Abstract:

The article presents analysis of 1500 cases of varicocele endovascular occlusion (EO) in children and adolescents, giving the exhaustive account of varicocele diagnostics and treatment. Standardization of the endovascular procedure was performed, and algorithm proposed for choosing the occlusion technique and embolization agent depending on the lesion anatomy.

The authors specify 5 anatomical varieties of left testicular vein (LTV), each having some particularities in occlusion procedure. For the first time in pediatric practice the Foam-form was used for LTV occlusion against the background of prominent veno-venous reflux, which considered to be one EO contraindications. The causes were specified for false and true varicocele recurrence: the former is shown to occur due to technical imperfections, and the causes of the latter can be LTV lumen recanalization or formation of the bridging collaterals.

EO of LTV is proved to be the effective for recurrent varicocele after conventional surgery in children and adolescents.   

Reference 

1.     Ерохин АП. Варикоцеле у детей (клинико-эксперементальное исследование). Дис.д-ра мед. наук. М. 1979.

2.     Тарусин Д.И. Факторы риска репродуктивных расстройств у мальчиков и юношей-подростков. Автореф. д-ра мед. наук. М. 2005.

3.     Кондаков В.Т., Пыков М.И., Годлевский Д.Н. Андрологические аспекты хирургического лечения варикоцеле у подростков. Медицина и здравоохранение. 2004;     10.9: 35-39.

4.     Годлевский Д.Н. Сперматогенная функцияяичек и органный кровоток при варикоцеле у детей и подростков. Автореф. канд. мед. наук. М. 2003.

5.     Корзникова И.И. Эндоваскулярная склеротерапия в лечении варикоцеле у детей.Автореф. канд. мед. наук. М. 1988.      12.

6.     Страхов С.Н. Варикозное расширение венгроздевидного сплетения и семенногоканотика. М. 2001.

7.     Лопаткин Н.А., Морозов А.В., Дзеранов Н.К. Трансфеморальная эндоваскулярная облитерация яичковой вены в лечении варикоцеле. Урол. нефрол. 1983; 6: 1-53.

8.     Tauber R., Johnsen N. Antegrade scrotal sclerotherapy for the treatment of varicocele. Technique and late results. J. Urol. 1994; 51 (2): 386-390.

9.     Palomo A., Bernard C.A. A practical resource in the surgical treatment of the scrotalrgans. Rev. Col. Med. Guatem. 1959; 10: 246-247.

10.   Esposito C, VallaJ.S., Najmaldin A. et al. Incidence and management of hydrocele following varicocele surgery in children. J. Urol. 2004; 171 (3): 1271-1273.

11.   Tessari L., Cavezzi A., Frullini A. Preliminary. Еxperience with a new sclerosing foam in the treatment of varicose veins. Dermatol. Surg. 2001; 27 (1): 58-60.

12.   Mali W.P., Oei H.Y., Arndt J.W. et al. Hemodynamics of the varicocele. II. Correlation among the results of renocaval pressure measurements, varicocele scintigraphy and phlebography. Urol. 1986; 135 (3): 489-493.

Abstract:

It has been described the experience of use of automatic injector Mark V Pro Vis (Medrad) for endovascular interventions in pediatry. The choice of optimal roentgen contrast media for angiography and endovascular interventions is considerated. It has been concluded that contrast enhancement by iopromide and automatic injector Mark V Pro Vis is effective and safety method of visualization of vessels, tumors and other pathology.  

References

1.      Поляев Ю.А., Мыльников А.А. Эндоваскулярная окклюзия в лечении гиперваскулярных образований головы. Практикующий врач. 2003; 1: 38–41.

2.      Поляев Ю.А., Щенев С.В. Опыт лечения некоторых форм ангиодисплазий периферической локализации у детей. Практикующий врач. 2003; 1: 42–45.

3.      Поляев Ю.А., Шимановский Н.Л., Лазарев В.В., Голенищев А.И. Десятилетний опыт использования неионного рентгеноконтрастного средства Ультравист в детской интервенционной радиологии. Детская больница. 2004; 1: 55–60.

