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  1. Article ; Online: Functional Outcomes of Patients Who Underwent Anorectal Malformation Repair Using MRI Guidance.

    Dougherty, Danielle / Ralls, Matthew W / Plagens, Connor J / Ladino-Torres, Maria / Williams, Keyonna M / Wild, Laurie / Jarboe, Marcus D

    Journal of pediatric surgery

    2024  Volume 59, Issue 6, Page(s) 1044–1049

    Abstract: Background: Despite the initiation of minimally invasive laparoscopic techniques, the majority of patients who undergo anorectal malformation repair still experience functional bowel issues in childhood, including constipation and fecal incontinence. In ...

    Abstract Background: Despite the initiation of minimally invasive laparoscopic techniques, the majority of patients who undergo anorectal malformation repair still experience functional bowel issues in childhood, including constipation and fecal incontinence. In this study, we evaluate the functional outcomes of a procedure in which magnetic resonance imaging guidance is used during initial laparoscopic repair to better locate the epicenter of the sphincter muscle complex and pelvic floor with the goal of more accurate placement of the neoanus and improved functional outcomes.
    Methods: A retrospective chart review evaluated demographic, operative, and outcome details for patients who underwent this procedure. A telephone survey was employed to determine levels of social continence using the validated Baylor Continence Scale and to determine what type of bowel management is used.
    Results: Twenty-six patients were included. Median age at operation was 7 months, and median age at follow-up was 4 years old, with a range of 1-9. Bowel management regimen results revealed that 19 % (n = 5) use no bowel management regimen, 58 % (n = 15) use laxatives only, and 23 % (n = 6) use enemas. Enema use was not associated with different spine or sacral anomalies (p = 0.77). Fifteen patients (58 %) answered the Baylor Continence Scale questions and had a median score of 14. No difference was found in scores when accounting for lesion level (p = 0.43), quality of needle placement (p = 0.46), or quality of sphincter muscles (p = 0.75).
    Conclusions: Using MRI guidance in the repair of anorectal malformations shows promise in both the qualitative and quantitative functional outcomes of this complex patient population.
    Level of evidence: Level III.
    MeSH term(s) Humans ; Retrospective Studies ; Male ; Female ; Magnetic Resonance Imaging/methods ; Anorectal Malformations/surgery ; Fecal Incontinence/etiology ; Infant ; Child, Preschool ; Treatment Outcome ; Laparoscopy/methods ; Follow-Up Studies ; Constipation/etiology ; Anal Canal/abnormalities ; Anal Canal/surgery ; Child ; Surgery, Computer-Assisted/methods ; Rectum/surgery ; Rectum/abnormalities ; Postoperative Complications/etiology ; Enema/methods ; Anus, Imperforate/surgery ; Anus, Imperforate/diagnostic imaging ; Laxatives/therapeutic use ; Laxatives/administration & dosage
    Language English
    Publishing date 2024-01-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80165-3
    ISSN 1531-5037 ; 0022-3468
    ISSN (online) 1531-5037
    ISSN 0022-3468
    DOI 10.1016/j.jpedsurg.2023.12.023
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  2. Article: Case Report: A Relatively Mild Presentation of Unilateral Congenital Pulmonary Lymphangiectasia.

    Adair, Dionne / Rabah, Raja / Ladino-Torres, Maria / Saba, Thomas G

    Frontiers in pediatrics

    2021  Volume 9, Page(s) 657473

    Abstract: Pulmonary lymphangiectasia (PL) is a rare congenital disorder of pulmonary lymphatic development. Although it was traditionally a fatal disorder of infancy, some cases in later childhood have been reported, suggesting a spectrum of severity. We present ... ...

