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Baird R, Pandya K, Lal DR, Calkins CM, Oldham KT, Tsai A, Naik-Mathuria B, St-Louis E, Luc MK, LaRusso K, Petroze R, Lofberg KM, Biller CK, Villalona GA, Gourlay DM, Klein M, DeUgarte D, Cleary M, Berdan EA, Siddiqui S, Lo A, Langer M, Duffy D, Blair G, Beres A, Laberge JM, Berdan EA, Radulescu A, Holterman A, Hoover JD, Fitzgerald T, Ganey M, Krishnaswami S, Ozgediz D. Regarding global pediatric surgery training opportunities. J Pediatr Surg 2018; 53:1256-1258. [PMID: 29605263 DOI: 10.1016/j.jpedsurg.2018.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 03/04/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Robert Baird
- Department of Pediatric General and Thoracic Surgery, British Columbia Children's Hospital, University of British Columbia, 4480 Oak, British Columbia, Vancouver V6H3V4, Canada.
| | - Kartik Pandya
- Tuft's University, Maine Medical Center, Portland, ME
| | - Dave R Lal
- Division of Pediatric Surgery, Children's Hospital of Wisconsin, Milwaukee, WI
| | | | | | | | - Bindi Naik-Mathuria
- Division of Pediatric Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Etienne St-Louis
- Division of Pediatric General and Thoracic Surgery, Montreal Children's Hospital, McGill University, Montreal, Canada
| | - Malemo Kalisya Luc
- Division of Pediatric General and Thoracic Surgery, Montreal Children's Hospital, McGill University; HEAL Africa Hospital, Goma, D.R., Congo
| | - Kathryn LaRusso
- Division of Pediatric General and Thoracic Surgery, Montreal Children's Hospital, McGill University, Montreal, Canada
| | - Robin Petroze
- Division of Pediatric General and Thoracic Surgery, Montreal Children's Hospital, McGill University, Montreal, Canada
| | | | | | - Gustavo A Villalona
- SSM Heath Cardinal Glennon Children's Hospital, Saint Louis University, St. Louis, MO
| | | | - Michael Klein
- Wayne State University, Children's Hospital of Michigan, Detroit, MI
| | - Daniel DeUgarte
- Division of Pediatric Surgery, UCLA and Harbor-UCLA, Los Angeles, CA
| | - Muriel Cleary
- University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA
| | | | - Sabina Siddiqui
- Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI
| | - Andrea Lo
- University of Calgary, Calgary, Alberta, Canada
| | | | - Damain Duffy
- Office of Pediatric Surgical Evaluation and Innovation, BC Children's Hospital, Vancouver, BC, Canada
| | - Geoffrey Blair
- Division of Pediatric Surgery, BC Children's Hospital, Vancouver, BC, Canada
| | - Alana Beres
- Division of Pediatric Surgery, UT Southwestern Medical Center, Dallas, TX
| | - Jean-Martin Laberge
- Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | | | | | | | | | | | - Michael Ganey
- Loma Linda University School of Medicine, Tenwek Hospital, Bomet, Kenya
| | - Sanjay Krishnaswami
- Division of Pediatric Surgery, Oregon Health and Science University, Portland, OR
| | - Doruk Ozgediz
- Yale Institute for Global Health, Yale University, New Haven, CT
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Thang C, Whitley M, Izadpanah N, DeUgarte D, Slusser W. Retrospective Review of Comorbid Conditions in a Multidisciplinary Pediatric Weight Management Clinic. Clin Pediatr (Phila) 2018; 57:815-820. [PMID: 28990428 DOI: 10.1177/0009922817734205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/16/2022]
Abstract
A retrospective medical chart review was conducted of patients enrolled in the Fit for Healthy Weight Clinic (Fit Clinic). At initial evaluation, comorbidities were identified by the patient and pediatrician. The number of comorbidities increased with age among patients. In reviewing the differences among the number of identified comorbidities among grade school age and adolescent patients, increases of 30% were observed in gastrointestinal-associated, 23% in psychiatric, 18% in endocrine, 16% in cardiovascular, and 14% in respiratory comorbidities. Fit Clinic patients already manifest many known obesity-related comorbidities as evidenced in identified conditions and abnormal laboratory values. The elevated blood pressures, blood glucose, and cholesterol levels raise concern for the future development of coronary artery disease and type 2 diabetes mellitus. With an average of five obesity-related comorbidities, Fit Clinic patients already have more comorbidities than what is evidenced in large US population-based studies, demonstrating that solely addressing body mass index is not sufficient.
