Clinical Focus

  • Pediatric Surgery

Academic Appointments

Administrative Appointments

  • Division Chief, Lucile Packard Children's Hospital (2002 - 2012)
  • Program Director, Pediatric Surgery Fellowship, Stanford Hospitals and Clinics (2006 - Present)
  • Medical Director, Perioperative Services (2006 - Present)
  • John A. and Cynthia Fry Gunn Director of Surgical Services, Lucile Packard Children's Hospital (2002 - Present)
  • Vice President, Quality and Performance Improvement, Stanford Children's Health (2010 - Present)

Honors & Awards

  • Associate Editor, Pediatric Surgery and Innovative Techniques (2000)
  • Editor, Journal of Pediatric Surgery (2004)
  • Editor, Pediatric Surgery International (2004)
  • President, International Pediatric Endosurgery Group (2002-2003)
  • Editor, Pediatric Surgery International (2007)

Professional Education

  • Residency:Mount Sinai Medical Center (1991) NY
  • Board Certification: Pediatric Surgery, American Board of Surgery (1996)
  • Fellowship:Children's Hospital of Pittsburgh (1994) PA
  • Internship:Mount Sinai Medical Center (1987) NY
  • Medical Education:State University of New York (1986) NY
  • MBA, Santa Clara University, Business Administration (2008)
  • ped surgery, Children's Hospital Pittsburgh, Pediatric Surgery (1994)
  • MD, SUNY-Health Science Center, Medicine (1986)
  • BS, Washington & Lee University, Natural Sciences and Mathematics (1982)


2016-17 Courses


All Publications

  • Outcomes of sutureless gastroschisis closure JOURNAL OF PEDIATRIC SURGERY Riboh, J., Abrajano, C. T., Garber, K., Hartman, G., Butter, M. A., Albanese, C. T., Sylvester, K. G., Dutta, S. 2009; 44 (10): 1947-1951


    A new technique of gastroschisis closure in which the defect is covered with sterile dressings and allowed to granulate without suture repair was first described in 2004. Little is known about the outcomes of this technique. This study evaluated short-term outcomes from the largest series of sutureless gastroschisis closures.A retrospective case control study of 26 patients undergoing sutureless closure between 2006 and 2008 was compared to a historical control group of 20 patients with suture closure of the abdominal fascia between 2004 and 2006. Four major outcomes were assessed: (1) time spent on ventilator, (2) time to initiating enteral feeds, (3) time to discharge from the neonatal intensive care unit, and (4) rate of complications.In multivariate analysis, sutureless closure of gastroschisis defects independently reduced the time to extubation as compared to traditional closure (5.0 vs 12.1 days, P = .025). There was no difference in time to full enteral feeds (16.8 vs 21.4 days, P = .15) or time to discharge (34.8 vs 49.7 days, P = .22) with sutureless closure. The need for silo reduction independently increased the time to extubation (odds ratio, 4.2; P = .002) and time to enteral feeds (odds ratio, 5.2; P < .001). Small umbilical hernias were seen in all patients.Sutureless closure of uncomplicated gastroschisis is a safe technique that reduces length of intubation and does not significantly alter the time required to reach full enteral feeds or hospital discharge.

    View details for DOI 10.1016/j.jpedsurg.2009.03.027

    View details for Web of Science ID 000271331700014

    View details for PubMedID 19853753

  • "Stealth surgery": transaxillary subcutaneous endoscopic excision of benign neck lesions JOURNAL OF PEDIATRIC SURGERY Dutta, S., Slater, B., Butter, M., Albanese, C. T. 2008; 43 (11): 2070-2074


    Benign neck lesions are traditionally removed through an overlying incision. The resultant scar can be aesthetically displeasing. We previously reported our experience with a transaxillary subcutaneous endoscopic approach for management of torticollis. We now report a similar technique for removal of benign lesions of the neck.The study uses a retrospective review of 5 elective transaxillary endoscopic procedures from March to December 2006. The lesions included an enlarged cervical lymph node, thyroglossal duct cyst, dermoid cyst, ectopic dilated neck vein, and a parathyroid adenoma. Outcome measures included need for conversion, cosmetic outcome, and complications.All procedures were successfully completed using the endoscopic approach. Postoperative pain was controlled with acetaminophen, and all patients were discharged from the hospital the same day. There were no intraoperative complications. The patient who had a thyroglossal cyst removed developed a postoperative seroma that resolved spontaneously. All families were pleased with the cosmetic results.A transaxillary subcutaneous endoscopic approach can be applied effectively to a variety of benign lesions of the neck, allowing adequate exposure for dissection, and resulting in a quick recovery. Neck scarring is absent, with small scars well hidden in the axilla.

    View details for DOI 10.1016/j.jpedsurg.2008.03.031

    View details for Web of Science ID 000260802800019

    View details for PubMedID 18970942

  • Doxycycline sclerotherapy as primary treatment of head and neck lymphatic malformations in children JOURNAL OF PEDIATRIC SURGERY Nehra, D., Jacobson, L., Barnes, P., Mallory, B., Albanese, C. T., Sylvester, K. G. 2008; 43 (3): 451-460


    The authors report their experience with doxycycline sclerotherapy as primary treatment of head and neck lymphatic malformations (LMs) in children.A retrospective chart review was used to collect data on 11 patients treated with doxycycline sclerotherapy for LMs of the head and neck at our institution since 2003. Radiographic imaging allowed classification of patient LM as macrocystic, microcystic, or mixed according to previously published guidelines. Only patients with macrocystic or mixed lesions were offered doxycycline sclerotherapy. Radiographic imaging and physical examination were used to determine efficacy of treatment. After each treatment, the clinical and radiographic response was characterized as excellent (> or = 95% decrease in lesion size), satisfactory (> or = 50% decrease in volume and asymptomatic), or poor (< 50% decrease in volume or symptomatic).Eleven patients underwent a total of 23 sclerotherapies with an average of 2 treatments per patient (range, 1-4). All 7 patients with macrocystic lesions achieved complete clinical resolution with an average radiographic resolution of 93%. The 4 patients with mixed lesions achieved only partial clinical resolution and an average of 73% radiographic resolution. No patient experienced any adverse effects related to the treatment. At a median follow-up of 8 months, 2 patients (18%) experienced lesion recurrence in the setting of concomitant infection.Doxycycline sclerotherapy is safe and effective as a primary treatment modality for macrocystic and mixed LMs of the head and neck in the pediatric population.

    View details for DOI 10.1016/j.jpedsurg.2007.10.009

    View details for Web of Science ID 000254803500008

    View details for PubMedID 18358281

  • Transaxillary subcutaneous endoscopic release of the sternocleidomastoid muscle for treatment of persistent torticollis JOURNAL OF PEDIATRIC SURGERY Dutta, S., Albanese, C. T. 2008; 43 (3): 447-450


    Surgical correction of torticollis is occasionally necessary to curtail the facial deformity that can result from this condition. The resultant neck scar can be of suboptimal cosmesis, with consequent psychological distress for the child. We have previously described an endoscopic approach to forehead and brow lesions through scalp incisions. We now describe a transaxillary subcutaneous endoscopic approach to division of the fibrotic sternocleidomastoid muscle.This study involved a retrospective chart review of 3 consecutive outpatient procedures (male-to-female ratio, 1:2; age range, 8 months to 7 years) from March to October of 2005. The 2 older patients had established sternocleidomastoid fibrosis, and 1 had complicated torticollis refractory to medical management. All procedures were performed using standard 3-mm-laparoscopic instrumentation through hidden incisions in the ipsilateral axilla. Outcome measures included need for conversion, operative time, cosmetic outcome, and complications.All patients were successfully treated endoscopically. Mean operative time was 50 minutes (range, 45-55 minutes). There were no intraoperative or postoperative complications. All families were pleased with the cosmetic outcome.This case series demonstrates the simplicity and effectiveness of a transaxillary endoscopic subcutaneous approach to torticollis.

    View details for DOI 10.1016/j.jpedsurg.2007.10.008

    View details for Web of Science ID 000254803500007

    View details for PubMedID 18358280

  • Laparoscopic adjustable gastric banding in a morbidly obese 18-year-old with hypertrophic cardiomyopathy OBESITY SURGERY Waipa, J., Dutta, S., Albanese, C. T., Morton, J. M. 2008; 18 (3): 332-335


    In this case report, we present an 18-year-old morbidly obese male with complicating hypertensive cardiomyopathy who underwent laparoscopic adjustable gastric band surgery. The patient had multiple comorbidities associated with his obesity, including obstructive sleep apnea, systemic hypertension, asthma, and depression. Given the severity of his underlying cardiac pathology and multiple previously unsuccessful attempts at weight loss with conventional medical and behavioral therapy, the patient opted to proceed with surgical intervention. We present this laparoscopic adjustable gastric banding surgical case to demonstrate the impact of surgical weight reduction on cardiac risk factors in a morbidly obese adolescent, highlighting the viability of this surgery for patients with existing cardiac dysfunction.

    View details for DOI 10.1007/s11695-007-9330-9

    View details for Web of Science ID 000253627700016

    View details for PubMedID 18193180

  • National trends in adolescent bariatric surgical procedures and implications for surgical centers of excellence JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS Schilling, P. L., Davis, M. M., Albanese, C. T., Dutta, S., Morton, J. 2008; 206 (1): 1-12


    Bariatric surgery is indicated for severely obese adolescents who have failed nonsurgical treatment. Our objective was to examine national trends in the use of bariatric operations among adolescents.The Kids' Inpatient Database was used to identify bariatric surgery patients in the pediatric population (age younger than 18 years) for 1997, 2000, and 2003. Patients were identified by procedure codes for bariatric operations with confirmatory diagnosis codes for obesity. Nationally representative estimates of trends in bariatric procedures, patient characteristics, hospital characteristics, and in-hospital complication rates were calculated. We augmented our analysis with the 2003 Nationwide Inpatient Sample, to ascertain hospitals' overall bariatric surgical volume (adolescents and adults).From 1997 to 2003, the estimated number of adolescent bariatric procedures performed nationally increased 5-fold from 51 to 282 (p < 0.01). More than 100 hospitals performed bariatric procedures on adolescents in 2003, most of which (87%) performed 4 or fewer adolescent bariatric operations annually. Operations were predominantly performed in adult hospitals (85%). Although most hospitals had high overall bariatric operation volumes (> 200 bariatric procedures for patients of any age), 39% of adolescent bariatric procedures were performed at lower-volume centers. Patients were predominantly Caucasian (68%) and female (72%), with a mean age of 16 years (minimum age 12 years). In-hospital complications occurred in 6% of patients. There were no in-hospital deaths.Our findings indicate a recent, rapid increase in the frequency of adolescent bariatric procedures. Most hospitals that performed bariatric procedures on adolescents had limited experience with adolescent bariatric patients, although many of these hospitals appear to have been experienced adult centers with high overall bariatric volume (adolescents and adults). Future research must better clarify the institutional qualifications considered mandatory for treatment of eligible adolescents.

    View details for DOI 10.1016/j.jamcollsurg.2007.07.028

    View details for Web of Science ID 000252109200001

    View details for PubMedID 18155562

  • A prospective, randomized, multicenter trial of amnioreduction vs selective fetoscopic laser photocoagulation for the treatment of severe twin-twin transfusion syndrome AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY Crombleholme, T. M., Shera, D., Lee, H., Johnson, M., D'alton, M., Porter, F., Chyu, J., Silver, R., Abuhamad, A., Saade, G., Shields, L., Kauffman, D., Stone, J., Albanese, C. T., Bahado-Singh, R., Ball, R. H., Bilaniuk, L., Coleman, B., Farmer, D., Feldstein, V., Harrison, M. R., Hedrick, H., Livingston, J., Lorenz, R. P., Miller, D. A., Norton, M. E., Polzin, W. J., Robinson, J. N., Rychik, J., Sandberg, P. L., Seri, I., Simon, E., Simpson, L. L., Yedigarova, L., Wilson, R. D., Young, B. 2007; 197 (4)


    The objective of the study was to examine the effect of selective fetoscopic laser photocoagulation (SFLP) vs serial amnioreduction (AR) on perinatal mortality in severe twin-twin transfusion syndrome (TTTS).This was a 5 year multicenter, prospective, randomized controlled trial. The primary outcome variable was 30 day postnatal survival of donors and recipients.There was no statistically significant difference in 30-day postnatal survival between SFLP or AR treatment for donors at 55% (11 of 20) vs 55% (11 of 20) (P = 1.0, odds ratio [OR] 1, 95% confidence interval [CI] 0.242 to 4.14) or recipients at 30% (6 of 20) vs 45% (9 of 20) (P = .51, OR 1.88, 95% CI 0.44 to 8.64). There was no difference in 30 day survival of 1 or both twins on a per-pregnancy basis between AR at 75% (15 of 20) and SFLP at 65% (13 of 20) (P = .73, OR 1.62, 95% CI 0.34 to 8.09). Overall survival (newborns divided by the number of fetuses treated) was not statistically significant for AR at 60% (24 of 40) vs SFLP 45% (18 of 40) (P = .18, OR 2.01, 95% CI 0.76 to 5.44). There was a statistically significant increase in fetal recipient mortality in the SFLP arm at 70% (14 of 20) vs the AR arm at 35% (7 of 20) (P = .25, OR 5.31, 95% CI 1.19 to 27.6). This was offset by increased recipient neonatal mortality of 30% (6 of 20) in the AR arm. Echocardiographic abnormality in recipient twin Cardiovascular Profile Score is the most significant predictor of recipient mortality (P = .055, OR 3.025/point) by logistic regression analysis.The outcome of the trial did not conclusively determine whether AR or SFLP is a superior treatment modality. TTTS cardiomyopathy appears to be an important factor in recipient survival in TTTS.

    View details for DOI 10.1016/j.ajog.2007.07.020

    View details for Web of Science ID 000250097300023

    View details for PubMedID 17904975

  • Laparoscopic Nissen fundoplication during gastrostomy tube placement and noninvasive ventilation may improve survival in type I and severe type II spinal muscular atrophy JOURNAL OF CHILD NEUROLOGY Yuan, N., Wang, C. H., Trela, A., Albanese, C. T. 2007; 22 (6): 727-731


    Progressive respiratory muscle weakness with bulbar involvement is the main cause of morbidity and mortality in type I and severe type II spinal muscular atrophy. Noninvasive positive pressure ventilation techniques coupled with laparoscopic gastrointestinal procedures may allow for improved morbidity and mortality. The authors present a series of 7 spinal muscular atrophy patients (6 type I and 1 severe type II) who successfully underwent laparoscopic gastrostomy tube insertion coupled with Nissen fundoplication and early postoperative extubation using noninvasive positive pressure ventilation techniques. The authors measured the length of survival and the frequencies of pneumonia and hospitalization before and after surgery as outcomes of these new surgical and medical interventions. All 7 patients had respiratory symptoms (unmanageable oropharyngeal secretions, cough, pneumonia), difficulty feeding, and weight loss. Six patients had documented reflux via diagnostic testing preoperatively. Five patients were on noninvasive positive pressure ventilation and other supportive respiratory therapies prior to surgery. All 7 patients survived the procedures. By August 2006, 5 patients with type I and 1 with severe type II spinal muscular atrophy were alive and medically stable at home 1.5 months to 41 months post-op. One patient with type I expired approximately 5 months post-op due to obstructive apnea. This case series demonstrates that laparoscopic gastrostomy tube placement coupled with Nissen fundoplication and noninvasive positive pressure ventilation can be successfully used as a treatment option to allow for early postoperative extubation and to optimize quality of life in type I and severe type II spinal muscular atrophy patients.

    View details for DOI 10.1177/0883073807304009

    View details for Web of Science ID 000247892900007

    View details for PubMedID 17641258

  • Experience with 144 consecutive pediatric thoracoscopic lobectomies JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES Albanese, C. T., Rothenberg, S. S. 2007; 17 (3): 339-341


    The early experience with the technique and short-term outcomes after pediatric thoracoscopic lobectomy were independently reported by the authors several years ago. This paper updates their combined experience, evaluating the safety, efficacy, and long-term outcomes.From January 1995 to May 2005, 144 consecutive patients underwent a thoracoscopic lobectomy. Preoperative diagnoses included cystic adenomatoid malformation/sequestration (n = 112), bronchiectasis (n = 19), lobar emphysema (n = 10), and malignancy (n = 3). Ages ranged from 2 days to 18 years, and weight ranged from 2.8 to 78 kgs. Three or four valved ports were used with a controlled pneumothorax. Single-lung ventilation was used in all cases. Follow-up ranged from 1 to 10 years.All but three procedures were completed thoracoscopically; one was converted to repair an injured upper lobe bronchus during a lower lobectomy, one resulting from bleeding, and another caused by what was believed to be a potentially inadequate margin during the resection of a large tumor. The operating time ranged from 35 to 220 minutes (median, 125). There were 110 lower, 24 upper, and 10 middle lobe resections. There was one intraoperative complication--the compromise of a left upper lobe bronchus. There were four postoperative complications: pneumonia, pneumothorax, empyema, and prolonged chest tube drainage. There were no reoperations. The median duration of hospital stay was 2.8 days. A long-term follow-up revealed no cases of musculoskeletal deformity or weakness.The current techniques and equipment allow for the complete thoracoscopic resection of pulmonary lobes in any age or size of a child, with low morbidity and no mortality. Long-term outcomes support the efficacy of this technique that spares growing children a thoracotomy that has the potential for late musculoskeletal morbidity.

    View details for DOI 10.1089/lap.2006.0184

    View details for Web of Science ID 000247349500017

    View details for PubMedID 17570785

  • Use of a prosthetic patch for laparoscopic repair of Morgagni diaphragmatic hernia in children JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES Dutta, S., Albanese, C. T. 2007; 17 (3): 391-394


    Morgagni hernias are well suited to laparoscopic repair. A primary suture closure may result in tension on the repair, thereby predisposing the patient to a recurrence. A prosthetic patch (PP) can be used to provide a tension-free repair. In this study, we reviewed our experience with the laparoscopic PP repair of Morgagni hernias in children.A retrospective chart review of all patients undergoing a laparoscopic Morgagni hernia repair using a PP was undertaken between November 2002 and January 2006. Outcome measures included age, gender, defect size, use of mesh, and outcome. The time of follow-up was from 6 to 37 months.Seven (7) patients (6 male, 1 female) underwent a laparoscopic repair of Morgagni hernia during this time period. Six (6) patients had a congenital hernia, and 1 patient was thought to have an iatrogenic hernia following a sternotomy for heart surgery. Defect size ranged from 4 to 7 cm in maximum dimension. All operations were completed laparoscopically, no patients presented with recurrence, and no PP complications were encountered.The laparoscopic repair of Morgagni hernia using a PP can be performed with relative ease and with a positive outcome, and may prevent future recurrence by effecting a tension-free repair.

    View details for DOI 10.1089/lap.2006.0113

    View details for Web of Science ID 000247349500028

    View details for PubMedID 17570796

  • Outcomes after laparoscopic surgery in neonates with hypoplastic heart left heart syndrome JOURNAL OF PEDIATRIC SURGERY Slater, B., Rangel, S., Ramamoorthy, C., Abrajano, C., Albanese, C. T. 2007; 42 (6): 1118-1121


    Laparoscopy has advanced the care of children for a variety of pediatric surgical diseases. However, complication rates for laparoscopic interventions in neonates with hypoplastic left heart syndrome (HLHS) have not been well described. The purpose of this study is to present the largest reported series of laparoscopic surgery performed in patients with HLHS.We conducted a single-institution, retrospective chart review for all neonates with HLHS who underwent a laparoscopic procedure from September 2002 to March 2005. Data regarding patient characteristics, intraoperative monitoring, previous cardiac surgery, perioperative complications, and postoperative mortality were assessed.Twelve patients with HLHS underwent a total of 13 operations during the study period (8 combined Nissen fundoplication and gastrostomy tubes, 3 isolated gastrostomy tubes, 1 Ladd procedure, and 1 combined Nissen fundoplication and gastrocutaneous fistula closure). All cases were completed laparoscopically. Patients had undergone palliative cardiac surgery but were not completely corrected; therefore, they were cyanotic. Perioperative complications were observed in 6 patients (3 gastrostomy tube site infections, 1 small bowel obstruction, 1 postoperative sepsis, and 1 urinary tract infection). There was no mortality in this series.From this experience, it appears that laparoscopy can be performed safely and with satisfactory outcomes in patients with HLHS. However, a multidisciplinary approach, including the availability of a skilled and experienced cardiac anesthesia team, is believed to be critical to optimize outcomes in these critically ill children.

    View details for DOI 10.1016/j.jpedsurg.2007.01.049

    View details for Web of Science ID 000247536300038

    View details for PubMedID 17560232

  • Minimal access portoenterostomy: Advantages and disadvantages of standard laparoscopic and robotic techniques JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES Dutta, S., Woo, R., Albanese, C. T. 2007; 17 (2): 258-264


    Minimal access portoenterostomy (Kasai procedure) for biliary atresia represents a technically challenging operation. The standard laparoscopic approach yields results comparable to the open technique. After an initial experience with standard laparoscopy, we assessed the potentially superior optics and dexterity of a surgical robotic system for performing portoenterostomy. We reviewed our experience with minimal access portoenterostomy to compare the relative advantages and disadvantages of standard laparoscopic and robotic approaches to biliary atresia.We reviewed the charts of all patients who underwent either laparoscopic or robotic portoenterostomy at our institution between October 2002 and October 2005. Outcome measures included the need to convert to laparotomy, complications, functional outcome expressed either as the direct bilirubin at most recent follow-up (> or = 3 months) or age at transplant, and density of adhesions at transplant. Surgeons' impressions of the two minimal access modalities were also reviewed.A total of 10 patients underwent minimal access portoenterostomy (7 standard laparoscopy; 3 robotic-assisted). Mean follow-up was 20 months (range, 1-36 months). There were no conversions to laparotomy and no intraoperative complications. There was one port site infection that resolved with antibiotics. Five patients (4 laparoscopic, 1 robotic) had progressed to transplantation at the time of follow-up. At transplant, one patient had mild adhesions and two had dense adhesions. Adhesions were not noted for 2 patients.We believe both surgical modalities are feasible from a technical point of view. However, the optical and dexterity advantages of the robotic system were offset by the large instrument size and lack of force feedback.

