Bio

Bio


Dr. Chiu obtained his B.S. degree in Biological Sciences and graduated with Honors from Stanford University. After graduating, he received his Medical Degree at Northwestern University Feinberg School of Medicine, where he remained for his internship and General Surgery residency training. Dr. Chiu completed his Pediatric Surgery training at The Children’s Hospital of Philadelphia. He is an Associate Professor at Stanford University School of Medicine where he has an active research program studying innovative approaches to treat patients with neuroblastoma.

Clinical Focus


  • Pediatric Surgery
  • Surgical Oncology
  • Anorectal Malformations
  • Minimally Invasive Surgery
  • Neonatal Surgery

Academic Appointments


Professional Education


  • Board Certification: Pediatric Surgery, American Board of Surgery (2011)
  • Fellowship:Childrens Hospital of Philadelphia Surgery Fellowship (2010) PA
  • Board Certification: General Surgery, American Board of Surgery (2008)
  • Residency:Northwestern University Feinberg Dept of Surgery (2008) IL
  • Medical Education:Northwestern University Feinberg School of Medicine (2001) IL

Publications

All Publications


  • Disseminated injection of vincristine-loaded silk gel improves the suppression of neuroblastoma tumor growth. Surgery Zeki, J., Taylor, J. S., Yavuz, B., Coburn, J., Ikegaki, N., Kaplan, D. L., Chiu, B. 2018

    Abstract

    BACKGROUND: Advanced-stage neuroblastoma patients require multiagent chemotherapy. Intratumoral implantation of vincristine-loaded silk gel uses local diffusion to decrease orthotopic neuroblastoma tumor growth in mice. We hypothesize that injecting vincristine-loaded silk gel into 8 locations within the tumor, instead of only centrally, decreases the diffusion distance and improves tumor growth suppression.METHODS: Human neuroblastoma cells, KELLY, were injected into mouse adrenal glands to create orthotopic tumors. After the tumors reached 100mm3 by ultrasound, silk gels loaded with 50 g vincristine were injected centrally or in 8 areas throughout the tumor. Drug-release profile was measured in vitro. Endpoints were tumor size >1,000 mm3 and histologic examination.RESULTS: Vincristine-loaded silk gels suppressed tumor growth up to an inflection point (458.7 ± 234.4mm3 for central, 514.3 ± 165.8 mm3 for 8-point injection) before tumor growth accelerated >200mm3 over 3 days. The time to inflection point was 6.6 days for central, 13.3 days for 8-point injection (P < .05). Using the sphere volume equation to approximate tumor volume, splitting the volume into 1/8 decreased the diffusion radius by 1/2. Histologic examination confirmed tumor necrosis adjacent to vincristine-loaded silk gel.CONCLUSION: Injecting vincristine-loaded sustained release silk gel at 8 separate locations halved the diffusion distance and doubled the time for the tumor to reach the growth inflexion point.

    View details for DOI 10.1016/j.surg.2018.06.017

    View details for PubMedID 30061039

  • Dexrazoxane Significantly Reduces Anthracycline-induced Cardiotoxicity in Pediatric Solid Tumor Patients: A Systematic Review. Journal of pediatric hematology/oncology Liesse, K., Harris, J., Chan, M., Schmidt, M. L., Chiu, B. 2018

    Abstract

    Cardiotoxicity is a dose-limiting and potentially lethal complication of anthracycline administration. Previous studies failed to determine definitive toxic doses or cardioprotective factors. Current dosing strategies may utilize unnecessarily high anthracycline doses, such that survival benefit may not outweigh increased toxicity rates. A systematic review of randomized controlled trials and prospective/retrospective studies investigating anthracycline treatment in pediatric solid tumors was performed from PubMed/MEDLINE and Cochrane databases. Generalized linear models mapping survival, cardiotoxicity, and cardiotoxicity-free survival adjusted for male-to-female ratio, follow-up time, and concomitant chemotherapeutic drugs or cardioprotective agents (dexrazoxane) were generated using R. Survival rose linearly with increasing cumulative anthracycline dose whereas cardiotoxicity demonstrated exponential increases both without (dose, >200mg/m) and with (dose, >400mg/m) dexrazoxane. Maximum cardiotoxicity-free survival was 268.2mg/m without and 431.8mg/m with dexrazoxane. Despite increasing cardiotoxicity-free dose by >150mg/m, dexrazoxane minimally improved projected survival (71.9% vs. 75.4%). Cardiotoxicity increased linearly as a function of follow-up time with rates doubling from 5 to 20 years, without evidence of plateau. On the basis of our model, current dosing regimens-doxorubicin doses >375mg/m without dexrazoxane-overvalue increased anthracycline administration and may contribute to devastating cardiotoxicity. The linear increase of cardiotoxicity without evidence of plateau confirms the necessity for lifelong cardiac monitoring.

    View details for DOI 10.1097/MPH.0000000000001118

    View details for PubMedID 29432315

  • MYC-family protein overexpression and prominent nucleolar formation represent prognostic indicators and potential therapeutic targets for aggressive high-MKI neuroblastomas: a report from the children's oncology group. Oncotarget Niemas-Teshiba, R., Matsuno, R., Wang, L. L., Tang, X. X., Chiu, B., Zeki, J., Coburn, J., Ornell, K., Naranjo, A., Van Ryn, C., London, W. B., Hogarty, M. D., Gastier-Foster, J. M., Look, A. T., Park, J. R., Maris, J. M., Cohn, S. L., Seeger, R. C., Asgharzadeh, S., Ikegaki, N., Shimada, H. 2018; 9 (5): 6416–32

    Abstract

    Neuroblastomas with a high mitosis-karyorrhexis index (High-MKI) are often associated with MYCN amplification, MYCN protein overexpression and adverse clinical outcome. However, the prognostic effect of MYC-family protein expression on these neuroblastomas is less understood, especially when MYCN is not amplified. To address this, MYCN and MYC protein expression in High-MKI cases (120 MYCN amplified and 121 non-MYCN amplified) was examined by immunohistochemistry. The majority (101) of MYCN-amplified High-MKI tumors were MYCN(+), leaving one MYC(+), 2 both(+), and 16 both(-)/(+/-), whereas non-MYCN-amplified cases appeared heterogeneous, including 7 MYCN(+), 36 MYC(+), 3 both(+), and 75 both(-)/(+/-) tumors. These MYC-family proteins(+), or MYC-family driven tumors, were most likely to have prominent nucleolar (PN) formation (indicative of augmented rRNA synthesis). High-MKI neuroblastoma patients showed a poor survival irrespective of MYCN amplification. However, patients with MYC-family driven High-MKI neuroblastomas had significantly lower survival than those with non-MYC-family driven tumors. MYCN(+), MYC-family protein(+), PN(+), and clinical stage independently predicted poor survival. Specific inhibition of hyperactive rRNA synthesis and protein translation was shown to be an effective way to suppress MYC/MYCN protein expression and neuroblastoma growth. Together, MYC-family protein overexpression and PN formation should be included in new neuroblastoma risk stratification and considered for potential therapeutic targets.

