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Summary: Presented here is a very rare and potentially life‐threatening complication of a very common procedure. Vascular injury with traumatic pseudoaneurysm following BMAT in a paediatric patient has only been reported once in the literature to the best of our knowledge. Presented here is a second case, with pathognomonic imaging findings on CT that underwent successful coil embolisation. [ABSTRACT FROM AUTHOR]

Interventional procedures in the airway can be performed in interventional radiology suites or the operating room, by radiologists or other specialists. The most common therapeutic interventions carried out by radiologists are balloon dilatation, stenting, and the treatment of certain airway fistulas. These operations can be very challenging for anesthetists in terms of planning, airway management, the identification and treatment of procedural complications and postoperative care. In particular, a multidisciplinary approach to decision‐making and planning is important to obtain the best results. [ABSTRACT FROM AUTHOR]

Objective To describe our experience with superselective ophthalmic artery chemotherapy ( SOAC) in retinoblastoma and to report the serious adverse cardio-respiratory reactions we have observed. Methods SOAC was performed using a standardized protocol for general anesthesia, ophthalmic artery catheterization, and pulsed infusion of melphalan. Adverse reactions were defined as those in which the patient required active treatment to maintain cardio-respiratory stability. Results Between December 2008 and May 2012, 54 eyes in 52 patients were treated. 143 catheterization procedures were performed, with a technical success rate of 93% ( n = 133). There were no deaths or major complications. Adverse cardio-respiratory reactions developed during 35 procedures (24%; 95% CI, 18-32%). All reactions occurred during second or subsequent catheterization procedures (39%; 95% CI, .29-49%) and were characterized by hypoxia, reduced lung compliance, systemic hypotension and bradycardia. Adverse events were successfully treated in all patients. One procedure was abandoned due to prolonged hemodynamic instability. Conclusion Adverse cardio-respiratory reactions are commonly observed in SOAC for retinoblastoma. We believe that the adverse clinical signs represent an autonomic reflex response, akin to the trigemino-cardiac or oculo-respiratory reflexes, and all patients should be considered at-risk. Reactions occur only during second or subsequent procedures and can be life-threatening. The routine use of intravenous atropine does not seem to have altered the incidence or severity of these reactions. Anesthetists and interventional neuroradiologists involved in SOAC must be vigilant to ensure adverse reactions, when they develop, are treated quickly and effectively. [ABSTRACT FROM AUTHOR]

Objective Polyarteritis nodosa (PAN) is a rare disease of childhood. The aims of this study were to describe the clinical features, treatment, and outcome of systemic childhood PAN and to identify predictors of relapse. Methods A single-center retrospective medical records review of children with PAN fulfilling the European League Against Rheumatism (EULAR)/Paediatric Rheumatology European Society (PRES)/Paediatric Rheumatology International Trials Organisation (PRINTO) classification criteria who were seen over a 32-year period was performed. Data on demographic and clinical features, treatments, relapses (recurrence of clinical signs/symptoms or occurrence of new symptoms after initial remission requiring escalation or resumption of immunosuppressive therapy), and deaths were recorded. A disease activity score was retrospectively assigned using the Paediatric Vasculitis Activity Score (PVAS) instrument. Cox regression analysis was used to identify significant predictors of relapse. Results Sixty-nine children with PAN were identified; 55% were male, and their median age was 8.5 years (range 0.9-15.8 years). Their clinical features at presentation were fever (87%), myalgia (83%), skin (88%), renal (19%), severe gastrointestinal (GI) (10%), and neurologic (10%) involvement. The PVAS at presentation was 9 of 63 (range 4-24). Histopathologic analysis of the skin showed necrotizing vasculitis in biopsy samples from 40 of 50 children. Results of selective visceral arteriography suggested the presence of PAN in 96% of patients. Treatment included cyclophosphamide and corticosteroids (83%), plasma exchange (9%), and biologic agents (after 2002; 13%). The relapse rate was 35%, and the mortality rate was 4%. Severe GI involvement was associated with increased risk of relapse ( P = 0.031), while longer time to induce remission ( P = 0.022) and increased cumulative dose of cyclophosphamide ( P = 0.005) were associated with lower relapse risk. Conclusion Childhood PAN is a severe inflammatory disease of insidious onset and variable clinical presentation. Relapses occurred more frequently in those with severe GI involvement. A higher cumulative dose of cyclophosphamide was associated with a lower risk of relapse. [ABSTRACT FROM AUTHOR]

Aim To describe the frequency of renovascular abnormalities and hypertension in an opportunistic cohort of children with complex cerebrovascular disease from a single tertiary/quaternary referral centre. Method This was a retrospective case note and imaging review of children who had had cerebral and renal angiography, with a diagnosis of moyamoya or other occlusive cerebrovascular disease ( OCVD). Hypertension was defined as at least three systolic blood pressure readings of the 95th centile or above. Results Of 34 children (12 males, 22 females; median age 5y 11mo, range 2mo-15y 3mo; 20 with moyamoya, 14 with OCVD), primary presentation was neurological in 29 (arterial ischaemic stroke, transient ischaemic attack, or headache) and with hypertension in five. Renovascular abnormalities were identified in 17, of whom 10 had main renal artery stenosis. Renovascular involvement was not predictable according to arteriopathy diagnosis. Blood pressure was rarely plotted on centile charts. Using the 50th height centile for blood pressure, and based on a median of five systolic blood pressure readings per patient, 20 out of 34 met the definition for hypertension (15/29 patients with primary neurological presentation). Interpretation Renovascular abnormalities were common in this group of children with complex cerebrovascular disease. Blood pressure was frequently abnormal but rarely measured and infrequently plotted on centile charts. Neurologists should be alert to potential systemic vascular involvement and its sequelae in children with complex cerebrovascular disease. [ABSTRACT FROM AUTHOR]