    Abstract Pulmonary lymphangiectasia (PL) is a rare congenital disorder of pulmonary lymphatic development. Although it was traditionally a fatal disorder of infancy, some cases in later childhood have been reported, suggesting a spectrum of severity. We present an unusual case of unilateral, congenital pulmonary lymphangiectasia. Our patient presented with neonatal respiratory distress, a chronic wet cough and recurrent episodes of bronchitis. Chest CT revealed thickening of the interlobular septae of the right lung. A lung biopsy confirmed the diagnosis of lymphangiectasia. His clinical course is characterized by chronic coughing and recurrent bronchitis but normal growth and development. This case illustrates a relatively mild presentation of unilateral PL, which, along with other reports, suggests variability in the presentation and severity of this disorder. In the absence of imaging and histological examination, mild presentations may go undiagnosed.
    Language English
    Publishing date 2021-04-22
    Publishing country Switzerland
    Document type Case Reports
    ZDB-ID 2711999-3
    ISSN 2296-2360
    ISSN 2296-2360
    DOI 10.3389/fped.2021.657473
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  3. Article ; Online: Prenatal Measurements of Congenital Lung Malformations: Can They Predict Postnatal Size?

    Dougherty, Danielle / Diaconescu, Andrada / Shah, Nikhil R / VanHulle, Rachel / Ladino-Torres, Maria / Treadwell, Marjorie C / Mychaliska, George B / Perrone, Erin E

    The Journal of surgical research

    2023  Volume 293, Page(s) 259–265

    Abstract: Introduction: Prenatally diagnosed congenital lung malformations (CLMs) are monitored via ultrasound and measured by congenital pulmonary airway malformation volume ratios (CVRs) which can predict postnatal respiratory symptoms. This study compared CVR ... ...

    Abstract Introduction: Prenatally diagnosed congenital lung malformations (CLMs) are monitored via ultrasound and measured by congenital pulmonary airway malformation volume ratios (CVRs) which can predict postnatal respiratory symptoms. This study compared CVR to postnatal lesion size to help guide prenatal counseling.
    Methods: A retrospective chart review evaluated the prenatal imaging and postnatal outcomes for patients who were prenatally diagnosed with CLMs and had a postnatal computed tomography (CT) scan at one institution.
    Results: Fifty-seven patients were included. Four had symptoms requiring urgent resection. The remaining were discharged and had clinic follow-up with CT scan to determine next steps: five had no identified lesions, eight had lesions whose diagnosis did not warrant an operation, and 40 had lesions whose diagnosis rendered size a factor in operative decision-making. Of these 40, 26/40 patients (65%) underwent elective resection (median maximum CVR 0.97; median lesion size 4 cm) and 14/40 patients (35%) were observed without resection (median maximum CVR 0.5; median lesion size 3 cm). There was a positive correlation between prenatal CVR and postnatal lesion size, with R-squared = 0.46. Maximum CVRs were better than last CVRs when predicting whether postnatal CT size would fall above or below our institution's level of recommended resection, with an area under the curve of 0.85 and a CVR cut-point of 0.61.
    Conclusions: For newborns with asymptomatic CLMs, higher maximum CVRs correlated with larger size on postnatal CT. A maximum CVR ≤0.6 was correlated with a smaller postnatal CT size that may be eligible for nonoperative management. While these results are not intended to recommend surgery based on higher CVRs alone, this information could potentially be used to reassure expectant parents whose babies' prenatal imaging demonstrate lower maximum CVRs.
    MeSH term(s) Pregnancy ; Infant ; Female ; Humans ; Infant, Newborn ; Lung/diagnostic imaging ; Lung/surgery ; Lung/abnormalities ; Retrospective Studies ; Ultrasonography, Prenatal/methods ; Lung Diseases/congenital ; Respiratory System Abnormalities/diagnostic imaging ; Respiratory System Abnormalities/surgery ; Prenatal Diagnosis
    Language English
    Publishing date 2023-10-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80170-7
    ISSN 1095-8673 ; 0022-4804
    ISSN (online) 1095-8673
    ISSN 0022-4804
    DOI 10.1016/j.jss.2023.09.022
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  4. Article ; Online: Understanding Lymphatic Anatomy and Abnormalities at Imaging.