    View details for DOI 10.18632/oncotarget.23740

    View details for PubMedID 29464082

    View details for PubMedCentralID PMC5814222

  • Manipulation of variables in local controlled release vincristine treatment in neuroblastoma Coburn, J. M., Harris, J., Cunningham, R., Zeki, J., Kaplan, D. L., Chiu, B. W B SAUNDERS CO-ELSEVIER INC. 2017: 2061–65
  • Silencing Intersectin 1 Slows Orthotopic Neuroblastoma Growth in Mice JOURNAL OF PEDIATRIC HEMATOLOGY ONCOLOGY Harris, J., Herrero-Garcia, E., Russo, A., Kajdacsy-Balla, A., O'Bryan, J. P., Chiu, B. 2017; 39 (8): E413–E418

    Abstract

    Neuroblastoma accounts for 15% of all pediatric cancer deaths. Intersectin 1 (ITSN1), a scaffold protein involved in phosphoinositide 3-kinase (PI3K) signaling, regulates neuroblastoma cells independent of MYCN status. We hypothesize that by silencing ITSN1 in neuroblastoma cells, tumor growth will be decreased in an orthotopic mouse tumor model. SK-N-AS neuroblastoma cells transfected with empty vector (pSR), vectors expressing scrambled shRNA (pSCR), or shRNAs targeting ITSN1 (sh#1 and sh#2) were used to create orthotopic neuroblastoma tumors in mice. Volume was monitored weekly with ultrasound. End-point was tumor volume >1000 mm. Tumor cell lysates were analyzed with anti-ITSN1 antibody by Western blot. Orthotopic tumors were created in all cell lines. Twenty-five days post injection, pSR tumor size was 917.6±247.7 mm, pSCR was 1180±159.9 mm, sh#1 was 526.3±212.8 mm, and sh#2 was 589.2±74.91 mm. sh#1-tumors and sh#2-tumors were smaller than pSCR (P=0.02), no difference between sh#1 and sh#2. Survival was superior in sh#2-tumors (P=0.02), trended towards improved survival in sh#1-tumors (P=0.09), compared with pSCR-tumors, no difference in pSR tumors. Western blot showed decreased ITSN1 expression in sh#1 and sh#2 compared with pSR and pSCR. Silencing ITSN1 in neuroblastoma cells led to decreased tumor growth in an orthotopic mouse model. Orthotopic animal models can provide insight into the role of ITSN1 pathways in neuroblastoma tumorigenesis.

    View details for DOI 10.1097/MPH.0000000000000931

    View details for Web of Science ID 000418060200002

    View details for PubMedID 28787396

    View details for PubMedCentralID PMC5656511

  • A Rare Case of Thoracoschisis. Journal of neonatal surgery Harris, J., Zhang, Y., Patel, S., Dille, B., Garzon, S., Lee, J. H., Chiu, B. 2017; 6 (3): 65

    Abstract

    A term male baby, after delivery, was found to have a 3-centimeter beefy-red mass protruding from the left chest wall, adjacent to the left nipple. Radiological imaging suggested it's origin from the left lateral liver segment. A diagnostic laparoscopy confirmed the isolated connection to the liver, elevated left hemidiaphragm, and protrusion between the ribs. The mass was excised using electrocautery, and pathologic examination showed normal liver tissue.

    View details for DOI 10.21699/jns.v6i3.581

    View details for PubMedID 28920025

  • Implantable chemotherapy-loaded silk protein materials for neuroblastoma treatment INTERNATIONAL JOURNAL OF CANCER Coburn, J., Harris, J., Zakharov, A. D., Poirier, J., Ikegaki, N., Kajdacsy-Balla, A., Pilichowska, M., Lyubimov, A. V., Shimada, H., Kaplan, D. L., Chiu, B. 2017; 140 (3): 726–35

    Abstract

    Neuroblastoma is the most common extracranial childhood solid tumor. Treatment of high risk tumors require intense multicycle chemotherapies, resulting in short- and long-term toxicities. Here, we present treatment of an orthotopic neuroblastoma mouse model, with silk fibroin materials loaded with vincristine, doxorubicin or the combination as a intratumoral, sustained release system. The materials, loaded with vincristine with or without doxorubicin, significantly decreased neuroblastoma tumor growth compared to materials loaded without drug or doxorubicin only as well as intravenous (IV) drug treatment. The intratumoral drug concentration was significantly higher with intratumoral delivery versus IV. Furthermore, intratumor delivery decreased the maximum plasma concentration compared to IV delivery, reducing systemic exposure and possibly reduing long-term side effects of chemotherapy exposure. Histopathologically, tumors with remission periods >25 days before recurrence transformed from a "small-round-blue cell" (SBRC) to predominantly "large cell" neuroblastoma (LCN) histopathology, a more aggressive tumor subtype with unfavorable clinical outcomes. These results show that intratumoral chemotherapy delivery may be a treatment strategy for pediatric neuroblastoma, potentially translatable to other focal tumors types. Furthermore, this treatment modality allows for a clinically relevant mouse model of tumor transformation that may be used for studying the phenotypical tumor recurrence and developing more effective treatment strategies for recurrent tumors.

    View details for DOI 10.1002/ijc.30479

    View details for Web of Science ID 000390702500025

    View details for PubMedID 27770551

  • Clinical Considerations of Focal Drug Delivery in Cancer Treatment CURRENT DRUG DELIVERY Harris, J., Klonoski, S. C., Chiu, B. 2017; 14 (5): 588–96

    Abstract

    According to the US Center for Disease Control, cancer deaths are the second most common cause of mortality in both adults and children. Definitive treatment of solid tumors involves surgical resection with or without systemic chemotherapy and radiation. The advent of local drug delivery presents a unique treatment modality that can offer substantial benefits in cancer management. Three main phases in solid tumor management exist for the treating physician: initial diagnosis with tissue biopsy, surgical resection with or without chemotherapy, and management of metastatic disease.A literature review of both basic science as well as clinical trials using local drug delivery strategies in the management of solid tumors was done on PubMed. These were then further divided into the categories of initial tissue biopsy intervention, surgical resection, and management of metastatic disease.A total of 27 articles were review that included both pre-clinical as well as clinical investigation of local drug delivery therapies in the treatment of solid tumors. Treatments such as MRI guided therapies, FDA approved local therapies for intracranial gliomas as well as local therapy for single site metastatic disease were identified.This review focuses the current state of local drug delivery in the treatment of solid tumors in both the pre-clinical as well as clinical investigation settings. Local drug delivery therapy offers an exciting new treatment modality for solid malignancies.

    View details for DOI 10.2174/1567201814666170224143706

    View details for Web of Science ID 000407013600001

    View details for PubMedID 28240175

  • Sustained delivery of vincristine inside an orthotopic mouse sarcoma model decreases tumor growth Harris, J. C., Coburn, J. M., Kajdacsy-Balla, A., Kaplan, D. L., Chiu, B. W B SAUNDERS CO-ELSEVIER INC. 2016: 2058–62

    Abstract

    Sarcoma accounts for 20% of solid tumors in children. Surgery has significant morbidity. We hypothesized that delivering chemotherapy directly into tumors through sustained release silk systems could slow tumor growth.Human Ewing sarcoma cells A673 were cultured with vincristine and doxorubicin to determine half maximal inhibitory concentration (IC50). Cells were injected into mouse hind leg to create orthotopic tumors. Tumor volumes were measured using ultrasound. When volume reached >250mm3, interventions included: implantation of drug-free silk foam (Control-F), doxorubicin 400μg foam (Dox400-F), vincristine 50μg foam (Vin50-F), drug-free silk gel (Control-G), vincristine 50μg gel (Vin50-G), or single dose intravenous vincristine 50μg (Vin50-IV). End-point was volume>1000mm3. Kaplan Meier and ANOVA were used.IC50 for vincristine and doxorubicin was 0.5ng/mL and 200ng/mL, respectively. There was no difference between Dox400-F [6±1days to end point (DTEP)] and Control-F (5±1.3 DTEP). Vin50-F (12.4±3.5 DTEP) had slower growth compared to Control-F (p<0.001), and there was no difference between Vin50-F and Vin50-IV (14±0 DTEP). Growth was slowest with Vin50-G, 28±10.3 DTEP compared to all other treatment groups (p<0.05).Sustained delivery of vincristine inside the sarcoma tumor with silk gel decreased tumor growth. Applying this intratumoral treatment strategy may potentially decrease the extent of surgical excision.

