Robin D Kaye

Phoenix Children's Hospital, Phoenix, Arizona, United States

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Publications (43)113.92 Total impact

  • Seminars in Ultrasound CT and MRI 07/2014; · 1.29 Impact Factor
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    ABSTRACT: In the pediatric population, obtaining venous access in high-risk neonates, severely ill children with cardiac anomalies or very young children (<10 kg) can be very challenging. In the literature to date, the greater saphenous vein has not been primarily used by interventional radiologists as an entry site for venous access in children. To demonstrate the utility and effectiveness of using the greater saphenous vein as a venous access site for the placement of peripherally inserted central catheters in children. This is a retrospective study from a large tertiary care children's hospital from November 2010 to August 2012. Peripheral insertion of central venous catheters (PICC) using the greater saphenous vein was attempted in 86 children ranging in age from 3 days to 17 years (mean: 1.8 years). Indications included congenital heart disease, urinary tract infection, intravenous access, pneumonia, meningitis, total parenteral nutrition, sepsis and other infections. All procedures were performed by interventional radiologists. No insertion-related complications were identified. There was no follow-up planning, but no mechanical or infectious complications were brought to our attention. Of the 86 patients in whom PICC placement was attempted, placement was successful in 67 (78%). Forty-two PICCs were placed in the greater saphenous vein at the thigh level using US guidance and 25 at the ankle level using anatomical landmarks. The mean weight of the 67 patients who underwent successful placement was 9.98 kg, with 51 (76%) weighing <10 kg. The mean vessel diameter in placement failures was 1.35 mm compared to 1.83 mm in successful placement. Inability to obtain venous access was the cause of failure in all thigh access sites while inability to advance the catheter centrally was the cause of failure for all ankle access sites. A total of 1,060 catheter days (with a maximum dwell time of 97 days in one patient) were reviewed without complication. In children, the greater saphenous vein provides a safe, suitable alternative for venous access, particularly in very young children (<10 kg) and in a select group of older children who are not mobile. In the lower extremities, greater saphenous venous puncture and access may be a preferred initial access site in small children to preserve future venous access.
    Pediatric Radiology 10/2013; · 1.57 Impact Factor
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    ABSTRACT: PURPOSE To show that the femoral vein is a satisfactory site for alternative central venous access. We place tunneled femoral catheters in congenital cardiac patients to preserve venous structures in the neck and chest for future cardiac surgery. Femoral catheters are also used when alternative central access is needed. There are few published studies in the pediatric radiology literature evaluating femoral venous catheters. METHOD AND MATERIALS Retrospective chart review performed at a tertiary pediatric medical center. The charts of 71 patients who received femoral central venous catheters between 2008 - 2010 were reviewed. 87 catheters were placed in the 71 patients. 82 of these catheters were tunneled, 5 were non-tunneled. The patient age range was 1 day - 19.5 years (mean age 24 months, median age 5 months). 24 patients had congenital cardiac disease, 47 had non-cardiac related illnesses. Each patient's case was evaluated for procedural and long-term complications. RESULTS Two procedural complications occurred. 1 catheter was placed in the femoral artery. 1 catheter was pulled out inadvertently at the end of the procedure. Two types of long-term complications occured, catheter infection and catheter occlusion. 5 catheters tested positive for bacterial infection between 11 - 25 days after placement. The infection rate for this series of patients is 6%. The overall infection rate at our institution was similar during the same time period (2008 - 2010). 1 catheter occluded 6 days after placement. CONCLUSION Our catheter complication rate is similar to other published data. Therefore, tunneled femoral catheters are a good choice for congenital cardiac patients because the venous structures in the neck and chest are spared potential complications associated with catheter placement. Tunneled femoral catheters are also a good alternative for non-ambulatory patients and when other vessels are not available for use due to indwelling lines or vessel occlusion. CLINICAL RELEVANCE/APPLICATION Tunneled femoral venous catheters can preserve venous structures in the neck and chest for future cardiac surgery in congenital cardiac patients.
