Showing papers by "Sue C. Kaste published in 1996"
TL;DR: In light of the low frequency of complications, power injectors and central venous access devices or small-gauge butterfly catheters are safe systems for delivery of intravenous contrast material to pediatric patients.
Abstract: Purpose. We report our experience in the safe use of power injectors with central and small-gauge peripheral venous access devices for intravenous administration of contrast agent to children undergoing computed tomography (CT) examinations.Materials and methods. We reviewed the medical records of 500 patients randomly selected from the 3121 children who underwent intravenous contrast-enhanced CT examinations at our institution from November 1993 through July 1995.Results. The group of 500 patients, all younger than 18 years of age, accounts for 16 % of the contrast-enhanced CT examinations performed during the study period. Medrad MCT 311 Mark V or Medrad MCT Plus 311 power injectors were used to intravenously administer Omnipaque 300 (2 ml/kg, maximum dose = 150 ml) through venous access devices. These devices comprised Hickman or Broviac lines (n = 228), subcutaneous Port-A-Caths (n = 55), small-gauge butterfly needles (n = 215), and percutaneous intravenous central lines (n = 2). Two complications, one involving a Hickman line and the other a subcutaneous Port-A-Cath, occurred in the study population. These complications correspond to a frequency of 0.4 %. Six cases of contrast extravasation, all of them with the use of 23- (n = 1) and 25-gauge (n = 5) butterfly catheters (frequency = 0.2 %), occurred among the remaining 2621 cases.Conclusion. In light of the low frequency of complications, power injectors and central venous access devices or small-gauge butterfly catheters are safe systems for delivery of intravenous contrast material to pediatric patients. We feel that our strict adherence to manufacturers' guidelines and previously reported techniques partially accounts for our success with these modes of delivery.
95 citations
TL;DR: Although the risk of fracture after therapy for soft tissue sarcoma may be multifactorial, radiation may play a significant role, optimal use of therapy could subsequently reduce side effects, such as osteoporosis and muscle and bone atrophy, that predispose patients to fractures.
Abstract: There is a clear association between multimodal therapy for bone tumors and the development of skeletal complications ; however, this has not been addressed in children with soft tissue sarcomas. We reviewed records of the 70 children treated for soft tissue sarcoma of the lower extremity at St Jude Children's Research Hospital between 1962 and 1991. Of the 12 patients who received radiation after surgical excision of their tumors, three subsequently developed fractures. Two of the three had also received chemotherapy. Our findings indicate that, although the risk of fracture after therapy for soft tissue sarcoma may be multifactorial, radiation may play a significant role. Minimizing the size of surgical incisions, improving radiotherapy techniques, maximizing chemotherapy, and emphasizing physical therapy and appropriate follow up can all serve to decrease long-term toxicities. Such optimal use of therapy could subsequently reduce side effects, such as osteoporosis and muscle and bone atrophy, that predispose patients to fractures.
31 citations
TL;DR: Of the eight children treated at St Jude Children's Research Hospital, seven presented with localized disease and one with metastatic disease; the primary tumor was located in the upper extremity in four patients; the other sites were the scalp, external ear, back, and mediastinum.
29 citations
TL;DR: Children with thick melanomas and those with unknown site of primary tumors are at increased risk of having clinically unsuspected metastases and should undergo CT of the chest, abdomen, and local-regional nodal basins at diagnosis to determine disease extent.
Abstract: Objective. The objective of this study was to investigate the role of diagnostic imaging in detecting unsuspected metastatic disease in children with malignant melanoma. This has not been well studied previously.
13 citations
TL;DR: From this study, magnetic resonance imaging appears to be a better modality for assessing sacral invasion and metastases and distinguishing fibrotic masses from recurrent tumor.
