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Tanga CF, Fakhoury E, Ham PB, Dosluoglu HH, Harris LM. Ruptured abdominal aortic aneurysm in an 11-year-old with multiple peripheral artery aneurysms. J Vasc Surg Cases Innov Tech 2020; 6:539-542. [PMID: 33134637 PMCID: PMC7588751 DOI: 10.1016/j.jvscit.2020.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/23/2020] [Indexed: 11/25/2022]
Abstract
Pediatric abdominal aortic aneurysms (AAAs) are rarely encountered in clinical practice. The combination of a pediatric AAA in a patient with multiple peripheral artery aneurysms is even more rare. We report the management of an 11-year-old boy who presented with a ruptured AAA who also had multiple peripheral arterial aneurysms. Infectious, genetic, and inflammatory workup was negative, classifying this aneurysm as congenital.
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Affiliation(s)
| | - Elias Fakhoury
- Department of Vascular Surgery, University at Buffalo, Buffalo, NY
| | - P Benson Ham
- Department of Vascular Surgery, University at Buffalo, Buffalo, NY
| | | | - Linda M Harris
- Department of Vascular Surgery, University at Buffalo, Buffalo, NY
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2
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Lamoshi A, Ham PB, Chen Z, Wilding G, Vali K. Timing of the definitive procedure and ileostomy closure for total colonic aganglionosis HD: Systematic review. J Pediatr Surg 2020; 55:2366-2370. [PMID: 32106964 DOI: 10.1016/j.jpedsurg.2020.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 10/02/2019] [Revised: 01/02/2020] [Accepted: 02/03/2020] [Indexed: 01/10/2023]
Abstract
AIM To establish the cogency of recommendations for the appropriate age for pull-through and ileostomy closure in Total Colonic Aganglionosis-Hirschsprung Disease's (TCA-HD). METHOD Medline, PubMed, Cochrane, and the ClinicalKey databases were searched without date restriction. The studies that reported TCA-HD cases were evaluated for the number of cases, age at the definitive procedure, age at the ileostomy closure, reported complications, and the type of procedure. Perianal excoriation and diaper rash rates were analyzed using SPSS software, with p < 0.05 considered significant. RESULTS Twenty-five studies mentioned TCA-HD findings between 1968 and 2019. The total number of patients who had definitive surgery was 218. Analysis showed no correlation between development of diaper rash and the age of the patient at the time of the definitive surgery or ileostomy closure. Studies scored between six and nine of nine possible stars on the NOS scoring system. CONCLUSION There is no correlation between age of surgery and postoperative diaper rash. Delaying the definitive procedure or ileostomy closure for TCA-HD has limited support on a review of current studies. The perianal excoriation/diaper rash is not reported in the literature at a high enough frequency to warrant keeping a diverting ileostomy until toilet trained of urine. TYPE OF STUDY Systematic review and meta-analysis. Levels of evidence IV.
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Affiliation(s)
- Abdulraouf Lamoshi
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, NY.
| | - P Benson Ham
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, NY
| | - Z Chen
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY
| | - G Wilding
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY
| | - Kaveh Vali
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, NY
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3
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Colosimo C, Yon JR, Ballesteros SR, Walsh N, Talukder A, Ham PB, Abuzeid AM, Mentzer CJ. Geospatial relationship of trauma and violent crime: An analysis of violent crime and trauma center utilization. Trauma 2020. [DOI: 10.1177/1460408620950882] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Descriptive epidemiologic and geographic analysis utilizing geographic information science (GIS) has been used to determine the utilization of trauma systems and to spatially describe patterns of trauma and crime. We examined the relationship between spatial components of criminality and injuries in order to evaluate the optimal trauma center location and determine a correlation between reported violent crime and trauma center utilization. Methods All adult trauma and violent crime (VC) encounters in a defined area over a single year were included. Geospatial statistics pattern analysis tools of Median Center (MC) and the Average Nearest Neighbor analysis (ANNa) were used to determine if mapped points occurred in complete spatial randomness or were clustered in a significant pattern. Results ANNa of VC resulted in a z-score of –20.54 and a p-value of <0.001, indicating a <1% likelihood that violent crimes were distributed randomly. Further ANNa yielded a zscore of –5.67 and p-value of <0.001 for injuries. Our trauma center is 1.45 miles from the MC of VC and 2.28 miles from the MC for injuries. Spatial autocorrelation failed to demonstrate a direct relationship between criminality and trauma center utilization with a z-score of 0.030 and p-value of 0.98. Conclusion While not statistically significant, the spatial trends of violent crime and trauma center utilization demonstrated a clear pattern. GIS is a powerful tool for the trauma director, and examination of the local regional patterns of trauma should be undertaken by health systems to assist with optimizing outreach, expansion, and response times.
