Jiliang Yang

The impact of using three-dimensional printed liver models for patient education:

Objective To investigate the impact of using a three-dimensional (3D) printed liver model for patient education. Methods Children with hepatic tumours who were scheduled for hepatectomy were enrolled, and patient-specific 3D liver models were printed with photosensitive resin, based on computed tomography (CT) images. Before surgery, their parents received information regarding liver anatomy, physiology, tumour characteristics, planned surgery, and surgical risks using these CT images. Then, parents completed questionnaires regarding this information. Thereafter, 3D printed models of each patient were presented along with an explanation of the general printing process, and the same questionnaire was completed. The median number of correct responses in each category before and after the 3D printed model presentation was compared. Results Seven children and their 14 parents were enrolled in the study. After the presentation of 3D printed models, parental understanding of basic liver anatomy and physiology, tumour characteristics, the planned surgical procedure, and surgical risks significantly improved. Parents demonstrated improvements in their understanding of basic liver anatomy by 26.4%, basic liver physiology by 23.6%, tumour characteristics by 21.4%, the planned surgical procedure by 31.4%, and surgical risks by 27.9%. Conclusions Using 3D printed liver models improved parental education regarding the understanding of liver anatomy and physiology, tumour characteristics, surgical procedure, and associated surgical risks.

Clinical and imaging differences between neonates and children with pyriform sinus fistula: which is preferred for diagnosis, computed tomography, or barium esophagography?

PURPOSE Pyriform sinus fistula (PSF) is very rare. It is difficult to make an accurate diagnosis preoperatively. The aim of this study is to summarize the characteristics of clinical and radiologic presentations in neonates and children with PSF and to assess which examination is more helpful for diagnosis. METHODS A retrospective review was performed in 29 patients with PSF at a single center from January 2013 to September 2016. The clinical presentation, computed tomography (CT) scan/magnetic resonance imaging (MRI), and barium esophagogram were evaluated between neonates and children. RESULTS This study comprised 14 neonates and 15 children. Neonatal patients presented with cervical cyst, dyspnea, and stridor. However, the most common presentations of children were recurrent neck abscess and thyroiditis. All the neonates and 12 the children underwent CT scan/MRI, which showed the characteristic air pocket in the cervical lesion of 11 (78.6%) neonates and 4 (33.3%) children. The positive rates of barium esophagography in the neonates and children were 27.3% and 86.7%, respectively, the difference of which was statistically significant. CONCLUSION To obtain an accurate diagnosis of PSF, the differences in clinical and radiologic presentation suggest that CT scan/MRI is preferred for neonates, and barium esophagography is preferred for children. CT scans performed immediately after barium swallow improve the positive rate.

Ruptured hepatoblastoma successfully treated with cisplatin monochemotherapy: A case report

Traditionally, ruptured hepatoblastoma is considered a high-risk occurrence, necessitating a chemotherapy regimen usually consisting of cisplatin alternating with carboplatin plus doxorubicin, based on International Childhood Liver Tumours Strategy Group studies. However, ruptured hepatoblastomas with intact hepatic capsules may represent a unique subgroup that may be successfully treated with TAE, cisplatin monotherapy, and surgical excision. We herein present a case of ruptured hepatoblastoma (pretreatment tumor extension stage II) in a 1-year-old female patient that was successfully managed with transarterial embolization (TAE), eight courses of cisplatin chemotherapy and surgical removal. The patient currently remains disease-free for >12 months. Given the rarity of ruptured hepatoblastomas, further study of patients within this subgroup is required to confirm the findings of the present study.

Cure of Hepatoblastoma Through Transcatheter Arterial Chemoembolization

Hepatoblastoma is the most common malignant liver tumor in children. Contrary to its adult counterparts (hepatocellular carcinoma [HCC]), hepatoblastoma is relatively rare, with a current rate of 1.2 to 1.5 cases/million population/year.1 Surgery and chemotherapy remain the mainstay of treatment for hepatoblastoma. The main controversy between various study groups has been the issue of primary hepatic resection, with Childhood Liver Tumors Strategy Group (SIOPEL) recommending preoperative chemotherapy, whereas other study groups have traditionally held that some early PRETEXT stage groups are amenable to upfront resection. Transcatheter arterial chemoembolization (TACE) is a practical and effective alternative for hepatic malignancies and is performed worldwide for adult patients with inoperable HCC.2 However, in childhood hepatoblastoma, TACE is less frequently performed and is mainly used to shrink advanced-stage hepatoblastoma after initial systemic chemotherapy, thus allowing complete surgical resection.3,4 To our knowledge, the cure of hepatoblastoma by TACE alone has not been reported. Here, we report a case of hepatoblastoma cured by multiple TACE procedures.

The Many Presentations of Pneumomediastinum

Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits noncommercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). Brief Report

The Whirl Sign and Small Intestinal Volvulus.

A 2-year-old girl presented with a 4-day history of persistent abdominal pain, localized to the periumbilical region and associated with vomiting. Her medical history included successful intestinal resection and primary anastomosis for necrotized enterocolitis at 15 days of age. Physical examination showed normal vital signs and mild upper abdominal tenderness without rebound. Abdominal radiography showed incomplete small intestinal obstruction. Ultrasonography revealed a corkscrew-like mass in the upper abdomen and a whirlpool-flow pattern of the superior mesenteric vein circling the superior mesenteric artery. Abdominal computed tomography demonstrated small intestinal and mesenteric pedicle twisting, with the superior mesenteric artery encircled by the superior mesenteric vein in a counter-clockwise rotation (Figures 1-4; Figures 2-4 available at www.jpeds.com), creating the whirl sign. Laparotomy confirmed small intestinal volvulus, in a counter-clockwise rotation around the mesenteric root