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Haider A, Scott JW, Gause CD, Meheš M, Hsiung G, Prelvukaj A, Yanocha D, Baumann LM, Ahmed F, Ahmed N, Anderson S, Angate H, Arfaa L, Asbun H, Ashengo T, Asuman K, Ayala R, Bickler S, Billingsley S, Bird P, Botman M, Butler M, Buyske J, Capozzi A, Casey K, Clayton C, Cobey J, Cotton M, Deckelbaum D, Derbew M, deVries C, Dillner J, Downham M, Draisin N, Echinard D, Elneil S, ElSayed A, Estelle A, Finley A, Frenkel E, Frykman PK, Gheorghe F, Gore-Booth J, Henker R, Henry J, Henry O, Hoemeke L, Hoffman D, Ibanga I, Jackson EV, Jani P, Johnson W, Jones A, Kassem Z, Kisembo A, Kocan A, Krishnaswami S, Lane R, Latif A, Levy B, Linos D, Linz P, Listwa LA, Magee D, Makasa E, Marin ML, Martin C, McQueen K, Morgan J, Moser R, Neighbor R, Novick WM, Ogendo S, Omigbodun A, Onajin-Obembe B, Parsan N, Philip BK, Price R, Rasheed S, Ratel M, Reynolds C, Roser SM, Rowles J, Samad L, Sampson J, Sanghvi H, Sellers ML, Sigalet D, Steffes BC, Stieber E, Swaroop M, Tarpley J, Varghese A, Varughese J, Wagner R, Warf B, Wetzig N, Williamson S, Wood J, Zeidan A, Zirkle L, Allen B, Abdullah F. Development of a Unifying Target and Consensus Indicators for Global Surgical Systems Strengthening: Proposed by the Global Alliance for Surgery, Obstetric, Trauma, and Anaesthesia Care (The G4 Alliance). World J Surg 2018; 41:2426-2434. [PMID: 28508237 PMCID: PMC5596034 DOI: 10.1007/s00268-017-4028-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
After decades on the margins of primary health care, surgical and anaesthesia care is gaining increasing priority within the global development arena. The 2015 publications of the Disease Control Priorities third edition on Essential Surgery and the Lancet Commission on Global Surgery created a compelling evidenced-based argument for the fundamental role of surgery and anaesthesia within cost-effective health systems strengthening global strategy. The launch of the Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care in 2015 has further coordinated efforts to build priority for surgical care and anaesthesia. These combined efforts culminated in the approval of a World Health Assembly resolution recognizing the role of surgical care and anaesthesia as part of universal health coverage. Momentum gained from these milestones highlights the need to identify consensus goals, targets and indicators to guide policy implementation and track progress at the national level. Through an open consultative process that incorporated input from stakeholders from around the globe, a global target calling for safe surgical and anaesthesia care for 80% of the world by 2030 was proposed. In order to achieve this target, we also propose 15 consensus indicators that build on existing surgical systems metrics and expand the ability to prioritize surgical systems strengthening around the world.
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Affiliation(s)
- Adil Haider
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - John W Scott
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Colin D Gause
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Ave, Box 63, Chicago, IL, 60611, USA
| | - Mira Meheš
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA
| | - Grace Hsiung
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Ave, Box 63, Chicago, IL, 60611, USA
| | - Albulena Prelvukaj
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA
| | - Dana Yanocha
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA
| | - Lauren M Baumann
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Ave, Box 63, Chicago, IL, 60611, USA
| | | | | | | | - Herve Angate
- The Pan African Association of Surgeons, Parktown, Johannesburg, South Africa
| | - Lisa Arfaa
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA
| | - Horacio Asbun
- Department of Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
- Society of American Gastrointestinal and Endoscopic Surgeons, Los Angeles, CA, USA
| | - Tigistu Ashengo
- St. Paul Medical College, Addis Ababa, Ethiopia
- Jhpiego, An Affiliate of Johns Hopkins University Baltimore, Baltimore, MD, USA