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Affiliation(s)
| | - James R Yon
- Swedish Medical Center, Department of Trauma, Engelwood, CO, USA
| | - Steven R Ballesteros
- Department of Surgery, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Nathanial Walsh
- Department of Surgery, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Asif Talukder
- Department of Surgery, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - P Benson Ham
- Department of Surgery, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Adel M Abuzeid
- Department of Surgery, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Caleb J Mentzer
- Division Trauma, Critical Care & Acute Care Surgery, Spartanburg Medical Center, Spartanburg, SC, USA
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Affiliation(s)
- Matthew Romine
- Section of Pediatric Surgery Department of General Surgery Georgia Regents University Augusta, Georgia
| | - P. Benson Ham
- Section of Pediatric Surgery Department of General Surgery Georgia Regents University Augusta, Georgia
| | - James R. Yon
- Section of Pediatric Surgery Department of General Surgery Georgia Regents University Augusta, Georgia
| | - Walter L. Pipkin
- Section of Pediatric Surgery Department of General Surgery Georgia Regents University Augusta, Georgia
| | - Charles G. Howell
- Section of Pediatric Surgery Department of General Surgery Georgia Regents University Augusta, Georgia
| | - Robyn M. Hatley
- Section of Pediatric Surgery Department of General Surgery Georgia Regents University Augusta, Georgia
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Abstract
Paraspinal tumors arising from the sympathetic chain include those on the ganglioneuroma-neuroblastoma spectrum. Accurate diagnosis often requires excision owing to the histopathologic heterogeneity of these tumors and the risk of false negative biopsy results. Choice of approach is dictated by location and extirpation is usually amenable to minimally invasive techniques. We present a patient whose paraspinal tumor included the T11-L2 vertebral body levels and was removed using a retroperitoneoscopic approach. This approach is rarely considered in pediatric general surgery and afforded a useful alternative to thoracoscopy or laparoscopy.
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Affiliation(s)
- P Benson Ham
- Division of Pediatric Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
| | - Clare J Twist
- Division of Pediatrics, Roswell Park Cancer Institute, Buffalo, NY
| | - David H Rothstein
- Division of Pediatric Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, NY.
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Campbell CR, Ham PB, Pipkin W, Hatley R, Walters KC. Total Parenteral Nutrition Lipid Emulsion Pleural and Pericardial Effusions May Present Similar Chylothorax with Milky White Chest Tube Output after Tracheoesophageal Fistula Repair. Am Surg 2018. [DOI: 10.1177/000313481808400906] [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: 11/16/2022]
Affiliation(s)
| | - P. Benson Ham
- Department of Surgery Medical College of Georgia, Augusta University Augusta, Georgia
| | - Walter Pipkin
- Section of Pediatric Surgery, Children's Hospital of Georgia Medical College of Georgia, Augusta University Augusta, Georgia
| | - Robyn Hatley
- Section of Pediatric Surgery, Children's Hospital of Georgia Medical College of Georgia, Augusta University Augusta, Georgia
| | - K. Christian Walters
- Section of Pediatric Surgery, Children's Hospital of Georgia Medical College of Georgia, Augusta University Augusta, Georgia
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Campbell CR, Ham PB, Pipkin W, Hatley R, Walters KC. Total Parenteral Nutrition Lipid Emulsion Pleural and Pericardial Effusions May Present Similar Chylothorax with Milky White Chest Tube Output after Tracheoesophageal Fistula Repair. Am Surg 2018; 84:e357-e359. [PMID: 30269706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Abstract
Patients presenting with near-obstructing colon lesions requiring segmental colectomy may benefit from intraoperative colonoscopy (IOC) after primary anastomosis for a more timely and accurate diagnosis of synchronous lesions. The aim of this study is to demonstrate the feasibility and safety of this technique. A retrospective cohort study of patients undergoing single-stage segmental colectomy and anastomosis at a single tertiary care institution from 2011 to 2013 was performed. One Hundred and sixty-eight consecutive patients underwent segmental colectomy and primary anastomosis of which 78 (46%) were unable to receive preoperative colonoscopy (POC) because of near-obstructing lesions and received IOC after the anastomosis. IOC detected synchronous adenomatous polyps in 24.4 per cent, diverticular disease in 19 per cent, and colitis/proctitis in 2.5 per cent. The IOC group was not significantly different from the POC group with regard to overall morbidity (31% vs 39% P = 0.45), anastomotic leakage (1.3% vs 0%, P = 0.46), or wound infection (5.1% vs 1.1%, P = 0.18). Operation time was 19 minutes longer in the intra-operative group, but overall length of hospital stay was not significantly different (6.4 ± 2.9 days vs 7.3 ± 4.6 days). In patients unable to receive POC because of partial obstruction, IOC after primary anastomosis is both feasible and safe for detecting proximal synchronous lesions.