    View details for DOI 10.1016/j.jpedsurg.2016.09.040

    View details for Web of Science ID 000392651100034

    View details for PubMedID 27680598

    View details for PubMedCentralID PMC5138133

  • Irreversible Electroporation as an Effective Technique for Ablating Human Metastatic Osteosarcoma JOURNAL OF PEDIATRIC HEMATOLOGY ONCOLOGY Harris, J. C., Chen, A., Macias, V., Mahon, B., Chiu, B., Pillai, S. 2016; 38 (3): 182–86

    Abstract

    Irreversible electroporation (IRE) induces apoptosis in tumor cells with electric energy, allowing treatment of unresectable tumors. One potential application is metastatic osteosarcoma (OS) in the pediatric population. A 12-year-old underwent thoracotomy with resection of metastatic OS. IRE was applied to 1 resected tumor section. Using 2 probes, 100 pulses with width of 90 ms were delivered. Efficacy was measured by increase in current draw during treatment. The treated sample was analyzed with hematoxylin and eosin and transmission electron microscopy. Default voltage of 1800 kV was ineffective. Voltage of 2700 kV caused excessive current draw and was aborted to prevent thermal injury. At 2200 kV, current draw rise was 9 amps, signifying successful treatment. Untreated specimen showed viable OS, normal surrounding lung tissue. Treated tumor had edema within the tumor and in surrounding lung tissue, with intra-alveolar hemorrhage and cellular architecture destruction. There was also evidence for cellular destruction such as disruption of lipid bilayer and release of intracellular fluid. Optimal voltage for treatment was 2200 kV, likely higher due to electrical conduction variation in the aerated lung. IRE may be an option for pediatric patients with unresectable metastatic OS.

    View details for DOI 10.1097/MPH.0000000000000516

    View details for Web of Science ID 000374777900017

    View details for PubMedID 26950088

  • Duodenal Atresia and Neonatal Cholestasis in R117H Cystic Fibrosis JOURNAL OF CLINICAL NEONATOLOGY Harris, J., Sheppard, S., Chiu, B., Shah, A. 2016; 5 (2): 112–14
  • Creation of a murine orthotopic hepatoma model with intra-abdominal metastasis. Gastroenterology and hepatology from bed to bench Harris, J., Kajdacsy-Balla, A., Chiu, B. 2016; 9 (3): 174–79

    Abstract

    AIM: To create an orthotopic hepatoma model with local metastasis monitored with ultrasound could be created as a platform for testing new treatments.BACKGROUND: Hepatoma accounts for 25% of liver tumors in children with poor overall survival. Intraabdominal metastasis are present in 35% of patients at time of diagnosis. We hypothesized that an orthotopic tumor model with local metastasis could be created as a platform for testing treatment modalities and could be monitored with ultrasound.PATIENTS AND METHODS: One million human hepatoma cells (Hep3B) were injected into the left lobe of the liver of immunocompromised mice. Tumor volume was monitored with high frequency-ultrasound until it reached 1,000mm(3). At that time animals were sacrificed and examined for gross metastatic disease. Tumor sections were analyzed with hematoxylin and eosin (H&E) staining.RESULTS: Tumor formed in 8/15 mice. The tumor was detected as small as 19.59mm(3) on ultrasound. Of the forming tumors, tumor size was 145±177.93mm(3) at 60 days post-injection, 665±650.39mm(3) at 67 days, and reached >1000mm(3) by 76.6±9.9 days. At necropsy, four mice (50%) had tumor only within the liver, four (50%) had additional tumors in omentum, pelvis and peritoneum. H&E showed tumor within the normal liver parenchyma, with multiple mitotic figures, small areas of necrosis, and hemorrhage within the tumor.CONCLUSION: We have successfully established an orthotopic hepatoma murine model, with a local metastatic rate of 50%. Non-invasive tumor monitoring is feasible via ultrasound.

    View details for PubMedID 27458509

  • Early Closure of Gastroschisis After Silo Placement Correlates with Earlier Enteral Feeding. Journal of neonatal surgery Harris, J., Poirier, J., Selip, D., Pillai, S., N Shah, A., Jackson, C., Chiu, B. 2015; 4 (3): 28

    Abstract

    OBJECTIVES: Gastroschisis is a congenital anomaly affecting 2.3-4.4/10,000 births. Previous studies show initiation of early enteral feeds predicts improved outcomes. We hypothesize that earlier definitive closure after silo placement; can lead to earlier enteral feed initiation. Design/ Setting/ Duration: Retrospective review of patients with gastroschisis from 2005 and 2014 at a single institution.MATERIAL AND METHODS: The data, including ethnicity, gestational age, birth weight, time to definitive closure, and time of first and full feeds, were analyzed using both Spearman's rho and the Kruskal-Wallis rank sum test where appropriate; a p value less than 0.05 was considered significant.RESULTS: Forty-three patients (24 males, 19 females) born with gastroschisis were identified. Overall survival rate was 88% (38/43). Forty of the 43 patients had a silo placed prior to definitive closure. Median days to closure were 6 (0 to 85) days. First feeds on average began on day of life (DOL) 17, and full feeds on DOL 25. Earlier closure of gastroschisis correlated with early initiation of feeds (p=0.0001) and shorter time to full feeds (p=0.018), closure by DOL4 showed a trend toward earlier feeding (p=0.13).CONCLUSION: Earlier closure of gastroschisis after silo placement was associated with earlier feed initiation and shorter time to full feeds.

    View details for PubMedID 26290810

  • Focal therapy of neuroblastoma using silk films to deliver kinase and chemotherapeutic agents in vivo ACTA BIOMATERIALIA Seib, F., Coburn, J., Konrad, I., Klebanov, N., Jones, G. T., Blackwood, B., Charest, A., Kaplan, D. L., Chiu, B. 2015; 20: 32–38

    Abstract

    Current methods for treatment of high-risk neuroblastoma patients include surgical intervention, in addition to systemic chemotherapy. However, only limited therapeutic tools are available to pediatric surgeons involved in neuroblastoma care, so the development of intraoperative treatment modalities is highly desirable. This study presents a silk film library generated for focal therapy of neuroblastoma; these films were loaded with either the chemotherapeutic agent doxorubicin or the targeted drug crizotinib. Drug release kinetics from the silk films were fine-tuned by changing the amount and physical crosslinking of silk; doxorubicin loaded films were further refined by applying a gold nanocoating. Doxorubicin-loaded, physically crosslinked silk films showed the best in vitro activity and superior in vivo activity in orthotopic neuroblastoma studies when compared to the doxorubicin-equivalent dose administered intravenously. Silk films were also suitable for delivery of the targeted drug crizotinib, as crizotinib-loaded silk films showed an extended release profile and an improved response both in vitro and in vivo when compared to freely diffusible crizotinib. These findings, when combined with prior in vivo data on silk, support a viable future for silk-based anticancer drug delivery systems.

