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Abstract No. 129: Prophylactic embolization for large angiomyolipoma in pediatric population
weight-for-age), PORT insertion data and complications post-procedure (early ⱕ 30 days; late ⬎ 30 days) were reviewed. CDC definition of CAI were used. PORT dwell time ranged from 1 to 42 months. Descriptive and inferential statistics were done.
Conclusion: Prophylactic embolization of large angiomyolipoma in children with TS is safe. In our series, there was no instance of bleeding from the AML following embolization after a mean follow-up of 27 months.
Results: 192 PORTs were inserted in 179 children. The majority of patients started on chemotherapy 3 days prior to the procedure. There were 43 CAI (22%) and the infection rate was 0.35/1000 catheter-days overall. The CAI rate of 15% in children with severe neutropenia on the day of the procedure (n⫽99) was not statistically different to the CAI of 24% in those who did not have severe neutropenia (n⫽93) (p⫽0.137). 12 PORTs (6%) were removed due to an infection, most commonly caused by Coagulase Negative Staphylococcus or Staphylococcus aureus. Patients with high risk precursor B and T cell ALL had a statistically significant higher incidence of late CAI than standard risk ALL (p⫽0.024). Gender (p⫽0.863), dexamethasone use during induction (p⫽0.201), malnutrition (p⫽0.659), low albumin (p⫽0.530), low total protein (p⫽0.759) and fever pre-procedure (p⫽0.339) were not risk factors for CAI. Patients who had an early CAI didn’t have a greater chance of a late CAI (p⫽0.813). Out of 9 wound dehiscences (4%), only one PORT required removal. The catheter infectionfree survival rate at 1 year was 88.6%, at 2 years 86.7% and at 3 years 83.9%.
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Abstract No. 129
Prophylactic embolization for large angiomyolipoma in pediatric population T.J. Norton, E. Paul, S. Kalva, T.G. Walker, B. Pomerantz, S. Ganguli, S. Wicky, G.M. Salazar; Massachusetts General Hospital, Boston, MA. Purpose: To assess the safety and effectiveness of prophylactic embolization for large angiomyolipoma (AML) in children with tuberous sclerosis Materials and Methods: Eight patients (age range 9 - 16 years, mean ⫽ 13.1yrs) with Tuberous sclerosis underwent embolization for 11 renal AMLs between September 2004 and August 2009. The size of the tumors ranged from 2.6 to 9.9 cm with a median of 7.0cm. Embolization was performed using 300-900 microns particles. All tumors were completely embolized until vascular stasis and absence of arterial feeders was demonstrated. The procedural complications and the frequency of post embolization hemorrhage from the AML were evaluated. Hemorrhage was defined by clinical and imaging criteria, as an acute symptomatic episode, with demonstration of a fluid collection within renal parenchyma or subcortical/subcapsular regions. Complications were recorded according to the SIR guidelines. Renal function was measured by pre and post procedure serum creatinine levels. Results: Embolization of the renal AMLs was technically successful in each of the 11 lesions. Two lesions required retreatment because of increasing size post embolization. No clinically symptomatic post embolization hemorrhage occurred during a mean follow-up time of 27 months (range 2-60 months). There were no periprocedural complications.