    View details for Web of Science ID 000246005000025

    View details for PubMedID 17484663

  • Clinical resolution of severely symptomatic pseudotumor cerebri after gastric bypass in an adolescent SURGERY FOR OBESITY AND RELATED DISEASES Chandra, V., Dutta, S., Albanese, C. T., Shepard, E., Farrales-Nguyen, S., Morton, J. 2007; 3 (2): 198-200


    Pseudotumor cerebri is a disease characterized by increased intracranial pressure, often manifested by headaches, and occasionally leading to severe visual impairment or even blindness. Most cases in adolescents, as in adults, are associated with obesity. We report a 16-year-old morbidly obese adolescent girl (body mass index 42.3 kg/m(2)) with severely symptomatic pseudotumor cerebri who had progressive visual field deficits and elevated intracranial pressure (opening pressure on lumbar puncture of 50 cm H(2)O) despite intensive medical management and placement of both ventriculoperitoneal and lumboperitoneal shunts. Six months after she underwent gastric bypass surgery, she had lost 43% of her excess body weight and had had near complete regression of her visual field deficits, along with normalization of her intracranial pressures. This case demonstrates the dramatic reversal of symptoms of pseudotumor cerebri with surgically induced weight loss. Gastric bypass should be considered as a treatment option for adolescents with severe and progressive pseudotumor cerebri.

    View details for DOI 10.1016/j.soard.2006.11.015

    View details for Web of Science ID 000261097100020

    View details for PubMedID 17324634

  • IPEG panel on clinical investigation JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES Morton, J., Albanese, C. T., Barnhart, D., Dutta, S. 2007; 17 (1): 67-76

    View details for DOI 10.1089/lap.2006.9998

    View details for Web of Science ID 000245056900015

    View details for PubMedID 17362183

  • Confronting the future of surgery: The Technology Committee of the International Pediatric Endosurgery Group JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES Albanese, C. T., Wulkan, M. 2006; 16 (6): 633-633

    View details for Web of Science ID 000243451900019

    View details for PubMedID 17243886

  • Surgical robotics and image guided therapy in pediatric surgery: emerging and converging minimal access technologies. Seminars in pediatric surgery Chandra, V., Dutta, S., Albanese, C. T. 2006; 15 (4): 267-275


    Minimal access surgery (MAS) is now commonplace in the armamentarium of the pediatric surgeon, and is being applied to a growing list of pediatric surgical diseases. Robot-assisted surgery and image guided therapy (IGT) have evolved as innovative minimal access approaches, and hold the promise of advancing MAS far beyond what is currently possible. The aims of this article are to describe the currently available robotic, and image guided therapy systems, review their present and potential applications, and discuss the future directions of these converging technologies.

    View details for PubMedID 17055957

  • Endoscopic excision of benign forehead masses: a novel approach for pediatric general surgeons JOURNAL OF PEDIATRIC SURGERY Dutta, S., Lorenz, H. P., Albanese, C. T. 2006; 41 (11): 1874-1878


    Benign tumors of the brow and forehead are commonly managed by pediatric general surgeons by excision through an overlying incision. Cosmetic results in children can be suboptimal. Plastic surgeons have used endoscopic brow-lift techniques for the removal of these lesions. We review our experience after adopting this endoscopic technique in a pediatric general surgery practice.We conducted a retrospective chart review of 9 consecutive outpatient procedures (5 girls and 4 boys; age range, 5 months to 12 years) between March and October 2005. Seven patients had lesions located on the lateral brow (left, n = 4; right, n = 3), 1 patient had a lesion on the left mid forehead, and 1 patient had a nasoglabellar cyst. All procedures were performed using endoscopic brow-lift equipment through a single small scalp incision 2 cm posterior to the hairline. Outcome measures included need for conversion, operative time, cosmetic outcome, and complications.All lesions (6 dermoid cysts and 3 pilomatrixomas) were successfully excised endoscopically. The mean operative time was 56 minutes (range, 22-90 minutes). There was no intraoperative or postoperative complication. All families were pleased with the cosmetic outcomes.This case report shows that endoscopic excision of forehead masses is a safe and efficacious procedure in the hands of pediatric general surgeons.

    View details for DOI 10.1016/j.jpedsurg.2006.06.047

    View details for Web of Science ID 000242395200017

    View details for PubMedID 17101362

  • Methamphetamine use following bariatric surgery in an adolescent OBESITY SURGERY Dutta, S., Morton, J., Shepard, E., Peebles, R., Farrales-Nguyen, S., Hammer, L. D., Albanese, C. T. 2006; 16 (6): 780-782


    Bariatric surgery is increasingly popular as a therapeutic strategy for morbidly obese adolescents. Adolescence represents a sensitive period of psychosocial development, and children with considerable weight loss may experience greater peer acceptance, accompanied by both positive and negative influences. Substance abuse exists as one of these negative influences. We present the case of an adolescent bariatric surgical patient who abused methamphetamines in the postoperative period, with consequent nutritional instability. A concerted effort must be made in the preoperative assessment of adolescent bariatric patients to delineate a history of illicit drug use, including abuse of diet pills and stimulants. Excessive postoperative weight loss or micronutrient supplementation non-compliance should raise a suspicion of stimulant use and appropriate screening tests should be performed. The consequent appetite suppression may manifest with signs of malnutrition such as bradycardia, hypotension, and weakness. Inpatient nutritional rehabilitation and psychiatric assessment should be considered.

    View details for Web of Science ID 000238156200019

    View details for PubMedID 16756743

  • Robot-assisted laparoscopic resection of a type I choledochal cyst in a child JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES Woo, R., Le, D., Albanese, C. T., Kim, S. S. 2006; 16 (2): 179-183


    Although the laparoscopic approach to the treatment of complex biliary disease is possible, it is technically challenging. In an attempt to overcome these difficulties, the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, California) was used to facilitate the minimally invasive treatment of a type I choledochal cyst in a 5-year-old, 22 kg, girl. Complete resection of the choledochal cyst and a Roux-en-Y hepaticojejunostomy were performed using the robotic surgical system. Total robotic setup time (preparation, port placement, docking) was 40 minutes. Total procedure time was 440 minutes. Total robotic operative time was 390 minutes. No intraoperative complications or technical problems were encountered. At 6-month follow-up, the child is doing well with no episodes of cholangitis. Robot-assisted laparoscopic type I choledochal cyst resection appears safe and feasible. The three-dimensional visualization and wristed instrumentation greatly aids in the dissection of the cyst and in the biliary reconstruction.

    View details for Web of Science ID 000237093800021

    View details for PubMedID 16646713

  • A novel laparoscopic technique for the repair of pediatric umbilical and epigastric hernias JOURNAL OF PEDIATRIC SURGERY Albanese, C. T., Rengal, S., Bermudez, D. 2006; 41 (4): 859-862


    The aim of this study was to determine whether a novel laparoscopic technique for pediatric umibilical and epigastric hernia repair is safe, quick, effective, durable, and cosmetically acceptable.Forty-one consecutive umbilical and 13 epigastric hernias were repaired laparoscopically. Six patients had concomitant epigastric and umbilical hernias repaired during one procedure. Two 3-mm ports were used via a lateral approach. Mean age was 4.2 years for those with an umbilical hernia and 2.0 years for those with an epigastric hernia.All procedures were completed laparoscopically. The mean operative time was 27 minutes for umbilical hernia repair and 16 minutes for epigastric hernia repair. There were no intraoperative or postoperative complications. Follow-up was 100% and ranged from 6 to 35 months. There have been no recurrent hernias, and patient/parent satisfaction was subjectively excellent.This case series demonstrated that this novel technique of laparoscopic anterior abdominal wall hernia repair is safe, quick, effective, durable, and cosmetically acceptable. It requires few instruments and minimal advanced laparoscopic techniques.

    View details for DOI 10.1016/j.pedsurg.2005.12.033

    View details for Web of Science ID 000237015800063

    View details for PubMedID 16567211

  • Laparoscopic resection of type 1 choledochal cysts in pediatric patients SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES Le, D. M., Woo, R. K., Sylvester, K., Krummel, T. M., Albanese, C. T. 2006; 20 (2): 249-251


    Choledochal cyst resection and hepaticojejunostomy have historically been performed using an open technique. We describe here the largest single experience with this procedure using laparoscopic techniques in eight consecutive pediatric patients.There were six girls and two boys, of ages ranging from 3 months to 13 years. All had type I choledochal cysts. Three were asymptomatic, having been noted on prenatal ultrasonography. Five ports were utilized: one 5-mm telescope port at the umbilicus, two 3-mm operating ports on both sides of the umbilicus, one 5-mm left subcostal port for liver retraction, and one LLQ 5-mm assistant port.The median operating time was 155 min (range 110-250 min), with one conversion to an open procedure due to a high transection of the cyst leading to partial retraction of the left hepatic duct into the liver substance. Mean hospital stay was 3 days. At a mean follow-up of 18.8 months, all patients were anicteric and asymptomatic.Laparoscopic resection of choledochal cysts can be performed safely in pediatric patients with minimal morbidity and good long-term results.

    View details for DOI 10.1007/s00464-005-0151-4

    View details for Web of Science ID 000235059700014

    View details for PubMedID 16391960

  • Successful thoracoscopic repair of esophageal atresia with tracheoesophageal fistula in a newborn with single ventricle physiology ANESTHESIA AND ANALGESIA Mariano, E. R., Chu, L. F., Albanese, C. T., Ramamoorthy, C. 2005; 101 (4): 1000-1002


    A neonate with VACTERL association including tricuspid atresia was scheduled for thoracoscopic esophageal atresia with tracheoesophageal fistula (EA/TEF) repair and laparoscopic gastrostomy tube placement. In addition to standard noninvasive monitoring, arterial blood pressure, central venous pressure, and cerebral oxygen saturation were monitored. Gastric distension resulting from positive pressure ventilation prevented laparoscopic gastrostomy tube placement. Thoracoscopy with a CO2 insufflation pressure of 6 mm Hg at low flow (1 L/min) was well tolerated hemodynamically despite hypercarbia and cerebral oxygen saturation was maintained. Careful monitoring and good communication were critical to the safe management of this single ventricle patient during thoracoscopic EA/TEF repair.Esophageal and tracheoesophageal fistula in conjunction with single ventricle physiology carries a significant risk of mortality. We present the anesthetic management of a neonate with unpalliated tricuspid atresia who underwent thoracoscopic tracheoesophageal fistula repair.

    View details for DOI 10.1213/01.ANE.0000175778.96374.4F

    View details for Web of Science ID 000232115400011

    View details for PubMedID 16192508

  • Thoracoscopic repair of esophageal atresia and tracheoesophageal fistula - A multi-institutional analysis ANNALS OF SURGERY Holcomb, G. W., Rothenberg, S. S., Bax, K. M., Martinez-Ferro, M., Albanese, C. T., Ostlie, D. J., van der Zee, D. C., Yeung, C. K. 2005; 242 (3): 422-430


    For the past 60 years, successful repair of esophageal atresia (EA) and distal tracheoesophageal fistula (TEF) has been performed via a thoracotomy. However, a number of reports have described adverse musculoskeletal sequelae following thoracotomy in infants and young children. Until now, only a few scattered case reports have detailed an individual surgeon's success with thoracoscopic repair of EA/TEF. This multi-institutional review represents the largest experience describing the results with this approach.A cohort of international pediatric surgeons from centers that perform advanced laparoscopic and thoracoscopic operations in infants and children retrospectively reviewed their data on primary thoracoscopic repair in 104 newborns with EA/TEF. Newborns with EA without a distal TEF or those with an isolated TEF without EA were excluded.In these 104 patients, the mean age at operation was 1.2 days (+/-1.1), the mean weight was 2.6 kg (+/-0.5), the mean operative time was 129.9 minutes (+/-55.5), the mean days of mechanical ventilation were 3.6 (+/-5.8), and the mean days of total hospitalization were 18.1 (+/-18.6). Twelve (11.5%) infants developed an early leak or stricture at the anastomosis and 33 (31.7%) required esophageal dilatation at least once. Five operations (4.8%) were converted to an open thoracotomy and one was staged due to a long gap between the 2 esophageal segments. Twenty-five newborns (24.0%) later required a laparoscopic fundoplication. A recurrent fistula between the esophagus and trachea developed in 2 infants (1.9%). A number of other operations were required in these patients, including imperforate anus repair in 10 patients (7 high, 3 low), aortopexy (7), laparoscopic duodenal atresia repair (4), and various major cardiac operations (5). Three patients died, one related to the EA/TEF on the 20th postoperative day.The thoracoscopic repair of EA/TEF represents a natural evolution in the operative correction of this complicated congenital anomaly and can be safely performed by experienced endoscopic surgeons. The results presented are comparable to previous reports of babies undergoing repair through a thoracotomy. Based on the associated musculoskeletal problems following thoracotomy, there will likely be long-term benefits for babies with this anomaly undergoing the thoracoscopic repair.

    View details for DOI 10.1097/01.sla.0000179649.15576.db

    View details for Web of Science ID 000231748200013

    View details for PubMedID 16135928

  • The safety and efficacy of laparoscopic adrenalectomy in children ARCHIVES OF SURGERY Skarsgard, E. D., Albanese, C. T. 2005; 140 (9): 905-908


    Laparoscopic adrenalectomy (LA) has become standard therapy for benign adrenal masses in adults. The utility of LA in children with adrenal masses is less well defined because of the infrequency and pathologic variability of pediatric adrenal masses, and body size and instrumentation considerations that exist in small children. Evaluation of a case series of children undergoing lateral, transperitoneal LA will reflect the safety and efficacy of this procedure in pediatric patients and identify preferred patient selection criteria.A combined case series including patients treated between March 1999 and November 2004.Urban tertiary referral pediatric teaching hospitals.All children with pathologic adrenal masses undergoing LA were included.The primary study outcome measures included operative duration, conversions to open adrenalectomy, complications, length of hospital stay, and freedom from recurrence of the original pathologic adrenal mass.A total of 21 LAs (including a staged, bilateral LA) were performed in 20 patients (13 girls, 7 boys) with a mean age of 6.4 years (range, 14 months to 18 years). Nine patients (43%) had neuroblastic tumors. Operative duration averaged mean +/- SD 101 +/- 48 minutes, and there was a single conversion to open adrenalectomy in a patient with a left adrenal carcinoma and tumor thrombus extending into the renal vein. There were no perioperative complications, and no patients required blood transfusions. The postoperative hospital stay averaged 1.5 days (range, 1-4.5 days). At a mean +/- SD follow-up of 31 +/- 17 months, all patients remained clinically (radiologically and/or biochemically) free of their original adrenal disease.Laparoscopic adrenalectomy can be used to safely treat suspected benign and selected malignant adrenal masses in children.

    View details for Web of Science ID 000231641400025

    View details for PubMedID 16175699

  • Subcutaneous endoscopically assisted ligation (SEAL) of the internal ring for repair of inguinal hernias in children: a novel technique JOURNAL OF PEDIATRIC SURGERY Harrison, M. R., Lee, H. M., Albanese, C. T., Farmer, D. L. 2005; 40 (7): 1177-1180


    Subcutaneous endoscopically assisted ligation (SEAL) is a technique for high ligation of the patent processus at the internal ring without a groin incision or dissection of the vas and vessels. Under endoscopic visualization through a single umbilical port, a suture is guided extraperitoneally around the internal ring, avoiding the vas and vessels. The safety, efficacy (recurrence risk), and cost-effectiveness of this unproven procedure must be tested against standard open repair in a trial.

    View details for DOI 10.1016/j.jpedsurg.2005.03.075

    View details for Web of Science ID 000231729000021

    View details for PubMedID 16034766

  • Anesthetic management of infants with palliated hypoplastic left heart syndrome undergoing laparoscopic Nissen fundoplication ANESTHESIA AND ANALGESIA Mariano, E. R., Boltz, M. G., Albanese, C. T., Abrajano, C. T., Ramamoorthy, C. 2005; 100 (6): 1631-1633


    The safety of laparoscopic surgery in infants with single ventricle physiology has been a subject of controversy despite potential benefits over open surgery. We present the anesthetic management of five infants with palliated hypoplastic left heart syndrome that underwent laparoscopic Nissen fundoplication. After anesthetic induction and tracheal intubation, an intraarterial catheter was placed for hemodynamic monitoring. Insufflation pressure was limited to 12 mm Hg and was well tolerated by all patients. There were no intraoperative or postoperative complications. In patients with hypoplastic left heart syndrome, laparoscopic Nissen fundoplication can be safely performed with careful patient selection and close intraoperative monitoring.

    View details for DOI 10.1213/01.ANE.0000149899.03904.3F

    View details for Web of Science ID 000229305600013

    View details for PubMedID 15920186

  • The "skinny" on adolescent bariatric surgery JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES-PART A Albanese, C. T. 2005; 15 (1): 70-70

    View details for Web of Science ID 000227564600015

    View details for PubMedID 15772482

  • Anesthetic concerns for robot-assisted laparoscopy in an infant ANESTHESIA AND ANALGESIA Mariano, E. R., Furukawa, L., Woo, R. K., Albanese, C. T., Brock-Utne, J. G. 2004; 99 (6): 1665-1667


    A 2-mo-old infant with biliary atresia was scheduled for laparoscopic Kasai with robot assistance. Before surgery, a practice trial maneuvering the cumbersome robotic equipment was performed to ensure rapid access to the patient in case of emergency. IV access, tracheal intubation, and arterial line placement followed inhaled anesthesia induction with sevoflurane. Robotic setup took 53 min and severely limited patient access. No adverse events occurred during the procedure requiring the removal of the robotic equipment, and the patient was discharged after a stable postoperative recovery. Advance preparation is required to maximize patient safety during robotic surgery.

    View details for DOI 10.1213/01.ANE.0000137394.99683.66

    View details for Web of Science ID 000225341600016

    View details for PubMedID 15562050

  • Infant pulmonary function in a randomized trial of fetal tracheal occlusion for severe congenital diaphragmatic hernia PEDIATRIC RESEARCH Keller, R. L., Hawgood, S., Neuhaus, J. M., Farmer, D. L., LEE, H., Albanese, C. T., Harrison, M. R., KITTERMAN, J. A. 2004; 56 (5): 818-825


    Congenital diaphragmatic hernia (CDH) carries a high mortality risk secondary to pulmonary hypoplasia and respiratory failure. In experimental animals, fetal tracheal occlusion (TO) induces lung growth and morphologic maturation. We measured indicators of pulmonary function in 20 infants who were enrolled in a randomized trial of fetal TO as treatment for severe CDH [nine with conventional treatment (controls); 11 with TO]. We hypothesized that TO would improve lung function. At birth, the TO group had a lower mean gestational age (30.8 +/- 2.0 versus 37.4 +/- 1.0 wk; p=0.0002). All infants required assisted ventilation. Mortality did not differ between groups (64 versus 78%, TO and control, respectively; p=0.64). We measured respiratory mechanics at four study points: 1) first 24 h, 2) before CDH operative repair (5.9 +/- 2.2 d), 3) immediately after repair (7.0 +/- 2.2 d), and 4) before elective extubation (32.5 +/- 16.1 d). We calculated perioperative oxygenation index and alveolar-arterial oxygen difference to assess efficiency of pulmonary gas exchange. Data were analyzed by univariate and repeated measures techniques. Respiratory system compliance (Crs) was low. The rate of increase in Crs over the four study points was greater in the TO group than in control subjects. Crs in the TO group was significantly greater at study 2 (0.28 +/- 0.12 versus 0.17 +/- 0.04 H2O(-1).kg(-1); p=0.02) and study 4 (0.93 +/- 0.45 versus 0.51 +/- 0.16 mL.cmH2O(-1).kg(-1); p=0.02). oxygenation index did not differ between groups, but alveolar-arterial oxygen difference was lower in the TO infants. We conclude that fetal TO for severe CDH results in modest improvements in neonatal pulmonary function that are of questionable clinical significance.

    View details for DOI 10.1203/01.PDR.0000141518.19721.D7

    View details for Web of Science ID 000224662800024

    View details for PubMedID 15319458

  • Spontaneous resolution of prenatal megalourethra JOURNAL OF PEDIATRIC SURGERY Nijagal, A., Sydorak, R. M., Feldstein, V. A., Hirose, S., Albanese, C. T. 2004; 39 (9): 1421-1423


    Urethral obstruction in the fetus is rare. Whereas proximal obstruction most often is caused by posterior urethral valves, causes of distal obstruction are less well recognized and can include urethral atresia, urethral webs, and anterior urethral valves. These latter abnormalities can lead to urinary retention, incontinence, enuresis, spontaneous bladder rupture, and megacystis. The authors present 3 fetuses (gestational age range, 18 to 20 weeks) in whom distal urethral obstruction was suspected by prenatal ultrasonography in the absence of a demonstrable lesion. All 3 experienced spontaneous resolution of the presumed obstruction. On follow-up, all are alive and well with no adverse genitourinary tract sequelae. No postpartum intervention was required.

    View details for DOI 10.1016/j.jpedsurg.2004.05.026

    View details for Web of Science ID 000223963300024

    View details for PubMedID 15359404

  • Bariatric surgery for severely overweight adolescents: Concerns and recommendations PEDIATRICS Inge, T. H., Krebs, N. F., Garcia, V. F., Skelton, J. A., Guice, K. S., Strauss, R. S., Albanese, C. T., Brandt, M. L., Hammer, L. D., Harmon, C. M., Kane, T. D., Klish, W. J., Oldham, K. T., Rudolph, C. D., Helmrath, M. A., Donovan, E., Daniels, S. R. 2004; 114 (1): 217-223


    As the prevalence of obesity and obesity-related disease among adolescents in the United States continues to increase, physicians are increasingly faced with the dilemma of determining the best treatment strategies for affected patients. This report offers an approach for the evaluation of adolescent patients' candidacy for bariatric surgery. In addition to anthropometric measurements and comorbidity assessments, a number of unique factors must be critically assessed among overweight youths. In an effort to reduce the risk of adverse medical and psychosocial outcomes and increase compliance and follow-up monitoring after bariatric surgery, principles of adolescent growth and development, the decisional capacity of the patient, family structure, and barriers to adherence must be considered. Consideration for bariatric surgery is generally warranted only when adolescents have experienced failure of 6 months of organized weight loss attempts and have met certain anthropometric, medical, and psychologic criteria. Adolescent candidates for bariatric surgery should be very severely obese (defined by the World Health Organization as a body mass index of > or =40), have attained a majority of skeletal maturity (generally > or =13 years of age for girls and > or =15 years of age for boys), and have comorbidities related to obesity that might be remedied with durable weight loss. Potential candidates for bariatric surgery should be referred to centers with multidisciplinary weight management teams that have expertise in meeting the unique needs of overweight adolescents. Surgery should be performed in institutions that are equipped to meet the tertiary care needs of severely obese patients and to collect long-term data on the clinical outcomes of these patients.