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Affiliation(s)
- Christine Thang
- 1 Mattel Children's Hospital University of California Los Angeles, CA, USA
| | - Margaret Whitley
- 2 RAND Corporation, Santa Monica, CA, USA.,3 University of California, Irvine, CA, USA
| | | | - Daniel DeUgarte
- 1 Mattel Children's Hospital University of California Los Angeles, CA, USA
| | - Wendy Slusser
- 1 Mattel Children's Hospital University of California Los Angeles, CA, USA.,5 University of California Los Angeles Fielding School of Public Health, CA, USA
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3
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Karimzada MM, Matthews MN, French SW, DeUgarte D, Kim DY. Langerhans cell histiocytosis masquerading as acute appendicitis: Case report and review. World J Gastrointest Endosc 2017; 9:139-144. [PMID: 28360976 PMCID: PMC5355761 DOI: 10.4253/wjge.v9.i3.139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/15/2016] [Accepted: 12/28/2016] [Indexed: 02/06/2023] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare syndrome characterized by unifocal, multifocal unisystem, or disseminated/multi-system disease that commonly involves the bone, skin, lymph nodes, pituitary, or sometimes lung (almost exclusively in smokers) causing a variety of symptoms from rashes and bone lesions to diabetes insipidus or pulmonary infiltrates. We present a previously unreported case of gastrointestinal LCH as well as a novel characteristic lesion affecting the colon of a young woman who presented with signs and symptoms mimicking acute on chronic appendicitis. Immunohistochemical analysis of appendectomy specimen and nodular specimens on colonoscopy demonstrated S-100, CD1a, and langerin reactivity. The patient underwent systemic chemotherapy with cytarabine and demonstrated excellent response to therapy.
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4
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Duron V, DeUgarte D, Bliss D, Salazar E, Casapia M, Ford H, Upperman J. Implementation and analysis of initial trauma registry in Iquitos, Peru. Health Promot Perspect 2016; 6:174-179. [PMID: 27766233 PMCID: PMC5071783 DOI: 10.15171/hpp.2016.28] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 07/15/2016] [Indexed: 12/20/2022] Open
Abstract
Background: In Peru, 11% of deaths are due to trauma. Iquitos is a large underserved Peruvian city isolated from central resources by its geography. Our objective was to implement a locally driven trauma registry to sustainably improve trauma healthcare in this region.
Methods: All trauma patients presenting to the main regional referral hospital were included in the trauma registry. A pilot study retrospectively analyzed data from the first two months after implementation.
Results: From March to April 2013, 572 trauma patients were entered into the database. Average age was 26.9 years. Ten percent of patients presented more than 24 hours after injury. Most common mechanisms of injury were falls (25.5%), motor vehicle collisions (23.3%), and blunt assault (10.5%). Interim analysis revealed that 99% of patients were entered into the database. However, documentation of vital signs was poor: 42% of patients had temperature, 26% had oxygen saturation documented. After reporting to registry staff, a significant increase in temperature (42 to 97%, P < 0.001) and oxygen saturation (26 to 92%, P < 0.001) documentation was observed. Conclusion: A trauma registry is possible to implement in a resource-poor setting. Future efforts will focus on analysis of data to enhance prevention and treatment of injuries in Iquitos.