| | - Kisembo Asuman
- African Agency for Integrated Development, Kampala, Uganda
| | | | - Stephen Bickler
- Alliance for Surgery and Anaesthesia Presence, Lupsingen, Switzerland
| | | | - Peter Bird
- AIC Kijabe Hospital, Kijabe County, Kenya
| | - Matthijs Botman
- Netherlands Society for International Surgery, Amsterdam, The Netherlands
| | | | - Jo Buyske
- American Board of Surgery, Philadelphia, PA, USA
| | | | - Kathleen Casey
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA
| | | | - James Cobey
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA
- Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Michael Cotton
- International Collaboration for Essential Surgery, Angwin, CA, USA
| | - Dan Deckelbaum
- Centre for Global Surgery, Montreal, QC, Canada
- McGill University Health Centre, Montreal, QC, Canada
| | - Miliard Derbew
- The College of Surgeons of East, Central and Southern Africa, Arusha, Tanzania
| | - Catherine deVries
- University of Utah Center for Global Surgery, Salt Lake City, UT, USA
| | | | - Max Downham
- International College of Surgeons, Chicago, IL, USA
| | | | | | | | | | | | | | | | - Philip K Frykman
- Global Pediatric Surgical Technology and Education Project, Irvine, CA, USA
| | | | | | - Richard Henker
- American Association of Nurse Anesthetists, Park Ridge, IL, USA
| | - Jaymie Henry
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA
| | | | | | | | - Iko Ibanga
- Pro-Health International, Edwardsville, IL, USA
| | | | - Pankaj Jani
- The College of Surgeons of East, Central and Southern Africa, Arusha, Tanzania
| | - Walter Johnson
- WHO Global Initiative for Emergency and Essential Surgical Care, Geneva, Switzerland
| | | | | | - Asuman Kisembo
- African Agency for Integrated Development, Kampala, Uganda
| | - Abbey Kocan
- Kupona Foundation, Saratoga Springs, NY, USA
| | - Sanjay Krishnaswami
- World Journal of Surgery, Portland, OR, USA
- Oregon Health and Science University, Portland, OR, USA
| | - Robert Lane
- International Federation of Surgical Colleges, Bogis-Bossey, Switzerland
| | - Asad Latif
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Barbara Levy
- American College of Obstetricians and Gynecologists, Washington, DC, USA
| | - Dimitrios Linos
- Institute of Preventive Medicine, Environmental and Occupational Health - Prolepsis, Attica, Greece
- National and Kapodistrian University, Athens Medical School, Athens, Greece
| | | | | | - Declan Magee
- Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Emmanuel Makasa
- Permanent Mission of the Republic of Zambia to the United Nations, Geneva, Switzerland
| | | | | | - Kelly McQueen
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | | | - William M Novick
- University of Tennessee Health Science Center, Memphis, TN, USA
- William Novick Global Cardiac Alliance, Memphis, TN, USA
| | - Stephen Ogendo
- The College of Surgeons of East, Central and Southern Africa, Arusha, Tanzania
| | | | | | - Neil Parsan
- Organization of American States, Washington, DC, USA
| | | | - Raymond Price
- University of Utah Center for Global Surgery, Salt Lake City, UT, USA
| | - Shahnawaz Rasheed
- The Institute of Global Health Innovation, Imperial College London, London, UK
| | | | | | - Steven M Roser
- International Association of Oral and Maxillofacial Surgeons, Chicago, IL, USA
| | - Jackie Rowles
- International Federation of Nurse Anesthetists, Sursee, Switzerland
| | | | - John Sampson
- Global Surgery Initiative, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - David Sigalet
- World Federation of Associations of Pediatric Surgeons, Geneva, Switzerland
| | | | | | - Mamta Swaroop
- Association for Academic Surgery, Los Angeles, CA, USA
| | - John Tarpley
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | | | | | | | | | | | - Anne Zeidan
- 2nd Chance Association Reconstructive Surgery for Life Reconstruction, Meyrin, Switzerland
| | | | - Brendan Allen
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA
| | - Fizan Abdullah
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Ave, Box 63, Chicago, IL, 60611, USA.
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA.