    View details for Web of Science ID 000222439200053

    View details for PubMedID 15231931

  • A randomized trial of fetal endoscopic tracheal occlusion for severe fetal congenital diaphragmatic hernia NEW ENGLAND JOURNAL OF MEDICINE Harrison, M. R., Keller, R. L., Hawgood, S. B., KITTERMAN, J. A., Sandberg, P. L., Farmer, D. L., LEE, H., Filly, R. A., Farrell, J. A., Albanese, C. T. 2003; 349 (20): 1916-1924


    Experimental and clinical data suggest that fetal endoscopic tracheal occlusion to induce lung growth may improve the outcome of severe congenital diaphragmatic hernia. We performed a randomized, controlled trial comparing fetal tracheal occlusion with standard postnatal care.Women carrying fetuses that were between 22 and 27 weeks of gestation and that had severe, left-sided congenital diaphragmatic hernia (liver herniation and a lung-to-head ratio below 1.4), with no other detectable anomalies, were randomly assigned to fetal endoscopic tracheal occlusion or standard care. The primary outcome was survival at the age of 90 days; the secondary outcomes were measures of maternal and neonatal morbidity.Of 28 women who met the entry criteria, 24 agreed to randomization. Enrollment was stopped after 24 patients had been enrolled because of the unexpectedly high survival rate with standard care and the conclusion of the data safety monitoring board that further recruitment would not result in significant differences between the groups. Eight of 11 fetuses (73 percent) in the tracheal-occlusion group and 10 of 13 (77 percent) in the group that received standard care survived to 90 days of age (P=1.00). The severity of the congenital diaphragmatic hernia at randomization, as measured by the lung-to-head ratio, was inversely related to survival in both groups. Premature rupture of the membranes and preterm delivery were more common in the group receiving the intervention than in the group receiving standard care (mean [+/-SD] gestational age at delivery, 30.8+/-2.0 weeks vs. 37.0+/-1.5 weeks; P<0.001). The rates of neonatal morbidity did not differ between the groups.Tracheal occlusion did not improve survival or morbidity rates in this cohort of fetuses with congenital diaphragmatic hernia.

    View details for Web of Science ID 000186502400006

    View details for PubMedID 14614166

  • One-stage transanal soave pullthrough for Hirschsprung disease - A multicenter experience with 141 children ANNALS OF SURGERY Langer, J. C., Durrant, A. C., De la Torre, L., Teitelbaum, D. H., Minkes, R. K., Caty, M. G., Wildhaber, B. E., Ortega, S. J., Hirose, S., Albanese, C. T. 2003; 238 (4): 569-573


    The surgical management of Hirschsprung's disease (HD) has evolved from the original 3-stage approach to the recent introduction of minimal-access single-stage techniques. We reviewed the early results of the transanal Soave pullthrough from 6 of the original centers to use it.The clinical course of all children with HD undergoing a 1-stage transanal Soave pullthrough between 1995 and 2002 were reviewed. Children with a preliminary stoma or total colonic disease were excluded.There were 141 patients. Mean time between diagnosis and surgery was 32 days, and mean age at surgery was 146 days. Sixty-six (47%) underwent surgery in the first month of life. Forty-seven (33%) had the pathologic transition zone documented laparoscopically or through a small umbilical incision before beginning the anal dissection. Mean blood loss was 16 mL, and no patients required transfusion. Mean time to full feeding was 36 hours, mean postoperative hospital stay was 3.4 days, and 87 patients (62%) required only acetaminophen for pain. Early postoperative complications included perianal excoriation (11%), enterocolitis (6%), and stricture (4%). One patient died of congenital cardiac disease. Mean follow-up was 20 months; 81% had normal bowel function for age, 18% had minor problems, and 1% had major problems. Two patients required a second operation (twisted pullthrough, and residual aganglionosis). One patient developed postoperative adhesive bowel obstruction.To date, this report represents the largest series of patients undergoing the 1-stage transanal Soave pullthrough. This approach is safe, permits early feeding, causes minimal pain, facilitates early discharge, and presents a low rate of complications.

    View details for DOI 10.1097/

    View details for Web of Science ID 000185926500024

    View details for PubMedID 14530728

  • Tissue ablation using high-intensity focused ultrasound in the fetal sheep model: Potential for fetal treatment AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY Paek, B. W., Vaezy, S., Fujimoto, V., Bailey, M., Albanese, C. T., Harrison, M. R., Farmer, D. L. 2003; 189 (3): 702-705


    The aim of this study was to investigate the efficacy of high-intensity focused ultrasound (HIFU) ablation of fetal tissue in a sheep model. HIFU can deliver large amounts of thermal energy by using ultrasonic waves to induce tissue necrosis, without damaging intervening tissues. In contrast to diagnostic ultrasound where intensity levels are below 0.1 W/cm(2), HIFU can deliver 1,000 to 10,000 W/cm(2) at the focal spot.A protocol for HIFU-induced tissue coagulation in the fetus was developed in the ovine model. The fetal liver, lung, kidney, muscle, and placenta were targets for ultrasound-guided tissue ablation by a HIFU beam. All lesions were assessed macroscopically and by histologic analysis.In all animals, a necrotic lesion, similar in size to the HIFU focus (approximately 1x9 mm), was achieved. The fetal heart rate remained stable immediately after the procedure.In conclusion, HIFU ablation seems to be an effective means to coagulate even highly vascularized tissues in the fetus. This procedure shows promise as a transcutaneous, minimally invasive technique to decrease blood flow through fetal tumors or vascular anastomoses. We are currently conducting further studies to refine the HIFU technique and assess safety for fetus and mother.

    View details for DOI 10.1067/S0002-9378(03)00664-1

    View details for Web of Science ID 000185718500022

    View details for PubMedID 14526297

  • Tracheal occlusion stimulates cell cycle progression and type I cell differentiation in lungs of fetal rats AMERICAN JOURNAL OF PHYSIOLOGY-LUNG CELLULAR AND MOLECULAR PHYSIOLOGY Yoshizawa, J., Chapin, C. J., Sbragia, L., Ertsey, R., Gutierrez, J. A., Albanese, C. T., KITTERMAN, J. A. 2003; 285 (2): L344-L353


    Fetal tracheal occlusion (TO) has been reported to stimulate lung growth but decreases number and maturation of type II cells, effects that vary with gestational age and duration of TO. We examined effects of a novel method of TO (unipolar microcautery to seal the trachea) produced at 19.5-20 days (d) of gestation in fetal rats; fetuses were delivered at term, 22 d. Controls were sham operated and unoperated littermates. TO increased wet lung weight but not dry lung weight or lung DNA and protein. To evaluate further the effects of TO, we examined the cell cycle regulators, cyclins D1 and A, in fetal lungs. Cyclin D1 increased with TO (P < 0.005). TO also increased expression of the type I epithelial cell marker RTI40 (mRNA and protein). TO decreased mRNA for surfactant proteins (SP)-A and -C but did not affect protein levels of SP-A and -B and of RTII70, a type II epithelial cell marker. We conclude that TO by microcautery, even of short duration, has diverse pulmonary effects including stimulating increased levels of cyclin D1 with probable cell cycle progression, type I cell differentiation, and possibly inhibiting type II cell function.

    View details for DOI 10.1152/ajplung.00281.2002

    View details for Web of Science ID 000183992300010

    View details for PubMedID 12679321

  • Comparison of drainage techniques for biliary atresia JOURNAL OF PEDIATRIC SURGERY Tsao, K., Rosenthal, P., Dhawan, K., Danzer, E., Sydorak, R., Hirose, S., Farmer, D. L., Albanese, C. T., Harrison, M. R., LEE, H. 2003; 38 (7): 1005-1007


    Traditional Kasai portoenterostomy and porto-appendiceal duodenostomy have been utilized for biliary atresia. Differences in outcome between patients who underwent either Kasai portoenterostomy or porto-appendiceal duodenostomy were compared.A review of all children who underwent a drainage procedure for biliary atresia from 1986 to 2000 (n = 30) was performed. Age at drainage procedure, subsequent liver transplantation, and outcomes were evaluated. Outcome variables included success rates (total bilirubin < 2.0 mg/dL) and survival rate. Statistical analysis was done with chi2 and Student's t test.Long-term follow-up was available on 28 of 30 patients. Age at biliary drainage was insignificant. Success rates between porto-appendiceal duodenostomy (31%) and Kasai portoenterostomy (82%) were statistically significant. Survival rate for patients who underwent a Kasai portoenterostomy was 10 of 11 patients. Survival rate for patients who underwent porto-appendiceal duodenostomy was 14 of 16 patients. Overall survival rate was comparable between porto-appendiceal duodenostomy (88%) and Kasai portoenterostomy (91%).Although overall survival rate was comparable, patients who underwent porto-appendiceal duodenostomy were less successful in alleviating hyperbilirubinemia compared with Kasai portoenterostomy. This is shown further by the greater incidence of subsequent liver transplantation in infants with prior porto-appendiceal duodenostomy. Although the appendix may serve as an alternative biliary conduit, traditional Kasai portoenterostomy appears to achieve better biliary drainage.

    View details for DOI 10.1016/S0022-3468(03)00180-5

    View details for Web of Science ID 000184156800003

    View details for PubMedID 12861527

  • Fetoscopic temporary tracheal occlusion for congenital diaphragmatic hernia: Prelude to a randomized, controlled trial JOURNAL OF PEDIATRIC SURGERY Harrison, M. R., Sydorak, R. M., Farrell, J. A., KITTERMAN, J. A., Filly, R. A., Albanese, C. T. 2003; 38 (7): 1012-1020


    As previously reported, high postnatal mortality seen in fetuses with congenital diaphragmatic hernia (CDH) with liver herniation and low lung-to-head ratio (LHR) appears to be improved in fetuses who undergo fetoscopic temporary tracheal occlusion (TO). To test whether further evolution of this technique produces results that justify a randomized controlled trial comparing prenatal intervention to postnatal care, the authors analyzed 11 additional cases and the cumulative experience with 19 cases.The authors analyzed retrospectively the outcome of 11 new and 8 previously reported cases of fetoscopic temporary tracheal occlusion. Various factors were studied including maternal morbidity, antenatal outcome, physiologic lung response, and neonatal course.Temporary TO can be accomplished using 3 5-mm radially expanding uterine ports without hysterotomy. Obstetric morbidity included mild pulmonary edema in 6 cases, chorioamniotic separation and premature rupture of membranes in 12 patients, and preterm labor and delivery in all patients. Thirteen of 19 (68%) neonates survived for 90 days after delivery; one died in utero, and 5 died after birth. Late mortality included one death caused by sepsis and 2 by complications associated with tracheostomies. Morbidity from gastroesophageal reflux requiring Nissen fundoplication, tracheal injury requiring repair or tracheostomy, and recurrent hernias after diaphragmatic repair were characteristic in longterm survivors.Fetoscopic temporary TO may improve outcome in poor-prognosis fetuses with CDH. However, complications related to tracheal dissection, premature delivery and late morbidity are significant. This experience has led to simpler techniques for fetoscopic tracheal occlusion and to an National Institutes of Health-sponsored randomized controlled trial comparing fetoscopic tracheal occlusion with optimal postnatal care.

    View details for DOI 10.1016/S0022-3468(03)00182-9

    View details for Web of Science ID 000184156800005

    View details for PubMedID 12861529

  • Minimal access fetal surgery EUROPEAN JOURNAL OF OBSTETRICS & GYNECOLOGY AND REPRODUCTIVE BIOLOGY Danzer, E., Sydorak, R. M., Harrison, M. R., Albanese, C. T. 2003; 108 (1): 3-13


    The development of fetal surgery has led to promising therapeutic options for a number of congenital malformations. However, preterm labor (PTL) and premature rupture of membranes continue to be ubiquitous risks for both mother and fetus. To reduce maternal morbidity and the risk of prematurity, minimal access surgical techniques were developed and are increasingly employed. Congenital diaphragmatic hernia (CDH), obstructive uropathy, twin-to-twin transfusion syndrome (TTTS), and sacrococcygeal teratoma have already been successfully treated using minimal access fetal surgical procedures. Other life-threatening diseases as well as severely disabling but not life-threatening conditions are potentially amenable to treatment. The wider application of minimal access fetal surgery depends on a continued improvement in technology and a better understanding of complications associated with fetal intervention.

    View details for Web of Science ID 000182814700001

    View details for PubMedID 12694962

  • Thoracoscopic lobectomy for prenatally diagnosed lung lesions JOURNAL OF PEDIATRIC SURGERY Albanese, C. T., Sydorak, R. M., Tsao, K., Lee, H. M. 2003; 38 (4): 553-555


    The aim of this report is to assess the technique and outcome of thoracoscopic lobectomy for asymptomatic prenatally diagnosed lung lesions.From June 1999 to March 2002, 14 consecutive asymptomatic patients with a prenatal diagnosis of congenital cystic adenomatoid malformation or pulmonary sequestration, ages 3 to 15 months, underwent postnatal thoracoscopic lobectomy. Single-lung ventilation and controlled pneumothorax with low pressure (4 torr) and low flow (1.0 L/min) were used in all. Follow-up ranged from 4 to 35 months.All procedures were completed successfully using 3 ports. Rather than using stapling devices or clips, pulmonary vessels were sealed and the fissure completed (when necessary) with the Ligasure thermal energy device. Eleven lesions were on the left (10 lower lobe), and 3 were in the right lower lobe. The mean operating time was 110 minutes. The average hospital stay was 38 hours. There were no intraoperative or postoperative complications.This is the first report of a completely thoracoscopic technique for pulmonary lobectomy in small children. Thoracoscopic lobectomy is a relatively quick and safe procedure, and the cosmetic result is excellent. Early resection obviates the risk of infection in these lesions.

    View details for DOI 10.1053/jpsu.2003.50120

    View details for Web of Science ID 000182020600006

    View details for PubMedID 12677564

  • Reversed latissimus dorsi muscle flap for repair of recurrent congenital diaphragmatic hernia JOURNAL OF PEDIATRIC SURGERY Sydorak, R. M., Hoffman, W., LEE, H., Yingling, C. D., Longaker, M., Chang, J., Smith, B., Harrison, M. R., Albanese, C. T. 2003; 38 (3): 296-300


    Neonates with large congenital diaphragmatic hernias (CDH) require prosthetic patch closure of the defect because of the paucity of native diaphragmatic tissue. As the child grows, patch separation can occur necessitating reoperation. Use of vascularized autologous tissue may decrease the incidence of reherniation as tissue incorporation and growth may be improved. The authors report our early experience using a local muscle advancement flap with microneural anastomosis for those children in whom reherniation develops after prosthetic patch placement.Seven patients with CDH (6 left and 1 right) whose synthetic diaphragmatic patch separated from the chest wall resulting in a clinically significant recurrent hernia were followed up with prospectively. After dissecting the ipsilateral latissimus dorsi off the chest wall and dividing the thoracodorsal neurovascular bundle (based on its lumbar blood supply), the synthetic patch was removed via an eighth intercostal incision. The muscle flap was placed into the hemithorax through the bed of the tenth rib and sutured in place over a Vicryl mesh scaffold. The thoracodorsal nerve was anastomosed to the phrenic nerve. Functional analysis of the flap was performed in 4 patients.Age at placement of the muscle graft ranged from 2 months to 48 months (median, 24 months). There has been no evidence of reherniation after placement of the muscle graft. Long-term outcome and functional analysis of the flap was available in 4 patients (mean, 19 months). Two infants had fluoroscopic and sonographic evidence of nonparadoxical neodiaphragmatic motion. In one of these, electromyographic evidence of function was documented with a phrenic nerve conduction velocity of 22 meters per second. The third infant showed no evidence of neodiaphragmatic motion, and the fourth infant had paradoxical motion.This is the first direct documentation of phrenic nerve function in an infant with CDH. An innervated reversed latissimus dorsi (RLD) flap reconstruction for recurrent CDH provides an alternative to prosthetic patch repair. This technique offers the advantages of autologous vascularized tissue with potential phrenic nerve innervation and physiologic neodiaphragmatic motion.

    View details for DOI 10.1053/jpsu.2003.50097

    View details for Web of Science ID 000181293000007

    View details for PubMedID 12632338

  • Resolution of hydrops fetalis in congenital cystic adenomatoid malformation after prenatal steroid therapy JOURNAL OF PEDIATRIC SURGERY Tsao, K. J., Hawgood, S., Vu, L., Hirose, S., Sydorak, R., Albanese, C. T., Farmer, D. L., Harrison, M. R., LEE, H. 2003; 38 (3): 508-510


    Development of hydrops fetalis in fetuses with congenital cystic adenomatoid malformations (CCAM) is a significant risk factor for fetal or neonatal demise. In rare cases, resolution of CCAM has occurred, presumably owing to lesion maturation or involution. Steroid therapy, utilized for lung maturity, has been postulated to accelerate this process. The natural history of hydropic fetuses with CCAM after receiving steroid therapy is presented.The authors prospectively followed up with 3 patients who had antenatally diagnosed CCAM and nonimmune hydrops fetalis with predicted mortality. All patients declined or were not candidates for fetal intervention and were treated with standard prenatal betamethasone to increase lung maturity.Three fetuses had CCAM and nonimmune hydrops fetalis diagnosed prenatally. After a course of prenatal steroids during the second trimester, all 3 patients had resolution of their hydrops and were delivered at term without respiratory distress.Nonimmune hydrops fetalis in fetuses with congenital cystic adenomatoid malformation is a harbinger for fetal demise. The resolution of hydrops in these patients after receiving steroid therapy is an interesting and compelling observation. Because the mechanism of this process is speculative, further studies are needed to elucidate the relationship between antenatal steroids and maturation of congenital cystic adenomatoid malformation.

    View details for DOI 10.1053/jpsu.2003.50089

    View details for Web of Science ID 000181293000072

    View details for PubMedID 12632377

  • Spectrum of intrapartum management strategies for giant fetal cervical teratoma JOURNAL OF PEDIATRIC SURGERY Hirose, S., Sydorak, R. M., Tsao, K., Cauldwell, C. B., Newman, K. D., Mychaliska, G. B., Albanese, C. T., LEE, H., Farmer, D. L. 2003; 38 (3): 446-450


    The management of the fetus with a large neck mass that obstructs the airway remains a clinical challenge. The authors review their experience with giant fetal cervical teratoma and discuss options for management.A retrospective review of all patients referred since 1994 for prenatal management of a fetal neck mass was performed. Variables examined included gestational age at diagnosis and delivery, size and location of the neck mass, presence of fetal hydrops, associated anomalies, management methods, operating time, and outcome.Seven patients were identified with a prenatal diagnosis of giant cervical teratoma. Four patients had fetal hydrops; of these, 2 died in utero of hydrops, and a third fetus underwent elective termination. The remaining hydropic and previable fetus underwent fetal surgery for resection of the mass. The 3 nonhydropic patients underwent ex utero intrapartum treatment (EXIT) procedures for airway control. Endotracheal intubation was possible in one patient, and one received a tracheostomy. In the third fetus, neither intubation nor tracheostomy were possible, and resection of the neck mass was performed on placental support. There were no deaths in the surgical group.The management of fetal giant cervical teratoma includes a spectrum of options. For the rare previable fetus with hydrops, fetal resection may be indicated. In patients with airway obstruction, EXIT procedure provides the luxury of time to obtain airway control either by intubation, tracheostomy, or, if necessary, tumor resection on placental support.

    View details for DOI 10.1053/jpsu.2003.50077

    View details for Web of Science ID 000181293000054

    View details for PubMedID 12632365

  • The lung-to-head ratio and fetoscopic temporary tracheal occlusion: prediction of survival in severe left congenital diaphragmatic hernia ULTRASOUND IN OBSTETRICS & GYNECOLOGY Keller, R. L., Glidden, D. V., Paek, B. W., Goldstein, R. B., Feldstein, V. A., Callen, P. W., Filly, R. A., Albanese, C. T. 2003; 21 (3): 244-249


    To evaluate the reliability of sonographic lung-to-head ratio (LHR) measurement as a predictor of survival in fetuses with congenital diaphragmatic hernia (CDH) and to compare the probability of survival in those with temporary tracheal occlusion (TO) or standard care with respect to the LHR.Fifty-six fetuses with left CDH with liver herniated into the thorax at complete prenatal evaluation were included in logistic regression analyses of antenatal predictors of survival to hospital discharge. Sixteen subjects underwent TO and 40 received standard care.LHR was a significant predictor of survival, with probability of survival increasing with increasing LHR (odds ratio (OR) 8.5, P = 0.04). When subjects with anomalies were excluded, the LHR effect was similar after adjustment for TO (OR 7.1, P = 0.11). Linear spline models suggested a plateau in survival at an LHR of 1.0 and all models suggested increased odds of survival with TO. Minimum LHR measurements had a high degree of inter- and intraobserver agreement (intraclass correlation coefficients of 0.70 and 0.80, respectively).Calculation of the LHR in fetuses with CDH is a reliable and powerful predictor of survival to hospital discharge, although improving odds of survival may plateau at an LHR of 1.0. TO may have an independent benefit on survival to hospital discharge.

    View details for DOI 10.1002/uog.44

    View details for Web of Science ID 000182050500008

    View details for PubMedID 12666218

  • Prenatal sonography and MR imaging of pulmonary sequestration. AJR. American journal of roentgenology Dhingsa, R., Coakley, F. V., Albanese, C. T., Filly, R. A., Goldstein, R. 2003; 180 (2): 433-437

    View details for PubMedID 12540448

  • Minimal access techniques for fetal surgery WORLD JOURNAL OF SURGERY Sydorak, R. M., Albanese, C. T. 2003; 27 (1): 95-102


    The impetus for the development of minimal access techniques for fetal surgery was the unusual occurrence with open hysterotomy of preterm labor, premature rupture of membranes, and the maternal complications resulting from tocolytic therapy. This strategy involves a constellation of techniques that allow surgical procedures to be performed inside the uterus without a hysterotomy. The unique requirements of this approach necessitated modifications of existing endoscopic techniques, development of novel fetoscopic instruments, and utilization of the expertise of a wide variety of specialists. Technical expertise in the field and a natural evolution of techniques have given rise to innovative repairs previously not envisioned. Severe congenital diaphragmatic hernia, diseases of monochorionic twins, and obstructive uropathy have already been successfully treated using fetoscopic surgical techniques. Fetoscopic correction of many other non-life-threatening anomalies continues to evolve. The future of fetoscopic surgical intervention depends on the continual evolution of novel techniques, the elucidation of the pathophysiology and treatment of other fetal disorders, and a better understanding of treatment of complications of intervention.