Abstract: Sacrococcygeal teratomas and their malignant counterparts (germ cell tumors) are the most common solid tumors in neonates. Prompt diagnosis is essential because the frequency of malignant transformation increases from 10–20 % in neonates to 67 % in patients over 2 months of age. Cross-sectional imaging has largely replaced surgical exploration for staging these tumors and assessing their response to chemotherapy. Radiologists must be familiar with changes in the imaging findings of these tumors during and after treatment so that they can advise clinicians regarding the efficacy of therapy and the presence or absence of recurrent disease. From our study, magnetic resonance imaging appears to be a better modality for assessing sacral invasion and metastases and distinguishing fibrotic masses from recurrent tumor.
8 citations
TL;DR: Broader than originally anticipated, the clinical spectrum of desmoplastic small round-cell tumors continues to evolve and primary intrathoracic tumors with soft-tissue dissemination and polyphenotypic expression should prompt suspicion of this malignancy.
Abstract: PURPOSE
Recently recognized as a distinct clinicopathologic entity, desmoplastic small round-cell tumors typically affect young men. These aggressive tumors usually arise in the abdomen; other sites of primary disease have been described only rarely. We report the case of an extraabdominal primary tumor with widespread dissemination, including the subcutaneous tissue, a previously unrecognized metastatic site.
PATIENT AND METHODS
We describe the case of a 16-year-old boy with a primary extraabdominal metastatic desmoplastic small round-cell tumor.
RESULTS
Our patient had a primary intrathoracic desmoplastic small round-cell tumor and widespread dissemination involving the subcutaneous tissue, kidney, liver, bone, and lymph nodes. Histopathologic analysis found intense desmoplasia and polyphenotypic expression of neural, muscle, and epithelial markers. Reverse transcriptase-polymerase chain reaction analysis of fresh tumor tissue confirmed the characteristic EWS-WT1 transcript.
CONCLUSIONS
Broader than originally anticipated, the clinical spectrum of desmoplastic small round-cell tumors continues to evolve. Primary intrathoracic tumors with soft-tissue dissemination and polyphenotypic expression should prompt suspicion of this malignancy. Molecular analysis of fresh tumor tissue is an important adjunct to diagnosing this rare neoplasm.
6 citations
TL;DR: The imaging findings of an uncommon cause of prosthetic failure, i.
Abstract: Limb-sparing procedures utilizing endoprostheses improve both the quality of life and functional level of patients treated for primary bone sarcomas. Herein, we present the imaging findings of an uncommon cause of prosthetic failure, i. e., foreign body reaction, manifested by progressive multifocal osteolysis along the prosthetic femoral shaft.
3 citations
TL;DR: Although many patients have abnormal99mTc-MDP avidity in the operative site after limb-sparing surgery, almost half eventually have normalization of uptake and planar bone scans have limited use for assessing the primary tumor site postoperatively as persistent abnormal avidity may preclude detection of changes associated with development of postoperative complications.
Abstract: Objective. The objective of this study was to evaluate the postoperative technetium-99m-labeled methylene diphosphonate (99mTc-MDP) scintigraphic appearance of limb-sparing procedures in patients treated for bone tumors.Materials and methods. We retrospectively reviewed the medical records and assessed planar bone scans, subjectively and semiquantitatively, of all patients treated with limb-sparing procedures at our institution who survived at least 1 year following resection of the primary lesion.Results. The operative sites of 20 of the evaluable 45 patients (44 %) demonstrated normal tracer avidity during follow-up (median 12 months). Nine patients (20 %) demonstrated normal avidity on their first follow-up bone scans (median 6 months). Coincident99mTc-MDP bone scans were obtained on 11 patients who developed 12 postoperative complications or injury during the study and accurately identified the lesion in eight (67 %).Conclusion. Although many patients have abnormal99mTc-MDP avidity in the operative site after limb-sparing surgery, almost half eventually have normalization of uptake. However, planar bone scans have limited use for assessing the primary tumor site postoperatively as persistent abnormal avidity may preclude detection of changes associated with development of postoperative complications.
2 citations