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Haider A, Scott JW, Gause CD, Meheš M, Hsiung G, Prelvukaj A, Yanocha D, Baumann LM, Ahmed F, Ahmed N, Anderson S, Angate H, Arfaa L, Asbun H, Ashengo T, Asuman K, Ayala R, Bickler S, Billingsley S, Bird P, Botman M, Butler M, Buyske J, Capozzi A, Casey K, Clayton C, Cobey J, Cotton M, Deckelbaum D, Derbew M, deVries C, Dillner J, Downham M, Draisin N, Echinard D, Elneil S, ElSayed A, Estelle A, Finley A, Frenkel E, Frykman PK, Gheorghe F, Gore-Booth J, Henker R, Henry J, Henry O, Hoemeke L, Hoffman D, Ibanga I, Jackson EV, Jani P, Johnson W, Jones A, Kassem Z, Kisembo A, Kocan A, Krishnaswami S, Lane R, Latif A, Levy B, Linos D, Linz P, Listwa LA, Magee D, Makasa E, Marin ML, Martin C, McQueen K, Morgan J, Moser R, Neighbor R, Novick WM, Ogendo S, Omigbodun A, Onajin-Obembe B, Parsan N, Philip BK, Price R, Rasheed S, Ratel M, Reynolds C, Roser SM, Rowles J, Samad L, Sampson J, Sanghvi H, Sellers ML, Sigalet D, Steffes BC, Stieber E, Swaroop M, Tarpley J, Varghese A, Varughese J, Wagner R, Warf B, Wetzig N, Williamson S, Wood J, Zeidan A, Zirkle L, Allen B, Abdullah F. Erratum to: Development of a Unifying Target and Consensus Indicators for Global Surgical Systems Strengthening: Proposed by the Global Alliance for Surgery, Obstetric, Trauma, and Anaesthesia Care (The G4 Alliance). World J Surg 2017. [PMID: 28642965 DOI: 10.1007/s00268-017-4067-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Adil Haider
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - John W Scott
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Colin D Gause
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Ave, Box 63, Chicago, IL, 60611, USA
| | - Mira Meheš
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA
| | - Grace Hsiung
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Ave, Box 63, Chicago, IL, 60611, USA
| | - Albulena Prelvukaj
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA
| | - Dana Yanocha
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA
| | - Lauren M Baumann
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Ave, Box 63, Chicago, IL, 60611, USA
| | | | | | | | - Herve Angate
- The Pan African Association of Surgeons, Parktown, Johannesburg, South Africa
| | - Lisa Arfaa
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA
| | - Horacio Asbun
- Department of Surgery, Mayo Clinic Florida, Jacksonville, FL, USA.,Society of American Gastrointestinal and Endoscopic Surgeons, Los Angeles, CA, USA
| | - Tigistu Ashengo
- St. Paul Medical College, Addis Ababa, Ethiopia.,Jhpiego, An Affiliate of Johns Hopkins University Baltimore, Baltimore, MD, USA
| | - Kisembo Asuman
- African Agency for Integrated Development, Kampala, Uganda
| | | | - Stephen Bickler
- Alliance for Surgery and Anaesthesia Presence, Lupsingen, Switzerland
| | | | - Peter Bird
- AIC Kijabe Hospital, Kijabe County, Kenya
| | - Matthijs Botman
- Netherlands Society for International Surgery, Amsterdam, The Netherlands
| | | | - Jo Buyske
- American Board of Surgery, Philadelphia, PA, USA
| | | | - Kathleen Casey
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA
| | | | - James Cobey
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA.,Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Michael Cotton
- International Collaboration for Essential Surgery, Angwin, CA, USA
| | - Dan Deckelbaum
- Centre for Global Surgery, Montreal, QC, Canada.,McGill University Health Centre, Montreal, QC, Canada
| | - Miliard Derbew
- The College of Surgeons of East, Central and Southern Africa, Arusha, Tanzania
| | - Catherine deVries
- University of Utah Center for Global Surgery, Salt Lake City, UT, USA
| | | | - Max Downham
- International College of Surgeons, Chicago, IL, USA
| | | | | | | | | | | | | | | | - Philip K Frykman
- Global Pediatric Surgical Technology and Education Project, Irvine, CA, USA
| | | | | | - Richard Henker
- American Association of Nurse Anesthetists, Park Ridge, IL, USA
| | - Jaymie Henry
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA
| | | | | | | | - Iko Ibanga
- Pro-Health International, Edwardsville, IL, USA
| | | | - Pankaj Jani
- The College of Surgeons of East, Central and Southern Africa, Arusha, Tanzania
| | - Walter Johnson
- WHO Global Initiative for Emergency and Essential Surgical Care, Geneva, Switzerland
| | | | | | - Asuman Kisembo
- African Agency for Integrated Development, Kampala, Uganda
| | - Abbey Kocan
- Kupona Foundation, Saratoga Springs, NY, USA
| | - Sanjay Krishnaswami
- World Journal of Surgery, Portland, OR, USA.,Oregon Health and Science University, Portland, OR, USA
| | - Robert Lane