    Lee, Elizabeth / Biko, David M / Sherk, William / Masch, William R / Ladino-Torres, Maria / Agarwal, Prachi P

    Radiographics : a review publication of the Radiological Society of North America, Inc

    2022  Volume 42, Issue 2, Page(s) 487–505

    Abstract: Lymphatic abnormalities encompass a wide range of disorders spanning solitary common cystic lymphatic malformations (LMs) to entities involving multiple organ systems such as lymphangioleiomyomatosis. Many of these disorders are rare, yet some, such as ... ...

    Abstract Lymphatic abnormalities encompass a wide range of disorders spanning solitary common cystic lymphatic malformations (LMs) to entities involving multiple organ systems such as lymphangioleiomyomatosis. Many of these disorders are rare, yet some, such as secondary lymphedema from the treatment of malignancy (radiation therapy and/or lymph node dissection), affect millions of patients worldwide. Owing to complex and variable anatomy, the lymphatics are not as well understood as other organ systems. Further complicating this is the variability in the description of lymphatic disease processes and their nomenclature in the medical literature. In recent years, medical imaging has begun to facilitate a deeper understanding of the physiology and pathologic processes that involve the lymphatic system. Radiology is playing an important and growing role in the diagnosis and treatment of many lymphatic conditions. The authors describe both normal and common variant lymphatic anatomy. Various imaging modalities including nuclear medicine lymphoscintigraphy, conventional lymphangiography, and MR lymphangiography used in the diagnosis and treatment of lymphatic disorders are highlighted. The authors discuss imaging many of the common and uncommon lymphatic disorders, including primary LMs described by the International Society for the Study of Vascular Anomalies 2018 classification system (microcystic, mixed, and macrocystic LMs; primary lymphedema). Secondary central lymphatic disorders are also detailed, including secondary lymphedema and chylous leaks, as well as lymphatic disorders not otherwise easily classified. The authors aim to provide the reader with an overview of the anatomy, pathology, imaging findings, and treatment of a wide variety of lymphatic conditions.
    MeSH term(s) Humans ; Lymphatic Diseases/pathology ; Lymphatic System/diagnostic imaging ; Lymphatic System/pathology ; Lymphedema/diagnostic imaging ; Lymphography/methods ; Magnetic Resonance Imaging/methods
    Language English
    Publishing date 2022-02-18
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 603172-9
    ISSN 1527-1323 ; 0271-5333
    ISSN (online) 1527-1323
    ISSN 0271-5333
    DOI 10.1148/rg.210104
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    Zs.A 1751: Show issues Location:
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  5. Article ; Online: Conjoined twins: an obstetrician's guide to prenatal care and delivery management.

    Greco, Patricia S / Pitts, D'Angela / Weadock, William J / Ladino-Torres, Maria / Laventhal, Naomi T / Mychaliska, George / Treadwell, Marjorie C / Carver, Alissa

    Journal of perinatology : official journal of the California Perinatal Association

    2021  Volume 41, Issue 10, Page(s) 2424–2431

    Abstract: Objective: Obstetricians infrequently encounter conjoined twins. Much of the clinical care literature focuses on postnatal management from a neonatology and pediatric surgery perspective; guidance on obstetrical management is limited. We outline steps ... ...

    Abstract Objective: Obstetricians infrequently encounter conjoined twins. Much of the clinical care literature focuses on postnatal management from a neonatology and pediatric surgery perspective; guidance on obstetrical management is limited. We outline steps for prenatal evaluation, obstetrical care, and delivery planning.
    Study design: Experiences with two cases of conjoined twins.
    Results: We identified several points throughout the planning, delivery, and postnatal process that are important to highlight for optimizing clinical outcome, patient safety, and parental satisfaction.
    Conclusion: After diagnosis, patients should be referred to a center experienced in the management of conjoined twins. Specialists in fields including maternal fetal medicine, pediatric surgery, neonatology, and radiology play a vital role in the management of these patients. Early referral allows for timely family counseling and decision-making. Prenatal evaluation beyond the first trimester should include a detailed ultrasound, fetal echocardiogram, and fetal MRI. 3D printed life-sized models can improve delivery planning and patient understanding.
    MeSH term(s) Child ; Female ; Humans ; Pregnancy ; Pregnancy Trimester, First ; Prenatal Care ; Twins, Conjoined/surgery ; Ultrasonography ; Ultrasonography, Prenatal
    Language English
    Publishing date 2021-06-22
    Publishing country United States
    Document type Journal Article
    ZDB-ID 645021-0
    ISSN 1476-5543 ; 0743-8346
    ISSN (online) 1476-5543
    ISSN 0743-8346
    DOI 10.1038/s41372-021-01107-5
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  6. Article ; Online: Ultrasound-guided pediatric inguinal hernia repair.