    View details for DOI 10.1007/s00268-002-6743-4

    View details for Web of Science ID 000180270800015

    View details for PubMedID 12557044

  • Prenatal therapy for thoracic and mediastinal lesions WORLD JOURNAL OF SURGERY Tsao, K. J., Albanese, C. T., Harrison, M. R. 2003; 27 (1): 77-83


    Most prenatally diagnosed lung lesions can be managed successfully during the neonatal period. Prenatal imaging and experimental models have provided a comprehensive understanding of the pathophysiology, natural history, and prognosis of intrathoracic and mediastinal lesions. Clinical experience has demonstrated that progression to nonimmune hydrops fetalis and pulmonary hypoplasia is a harbinger of fetal or neonatal demise. Advances in fetal anesthesia, tocolysis, and surgical techniques have made fetal surgery a viable in utero option to ameliorate life-threatening masses. Congenital cystic adenomatoid malformation, bronchopulmonary sequestration, and congenital hydrothorax are the most common abnormalities amenable to surgical intervention. The natural history, evaluation, and treatment of intrathoracic and mediastinal lesions are discussed.

    View details for DOI 10.1007/s00268-002-6740-7

    View details for Web of Science ID 000180270800012

    View details for PubMedID 12557041

  • Prenatal diagnosis WORLD JOURNAL OF SURGERY Paek, B., Goldberg, J. D., Albanese, C. T. 2003; 27 (1): 27-37

    View details for DOI 10.1007/s00268-002-6734-5

    View details for Web of Science ID 000180270800006

    View details for PubMedID 12557035

  • Prenatal therapy for obstructive uropathy WORLD JOURNAL OF SURGERY Tsao, K. J., Albanese, C. T. 2003; 27 (1): 62-67


    The increasing use of routine prenatal imaging and diagnosis has provided a better understanding of the natural history of obstructive uropathy. Fortunately, most disorders portend little clinical significance prenatally, although a select subset can incur irreversible renal injury and pulmonary hypoplasia depending on the onset, duration, severity, and level of obstruction. In these cases, timely antenatal evaluation and prenatal intervention can provide an optimal postnatal outcome. The natural history, evaluation, and management of fetal obstructive uropathies are discussed.

    View details for DOI 10.1007/s00268-002-6738-1

    View details for Web of Science ID 000180270800010

    View details for PubMedID 12557039

  • Fetal sacrococcygeal teratoma WORLD JOURNAL OF SURGERY Graf, J. L., Albanese, C. T. 2003; 27 (1): 84-86


    Advances in prenatal diagnosis including improvements in ultrasonography have revealed the natural history of fetal sacrococcygeal teratomas, and this natural history differs substantially from that for postnatally diagnosed sacrococcygeal teratoma. A fetal sacrococcygeal teratoma may lead to perinatal morbidity and mortality by a variety of mechanisms. Adverse clinical sequelae of a sacrococcygeal teratoma can be prevented by accurate prenatal assessment and appropriate obstetrical and perinatal management. Development of fetal hydrops and/or placentomegaly predicts fetal demise. Fetal surgical intervention has proven successful in highly selected cases.

    View details for DOI 10.1007/s00268-002-6741-6

    View details for Web of Science ID 000180270800013

    View details for PubMedID 12557042

  • Pathophysiologic patterns influencing fetal surgery WORLD JOURNAL OF SURGERY Sydorak, R. M., Hedrick, M. H., Longaker, M. T., Albanese, C. T. 2003; 27 (1): 45-53


    There are a growing number and variety of fetal disorders that may benefit from intervention prior to birth. Despite the diversity, there are common pathophysiologic denominators or patterns that tie together many seemingly disparate disorders. The purpose of this article was not to review disorders presented in other, accompanying articles but, rather, to present pathophysiologic patterns that common influence fetal surgery within a cohesive framework.

    View details for DOI 10.1007/s00268-002-6736-3

    View details for Web of Science ID 000180270800008

    View details for PubMedID 12557037

  • Giant fetal hepatic hemangioma - Case report and literature review FETAL DIAGNOSIS AND THERAPY Pott Bartsch, E. M., Paek, B. W., Yoshizawa, J., Goldstein, R. B., Ferrell, L. D., Coakley, F. V., Harrison, M. R., Albanese, C. T. 2003; 18 (1): 59-64


    The purpose of this case report is to demonstrate the importance of prenatal imaging for treatment management of fetal giant hepatic hemangiomas. Prenatal ultrasound revealed an abdominal mass with several cystic areas and punctate calcifications in a fetus at 29 weeks' gestation. Doppler scans confirmed the highly vascular nature of the mass. In this case, ultrasound diagnosed the mass was of hepatic origin, while magnetic resonance imaging at 32 weeks' gestation was more equivocal with respect to the anatomy source of the lesion. Imminent hydrops caused by a rapidly enlarged liver tumor was sonographically demonstrated at 34 weeks' gestation. An elective C-section and immediate tumor resection was performed. At the age of 20 months the infant is thriving. This case supports the notion that the survival rates for giant hepatic hemangiomas improve when fetal hydrops is averted and specific pre- and postnatal treatment is applied based on correct prenatal imaging diagnostics.

    View details for DOI 10.1159/000066387

    View details for Web of Science ID 000181165000014

    View details for PubMedID 12566779

  • Fetal endoscopic surgery: Lessons learned and trends reviewed JOURNAL OF PEDIATRIC SURGERY Fowler, S. F., Sydorak, R. M., Albanese, C. T., Farmer, D. L., Harrison, M. R., LEE, H. 2002; 37 (12): 1700-1702


    Fetal surgery is performed increasingly with minimal access approaches. The authors report their experience with fetal endoscopic procedures (fetendo) with emphasis on changing techniques and outcome trends.All fetal endoscopic cases performed at a single institution from January 1996 to August 2001 were reviewed (n = 66). Cases were examined with respect to year performed, type of operation, operative data, and outcome.Twin-twin transfusion syndrome (26 cases) and congenital diaphragmatic hernia (35 cases) were the most common diseases treated. From 1996 to 2001, there was a decrease in average operating time (256 to 127 minutes [P =.0006]), number of ports utilized (3.8 to one [P =.00001]), pump volume (28.7 to 2.7 L [P =.00001]), and estimated blood loss (408 to 29 mL [P =.008]). In addition, port size changed from 10 mm to 5 mm. Chorioamniotic separation (31 of 66), premature rupture of membranes (32 of 66), chorioamnionitis (12 of 66), and fetal death (10 of 66) continued to be significant complications.Fetal endoscopic surgery over the last 6 years has evolved toward shorter operating time, the use of smaller and fewer ports, decreased pump fluid exchange, and decreased blood loss, with the types of cases centered on twin-twin transfusion syndrome and congenital diaphragmatic hernia.

    View details for DOI 10.1053/jpsu.2002.36699

    View details for Web of Science ID 000179661100013

    View details for PubMedID 12483634

  • Fetoscopic treatment for discordant twins JOURNAL OF PEDIATRIC SURGERY Sydorak, R. M., Feldstein, V., Machin, G., Tsao, K., Hirose, S., LEE, H., Farmer, D. L., Harrison, M. R., Albanese, C. T. 2002; 37 (12): 1736-1739


    In rare instances in monochorionic twin pregnancies, one twin can have a discordant anomaly (eg, cystic hygroma). If this twin dies in utero, neurologic injury and death can occur in the surviving cotwin. To protect the normal twin, the authors developed an approach to separate the circulations and ablate the umbilical cord of the abnormal twin.From September 1998 to February 2001, 6 cases of discordant anomalous twins were diagnosed by prenatal ultrasound scan in which the anomaly was lethal or parents desired prenatal termination for this abnormal twin. All underwent surgical intervention with gestational ages varying from 19 to 24 weeks.Depending on cord insertion site and placental anatomy, blood flow was interrupted to the anomalous fetus by either radiofrequency ablation (RFA; 2 cases), cord transection (1 case), or cord transection after laser ablation of communicating vessels (3 cases). Fetal death occurred in one normal twin 4 days postoperatively. Average age at delivery for the 5 surviving fetuses was 34.5 weeks' gestation. On follow-up, all surviving infants are neurologically intact.An otherwise normal monochorionic twin threatened by an anomalous cotwin can be salvaged successfully with a strategy tailored to interrupt the vascular connections between the 2 twins.

    View details for DOI 10.1053/jpsu.2002.36709

    View details for Web of Science ID 000179661100023

    View details for PubMedID 12483644

  • Gastroschisis: Small hole, big cost JOURNAL OF PEDIATRIC SURGERY Sydorak, R. M., Nijagal, A., Sbragia, L., Hirose, S., Tsao, K., Phibbs, R. H., Schmitt, S. K., LEE, H., Farmer, D. L., Harrison, M. R., Albanese, C. T. 2002; 37 (12): 1669-1672


    This study was designed to assess the outcome and financial costs incurred for the treatment of gastroschisis.A retrospective analysis was conducted of all patients with gastroschisis at a single institution over the past decade (n = 69). Hospital costs were determined and standardized to December 2001 dollars.Of the 69 patients, average gestational age at delivery was 35.9 weeks. Thirty-six patients had a primary fascial closure; 33 had a silo placed. The mean time to first feeding was 22 days and full feeding, 33 days. Average length of stay was 47 days. There were 3 deaths (2 shortly after birth, and one 131 days later owing to sepsis). The average cost of hospitalization and physician fees for patients with gastroschisis was $123,200. Using multivariate regression analysis, significant variables (P <.05) associated with cost of hospitalization were number of operative procedures, ventilatory days, male gender, and length of stay. Room expenses (43%), physician fees (15%), respiratory and pulmonary care (10%), and supply and devices (10%) made up the majority of costs.Cost of care associated with treatment for gastroschisis is high. Strategies designed to reduce cost must limit gastrointestinal, respiratory, and operative complications and reduce length of stay.

    View details for DOI 10.1053/jpsu.2002.36689

    View details for Web of Science ID 000179661100005

    View details for PubMedID 12483626

  • Congenital diaphragmatic hernia and hydrops: A lethal association? JOURNAL OF PEDIATRIC SURGERY Sydorak, R. M., Goldstein, R., Hirose, S., Tsao, K., Farmer, D. L., LEE, H., Harrison, M. R., Albanese, C. T. 2002; 37 (12): 1678-1680


    Nonimmune hydrops in the fetus is a finding that often portends death. The association and prognosis of fetuses with congenital diaphragmatic hernia (CDH) and hydrops is not known.A retrospective review of all prenatally diagnosed cases and referrals of CDH was performed. Variables analyzed included gestational age at diagnosis and delivery, side of hernia, presence of associated anomalies and hydrops, and neonatal outcome.Since 1993, 474 prenatal referrals for CDH have been made. One hundred seventy-five were evaluated; 15 fetuses had hydrops (9%). Five patients had CDH, hydrops, and associated lethal anomalies. In the remaining 10 patients, 6 of the diaphragmatic defects were right-sided and 4 were left-sided. All except one had a major portion of the liver herniated into the chest. Six fetuses had prenatal intervention. Five neonates died shortly after birth. There were 5 long-term survivors; all received prenatal intervention.The association of CDH and hydrops is rare but often results in fatality. Hydrops appears to be associated with liver in the hernia, right-sided lesions, and lethal anomalies. Fetal intervention can be performed successfully in patients with CDH and hydrops, and may improve long-term survival rate in this group.

    View details for DOI 10.1053/jpsu.2002.36691

    View details for Web of Science ID 000179661100007

    View details for PubMedID 12483628

  • Laparoscopic repair of high imperforate anus. Seminars in pediatric surgery Sydorak, R. M., Albanese, C. T. 2002; 11 (4): 217-225


    Numerous laparoscopic operations have replaced the traditional open procedure in both adults and children. These new procedures have allowed access to body cavities without significantly traumatizing intervening tissue. The laparoscopically assisted anorectal pull-through (LAARP) for high anorectal malformations (ARM) uses fundamental concepts learned from decades of high ARM repair and incorporates modern technologic advancements in surgical instrumentation and techniques. This laparoscopic approach offers good visualization of an infant's deep pelvis with a reconstruction technique that minimizes trauma to important surrounding structures. The laparoscopic repair can be completed in one stage, 2 stages, or 3 stages. Currently, either the 2-stage or 3-stage operation is recommended. With the 3-stage approach, a temporary colostomy is created initially followed by LAARP in several weeks to months. The colostomy then is closed several months later.

    View details for PubMedID 12407503

  • Fetal therapy for giant hepatic cysts. Journal of pediatric surgery Tsao, K., Hirose, S., Sydorak, R., Goldstein, R. B., Machin, G. A., Albanese, C. T., Farmer, D. L. 2002; 37 (10): E31-?


    Cystic mesenchymal hamartoma is an extremely rare, benign tumor. Rapid growth to a giant size can pose a threat not only in early childhood but also during fetal life. The experience with 2 antenatally diagnosed giant hepatic cysts with widely disparate approaches to management, treatment, and outcome is presented. A giant hepatic cyst was diagnosed on routine screening ultrasound scan. Because of its extremely massive size, the cyst was treated in utero with repeated aspirations, primarily for obstetric considerations. The infant did well, and the lesion was excised laparoscopically during the neonatal period. A second fetus with a giant hepatic cyst was not treated in utero, and the pregnancy continued to term. Nonimmune hydrops fetalis developed, and the fetus was delivered prematurely at 34 weeks. At birth, the infant was noted to have diffuse neurologic injury and no urine output despite normal-appearing kidneys. The lesion was excised during the neonatal period by open laparotomy. Observations at the time of surgery and pathologic studies of the placenta showed aneurysmal dilatation of the placental veins suggesting in utero compression of the fetal intraabdominal umbilical vein. The infant died shortly after birth. The experience with these 2 cases suggests the possibility that giant mesenchymal hamartoma diagnosed in utero may cause umbilical venous obstruction leading to ischemia during fetal life. Decompression of giant hepatic cysts may reverse this phenomenon and allow normal fetal development.

    View details for PubMedID 12378477

  • Selective reduction of acardiac twin by radiofrequency ablation AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY Tsao, K., Feldstein, V. A., Albanese, C. T., Sandberg, P. L., LEE, H., Harrison, M. R., Farmer, D. L. 2002; 187 (3): 635-640


    Acardiac/acephalic twinning is a rare anomaly in which a normal "pump" twin perfuses an acardiac twin, which results in twin reversed arterial perfusion sequence. A novel technique for selective reduction and obliteration of blood flow in the acardiac twin is described.Thirteen consecutive cases of monochorionic twin gestation with twin reversed arterial perfusion sequence underwent selective reduction of the abnormal twin with the use of radiofrequency ablation. Under direct real-time sonographic guidance, a 3-mm (14-gauge) radiofrequency ablation needle was percutaneously inserted through the maternal abdominal wall into the intrauterine fetal abdomen at the level of the cord insertion site of the acardiac twin. Energy was applied until termination of blood flow to the acardiac fetus was documented by Doppler ultrasound scanning.All 13 mothers tolerated the procedure without major complications. All 13 "pump" fetuses have been delivered. Twelve of 13 infants are alive and well. The first patient in this series was delivered at 24.4 weeks and the infant subsequently died from complications of prematurity. Average gestational age at intervention was 20.7 weeks, and the average gestational age at delivery was 36.2 weeks.Radiofrequency ablation is a minimally invasive, percutaneous technique that can effectively obliterate blood supply to an acardiac twin to preserve and protect the pump twin.

    View details for DOI 10.1067/mob.2002.125242

    View details for Web of Science ID 000178256400020

    View details for PubMedID 12237640

  • Laparoscopic antireflux procedures in children: evaluating the evidence. Seminars in laparoscopic surgery Sydorak, R. M., Albanese, C. T. 2002; 9 (3): 133-138


    A growing number of the pediatric antireflux procedures are performed laparoscopically. Although there are no prospective randomized studies comparing conventional open surgery to laparoscopic surgery, there are retrospective and anecdotal data suggesting that the laparoscopic approach is at least as good and, in many cases, better than the open procedure. Once the significant learning curve is achieved, one may attain similar operative times with the benefit of magnification and enhanced visualization of the operative field compared to open surgery. The greatest benefits of laparoscopic antireflux surgery are the cosmetic result, a decrease in postoperative analgesia requirements, and an earlier return to normal daily life for both parents and their children.

    View details for PubMedID 12407520

  • Successful fetal intervention for congenital high airway obstruction syndrome FETAL DIAGNOSIS AND THERAPY Paek, B. W., Callen, P. W., KITTERMAN, J., Feldstein, V. A., Farrell, J., Harrison, M. R., Albanese, C. T. 2002; 17 (5): 272-276


    Complete congenital high airway obstruction syndrome (CHAOS) usually leads to stillbirth or death within minutes of delivery. We describe the management and long-term follow-up of a baby with a prenatally diagnosed airway obstruction.Because of progressive hydrops fetalis, massive ascites and everted diaphragms due to CHAOS in a fetus at 24 weeks of gestation, a fetal tracheostomy was performed. Persistent fetal bradycardia at the time of the fetal procedure led to delivery of the infant. Adequate oxygenation and ventilation were attained using relatively low oxygen concentrations and low ventilatory pressures. Plain radiographs demonstrated that the lungs were large and the ribs thin. The infant has a permanent tracheostomy, required continuous assisted ventilation for several months and assisted ventilation at night at home for 3 years. At 4 years of age, he has no speech, all feedings are by gastrostomy, and developmentally he is mildly to moderately delayed.Laryngeal atresia produced over-distended lungs and hydrops. Precise prenatal imaging and fetal surgical strategies may allow the survival of affected fetuses.

    View details for Web of Science ID 000177631000004

    View details for PubMedID 12169810

  • Prenatal resection of a fetal pericardial teratoma FETAL DIAGNOSIS AND THERAPY Sydorak, R. M., Kelly, T., Feldstein, V. A., Sandberg, P. L., Silverman, N. H., Harrison, M. R., Albanese, C. T. 2002; 17 (5): 281-285


    Pericardial teratomas are rare congenital tumors which invade the developing mediastinum, compressing the venous return to the heart, leading to hydrops. Tumors, with large cystic components, have been treated previously with in utero pericardiocentesis with some success. We present the first reported case of in utero open resection of a fetal pericardial teratoma.A 31-year-old G1P0 woman was found to have a fetus with a pericardial teratoma. Hydrops developed at 24 weeks' gestation. After counseling, open fetal resection was performed via a fetal median sternotomy.Although the tumor was successfully removed, the hydrops did not resolve. In addition, over the course of 3 weeks, the mother developed maternal mirror syndrome which prompted an emergent cesarean section. Neonatal death ensued shortly after birth.The fetus with a pericardial teratoma complicated by hydrops is compromised. Treatment options include early delivery, aspiration of the pericardial effusion, and in utero operative resection.

    View details for Web of Science ID 000177631000006

    View details for PubMedID 12169812

  • Chorioamniotic membrane separation following fetal surgery. Journal of perinatology Sydorak, R. M., Hirose, S., Sandberg, P. L., Filly, R. A., Harrison, M. R., Farmer, D. L., Albanese, C. T. 2002; 22 (5): 407-410


    As the volume of fetal surgery cases has steadily increased, an increasing incidence of chorioamniotic membrane separation (CMS) has been noted. Due to the potential adverse consequences from this abnormality, we reviewed the last decade of experience with fetal intervention at our institution and examined the incidence and outcomes of fetuses given this diagnosis.A retrospective chart review of 75 fetal surgery cases at our institution was performed. Variables analyzed included preoperative, operative, and outcome data. Postoperative ultrasounds were evaluated for the presence of CMS.Excluding operative deaths, the incidence of CMS was 47%. There were significant differences (p<0.05) in time to delivery (7 vs 5 weeks), cases using a perfusion pump (80% vs 60%), and number of trocars (2.13 vs 1.54) in cases of CMS versus those without. Ultrasounds showed normal to high levels of amniotic fluid in 97% of cases. There was an increased incidence of premature rupture of membranes (63% vs 45%), preterm labor (57% vs 38%), and chorioamnionitis (29% vs 15%) with CMS, but no difference in mortality rate.CMS is a frequent finding following fetal surgery. It is associated with significant morbidity but is manageable with close follow-up in a hospital setting. Following fetal surgery, the finding of CMS can be a life-threatening complication that warrants further study to understand its etiology and prevention.

    View details for PubMedID 12082478

  • Short-term maternal outcomes that are associated with the EXIT procedure, as compared with cesarean delivery AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY Noah, M. M., Norton, M. E., Sandberg, P., Esakoff, T., Farrell, J., Albanese, C. T. 2002; 186 (4): 773-777


    The ex utero intrapartum treatment procedure was developed to treat iatrogenic tracheal obstruction that resulted from in utero fetal therapy for congenital diaphragmatic hernia. The ex utero intrapartum treatment procedure allows for controlled intubation while the neonate is maintained on placental circulation, prolonging operative time. This study evaluates whether there is increased maternal morbidity associated with this procedure compared with routine cesarean deliveries.Maternal outcomes on 34 patients who underwent the ex utero intrapartum treatment procedure were evaluated. Infection rate, estimated blood loss, need for transfusion, and length of postoperative hospital stay were compared to maternal outcomes from 52 non-laboring patients who underwent non-emergent primary cesarean delivery of singleton fetuses during the same time interval.The rate of chorioamnionitis was similar between groups (26% vs 21%; P =.57). Postpartum wound complications were more common in patients who underwent ex utero intrapartum treatment (15% vs 2%; P =.03), although the rate of endometritis was similar (15% vs 10%; P =.50). Estimated blood loss was higher in the patients who underwent ex utero intrapartum treatment (1104 mL vs 883 mL; P <.001), but there was no difference between groups in hematocrit level change or postpartum hospital stay.Women who undergo the ex utero intrapartum treatment procedure experience more wound complications but no difference in postoperative hematocrit level change or postpartum length of stay.