4.      Сергеев П.В., Поляев Ю.А., Юдин А.Л., Шимановский Н.Л. Контрастные средства. М: Известия. 2007; 496.

5.      Liss P., Persson P.B., Hansell P., Lagerqvist B. Renal failure in 57 925 patients undergoing coronary procedures using iso-osmolar or low-osmolar contrast media. Kidney Int. 2006;. 70: 1811–1817.

6.      Ultravist. Monograph, Schering AG, Berlin, Second edition. 2005; 72.

7.      Misawa M., Sato Y., Hara M. et al. Use of non-ionic contrast medium, iopromide (Proscope-370), in pediatric cardiovascular angiography. Nihion Shoni Hoshasen Gakkai Zasshi. 2000; 2: 42–48.

8.      Liss P., Hansell P., Lagerkvist B. Higher Incidence of Renal Failure in 23 224 Patients Using Iso-osmolar Compared to Low-osmolar Contrast Media during Coronary Interventions in Swedish Hospitals. RSNA, 2008; SSG 08–01.

Abstract:

This article deals with the role of arterio-venous conflicts in case of varicocele development in children. As varicocele is a widespread disease, it is important to investigate the etiology of hemodynamic disturbances in renotesticular (RTT) and ileotesticular (ITT) fields in patients with varicocele. The number of procedures registered in Russian State Pediatric Hospital (Moscow) is more than 1600 including primary and recurrent cases. Pathophisiology of the disease is not quite clear, but hemodynamic changes in RTT and ITT were thoroughly investigated. Left renal vein compression between upper mesenterial vein and aorta causes renal venous hypertension in 24% of cases. In most cases etiology of varicocele was primary valve insufficiency. Ileofemoral vericocele is rare and occurs as a result of common iliac vein flow disturbance. Endovascular procedures should be performed only after diagnostic hemodynamic study, and should not be used in pediatric practice. 

References 

1.      May R., Thurner J. The cause of the predominately sinistral occurrence of thrombosis of the pelvic veins. Angiology. 1957; 8: 419-427.

2.      De Schepper A. Nutcracker phenomenon of the renal vein causing left renal vein pathology.J. Belg. Rad. 1972; 55: 507-511.

3.      Trambert J.J. et al. Pericaliceal varices due to the nutcracker phenomenon. AJR. 1990; 154:305-306.

4.      Scholbach T. From the nutcracker-phenome non of the left renal vein to the midline congestion syndrome as a cause of migraine, headache, back and abdominal pain and functional   disorders   of   pelvic   organs.   Medical. Hypotheses. 2007; 68: 1318-1327.

5.      Лопаткин Н.А., Морозов А.В., Житникова Л.Н. Стеноз почечной вены. М.: Медицина.1984.

6.      Страхов С.Н. Варикозное расширение вен гроздевидного   сплетения   и   семенного канатика (варикоцеле). М. 2001.

7.      Kim et al. Hemodynamic Investigation of the Left Renal Vein in Pediatric Varicocele. Doppler US, Venography and Pressure Measurements. Radiology. 2006; 241.

8.      Coolsaet l.E. The varicocele syndrome: Venography determining tin' optimal level for surgical management.J. Urol. 1980; 124: 833-839.

9.      Ерохин А.П. Варикоцеле у детей (клинико-экспериментальное исследование). Дис. д-ра мед. наук. М. 1979.

10.    Neglén А. et al. Stenting of the venous outflow in chronic venous disease. Long-term stent-related outcome, clinical and hemodynamic result.J. Vasc. Surg. 2007; 46: 979-990.

11.    Гарбузов Р.В. Ретроградная эндоваскулярная окклюзия при варикоцеле у детей и подростков. Дис. канд. мед. наук. М. 2007

Abstract:

Purpose: to prove the safety and efficiency of minimally invasive endovascular and puncture techniques in management of splen diseases in children.

Aims: to develop standard procedures and justify the necessity of splenic artery embolization (SAE) in hemangiomas, extrahepatic portal hypertension, and idiopathic thrombocytopenic purpura (ITP). Develop standard procedures for splenic cysts treatment in pediatric practice.