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Affiliation(s)
| | - Ray S. King
- Colon and Rectal Surgery Associates, University Hospital, Augusta, Georgia
| | - P. Benson Ham
- Medical College of Georgia at Augusta University, Augusta, Georgia and
| | - Vendie H. Hooks
- Colon and Rectal Surgery Associates, University Hospital, Augusta, Georgia
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Ham PB, Ellis MA, Simmerman EL, Walsh NJ, Lalani A, Young M, Hatley R, Howell CG, Hughes CA. Analysis of 334 Cases of Pediatric Esophageal Foreign Body Removal Suggests that Traditional Methods Have Similar Outcomes Whereas a Magnetic Tip Orogastric Tube Appears to Be an Effective, Efficient, and Safe Technique for Disc Battery Removal. Am Surg 2018; 84:1152-1158. [PMID: 30064579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Procedures and outcomes for pediatric esophageal foreign body removal were analyzed. Traditional methods of battery removal were compared with a magnetic tip orogastric tube (MtOGT). A single institution retrospective review from 1997 to 2014 of pediatric patients with esophageal foreign bodies was performed. Balloon extraction with fluoroscopy (performed in 173 patients with 91% success), flexible endoscopy (92% success in 102 patients), and rigid esophagoscopy (95% in 38 patients) had excellent success rates. A MtOGT had 100 per cent success in six disc battery patients, when other methods were more likely to fail, and was the fastest. Power analysis suggested 20 patients in the MtOGT group would be needed for significant savings in procedural time. Thirty-two per cent of all foreign bodies and 95 per cent of batteries had complications (P = 0.002) because of the foreign body. Overall, 1.2 per cent had severe complications, whereas 10 per cent of batteries had severe complications (P = 0.04). Each technique if applied appropriately can be a reasonable option for esophageal foreign body removal. Magnetic tip orogastric tubes used to extract ferromagnetic objects like disc batteries had the shortest procedure time and highest success rate although it was not statistically significant. Disc batteries require emergent removal and have a significant complication rate.
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10
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Ham PB, Ellis MA, Simmerman EL, Walsh NJ, Lalani A, Young M, Hatley R, Howell CG, Hughes CA. Analysis of 334 Cases of Pediatric Esophageal Foreign Body Removal Suggests that Traditional Methods Have Similar Outcomes Whereas a Magnetic Tip Orogastric Tube Appears to be an Effective, Efficient, and Safe Technique for Disc Battery Removal. Am Surg 2018. [DOI: 10.1177/000313481808400729] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Procedures and outcomes for pediatric esophageal foreign body removal were analyzed. Traditional methods of battery removal were compared with a magnetic tip orogastric tube (MtOGT). A single institution retrospective review from 1997 to 2014 of pediatric patients with esophageal foreign bodies was performed. Balloon extraction with fluoroscopy (performed in 173 patients with 91% success), flexible endoscopy (92% success in 102 patients), and rigid esophagoscopy (95% in 38 patients) had excellent success rates. A MtOGT had 100 per cent success in six disc battery patients, when other methods were more likely to fail, and was the fastest. Power analysis suggested 20 patients in the MtOGT group would be needed for significant savings in procedural time. Thirty-two per cent of all foreign bodies and 95 per cent of batteries had complications (P = 0.002) because of the foreign body. Overall, 1.2 per cent had severe complications, whereas 10 per cent of batteries had severe complications (P = 0.04). Each technique if applied appropriately can be a reasonable option for esophageal foreign body removal. Magnetic tip orogastric tubes used to extract ferromagnetic objects like disc batteries had the shortest procedure time and highest success rate although it was not statistically significant. Disc batteries require emergent removal and have a significant complication rate.