    View details for DOI 10.1067/mob.2002.112249

    View details for Web of Science ID 000175545300029

    View details for PubMedID 11967506

  • Endoscopic techniques in fetal surgery YONSEI MEDICAL JOURNAL Sydorak, R. M., Nijagal, A., Albanese, C. T. 2001; 42 (6): 695-710


    Fetal endoscopic surgery (FETENDO) involves many techniques that allow surgical procedures to be performed inside the uterus without an hysterotomy. The impetus for developing these minimal access techniques for fetal surgery is the unusual occurrence with an open hysterotomy of preterm labor, premature rupture of membranes, and maternal complications resulting from tocolytic therapy. The unique requirements of this approach necessitated a modification of existing endoscopic techniques, the development of novel fetoscopic instruments, and the inclusion of a wide variety of specialists. Technical expertise in the field and a natural evolution of techniques have given rise to innovative repairs previously not envisioned. Severe congenital diaphragmatic hernia, diseases of monochorionic twins, and obstructive uropathy have already been successfully treated using fetoscopic surgical techniques. Fetoscopic correction of many other non-life threatening anomalies continues to evolve. The future of fetoscopic surgical intervention depends on the continual evolution of novel approaches to disease, the elucidation of the pathophysiology and treatment of other fetal disorders, and a better understanding of treatment of complications of such intervention.

    View details for Web of Science ID 000173016100014

    View details for PubMedID 11754153

  • Fetal surgical therapy for severe congenital malformations ZEITSCHRIFT FUR GEBURTSHILFE UND NEONATOLOGIE Danzer, E., Schier, F., Paek, B., Harrison, M. R., Albanese, C. T. 2001; 205 (5): 174-?


    Over the past two decades the diagnosis of life threatening congenital malformations has evolved rapidly. Sophisticated and powerful new imaging and sampling techniques have stripped the veil of mystery from the once secretive fetus. Early detection and close follow-up of the fetus with congenital malformations have allowed us to define their natural history, determine the clinical features that affect clinical outcome, and plan management approaches to improve prognosis. Fetal surgical intervention is the logical culmination of the progress in fetal diagnosis. The purpose of this article is to describe the current techniques and recent advances in prenatal diagnosis and fetal intervention of severe congenital malformation.A complete review of the literature and our own experience concerning fetal surgery was performed.Although most prenatally diagnosed malformations are best managed by appropriate medical and surgical therapy after maternal transport and planned delivery at a tertiary care center, an expanding number of simple anatomical abnormalities with predictable, lethal consequences have been successfully corrected before birth. A malformation amenable to prenatal surgical intervention must fulfill a number of conditions. It must be severe enough to warrant the risks associated with in utero treatment and must be reliably detectable before birth. Additionally, the pathophysiology must be reversible by fetal surgery, significantly improving the prognosis over post-natal treatment. Many technical intricacies of open fetal surgery have been solved, but pre-term labor and premature rupture of membranes remain a omnipresent risks to both the mother and the fetus. To reduce maternal morbidity and the risk of prematurity we developed minimally invasive techniques to treat the fetus prenatally. Current indications of fetal surgery include the treatment of congenital diaphragmatic hernia, cystic adenomatoid malformation of the lung, sacrococcygeal teratoma, obstructive uropathy, twin-to-twin-transfusion-syndrome and myelomeningocele. Minimally invasive surgical techniques (FETENDO) have significantly lessened the incidence of preterm labor and promise to extend the indications for fetal surgical intervention.Fetal surgical therapy for severe congenital malformations may improve the outcome of selected patients. The development of FETENDO will in all probability reduce the importance of open fetal surgery in the future.

    View details for Web of Science ID 000172197100002

    View details for PubMedID 11727664

  • Fetoscopic temporary tracheal occlusion by means of detachable balloon for congenital diaphragmatic hernia AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY Harrison, M. R., Albanese, C. T., Hawgood, S. B., Farmer, D. L., Farrell, J. A., Sandberg, P. L., Fillly, R. A. 2001; 185 (3): 730-733


    Occlusion of the fetal trachea blocks the egress of fetal lung fluid and stimulates the growth of hypoplastic lungs in fetuses with diaphragmatic hernia. Accomplishing temporary and reversible occlusion of the fetal trachea has proven difficult without invasive fetal surgery. Using simultaneous real-time ultrasonography and fetal bronchoscopy through a single uterine port, we placed a detachable balloon in the trachea of 2 fetuses with severe diaphragmatic hernia. In both fetuses the fetal lung subsequently enlarged, allowing survival after birth.

    View details for Web of Science ID 000171164600034

    View details for PubMedID 11568805

  • Pylephlebitis, portal-mesenteric thrombosis, and multiple liver abscesses owing to perforated appendicitis. Journal of pediatric surgery Chang, T. N., Tang, L., Keller, K., Harrison, M. R., Farmer, D. L., Albanese, C. T. 2001; 36 (9): E19-?


    The authors report a case of a ruptured retrocecal appendix presenting with pylephlebitis, portal-mesenteric thrombosis, and multiple liver abscesses in an 8-year-old boy. A right hemicolectomy was performed, and liver abscesses were drained. The patient was treated with long-term antibiotics and anticoagulation. This the only case of perforated appendicitis associated with these 3 morbid complications in the modern literature.

    View details for PubMedID 11528636

  • Outcome of prenatally diagnosed solid fetal tumors Sbragia, L., Paek, B. W., Feldstein, V. A., Farrell, J. A., Harrison, M. R., Albanese, C. T., Farmer, D. L. W B SAUNDERS CO-ELSEVIER INC. 2001: 1244-1247


    In the last 10 years, the ability to diagnose fetal tumors in the prenatal period has improved greatly because of technical advances in imaging. Early diagnosis and determination of tumor may affect prognosis.The authors retrospectively reviewed the records of 1316 fetuses who underwent sonographic evaluation for congenital defects at University of California-San Francisco over a 6-year period. Of these, 16 had fetal tumors and were followed up at our institution. There were solid or predominantely solid with small cystic component masses in one of 3 locations: cervical, mediastinal, or abdominal. Excluded from our study were those fetuses with either sacrococcygeal teratoma, congenital cystic adenomatoid malformation of the lung, or ovarian cyst, because these defects have been extensively reviewed elsewhere. In addition, masses that were primarily cystic also were excluded. Data collected included diagnosis, gestational age at diagnosis and at delivery, mode of delivery, fetal and neonatal survival, and disease confirmation.Of the 16 fetuses, 4 had mediastinal tumors: 2 with pericardial teratomas (both of whom died in utero) and 2 with cardiac rhabdomyomas (1 died; the other presented tuberous sclerosis and is alive at 2 years of age). Four patients had cervical tumors (3 died; 1 survived and is alive and well), and 8 had abdominal tumors (3 with liver tumors, 4 with a left adrenal mass, and 1 with retroperitoneal teratoma). All eight patients with an abdominal tumor are alive and well.Fetal tumors are rare, and the prognosis seems to depend on their location and size. Although easier to detect, cervical and mediastinal tumors have a worse prognosis. Abdominal masses are more difficult to detect but have a better prognosis.

    View details for Web of Science ID 000170120300032

    View details for PubMedID 11479867

  • Laparoscopic Heller myotomy and Dor fundoplication for esophageal achalasia in children Patti, M. G., Albanese, C. T., Holcomb, G. W., Molena, D., Fisichella, P. M., Perretta, S., Way, L. W. W B SAUNDERS CO-ELSEVIER INC. 2001: 1248-1251


    In the past, surgical treatment in achalasia usually has been reserved for patients whose dysphagia does not respond to pneumatic dilatation. The success of minimally invasive myotomy, however, has resulted in a shift in practice in adult patients, whereby laparoscopic surgery is becoming preferred as primary treatment by most gastroenterologists and surgeons. The aim of this study was to assess the efficacy of laparoscopic Heller myotomy and Dor fundoplication for esophageal achalasia in children.Thirteen patients with esophageal achalasia (median age, 15 years; 6 boys and 7 girls; median duration of symptoms, 24 months) underwent laparoscopic Heller myotomy and Dor fundoplication between 1996 and 1999. Two patients had been treated previously by pneumatic dilatation, and 1 patient had received intrasphincteric Botulinum toxin injections.Median duration of the operation was 130 minutes. The patients were fed after an average of 33 hours, and they all left the hospital within 2 days. At a median follow-up of 19 months, there was no residual dysphagia in any patient.Laparoscopic Heller myotomy and Dor fundoplication were effective and safe for children with esophageal achalasia. Hospital stay and recovery time was short, and the functional results were excellent. These data support the notion that laparoscopic Heller myotomy should become the primary treatment of esophageal achalasia in children.

    View details for Web of Science ID 000170120300033

    View details for PubMedID 11479868

  • Congenital diaphragmatic hernia: Prenatal evaluation with MR lung volumetry-preliminary experience RADIOLOGY Paek, B. W., Coakley, F. V., Lu, Y., Filly, R. A., Lopoo, J. B., Qayyum, A., Harrison, M. R., Albanese, C. T. 2001; 220 (1): 63-67


    To determine the interobserver variability of prenatal magnetic resonance (MR) lung volumetry and to assess the value of MR lung volumetric findings as predictors of outcome in fetuses with congenital diaphragmatic hernia.Prenatal MR imaging was performed in 26 fetuses with unilateral congenital diaphragmatic hernia. Two independent observers performed planimetric measurement of lung volume. Relative lung volume was calculated as the observed total lung volume expressed as a percentage of the total lung volume predicted from fetal size. Relative lung volume was correlated with the ultrasonographic lung-head ratio in left-sided congenital diaphragmatic hernias evaluated before 27 weeks gestation (n = 21) and with pregnancy outcome in all cases of isolated left-sided congenital diaphragmatic hernia without prenatal intervention (n = 11).Observers demonstrated excellent agreement in total lung volume measurements at MR imaging, with an intraclass correlation coefficient of 0.95. Relative lung volume was positively correlated with lung-head ratio (r = 0.78, P <.001). By using rank order analysis in the pregnancy outcome group, relative lung volume was predictive of prognosis (P <.05) when adjusted for gestational age at delivery and birth weight. Three of four fetuses with a relative lung volume of less than 40% died.Interobserver agreement is high at MR lung volumetry, and its findings are predictive of outcome in fetuses with isolated left-sided congenital diaphragmatic hernia.

    View details for Web of Science ID 000169468400009

    View details for PubMedID 11425973

  • Coccidioides immitis in the gallbladder and biliary tree JOURNAL OF PEDIATRIC SURGERY Sydorak, R. M., Albanese, C. T., Chen, Y. Y., Weintraub, P., Farmer, D. 2001; 36 (7): 1054-1056


    Intraabdominal coccidioidomycosis is a very rare entity and usually responds to medical therapy. Operative intervention is reserved for diagnosis or drainage of localized collections. With biliary coccidioidomycosis, medical treatment appears to be ineffective, and biliary tract drainage is necessary for optimal management. A case of coccidioidomycosis in the gallbladder and biliary tree is described and the literature reviewed.

    View details for Web of Science ID 000169653400019

    View details for PubMedID 11431776

  • Congenital diaphragmatic hernia associated with a gastroesophageal duplication cyst: A case report JOURNAL OF PEDIATRIC SURGERY Danzer, E., Paek, B. W., Farmer, D. L., Poulain, F. R., Farrell, J. A., Harrison, M. R., Albanese, C. T. 2001; 36 (4): 626-628


    Severe left congenital diaphragmatic hernia was diagnosed in a baby prenatally, and she underwent hernia repair on the sixth postnatal day of life. She was found to have a huge symptomatic gastroesophageal duplication cyst on day 24 of life. A thoracoabdominal dissection allowed successful cyst excision. J Pediatr Surg 36:626-628.

    View details for Web of Science ID 000167792300020

    View details for PubMedID 11283892

  • Fetal surgery for myelomeningocele CURRENT OPINION IN OBSTETRICS & GYNECOLOGY Hirose, S., Farmer, D. L., Albanese, C. T. 2001; 13 (2): 215-222


    Myelomeningocele is a devastating birth defect affecting a significant number of live births worldwide. Prenatal repair of myelomeningocele has been performed in the United States for 5 years with mixed results. The initial intent was to preserve distal neurological function by covering the exposed spinal cord. Although there has been relatively little effect on distal sensorimotor function, prenatal repair serendipitously led to an apparent reduction in hindbrain herniation and a possible decreased need for ventriculoperitoneal shunting. The long-term clinical consequences of these findings are not clear. What is clear, however, is that further study in the form of a prospective, randomized trial is mandatory.

    View details for Web of Science ID 000168001000017

    View details for PubMedID 11315877

  • Safety of chronic feta vascular access in the sheep model FETAL DIAGNOSIS AND THERAPY Paek, B. W., Lopoo, J. B., Jennings, R. W., Farmer, D. L., Albanese, C. T., Harrison, M. R. 2001; 16 (2): 98-100


    Long-term access to the fetal circulation has the potential to open up new perspectives in the treatment of numerous fetal anomalies. The purpose of this study was to investigate the safety of long-term catheterization of fetal placental vessels.A midline laparotomy was performed in 4 time-mated pregnant ewes at 125 days' gestation (term 145 days). Placental vessels were exposed by a small uterine incision. A specially designed catheter was inserted into a placental vessel over a length of 3 cm, the distal end of the catheter was tunneled underneath the maternal skin and attached to a subcutaneous port implanted in the maternal flank. All pregnancies were allowed to go to term.Ewes and fetuses tolerated the placement of the catheter and port without complications. The catheter remained patent in all cases. All lambs were delivered vaginally at term and did not require resuscitation after birth. No fetal anomalies or growth restriction were noted.The ovine placental vessel can be accessed long term without complication.

    View details for Web of Science ID 000167106900006

    View details for PubMedID 11173956

  • Radiofrequency ablation of human fetal sacrococcygeal teratoma AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY Paek, B. W., Jennings, R. W., Harrison, M. R., Filly, R. A., Tacy, T. A., Farmer, D. L., Albanese, C. T. 2001; 184 (3): 503-507


    Fetuses with solid, highly vascularized sacrococcygeal teratomas can die as a result of the vascular steal syndrome. This is the first report in which a percutaneous technique, radiofrequency ablation, was used to interrupt blood flow to a sacrococcygeal teratoma in 4 human fetuses.A radiofrequency ablation probe was percutaneously inserted into the fetal tumor under ultrasonographic guidance. In 2 fetuses a significant portion of the tumor mass was ablated, whereas in the other 2 fetuses only the major feeding vessels were targeted.Two infants were delivered at 28 and 31 weeks' gestation, respectively, and are doing well. In 2 other cases hemorrhage into the tumor led to an unfavorable fetal outcome.Ablation of a majority of the tumor tissue in sacrococcygeal teratoma is not necessary and proved fatal in two instances. Targeted ablation of the feeding tumor vessels diminishes blood flow sufficiently to reverse high-output fetal heart failure.

    View details for Web of Science ID 000167306100041

    View details for PubMedID 11228510

  • Transplantation of a fetus with paternal Thy-1(+)CD34(+) cells for chronic granulomatous disease BONE MARROW TRANSPLANTATION Muench, M. O., Rae, J., Barcena, A., Leemhuis, T., Farrell, J., Humeau, L., Maxwell-Wiggins, J. R., Capper, J., Mychaliska, G. B., Albanese, C. T., Martin, T., Tsukamoto, A., Curnutte, J. T., Harrison, M. R. 2001; 27 (4): 355-364


    A fetus diagnosed with X-linked chronic granulomatous disease was transplanted with Thy-1(+)CD34(+) cells of paternal origin. The transplant was performed at 14 weeks gestation by ultrasound guided injection into the peritoneal cavity. The fetus was delivered at 38 weeks gestation after an otherwise uneventful pregnancy. Umbilical cord blood was collected and used to determine the level of peripheral blood chimerism as well as levels of functional engrafted cells. Flow cytometry was used to detect donor leukocytes identified as HLA-A2(-)B7(+) cells, whereas recipient cells were identified as HLA-A2(+)B7(-) cells. No evidence of donor cell engraftment above a level of 0.01% was found. PCR was used to detect HLA-DRB1*15(+) donor cells among the recipient's HLA-DRB1*15(-) cells, but no engraftment was seen with a sensitivity of 1:1000. The presence of functional, donor-derived neutrophils was assessed by flow cytometry using two different fluorescent dyes that measure reactive oxygen species generated by the phagocyte NADPH oxidase. No evidence of paternal-derived functional neutrophils above a level of 0.15% was observed. Peripheral blood and bone marrow samples were collected at 6 months of age. Neither sample showed engraftment by HLA typing using both flow cytometry and PCR. Functional phagocytes were also not observed. Furthermore, no indication of immunological tolerance specific for the donor cells was indicated by a mixed lymphocyte reaction assay performed at 6 months of age. While there appears to be no engraftment of the donor stem cells, the transplant caused no harm to the fetus and the child was healthy at 6 months of age. Analyses of fetal tissues, obtained from elective abortions, revealed that CD3(+) T cells and CD56(+)CD3(-) NK cells are present in the liver at 8 weeks gestation and in the blood by 9 weeks gestation. The presence of these lymphocytes may contribute to the lack of donor cell engraftment in the human fetus.

    View details for Web of Science ID 000167443500002

    View details for PubMedID 11313664

  • Major complications after minimally invasive repair of pectus excavatum: Case reports Moss, R. L., Albanese, C. T., Reynolds, M. W B SAUNDERS CO-ELSEVIER INC. 2001: 155-158


    A recently introduced technique allows for minimally invasive repair of pectus excavatum deformity. Successful application of the procedure has been reported by several centers. The purpose of this report is to describe the occurrence of 3 major complications in 5 patients.These cases are taken from the combined experience of 3 surgeons at different institutions. Operative technique and postoperative management was not uniform.The first complication was cardiac perforation requiring repair. This occurred in an 8-year-old boy who had hemorrhage immediately after transthoracic placement of the clamp. He required urgent sternotomy with right atrial, and right ventricle repair followed by tricuspid valve repair on cardiopulmonary bypass. The second complication is staphylococcal sepsis, bilateral empyema thoracis, and bacterial pericarditis. This 13-year-old boy required bilateral pleural debridement followed 2 days later by open debridement of his heart. The final complication is thoracic outlet syndrome. These patients, age 12, 14, and 15, experienced persistent parasthesias in one upper extremity. One case was further complicated by instability of the bar requiring removal. In the other 2 patients, the symptoms resolved within 4 weeks with the bar in place.Minimally invasive pectus repair is a new surgical procedure. The spectrum and rate of complications is still emerging. Thorough and critical evaluation of the combined experience from many centers is essential to evaluate fully this novel approach to pectus repair.

    View details for Web of Science ID 000166180500028

    View details for PubMedID 11150456

  • Congenital diaphragmatic hernia without herniation of the liver: Does the lung-to-head ratio predict survival? JOURNAL OF ULTRASOUND IN MEDICINE Sbragia, L., Paek, B. W., Filly, R. A., Harrison, M. R., Farrell, J. A., Farmer, D. L., Albanese, C. T. 2000; 19 (12): 845-848


    The purpose of the present study was to determine the ability of lung-to-head ratio to predict survival and need for extracorporeal membrane oxygenation support in fetuses with left congenital diaphragmatic hernia without herniation of the liver into the chest. The perinatal records of 20 fetuses with isolated left congenital diaphragmatic hernia without herniation of the left lobe of the liver into the chest were reviewed. Fetuses were stratified into two groups depending on lung-to-head ratio: those with a ratio of less than 1.4 (historically a poor prognosis group) and those with a ratio of greater than 1.4. The outcome of both groups was compared with chi-square analysis. Eight of 11 fetuses with a lung-to-head ratio greater than 1.4 survived, whereas 8 of 9 fetuses with a ratio of less than 1.4 survived. No differences were noted in the need for extracorporeal membrane oxygenation support or survival between the two groups. Fetuses with a prenatally diagnosed left congenital diaphragmatic hernia without herniation of liver into the chest have a favorable prognosis even in the presence of a low lung-to-head ratio.

    View details for Web of Science ID 000167755000006

    View details for PubMedID 11127009

  • Balloon tracheal occlusion for congenital diaphragmatic hernia: Experimental studies Chiba, T., Albanese, C. T., Farmer, D. L., Dowd, C. F., Filly, R. A., Machin, G. A., Harrison, M. R. W B SAUNDERS CO-ELSEVIER INC. 2000: 1566-1570


    Temporary tracheal occlusion is an effective strategy to enlarge fetal lungs, but the optimal technique to accomplish occlusion is unknown. External clips are effective when applied fetoscopically (Fetendo clip), but require a difficult fetal neck dissection. This study was undertaken to assess the feasibility of intratracheal balloon occlusion, revisiting the internal occlusion strategy.(1) The internal diameter (ID) of human fetal trachea (53 fetuses; 14 to 41 weeks' gestation) was compared using a computer-assisted image analyzer and sonography, ex vivo. (2) Volume to diameter relationship of the balloon (balloon configuration curve) was defined using an image analyzing computer. (3) Using the trachea of fetal sheep, pressures that break balloon tracheal seal (seal pressure) were investigated.(1) Between 16 and 41 weeks' gestation, tracheal ID (range, 0.7 to 5.4 mm) correlates significantly with gestational age. (2) Balloon volume required to achieve tracheal seal could be determined based on the tracheal growth curve and the balloon configuration curve. (3) Tracheal seal breaking points varied depending on the tracheal specimen tested.Internal tracheal occlusion using a balloon is feasible with minimal tracheal damage if the balloon volume is adjusted to fetal tracheal growth.

    View details for Web of Science ID 000165100100009

    View details for PubMedID 11083424

  • Tracheal stenosis: The long and the short of it Acosta, A. C., Albanese, C. T., Farmer, D. L., Sydorak, R., Danzer, E., Harrison, M. R. W B SAUNDERS CO-ELSEVIER INC. 2000: 1612-1616


    The aim of this study was to present slide tracheoplasty as the procedure of choice for tracheal stenosis. From 1990 through 1997, patients referred to University of California, San Francisco for tracheal stenosis were managed by resection and anastomosis. During this period, other centers reported successful use of slide tracheoplasty and, from 1998 to 1999, we performed 3 slide tracheoplasties in addition to 3 more resection and anastomosis procedures.Between 1990 and 1999, 9 patients with tracheal stenosis of varying lengths underwent surgery at the University of California, San Francisco. They were treated surgically with either resection and anastomosis or with slide tracheoplasty.Two of the 6 patients treated by resection and anastomosis had an anastomotic breakdown; all 3 patients undergoing slide tracheoplasty did not have anastomotic problems. Technically, a slide tracheoplasty has only one half the tension distributed over an oblique anastomosis that is more than the circumferential length of a resection and anastomosis approach.Based on these results, a slide tracheoplasty may be the procedure of choice for tracheal stenosis, whether long or short.