Materials and methods: there were 129 children aged 3-16 years treated in Endovascular Surgery Department of Russian State Pediatric Hospital (Moscow) with the following diagnoses: hemangiomas (4 patients), hereditary hemolytic globular-cell anemia - HHGCA (41 cases), extrahepatic portal hypertension - EHPG (25 cases), ITP (24 cases), and nonparasitic cysts (35 patients).

Results: SAE is shown to be effective in treatment the diseases where splenic hyperfunctioning is seen. In HHGCA and ITP no hemolytic crises were seen, and there was no need of substitution therapy after performing the SAE procedure. In cases of EHPG splenic artery embolization is proved to reduce the esophageal varices and decrease hypersplenia symptoms. Among the advantages of endovascular approach can be named minimal operation trauma and splenic tissue preservation. The authors present an algorithm for splenic cysts treatment in pediatric practice. It was shown that laparoscopy is effective in big (over 70-80 mm) subcapsular cysts, whereas intraparenchymatous cysts fewer than 70 mm in diameter are more suitable for puncture techniques.

Conclusions: the minimally invasive techniques are shown to be safe and effective in management of splen diseases in pediatric practice. It was shown that their effectiveness is comparable to the conventional methods, meanwhile they cause much less operation trauma, reduce the hospital stay and terms of rehabilitation.

References 

1.    LokichJ., Cosstello P. Splenic embolization to prevent dose limitation of cancer chemotherapy. Am.J. Roentgenol. 1983; 140: 159-161.

2.    Spigos  D.G., Jonasson  O.  Partial  splenic embolisation in the treatment of hypersplenism. Am.J. Roentgenol. 1979; 132: 777-782.

3.    Styrt B.  Infection associated with asplenia: risk, echanism and prevention. Am. J. Med.1990; 88: 5-33.

4.    Никаноров А.Ю.  Рентгеноэндоваскулярная окклюзия в подавлении патологической функции селезенки у детей. Дис. канд.мед. наук. М. 1990.    13.

5.    Григорьева Е.Г., Апарицина К.А.  Органосохраняющая хирургия селезенки.  Новосибирск. 2001; 23-78.

6.    Дергачев А.И. Абдоминальная эхография. М. 2002; 15-25.

7.    Журило И.П., Литовка В.П., Кононученко В.П.,  Москаленко  В.З.  Непаразитарные кисты селезенки у детей. Хирургия. 1993; 8:59-61

8.    Куликов Л.К.,  Филиппов А.Г. Хирургическая тактика при непаразитарных кистах селезенки. Хирургия. 1995; 2: 62-63.

9.      Fowler   R.H.   Nonparasitic   bening   cystic tumors of the spleen. Int. Abstr. Surg. 1953; 96: 209-227.

10.    Martel M., Cheuk W. Angiomatoid Nodular Transformation (SANT). Report of 25 Cases of Distinctive Begin Splenic Lesion. J. Surg. Pathol. 2004; 28 (10): 1268-1279.

11.    Кургузов О.П., Кузнецов Н.А., Артюхина Е.Г. Непаразитарные кисты селезенки. Хирургия. 1990; 6: 130-133.

12.    Папаскуа И.З. Возможности чрескожных пункционно-дренирующих вмешательств с ультразвуковым контролем в лечении кист печени, почек и селезенки. Дис. канд. мед. наук. С-Пб. 2003.

13.    Ратнер Г.Р. Непаразитарные кисты селезенки. Вестник хирургии.1997; 5: 104-105.

14.    Шишкин К.В. Хирургическое лечение непаразитарных кист печени и селезенки. Хирургия (журнал имени Н.И. Пирогова). 2006; 10: 62-66.

15.    Маннанов А.Г. Эндоскопическая хирургия непаразитарных кист селезенки у детей. Дис. канд. мед. наук. М. 2004.

16.    Филижанко В.Н.,  Шеменева Е.Г.,  Фомин А.М. и др. Лапароскопические вмешательства при кистах печени и селезенки. Эндоскопическая хирургия. 1998; 1: 56.