    Radiological Society of North America 2011 Scientific Assembly and Annual Meeting; 12/2011
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    ABSTRACT: To compare ultrasound (US)-guided radial artery cannulation with the traditional palpation technique. : Prospective randomized study. Operating room in a tertiary care pediatric center. One hundred fifty-two children under 18 yrs of age requiring radial artery cannulation. Patients were randomized to either 1) palpation or 2) US guidance technique for radial artery cannulation. The primary end point of the study was the time taken for attempted cannulation by the first operator at the first site. Secondary end points included the number of attempts at arterial cannulation, the number of cannulae used, and the need for additional assistance from another anesthesiologist. Eighty and 72 children were randomized to the palpation and the US-guided groups, respectively. There were no statistically significant differences in age, gender, weight, and systolic blood pressure between the two study groups. The designated first operator (20 pediatric subspecialty trainees and eight consultant anesthesiologists) had previous experience in US-guided arterial cannulation in <10 cases, with 94% having experience in <5 cases. Although the radial artery was eventually cannulated in all patients, the designated operator was successful at the first site of cannulation in only 66% and 69% in the palpation and US groups, respectively. There were no statistically significant differences between the groups in time to successful cannulation, total number of attempts, number of successful cannulations during the first attempt, or in the number of cannulae used for catheterization. US guidance did not facilitate faster cannulation of the radial artery in children in our study.
    Pediatric Critical Care Medicine 01/2009; 10(1):45-8. · 2.35 Impact Factor
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    ABSTRACT: Children with arthritis may endure a lifetime of disfigurement, dysfunction, and pain if acute inflammation progresses to chronic changes in the joint cartilage and underlying bone. Intraarticular steroids have become an integral component of treatment, but at times are difficult to deliver to joints, such as the subtalar joint, that have complex anatomies. We describe our technique and outcomes using fluoroscopically guided intraarticular subtalar steroid injection in patients with active symptoms of juvenile idiopathic arthritis (JIA). Fluoroscopically guided subtalar joint injections were performed in 38 children (mean age 6.7 years). Medical records were reviewed retrospectively and improvement was evaluated clinically by the degree of foot movement in eversion and inversion. Subtalar joint injection was technically successful in 100% of the JIA patients with improvement in physical symptoms in 34/38 (89%). Of the 38 children, 32 were followed up within 13 weeks of the initial injection and, therefore, satisfied the eligibility criteria for resolution of arthritis. Of these 32 children, 14 showed clinical resolution (44%). The mean duration of improvement was 1.2 +/- 0.9 years. Children with a longer interval (>1 year) from diagnosis to treatment had significantly less resolution (P = 0.04). Local subcutaneous atrophy or hypopigmentation were observed in 53% of the children after steroid injection (20/38). These minor complications were associated with a greater volume of steroid injected into the site per child (P = 0.02). Fluoroscopically guided subtalar joint injection is an effective treatment for subtalar arthropathy. Prompt referral for intraarticular steroid treatment in the acute phase improves response. Skin changes often occur at the injection site, and specific precautions should be employed to reduce this risk. Prospective study is indicated to determine the most effective treatment strategy to prevent long-term pain and disability.
    Pediatric Radiology 06/2007; 37(6):544-8. · 1.57 Impact Factor
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    ABSTRACT: Priapism is defined as involuntary, prolonged penile erection caused by factors other than sexual arousal, and is classified as either low-flow or high-flow. Embolotherapy is an accepted form of therapy in adults with high-flow priapism. Because the differences in etiology, management and outcome are significant, accurate and timely diagnosis is imperative. The purpose of this report is to present our experience with embolotherapy for treatment of high-flow priapism in three children. This was a retrospective study. During an 18-month period, three boys ranging in age from 6 to 15 years presented with priapism. All three children were treated with embolotherapy. All three children were successfully treated with angiography and embolotherapy. One boy had a presentation that initially raised the possibility of low-flow priapism. No complications occurred, and to date all children are able to maintain normal erections. Subselective transcatheter embolization is the procedure of choice for high-flow priapism. In cases where priapism persists despite adequate therapy, angiography might be useful to exclude high-flow disease. In children with high-flow priapism, selective occlusion of the penile arteriovenous fistula led to detumescence and normal erectile function.
    Pediatric Radiology 06/2007; 37(5):483-7. · 1.57 Impact Factor
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    ABSTRACT: OBJECTIVE: The purposes of this study were to retrospectively review an injection technique, to develop a grading system for evaluation of imaging findings, and to report preliminary outcome related to percutaneous CT-guided steroid injection into the temporomandibular joints of children with inflammatory arthropathy. CONCLUSION: CT-guided steroid injection into the temporomandibular joint of children with inflammatory arthropathy results in clinical and imaging improvement in a substantial proportion of children treated.