- International Federation of Surgical Colleges, Bogis-Bossey, Switzerland
| | - Asad Latif
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Barbara Levy
- American College of Obstetricians and Gynecologists, Washington, DC, USA
| | - Dimitrios Linos
- Institute of Preventive Medicine, Environmental and Occupational Health - Prolepsis, Attica, Greece.,National and Kapodistrian University, Athens Medical School, Athens, Greece
| | | | | | - Declan Magee
- Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Emmanuel Makasa
- Permanent Mission of the Republic of Zambia to the United Nations, Geneva, Switzerland
| | | | | | - Kelly McQueen
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | | | - William M Novick
- University of Tennessee Health Science Center, Memphis, TN, USA.,William Novick Global Cardiac Alliance, Memphis, TN, USA
| | - Stephen Ogendo
- The College of Surgeons of East, Central and Southern Africa, Arusha, Tanzania
| | | | | | - Neil Parsan
- Organization of American States, Washington, DC, USA
| | | | - Raymond Price
- University of Utah Center for Global Surgery, Salt Lake City, UT, USA
| | - Shahnawaz Rasheed
- The Institute of Global Health Innovation, Imperial College London, London, UK
| | | | | | - Steven M Roser
- International Association of Oral and Maxillofacial Surgeons, Chicago, IL, USA
| | - Jackie Rowles
- International Federation of Nurse Anesthetists, Sursee, Switzerland
| | | | - John Sampson
- Global Surgery Initiative, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - David Sigalet
- World Federation of Associations of Pediatric Surgeons, Geneva, Switzerland
| | | | | | - Mamta Swaroop
- Association for Academic Surgery, Los Angeles, CA, USA
| | - John Tarpley
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | | | | | | | | | | | - Anne Zeidan
- 2nd Chance Association Reconstructive Surgery for Life Reconstruction, Meyrin, Switzerland
| | | | - Brendan Allen
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA
| | - Fizan Abdullah
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Ave, Box 63, Chicago, IL, 60611, USA. .,The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, New York, NY, USA.
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Hsiung GE, Schwab B, O'Brien EK, Gause CD, Hebal F, Barsness KA, Rooney DM. Preliminary Evaluation of a Novel Rigid Bronchoscopy Simulator. J Laparoendosc Adv Surg Tech A 2017; 27:737-743. [PMID: 28498063 DOI: 10.1089/lap.2016.0250] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Emergent retrieval of airway foreign bodies (AFBs) in children remains a priority skill set for pediatric surgeons. In the setting of low procedural volume, simulation-based education with deliberate practice is essential to ensure trainees reach expected surgical competency. The purposes of this work were to (1) create a realistic rigid bronchoscopy for AFB retrieval simulation model and (2) to evaluate preliminary validity evidence of a novel simulator for the use of training and assessing pediatric surgical trainees' rigid bronchoscopy skills. METHODS After institutional review board exemption determination, 18 participants performed AFB retrieval of two different objects on a novel simulator that represented an 18-month-old pediatric tracheobronchial airway. Participants reported their experience and comfort level, and rated the simulator across two domains-Authenticity and their Ability to perform tasks. Authenticity was measured by 23 items across five subdomains (Visual Attributes, Materials' Response, Realism of Experience, Value and Relevance, and Global Value). Participants who had previously performed ≥10 rigid bronchoscopies were categorized as "experienced," while those reporting <10 were considered "novice." Validity evidence relevant to test content and internal structure was evaluated using a many-facet Rasch model. RESULTS Novice surgeons (n = 12) had previously performed a mean of 2.7 (±2.0) rigid bronchoscopies, compared to 15.4 (±7.7) by experienced surgeons (n = 6). For both models, the Value and Relevance subdomain received the highest ratings (observed average [OA] = 3.9, while Materials' Response received the lowest (OA <3.0). Participants' Global Value rating for this model was consistent with "requires minor improvements before it can be considered for use in rigid bronchoscopy training." CONCLUSIONS We successfully designed, assembled, and evaluated a novel pediatric rigid bronchoscopy model for AFB retrieval. The model was considered as relevant to educational needs and valuable as a testing and training tool. With recommended improvements, the model could be used for implementation with a Mastery Learning curriculum.