17.    Bove T., Delvaux G., Van Eijkelenburg P., De Backer A., Willems G. Laparoscopic-assisted surgery of the spleen: clinical experience in expanding indications. J. Laparoendosc. Surg. 1996; 6 (4): 213-217.

18.  Bean WJ., Rodan B.A. Hepatic cysts: Treatment with alcohol. AJR. 1985; 237-241.

19.  Gresik M.V.  Pathology of the spleen. New-York. 1989; 37.

20.  Velkova K., Nedeva A. Our experience in the diagnostiks of liver and spleen hemangiomas. Plovdiv. Folia. Med. 1997; 39 (1): 85-91.

21.  Levy A.D., Abbot R.M., Abbondanso S.L. Littoral cell angioma of the splen: CT features with clinicopatologic comparison. Radiology. 2004; 230 (2): 485-490.

22.  Yano H., Imasato M., Monde T. et al. Hand-assisted   laparoscopic splenectomy for splenic vascular tumors:  report of two cases.  Surg.Laparosc. Percutan. Tech. 2003; 13 (4): 286-289.

23.  Coon W.W. Splenectomy in the threatment of hemolitic   anemia.   Arch.   Surg.   1985;   120: 625-628.

Article exists only in Russian.

Abstract:

In the treatment of macro-cystic forms of lymphangiomas, puncture methods have great value. Relapses occure in 50% of cases. The cause of lymphangiomas is the accumulation of liquid and spreading of cystic walls.

Aim. Was to develop and propose methods of interventional radiology in the diagnosis and treatment of macro-cystic lymphangiomas.

Materials and methods. In 2007-2011, in the radiological department of our hospital were examined and treated 31 children with macro-cystic forms of lymphangiomas. The proposed method of treatment was: puncture, catheterization of cyst, aspiration, performance of cystography and then sclerotherapy with 3% solute of Fibro-Vein or ethoxysclerol.Then - inserting active aspiration system into cyst. The system operated for 3-5 days, during which carried constant active aspiration with sclerotherapy sessions. The indications for catheter removal was the end of cyst liquid secretion. In 20 children we performed a single-stage treatment. In 6 - two-staged, and only in 5 cases, after the second phase of treatment, we observed a relapse of the disease, which leaded for the third phase of treatment.

Results. Good results were achieved in 15 of 19 children with lymphangioma of the head and neck, satisfactory - in 4 children. Unsatisfactory results were not noticed. In children with lymphangioma of internal organs a good result was achieved in 11 cases of 12. Only in 1 case remained a small residual cavity

Conclusion. The method of active aspiration of macro-cystic lymphangiomas showed very good results. The use of techniques of interventional radiology in the diagnosis of macro-cystic forms of lymphangiomas can assess the condition, shape and size of the cyst, and spend the most effective treatment. The use of interventional techniques as an alternative to surgical excision of the lymphangioma can significantly improve the quality of life.

References

1.     Schwartz R.A., Fern6ndez G. Lymphangioma. Medicine Dermatology [Journal serial online]. 2009. November 13 [cited 2009 Dec 9]. Available at ttp://emedicine.medscape.com/article/1086806-overview.

2.     Eijun Itakura & Hidetaka Yamamoto & Yoshinao Oda & Masutaka Furue & Masazumi Tsuneyoshi. VEGF-C and VEGFR-3 in a series of lymphangiomas: Is superficial lymphangioma a true lymphangioma? Virchows Arch. (2009) 454:317-325 DOI 10.1007/s00428-008-0720-8.

3.     Flanagan B.P., Helwig E.B. Cutaneous lymphangioma. Arch. Dermatol. 1977;113:24-30.

4.     Bond J., Basheer M.H., Gordon D. Lymphangioma circumscriptum: pitfalls and problems in definitive management. Dermatol. Surg. 2008;34:271-5.

5.     Khan Z.A., Melero-Martin J.M., Wu X. et al Endothelial progenitor cells from infantile hemangioma and umbilical cord blood display unique cellular responses to endostatin. Blood. 2006;108:915-921.

6.     Weiss S.W., Goldblum J.R. Enzinger and Weiss’s soft tissue tumors, 4th edn. Mosby. St. Louis, MO. 2001.