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Affiliation(s)
- Vincent Duron
- Department of Pediatric Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, USA
| | - Daniel DeUgarte
- Department of Pediatric Surgery, Mattel's Children Hospital, University of California, Los Angeles, CA, USA
| | - David Bliss
- Department of Pediatric Surgery, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - Ernesto Salazar
- Chief of Surgery, Department of Surgery, Hospital Regional Loreto, Punchana, Iquitos, Peru
| | - Martin Casapia
- Chief of Medicine, Department of Medicine, Hospital Regional Loreto, Punchana, Iquitos, Peru
| | - Henri Ford
- Department of Pediatric Surgery, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - Jeffrey Upperman
- Department of Pediatric Surgery, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
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5
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Rouch JD, Keeley JA, Scott A, Sydorak R, DeUgarte D, Lee SL. Short- and Long-term Results of Unroofing and Marsupialization for Adolescent Pilonidal Disease. JAMA Surg 2016; 151:877-9. [DOI: 10.1001/jamasurg.2016.0850] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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)
- Joshua D. Rouch
- Division of Pediatric Surgery, University of California–Los Angeles
| | - Jessica A. Keeley
- Division of Pediatric Surgery, Harbor–University of California–Los Angeles Medical Center, Los Angeles
| | - Andrew Scott
- Division of Pediatric Surgery, University of California–Los Angeles
| | - Roman Sydorak
- Department of Surgery, Kaiser Permanente, Los Angeles Medical Center, Los Angeles, California
| | - Daniel DeUgarte
- Division of Pediatric Surgery, University of California–Los Angeles
| | - Steven L. Lee
- Division of Pediatric Surgery, Harbor–University of California–Los Angeles Medical Center, Los Angeles
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Abstract
The movement of health care workers from countries with resource scarcity and immense need ("source" countries) to areas of resource abundance and greater personal opportunity ("destination" countries) presents a complex set of decisions and relationships that affect the development of international health care systems. We explore the extent to which ethical quandaries arising from this movement are the responsibility of the said actors and the implications of these ethical quandaries for patients, governments, and physicians through the case of Dr. R, a surgeon from Nigeria who is considering working in the United States, where he is being trained to help develop surgical capacity in his country. We suggest how Dr. R, the United States, and Nigeria all contribute to "brain drain" in different but complementary ways.
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Affiliation(s)
| | - Daniel DeUgarte
- Associate clinical professor of surgery and co-director of the Global Health Education Programs at the University of California, Los Angeles (UCLA), Center for World Health
| | - Michele Barry
- Senior associate dean for global health and director of the Center for Innovation in Global Health at Stanford University in Stanford, California
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7
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Martins D, Amado V, Johnson B, Karan A, Hartford E, Taela A, DeUgarte D. Case Volume Distribution in the Mozambican Pediatric General Surgery Training Unit. J Surg Res 2014. [DOI: 10.1016/j.jss.2013.11.452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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8
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Schulte M, Schon S, Tuuli M, DeUgarte D, Jungheim E. Obesity and in vitro fertilization (IVF) with donor oocytes: a systematic review and meta-analysis. Fertil Steril 2012. [DOI: 10.1016/j.fertnstert.2012.07.742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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9
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Bondada S, Chestovich P, Kee S, DeUgarte D. Ganglioneuroblastoma Masquerading as a Traumatic Lumbar Artery Injury and Hematoma. Am Surg 2012. [DOI: 10.1177/000313481207800110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Sandhya Bondada
- Department of Surgery University of California Los Angeles Los Angeles, California
| | - Paul Chestovich
- Department of Surgery University of California Los Angeles Los Angeles, California
| | - Stephen Kee
- Department of Radiology University of California Los Angeles Los Angeles, California
| | - Daniel DeUgarte
- Department of Surgery University of California Los Angeles Los Angeles, California
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10
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Bondada S, Chestovich P, Kee S, DeUgarte D. Ganglioneuroblastoma masquerading as a traumatic lumbar artery injury and hematoma. Am Surg 2012; 78:E15-E16. [PMID: 22273290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Sandhya Bondada
- Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
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11
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Shekherdimian S, DeUgarte D. Transumbilical laparoscopic-assisted appendectomy: an extracorporeal single-incision alternative to conventional laparoscopic techniques. Am Surg 2011; 77:557-60. [PMID: 21679587 DOI: 10.1177/000313481107700513] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Recently the use of a single umbilical incision to perform an appendectomy has been described. The purpose of this study was to review our initial experience with transumbilical laparoscopic-assisted appendectomy (TULAA) in the pediatric population. A retrospective review of all pediatric patients treated for appendicitis over a 10-month period was performed. The surgical technique involved using a standard 3-mm or 5-mm trocar for visualization and insufflation. A dissecting/grasping instrument was used adjacent to the trocar through the same incision. Patient demographics, operative findings and time as well as postoperative course were reviewed. Of 21 patients undergoing laparoscopy appendectomy, 18 patients successfully underwent TULAA. Five patients had advanced appendicitis, four had a retrocecal appendix, and three had appendicoliths. The average total operative time was 51 ± 15 minutes. Overall, the average length of stay was 1.2 ± 0.8 days; however, all patients with nonperforated appendicitis were discharged the day after surgery. All patients were followed postoperatively, and none reported postoperative complications of abscess or wound infection. Cost analysis demonstrated a markedly reduced associated cost for TULAA compared with conventional laparoscopy. TULAA is a safe and effective single-incision approach for early appendicitis that incorporates both open and laparoscopic techniques to provide excellent exploration of the abdomen, a short hospital stay, minimal pain, and an excellent cosmetic result. The technique described is cost-effective, because it does not use any special laparoscopes, trocars, or staplers. When performed as described in this study, only a single trocar and a standard laparoscopic setup are required. Cases of advanced appendicitis may require additional trocars or "conversion" to conventional laparoscopic techniques.