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Affiliation(s)
- Grace E Hsiung
- 1 Department of Surgery, Northwestern University , Feinberg School of Medicine, Chicago, Illinois.,2 Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois
| | - Ben Schwab
- 1 Department of Surgery, Northwestern University , Feinberg School of Medicine, Chicago, Illinois
| | - Ellen K O'Brien
- 3 Department of Medical Education, Northwestern University , Feinberg School of Medicine, Chicago, Illinois
| | - Colin D Gause
- 1 Department of Surgery, Northwestern University , Feinberg School of Medicine, Chicago, Illinois.,2 Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois
| | - Ferdynand Hebal
- 1 Department of Surgery, Northwestern University , Feinberg School of Medicine, Chicago, Illinois.,2 Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois
| | - Katherine A Barsness
- 1 Department of Surgery, Northwestern University , Feinberg School of Medicine, Chicago, Illinois.,2 Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois
| | - Deborah M Rooney
- 4 Department of Learning Health Sciences, University of Michigan Medical School , Ann Arbor, Michigan
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Blackwood BP, Gause CD, Harris JC, Theodorou CM, Helenowski I, Lautz TB, Grabowski J, Hunter CJ. Overweight and Obese Pediatric Patients Have an Increased Risk of Developing a Surgical Site Infection. Surg Infect (Larchmt) 2017; 18:491-497. [DOI: 10.1089/sur.2016.179] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Brian P. Blackwood
- Department of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Department of General Surgery, Rush University Medical Center, Chicago, Illinois
| | - Colin D. Gause
- Department of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Jamie C. Harris
- Department of General Surgery, Rush University Medical Center, Chicago, Illinois
| | - Christina M. Theodorou
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Irene Helenowski
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Timothy B. Lautz
- Department of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Julia Grabowski
- Department of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Catherine J. Hunter
- Department of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Sacco Casamassima MG, Goldstein SD, Yang J, Gause CD, Abdullah F, Meoded A, Makary MA, Colombani PM. The impact of surgical strategies on outcomes for pediatric chronic pancreatitis. Pediatr Surg Int 2017; 33:75-83. [PMID: 27815641 DOI: 10.1007/s00383-016-3999-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE To review our institutional experience in the surgical treatment of pediatric chronic pancreatitis (CP) and evaluate predictors of long-term pain relief. METHODS Outcomes of patients ≤21 years surgically treated for CP in a single institution from 1995 to 2014 were evaluated. RESULTS Twenty patients underwent surgery for CP at a median of 16.6 years (IQR 10.7-20.6 years). The most common etiology was pancreas divisum (n = 7; 35%). Therapeutic endoscopy was the first-line treatment in 17 cases (85%). Surgical procedures included: longitudinal pancreaticojejunostomy (n = 4, 20%), pancreatectomy (n = 9, 45%), total pancreatectomy with islet autotransplantation (n = 2; 10%), sphincteroplasty (n = 2, 10%) and pseudocyst drainage (n = 3, 15%). At a median follow-up of 5.3 years (IQR 4.2-5.3), twelve patients (63.2%) were pain free and five (26.3%) were insulin dependent. In univariate analysis, previous surgical procedure or >5 endoscopic treatments were associated with a lower likelihood of pain relief (OR 0.06; 95% CI 0.006-0.57; OR 0.07; 95%, CI 0.01-0.89). However, these associations were not present in multivariate analysis. CONCLUSION In children with CP, the step-up practice including a limited trial of endoscopic interventions followed by surgery tailored to anatomical abnormalities and gene mutation status is effective in ensuring long-term pain relief and preserving pancreatic function.
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Affiliation(s)
| | - Seth D Goldstein
- Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jingyan Yang
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Colin D Gause
- Department of Surgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Fizan Abdullah
- Department of Surgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Avner Meoded
- Division of Pediatric Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA
| | - Martin A Makary
- Department of Surgery, Pancreatitis Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paul M Colombani
- Department of Surgery, Johns Hopkins All Children's Hospital, 601 5th Street South, Suite 501, St Petersburg, FL, 33701, USA.
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6
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Gause CD, Hayashi M, Haney C, Rhee D, Karim O, Weir BW, Stewart D, Lukish J, Lau H, Abdullah F, Gauda E, Pryor HI. Mucous fistula refeeding decreases parenteral nutrition exposure in postsurgical premature neonates. J Pediatr Surg 2016; 51:1759-1765. [PMID: 27614807 DOI: 10.1016/j.jpedsurg.2016.06.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 06/06/2016] [Accepted: 06/28/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND/PURPOSE Premature neonates can develop intraabdominal conditions requiring emergent bowel resection and enterostomy. Parenteral nutrition (PN) is often required, but results in cholestasis. Mucous fistula refeeding allows for functional restoration of continuity. We sought to determine the effect of refeeding on nutrition intake, PN dependence, and PN associated hepatotoxicity while evaluating the safety of this practice. METHODS A retrospective review of neonates who underwent bowel resection and small bowel enterostomy with or without mucous fistula over 2years was undertaken. Patients who underwent mucous fistula refeeding (RF) were compared to those who did not (OST). Primary outcomes included days from surgery to discontinuation of PN and goal enteral feeds, and total days on PN. Secondary outcomes were related to PN hepatotoxicity. RESULTS Thirteen RF and eleven OST were identified. There were no significant differences among markers of critical illness (p>0.20). In the interoperative period, RF patients reached goal enteral feeds earlier than OST patients (median 28 versus 43days; p=0.03) and were able to have PN discontinued earlier (median 25 versus 41days; p=0.04). Following anastomosis, the magnitude of effect was more pronounced, with RF patients reaching goal enteral feeds earlier than OST patients (median 7.5 versus 20days; p≤0.001) and having PN discontinued sooner (30.5 versus 48days; p=0.001). CONCLUSIONS RF neonates reached goal feeds and were able to be weaned from PN sooner than OST patients. A prospective multicenter trial of refeeding is needed to define the benefits and potential side effects of refeeding in a larger patient population in varied care environments.