    View details for DOI 10.1016/j.actbio.2015.04.003

    View details for Web of Science ID 000355708200004

    View details for PubMedID 25861948

    View details for PubMedCentralID PMC4428956

  • Surgery combined with controlled-release doxorubicin silk films as a treatment strategy in an orthotopic neuroblastoma mouse model BRITISH JOURNAL OF CANCER Chiu, B., Coburn, J., Pilichowska, M., Holcroft, C., Seib, F. P., Charest, A., Kaplan, D. L. 2014; 111 (4): 708–15

    Abstract

    Neuroblastoma tumour resection goal is maximal tumour removal. We hypothesise that combining surgery with sustained, local doxorubicin application can control tumour growth.We injected human neuroblastoma cells into immunocompromised mouse adrenal gland. When KELLY cell-induced tumour volume was >300 mm(3), 80-90% of tumour was resected and treated as follows: instantaneous-release silk film with 100 μg doxorubicin (100IR), controlled-release film with 200 μg (200CR) over residual tumour bed; and 100 and 200 μg intravenous doxorubicin (100IV and 200IV). Tumour volume was measured and histology analysed.Orthotopic tumours formed with KELLY, SK-N-AS, IMR-32, SH-SY5Y cells. Tumours reached 1800±180 mm(3) after 28 days, 2200±290 mm(3) after 35 days, 1280±260 mm(3) after 63 days, and 1700±360 mm(3) after 84 days, respectively. At 3 days post KELLY tumour resection, tumour volumes were similar across all groups (P=0.6210). Tumour growth rate was similar in untreated vs control film, 100IV vs 100IR, and 100IV vs 200IV. There was significant difference in 100IR vs 200CR (P=0.0004) and 200IV vs 200CR (P=0.0003). Tumour growth with all doxorubicin groups was slower than that of control (P: <0.0001-0.0069). At the interface of the 200CR film and tumour, there was cellular necrosis, surrounded by apoptotic cells before reaching viable tumour cells.Combining surgical resection and sustained local doxorubicin treatment is effective in tumour control. Administering doxorubicin in a local, controlled manner is superior to giving an equivalent intravenous dose in tumour control.

    View details for DOI 10.1038/bjc.2014.324

    View details for Web of Science ID 000341024100011

    View details for PubMedID 24921912

    View details for PubMedCentralID PMC4134491

  • Management of patients with combined tracheoesophageal fistula, esophageal atresia, and duodenal atresia. International journal of surgery case reports Nabzdyk, C. S., Chiu, B., Jackson, C., Chwals, W. J. 2014; 5 (12): 1288–91

    Abstract

    INTRODUCTION: Patients with combined esophageal atresia (EA), tracheoesophageal fistula (TEF), and duodenal atresia (DA) pose a rare management challenge.PRESENTATION OF CASE: Three patients with combined esophageal atresia (EA), tracheoesophageal fistula (TEF), and duodenal atresia safely underwent a staged approach inserting a gastrostomy tube and repairing the EA/TEF first followed by a duodenoduodenostomy within one week. None of the patients suffered significant pre- or post-operative complications and our follow-up data (between 12 and 24 months) suggest that all patients eventually outgrow their reflux and respiratory symptoms.DISCUSSION: While some authors support repair of all defects in one surgery, we recommend a staged approach. A gastrostomy tube is placed first for gastric decompression before TEF ligation and EA repair can be safely undertaken. The repair of the DA can then be performed within 3-7 days under controlled circumstances.CONCLUSION: A staged approach of inserting a gastrostomy tube and repairing the EA/TEF first followed by a duodenoduodenostomy within one week resulted in excellent outcomes.

    View details for DOI 10.1016/j.ijscr.2013.09.016

    View details for PubMedID 25460495

  • Congenital Lung Lesions FUNDAMENTALS OF PEDIATRIC SURGERY Chiu, B., Flake, A. W., Mattei, P. 2011: 293–97
  • How does the operative strategy for primary hyperparathyroidism impact the findings and cure rate? A comparison of 800 parathyroidectomies JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS McGill, J., Sturgeon, C., Kaplan, S. P., Chiu, B., Kaplan, E. L., Angelos, P. 2008; 207 (2): 246–49

    Abstract

    We hypothesized that a higher frequency of multigland disease and higher cure rate would result if routine four-gland exploration (4GL) was used as compared with focused parathyroidectomy (FP) for treatment of primary hyperparathyroidism.During a 5-year period, data from two academic endocrine surgical practices were retrospectively reviewed for patients having an operation for primary hyperparathyroidism. Three hundred ninety-five consecutive patients underwent 4GL at one institution (A), and 405 consecutive patients underwent FP with selective use of 4GL at the other institution (B). The main outcomes measures were gender, preoperative imaging, surgical findings, gland weight, and operative success.Three hundred ten (78%) patients at institution A were women, and 292 (72%) at institution B were women (p < 0.05). Routine 4GL strategy at institution A yielded a 16.5% frequency of multigland disease; and an FP strategy at institution B yielded 11.1% multigland disease (p = 0.028). At both institutions, single adenomas weighed more than multigland disease. Gland weights were not significantly different between the two institutions. Nine of 395 (2.3%) patients at institution A remained hypercalcemic postoperatively compared with 15 of 405 (3.7%) at B (p = 0.24; not significant).A greater frequency of multigland disease was found with routine 4GL. There was no statistically significant difference in operative success between the two approaches. Sound surgical technique and intraoperative judgment, including interpretation of intraoperative parathyroid hormone values, will result in a high success rate, regardless of the operative strategy chosen for primary hyperparathyroidism.

    View details for DOI 10.1016/j.jamcollsurg.2008.01.066

    View details for Web of Science ID 000258517600014

    View details for PubMedID 18656054

  • Human extrahepatic portal vein obstruction correlates with decreased factor VII and protein c transcription but increased hepatocyte proliferation JOURNAL OF PEDIATRIC SURGERY Chiu, B., Melin-Aldana, H., Superina, R. A. 2007; 42 (10): 1768–71

    Abstract

    A 3-year-old girl developed extrahepatic portal vein obstruction (EHPVO) after a liver transplant. She had sequelae of portal hypertension that required another transplantation. The circumstances allowed for comparison of liver-dependent coagulation factor production between the second donor liver and the explanted liver with EHPVO.Liver samples from the explanted first graft and the second transplant were obtained. Fresh tissue was used to perform reverse transcription-polymerase chain reaction with primers against factors V, VII, as well as VIII, protein C, and paraffin-embedded sections for hepatocyte proliferation using Ki-67 antibody as well as for apoptosis using TUNEL assay.The transcription of factor VII and that of protein C were decreased in the explant as compared with the newly transplanted liver (factor VII, 77% of the donor; protein C, 88% of the donor). The transcription of factor V and that of factor VIII were unchanged. The explant had a greater percentage of proliferating hepatocytes than the new organ (0.85% +/- 0.75% vs 0.11% +/- 0.21%). The percentage of apoptotic cells was similar between the 2 livers (0.09% +/- 0.13% vs 0.09% +/- 0.13%).Idiopathic EHPVO is associated with a reduction in liver-dependent coagulation factor transcription and an increase in hepatocyte proliferation. Portal blood flow deprivation alters hepatic homeostasis and initiates mechanisms that attempt to restore liver-dependent coagulation factors.

