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Abramov A, De Bie F, Hwang R, Hornick M, Allukian M, Wayne Nace G. Management of Pneumatosis Intestinalis beyond the Neonatal Period. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.08.475] [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: 10/23/2022]
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Partridge EA, Davey MG, Hornick M, Dysart KC, Olive A, Caskey R, Connelly JT, Hedrick HL, Peranteau WH, Flake AW. Pumpless arteriovenous extracorporeal membrane oxygenation: A novel mode of respiratory support in a lamb model of congenital diaphragmatic hernia. J Pediatr Surg 2018; 53:1453-1460. [PMID: 29605270 DOI: 10.1016/j.jpedsurg.2018.02.061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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] [Received: 05/29/2017] [Revised: 02/26/2018] [Accepted: 02/27/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) is commonly required in neonates with congenital diaphragmatic hernia (CDH) complicated by pulmonary hypertension (PH). ECMO carries significant risk, and is contraindicated in the setting of extreme prematurity or intracranial hemorrhage. Pumpless arteriovenous ECMO (P-ECMO) may represent an alternative for respiratory support. The present study summarizes our initial experience with P-ECMO in a lamb model of CDH. STUDY DESIGN Surgical creation of CDH was performed at 65-75days' gestation. At term (135-145days), lambs were delivered into the P-ECMO circuit. Three animals were maintained on a low-heparin infusion protocol (target ACT 160-180) and three animals were maintained with no systemic heparinization. RESULTS Animals were supported by the circuit for 380.7 +/- 145.6h (range, 102-504h). Circuit flow rates ranged from 97 to 208ml/kg/min, with adequacy of organ perfusion demonstrated by stable serum lactate levels (3.0 +/- 1.7) and pH (7.4 +/- 0.3). Necropsy demonstrated no evidence of thrombogenic complications. CONCLUSION Pumpless extracorporeal membrane oxygenation achieved support of CDH model lambs for up to three weeks. This therapy has the potential to bridge neonates with decompensated respiratory failure to CDH repair with no requirement for systemic anticoagulation, and may be applicable to patients currently precluded from conventional ECMO support.
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Affiliation(s)
- Emily A Partridge
- Center for Fetal Research, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104
| | - Marcus G Davey
- Center for Fetal Research, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104
| | - Matthew Hornick
- Center for Fetal Research, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104
| | - Kevin C Dysart
- Center for Fetal Research, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104
| | - Aliza Olive
- Center for Fetal Research, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104
| | - Robert Caskey
- Center for Fetal Research, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104
| | - James T Connelly
- Center for Fetal Research, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104
| | - Holly L Hedrick
- Center for Fetal Research, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104
| | - William H Peranteau
- Center for Fetal Research, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104
| | - Alan W Flake
- Center for Fetal Research, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104.
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Han J, Hornick M, Ko H, Yang X, He Y. Severe tortuous intra-abdominal segment of isolated single umbilical artery by three-dimensional high-definition flow imaging. CLIN EXP OBSTET GYN 2017. [DOI: 10.12891/ceog3678.2017] [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: 11/01/2022]
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Elefteriades JA, Sang A, Kuzmik G, Hornick M. Guilt by association: paradigm for detecting a silent killer (thoracic aortic aneurysm). Open Heart 2015; 2:e000169. [PMID: 25932333 PMCID: PMC4410139 DOI: 10.1136/openhrt-2014-000169] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 01/16/2015] [Accepted: 03/04/2015] [Indexed: 01/22/2023] Open
Abstract
Recent studies have confirmed a close association between various medical conditions (intracranial aneurysm, abdominal aortic aneurysm, temporal arteritis, autoimmune disorder, renal cysts), certain aortic anatomic variants (bovine aortic arch, direct origin of left vertebral artery from aortic arch, bicuspid aortic valve), and family history of aneurysm disease with thoracic aortic aneurysm and dissection. This paper reviews these associations. We propose to capitalise on these associations as powerful and expanding opportunities to diagnose the virulent but silent disease of thoracic aortic aneurysm. This can be accomplished by recognition of this 'guilt by association' with the other conditions. Thus, patients with associated diseases and anatomic variants should be investigated for silent aortic aneurysms. Such a paradigm holds substantial potential for reducing death from the silent killer represented by thoracic aortic aneurysm disease.
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Affiliation(s)
- John A Elefteriades
- Aortic Institute at Yale-New Haven, Boardman 2, Yale University School of Medicine , New Haven, Connecticut , USA
| | - Adam Sang
- Aortic Institute at Yale-New Haven, Boardman 2, Yale University School of Medicine , New Haven, Connecticut , USA
| | - Gregory Kuzmik
- Aortic Institute at Yale-New Haven, Boardman 2, Yale University School of Medicine , New Haven, Connecticut , USA
| | - Matthew Hornick
- Aortic Institute at Yale-New Haven, Boardman 2, Yale University School of Medicine , New Haven, Connecticut , USA
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Hornick M, Moomiaie R, Mojibian H, Ziganshin B, Almuwaqqat Z, Lee ES, Rizzo JA, Tranquilli M, Elefteriades JA. Bovine Aortic Arch A Marker for Thoracic Aortic Disease. Cardiology 2012; 123:116-24. [DOI: 10.1159/000342071] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 07/13/2012] [Indexed: 11/19/2022]
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O'Dell C, Shinnar S, Ballaban-Gil KR, Hornick M, Sigalova M, Kang H, Moshé SL. Rectal diazepam gel in the home management of seizures in children. Pediatr Neurol 2005; 33:166-72. [PMID: 16139730 DOI: 10.1016/j.pediatrneurol.2005.03.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2004] [Revised: 02/10/2005] [Accepted: 03/14/2005] [Indexed: 11/21/2022]
Abstract
This study assessed the utility of rectal diazepam gel in the home management of prolonged or repetitive seizures in children. Thirty-eight children being prescribed rectal diazepam gel by their clinician were prospectively recruited. Seizures, rectal diazepam use, emergency department visits, and quality of life data before and after study entry were recorded. The 38 children included 14 (37%) with complex febrile seizures, and 24 with epilepsy (n = 22) or a single seizure (n = 2). There were 23 (61%) children with prolonged seizures and 15 (39%) with repetitive seizures. During the 6-month follow-up period, 12 children experienced 26 seizures which met the criteria for rectal diazepam administration. Rectal diazepam gel was administered to 8 children on 19 occasions. In 16 (84%) of these episodes, seizures stopped and no emergency department visit was required. Parental stress was decreased between baseline and 6 months in both the overall group and in all the subgroups. Home use of rectal diazepam gel is effective in aborting seizure activity, often avoiding an emergency department visit. Its use reduces morbidity and costs associated with hospital visits and provides parents a treatment option for home management of prolonged or repetitive seizures.
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Affiliation(s)
- Christine O'Dell
- Department of Neurology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York 10467, USA
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