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Affiliation(s)
- Colin D Gause
- Department of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Madoka Hayashi
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Courtney Haney
- Department of Pediatric Nutrition, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Daniel Rhee
- Department of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Omar Karim
- Department of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Brian W Weir
- Biostatistics, Epidemiology and Data Management Core, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Dylan Stewart
- Department of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jeffrey Lukish
- Department of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Henry Lau
- Department of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Fizan Abdullah
- Department of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Estelle Gauda
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Howard I Pryor
- Department of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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7
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Sacco Casamassima MG, Gause CD, Goldstein SD, Abdullah F, Meoded A, Lukish JR, Wolfgang CL, Cameron J, Hackam DJ, Hruban RH, Colombani PM. Pancreatic surgery for tumors in children and adolescents. Pediatr Surg Int 2016; 32:779-88. [PMID: 27364750 DOI: 10.1007/s00383-016-3925-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2016] [Indexed: 12/11/2022]
Abstract
PURPOSE Pancreatic neoplasms are uncommon in children. This study sought to analyze the clinical and pathological features of surgically resected pancreatic tumors in children and discuss management strategies. METHODS We conducted a retrospective review of patients ≤21 years with pancreatic neoplasms who underwent surgery at a single institution between 1995 and 2015. RESULTS Nineteen patients were identified with a median age at operation of 16.6 years (IQR 13.5-18.9). The most common histology was solid pseudopapillary neoplasm (SPN) (n = 13), followed by pancreatic neuroendocrine tumor (n = 3), serous cystadenoma (n = 2) and pancreatoblastoma (n = 1). Operative procedures included formal pancreatectomy (n = 17), enucleation (n = 1) and central pancreatectomy (n = 1). SPNs were noninvasive in all but one case with perineural, vascular and lymph node involvement. Seventeen patients (89.5 %) are currently alive and disease free at a median follow-up of 5.7 (IQR 3.7-10.9) years. Two patients died: one with metastatic insulinoma and another with SPN who developed peritoneal carcinomatosis secondary to a concurrent rectal adenocarcinoma. CONCLUSIONS Pediatric pancreatic tumors are a heterogeneous group of neoplastic lesions for which surgery can be curative. SPN is the most common histology, is characterized by low malignant potential and in selected cases can be safely and effectively treated with a tissue-sparing resection and minimally invasive approach.
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Affiliation(s)
| | - Colin D Gause
- Division of Pediatric Surgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Seth D Goldstein
- Division of Pediatric Surgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Fizan Abdullah
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Avner Meoded
- Division of Pediatric Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA
| | - Jeffrey R Lukish
- Division of Pediatric Surgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Christopher L Wolfgang
- Department of Surgery, The Sol Goldman Pancreatic Research Center, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - John Cameron
- Department of Surgery, The Sol Goldman Pancreatic Research Center, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - David J Hackam
- Division of Pediatric Surgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ralph H Hruban
- Department of Pathology, The Sol Goldman Pancreatic Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paul M Colombani
- Department of Surgery, Johns Hopkins All Children's Hospital, 601 5th Street South, Suite 501, Saint Petersburg, FL, 33701, USA.