    View details for DOI 10.1016/j.jpedsurg.2007.06.016

    View details for Web of Science ID 000250558300025

    View details for PubMedID 17923213

  • Factor VII transcription correlates with hepatocyte proliferation and hepatocyte growth factor expression in a rodent extrahepatic portal vein obstruction model Chiu, B., Melin-Aldana, H., Pillai, S., Chu, F., Superina, R. A. ELSEVIER SCIENCE INC. 2007: 277–83

    Abstract

    Extrahepatic portal vein obstruction (EHPVO) is clinically associated with decreased liver-dependent coagulation factors and smaller than normal liver volumes. We developed a rodent EHPVO model to describe changes in coagulation factor regulation and liver homeostasis.Fifteen rats underwent controlled narrowing of the portal vein (PV) at the hilum, and 15 underwent sham operations. Three animals from each group were sacrificed at postoperative days (PODs) 1, 2, 4, 7, and 21. Their livers were studied for apoptosis, proliferation, and hepatocyte growth factor (HGF) expression using terminal transferase dUTP nick end labeling (TUNEL) assays, Ki-67, and hepatocyte growth factor antibody. Liver total RNA was harvested for reverse transcriptase-polymerase chain reaction (RT-PCR), using primers for factors V, VII, VIII, X, protein C, and antithrombin. Appropriate statistical analysis was applied.Ligation of the portal vein in the experimental group resulted in a 59+/-17% (mean +/- standard deviation) decrease in distal portal vein diameter. Proportional body weight was equivalent in both groups, but spleen weight was higher in the experimental group at PODs 4, 7, 21, and liver weight was higher at POD 7 (p < 0.05). The percentage of apoptotic cells in the experimental group increased from that of the control group at POD 4 (p < 0.05). The percentages of proliferating cells, HGF expression, and factor VII transcription in the experimental group were lower than those of controls at POD 2 (p < 0.05) but higher at POD 7 (p < 0.05). Ki-67/TUNEL double staining showed no grouping of apoptotic and proliferating cells. Factor V transcription in the experimental group was increased compared with that in controls at POD 2 (p < 0.05). Transcription of factors VIII, X, protein C, and antithrombin was unchanged.Our model demonstrated an early increase in hepatocyte apoptosis, impairment of factor VII transcription, and decrease in proliferative indices. These data support the hypothesis that EHPVO disrupts hepatic homeostasis and leads to dysregulation of coagulation factor synthesis.

    View details for DOI 10.1016/j.jamcollsurg.2007.04.005

    View details for Web of Science ID 000248645100009

    View details for PubMedID 17660074

  • Novel action of epidermal growth factor on caspase 3 and its potential as a chemotherapeutic adjunct for neuroblastoma JOURNAL OF PEDIATRIC SURGERY Chiu, B., Mirkin, B., Madonna, M. 2007; 42 (8): 1389–95

    Abstract

    We previously reported that epidermal growth factor (EGF) induced cleaved caspase 3 expression and apoptosis in human neuroblastoma cells. We hypothesized that EGF upregulates total caspase 3 expression, thereby enhancing the cytotoxic potency of chemotherapeutic agents.Wild-type (WT) and doxorubicin-resistant (Dox-R) SK-N-SH neuroblastoma cells were incubated with EGF 0 to 250 ng/mL for 24 hours or with 5 ng/mL for 0 to 5 days, and total caspase 3 expression and transcription were determined by immunoblots and reverse transcription and polymerase chain reaction, respectively. Cell proliferation was determined after EGF (5 ng/mL) incubation for 1 to 5 days. Cells incubated with EGF (5 ng/mL) for 24 hours before doxorubicin treatment were used to determine the effect of EGF on cell replication and cleaved caspase 3 expression.Wild-type and Dox-R cells had maximal total caspase 3 expression after incubation with EGF (5 ng/mL) for 3 and 5 days, respectively, and a corresponding increase in DNA transcription. Treating the cells with or without EGF (5 ng/mL) resulted in similar replication rate. However, cell death was increased by EGF pretreatment and doxorubicin when compared with that by doxorubicin alone (WT, 53% +/- 8%; Dox-R, 44% +/- 9%; P < .05). Cleaved caspase 3 expression was upregulated when cell death was increased.Epidermal growth factor upregulates the expression and transcription of total caspase 3 in WT and Dox-R cells in a concentration- and time-dependent manner. Epidermal growth factor pretreatment augments the cytotoxic effect of doxorubicin.

    View details for DOI 10.1016/j.jpedsurg.2007.03.047

    View details for Web of Science ID 000249718300015

    View details for PubMedID 17706502

  • Experience with alternate sources of venous inflow in the meso-Rex bypass operation: the coronary and spienic veins JOURNAL OF PEDIATRIC SURGERY Chiu, B., Pittai, S. B., Sandier, A. D., Superina, R. A. 2007; 42 (7): 1199–1202

    Abstract

    The meso-Rex bypass procedure has been used to treat patients with portal hypertension from extrahepatic portal vein obstruction. This report describes modifications of this procedure in 5 patients. Either the splenic or coronary vein was used as the venous inflow point, and the bypass was performed either directly through transposition of the vein or with the use of a venous conduit.

    View details for DOI 10.1016/j.jpedsurg.2007.02.033

    View details for Web of Science ID 000248692800007

    View details for PubMedID 17618880

  • Extrahepatic portal vein obstruction results in hepatocyte proliferation but a decrease in protein-C synthesis JOURNAL OF PEDIATRIC SURGERY Chiu, B., Melin-Aldana, H., Pillai, S., Hernandez, J. M., Superina, R. A. 2007; 42 (5): 796–99

    Abstract

    Extrahepatic portal vein obstruction (EHPVO) results in decreased levels of liver-dependent coagulation factors in children. We developed a rat model to test the hypothesis that lower factor levels associated with EHPVO were from diminished synthesis rather than increased consumption.A total of 8 rats (experimental group) underwent narrowing of portal vein (PV) and 8 underwent sham operations. Liver and spleen mass, serum alanine aminotransferase, bilirubin, ammonia, prothrombin time, factor VII, and protein-C were measured before and 3 months after PV narrowing. Hepatocyte proliferation and apoptosis were quantified using Ki-67 and TUNEL assays.Portal vein diameter was 71% +/- 13% narrower in experimental animals. Liver mass was unchanged, but proportional spleen mass was higher in the experimental group at 3 months (0.31% +/- 0.05% vs 0.26% +/- 0.04%; P < .05). Percent apoptotic cells at 3 months was similar in both groups (0.14% +/- 0.08% vs 0.13% +/- 0.07%), but percent proliferating cells was higher in the experimental group (0.63% +/- 0.17% vs 0.34% +/- 0.11%; P < .05). Three-month protein-C levels decreased significantly only in the experimental group compared with preoperative values (12.8% +/- 4.4% vs 7.6% +/- 5.1%; P < .05). Changes in other parameters were not significant.Our EHPVO model consistently produced PV narrowing. The increase in hepatocyte proliferation seen after EHPVO suggests a liver repair response that is insufficient to maintain normal protein-C synthesis and serum levels.