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Affiliation(s)
- P. Benson Ham
- Department of Surgery, Children's Hospital of Georgia, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Mark A. Ellis
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Erika L. Simmerman
- Department of Surgery, Children's Hospital of Georgia, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Nathaniel J. Walsh
- Department of Surgery, Children's Hospital of Georgia, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Alykhan Lalani
- Department of Surgery, Children's Hospital of Georgia, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Morgan Young
- Department of Surgery, Children's Hospital of Georgia, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Robyn Hatley
- Department of Surgery, Children's Hospital of Georgia, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Charles G. Howell
- Department of Surgery, Children's Hospital of Georgia, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Charles Anthony Hughes
- Department of Otolaryngology, Head and Neck Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia
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11
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Simmerman EL, King RS, Ham PB, Hooks VH. Feasibility and Safety of Intraoperative Colonoscopy after Segmental Colectomy and Primary Anastomosis. Am Surg 2018; 84:1175-1179. [PMID: 30064583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Patients presenting with near-obstructing colon lesions requiring segmental colectomy may benefit from intraoperative colonoscopy (IOC) after primary anastomosis for a more timely and accurate diagnosis of synchronous lesions. The aim of this study is to demonstrate the feasibility and safety of this technique. A retrospective cohort study of patients undergoing single-stage segmental colectomy and anastomosis at a single tertiary care institution from 2011 to 2013 was performed. One Hundred and sixty-eight consecutive patients underwent segmental colectomy and primary anastomosis of which 78 (46%) were unable to receive preoperative colonoscopy (POC) because of near-obstructing lesions and received IOC after the anastomosis. IOC detected synchronous adenomatous polyps in 24.4 per cent, diverticular disease in 19 per cent, and colitis/proctitis in 2.5 per cent. The IOC group was not significantly different from the POC group with regard to overall morbidity (31% vs 39% P = 0.45), anastomotic leakage (1.3% vs 0%, P = 0.46), or wound infection (5.1% vs 1.1%, P = 0.18). Operation time was 19 minutes longer in the intraoperative group, but overall length of hospital stay was not significantly different (6.4 ± 2.9 days vs 7.3 ± 4.6 days). In patients unable to receive POC because of partial obstruction, IOC after primary anastomosis is both feasible and safe for detecting proximal synchronous lesions.