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8
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Abdullah F, Salazar JH, Gause CD, Gadepalli S, Biester TW, Azarow KS, Brandt ML, Chung DH, Lund DP, Rescorla FJ, Waldhausen JHT, Tracy TF, Fallat ME, Klein MD, Lewis FR, Hirschl RB. Understanding the Operative Experience of the Practicing Pediatric Surgeon. JAMA Surg 2016; 151:735-41. [DOI: 10.1001/jamasurg.2016.0261] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Fizan Abdullah
- Department of Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Jose H. Salazar
- Department of Surgery, University of Maryland Medical Center, Baltimore
| | - Colin D. Gause
- Department of Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Samir Gadepalli
- Department of Surgery, University of Michigan Health System, Ann Arbor
| | | | - Kenneth S. Azarow
- Department of Surgery, Oregon Health and Science University, Portland
| | - Mary L. Brandt
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Dai H. Chung
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dennis P. Lund
- Department of Surgery, Stanford School of Medicine, Stanford, California
| | | | | | - Thomas F. Tracy
- Department of Surgery, Brown University, Providence, Rhode Island
| | - Mary E. Fallat
- Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Michael D. Klein
- Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | | | - Ronald B. Hirschl
- Department of Surgery, University of Michigan Health System, Ann Arbor
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9
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Gause CD, Hsiung G, Schwab B, Clifton M, Harmon CM, Barsness KA. Advances in Pediatric Surgical Education: A Critical Appraisal of Two Consecutive Minimally Invasive Pediatric Surgery Training Courses. J Laparoendosc Adv Surg Tech A 2016; 26:663-70. [PMID: 27352106 DOI: 10.1089/lap.2016.0249] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mandates for improved patient safety and increasing work hour restrictions have resulted in changes in surgical education. Educational courses increasingly must meet those needs. We sought to determine the experience, skill level, and the impact of simulation-based education (SBE) on two cohorts of pediatric surgery trainees. MATERIALS AND METHODS After Institutional Review Board (IRB) exempt determination, a retrospective review was performed of evaluations for an annual advanced minimally invasive surgery (MIS) course over 2 consecutive years. The courses included didactic content and hands-on skills training. Simulation included neonatal/infant models for rigid bronchoscopy-airway foreign body retrieval, laparoscopic common bile duct exploration, and real tissue diaphragmatic hernia (DH), duodenal atresia (DA), pulmonary lobectomy, and tracheoesophageal fistula models. Categorical data were analyzed with chi-squared analyses with t-tests for continuous data. RESULTS Participants had limited prior advanced neonatal MIS experience, with 1.95 ± 2.84 and 1.16 ± 1.54 prior cases in the 2014 and 2015 cohorts, respectively. The 2015 cohort had significantly less previous experience in lobectomy (P = .04) and overall advanced MIS (P = .007). Before both courses, a significant percentage of participants were not comfortable with DH repair (39%-42%), DA repair (50%-74%), lobectomy (34%-43%), and tracheoesophageal fistula repair (54%-81%). After course completion, > 60% of participants reported improvement in comfort with procedures and over 90% reported that the course significantly improved their perceived ability to perform each operation safely. CONCLUSION Pediatric surgery trainees continue to have limited exposure to advanced MIS during clinical training. SBE results in significant improvement in both cognitive knowledge and trainee comfort with safe operative techniques for advanced MIS.
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Affiliation(s)
- Colin D Gause
- 1 Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois.,2 Department of Surgery, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Grace Hsiung
- 1 Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois.,2 Department of Surgery, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Ben Schwab
- 2 Department of Surgery, Northwestern University Feinberg School of Medicine , Chicago, Illinois.,3 Department of Medical Education, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Matthew Clifton
- 4 Division of Pediatric Surgery, Department of Surgery, Children's Healthcare of Atlanta , Atlanta, Georgia .,5 Division of Pediatric Surgery, Department of Surgery, Emory University , Children's Hospital of Atlanta, Atlanta, Georgia
| | - Carroll M Harmon
- 6 Division of Pediatric Surgery, Department of Surgery, Women and Children's Hospital of Buffalo , Buffalo, New York.,7 Department of Surgery, State University of New York at Buffalo , Buffalo, New York
| | - Katherine A Barsness
- 1 Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois.,2 Department of Surgery, Northwestern University Feinberg School of Medicine , Chicago, Illinois.,3 Department of Medical Education, Northwestern University Feinberg School of Medicine , Chicago, Illinois
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10
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Gause CD, Glenn I, Liu M, Seifarth FG. Temporary Retrograde Occlusion of High-Flow Tracheo-Esophageal Fistula. Pediatrics 2015; 136:e1051-4. [PMID: 26391942 DOI: 10.1542/peds.2015-1234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2015] [Indexed: 11/24/2022] Open
Abstract
This report describes a temporary retrograde occlusion technique for control of a high-flow tracheo-esophageal fistula in a critically ill, premature infant born at 29 weeks' gestational age, with a diagnosis of type C (Gross) esophageal atresia and tetralogy of Fallot (TOF). This procedure is a useful bridging maneuver before definitive surgical correction for extremely low birth weight, unstable neonates with tracheo-esophageal fistula who are suffering from associated malformations.