Purpose: To evaluate factors that impact stability of protein foam for percutaneous ultrasound guided (USG) treatment of microcystic lymphatic malformation (LM). Materials and Methods: Albumin-based solutions (ABS) were agitated into protein foams and evaluated for stability after 15 minutes. Solution pH was determined and air:liquid ratio (4:1, 3:1, 2:1, 1:1) was selected prior to agitation. Solutions included combinations of albumin (AL) (25%), doxycycline (D), normal saline (NSS), 0.5% Lidocaine (Lido 0.5), 1.0% Lidocaine (Lido 1), and Optiray 320 (Opti 320). Solutions with doxycycline were mixed to 20mg/ml doxycycline prior to agitation into foam. Homogeneous ABS foams were created with 30 dual syringe/stopcock agitations and evaluated for liquid-phase separation after 15 minutes. Liquid-phase separation (LPS) was recorded as a percentage of total liquid and foam volume (3 trials for each combination). Echogenicity was tested with 15 MHZ USG injections in turkey breast phantoms. Results: Agitated solutions not containing albumin did not form foam. pH of solutions containing saline, lidocaine, and albumin were 7.0. The pH of doxycycline-based solutions without albumin were 2.0 without contrast, 3.0 with contrast, and 4.0 with albumin. Stability data demonstrate that at 3:1 and 4:1 liquid:air ratios, the addition of doxycycline (acidic pH) enhances the stability of albumin microfoam. The AL/D/Lido solutions mixed 3:1 and 4:1 air:liquid produced microfoam with 96-98% stability over 15 minutes, with doxycycline microfoam concentrations of 5mg/ml and 4mg/ml respectively. All microfoams were injectable through 23G needles and were echogenic for USG treatment. SUMMARY:Solution;Air:Liquid Ratio-1:1 2:1 3:1 4:1. AL, LPS(Avg) %-26,12.6, 8.5, 2; AL/NSS, LPS-29, 9.8, 14, 2; AL/Lido 0.5,LPS-30, 21, 17,10; AL/Lido 1,LPS-34, 21, 17.5, 7.6; AL/D/Lido 0.5, LPS-22, 6.6, 4.4, 4.1; AL/D/NSS/Opti 320, LPS-28, 13, 12.5, 6.7;AL/D/Lido 0.5/NSS, LPS-24, 3.5, 1.3, 2.8 Conclusion: Albumin serves as an excellent protein agent forming doxycycline microfoam that is stable and injectable for percutaneous use. Doxycycline /albumin, mixed as a 3:1 air:liquid ratio foam provides a 5 mg/ml echogenic microfoam for treatment of LM. 11:00 AM
Abstract No. 131
Venous recanalization for severe stenosis and occlusion in children K.M. Baskin, C. Hunnicutt, J. Crowley, C. Fitz; Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA. Purpose: Children with liver and small bowel disease may be dependent upon “lifeline” central venous access devices (CVAD) for nutrition and medications. Numerous venous S51
TUESDAY
10:36 AM
In-vitro assessment of a protein foam drug delivery system D. Pipitone, M.E. McCrate, W.E. Shiels; Nationwide Children’s Hospital, Columbus, OH.
Scientific Sessions
Conclusion: Severe neutropenia on the day of PORT insertion did not increase the incidence of CAI in children with ALL. High risk ALL (precursor B and T cell) was a risk factor for late CAI. Most wound dehiscences did not require PORT removal.
Abstract No. 130
Conclusion: Prophylactic embolization of large angiomyolipoma in children with TS is safe. In our series, there was no instance of bleeding from the AML following embolization after a mean follow-up of 27 months.
Results: 192 PORTs were inserted in 179 children. The majority of patients started on chemotherapy 3 days prior to the procedure. There were 43 CAI (22%) and the infection rate was 0.35/1000 catheter-days overall. The CAI rate of 15% in children with severe neutropenia on the day of the procedure (n⫽99) was not statistically different to the CAI of 24% in those who did not have severe neutropenia (n⫽93) (p⫽0.137). 12 PORTs (6%) were removed due to an infection, most commonly caused by Coagulase Negative Staphylococcus or Staphylococcus aureus. Patients with high risk precursor B and T cell ALL had a statistically significant higher incidence of late CAI than standard risk ALL (p⫽0.024). Gender (p⫽0.863), dexamethasone use during induction (p⫽0.201), malnutrition (p⫽0.659), low albumin (p⫽0.530), low total protein (p⫽0.759) and fever pre-procedure (p⫽0.339) were not risk factors for CAI. Patients who had an early CAI didn’t have a greater chance of a late CAI (p⫽0.813). Out of 9 wound dehiscences (4%), only one PORT required removal. The catheter infectionfree survival rate at 1 year was 88.6%, at 2 years 86.7% and at 3 years 83.9%.