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12
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Bateson B, Ham PB, Patel V, Shah R. Delayed Presentation of Traumatic Tricuspid Valve Injury during Index Hospitalization. Am Surg 2018; 84:e67-e69. [PMID: 30454482] [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: 06/09/2023]
Affiliation(s)
- Brian Bateson
- Department of General Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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13
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Hwang B, Keyser D, Ham PB, Holsten SB. Efficiency and Utilization of a Surgical Procedure Proficiency Identification Card to Verify Resident Competency for Bedside Procedures. Am Surg 2017. [DOI: 10.1177/000313481708301103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Brice Hwang
- Department of Surgery Augusta University Augusta, Georgia
| | - Daria Keyser
- Department of Surgery Augusta University Augusta, Georgia
| | - P. Benson Ham
- Department of Surgery Augusta University Augusta, Georgia
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14
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Hwang B, Keyser D, Ham PB, Holsten SB. Efficiency and Utilization of a Surgical Procedure Proficiency Identification Card to Verify Resident Competency for Bedside Procedures. Am Surg 2017; 83:e424-e426. [PMID: 30454225] [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: 06/09/2023]
Affiliation(s)
- Brice Hwang
- Department of Surgery, Augusta University, Augusta, Georgia, USA
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Erwin P, Ham PB, Mentzer CJ, Hatley RM, Pipkin WL, Howell CG, Walters KC. Familial Intussusception—Younger Age at Presentation, Male Predisposition, More Difficult to Reduce Radiographically, and More Likely to Recur. Am Surg 2017. [DOI: 10.1177/000313481708300920] [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: 11/17/2022]
Affiliation(s)
- Philip Erwin
- Department of Surgery Augusta University Augusta, Georgia
| | - P. Benson Ham
- Department of Surgery Augusta University Augusta, Georgia
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16
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Erwin P, Ham PB, Mentzer CJ, Hatley RM, Pipkin WL, Howell CG, Walters KC. Familial Intussusception-Younger Age at Presentation, Male Predisposition, More Difficult to Reduce Radiographically, and More Likely to Recur. Am Surg 2017; 83:e392-e395. [PMID: 30454365] [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: 06/09/2023]
Affiliation(s)
- Philip Erwin
- Department of Surgery, Augusta University, Augusta, Georgia, USA
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Stansfield BK, Wise L, Ham PB, Patel P, Parman M, Jin C, Mathur S, Harshfield G, Bhatia J. Outcomes following routine antithrombin III replacement during neonatal extracorporeal membrane oxygenation. J Pediatr Surg 2017; 52:609-613. [PMID: 27847121 DOI: 10.1016/j.jpedsurg.2016.10.047] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [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: 06/20/2016] [Revised: 10/05/2016] [Accepted: 10/17/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND We sought to examine the effect of routine antithrombin III (AT3) infusion on hemorrhagic and thrombotic complications, blood product utilization, and circuit lifespan in neonatal extracorporeal membrane oxygenation (ECMO). METHODS We performed a retrospective cohort study of 162 infants placed on ECMO for hypoxic respiratory failure. Infants requiring ECMO for primary cardiac support were excluded. Demographic data, time on ECMO, blood product usage, coagulation profile, and complications were compared between 90 control patients and 72 patients treated with AT3. RESULTS Infants receiving AT3 during ECMO had less thrombotic and similar bleeding complications as compared to infants receiving standard anticoagulation therapy. Total blood product infusion during ECMO was decreased (54.7±20.1 vs. 67.4±34.9mL/kg per day, p=0.001) in infants receiving AT3 during ECMO. Tighter control of activated clotting time and higher serum heparin anti-Xa levels were observed in the AT3 cohort during the first days of ECMO support. 1st ECMO circuit lifespan did not differ between groups. CONCLUSIONS Routine administration of AT3 in neonates receiving ECMO therapy was associated with tighter control of anticoagulation and a reduction in thrombotic events without increasing unwanted bleeding. However, circuit lifespan was unaffected. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Brian K Stansfield
- Department of Pediatrics, Augusta University, Augusta, GA, USA; Vascular Biology Center, Augusta University, Augusta, GA, USA.
| | - Linda Wise
- Department of Pediatrics, Augusta University, Augusta, GA, USA
| | - P Benson Ham
- Department of Surgery, Augusta University, Augusta, GA, USA
| | - Pinkal Patel
- Department of Pediatrics, Augusta University, Augusta, GA, USA
| | - Malinda Parman
- Department of Pediatrics, Augusta University, Augusta, GA, USA
| | - Chan Jin
- Department of Biostatistics and Epidemiology, Augusta University, Augusta, GA
| | - Sunil Mathur
- Department of Biostatistics and Epidemiology, Augusta University, Augusta, GA
| | - Gregory Harshfield
- Department of Pediatrics, Augusta University, Augusta, GA, USA; Georgia Prevention Institute, Augusta University, Augusta, GA, USA