    American Journal of Roentgenology 02/2007; 188(1):182-6. · 2.90 Impact Factor
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    ABSTRACT: To determine the demographics of subtalar arthritis, the response to intraarticular corticosteroid injection, and the injection complication rate in a clinic sample of children with juvenile idiopathic arthritis (JIA). A chart review was performed of all patients at a tertiary medical center who underwent subtalar corticosteroid injection during the past 5 years. Injection of 1 ml of triamcinolone hexacetonide or acetonide into the midsubtalar joint was performed using a lateral oblique approach under fluoroscopic guidance. Improvement was defined by enhanced foot inversion and eversion at the following office visit. Thirty-eight patients underwent 55 subtalar injections during the study period. All 7 JIA subtypes were represented. Thirty-one patients (82%) had subtalar arthritis at time of JIA diagnosis and 32 (84%) had concomitant tibiotalar ankle arthritis. Improvement was observed following 34 (89%) of the initial 38 injections. The mean duration of improvement was 1.2 years (SD +/- 0.9). Twenty patients (53%) developed hypopigmentation or subcutaneous atrophy. This complication was associated with a higher volume of injected corticosteroid per patient weight (p = 0.02) and with less efficacious injections (p = 0.04). Subtalar arthritis in children with JIA is common. Similar to other joints, subtalar arthritis responds to corticosteroid injection in approximately 90% of cases and often remains improved for greater than one year. Hypopigmentation and subcutaneous atrophy are frequent complications and are likely related to the dose of injected corticosteroid and possibly the accuracy of needle placement.
    The Journal of Rheumatology 12/2006; 33(11):2330-6. · 3.26 Impact Factor
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    ABSTRACT: May-Thurner syndrome refers to anatomic compression of the left iliofemoral vein by the overriding right iliac artery. We report three adolescents who presented to our pediatric hospital with iliac vein thrombosis and were diagnosed with May-Thurner syndrome. Each received catheter-directed thrombolysis followed by balloon angioplasty to restore flow. Two patients had endovascular stents placed. The procedures were well tolerated, without major complications. Additional thrombophilic risk factors were identified in each patient. Though uncommon, pediatric hematologists should consider May-Thurner syndrome in adolescents who present with a left lower extremity thrombosis. Aggressive therapy may be warranted due to the risk of post-thrombotic syndrome.
    Pediatric Blood & Cancer 12/2006; 47(6):834-8. · 2.35 Impact Factor
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    ABSTRACT: LEARNING OBJECTIVES In this course, participants will be able to: (1) Identify basic skills, techniques, and pitfalls of freehand invasive sonography, with specific focus on small parts applications; (2) Discuss and perform basic skills involved in breast, musculoskeletal, and head/neck invasive sonography; (3) Perform specific US-guided procedures to include core biopsy, abscess drainage, thyroid biopsy, cyst aspiration, access for sclerotherapy of lymphatic malformations, soft tissue foreign body removal, and joint injection. ABSTRACT
    Radiological Society of North America 2006 Scientific Assembly and Annual Meeting; 11/2006
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    ABSTRACT: The authors offer a modular approach to the development of new procedures in the field of pediatric interventional radiology as a conceptual model and a springboard for further discussion.
    Pediatric Radiology 06/2006; 36(5):378-85. · 1.57 Impact Factor
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    ABSTRACT: Nat. Med. 12, 342–347; 2006; published online 12 February 2006; corrected after print 19 April 2006
    Nature Medicine. 04/2006; 12(5):592-592.
