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Society for Pediatric Radiology – Poster Archive

Mario Zaritzky

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Showing 3 Abstracts.

<b>Purpose: </b> <b>A new minimally invasive procedure, the use of magnets (Flourish™) for the treatment of esophageal atresia will be described. The invention’s background, patient selection criteria, procedure details and complications are the subject of this exhibit.</b> <b>Background:</b> <b>Esophageal atresia is a rare congenital defect where the proximal esophagus does not connect to the distal esophagus. Classically, this defect has been treated by surgery to reconnect the ends and reestablish esophageal continuity, however a small subset may be treated with a magnetic catheter-based system. The primary goal of this procedure is to form an anastomosis while avoiding a major thoracic surgery and its complications.</b> <b>The Flourish™ device uses bullet-shaped rare earth magnets which are inserted into the upper esophagus and lower esophagus. Included in these magnets is the rare earth element neodymium, which along with iron and boron create an alloy with a strength of up to 1.2 Tesla. </b> <b>When the magnets are placed in close proximity at the ends of the esophageal pouches, they will attract over several days, eventually connecting the ends of the esophagus and causing an anastomosis via pressure necrosis.</b> <b> </b> <b>Criteria:</b> <b>Selection is based on absence of tracheoesophageal fistula, esophageal gap shorter than 4 cm and a mature gastrostomy tract.</b> <b>Procedure:</b> <b>Under fluoroscopy, the gastric catheter is advanced superiorly through the gastrostomy to the most superior end of the distal esophageal pouch. The oral catheter is then advanced in order to bring the magnets to closest proximity. Daily radiographs are obtained to evaluate magnet positions. </b> <b>Complications/outcomes:</b> <b>Thirteen patients that have undergone placement of the magnetic catheter-based system at six institutions. Twelve patients had an average time to achieve anastomosis of six days and progressed to full oral feeds. The most common complication was magnetic anastomosis stenosis requiring dilatation. Currently, Flourish is approved as a Humanitarian Device Exemption (HDE). </b> Read More

Meeting name: SPR 2020 Annual Meeting & Postgraduate Course , 2020

Authors: Groene John, Ong Seng, Feinstein Kate, Slater Bethany, Zaritzky Mario

Keywords: Esophageal Atresia, Atresia, Flourish

In this exhibit we will describe a fairly new surgical procedure - total pancreatectomy and islet autotransplant (TPIAT). TPIAT is an uncommon procedure performed in children who suffer from chronic or recurrent acute pancreatitis. The purpose of the exhibit is to learn about the selection criteria, the surgery itself, and the imaging features of surgical complications. Candidates are selected for surgery based on a multitude of factors including severity and chronicity of pain, laboratory evaluation of pancreatic exocrine and endocrine function, and imaging features of chronic pancreatitis on MRCP and/or endoscopic ultrasound. In the surgical procedure, the pancreas and duodenum are resected, islet cells are isolated and then infused through the portal vein into the liver. A splenectomy is performed and continuity of the GI tract restored. Patients may spend three weeks in the hospital after surgery. Months after the infusion, the islet cells will be embedded within the liver and begin to produce insulin. The primary goal of this procedure is to relieve debilitating pain and improve quality of life, for which this procedure is around 90% successful. The secondary goal of the procedure is to retain islet cell function. In this regard, approximately 40% of the pediatric patients will regain complete islet cell function, 30% will regain partial function while 30% will have no islet cell function. Follow up imaging may also be performed on these patients for evaluation of complications such as delayed gastric emptying, small bowel obstruction, surgical site infections, bile leak, and intra-abdominal hemorrhage. Complications seen in our hospital, including small bowel obstruction, delayed gastric emptying, and prolonged ileus will be highlighted. Read More

Meeting name: SPR 2019 Annual Meeting & Postgraduate Course , 2019

Authors: Groene John, Wieck Minna, Ong Seng, Zaritzky Mario, Feinstein Kate

Keywords: total pancreatectomy and islet autotransplant, TPIAT, islet cell transplantation

In this exhibit, we will outline the revised International Neuroblastoma Response Criteria (INRC) used to assess treatment response in children with neuroblastoma, particularly high risk patients, in the context of clinical relevance to their treatment plan. Neuroblastoma is the most common extracranial solid malignancy in children, accounting for approximately 12% of deaths in children younger than 15 years of age affected with cancer. Up to 50% of children with neuroblastoma are found to have a high-risk phenotype with poor long-term survival and risk of therapy-related toxicity. Due to a lack of consensus regarding the definition of disease response, the development of more effective therapy treatment of high-risk disease has been hindered. The revised INRC consensus integrates modern, functional imaging techniques and quantitative assessment of bone marrow disease. It is anticipated that the revised INRC will enable a more precise assessment of treatment response that can be used to inform treatment decisions. This exhibit will delve into these modalities which are more sensitive and specific for Neuroblastoma detection. This exhibit will also demonstrate how the revised response criteria are used in the clinical setting in the Children’s Oncology Group clinical trials. Read More

Meeting name: SPR 2020 Annual Meeting & Postgraduate Course , 2020

Authors: Telleria Jessica, Pudela Caileigh, Zaritzky Mario, Cohn Susan, Feinstein Kate

Keywords: Neuroblastoma, INRC, Oncology