    View details for Web of Science ID 000165100100019

    View details for PubMedID 11083434

  • Hindbrain herniation develops in surgically created myelomeningocele but is absent after repair in fetal lambs Paek, B. W., Farmer, D. L., Wilkinson, C. C., Albanese, C. T., Peacock, W., Harrison, M. R., Jennings, R. W. MOSBY-ELSEVIER. 2000: 1119-1123


    The purpose of our study was to determine whether prenatal repair of myelomeningocele prevents or reverses hindbrain herniation in the sheep model.A myelomeningocele was surgically created in fetal sheep. One group was repaired later in utero; the others were delivered without repair. After delivery, lambs were assessed for the presence of hindbrain herniation.In all lambs that had not undergone repair of the myelomeningocele, severe hindbrain herniation developed, whereas the brains of all lambs that had undergone fetal repair were normal.Prenatal repair of myelomeningocele prevents or reverses development of hindbrain herniation in the fetal lamb model.

    View details for Web of Science ID 000165512000013

    View details for PubMedID 11084552

  • Successful fetal sacrococcygeal teratoma resection in a hydropic fetus JOURNAL OF PEDIATRIC SURGERY Graf, J. L., Albanese, C. T., Jennings, R. W., Farrell, J. A., Harrison, M. R. 2000; 35 (10): 1489-1491


    The development of hydrops in a fetus with a sacroccocygeal teratoma (SCT) usually is a predictor of fetal demise; in utero resection may offer the only chance of survival. Although the authors had performed this procedure in 3 previous cases, they had no long-term patient survival. The authors report a successful case of in utero resection of a fetal sacrococcygeal teratoma.The authors resected a fetal SCT from a 23-weeks-gestation hydropic fetus, using gradually tightening umbilical tapes at the tumor base, electrocautery, and careful sharp dissection. After a blood transfusion, the fetus suffered cardiac arrest but was resuscitated and returned to the uterus.Postoperatively, residual SCT growth ceased, and hydrops rapidly resolved. Five weeks after the procedure, the infant was delivered because of preterm labor, and, after resection of residual SCT, was discharged home at 3 months of age. She is now a healthy 3 year old.This case shows that successful fetal SCT resection and long-term patient survival is possible.

    View details for Web of Science ID 000089701200019

    View details for PubMedID 11051157

  • Twin-twin transfusion syndrome: The 'Select' procedure FETAL DIAGNOSIS AND THERAPY Feldstein, V. A., Machin, G., Albanese, C. T., Sandberg, P., Farrell, J. A., Farmer, D. L., Harrison, M. R. 2000; 15 (5): 257-261


    Twin-twin transfusion syndrome (TTTS) is associated with a high risk of perinatal morbidity and mortality. The condition results from intertwin vascular connections in the shared placenta. We report here a case of early, severe TTTS that failed to respond to serial amniocenteses and that was successfully treated by means of superselective laser coagulation.A causative arteriovenous anastomosis was identified by means of prenatal obstetrical sonography, using color and spectral Doppler techniques. At fetoscopy, performed at 23 weeks' gestation, laser occlusion of only this connection was achieved.This therapeutic intervention resulted in rapid resolution of all evidence of TTTS and a successful pregnancy outcome, with subsequent delivery of 2 healthy infants at 33 weeks' gestation.The potentially fatal pathophysiology of TTTS was reversed by interruption of a single arteriovenous connection. We have termed this the sonographically evaluated, laser-endoscopic coagulation for twins ('Select') procedure.

    View details for Web of Science ID 000089340400002

    View details for PubMedID 10971077

  • Successful resuscitation during fetal surgery JOURNAL OF PEDIATRIC SURGERY Graf, J. L., Paek, B. W., Albanese, C. T., Farrell, J. A., KITTERMAN, J. A., Jennings, R. W., Harrison, M. R. 2000; 35 (9): 1388-1389


    After in utero resection of a sacrococcygeal teratoma coupled with a transfusion of packed red blood cells, a 23-week-gestation fetus had bradycardia. Chest compressions were begun and epinephrine, atropine, and sodium bicarbonate were given, while the fetus remained bathed in warm saline. After 3 rounds of drugs, and just before withdrawing support, the fetal heart resumed beating and normal cardiac function. Based on to this case, the authors developed a resuscitation protocol for fetal surgery.

    View details for Web of Science ID 000089146600032

    View details for PubMedID 10999709

  • Differential effects of interleukin-3, interleukin-7, interleukin 15, and granulocyte-macrophage colony-stimulating factor in the generation of natural killer and B cells from primitive human fetal liver progenitors EXPERIMENTAL HEMATOLOGY Muench, M. O., Humeau, L., Paek, B., Ohkubo, T., Lanier, L. L., Albanese, C. T., Barcena, A. 2000; 28 (8): 961-973


    The regulatory roles of a number of early-acting growth factors on the generation of natural killer (NK) cells and B cells from primitive progenitors were studied. Experiments focused on the contributions of granulocyte-macrophage colony-stimulates factor (GM-CSF) and interleukin-3 (IL-3) to the regulation of the early events of lymphopoiesis.Two progenitor populations isolated from human fetal liver were studied, CD38(-)CD34(++)lineage(-) (Lin(-)) cells (candidate hematopoietic stem cells [HSCs]) and the more mature CD38(+)CD34(++)Lin(-) cells. The effects of different cytokines on the generation of CD56(+)CD3(-) NK cells and CD19(+) B cells were studied in serum-deprived cultures in the absence of stroma.NK cells generated in vitro were able to kill NK-sensitive target cells, expressed NK-associated marker CD161 (NKR-P1A), but exhibited little or no expression of CD2, CD8, CD16, CD94/NKG2A, or killer cell inhibitory receptors (KIRs). Among the cytokine combinations tested, kit ligand (KL) and IL-15 provided the best conditions for generating CD56(+) NK cells from CD38(+)CD34(++)Lin(-) cells. However, either flk-2/flt3 ligand (FL), GM-CSF, IL-3, or IL-7 could partially substitute KL. All of these cytokines also supported the growth of NK-cell progenitors from candidate HSC, with the combination of IL-15, KL, GM-CSF, and FL generating the greatest number of CD56(+) cells. B cells were generated from both progenitor populations in response to the combined effects of KL, FL, and IL-7. Both B and NK cells were generated with the further addition of IL-15 to these cultures. The in vitro generated B cells were CD10(+), CD19(+), HLA-DR(+), HLA-DQ(+), and some were CD20(+), but no cytoplasmic or surface immunoglobulin M expression was observed. In contrast with NK lymphopoiesis, GM-CSF, IL-3, and IL-15 had no effect on the generation of B cells from CD38(-)CD34(++)Lin(-) cells, and GM-CSF inhibited B-cell generation from CD38(+)CD34(++)Lin(-) progenitors. These findings indicate a differential regulation of NK and B lymphopoiesis beginning in the early stages of hematopoiesis as exemplified by the distinctive roles of IL-7, IL-15, GM-CSF, and IL-3.

    View details for Web of Science ID 000089276100010

    View details for PubMedID 10989197

  • Normal and hypoplastic fetal lungs: Volumetric assessment with prenatal single-shot rapid acquisition with relaxation enhancement MR imaging RADIOLOGY Coakley, F. V., Lopoo, J. B., Lu, Y., Hricak, H., Albanese, C. T., Harrison, M. R., Filly, R. A. 2000; 216 (1): 107-111


    To determine which parameters are most closely correlated with normal fetal total lung volume and to investigate the use of these parameters in the evaluation of fetal pulmonary hypoplasia.Single-shot rapid acquisition with relaxation enhancement (RARE) magnetic resonance (MR) imaging was used to perform planimetric measurement of total lung volume in 46 fetuses at 18-32 weeks gestation. Total lung volume was correlated with gestational age, and biometric parameters in fetuses were correlated with normal chest findings at ultrasonography (US) (n = 24). This analysis was used to evaluate relative lung volume in fetuses suspected of having pulmonary hypoplasia (n = 22).Normal fetal total lung volume was strongly correlated with liver volume measured at MR imaging (r = 0.94), fetal weight estimated at US (r = 0.93), head circumference measured at US (r = 0.90), and gestational age (r = 0.87). In fetuses suspected of having pulmonary hypoplasia, the relative lung volume varied from 4.6% to 81.6% when the observed total lung volume was expressed as a percentage of the predicted total lung volume.Normal fetal total lung volume is strongly correlated with biometric measurements. Relative fetal lung volume can be calculated by expressing the observed volume as a percentage of the predicted volume calculated from biometric measurements; knowledge of the relative fetal lung volume assists in the confirmation and quantification of fetal pulmonary hypoplasia.

    View details for Web of Science ID 000087829500015

    View details for PubMedID 10887234

  • Prenatal diagnosis of bilateral diaphragmatic hernia: Diagnostic pitfalls JOURNAL OF ULTRASOUND IN MEDICINE Paek, B. W., Danzer, E., Machin, G. A., Coakley, F., Albanese, C. T., Filly, R. A. 2000; 19 (7): 495-500

    View details for Web of Science ID 000167754500010

    View details for PubMedID 10898305

  • Laparoscopically assisted anorectal pull-through for high imperforate anus - A new technique Georgeson, K. E., Inge, T. H., Albanese, C. T. W B SAUNDERS CO-ELSEVIER INC. 2000: 927-930


    This report describes a new technique of laparoscopically assisted anorectal pull-through (LAARP) for repair of high imperforate anus. The procedure utilizes minimal perineal dissection, preservation of the distal rectum, and accurate placement of the rectum within the levator ani and external anal sphincter muscle complex.Sharp dissection and cautery was used laparoscopically to expose the rectal pouch down to the urethral or vaginal fistula, which was clipped distally and divided. The pelvic floor musculature was then assessed and the levator sling identified. Externally, electrostimulation was used to define the center of the anal dimple. An 8-mm skin incision was made, centered at the strongest cephalad contraction. Using a hemostat, minimal blunt dissection on the perineum was guided by transillumination from the laparoscopic light source. A trocar, consisting of a radially expandable sheath over a Varess needle, was passed through this defined plane in the external sphincter muscle complex and advanced into the pelvis between the 2 bellies of the pubococcygeus muscle, guided by laparoscopic visualization. This perineal trocar therefore formed a passage through the center of the striated muscle complex and levators. The rectal fistula, which had been dissected out laparoscopically, was grasped using the perineal trocar and exteriorized to the perineum. Anorectal anastomosis was performed with absorbable interrupted suture.Seven patients were treated with initial colostomy in the newborn period followed by delayed LAARP 2 to 12 months later. In 4 newborn infants, the LAARP was performed as a primary procedure without prior colostomy. Laparoscopic mobilization has been possible on all cases attempted. All of the patients have a brisk and symmetric anal contraction with perineal electrostimulation.Lack of long-term follow-up precludes accurate assessment of the potential for fecal continence. However, short-term experience has been that this new method of pull-through for imperforate anus offers many advantages, including excellent visualization of the rectal fistula and surrounding structures, accurate placement of the bowel through the anatomic midline and levator sling, and minimally invasive abdominal and perineal wounds.

    View details for Web of Science ID 000087429900036

    View details for PubMedID 10873037

  • Prenatal MR imaging of congenital diaphragmatic hernia AMERICAN JOURNAL OF ROENTGENOLOGY Leung, J. W., Coakley, F. V., Hricak, H., Harrison, M. R., Farmer, D. L., Albanese, C. T., Filly, R. A. 2000; 174 (6): 1607-1612

    View details for Web of Science ID 000087213700025

    View details for PubMedID 10845492

  • In utero repair of rectal atresia after complete resection of a sacrococcygeal teratoma FETAL DIAGNOSIS AND THERAPY Chiba, T., Albanese, C. T., Jennings, R. W., Filly, R. A., Farrell, J. A., Harrison, M. R. 2000; 15 (3): 187-190


    A case of a fetus with a prenatally diagnosed sacrococcygeal teratoma that produced high-output cardiac failure, hydrops, rectal atresia, and urinary tract obstruction is presented. The unique prenatal surgical management along with the embryogenesis of tumor-related rectal atresia is discussed.A large fetal sacrococcygeal teratoma with a significant intrapelvic component was detected at routine ultrasound in a 35-year-old gravida 3 para 2. Fetal hydrops developed rapidly due to high-output cardiac failure from the vascular 'steal' by the growing tumor. The urinary tract was obstructed due to the intrapelvic tumors mass. At 27 weeks' gestation, the female fetus underwent hysterotomy, resection of the entire mass and urinary diversion via bilateral flank ureterostomies. The rectum was found to be completely atretic due to apparent encasement by the tumor. Pull-through anorectoplasty was carried out concurrently. At 30 weeks' gestation, the mother developed preterm labor and a 1.8-kg was delivered by cesarean section. The baby did very well for 3 days but had a cardiac arrest and died due to an atrial perforation by a transfemoral venous catheter.To our knowledge this is the first report of a complete prenatal resection of a sacrococcygeal teratoma with concomitant pull-through anorectoplasty for rectal atresia.

    View details for Web of Science ID 000087040800014

    View details for PubMedID 10782007

  • Cord ultrasonic transection procedure for selective termination of a monochorionic twin FETAL DIAGNOSIS AND THERAPY Lopoo, J. B., Paek, B. W., Maichin, G. A., Lipshutz, G. S., Jennings, R. W., Farmer, D. L., Sandberg, P. L., Feldstein, V. A., Filly, R. A., Farrell, J. A., Harrison, M. R., Albanese, C. T. 2000; 15 (3): 177-179


    Placental vascular communications can present a life-threatening problem in monochorionic twins when one fetus has a lethal anomaly. Although selective feticide is the best option for salvaging the normal twin, techniques normally employed (i.e. intracardiac potassium, air embolism) are not prudent given the common circulatory system. Furthermore, in monoamniotic, monochorionic twin gestations it is important to transect the umbilical cord completely to prevent entanglement of the dead fetus around the cord of the normal twin. We present two cases of monochorionic twins in which the cords were transected with a harmonic scalpel under ultrasonic guidance via one trocar. The harmonic scalpel is an instrument which can simultaneously coagulate and cut blood vessels or tissues. The cord ultrasonic transection procedure is a novel, minimally invasive technique which offers several advantages over the methods currently used for selective feticide in discordant monochorionic twin gestations.

    View details for Web of Science ID 000087040800012

    View details for PubMedID 10782005

  • Sonographic prognostic factors in fetuses with sacrococcygeal teratoma Westerburg, B., Feldstein, V. A., Sandberg, P. L., Lopoo, J. B., Harrison, M. R., Albanese, C. T. W B SAUNDERS CO-ELSEVIER INC. 2000: 322-325


    A subset of fetuses with sacrococcygeal teratoma (SCT) develops hydrops caused by high-output heart failure. Identification of fetuses at risk for hydrops is important because fetal intervention may reverse the pathophysiology of the disease. To date, no reliable sonographic prognostic factors have been identified.An experienced sonologist reviewed the sonographic records of 17 fetuses with SCT referred to the authors' institution. Size of the tumor was measured and corrected for fetal size. The appearance of the tumor (solid versus cystic) and its vascularity were graded on a subjective scale of 1 to 5.Only 4 of 12 fetuses that had hydrops survived; of the survivors, 3 had undergone fetal intervention. All nonhydropic fetuses survived. Fetuses with hydrops had tumors that were mainly solid and highly vascular, whereas nonhydropic fetuses had predominantly cystic tumors with comparatively less vascularity. There was no significant difference in tumor size between these 2 groups.Fetuses with SCT that are mainly solid in appearance and are highly vascularized have a higher risk of getting hydrops in utero. Tumor size is not an independent prognostic factor.

    View details for Web of Science ID 000085128700059

    View details for PubMedID 10693688

  • Slide tracheoplasty for congenital tracheal stenosis: A case report Lipshutz, G. S., Jennings, R. W., Lopoo, J. B., Farmer, D., Harrison, M. R., Albanese, C. T. W B SAUNDERS CO-ELSEVIER INC. 2000: 259-261


    A variety of techniques have been used to manage pediatric congenital tracheal stenosis. The authors report the technique of slide tracheoplasty for a child with long congenital tracheal stenosis.A 2-year-old male presented with a history of stridor with feeding. Bronchoscopy findings showed 50% stenosis from complete cartilaginous rings, extending from 2.5 cm below the vocal cords to 2 cm above the carina. Through a neck incision, the trachea was exposed from the cricoid to both bronchi and transected at the midpoint of the stenosis. The upper trachea was split anteriorly to the area of stenosis just below the cricoid. The lower trachea was split posteriorly in the midline. Posterior dissection allowed sliding and anastomosis of both tracheal segments while the lateral vascular supply was left intact. A brace was placed to maintain cervical flexion, and the patient underwent extubation in the operating room.He recovered without complication and was dis charged on postoperative day 4.Slide tracheoplasty offers several advantages for tracheal reconstruction because it is performed with the native tracheal tissues, can be accomplished through a transverse collar incision, and can repair long stenoses without significant tracheal shortening.

    View details for Web of Science ID 000085128700036

    View details for PubMedID 10693676

  • Are bilateral fetal lung masses double trouble? FETAL DIAGNOSIS AND THERAPY Lipshutz, G. S., Lopoo, J. B., Jennings, R. W., Farrell, J., Harrison, M. R., Albanese, C. T. 1999; 14 (6): 348-350


    To examine the perinatal natural history of bilateral fetal cystic lung masses.The records of a tertiary medical center over a 3-year period were reviewed for cases of fetal bilateral pulmonary masses.Three of 98 fetuses referred for evaluation over a 3-year period from September of 1995 to August of 1998 had bilateral lung lesions. Two of these cases resulted in live births, while one, associated with hydrops, resulted in death after preterm delivery.Similar to prenatally diagnosed unilateral lung lesions, hydropic fetuses with bilateral cystic lung lesions have a poor prognosis. Nonhydropic fetuses, however, may be asymptomatic despite persistent lesions on postnatal CT scan. These observation may prove helpful for prenatal counseling for these rare lesions.

    View details for Web of Science ID 000084954400008

    View details for PubMedID 10640874

  • Fetal pulmonary sequestration: A favorable congenital lung lesion OBSTETRICS AND GYNECOLOGY Lopoo, J. B., Goldstein, R. B., Lipshutz, G. S., Goldberg, J. D., Harrison, M. R., Albanese, C. T. 1999; 94 (4): 567-571


    We reviewed the perinatal clinical course of prenatally diagnosed pulmonary sequestrations to determine the natural history of this anomaly.From January 1992 to August 1998, 192 women were referred to the University of California, San Francisco, Fetal Treatment Center because obstetric ultrasound had demonstrated fetal lung lesions. In 14 fetuses, the echogenic lung masses were pulmonary sequestrations deriving arterial blood supply from clearly identifiable systemic arteries rather than the pulmonary artery. We examined records of the 14 fetuses and documented the location of the lesion, gestational age at diagnosis, need for fetal intervention, prenatal and postnatal complications, gestational age at delivery, and survival.There were 16 intrathoracic pulmonary sequestrations in 14 fetuses (eight left-sided, four right-sided, two bilateral). Three fetuses had histologically mixed lesions (congenital cystic adenomatoid malformation and pulmonary sequestration). The mean age at diagnosis was 23 weeks' gestation (range 19-31 weeks). Two fetuses required prenatal intervention (placement of a thoracoamniotic shunt for drainage of an ipsilateral tension hydrothorax). The mean gestational age at delivery was 37 weeks (range 32-40 weeks). The large lesions of four fetuses regressed completely prior to birth, and the lesions of the remaining ten fetuses were electively resected after birth without causing morbidity or mortality.Pulmonary sequestrations are a subgroup of congenital lung lesions with a favorable outlook; many regress prenatally, and the persistent ones are resected safely postnatally. Pulmonary sequestrations cause hydrops only because of a tension hydrothorax, which can be drained prenatally, if necessary.

    View details for Web of Science ID 000082781300015

    View details for PubMedID 10511360

  • Prenatal cellular transplantation. Seminars in pediatric surgery Albanese, C. T., Harrison, M. R. 1999; 8 (3): 101-108


    Based on the ontogeny of fetal immunologic development, the strategy of fetal cellular transplantation may prove to be the most physiological way to achieve replacement of abnormal hemoglobin, immune cells, or enzyme defects diagnosed early prenatally. Similarly, if cellular transplantation can induce tolerance, postnatal solid organ transplantation may be performed without the need for chronic immunosuppression or with a reduced risk of graft-versus-host disease. This review presents experimental data from the late 1940s until the present for both small and large animal models; it also describes the limited clinical experience with prenatal cellular transplantation.

    View details for PubMedID 10461322

  • Maternal fertility is not affected by fetal surgery FETAL DIAGNOSIS AND THERAPY Farrell, J. A., Albanese, C. T., Jennings, R. W., Kilpatrick, S. J., Bratton, B. J., Harrison, M. R. 1999; 14 (3): 190-192


    The purpose of this report is to assess the impact of fetal surgery on future maternal fertility, subsequent pregnancy outcome, and the incidence of pregnancy complications. Retrospective data were collected on 70 mothers who underwent fetal surgery between April 1981 and June 1996. Indications for open hysterotomy fetal surgery included congenital diaphragmatic hernia (n = 44), congenital cystic adenomatoid malformation of the lung (n = 11), urinary obstruction (n = 9), sacrococcygeal teratoma (n = 4), heart block (n = 1), and acardiac-acephalic twin reduction (n = 1). The following data were obtained: number of pregnancy attempts, number of successful pregnancies, pregnancy outcome including obstetrical and neonatal complications, and infertility after fetal surgery. There were 45 respondents, of whom 35 attempted subsequent pregnancies. Thirty-two were successful, resulting in 31 livebirths. Two women had a strong prefetal surgery history of infertility, 1 has only attempted to conceive for 3 months. We report this experience because the effect of open fetal surgery on futrue fertility is such an important question for our patients and referring physicians. This analysis suggests that hysterotomy and open fetal surgery has a negligible impact on maternal fertility.

