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Splenic angioembolization (SAE) is increasingly used in the management of splenic injuries in adults, although its value in pediatric trauma is unclear. We sought to assess outcomes related to splenectomy vs SAE. The National Trauma Data Bank was queried for patients 0 to 15 years of age from 2007 to 2011. Subgroup analysis of splenectomy vs SAE was performed for high-grade injuries using propensity analysis and inverse probability weighting. Of 11,694 children presenting with splenic trauma, over 90% were treated nonoperatively. Adjusted analysis of high-grade injuries included 265 children who underwent splenectomy and 199 who underwent SAE. The Injury Severity Score, number of transfusions, and complications rates were not significantly different between the 2 groups. Overall adjusted mortality for children with high-grade injuries was 13.4% following splenectomy and 10.0% following SAE (P = .31) Patients undergoing SAE for high-grade splenic trauma have comparable morbidity and mortality with splenectomy. •Splenectomy was compared with splenic angioembolization for management of splenic trauma in children.•Less than 10% of the children require intervention for splenic injury.•There was no difference in transfusion rates or postprocedural complications.•Mortality rates between the 2 groups were not statistically different.

Purpose Sclerotherapy is the mainstay of treatment of macrocystic lymphatic malformation (LM), but the response using traditional sclerosants is much less beneficial in microcystic lesions. Intralesional bleomycin has been reported to be effective in microcystic LM; however, its use is limited by concerns about pulmonary fibrosis. The purpose of this study was to evaluate the safety and efficacy of bleomycin sclerotherapy in microcystic LM. Methods The medical records and imaging studies of all patients with microcystic or combined LM who underwent percutaneous image-guided sclerotherapy using bleomycin were retrospectively reviewed. Only patients with pre- and postprocedure imaging were included. Thirty-one patients with a mean age of 13.4 years (range 3 months–31 years) were treated. Response was graded as complete (>90 % size reduction), partial (25–90 %), or minimal/no response (<25 %). Pulmonary function tests (PFT) and chest X-rays were performed before the procedure. PFT were repeated at 6 months and 1 year postprocedure. Annual postprocedure chest X-rays were also performed. Results The malformations were located in the head and neck ( n  = 27) and trunk ( n  = 4). The number of procedures ranged from 1 to 4 (mean 1.7). Up to 1 U/kg of bleomycin was injected per session, with a maximum of 15 U. The mean follow-up period was 3.2 years (range 1.5–5 years). There was complete response in 38 % ( n  = 12), partial response in 58 % ( n  = 18), and no response in 3 % ( n  = 1). No complications were identified. Conclusions Preliminary indicate that sclerotherapy of microcystic LMs using bleomycin is effective and safe.

PURPOSE We aimed to evaluate the safety and effectiveness of cryoablation in the treatment of low-flow malformations, specifically venous malformation (VM) and fibroadipose vascular anomaly (FAVA). METHODS We conducted a retrospective review of 11 consecutive patients with low-flow malformations (14 lesions; 9 VM, 5 FAVA), median lesion volume 10.8 cm3, (range, 1.8–55.6 cm3) with a median age of 19 years (range, 10–50 years) who underwent cryoablation to achieve symptomatic control. Average follow-up was at a median of 207 days postprocedure (range, 120–886 days). Indications for treatment included focal pain and swelling. Technical success was achieved if the cryoablation ice ball covered the region of the malformation that corresponded to the patient’s symptoms. Clinical success was considered complete if all symptoms resolved and partial if some symptoms persisted but did not necessitate further treatment. RESULTS The technical success rate was 100%. At 1-month follow-up, 13 of 14 lesions (93%) had a complete response and one (7%) had a partial response. At 6-month follow-up 12 of 13 (92%) had a complete response and 1 (8%) had a partial response. A total of 6 patients underwent primary cryoablation. Out of 9 VM cases, 7 had prior sclerotherapy and 2 had primary cryoablation. Out of the 5 FAVA cases, 1 had prior sclerotherapy and the remaining 4 cases underwent primary cryoablation. There were 3 minor complications following cryoablation including 2 cases of skin blisters and 1 case of transient numbness. These complications resolved with conservative management. CONCLUSION Cryoablation is safe and effective in the treatment of low-flow vascular malformations, either after sclerotherapy or as primary treatment.

Background Chylothorax is a rare complication of pediatric cardiac operations that occurs more frequently in children with Noonan syndrome, a genetic disorder associated with cardiac defects and lymphatic anomalies. Case presentation We report a case of postoperative chylothorax in a 6-month-old infant with Noonan syndrome where multimodality lymphatic imaging guided management was followed. Drainage patterns of the lymphatic capillaries in the lower and upper extremities were visualized during near-infrared fluorescence lymphatic imaging (NIRFLI). Dynamic magnetic resonance lymphangiography (MRL) further identified the site of leakage in the thoracic duct and subsequently guided surgical intervention. Conclusions Application of multimodality imaging allows for greater individualization of treatment and should be considered in patients with complex cases such as those with syndromes associated with a higher incidence of chylothorax. IRB Number: HSC-MS-13–0754, December 10, 2013