10:48 AM
Abstract No. 129
Prophylactic embolization for large angiomyolipoma in pediatric population T.J. Norton, E. Paul, S. Kalva, T.G. Walker, B. Pomerantz, S. Ganguli, S. Wicky, G.M. Salazar; Massachusetts General Hospital, Boston, MA. Purpose: To assess the safety and effectiveness of prophylactic embolization for large angiomyolipoma (AML) in children with tuberous sclerosis Materials and Methods: Eight patients (age range 9 - 16 years, mean ⫽ 13.1yrs) with Tuberous sclerosis underwent embolization for 11 renal AMLs between September 2004 and August 2009. The size of the tumors ranged from 2.6 to 9.9 cm with a median of 7.0cm. Embolization was performed using 300-900 microns particles. All tumors were completely embolized until vascular stasis and absence of arterial feeders was demonstrated. The procedural complications and the frequency of post embolization hemorrhage from the AML were evaluated. Hemorrhage was defined by clinical and imaging criteria, as an acute symptomatic episode, with demonstration of a fluid collection within renal parenchyma or subcortical/subcapsular regions. Complications were recorded according to the SIR guidelines. Renal function was measured by pre and post procedure serum creatinine levels. Results: Embolization of the renal AMLs was technically successful in each of the 11 lesions. Two lesions required retreatment because of increasing size post embolization. No clinically symptomatic post embolization hemorrhage occurred during a mean follow-up time of 27 months (range 2-60 months). There were no periprocedural complications.
Purpose: To evaluate factors that impact stability of protein foam for percutaneous ultrasound guided (USG) treatment of microcystic lymphatic malformation (LM). Materials and Methods: Albumin-based solutions (ABS) were agitated into protein foams and evaluated for stability after 15 minutes. Solution pH was determined and air:liquid ratio (4:1, 3:1, 2:1, 1:1) was selected prior to agitation. Solutions included combinations of albumin (AL) (25%), doxycycline (D), normal saline (NSS), 0.5% Lidocaine (Lido 0.5), 1.0% Lidocaine (Lido 1), and Optiray 320 (Opti 320). Solutions with doxycycline were mixed to 20mg/ml doxycycline prior to agitation into foam. Homogeneous ABS foams were created with 30 dual syringe/stopcock agitations and evaluated for liquid-phase separation after 15 minutes. Liquid-phase separation (LPS) was recorded as a percentage of total liquid and foam volume (3 trials for each combination). Echogenicity was tested with 15 MHZ USG injections in turkey breast phantoms. Results: Agitated solutions not containing albumin did not form foam. pH of solutions containing saline, lidocaine, and albumin were 7.0. The pH of doxycycline-based solutions without albumin were 2.0 without contrast, 3.0 with contrast, and 4.0 with albumin. Stability data demonstrate that at 3:1 and 4:1 liquid:air ratios, the addition of doxycycline (acidic pH) enhances the stability of albumin microfoam. The AL/D/Lido solutions mixed 3:1 and 4:1 air:liquid produced microfoam with 96-98% stability over 15 minutes, with doxycycline microfoam concentrations of 5mg/ml and 4mg/ml respectively. All microfoams were injectable through 23G needles and were echogenic for USG treatment. SUMMARY:Solution;Air:Liquid Ratio-1:1 2:1 3:1 4:1. AL, LPS(Avg) %-26,12.6, 8.5, 2; AL/NSS, LPS-29, 9.8, 14, 2; AL/Lido 0.5,LPS-30, 21, 17,10; AL/Lido 1,LPS-34, 21, 17.5, 7.6; AL/D/Lido 0.5, LPS-22, 6.6, 4.4, 4.1; AL/D/NSS/Opti 320, LPS-28, 13, 12.5, 6.7;AL/D/Lido 0.5/NSS, LPS-24, 3.5, 1.3, 2.8 Conclusion: Albumin serves as an excellent protein agent forming doxycycline microfoam that is stable and injectable for percutaneous use. Doxycycline /albumin, mixed as a 3:1 air:liquid ratio foam provides a 5 mg/ml echogenic microfoam for treatment of LM. 11:00 AM
Abstract No. 131
Venous recanalization for severe stenosis and occlusion in children K.M. Baskin, C. Hunnicutt, J. Crowley, C. Fitz; Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA. Purpose: Children with liver and small bowel disease may be dependent upon “lifeline” central venous access devices (CVAD) for nutrition and medications. Numerous venous S51
TUESDAY
10:36 AM
In-vitro assessment of a protein foam drug delivery system D. Pipitone, M.E. McCrate, W.E. Shiels; Nationwide Children’s Hospital, Columbus, OH.
Scientific Sessions
Conclusion: Severe neutropenia on the day of PORT insertion did not increase the incidence of CAI in children with ALL. High risk ALL (precursor B and T cell) was a risk factor for late CAI. Most wound dehiscences did not require PORT removal.
Abstract No. 130