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    ABSTRACT: We have previously shown that a single portal vein infusion of a recombinant adeno-associated viral vector (rAAV) expressing canine Factor IX (F.IX) resulted in long-term expression of therapeutic levels of F.IX in dogs with severe hemophilia B. We carried out a phase 1/2 dose-escalation clinical study to extend this approach to humans with severe hemophilia B. rAAV-2 vector expressing human F.IX was infused through the hepatic artery into seven subjects. The data show that: (i) vector infusion at doses up to 2 x 10(12) vg/kg was not associated with acute or long-lasting toxicity; (ii) therapeutic levels of F.IX were achieved at the highest dose tested; (iii) duration of expression at therapeutic levels was limited to a period of approximately 8 weeks; (iv) a gradual decline in F.IX was accompanied by a transient asymptomatic elevation of liver transaminases that resolved without treatment. Further studies suggested that destruction of transduced hepatocytes by cell-mediated immunity targeting antigens of the AAV capsid caused both the decline in F.IX and the transient transaminitis. We conclude that rAAV-2 vectors can transduce human hepatocytes in vivo to result in therapeutically relevant levels of F.IX, but that future studies in humans may require immunomodulation to achieve long-term expression.
    Nature Medicine 04/2006; 12(3):342-7. · 22.86 Impact Factor
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    ABSTRACT: The Bispectral Index (BIS) is an empirically calibrated number derived from adult electroencephalograph data that correlates with the depth of sedation in adults. We tested the hypothesis that the BIS score is a valid measure of the depth of pediatric sedation in a study designed to avoid limitations of a previously published report. BIS values from 96 healthy ASA physical status I-II children aged 1-12 yr undergoing sedation were continually recorded and electronically transferred to a computer. Two independent observers blinded as to BIS score evaluated sedation using the Observer's Assessment of Alertness/Sedation (OAA/S) and the University of Michigan Sedation Scale (UMSS) at 3-5 min intervals. There was a significant correlation between BIS and UMSS and between BIS and OAA/S by both the Spearman's rank correlation test and by prediction probability (P < 0.001). In children <6 yr, there was a significant correlation between BIS and the clinical sedation scores for subgroups undergoing invasive and noninvasive procedures (P < 0.001). There was also good agreement between the 2 independent observers who assessed clinical sedation scores (kappa = 0.51, P < 0.001). We conclude that the BIS monitor is a quantitative, nondisruptive and easy to use depth of sedation monitor in children.
    Anesthesia and analgesia 03/2006; 102(2):383-8. · 3.08 Impact Factor
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    ABSTRACT: We describe 2 children with severe spastic quadriplegic cerebral palsy (CP) who have significant drooling and frequent aspiration pneumonia. They underwent simultaneous botulinum toxin type A (BTX-A) injections to salivary glands for drooling and prevention of aspiration pneumonia along with single-event multilevel chemoneurolysis (SEMLC) with BTX-A and 5% phenol for severe diffuse spasticity. There was significant improvement in drooling, frequency of aspiration pneumonia, and spasticity without adverse effect. BTX-A injections into the salivary glands, in addition to SEMLC, for these 2 children with medically complicated severe spastic quadriplegic CP, were safe and highly successful procedures, which improved their health-related quality of life.
    Archives of Physical Medicine and Rehabilitation 02/2006; 87(1):141-4. · 2.36 Impact Factor
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    ABSTRACT: To assess the effects of computed tomography (CT)-guided injection of corticosteroid into the temporomandibular joint (TMJ) in children with juvenile idiopathic arthritis (JIA) and clinical and magnetic resonance imaging (MRI) evidence of TMJ inflammation. Twenty-three children ages 4-16 years with JIA and MRI evidence of TMJ inflammation received CT-guided TMJ injections of corticosteroid (triamcinolone acetonide [n = 16] or triamcinolone hexacetonide [n = 7]). Jaw pain or dysfunction and maximal incisal opening (MIO) distance were assessed before and after injection. Fourteen patients had followup MRI studies of the TMJ 6-12 months after injection. Of the 13 patients with symptoms of jaw pain prior to corticosteroid treatment, 10 (77%) had complete resolution of pain (P < 0.05). Prior to corticosteroid injection, MIO in all 23 patients was below age-matched normal values. After injection, the MIO was improved by at least 0.5 cm in 10 patients (43%) (P = 0.0017). Patients under 6 years of age at the time of injection showed the best response, with a postinjection MIO similar to that in age-matched controls (P = 0.2267). There was involvement of 23 TMJs in the 14 patients who had followup MRI studies; resolution of effusions was observed in 11 (48%) of the TMJs. Other than short-term facial swelling in 2 patients, there were no side effects. The majority of children with symptomatic TMJ arthritis improved after intraarticular corticosteroid injection. Approximately half the patients experienced significant improvement in MIO and TMJ effusion. These data suggest that corticosteroid injection may be a useful procedure for the prevention and treatment of morbidities associated with TMJ arthritis in JIA.