    Johnson, Kevin N / Criss, Cory N / Hirschl, Ronald B / Ladino-Torres, Maria / Yang, Daniel / Jarboe, Marcus D

    Journal of pediatric surgery

    2021  Volume 56, Issue 7, Page(s) 1240–1245

    Abstract: Purpose: Inguinal hernias are amongst the most common surgical conditions in children. Typically, these repairs are performed through an open or laparoscopic approach, using a high ligation of the hernia sac. The use of ultrasound has been described in ... ...

    Abstract Purpose: Inguinal hernias are amongst the most common surgical conditions in children. Typically, these repairs are performed through an open or laparoscopic approach, using a high ligation of the hernia sac. The use of ultrasound has been described in identifying and evaluating hernia contents in children. Our goal was to determine if ultrasound guidance could be used to perform a high ligation of the hernia sac in pediatric patients.
    Methods: Following IRB approval, a retrospective review of all female patients at a single center undergoing ultrasound guided inguinal hernia repair between 2017 and 2018 was performed. Pre-operative characteristics, intra-operative outcomes, and post-operative outcomes were all evaluated. Laparoscopy was used to evaluate the repair and evaluate for a contralateral hernia. Male patients did not undergo ultrasound inguinal hernia repair to avoid damage to the vas deferens and vessels.
    Results: A total of 10 patients with 13 hernias total were found during the study period. A total of one patient was converted to a laparoscopic repair. No patients were found to have an inappropriate repair or a missed contralateral hernia, and there were no vascular injuries or injuries to surrounding structures. No patients had a hernia recurrence during the study period.
    Conclusion: This study demonstrates the safety and feasibility of ultrasound guided inguinal hernia repairs in female pediatric patients. Further study is needed to compare these repairs to existing techniques, evaluate for recurrences over time, and evaluate if these repairs can be performed without general anesthetic in some patients.
    MeSH term(s) Child ; Female ; Hernia, Inguinal/diagnostic imaging ; Hernia, Inguinal/surgery ; Herniorrhaphy ; Humans ; Laparoscopy ; Male ; Recurrence ; Retrospective Studies ; Treatment Outcome ; Ultrasonography, Interventional
    Language English
    Publishing date 2021-03-11
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80165-3
    ISSN 1531-5037 ; 0022-3468
    ISSN (online) 1531-5037
    ISSN 0022-3468
    DOI 10.1016/j.jpedsurg.2021.02.053
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  7. Article: Salvage Laparoscopic-Assisted Anorectoplasty after Failed Vestibular Fistula Repair Using Magnetic Resonance Image Guidance.

    Ralls, Matthew W / Fallon, Brian P / Ladino-Torres, Maria / Ehrlich, Peter F / Jarboe, Marcus D

    European journal of pediatric surgery reports

    2019  Volume 7, Issue 1, Page(s) e12–e15

    Abstract: Patients with vestibular fistula have a good functional outcome after posterior sagittal anorectoplasty (PSARP). While continence is often preserved, close follow-up and management of constipation are often required. Redo anorectal surgery has been ... ...