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Affiliation(s)
- Colin D Gause
- Department of Pediatric Surgery, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Ian Glenn
- Department of Pediatric Surgery, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Michael Liu
- Department of Pediatric Surgery, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Federico G Seifarth
- Department of Pediatric Surgery, Cleveland Clinic Children's Hospital, Cleveland, Ohio
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11
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Morris CM, Pardo-Villamizar C, Gause CD, Singer HS. Serum autoantibodies measured by immunofluorescence confirm a failure to differentiate PANDAS and Tourette syndrome from controls. J Neurol Sci 2008; 276:45-8. [PMID: 18823914 DOI: 10.1016/j.jns.2008.08.032] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Revised: 07/21/2008] [Accepted: 08/21/2008] [Indexed: 10/21/2022]
Abstract
PANDAS and some cases of Tourette syndrome (TS) have been proposed to be post-streptococcal movement disorders in which antibodies produced against group A beta-hemolytic streptococcus cross react against brain epitopes. Attempts to identify disease specific anti-striatal antibodies in the serum of affected patients have focused on the use of Western immunoblotting and ELISA methodologies. In this study, immunohistochemical techniques were used to identify serum anti-striatal antibody reactivity. In positive samples, double staining with anti-GFAP (glial) and anti-MAP2 (neuronal) was used to establish localization of the immunofluorescence. No significant differences in immunofluorescence or localization were identified in patients with PANDAS (n=30) and TS (n=30) as compared to controls (n=30). IF reactivity did not correlate with tic severity or elevated titers of antistreptococcal antibodies. Further comparisons showed no correlation between autoreactivity determined by immunofluorescence and the presence of previously measured immunoblot reactivity against human caudate or putative antigens (pyruvate kinase M1 and aldolase C). These results confirm an inability to distinguish patient populations by antibody measurements and raise further concerns about the presence of an autoimmune mechanism in PANDAS and TS.
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Affiliation(s)
- Christina M Morris
- Department of Neurology, Pathology 235, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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12
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Singer HS, Morris CM, Gause CD, Gillin PK, Crawford S, Zimmerman AW. Antibodies against fetal brain in sera of mothers with autistic children. J Neuroimmunol 2008; 194:165-72. [PMID: 18093664 DOI: 10.1016/j.jneuroim.2007.11.004] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Revised: 10/26/2007] [Accepted: 11/14/2007] [Indexed: 01/23/2023]
Abstract
Serum antibodies in 100 mothers of children with autistic disorder (MCAD) were compared to 100 age-matched mothers with unaffected children (MUC) using as antigenic substrates human and rodent fetal and adult brain tissues, GFAP, and MBP. MCAD had significantly more individuals with Western immunoblot bands at 36 kDa in human fetal and rodent embryonic brain tissue. The density of bands was greater in fetal brain at 61 kDa. MCAD plus developmental regression had greater reactivity against human fetal brain at 36 and 39 kDa. Data support a possible complex association between genetic/metabolic/environmental factors and the placental transfer of maternal antibodies in autism.
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Affiliation(s)
- Harvey S Singer
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, United States.
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13
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Yoon DY, Gause CD, Leckman JF, Singer HS. Frontal dopaminergic abnormality in Tourette syndrome: a postmortem analysis. J Neurol Sci 2007; 255:50-6. [PMID: 17337006 DOI: 10.1016/j.jns.2007.01.069] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2006] [Revised: 12/21/2006] [Accepted: 01/23/2007] [Indexed: 10/23/2022]
Abstract
Frontal-subcortical abnormalities have been implicated in the pathophysiology of Tourette syndrome (TS). The goal of this study was to more extensively evaluate a possible underlying neurochemical abnormality in frontal cortex. Postmortem brain tissue from frontal and occipital regions (Brodmann's areas 4, 6, 9, 10, 11, 12, and 17) from three TS patients and three age-and sex-matched controls were analyzed by semiquantitative immunoblotting. Relative densities were measured for a variety of neurochemical markers including dopamine (D1, D2), serotonin (5HT-1A), and alpha-adrenergic (alpha-2A) receptors, the dopamine transporter (DAT), a monoamine terminal marker (vesicular monoamine transporter type 2, VMAT-2), and vesicular docking and release proteins (VAMP-2, synaptotagmin, SNAP-25, syntaxin, synaptophysin). Data from each TS sample, corrected for actin content, was expressed as a percentage value of its control. Results identified consistent increases of DAT and D2 receptor density in five of six frontal regions in all three TS subjects. D1 and alpha-2A receptor density were increased in a few frontal regions. These results support the hypothesis of a dopaminergic dysfunction in the frontal lobe and a likely role in the pathophysiology of TS.
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Affiliation(s)
- Dustin Y Yoon
- Department of Neurology, Johns Hopkins University School of Medicine, Harriett Lane Outpatient Building, 200 N. Wolfe Street, Suite 2158, Baltimore, MD 21205, USA
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