    Arthritis & Rheumatology 12/2005; 52(11):3563-9. · 7.48 Impact Factor
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    ABSTRACT: LEARNING OBJECTIVES Objective: In this course, participants will be able to: (1) Identify basic skills, techniques, and pitfalls of freehand invasive sonography, with specific focus on small parts applications; (2) Discuss and perform basic skills involved in breast, musculoskeletal, and head/neck invasive sonography; (3) Perform specific US-guided procedures to include core biopsy, abscess drainage, thyroid biopsy, cyst aspiration, access for sclerotherapy of lymphatic malformations, soft tissue foreign body removal, and joint injection. ABSTRACT
    Radiological Society of North America 2005 Scientific Assembly and Annual Meeting; 11/2005
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    ABSTRACT: Pseudoaneurysms (PAn) are uncommon in adults and even less common in children. They are most often encountered after iatrogenic arterial injury. Presentation may be substantially delayed after the iatrogenic event, and diagnosis can be difficult, especially when the PAn occurs in an unexpected location. Treatment of PAn has evolved during the last two decades from a reliance on surgical resection to US-guided compression, coil embolization, covered stents, and stent-graft exclusion. More recently, direct percutaneous US-guided thrombin injection has been used in the treatment of PAn. We present three cases of successful PAn thrombosis by US-guided percutaneous thrombin injection in children, one of the epigastric artery and two of the femoral artery.
    Pediatric Radiology 05/2005; 35(4):434-9. · 1.57 Impact Factor
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    ABSTRACT: To evaluate a transgluteal approach for draining pelvic fluid collections in pediatric patients. Institutional review board approval and informed consent for interventional procedures were obtained. From September 1995 to December 2002, 140 abdominopelvic fluid collections were drained at two institutions. Retrospective analysis of a prospectively gathered procedural database revealed that a transgluteal approach was used to drain 53 of these 140 collections (38%) in 51 patients (29 female, 22 male; mean age, 11.2 years; age range, 0.2-19 years). All patients received antibiotics before the procedure. A retrospective analysis was conducted of the patients' medical records and diagnostic imaging and interventional procedure findings, including the reason for referral; location, volume, and character of collections; method and equipment used for evacuation; duration of therapy; evidence of complications; results of microbiologic examination of specimens; and success rates. Transgluteal drainage was performed with computed tomographic (CT) guidance in 45 of the 53 collections (85%), with fluoroscopic guidance in three (6%), and with a combination of both modalities in five (9%). A drainage catheter was successfully placed in 49 collections; four small collections were aspirated without drain placement. Infected fluid was obtained from 41 collections, and serosanguineous fluid was obtained from 12 collections. The mean volume aspirated was 80 mL (2-600 mL). A positive culture was obtained at 28 of the 53 procedures. The mean duration of catheter placement was 4 days (range, 2-14 days). There were no major complications. The transgluteal approach to the drainage of abdominopelvic fluid collections with imaging guidance is safe and effective.
    Radiology 04/2005; 234(3):893-8. · 6.34 Impact Factor
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    ABSTRACT: We report the inadvertent passage of an epidural catheter threaded from the caudal space out of a lumbar intervertebral foramen and into the lower thoracic paravertebral space in an infant. We identified the errant catheter by radiography and removed it without sequelae.
    Anesthesia & Analgesia 03/2005; 100(2):365-6. · 3.30 Impact Factor

Publication Stats

1k Citations
113.92 Total Impact Points

Institutions

  • 2014
    • Phoenix Children's Hospital
      Phoenix, Arizona, United States
  • 2007
    • University of Pennsylvania
      • Department of Radiology
      Philadelphia, PA, United States
    • Children's Hospital of Wisconsin
      Madison, Wisconsin, United States
  • 2002–2007
    • The Children's Hospital of Philadelphia
      • Department of Radiology
      Philadelphia, PA, United States
  • 1996–2001
    • Childrens Hospital of Pittsburgh
      • Division of Pediatric Cardiology
      Pittsburgh, Pennsylvania, United States