Richard A. Courtney

Anesthetic management of the exit (ex utero intrapartum treatment) procedure

The EXIT (ex utero intrapartum treatment) procedure is used to maintain fetal-placental circulation during partial delivery of a fetus with a potentially life-threatening upper airway obstruction. We performed the EXIT procedure on a fetus with a large intra-oral cyst. Sevoflurane was used as the anesthetic because of its rapid titratability. Sevoflurane provided excellent maternal and fetal anesthesia. Modifications to previously described monitoring techniques for the EXIT procedure were also used.

Preoperative chemoembolization for unresectable hepatoblastoma.

Abstract Complete surgical resection offers the only chance for cure in patients with hepatoblastoma (HB). Patients with unresectable lesions are given preoperative chemotherapy in an attempt to create a resectable lesion. We present a case of an 11-month-old with an unresectable stage III HB unresponsive to systemic chemotherapy. Transfemoral hepatic-artery chemoembolization resulted in a surgically resectable tumor. The patient underwent a right trisegmentectomy with complete resection of the tumor and remains tumor-free 24 months postoperatively. Salvage chemoembolization can be an effective preoperative modality to convert an unresectable tumor into a resectable one.

Diffuse gastrointestinal polyposis associated with chronic blood loss, hypoproteinemia, and anasarca in an infant

Summary An infant is described who had severe intestinal loss of protein and died of polypoid adenomatosis of the entire gastrointestinal tract from the esophagogastric junction to the anus. Consideration of possible diagnostic entities reveals that this was a sporadic case not fitting into the more common syndromes.

Endoscopic treatment with Deflux for refluxing duplex systems.

PURPOSE The aim of this study was to review the experience of a single institution with the endoscopic Deflux (Q-Med Scandinavia, Uppsala, Sweden) procedure and assess its effectiveness in the treatment of refluxing duplex systems. MATERIALS AND METHODS A retrospective review of all patients that underwent endoscopic Deflux treatment for vesicoureteral reflux (VUR) in duplex systems between June 2003 and July 2007 was performed. Data collection included: age, gender, side of refluxing ureter, preoperative radiologic grade of VUR on a voiding cystourethrogram (VCUG), presence of VUR on a radionuclide VCUG 3 months postprocedure, volume of Deflux injected, number of Deflux injections performed per patient, and number of patients that underwent reimplantation surgery. RESULTS Sixteen patients with duplex systems, two being bilateral, for a total of 18 duplex ureteral systems, underwent the Deflux procedure. Grades of reflux were as follows: grade II: 4 ureters; grade III: 8 ureters; grade IV: 4 ureters; and grade V: 2 ureters. Deflux injection volume ranged from 0.28 to 1.5 cc (mean, 0.84). Fourteen ureteral systems required one injection, three required two injections, and one required three injections. The overall success rate of the procedure after a maximum of three injections was 94%. One patient with preoperative unilateral grade V reflux had persistent high-grade reflux after two injections and opted to proceed with surgical reimplantation. The mean follow-up was 24 months (mean, 6-48). CONCLUSIONS We conclude that the Deflux procedure is a safe, effective minimally invasive treatment alternative for patients with refluxing duplex systems.