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Affiliation(s)
- Shant Shekherdimian
- Division of Pediatric Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-7098, USA
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12
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Affiliation(s)
- Daniel DeUgarte
- UCLA Fit for Healthy Weight Program, Department of Surgery, Division of Pediatric Surgery
| | - Wendy Slusser
- UCLA Fit for Healthy Weight Program, Department of Surgery, Division of Pediatric Surgery, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA
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13
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Kirschenbaum DS, DeUgarte D, Frankel F, Germann JN, McKnight TL, Nieman P, Sandler RH, Slusser W. Seven Steps to Success: A Handout for Parents of Overweight Children and Adolescents. ACTA ACUST UNITED AC 2009. [DOI: 10.1089/obe.2009.0107] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Daniel S. Kirschenbaum
- Northwestern University Medical School, Chicago, IL, Wellspring, A Division of CRC Health, Cupertino, CA
| | | | - Fred Frankel
- Department of Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | | | - Peter Nieman
- Pediatric Obesity Clinic of Calgary, University of Calgary, Calgary, Alberta, Canada
| | - Richard H. Sandler
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Rush Children’s Hospital & Rush University Medical School, Chicago, IL
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14
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Ashjian PH, Elbarbary AS, Edmonds B, DeUgarte D, Zhu M, Zuk PA, Lorenz HP, Benhaim P, Hedrick MH. In vitro differentiation of human processed lipoaspirate cells into early neural progenitors. Plast Reconstr Surg 2003; 111:1922-31. [PMID: 12711954 DOI: 10.1097/01.prs.0000055043.62589.05] [Citation(s) in RCA: 274] [Impact Index Per Article: 13.0] [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] [Indexed: 01/12/2023]
Abstract
Human processed lipoaspirate (PLA) cells are multipotent stem cells, capable of differentiating into multiple mesenchymal lineages (bone, cartilage, fat, and muscle). To date, differentiation to nonmesodermal fates has not been reported. This study demonstrates that PLA cells can be induced to differentiate into early neural progenitors, which are of an ectodermal origin. Undifferentiated cultures of human PLA cells expressed markers characteristic of neural cells such as neuron-specific enolase (NSE), vimentin, and neuron-specific nuclear protein (NeuN). After 2 weeks of treatment of PLA cells with isobutylmethylxanthine, indomethacin, and insulin, about 20 to 25 percent of the cells differentiated into cells with typical neural morphologic characteristics, accompanied by increased expression of NSE, vimentin, and the nerve-growth factor receptor trk-A. However, induced PLA cells did not express the mature neuronal marker, MAP, or the mature astrocyte marker, GFAP. It was also found that neurally induced PLA cells displayed a delayed-rectifier type K+ current (an early developmental ion channel) concomitantly with morphologic changes and increased expression of neural-specific markers. The authors concluded that human PLA cells might have the potential to differentiate in vitro into cells that represent early progenitors of neurons and/or glia.