    View details for DOI 10.1016/j.jpedsurg.2006.12.063

    View details for Web of Science ID 000247010500010

    View details for PubMedID 17502186

  • Epidermal growth factor can induce apoptosis in neuroblastoma JOURNAL OF PEDIATRIC SURGERY Chiu, B., Mirkin, B., Madonna, M. 2007; 42 (3): 482–88

    Abstract

    In previous studies, incubation of doxorubicin-resistant neuroblastoma SK-N-SH (Dox-R) cells with epidermal growth factor (EGF) decreased extracellular signal-regulated kinase activation. Because extracellular signal-regulated kinase activation is associated with cell proliferation, we hypothesized that EGF could induce apoptosis and decrease the rate of cell growth in these cells.The growth of wild-type (WT) SK-N-SH and Dox-R cells after incubation with EGF concentrations ranging from 1 to 100 ng/mL was determined by a colorimetric assay. Apoptosis was assessed by Hoechst staining and DNA laddering in WT, Dox-R, and cisplatin-resistant cells treated with EGF (100 ng/mL). Cleaved caspase-3 and EGF receptor (human epidermal growth factor receptor [HER1-HER4]) expression were verified by Western blot and reverse transcriptase-polymerase chain reaction.Epidermal growth factor decreased WT cell growth at concentrations between 50 and 100 ng/mL; Dox-R cell growth was attenuated at all EGF concentrations. Apoptosis was observed in WT and Dox-R cells incubated with EGF. Maximal cleaved caspase-3 expression occurred in WT cells treated with EGF 100 ng/mL and in Dox-R treated with EGF 5 to 10 ng/mL. Epidermal growth factor did not induce apoptosis in cisplatin-resistant cells. HER2 and HER3 transcription was maximal in WT and Dox-R cells, respectively.Wild-type and Dox-R cells exhibited decreased cell growth after EGF treatment because of apoptosis. This involved caspase-3 activation and could work through HER2 and HER3 receptors.

    View details for DOI 10.1016/j.jpedsurg.2006.10.055

    View details for Web of Science ID 000245002900006

    View details for PubMedID 17336184

  • Mitogenic and apoptotic actions of epidermal growth factor on neuroblastoma cells are concentration-dependent Chiu, B., Mirkin, B., Madonna, M. ACADEMIC PRESS INC ELSEVIER SCIENCE. 2006: 209–12

    Abstract

    In previous studies we have shown that epidermal growth factor (EGF) at concentrations between 50 and 100 ng/mL induced apoptosis in wild-type SK-N-SH neuroblastoma cells. We hypothesize that this apoptotic event separates EGF-induced neuroblastoma cell growth into a biphasic concentration-dependent process, due to activation of different signaling cascades.Cells were incubated in concentrations of EGF ranging from 5 to 250 ng/mL for 3 days, and cell proliferation was determined by the MTT assay. Cells incubated with EGF 5, 100, or 250 ng/mL for 17 h were also assayed for apoptosis by DNA laddering. Western immunoblots were performed on whole cell lysates prepared from cells incubated with EGF (5-250 ng/mL) for 17 h. Antibodies against cleaved caspase3, p-AKT, p-GSK-3beta, p-BAD, p-RAF, p-ERK, and p-P38 were used as probes.A triphasic, concentration-dependent response was observed following incubation of cells with EGF. Cell proliferation was increased by EGF 5 ng/mL (P < 0.05), decreased by EGF 100 ng/mL, and increased when incubated with EGF 250 ng/mL (P < 0.05). DNA laddering only occurred after treatment with EGF 100 ng/mL. The expressions of p-ERK, p-RAF, p-BAD, and p-GSK-3beta were increased at EGF concentrations of 5-10 ng/mL. At 50-100 ng/mL EGF, the expression of cleaved caspase3 was increased. Maximal p-P38 expression was at 50 ng/mL EGF. At EGF concentrations of 150-250 ng/mL, the expressions of p-AKT and p-GSK-3beta were elevated.Neuroblastoma cell growth induced by EGF exhibited a triphasic pattern; cell growth was increased at EGF concentrations 5-20 and 150-250 ng/mL, but decreased at 50-100 mg/mL. Apoptosis was induced at 50-100 ng/mL EGF. Each growth phase activated different signaling molecules.

    View details for DOI 10.1016/j.jss.2006.04.018

    View details for Web of Science ID 000241273500001

    View details for PubMedID 16872636

  • What is the link between nonlocalizing sestamibi scans, multigland disease, and persistent hypercalcemia? A study of 401 consecutive patients undergoing parathyroidectomy SURGERY Chiu, B., Sturgeon, C., Angelos, P. 2006; 140 (3): 418–22

    Abstract

    We hypothesized that nonlocalizing sestamibi scans would correlate with multigland disease and persistent primary hyperparathyroidism.We reviewed records for 401 consecutive patients who underwent parathyroidectomy from 1999 to 2004. Gender, age, preoperative imaging, surgical findings, gland weight and volume, and 6-month calcium levels (Ca) were examined.We identified 289 women and 112 men, 297 of whom had a preoperative sestamibi scan localized to a single gland (localized group; LG). Ninety-six percent of the LG were found to have single-gland disease, and 4% had multigland disease (MGD). In the nonlocalized group (NLG), 76% had single-gland disease and 24% MGD. Mean gland weight was greater in the LG than in the NLG (1128 mg vs 699 mg; P < .05). Mean gland volume was larger in the LG (1.34 cc vs 0.89 cc; P < .05). A localizing sestamibi scan had a positive predictive value (PPV) of 96% and a likelihood ratio of 2.29 for predicting "curative" intraoperative parathyroid hormone drop after removal of a single abnormal gland. Patients were stratified into normocalcemic (NCa) and hypercalcemic (HCa) groups based on 6-month postoperative serum calcium data (n = 328). HCa incidence at 6 months did not differ significantly between the LG (5%) and NLG (3%). A localizing scan had a PPV of 95% for normocalcemia at 6 months. A nonlocalizing scan had a PPV of 21% for HCa at 6 months.Nonlocalizing sestamibi scans were more common in primary hyperparathyroidism with MGD and were associated with smaller-volume abnormal glands found at operation. Preoperative sestamibi scan-results did not predict HCa at 6 months.

    View details for DOI 10.1016/j.surg.2006.03.021

    View details for Web of Science ID 000240513900017

    View details for PubMedID 16934604

  • Injury in the first year of life: Risk factors and solutions for high-risk families Crandall, M., Chiu, B., Sheehan, K. ACADEMIC PRESS INC ELSEVIER SCIENCE. 2006: 7–10

    Abstract

    Injury is one of the leading causes of death for infants younger than 1 year of age. We investigated potential contributing factors for injury among children born to high-risk families.The Fragile Families and Child Wellbeing Study is a longitudinal cohort of approximately 5000 children from mostly unwed parents across the United States. Data from interviews with mothers conducted shortly after birth and follow-up surveys at 1 year were used for this analysis. Injuries sustained in the first year of life that required medical attention were studied. Multivariate regression analysis was used to identify independent risk factors for injury in this population.A total of 13.7% of mothers reported that their child had sustained an injury in the first year of life. We identified 17 potential maternal, paternal, and environmental risk factors for injury, including socioeconomic, mental health, relationship violence, criminal justice system involvement, and substance abuse challenges. Multivariate regression analyses revealed two significant independent risk factors, maternal alcohol use (odds ratio 2.15, P = 0.044) and mother spanking child in the previous month (odds ration 2.32, P = 0.027).Among this higher-risk group, injury in the first year of life is more than twice the national incidence. Predisposing factors to injury often are complex and interrelated, but with focused education and prevention efforts, including discussions of maternal alcohol use and attitudes toward physical discipline, we may decrease the burden of infant injury in this vulnerable population.

    View details for DOI 10.1016/j.jss.2006.02.027

    View details for Web of Science ID 000237749900002

    View details for PubMedID 16566944

  • Encephalopathy caused by a splenorenal shunt can be reversed by performing a mesenteric-to-left portal vein bypass JOURNAL OF PEDIATRIC SURGERY Chiu, B., Superina, R. A. 2006; 41 (6): 1177–79

    Abstract

    Surgically created portosystemic shunts can alleviate the symptoms of bleeding from gastric and esophageal varices and improve the hematologic consequences of hypersplenism in patients with portal hypertension. However, the diversion of mesenteric venous blood away from the liver can result in encephalopathy. In this report, we describe a case in which encephalopathy caused by a proximal splenorenal shunt was reversed by the restoration of portal flow to the liver by a mesenteric-to-left portal vein bypass operation.