Purpose Venous malformations (VM) involving the hand and forearm often lead to chronic pain and dysfunction, and the threshold for treatment is high due to the risk of nerve and skin damage, functional deterioration and compartment syndrome. The purpose of this study is to demonstrate that sclerotherapy of diffuse and infiltrative VM of the hand is a safe and effective therapy. Materials and Methods A retrospective review of all patients with diffuse and infiltrative VM of the hand and forearm treated with sclerotherapy from 2001 to 2014 was conducted. All VM were diagnosed during the clinical visit by a combination of physical examination and imaging. Sclerotherapy was performed under imaging guidance using ethanol and/or sodium tetradecyl sulfate foam. Clinical notes were reviewed for signs of treatment response and complications, including skin blistering and nerve injury. Results Seventeen patients underwent a total of 40 sclerotherapy procedures. Patients were treated for pain (76 %), swelling (29 %) or paresthesias (6 %). Treatments utilized ethanol (70 %), sodium tetradecyl sulfate foam (22.5 %) or a combination of these (7.5 %). Twenty-four percent of patients had complete resolution of symptoms, 24 % had partial relief of symptoms without need for further intervention, and 35 % had some improvement after initial treatment but required additional treatments. Two skin complications were noted, both of which resolved. No motor or sensory loss was reported. Conclusion Sclerotherapy is a safe and effective therapy for VM of the hand with over 83 % of patients experiencing relief.

This is a case report of an adolescent male who underwent surgical ligation for a left-sided varicocele that recurred 2 years later. Standard retrograde embolization via the left renal vein was not possible, because there was no connection from the renal vein to the gonadal vein following surgical ligation. The patient was treated via antegrade access of the spermatic vein at the inguinal level with subsequent coil embolization.

The use of thrombolysis in the treatment of venous thromboembolism (VTE) began with the use of systemic thrombolytic therapy, but has evolved substantially to include both pharmacological and mechanical methods, of which some are delivered via a small catheter. The goal of catheter‐directed thrombolysis (CDT) in most patients with extensive lower extremity deep vein thrombosis (DVT) is to remove the thrombus and restore physiological and anatomical venous flow, to decrease the inflammatory changes, increase the likelihood of vessel patency, preserve venous valvular function and, ultimately, limit post thrombotic syndrome (PTS) development. In recent years, the use of ultrasound‐accelerated CDT for patients with massive or sub‐massive pulmonary embolism (PE) has been studied with somewhat more rigour. With this method, a specialised catheter that emits low‐power ultrasound is used to achieve the intra‐thrombus drug delivery and to enhance thrombolysis via ostensibly improved drug dispersion.

We propose an algorithm for management after transjugular intrahepatic portosystemic shunt (TIPS) placement according to clinical manifestations. For patients with an initial good clinical response, surveillance Doppler ultrasound is recommended to detect stenosis or occlusion. A TIPS revision can be performed using basic or advanced techniques to treat stenosis or occlusion. In patients with an initial poor clinical response, a TIPS venogram with pressure measurements should be performed to assess shunt patency. The creation of a parallel TIPS may also be required if the patient is symptomatic and the portal pressure remains high after TIPS revision. Additional procedures may also be necessary, such as peritoneovenous shunt (Denver shunt) placement for refractory ascites, tunneled pleural catheter for hepatic hydrothorax, and balloon-occluded retrograde transvenous obliteration procedure for gastric variceal bleeding. A TIPS reduction procedure can also be performed in patients with uncontrolled hepatic encephalopathy or hepatic failure.

The effect of different solvents and extraction methods on total anthoc yanins, phenolic compounds, and antioxidant capacity from x´kijit (renealmia alpinia Rottb. Maas) peels was evaluated. In order to evaluate the effect of solvents on the bioactive compounds extraction efficienc y and antioxidant capacity, a special cubic mixture design model was implemented with ethanol, methanol, and acetone as solvents and conventional (agitation – 1 and 6 h; Soxhlet – 2 and 4 h), novel (power ultrasound – 2.5 and 5 min) methods, and combination of extraction methods. Acceptable correla - tions between predicted and experimental data were obtained for total anthoc yanins ( r2 = 0.95), phenolic compounds (r2 = 0.78), and antioxidant capacity (r2 = 0.97), with methanol exhibiting the highest extraction yield of bioactive compounds and resultant antioxidant capacity. Although the extraction of total anthocyanins (82.2–85.8 mg cyanidine/ kg) and phenolic compounds (183.6–207.0 mg GAE/kg) was best carried out through Soxhlet, the ultrasonic treat- ment showed similar antioxidant capacity values (27.4–34.3 mg Trolox/kg) to those of 2-h Soxhlet. Moreover, a 5-min ultrasound pretreatment significantly increased (p < 0.05) phenolic compounds by 11, 21 and 12% when combined with agitation 1, 6, and 2-h Soxhlet treatments, respectively ; while the antioxidant capacity increased by 26, 48, and 22% for the same treatments. Ultrasound might be used as a valuable, green alternative procedure for improving the solvent extraction of bioactive compounds.