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Affiliation(s)
- Peter H Ashjian
- Laboratory for Regenerative Bioengineering and Repair, Department of Surgery,University of California, Los Angeles, CALIF. 90095, USA
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Abstract
OBJECTIVE To determine the feasibility of surgically correcting pectus excavatum and carinatum deformities in adult patients. SUMMARY BACKGROUND DATA Although pectus chest deformities are common, many patients progress to adulthood without surgical repair and experience increasing symptoms. There are sparse published data regarding repair of pectus deformities in adults. METHODS Since 1987, 116 patients over the age of 18 years with pectus excavatum (n = 104) or carinatum (n = 12) deformities underwent correction using a highly modified Ravitch repair, with a temporary internal support bar. The ages ranged from 19 to 53 years (mean 30.1). Eighty-six patients sought repair after reviewing information regarding pectus deformities available on the Internet. Each patient experienced dyspnea with mild exertion and decreased endurance; 84 had chest pain with activity; 75 had palpitations and/or tachycardia. Seven patients underwent repair for symptomatic recurrent deformities. The mean severity score (chest width divided by distance from sternum to spine) was 4.8. The sternal bar was removed from 101 patients 6 months after the repair without complications. RESULTS Each of the patients with reduced endurance or dyspnea with mild exercise experienced marked improvement within 6 months. Chest discomfort was reduced in 82 of the 84 patients. Complications included pleural effusion (n = 7), pneumothorax (n = 2), pericarditis (n = 2), dislodged sternal bar (n = 3), and mildly hypertrophic scar (n = 12). Mean hospitalization was 2.9 days; mean blood loss was 122 mL. Pain was mild and of short duration (intravenous analgesics were used a mean of 2.1 days). There were no deaths. With a mean follow-up of 4.3 years, 109 of 113 respondents had a very good or excellent result. CONCLUSIONS Although technically more difficult than in children, pectus deformities may be repaired in adults with low morbidity, short hospital stay, and very good physiologic and cosmetic results.
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Fischer TA, Ungureanu-Longrois D, Singh K, de Zengotita J, DeUgarte D, Alali A, Gadbut AP, Lee MA, Balligand JL, Kifor I, Smith TW, Kelly RA. Regulation of bFGF expression and ANG II secretion in cardiac myocytes and microvascular endothelial cells. Am J Physiol 1997; 272:H958-68. [PMID: 9124460 DOI: 10.1152/ajpheart.1997.272.2.h958] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Basic fibroblast growth factor (bFGF; fibroblast growth factor-2) and angiotensin II (ANG II), among other peptide signaling autacoids (cytokines), are known to regulate the phenotypic adaptation of cardiac muscle to physiological stress. The cell type(s) in cardiac muscle responsible for ANG II synthesis and secretion and the role of endogenous cytokines in the regulation of bFGF induction remain unclear. With the use of confluent, serum-starved, low-passage cultures of cardiac microvascular endothelial cells (CMEC), ANG II could be detected in cellular lysates and in medium conditioned by these cells with the use of high-performance liquid chromatography followed by radioimmunoassay. The secretion of angiotensins by individual CMEC could be detected with a cell-blot assay technique. ANG II secretion was decreased by brefeldin A, an agent that interrupts constitutive and regulated secretory pathways for peptide autacoid/ hormone synthesis, suggesting de novo synthesis, activation, and secretion of angiotensins by CMEC. In primary isolates of adult rat ventricular myocytes (ARVM) and CMEC, ANG II, acting at ANG II type 1 receptors in both cell types, was found to increase bFGF mRNA levels measured by ribonuclease protection assay. Endothelin-1 (ET-1), which is known to be synthesized by CMEC, and bFGF itself, which has been detected in both ARVM and CMEC, increased bFGF transcript levels in both cell types. Interleukin-1beta (IL-1beta), which like ANG II and ET-1 is known to activate mitogen-activated protein kinases in both ARVM and CMEC, increased bFGF mRNA levels only in cardiac myocytes. Thus cytokines such as ANG II, ET-1, bFGF, and IL-1beta locally generated by cellular constituents of cardiac muscle, including CMEC, regulate bFGF mRNA levels in a cell type-specific manner.
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Affiliation(s)
- T A Fischer
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
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