciplines. Because of the wide variety of potential therapies, treatment protocols for various malignancies continue to evolve. Consequently, development of appropriate therapeutic algorithms necessitates consideration of medical options, such as systemic chemotherapy; surgical options, such as resection or transplantation; and locoregional therapies, such as thermal ablation and transarterial embolization. The authors discuss treatment strategies for the 3 most common subtypes of hepatic malignancy treated with locoregional therapies: hepatocellular carcinoma, neuroendocrine metastases, and colorectal metastases. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

ACR Appropriateness Criteria Radiologic Management of Infected Fluid Collections

The best management of infected fluid collections depends on a careful assessment of clinical and anatomic factors as well as an up-to-date review of the published literature, to be able to select from a host of multidisciplinary treatment options. This article reviews conservative, radiologic, endoscopic, and surgical options and their best application to infected fluid collections as determined by the ACR Appropriateness Criteria Expert Panel on Interventional Radiology. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals, and the application, by the panel, of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

Quality improvement guidelines for pediatric gastrostomy and gastrojejunostomy tube placement

John J. Crowley, MB, Mark J. Hogan, MD, Richard B. Towbin, MD, Wael E. Saad, MD,Kevin M. Baskin, MD, Anne Marie Cahill, MD, Drew M. Caplin, MD, Bairbre L. Connolly, MB,Sanjeeva P. Kalva, MD, Venkataramu Krishnamurthy, MD, Francis E. Marshalleck, MD,Derek J. Roebuck, MD, Nael E. Saad, MD, Gloria M. Salazar, MD, Leann S. Stokes, MD,Michael J. Temple, MD, T. Gregory Walker, MD, and Boris Nikolic, MD, MBA,for the Society of Interventional Radiology Standards of Practice Committee andthe Society for Pediatric Radiology Interventional Radiology Committee

Hemodialysis Graft and Fistula Access and Intervention

The incidence of renal failure in children is 1–2/100,000 as compared to 30/100,000 in adults. Although the method of dialysis depends on many factors, in some European countries, hemodialysis is preferred in children older than 5 years with peritoneal dialysis used in younger children and those less than 10 kg in weight. The National Kidney Foundation (NKF) has developed the Kidney Dialysis Outcomes Quality Initiative (K/DOQI) guidelines that serve as the standards of hemodialysis access management. Methods of dialysis access that are used in patients requiring hemodialysis include hemodialysis catheters, arteriovenous grafts (AVGs), and arteriovenous fistulae (AVFs). One of the current goals of the DOQI guidelines is to have an AVF placed in at least 50 % of patients with new onset renal failure and in at least 40 % of patients requiring hemodialysis. The DOQI guidelines also recommend that catheters should be used in less than 10 % of patients requiring hemodialysis. This chapter will focus on the management of dysfunctional AVGs and AVFs.