    View details for Web of Science ID 000081073900013

    View details for PubMedID 10364673

  • One-stage correction of high imperforate anus in the male neonate Albanese, C. T., Jennings, R. W., Lopoo, J. B., Bratton, B. J., Harrison, M. R. W B SAUNDERS CO-ELSEVIER INC. 1999: 834-836


    The aim of this study was to examine the feasibility, safety, and short-term outcome of complete one-stage repair of high imperforate anus in the newborn boy.A retrospective review was conducted of five full-term male infants who underwent posterior sagittal anorectoplasty without a colostomy within the first 48 hours of birth. Preoperative imaging was performed to assess associated anomalies. All infants underwent cystoscopy before the perineal operation to determine the level of the urinary tract fistula, if present. After completion of the anoplasty, all were turned supine and the colon irrigated free of meconium. Follow-up ranged from 10 to 24 months.Laparotomy was not required for any patient. Three patients had a rectoprostatic urethral fistula, one a rectovesical fistula, and one no fistula (common wall at level of prostate). Tapering rectoplasty was required for only the one patient with a rectovesical fistula. There were no intraoperative complications. All patients passed stool within 12 hours after operation and took full feeding by 48 hours. The average hospital stay was 7 days. Postoperative and stenosis occurred in one patient secondary to parental noncompliance with the postoperative dilation regimen. There were no perineal wound complications. All patients have a strong urinary stream and defecate spontaneously without the aid of oral medication or rectal stimulation or enemas.One-stage repair of high imperforate anus in the male neonate is feasible without short-term genitourinary or gastrointestinal morbidity. Whether it is preferable compared with a delayed (two or three stage) repair depends on ultimate long-term anorectal function, which cannot be assessed for several years.

    View details for Web of Science ID 000080447500063

    View details for PubMedID 10359190

  • Transabdominal oxygenation using perfluorocarbons Chiba, T., Harrison, M. R., Ohkubo, T., Rollins, M. D., Talbanese, C. T., Jennings, R. W. W B SAUNDERS CO-ELSEVIER INC. 1999: 895-900


    Evaluation of the intraabdominal (intraperitoneal and intraluminal) administration of oxygen-saturated perfluorocarbon on both portal and arterial blood oxygenation.Eight male rabbits were divided into the test (n = 5) and control (n = 3) groups. Each underwent intrajejunal, intraperitoneal, and intravascular (artery, portal vein) catheter placements along with ligation of the duodenum and the terminal ileum under general anesthesia. The test group received oxygen-saturated perfluorotripropylamine (FTPA), and the control group received oxygen desaturated FTPA. The oxygen delivery was assessed by serial blood gas measurements before and after the administration of FTPA.The administration of oxygen-saturated FTPA significantly increased the partial pressure of oxygen within both the arterial and the portal venous blood (PaO2, PpVO2) without significant changes in PCO2 values. Oxygen desaturated FTPA failed to show any effects on blood gas values. Compared with oxygen desaturated FTPA, oxygen-saturated FTPA increased PaO2, PpVO2, and oxygen saturation (artery, portal vein) significantly at some, but not all of the time-points measured.The intraabdominal administration of saturated FTPA improved both the portal venous and the arterial oxygenation. This new mode of oxygenation may be helpful as an adjunct to conventional oxygen delivery systems.

    View details for Web of Science ID 000080447500085

    View details for PubMedID 10359202

  • Perineal one-stage pull-through for Hirschsprung's disease JOURNAL OF PEDIATRIC SURGERY Albanese, C. T., Jennings, R. W., Smith, B., Bratton, B., Harrison, M. R. 1999; 34 (3): 377-380


    The aim of this study was to present the strategy of a one-stage repair of Hirschsprung's Disease (HD) performed via a transanal approach.Ten consecutive neonates and one toddler underwent transanal repair for biopsy-proven HD. A rectosigmoid transition zone was suggested by contrast enema in all patients. The mean age at operation for the neonates was 4 days. A mucosal dissection was begun 0.5 cm proximal to the dentate line. Once the correct plane was established, up to 15 cm of bowel can be resected without ligating vessels or performing a transabdominal dissection. The proximal extent of dissection was delineated by the presence of ganglion cells seen on frozen section analysis.The mean operating time was 105 minutes. There were no intraoperative or postoperative complications. All children had the presence of ganglion cells confirmed postoperatively on permanent sections. The mean hospital stay was 2 days. All children averaged three to six bowel movements per day without oral or enema therapy.The perineal one-stage operative pull-through (POOP) procedure for Hirschsprung's disease is a quick and easy adaptation of a well-described technique of transanal mucosectomy. Long-term follow-up will be required to determine whether bowel function is better that that seen after traditional staged repairs.

    View details for Web of Science ID 000079227500001

    View details for PubMedID 10211635

  • Fetal neurenteric cyst causing hydrops: Case report and review of the literature PRENATAL DIAGNOSIS Wilkinson, C. C., Albanese, C. T., Jennings, R. W., Feldstein, V. A., Goldberg, J. D., Baehner, F. L., Farrell, J. A., Peacock, W. J., Harrison, M. R. 1999; 19 (2): 118-121


    Routine prenatal ultrasound revealed a unilocular cystic mass associated with upper thoracic hemivertebrae that grew to 6 cm at 28 weeks and was associated with hydrops. A thoraco-amniotic shunt decompressed the cyst and resolved the hydrops, but the shunt occluded 17 days later. Preterm labour led to vaginal delivery at 31 2/7 weeks. Postnatally, the cyst was decompressed by thoracentesis due to respiratory distress. It was resected on day four of life. Severe tracheobronchomalacia was present post-operatively, presumably due to prenatal mass effect of the cyst. At one year of age, the child has recovered completely without adverse respiratory or neurological sequelae.

    View details for Web of Science ID 000079100200006

    View details for PubMedID 10215067

  • A strategy for primary reconstruction of long gap esophageal atresia using neonatal colon esophagoplasty: A case report Lipshutz, G. S., Albanese, C. T., Jennings, R. W., Bratton, B. J., Harrison, M. R. W B SAUNDERS CO-ELSEVIER INC. 1999: 75-77


    Treatment options for long gap esophageal atresia without tracheoesophageal fistula generally require several stages over many months. An early neonatal vascularized conduit would allow a tension-free anastomosis, but the precarious blood supply of the neonatal bowel makes mobilization and immediate interposition hazardous. This report describes the successful application of a strategy for primary reconstruction in the neonate using a short piece of colon mobilized into the mediastinum for subsequent delayed anastomosis.

    View details for Web of Science ID 000078137400026

    View details for PubMedID 10022147

  • Fetal liver position and perinatal outcome for congenital diaphragmatic hernia PRENATAL DIAGNOSIS Albanese, C. T., Lopoo, J., Goldstein, R. B., Filly, R. A., Feldstein, V. A., Calen, P. W., Jennings, R. W., Farrell, J. A., Harrison, M. R. 1998; 18 (11): 1138-1142


    Despite advances in postnatal care, patients born with a congenital diaphragmatic hernia (CDH) suffer substantial morbidity and mortality. The present study was undertaken to determine the prognostic influence of prenatally-diagnosed liver herniation in the hemithorax in fetuses with CDH. The medical records of 48 patients evaluated for a prenatally-diagnosed left CDH were retrospectively reviewed. Patients were analysed according to the position of the liver by prenatal ultrasound; 32 fetuses had a major portion of the liver herniated into the left hemithorax ('liver up') and 16 had an intra-abdominal liver ('liver down'). Liver position was determined using colour-flow Doppler ultrasonography. There were two fetal deaths in the liver-up group and one in the liver-down group. The liver-up group more frequently required extracorporeal membrane oxygenation (ECMO) support (53 per cent) compared with the liver-down group (19 per cent). Postnatal survival was significantly less in the liver-up group (43 per cent) vs. the liver-down group (93 per cent). Fetuses with congenital diaphragmatic hernia and liver herniated into the hemithorax have a much worse prognosis than similarly afflicted fetuses without liver herniation. Prenatal ultrasonographic diagnosis of congenital diaphragmatic hernia allows for preparation for a critically ill newborn and aids in prenatal family counselling.

    View details for Web of Science ID 000077264300006

    View details for PubMedID 9854721

  • Hypercalcemia in malignant paraganglioma due to parathyroid hormone-related protein HORMONE RESEARCH Loh, K. C., Matthay, K. K., Hoover, M., Bracho, F. A., Cortez, A. B., Conte, F. A., Albanese, C. T., Miller, T. R., Price, D. C., Flores, A. J., Kaviani, A., Shoback, D. 1998; 50 (4): 217-221


    A 15-year-old boy had hypercalcemia in association with malignant retroperitoneal paraganglioma. He had suppressed circulating levels of intact parathyroid hormone, whereas parathyroid hormone-related protein (PTHrP) immunoreactivity was elevated in plasma. Both the serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels were normal. Preoperatively the patient required control of hypercalcemia with intravenous pamidronate therapy. His circulating calcium and PTHrP concentrations became normal after a successful surgical resection of the primary retroperitoneal tumor. To our knowledge, this is the first reported case of elevated PtHrP levels in a patient with paraganglioma which resolved postoperatively.

    View details for Web of Science ID 000077541100005

    View details for PubMedID 9838243

  • Venous access in pediatric patients. Journal of intravenous nursing : the official publication of the Intravenous Nurses Society Wiener, E. S., Albanese, C. T. 1998; 21 (5): S122-33


    Long-term central venous access is an integral part of managing children with cancer, certain congenital malformations, and gastrointestinal malfunction, as well as for those who need long-term access to medications or blood products. Disease and patient-specific selection of access device type is important in minimizing complications and obtaining optimal outcomes. Because infection is the most common complication, enthusiasm has increased for developing methods to prevent infection, although without clear impact. Most infections can be treated successfully without device removal. Premature removal occurs more frequently with external catheters and may be minimized by techniques used for insertion and catheter care. Occlusion, if detected early, usually can be successfully managed by clot lysis.

    View details for PubMedID 9814287

  • Tissue repair in the fetal intestinal tract occurs with adhesions, fibrosis, and neovascularization ANNALS OF PLASTIC SURGERY Mast, B. A., Albanese, C. T., Kapadia, S. 1998; 41 (2): 140-144


    Cutaneous wound healing in the fetus can occur in a nonfibrotic, regenerative manner. However, other fetal tissues such as bone and stomach heal with scar formation. In light of potential ramifications for adult hollow visceral scarring (biliary and intestinal strictures), this study was undertaken to determine if tubular visceral tissue repair in the fetus is regenerative or fibrotic. Fetal rabbits underwent laparotomy on day 24 of gestation, during which a controlled intestinal enterotomy was created and suture repaired immediately using microsurgical techniques. Maternal rabbits and adult male rabbits also underwent enterotomy and repair. After 5 days all animals were sacrificed and the wounds analyzed histologically by a pathologist in a blinded fashion. All animals demonstrated a similar degree of peri-intestinal adhesion formation. Fetal and maternal wounds contained fibroblastic and smooth muscle cell proliferation, mild inflammatory infiltration, and new blood vessel formation. The male adult wounds demonstrated a more pronounced fibrovascular healing response. Immunohistochemical staining for CD31 (endothelial cell marker) was quantitated on a scale of 0 to 4+, indicating degree of neovascularization. The mean scores for the fetal and maternal groups were similar (1.70 +/- 0.68 and 1.23 +/- 1.07 respectively), but were significantly greater for male adults (2.93 +/- 0.12; p = 0.001 by analysis of variance). The results of this study indicate that hollow visceral tissue repair in the fetal rabbit intestine occurs in a similar fibrotic manner as adult healing. This provides further evidence that regenerative healing in the fetus is not ubiquitous. Differences in the degrees of fibrosis and neovascularization between adult male and pregnant female wounds deserve further investigation.

    View details for Web of Science ID 000075270000006

    View details for PubMedID 9718146

  • The antegrade continence enema procedure: A review of the literature JOURNAL OF PEDIATRIC SURGERY Graf, J. L., Strear, C., Bratton, B., Housley, H. T., Jennings, R. W., Harrison, M. R., Albanese, C. T. 1998; 33 (8): 1294-1296


    Since the antegrade continence enema (ACE) was first described in 1990 for fecal incontinence, more than 100 cases have been reported in the literature. This report reviews the indications, operative modifications, outcome, and complications of the procedure.

    View details for Web of Science ID 000075365100025

    View details for PubMedID 9722008

  • Correction of congenital diaphragmatic hernia in utero IX: Fetuses with poor prognosis (liver herniation and low lung-to-head ratio) can be saved by fetoscopic temporary tracheal occlusion JOURNAL OF PEDIATRIC SURGERY Harrison, M. R., Mychaliska, G. B., Albanese, C. T., Jennings, R. W., Farrell, J. A., Hawgood, S., Sandberg, P., Levine, A. H., Lobo, E., Filly, R. A. 1998; 33 (7): 1017-1022


    Fetuses with congenital diaphragmatic hernia (CDH) who have a "poor prognosis" with postnatal treatment now can be identified on the basis of liver herniation, early diagnosis (before 25 weeks' gestation) and a low lung-to-head ratio (LHR). Because complete in utero repair proved unsuccessful for this group, the strategy of temporary tracheal occlusion was developed to gradually enlarge the hypoplastic fetal lung. The purpose of this study is to compare the outcome of patients in the poor-prognosis group treated by one of three methods: (1) standard postnatal care, (2) fetal tracheal occlusion via open hysterotomy, and (3) the recently developed video-fetoscopic (Fetendo) technique of tracheal occlusion without hysterotomy.In the past 3 years, 34 of 86 fetuses with an isolated left CDH met criteria for the poor-prognosis group. Thirteen families chose postnatal treatment at an extracorporeal membrane oxygenation (ECMO) center, 13 underwent open fetal tracheal occlusion, and eight underwent fetoscopic tracheal occlusion.The survival rate was 38% in the group treated by standard postnatal therapy, 15% in the open tracheal occlusion group, and 75% in the Fetendo group. There were less postoperative pulmonary complications noted in mothers who underwent the Fetendo procedure versus the open tracheal occlusion. All but one Fetendo clip patient had a striking physiological response demonstrated by sonographic enlargement of the small left lung that was documented postnatally by plain radiographs and its subjective appearance during repair of the CDH. In contrast, only 5 of the 13 open tracheal occlusion patients demonstrated lung growth.Fetuses with a left CDH who have liver herniation and a low LHR are at high risk of neonatal demise and appear to benefit from temporary tracheal occlusion when performed fetoscopically, but not when performed by open fetal surgery.

    View details for Web of Science ID 000074841300020

    View details for PubMedID 9694087

  • Successful treatment of liver hemorrhage in the premature infant JOURNAL OF PEDIATRIC SURGERY Strear, C. M., Graf, J. L., Albanese, C. T., Harrison, M. R., Jennings, R. W. 1998; 33 (6): 849-851


    Intraoperative neonatal liver hemorrhage usually results in exsanguination and death. The parenchyma of a neonatal liver is fragile, and the capsule is very thin, unlike that in the pediatric and adult patient. This renders the treatment of a neonatal liver fracture almost universally unsuccessful. The current report describes two cases of successful management of intraoperative neonatal liver hemorrhage during surgery for necrotizing enterocolitis (NEC).

    View details for Web of Science ID 000074327400010

    View details for PubMedID 9660212

  • Papillary cystic neoplasm of the pancreas: A report of three pediatric cases and literature review JOURNAL OF PEDIATRIC SURGERY Wang, K. S., Albanese, C., Dada, F., Skarsgard, E. D. 1998; 33 (6): 842-845


    Papillary cystic neoplasms are rare pancreatic tumors that typically present in women in their third decade of life. Few cases have been reported in children.The authors report on three pediatric patients: a 10-year-old boy, an 11-year-old girl, and a 14-year-old girl. The authors have reviewed the existing literature on papillary cystic neoplasms of the pancreas and suggest that these tumors probably arise early in life, grow slowly, and metastasize infrequently.Even when these tumors metastasize, patients seldom die as a result of the malignancy.

    View details for Web of Science ID 000074327400008

    View details for PubMedID 9660210

  • A surprising histological evolution of preterm sacrococcygeal teratoma JOURNAL OF PEDIATRIC SURGERY Graf, J. L., Housely, H. T., Albanese, C. T., Adzick, N. S., Harrison, M. R. 1998; 33 (2): 177-179


    In fetuses with sacrococcygeal teratomas (SCT), the development of hydrops is a harbinger of imminent fetal demise. In such instances, tumor debulking, either at fetal surgery or postnatally after urgent cesarean section, may prove lifesaving. Definitive SCT resection is carried out in the newborn period when the infant has stabilized. In five such patients, retrospective comparison of the SCT histological findings from the initial debulking procedure and later definitive resection or, in one case, autopsy results, showed a surprising change. After the initial debulking procedure, SCT histology findings from three patients were grade 3 immature teratoma without malignant elements, and in two patients grade 3 immature teratoma with nests of malignant yolk sac elements. In the three patients having grade 3 immature tumor without malignant elements, histological examination after definitive resection (two cases) and autopsy (one case) showed only fibrosis; there was no evidence of the SCT despite the fact that residual tumor had clearly been left at the initial debulking. In the patients in whom the initial histology finding was grade 3 immature with malignant elements, SCT histology results from the definitive resection showed grade 3 immature teratoma without malignancy in one case, and mature, benign tissue in the other. Preterm SCT debulking may induce tumor maturation or, alternatively, maturation of SCT that occurs naturally during gestation may be observed.

    View details for Web of Science ID 000072026100008

    View details for PubMedID 9498382

  • Transmucosal passage of bacteria across rat intestinal epithelium in the ussing chamber: Effect of nutritional factors and bacterial virulence SHOCK Kurkchubasche, A. G., Cardona, M., Watkins, S. C., Smith, S. D., Albanese, C. T., SIMMONS, R. L., Rowe, M. I., Ford, H. R. 1998; 9 (2): 121-127


    Transmucosal passage of bacteria across the intestine, the essential and prerequisite step for bacterial translocation, cannot be effectively studied using in vivo models of translocation. We have adapted the Ussing chamber into a fresh, sterile organ culture system that can facilitate the study of bacterial-epithelial interactions. Intestinal membranes were mounted in the Ussing chamber and perfused with a solution rich in putative mucosal micronutrients. The transmembrane potential difference was constantly monitored as a marker of intestinal integrity. Transmucosal passage of various bacteria across the normal intestinal epithelium was quantitated, and the mucosal membrane was examined by light and transmission electron microscopy. The addition of potassium cyanide to the mucosal perfusate resulted in an irreversible loss of potential difference. Oxygen deprivation also led to a precipitous drop in potential difference, but it was reversible with prompt reoxygenation. In contrast, intestinal membranes perfused with a solution consisting of Dulbecco's modified Eagle's medium + 20 mM glutamine maintained their potential difference for a sustained period (>180 min). Both the viability and structural integrity of the ileal intestinal membrane were maintained in culture ex vivo using this perfusate. Qualitative differences were observed in the mechanism of transmucosal passage of mild to moderately virulent bacteria such as Escherichia coli C-25 and Proteus mirabilis M-13, which pass through the intestinal epithelium without causing overt damage to the mucosa, and more virulent organisms such as Salmonella typhimurium, which cause extensive mucosal damage by light and transmission electron microscopy. The Ussing system should provide a useful model of intact organ culture for the study of the mechanisms of bacterial translocation and the pathogenesis of enteric infections.

    View details for Web of Science ID 000071771700008

    View details for PubMedID 9488257

  • Anterior cervical approach for repair of laryngotracheoesophageal cleft JOURNAL OF PEDIATRIC SURGERY Lipshutz, G. S., Albanese, C. T., Harrison, M. R., Jennings, R. W. 1998; 33 (2): 400-402


    Laryngotracheoesophageal cleft is a very rare congenital malformation characterized by a long midline communication between the esophagus and trachea extending from the larynx down the trachea for a variable distance. The most common repair strategy involves separation of the trachea and esophagus by a lateral approach via both a thoracotomy and a neck incision. The authors report a case of complete repair (without thoracotomy) via a neck incision through the anterior wall of the trachea.

    View details for Web of Science ID 000072026100086

    View details for PubMedID 9498426

  • Surgical treatment for fetal disease - The state of the art ULTRASOUND SCREENING FOR FETAL ANOMALIES: IS IT WORTH IT? Albanese, C. T., Harrison, M. R. 1998; 847: 74-85


    Sophisticated imaging and fetal sampling techniques have defined the natural history and pathophysiologic characteristics of many previously mysterious conditions of newborn. Although most prenatally diagnosed malformations are best managed by appropriate medical and surgical therapy after delivery, an increasing number of simple anatomic abnormalities with predictably devastating developmental consequences have been successfully corrected before birth. Many of the technical intricacies of open fetal surgery have been solved, but preterm labor remains an omnipresent risk to the mother and fetus. The recent development of minimally invasive techniques to treat the fetus prenatally has significantly lessened preterm labor. Minimally invasive surgical techniques, in combination with new tocolytic strategies, promise to extend the indications for fetal surgical intervention.

    View details for Web of Science ID 000074931900008

    View details for PubMedID 9668700

  • Prospective analysis of lung-to-head ratio predicts survival for patients with prenatally diagnosed congenital diaphragmatic hernia Lipshutz, G. S., Albanese, C. T., Feldstein, V. A., Jennings, R. W., Housley, H. T., Beech, R., Farrell, J. A., Harrison, M. R. W B SAUNDERS CO-ELSEVIER INC. 1997: 1634-1636


    Accurate prenatal prediction of outcome for fetuses who have congenital diaphragmatic hernia (CDH) is very difficult. The authors previously reported a retrospective analysis of risk factors for fetal CDH and proposed a new index of severity: the lung-to-head ratio (LHR). The authors now report a prospective study to test whether this new index predicts neonatal outcome.Fifteen patients who had left-sided CDH were sonographically evaluated at the University of California, San Francisco (UCSF) and followed prenatally and postnatally. LHR was measured at 24 to 26 weeks' gestation. Outcome variables included survival and the need for extracorporeal membrane oxygenation (ECMO).Overall survival was 47%. LHR ranged from 0.62 to 1.86. No patient with an LHR of less than 1.0 (n = 3) survived despite ECMO, whereas all patients with an LHR greater than 1.4 survived (n = 4), one requiring ECMO. LHR values between 1.0 to 1.4 were associated with 38% survival (n = 8), 75% requiring ECMO. Overall, survivors had a mean LHR of 1.4 +/- 0.33 and nonsurvivors, 1.05 +/- 0.3 (P < .05).The LHR is a useful index to help predict neonatal outcome in patients who have left-sided CDH.