    Abstract Patients with vestibular fistula have a good functional outcome after posterior sagittal anorectoplasty (PSARP). While continence is often preserved, close follow-up and management of constipation are often required. Redo anorectal surgery has been associated with worse functional outcomes compared with primary procedures, possibly due to injury and scarring of the pelvic floor musculature and sphincter complex. Our group has a growing experience in the use of intraoperative real-time magnetic resonance imaging (MRI) for anorectal malformation repairs. We present a case of salvage operation of a failed PSARP for vestibular fistula.
    Language English
    Publishing date 2019-05-23
    Publishing country Germany
    Document type Case Reports
    ZDB-ID 2674016-3
    ISSN 2194-7627 ; 2194-7619
    ISSN (online) 2194-7627
    ISSN 2194-7619
    DOI 10.1055/s-0039-1688486
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  8. Article ; Online: Prenatal assessment of congenital diaphragmatic hernia at north american fetal therapy network centers: A continued plea for standardization.

    Perrone, Erin E / Abbasi, Nimrah / Cortes, Magdalena Sanz / Umar, Uzma / Ryan, Greg / Johnson, Anthony / Ladino-Torres, Maria / Ruano, Rodrigo

    Prenatal diagnosis

    2020  Volume 41, Issue 2, Page(s) 200–206

    Abstract: Introduction: Prenatal work-up for congenital diaphragmatic hernia (CDH) is important for risk stratification, standardization, counseling, and optimal therapeutic choice. To determine current practice patterns regarding prenatal CDH work-up, including ... ...

    Abstract Introduction: Prenatal work-up for congenital diaphragmatic hernia (CDH) is important for risk stratification, standardization, counseling, and optimal therapeutic choice. To determine current practice patterns regarding prenatal CDH work-up, including prenatal ultrasound and magnetic resonance imaging (MRI) use, and to identify areas for standardization of such evaluation between fetal centers.
    Methods: A survey regarding prenatal CDH work-up was sent to each member center of the North American Fetal Therapy Network (NAFTNet) (n = 36).
    Results: All responded. Sonographic measurement of lung-to-head ratio (LHR) was determined by all, 89% (32/36) of which routinely calculate observed-to-expected LHR. The method for measuring LHR varied: 58% (21/36) used a "trace" method, 25% (9/36) used "longest axis," and 17% (6/36) used an "antero-posterior" method. Fetal MRI was routinely used in 78% (28/36) of centers, but there was significant variability in fetal lung volume measurement. Whereas all generated a total fetal lung volume, the planes, methodology and references values varied significantly. All evaluated liver position, 71% (20/28) evaluated stomach position and 54% (15/28) quantified the degree of liver herniation. More consistency in workup was seen between centers offering fetal intervention.
    Conclusion: Prenatal CDH work-up and management differs considerably among North American fetal diagnostic centers, highlighting a need for its standardization.
    MeSH term(s) Counseling ; Female ; Hernias, Diaphragmatic, Congenital/diagnosis ; Hernias, Diaphragmatic, Congenital/diagnostic imaging ; Humans ; Liver/diagnostic imaging ; Lung/diagnostic imaging ; Lung/embryology ; Magnetic Resonance Imaging/methods ; North America ; Organ Size ; Practice Patterns, Physicians' ; Pregnancy ; Prenatal Care/methods ; Reference Standards ; Surveys and Questionnaires ; Ultrasonography, Prenatal/methods
    Language English
    Publishing date 2020-11-12
    Publishing country England
    Document type Journal Article
    ZDB-ID 82031-3
    ISSN 1097-0223 ; 0197-3851
    ISSN (online) 1097-0223
    ISSN 0197-3851
    DOI 10.1002/pd.5859
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    Zs.A 1625: Show issues Location:
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  9. Article ; Online: Imaged-guided and muscle sparing laparoscopic anorectoplasty using real-time magnetic resonance imaging.