    View details for DOI 10.1016/j.jpedsurg.2006.01.075

    View details for Web of Science ID 000238710900027

    View details for PubMedID 16769357

  • Which Intraoperative parathyroid hormone assay criterion best predicts operative success? A study of 352 consecutive patients Chiu, B., Sturgeon, C., Angelos, P. AMER MEDICAL ASSOC. 2006: 483–87

    Abstract

    The 6 published criteria for predicting curative parathyroid resection by means of intraoperative parathyroid hormone (IOPTH) assay are not equivalent.Retrospective review of 352 patients undergoing parathyroidectomy for primary hyperparathyroidism from January 1, 1999, to December 31, 2004. We evaluated 6-month postoperative IOPTH values and serum calcium levels.Tertiary referral center.The IOPTH values at baseline (preincision and preexcision) and at 5 and 10 minutes after parathyroidectomy were reviewed according to the Miami criterion (>50% drop from highest baseline IOPTH level at 10 minutes after excision), criterion 1 (>50% drop from preincision IOPTH level at 10 minutes), criterion 2 (>50% drop from highest baseline IOPTH level at 10 minutes and final IOPTH level within the reference range), criterion 3 (>50% drop from highest baseline IOPTH level at 10 minutes and final IOPTH level less than the preincision value), criterion 4 (>50% drop from highest baseline IOPTH level at 5 minutes), and criterion 5 (>50% drop from preexcision IOPTH level at 10 minutes).Criterion 2 had sensitivity of 88%, specificity of 22%, positive predictive value of 97%, and negative predictive value of 6%. Criterion 2 had good agreement with criteria 1 and 3. Of patients whose IOPTH level drop satisfied criterion 2 but not criterion 1, 14% had postoperative hypercalcemia at 6 months. When criterion 2 was not satisfied but criteria 1, 3, 4, and 5 and the Miami criterion were, failure rates were 0%, 4%, 7%, 6%, and 9%, respectively.Satisfying criterion 2 had a high operative success but resulted in additional unnecessary surgical exploration. Criterion 1 was better at predicting postoperative normocalcemia than criterion 2.

    View details for DOI 10.1001/archsurg.141.5.483

    View details for Web of Science ID 000237473900013

    View details for PubMedID 16702520

  • Longitudinal pancreaticojejunostomy and selective biliary diversion for chronic pancreatitis in children Chiu, B., Lopoo, J., Superina, R. A. W B SAUNDERS CO-ELSEVIER INC. 2006: 946–49

    Abstract

    Chronic pancreatitis requiring surgery is rare in children. We review our experience in treating pediatric chronic pancreatitis with longitudinal pancreaticojejunostomy (LPJ).Records of children with chronic pancreatitis treated with LPJ between 1997 and 2003 were reviewed. Demographic data, associated conditions, endoscopic interventions, operative procedures, postoperative complications, length and costs of hospitalization, and long-term outcome were recorded.Four patients (one girl), 3 to 16 years old, underwent LPJ. Associated conditions included bile duct obstruction (2), single (1) or multiple (1) pancreatic duct strictures, recurrent familial pancreatitis (1), pseudocyst (1), Down's syndrome (1), and duodenal web (1). Preoperative endoscopic stenting was performed in two patients. All were on restricted diets, one on parenteral nutrition. Pre-LPJ, each child had 3 to 6 admissions for pancreatitis with mean total cost of 39,000 dollars, excluding diet charges. At surgery, two patients required biliary diversion for persistent biliary obstruction in addition to LPJ. Postoperatively, no patient developed fistulas or anastomotic leaks. There were no deaths. The median length of hospitalization post-LPJ was 8 days with mean cost of US37,000 dollars. All patients resumed a normal diet post-LPJ. There were no recurrences of pancreatitis with follow-ups between 2 and 6 years.Longitudinal pancreaticojejunostomy is safe and cost-effective for treating pediatric chronic pancreatitis. It has minimal complications and frees patients from pancreatitis-related hospitalizations.

    View details for DOI 10.1016/j.jpedsurg.2006.01.015

    View details for Web of Science ID 000238390700016

    View details for PubMedID 16677890

  • Closing arguments for gastroschisis: management with silo reduction JOURNAL OF PERINATAL MEDICINE Chiu, B., Lopoo, J., Hoover, J. D., Almond, P. S., Arensman, R., Madonna, M. B. 2006; 34 (3): 243–45

    Abstract

    There are two approaches to close gastroschisis. Primary closure (PC) is reduction and fascial closure; silo closure (SC) places viscera in a preformed-silo and reduces the contents over time. We have shifted from PC to SC. This study compared the outcomes of these two techniques.Records of babies with gastroschisis from 1994-2004 were reviewed. Closure type, ventilator days, days to full-feeds, hospital days, complications, and mortality were recorded.Twenty-eight patients underwent PC; 20 patients had SC. Differences in ventilator days, days to full-feeds, and hospital days were not statistically significant. Nine PC patients developed closure-related complications vs. none in SC (P < 0.05). Eight PC vs. two SC patients had non-closure-related complications (P < 0.05). Four PC vs. zero SC patients developed necrotizing enterocolitis (P < 0.05). Five PC vs. one SC patients had ventral hernia (P < 0.05). No patient died.PC resulted in higher incidence of reclosure, non-closure-related complications, and necrotizing enterocolitis. Consequently, we recommend SC as the preferred treatment.

    View details for DOI 10.1515/JPM.2006.043

    View details for Web of Science ID 000236957200011

    View details for PubMedID 16602846

  • To drain or not to drain: a single institution experience with neonatal intestinal perforation JOURNAL OF PERINATAL MEDICINE Chiu, B., Pillai, S. B., Almond, R., Madonna, M., Reynolds, M., Luck, S. R., Arensman, R. M. 2006; 34 (4): 338–41

    Abstract

    The optimal surgical treatment for extremely-low-birth-weight (ELBW) neonates with pneumoperitoneum is controversial. This study aimed to identify clinical factors associated with two known causes of pneumoperitoneum-necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP), and assesses the treatment outcome with primary peritoneal drainage (PPD) vs. laparotomy.We reviewed and analyzed clinical characteristics and outcome from records of neonates with pneumoperitoneum treated at our institution from January 1999 to January 2003.Forty-six neonates (31 NEC, 15 SIP) were treated with either PPD (20 with NEC, 13 with SIP) or laparotomy (11 with NEC, 2 with SIP). In neonates who underwent PPD, those with NEC (vs. SIP) were less likely to have a patent ductus arteriosus, but were more likely to have been fed, have drains placed later in life, have a subsequent laparotomy, a longer total parental nutrition course, a higher 30-day mortality, and to take more days to begin enteral feeds.The etiology of pneumoperitoneum (NEC vs. SIP) in ELBW neonates can usually be determined preoperatively. Neonates with SIP should have a drain placed while those with NEC should undergo laparotomy.