    View details for Web of Science ID A1997YF52300028

    View details for PubMedID 9396544

  • Computed tomography grade of splenic injury is predictive of the time required for radiographic healing Lynch, J. M., Meza, M. P., Newman, B., Gardner, M. J., Albanese, C. T. W B SAUNDERS CO. 1997: 1093-1095


    It is largely unknown when a child who has suffered a splenic laceration can return to full unrestricted activity. The purpose of this prospective study is to establish whether the grade of splenic injury is predictive of the length of time required for radiographic healing, and to determine whether there are any adverse long-term sequelae after resumption of unlimited activity. Sixty-nine patients underwent successful nonoperative management (NOM) of computed tomography (CT)-documented splenic injury over a 4-year period. Fifty-eight patients completed follow-up. Mean age was 9.8 years (range, 1 to 17) and mean injury severity score (ISS) was 14.4 (range, 4 to 38). Mechanisms of injury were motor vehicle accident (n = 11), motor vehicle pedestrian (n = 5), falls (n = 13), bike crashes (n = 12), sports (n = 8), all-terrain vehicle (n = 4), and horse (n = 5). The CT-documented injury was identified by discharge ultrasound scan (US) in all cases. There were no long-term complications. Mean time to US healing in grade I (n = 9), II (n = 26), III (n = 19), IV (n = 4) injuries was 3.1, 8.2, 12.1, and 20.7 weeks, respectively. P values were significant (P < .01) in all cases when compared with the next lower injury grade. The time to radiographic healing is directly proportional to the severity of the splenic injury. There was excellent correlation between the initial CT scan and identification of the injury on the discharge US. No long-term complications leg, delayed splenic rupture, splenic pseudocyst) were seen in this study. Pediatric patients who have suffered splenic injury can safely return to full unrestricted activity when the US documents healing.

    View details for Web of Science ID A1997XM22100065

    View details for PubMedID 9247241

  • Single rope tree swing injuries among children PEDIATRICS Albanese, C. T., Gardner, M. J., ADKINS, M. A., Schall, L., Lynch, J. M. 1997; 99 (4): 548-550


    To examine the scope and severity of injuries sustained from falls from single rope tree swings among children.Twenty-six children formed the basis of this retrospective study. Patients were divided into three groups based on the estimated distance of their fall (one, two, or three stories). Data were analyzed with respect to mechanism of injury, age, gender, length of hospital stay, injury severity score, number and type of injuries, and mortality.Eighteen patients fell from ropes, and 8 from vines (all onto packed dirt). Fourteen falls occurred from one story or less, 8 from two stories, and 4 from three stories. One death occurred from intracranial injury following a two-story fall. No difference in age, gender, injury severity score, or length of hospital stay with respect to the height of the fall was observed. Falls from lower heights resulted in equally severe injuries as falls from higher heights. Overall, head trauma was the most common injury (58%) followed by long bone fractures (42%), axial skeletal fractures (23%), and intra-abdominal visceral injuries (8%).The present study demonstrated that recreational single rope tree swing injuries among children resulted in significant morbidity regardless of the height of the fall. This activity carries a substantial risk for serious injury. The mechanism of injury, clinical data, and the importance of medical awareness and patient education are emphasized.

    View details for Web of Science ID A1997WQ80200008

    View details for PubMedID 9093296

  • Intestinal stricture following seat belt injury in children JOURNAL OF PEDIATRIC SURGERY Lynch, J. M., Albanese, C. T., Meza, M. P., Wiener, E. S. 1996; 31 (10): 1354-1357


    The most commonly reported intestinal injury from seat belts in children is perforation. A rarely reported late sequela following this type of injury is posttraumatic intestinal stricture (PTIS). A review of the literature reveals a common clinical pattern of presentation in children and adults but an apparent difference in the pathophysiologic mechanism between the pediatric and adult patient. Recently, we treated two children with PTIS. Each case is discussed, and a pathophysiological mechanism for this injury in children is proposed. Recommendations are made for the evaluation and treatment of these uncommon complications of seat belt-related blunt intestinal injury.

    View details for Web of Science ID A1996VM28500004

    View details for PubMedID 8906659

  • Is computed tomography a useful adjunct to the clinical examination for the diagnosis of pediatric gastrointestinal perforation from blunt abdominal trauma in children? JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE Albanese, C. T., Meza, M. P., Gardner, M. J., Smith, S. D., Rowe, M. I., Lynch, J. M. 1996; 40 (3): 417-421


    Perforations of the gastrointestinal (GI) tract, compared to solid organ injuries, are a relatively infrequent sequela of blunt abdominal trauma in children. The purpose of this study is to review retrospectively the diagnostic modalities used in 30 children with proven traumatic intestinal perforations treated at one institution. Since computed tomography with intravenous and oral GI contrast is commonly used in the diagnosis of suspected solid organ injury from blunt abdominal trauma, we evaluated retrospectively the computed tomographic (CT) scan findings in these children in an attempt to accurately predict or suggest GI perforation. Between January 1987 and December 1993, 5,795 children were admitted. Three hundred fifty suffered blunt abdominal trauma of which 30 patients (8.5%) required surgery for a GI perforation and formed the basis for this study. Data collected were mechanisms of injury, results of admission and serial clinical examinations, results of radiologic imaging, associated injuries, operative findings, and outcome. Follow-up was obtained on all patients and averaged 2.5 years. Blows to the abdomen (handlebars, cars, kicks) were the most common cause of perforation, followed by seatbelt injuries. Eleven patients underwent immediate laparotomy an average of 0.75 hours after admission. The indication for surgery was shock (three), clinically apparent peritonitis (five), and free air on plain abdominal radiograph (three). Nineteen patients underwent "later" laparotomy, an average of 3.4 hours after admission, all because of the eventual development of peritonitis. Retrospective review of these CT scans revealed free air anterior to the liver in three, and the remaining 16 had CT findings suggestive of GI injury such as free fluid, focal fluid-filled thick-walled bowel loops, and mesenteric infiltration. There were five (26%) false negative CT scans performed an average of 5.0 hours after injury. We believe serial physical examinations are the gold standard for diagnosing pediatric GI perforation from blunt abdominal trauma. The CT scan may be a useful adjunct to the diagnosis of an intestinal perforation in patients who have no immediate indication for surgery. Presently, the only CT finding that is an absolute indication for laparotomy is free air (in the absence of pulmonary/mediastinal injury or barotrauma). The other CT "findings" need to be validated prospectively.

    View details for Web of Science ID A1996UA97300017

    View details for PubMedID 8601860

  • Blunt urogenital trauma in prepubescent female patients: More than meets the eye! PEDIATRIC EMERGENCY CARE Lynch, J. M., Gardner, M. J., Albanese, C. T. 1995; 11 (6): 372-375


    Blunt traumatic injury to the urogenital region in the prepubescent girl is commonly evaluated in pediatric emergency departments (ED). The purpose of this study is: 1) to establish recommendations for an accurate, painless (both physically and psychologically), and timely diagnosis, and 2) to determine whether the ED examination can accurately determine the extent of the injury. Over a 24-month period (January 1991 through December 1992), 22 girls with blunt trauma to the urogenital region (mean age 5.7 years, range 2-9 years) were retrospectively evaluated. Initial ED evaluations were by both an emergency physician and a pediatric surgeon. All 22 patients underwent an examination under anesthesia (EUA) in the operating room to evaluate the extent of the injury and to repair the injury as needed. Follow-up was obtained in all patients and averaged 18 months. The findings at EUA demonstrated a significant disagreement with the preoperative ED evaluation. In only five patients was there agreement between the preoperative ED assessment and the findings during the EUA (24% concurrence). Thus, 16 patients (76%) had injuries of greater extent than was appreciated during the preoperative examination in the ED. Partial or complete disruption of the perianal sphincters occurred in six patients (27%) and was unrecognized preoperatively in each. Twenty-one of the 22 patients required suture repair of lacerations, the remaining patient did not require surgical therapy. Three patients had contusions or lacerations to the urethral area requiring repair and/or prolonged bladder catheter drainage for two to 14 days (average seven days). The average hospital stay was 19.3 hours. There were three minor wound complications following surgery: two required repeat EUA with suturing or cauterization, and one required no further therapy. This study clearly demonstrates that the ED examination, by both emergency physicians and pediatric surgeons, of young girls who have suffered blunt urogenital trauma grossly underestimates the severity of injuries when compared to the EUA in the operating room. EUA is safe and allows early discharge with minimal psychologic sequelae. Recommendations for mandatory EUA are made.

    View details for Web of Science ID A1995TM87800010

    View details for PubMedID 8751174

  • Necrotizing enterocolitis. Seminars in pediatric surgery Albanese, C. T., Rowe, M. I. 1995; 4 (4): 200-206


    Advances in neonatal care have resulted in an enlarging population of vulnerable premature newborns at risk for necrotizing enterocolitis (NEC). This article presents data supporting a unifying hypothesis for the initiation of NEC based on bacteria as the inciting agent(s), and the preterm baby as the vulnerable host. Facts and controversies concerning the pathology, microbiology, clinical presentation, management and outcome of infants afflicted with NEC are presented.

    View details for PubMedID 8548207



    Bacterial translocation is a process believed to result in nosocomial infections. Secretory IgA (sIgA) may have a role in the prevention of translocation by its ability to bind and aggregate bacteria, a function termed "immune exclusion." The present study was done to determine the effect of specific binding of sIgA to bacteria on the movement of these organisms across the intact epithelial membrane.Bacterial translocation across intact intestinal segments of rats were assessed in vitro using the Ussing model. Secretory IgA (0.25 mg per mL) from pooled human colostrum was added to the perfused segments of ileum in the Ussing system. Subsequently, the membranes were exposed to 5 x 10(9) cfu per mL Escherichia coli on their mucosal side. A second experiment tested the effect of human IgG when perfused with E. coli using the same preparation. All experiments had paired matched rats in a control group without immunoglobulin. The ability of sIgA and IgG to bind to E. coli was studied by an in vitro assay, as well as by transmission electron microscopy and immunofluorescence of random IgA/E. coli experiments. Measurements obtained in all experimental and control groups were the incidence and amount of bacterial passage and the potential difference generated by the intestinal segments (an index of viability).There were no differences in potential difference between control and experimental groups in either of the two experiments. Secretory IgA bound E. coli and completely prevented passage of E. coli as compared with rats in the control group. IgG bound E. coli; however, the incidence of passage was equal to that of rats in the control group. However, the presence of IgG resulted in a significantly reduced number of bacteria that passed when compared with controls (p < 0.05). Electron microscopic studies revealed intact surface morphology and immunofluorescence revealed aggregates of IgA and E. coli on the mucosal, but not submucosal, surface of the ileal membranes.This study provides direct evidence of immune exclusion by sIgA. When bound to bacteria, it prevents passage across a morphologically intact segment of viable intestinal tissue.

    View details for Web of Science ID A1994PV57200008

    View details for PubMedID 7952481



    To elucidate the mechanisms of bacterial translocation in animals fed a conventional formula by correlating transmucosal bacterial passage in vitro with the structural characteristics of the neonatal intestinal mucosa.Newborn rabbits were randomized to receive a conventional formula or breast milk. Bacterial translocation to the mesenteric lymph nodes, liver, and spleen was quantitated after 7 days, and transmucosal passage of bacteria was measured in vitro using the Ussing chamber. The mucosal membranes were examined by light, transmission electron, and confocal laser scanning microscopy.Bacterial passage was rarely seen in the breast milk-fed animals in contrast to the formula-fed animals. Unlike the normal-appearing membranes from breast milk-fed animals, the epithelial cells of formula-fed animals were vacuolated but healthy, with normal polarization and microvillus border by confocal laser scanning microscopy. Villi of formula-fed animals were less densely packed than those of the breast milk-fed animals. Bacterial adhesion, internalization, and transmucosal passage were seen only in membranes from formula-fed animals. Transmission electron microscopy demonstrated bacteria incorporating into the epithelial surface through an active phagocytic process, with rearrangement of the actin cytoskeleton. Once internalized, these bacteria were seen within the cytoplasmic vacuoles and subsequently in the submucosa. No bacteria passed between epithelial cells.Morphological changes in the intestinal mucosa of formula-fed newborn rabbits may increase permeability to bacteria.

    View details for Web of Science ID A1994PQ69300011

    View details for PubMedID 7979951



    Clinical and experimental evidence suggests that breast milk enhances the neonatal gut barrier. Using bacterial translocation (BT) as a measure of gut barrier function, a series of experiments was designed to explore the relationship between the neonatal gut barrier and breast milk as well as the factors associated with the feeding of breast milk. Full-term newborn rabbits were assigned to one of four groups: formula-fed (group I), fed with colostrum plus formula (group II), breast-fed with breast milk (group III), and fed with colostrum plus stored breast milk (group IV). At 7 days of age, body weights were obtained, the rabbits were killed, and the mesenteric lymph nodes (MLN), liver, and spleen were quantitatively cultured for translocating bacteria. The cecum was cultured for aerobic and anaerobic enteric organisms. Distal ileal tissues were examined by light and transmission electron microscopy and compared among groups. The viability of cells in the stored, frozen breast milk was assessed by Trypan blue staining. Group I rabbits had significantly lower mean body weights compared with the other groups. The animals breast-fed breast milk had no BT to the MLN or liver and had a 9% incidence of BT to the spleen. There was no difference between BT in groups III and IV. The stored breast milk contained no viable cells. The incidence of BT to all three areas was significantly lower than in groups I and II. The animals fed with formula alone had the highest incidence of BT to the MLN (88%), liver (60%), and spleen (32%). BT in this group was significantly higher compared with groups III and IV.(ABSTRACT TRUNCATED AT 250 WORDS)

    View details for Web of Science ID A1994PB51600022

    View details for PubMedID 7965506



    Nonshivering thermogenesis (NST) is a normal physiological response of the neonate to cold exposure, characterized by increased blood flow to metabolically active brown fat stores. It is standard practice during neonatal surgery to warm the ambient environment in order to avoid consuming vital energy stores. While NST has been well-studied in the neonate, the response during anesthesia and paralysis has not been fully characterized. Rabbit pups (aged 1 to 7 days) were randomized into several groups. The experimental groups consisted of animals mechanically ventilated and administered either metocurine, pancuronium, curare, fentanyl, nitrous oxide (N2O), or halothane. The controls were spontaneously breathing animals. Oxygen consumption (VO2), an index of metabolic activity, was measured at thermoneutrality (39 degrees C) and after cold exposure (25 degrees C). Control and metocurine animals had a significant increase in VO2 in response to cold exposure. The increase in VO2 was not noted in animals that received curare, pancuronium, fentanyl, N2O, or halothane. To test the effect of anesthetic withdrawal during cold exposure on VO2, additional series of animals were studied. One group received continuous halothane throughout the period of cold exposure; the other had cessation of the halothane during cold exposure. Both groups were rewarmed subsequently. The animals that had withdrawal of halothane during cold exposure had a marked and significant increase in VO2 compared with the control group (continuous halothane). VO2 returned to near-baseline levels upon rewarming. The authors conclude that many commonly used anesthetic and paralyzing agents inhibit the thermogenic response to cold exposure. However, cessation of anesthesia (halothane) in a cold environment results in a marked increase in metabolic activity.

    View details for Web of Science ID A1994PB51600006

    View details for PubMedID 7965534

  • ROLE OF INTESTINAL MUCUS IN TRANSEPITHELIAL PASSAGE OF BACTERIA ACROSS THE INTACT ILEUM IN-VITRO SURGERY Albanese, C. T., Cardona, M., Smith, S. D., Watkins, S., Kurkchubasche, A. G., Ulman, I., SIMMONS, R. L., Rowe, M. I. 1994; 116 (1): 76-82


    Although gastrointestinal mucus is one of a number of putative host defense mechanisms that protect the gut barrier against microbial translocation, little experimental data are available to show its role in this process. The present study sought to determine the role of mucus depletion on the transepithelial passage of bacteria across viable segments of rat ileum mounted in Ussing chambers in vitro.Intestinal mucus was depleted in 12 rats after injection with pilocarpine (160 mg/kg intraperitoneally) 45 minutes before intestinal harvest. The mucosal surfaces of the perfused gut segments mounted in the Ussing chamber were exposed to 5 x 10(9) CFU/ml Escherichia coli C-25. Viability was monitored by continuous measurements of the potential difference generated by the membranes. The electrical characteristics were unaltered by pilocarpine pretreatment or exposure to bacteria.Bacterial passage occurred in 100% of pilocarpine membranes as compared with 33.3% in controls (p < 0.05). Pilocarpine-treated membranes resulted in 19.9 +/- 7.5 mg of retrievable mucus as compared with 28.8 +/- 7.2 mg in controls (p < 0.05). Light and transmission electron microscopy revealed an intact epithelial surface in all membranes. There was a marked decrease in mucus on the surface of pilocarpine-treated membranes.Intestinal mucus secretion is a critical factor in the barrier function of the gut, and its depletion results in a dramatic increase in bacterial passage across the intact rat ileum.

    View details for Web of Science ID A1994NV64500012

    View details for PubMedID 8023272



    Long-term central venous access is an integral part of the management of many, but not all children with cancer. The proper selection of those children who require this access and which access device (external vs. totally implanted) is best suited to that child is important to minimize complications and obtain optimal results. Although most of these devices can be expected to last the duration of the treatment protocol or the patient's life, complications (infection, occlusion, dislodgment) occur with higher than desired frequency, infection being the most common. No measures are clearly beneficial in preventing infection, but most infections can be treated successfully without device removal. Premature removal or dislodgement occurs more frequently with external catheters and may be minimized by techniques used at insertion. Occlusion, detected early, can be successfully managed by clot lysis in most children.

    View details for Web of Science ID A1993MG39200003

    View details for PubMedID 8284565



    The surgical management of familial childhood pheochromocytoma is based on data derived from clinical series that have focused primarily on the multiple endocrine neoplasia (MEN)-associated cases. Prophylactic bilateral total adrenalectomy has been advocated for this group due to a high incidence of bilateral adrenal involvement and the propensity for tumor recurrence after partial adrenal resections. We retrospectively reviewed our experience with a cohort of children with nonsyndromatic familial pheochromocytoma to see if their surgical management should parallel that advocated for patients with the MEN syndrome. From 1977 through 1991, 17 children from 9 families with a strong family history of pheochromocytoma were treated at the Children's Hospital of Pittsburgh. None of the patients or their families displayed an association with the MEN syndrome. There were 13 males and 4 females with a mean age of 10.1 years. Follow-up was obtained on all patients and averaged 6 years. All tumors were located within the abdominal cavity. Seven patients presented with unilateral adrenal tumors while four patients had synchronous bilateral tumors. Eight patients had tumors in extra-adrenal locations; 2 with concomitant adrenal tumors. Ten patients underwent total unilateral adrenalectomy with or without resection of extra-adrenal tumor(s). All patients with synchronous bilateral adrenal tumors underwent unilateral adrenalectomy in combination with a partial contralateral adrenal resection without a recurrence after an average of 7.3 years. Three patients developed metachronous adrenal tumors an average of 4.2 years after their initial surgery. All required complete removal of the affected adrenal, resulting in two patients with bilateral adrenalectomies.(ABSTRACT TRUNCATED AT 250 WORDS)

    View details for Web of Science ID A1993MD71600006

    View details for PubMedID 8263682



    To determine the optimal method of providing enteral feeding to neurologically impaired children with gastroesophageal reflux, Nissen fundoplication with simultaneous gastrostomy tube placement (NGT) was compared with anterograde percutaneous gastrojejunostomy (APGJ), a nonsurgical procedure performed under fluoroscopic guidance. The records of 112 neurologically impaired children with gastroesophageal reflux were retrospectively reviewed; 68 had undergone NGT and 44 APGJ. Follow-up data were available for 45 NGT patients (mean age, 6.4 years) and 34 APGJ patients (mean age, 7.9 years). Mean follow-up was 1.8 years in the NGT group and 2.5 years in the APGJ group. Complications resulting from either procedure were classified either as major, which included treatment failures or morbidity resulting in prolonged hospitalization, or as minor, those requiring outpatient treatment only or not directly caused by the procedure. The NGT group had a significantly higher incidence of major complications in comparison with the APGJ group (33.3% vs 11.8%, p < 0.05). Ten patients (22.2%) in the NGT group required reoperation for complications; six required a second NGT for wrap hernia, failure, and continued gastroesophageal reflux. Two patients (5.9%) in the APGJ group required surgery for complications; one of these eventually required an NGT, and the other had an intussusception that necessitated a small-bowel resection. Minor complications were more common in the APGJ group than in the NGT group (44.1% vs 6.6%); the majority of complications were related to the jejunostomy tube. Premature replacement or reinsertion of the jejunostomy tube was necessary in 14 APGJ patients (32%). The mortality rate was 8.8% in the NGT group and 5.9% in the APGJ group (p = not significant). No death occurred within 30 days of either procedure. We conclude that APGJ is a safe alternative method for feeding the neurologically impaired child with gastroesophageal reflux.

    View details for Web of Science ID A1993LW16000005

    View details for PubMedID 8355112



    The effect of the thromboxane synthetase inhibitor OKY-046 on renal blood flow and ureteral pressure in awake dogs during 18 hours of complete unilateral ureteral obstruction was studied. OKY-046 was infused continuously throughout the period of obstruction and post-release. Renal blood flow and ureteral pressure were constantly monitored during the study. Urinary thromboxane B2 and prostaglandin E2 excretion served as markers for inhibition of renal thromboxane A2 synthesis. The triphasic relationship between ipsilateral renal blood flow and ureteral pressure previously found following unilateral ureteral obstruction was observed despite OKY-046 infusion. Inhibition of ipsilateral urinary thromboxane B2 excretion was greater than 90% compared to control while ipsilateral urinary prostaglandin E2 excretion was not consistently decreased showing specific thromboxane inhibition. These results suggest that urinary thromboxane B2 may serve as a useful marker for determining the effects of inhibition on renal thromboxane A2 production. At the level of inhibition of thromboxane synthesis achieved we did not observe any change in the late decrease in renal blood flow which is typically seen with chronic unilateral ureteral obstruction.

    View details for Web of Science ID A1986E972000053

    View details for PubMedID 3464764