    Jarboe, Marcus / Ladino-Torres, Maria / Wild, Laurie / Spremo, Dragan / Elkins, Samual / Ladouceur, Robert / Nagy, Dave / Ehrlich, Peter / Ralls, Matthew

    Pediatric surgery international

    2020  Volume 36, Issue 10, Page(s) 1255–1260

    Abstract: A challenge when repairing imperforate anus is positioning the neo-rectum into the center of the sphincter muscle complex (SMC) with limited muscle injury and scarring. Unfortunately, the path through the components of the SMC are often non-linear. We ... ...

    Abstract A challenge when repairing imperforate anus is positioning the neo-rectum into the center of the sphincter muscle complex (SMC) with limited muscle injury and scarring. Unfortunately, the path through the components of the SMC are often non-linear. We have used MRI to delineate the complex and guide the needle through the center using standard MRI-guidance (Raschbaum GR et al. J Pediatr Surg 45:220-223, 2010; Thomas TT et al. J Pediatr Surg 35:927-930, 2000). However, asynchronous scanning requires multiple, time-consuming scans to advance the needle in stepwise fashion. Asynchronous scanning also prevents visualizing the needle as it is advanced. We recently integrated software into the MRI operative suite that allows placement of the needle with real-time MRI. We report the feasibility and utility of real-time MRI-assisted laparoscopic assisted anorectoplasty (RT MRI-LAARP). Needle guidance was performed with Siemens Espree 1.5 T MRI with T1 Flash RT Sequence. After needle placement, laparoscopic mobilization, fistula takedown and pull-through was performed using the needle to guide dilation to create a tract to pull-through the neo-rectum. Charts of patients who underwent RT MRI-LAARP were reviewed. Demographics, anatomy, number of needle passes, OR duration and complications are reported. There were five children that underwent RT MRI-LAARP; one was a redo secondary to a retracted rectovestibular fistula. Operative time ranged from 187-505 min. Average hospital stay was 4.0 ± 1.0 days. There were no intraoperative complications although one patient had temporary urinary retention post-op. Muscle sparring laparoscopic anorectoplasty using real-time MRI is feasible and facilitates needle placement through the SMC.
    MeSH term(s) Anal Canal/diagnostic imaging ; Anal Canal/surgery ; Anus, Imperforate/diagnosis ; Anus, Imperforate/surgery ; Child, Preschool ; Female ; Humans ; Infant ; Laparoscopy/methods ; Length of Stay ; Magnetic Resonance Imaging/methods ; Male ; Reconstructive Surgical Procedures/methods ; Surgery, Computer-Assisted/methods ; Treatment Outcome
    Language English
    Publishing date 2020-07-07
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 632773-4
    ISSN 1437-9813 ; 0179-0358
    ISSN (online) 1437-9813
    ISSN 0179-0358
    DOI 10.1007/s00383-020-04700-5
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  10. Article ; Online: Spine ultrasound imaging in the newborn.

    Ladino Torres, Maria F / DiPietro, Michael A

    Seminars in ultrasound, CT, and MR

    2014  Volume 35, Issue 6, Page(s) 652–661

    Abstract: Ultrasound of the spine in the neonate is widely used as the initial modality to evaluate spinal canal anatomy, anatomical variants, and congenital malformations. The spinal canal and its contents are best visualized in the newborn and young infant owing ...

    Abstract Ultrasound of the spine in the neonate is widely used as the initial modality to evaluate spinal canal anatomy, anatomical variants, and congenital malformations. The spinal canal and its contents are best visualized in the newborn and young infant owing to incomplete ossification of the posterior vertebral elements.
    MeSH term(s) Humans ; Infant, Newborn ; Lumbosacral Region ; Meningocele/diagnostic imaging ; Neural Tube Defects/diagnostic imaging ; Sacrococcygeal Region ; Spinal Canal/diagnostic imaging ; Spine/abnormalities ; Spine/diagnostic imaging ; Spine/embryology ; Teratoma/diagnostic imaging ; Ultrasonography
    Language English
    Publishing date 2014-12
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1353113-x
    ISSN 1558-5034 ; 0887-2171
    ISSN (online) 1558-5034
    ISSN 0887-2171
    DOI 10.1053/j.sult.2014.08.001
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