    View details for DOI 10.1515/JPM.2006.065

    View details for Web of Science ID 000239497400015

    View details for PubMedID 16856827

  • Management of an epidermoid cyst of the intrahepatic ducts JOURNAL OF PEDIATRIC SURGERY Chiu, B., Melin-Aldana, H., Superina, R. A. 2005; 40 (12): e31–3

    Abstract

    Epidermoid cysts of the biliary tree have not previously been described. A baby boy presented with a prenatally diagnosed echolucent intrahepatic cyst. Postnatal radioisotope study of the liver demonstrated that the cyst communicated with the biliary tree. Follow-up ultrasound at 6 months demonstrated that the cyst was filled with echogenic material consistent with either blood or biliary debris. Due to the potential for obstruction and cholangitis, surgery was planned. The cyst was located at the confluence of the right and left hepatic ducts and involved all of the common hepatic duct. The entire cyst was resected except for the patch containing 3 duct orifices: the opening of both hepatic ducts as well as the orifice leading to the common bile duct. A Roux-en-Y cyst jejunostomy was created to allow drainage of both left and right hepatic ducts. The connection also provided access to the cyst remnant through the common duct for future endoscopic monitoring of potential malignant transformation.

    View details for DOI 10.1016/j.jpedsurg.2005.08.038

    View details for Web of Science ID 000235189900046

    View details for PubMedID 16338291

  • Intestinal obstruction from furniture cushion foam bezoar SURGERY Chin, B., Ciaccio, C., West, M. A. 2005; 138 (5): 956–58
  • Extrahepatic portal vein thrombosis is associated with an increased incidence of cholelithiasis JOURNAL OF PEDIATRIC SURGERY Chiu, B., Superina, R. 2004; 39 (7): 1059–61

    Abstract

    The effect of portal flow deprivation to the liver on bile composition and the biliary system remains undefined in children. This report catalogues the authors' experience with biliary tract problems in children with extrahepatic portal vein thrombosis (EHPVT).Twenty-nine children with symptomatic idiopathic EHPVT were evaluated for the Rex shunt procedure (mesenterico-left portal bypass) over a 4-year period. The authors retrospectively reviewed all operative reports and pre- and postoperative abdominal ultrasound findings with regard to associated congenital anomalies and abnormal biliary tract findings.Seven of the 29 patients with EHPVT (24%) had associated nonbiliary congenital abnormalities. Twenty-four of 29 (83%) patients had detectable biliary tract pathology by ultrasound examination. Biliary symptoms developed in 3 of the 9 (33%) patients with either stones or sludge (10.3% of all patients). Two patients were treated by cholecystectomy. There was no statistical correlation between biliary tract pathology and the age of presentation, symptoms of portal hypertension, gender, or underlying medical condition.The authors have noted a high incidence of biliary tract pathology in patients with EHPVT compared with the normal population and a 10% incidence of symptomatic biliary pathology in this series.

    View details for DOI 10.1016/j.jpedsurg.2004.03.051

    View details for Web of Science ID 000222802700012

    View details for PubMedID 15213899

  • Periodic alternating nystagmus provoked by an attack of Meniere's disease JOURNAL OF NEURO-OPHTHALMOLOGY Chiu, B., Hain, T. C. 2002; 22 (2): 107–9

    Abstract

    Periodic alternating nystagmus is a rare central nervous system disorder in which the eyes undergo a horizontal jerk nystagmus that periodically reverses direction. A patient with a hypoplastic cerebellum and enlarged cisterna magna exhibited transient periodic alternating nystagmus following an attack of Ménière's disease. We hypothesize that in susceptible individuals with cerebellar disturbances, periodic alternating nystagmus may be transiently induced by vestibular stimuli.

    View details for DOI 10.1097/01.WNO.0000019664.18442.76

    View details for Web of Science ID 000176959900009

    View details for PubMedID 12131470

  • Murine aortic aneurysm produced by periarterial application of calcium chloride JOURNAL OF SURGICAL RESEARCH Chiou, A. C., Chiu, B., Pearce, W. H. 2001; 99 (2): 371–76

    Abstract

    A murine abdominal aortic aneurysm model was developed by applying calcium chloride periarterially. A 13.6 mEq/10 ml calcium chloride solution was applied to the abdominal aorta of nine mice. Three mice were randomly selected at the end of the first, second, and third weeks postoperatively, and their vessel diameters were measured. The vessel diameter at the end of the first week postoperatively was 0.39 +/- 0.03 mm (mean +/- SD) pretreatment and 0.41 +/- 0.03 mm posttreatment (5.3% increase, P > 0.05). The vessel diameter at the end of the second week postoperatively was 0.48 +/- 0.03 mm pretreatment and 0.78 +/- 0.20 mm posttreatment (64% increase, P < 0.05). The vessel diameter at the end of the third week postoperatively was 0.57 +/- 0.14 mm pretreatment and 1.16 +/- 0.43 mm posttreatment (110% increase, P < 0.05). Nine other murine abdominal aortas were treated with sodium chloride, and their vessel diameters were measured in similar 7-day intervals. No measurements in this group were statistically significant when comparing pretreatment to posttreatment vessel diameters. A larger number of inflammatory infiltrates was observed in the intima and media layers of calcium-chloride-treated mice. Underlying mechanisms for this model include disrupting the elastic network within the media by calcium precipitations and activating the inflammatory response. We conclude that periarterial application of calcium chloride is a convenient and reliable model for creating abdominal aortic aneurysms in mice.

    View details for DOI 10.1006/jsre.2001.6207

    View details for Web of Science ID 000170299200032

    View details for PubMedID 11469913

  • Transplanting a kidney with a renal artery aneurysm--a case report and literature review. Vascular surgery Chiu, B., Chiou, A. C., Leventhal, J. R., Stuart, F. P., Pearce, W. H. 2001; 35 (4): 321-324

    Abstract

    As a rare postoperative complication, renal artery aneurysm has been reported in 0.95% of kidney transplants. A renal artery aneurysm was repaired prior to transplantation of the kidney.

    View details for PubMedID 11586459

  • Transrectal ultrasound assessment of murine aorta and iliac arteries JOURNAL OF SURGICAL RESEARCH Chiou, A. C., Chiu, B., Oppat, W. F., Matsumura, J. S., Chisholm, R. L., Pearce, W. H. 2000; 88 (2): 193–99

    Abstract

    Recent research in arterial aneurysm formation has focused on animal model development. Mice are an ideal experimental organism due to their short life cycle, prolific progeny, and extensively studied genome. Most experiments require the sacrifice of the mice to observe and assess any morphological changes. Noninvasive or minimally invasive imaging is limited due to the relatively small size of the structures. The development of such a technique, therefore, is especially useful for allowing repeated measurement without sacrificing the mice. We introduce a novel technique of imaging and measuring the aorta, the aorta/inferior vena cava complex, and the right and the left common iliac artery/vein complex by the use of an intravascular ultrasound catheter. The catheter is inserted through the anus and rectum and into the sigmoid and left colon, where the aorta can be observed to fluctuate at approximately 500 beats/min. The aortic bifurcation can also be observed. The diameters of the aorta and the inferior vena cava were measured first with the transrectal ultrasound technique and then with direct visualization upon laparotomy for 10 mice. This revealed a percentage error between 13.7 and 14.2% for this novel technique. Fifteen more sets of vessel measurements were also made with 8 male and 7 female mice. The results demonstrated a correlation between vessel size and body weight in male but not female mice and suggested an intersex difference in vessel growth rate. We conclude that transrectal ultrasound is a useful tool in imaging and measuring the murine aorta and its bifurcation.

    View details for DOI 10.1006/jsre.1999.5790

    View details for Web of Science ID 000085065400020

    View details for PubMedID 10644488