SUMMARY Rhabdoid tumour of the kidney is an uncommon malignancy with a poor prognosis that usually occurs in childhood. Certain imaging features may help distinguish this lesion from the much more common Wilmstumour '. Extra-renal rhabdoid tumours appear to have no specific imaging characteristics. [ABSTRACT FROM AUTHOR]

This article proposes a course outline on law and business studies. The first year course in law would take its place with the other introductory courses. It is possible to show the student at this early stage that these subjects are facets rather than compartments. In the second year, a start would be made on the study of the two most important areas of substantive law for the businessman, and their place and function in business. Contract, the basic tool of business, would be followed by a study of the ways in which the businessman can extend his personality and power by using agents, joining in partnership, forming a limited liability company and otherwise. In the third year, the student would consider certain basic business problems, primarily of selling his product and raising finance, and such other problems, within or outside the area of sales and finance, as might arise and be suitable for inquiry. This inquiry would be interdisciplinary in the sense that the student would probably by this time have studied some economics, some accountancy, some politics, some administration, and some other subjects related to business. The problems dealt with at the third stage of the law course would require the student to make use of the learning he had acquired in these courses.

In this article the authors discuss various techniques for the imaging of tracheobronchomalacia (TBM). TBM refers to a softening of the wall of the airway that leads to expiratory collapse. According to the authors, traditional methods of diagnosing TBM include rigid or flexible bronchoscopy and bronchography, which require general anaesthesia. The authors say that the multidetector computed tomography (MDCT) is an important technique for the evaluation of TBM.

SUMMARY We report the imaging findings in a 3 year old girl with a mild form of holoprosencephaly. The malformation is of interest because it may contribute to our understanding of brain development. The relatively mild clinical features are emphasized. [ABSTRACT FROM AUTHOR]

Summary Histiocytoses are rare multi‐system disorders marked by abnormal histiocyte cell proliferation, affecting children with diverse clinical presentations. Classified into five groups in 2016, including Langerhans‐related (L), cutaneous (C), malignant (M), Rosai–Dorfman disease (R) and haemophagocytic lymphohistiocytosis (H), newer entities such as ALK‐positive histiocytosis have also emerged, heralding the era of molecular (sub)classification. Common entities include Langerhans cell histiocytosis (LCH), Erdheim–Chester disease (ECD), Rosai–Dorfman disease (RDD) and haemophagocytic lymphohistiocytosis (HLH). This pictorial essay aids radiologists in recognising and differentiating paediatric histiocytoses based on unique neuroimaging features. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Successful nontransplant resection of POST-TEXT III and IV hepatoblastoma" by Lautz et al in the 2012 issue.

Objectives: Metallic tracheobronchial stents are placed at our institution (tertiary referral academic specialist children’s hospital) by the interventional radiology unit following a multidisciplinary “tracheal team” meeting. Indications include tracheobronchial stenosis (congenital or acquired), extrinsic compression and tracheobronchomalacia. This presentation reviews the experience of 50 metallic stents in 26 children seen consecutively from September 1999 to August 2003.Methods: Data were collected prospectively and information regarding the following was recorded: patient demographics and indications, type of stent used, follow-up procedures required, and survival rates.Results: Of the 26 patients, 12 were male and 14 female with ages ranging from 7 weeks to 16 years (median, 8 months). A total of 40 procedures were carried out involving the placement of 50 stents (types used were Palmaz, Wall Stent, Symphony, and Smart Control). Stent location was as follows : trachea (n = 27), left main bronchus (n = 17), left lower lobe bronchus (n = 2) and right main bronchus (n = 4). Twenty-four patients have required follow-up bronchography ± flexible bronchoscopy, with 16 needing further procedures. Of these, 10 had balloon dilatations alone and 6 had these in combination with additional stent intervention. Complications incude hemorrhage, stent collapse, and formation of granultions. There have been 8 deaths.Conclusions: In summary, we believe that metallic tracheobronchial stenting has value in the management of lower airway problems in children previously viewed as having an extremely poor prognosis. It is vital, however, that it is performed in a unit with a multidisciplinary team consisting of interventional radiologists, otolaryngologists, cardiothoracic surgeons, pulmonologists and intensivists. [Copyright &y& Elsevier]

Pulmonary artery slings are rare congenital anomalies seen only on the left side. The presence of right pulmonary artery (RPA) sling is extremely rare. We report a case of a RPA sling with a single lung associated with tracheal stenosis and its management., (© 2013 Wiley Periodicals, Inc.)