| | - Jatinder Bhatia
- Department of Pediatrics, Augusta University, Augusta, GA, USA
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Ham PB, Hwang B, Wise LJ, Walters KC, Pipkin WL, Howell CG, Bhatia J, Hatley R. Venovenous Extracorporeal Membrane Oxygenation in Pediatric Respiratory Failure. Am Surg 2016. [DOI: 10.1177/000313481608200937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Conventional treatment of respiratory failure involves positive pressure ventilation that can worsen lung damage. Extracorporeal membrane oxygenation (ECMO) is typically used when conventional therapy fails. In this study, we evaluated the use of venovenous (VV)-ECMO for the treatment of severe pediatric respiratory failure at our institution. A retrospective analysis of pediatric patients (age 1–18) placed on ECMO in the last 15 years (1999–2014) by the pediatric surgery team for respiratory failure was performed. Five pediatric patients underwent ECMO (mean age 10 years; range, 2–16). All underwent VV-ECMO. Diagnoses were status asthmaticus (2), acute respiratory distress syndrome due to septic shock (1), aspergillus pneumonia (1), and respiratory failure due to parainfluenza (1). Two patients had severe barotrauma prior to ECMO initiation. Average oxygenation index (OI) prior to cannulation was 74 (range 23–122). No patients required conversion to VA-ECMO. The average ECMO run time was 4.4 days (range 2–6). The average number of days on the ventilator was 15 (range 4–27). There were no major complications due to the procedure. Survival to discharge was 100%. Average follow up is 4.4 years (range 1–15). A short run of VV-ECMO can be lifesaving for pediatric patients in respiratory failure. Survival is excellent despite severely elevated oxygen indices. VV-ECMO may be well tolerated and can be considered for severe pediatric respiratory failure.
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Affiliation(s)
- P. Benson Ham
- Sections of Pediatric Surgery and Neonatology, Departments of Surgery and Pediatrics, Children's Hospital of Georgia, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Brice Hwang
- Sections of Pediatric Surgery and Neonatology, Departments of Surgery and Pediatrics, Children's Hospital of Georgia, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Linda J. Wise
- Sections of Pediatric Surgery and Neonatology, Departments of Surgery and Pediatrics, Children's Hospital of Georgia, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - K. Christian Walters
- Sections of Pediatric Surgery and Neonatology, Departments of Surgery and Pediatrics, Children's Hospital of Georgia, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Walter L. Pipkin
- Sections of Pediatric Surgery and Neonatology, Departments of Surgery and Pediatrics, Children's Hospital of Georgia, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Charles G. Howell
- Sections of Pediatric Surgery and Neonatology, Departments of Surgery and Pediatrics, Children's Hospital of Georgia, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Jatinder Bhatia
- Sections of Pediatric Surgery and Neonatology, Departments of Surgery and Pediatrics, Children's Hospital of Georgia, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Robyn Hatley
- Sections of Pediatric Surgery and Neonatology, Departments of Surgery and Pediatrics, Children's Hospital of Georgia, Medical College of Georgia, Augusta University, Augusta, Georgia
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Lalani A, Ham PB, Wise LJ, Daniel JM, Walters KC, Pipkin WL, Stansfield B, Hatley RM, Bhatia J. Management of Patients with Gastroschisis Requiring Extracorporeal Membrane Oxygenation for Concurrent Respiratory Failure. Am Surg 2016. [DOI: 10.1177/000313481608200929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Treatment of gastroschisis often requires multiple surgical procedures to re-establish abdominal domain, reduce abdominal contents, and eventually close the abdominal wall. In patients who have concomitant respiratory failure requiring extracorporeal membrane oxygenation (ECMO), this process becomes further complicated. This situation is rare and only five such cases have been reported in the ECMO registry database. Management of three of the five patients along with results and implications for future care of similar patients is discussed here. Two patients had respiratory failure due to meconium aspiration syndrome and one patient had persistent acidosis as well as worsening pulmonary hypertension leading to the decision of ECMO. The abdominal contents were placed in a spring-loaded silastic silo while on ECMO and primary closure was performed three to six days after the decannulation. All three patients survived and are developmentally appropriate. We recommend avoiding aggressively reducing the abdominal contents and using a silo to conservatively reducing the gastroschisis while the patient is on ECMO therapy. Keeping the intra-abdominal pressure below 20 mm Hg can possibly reduce ECMO days and ventilator time and has been shown to decrease morbidity and mortality. Patients with gastroschisis and respiratory failure requiring ECMO can have good outcomes despite the complexity of required care.
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Affiliation(s)
- Alykhan Lalani
- Medical College of Georgia, Georgia Regents University, Augusta, Georgia
| | - P. Benson Ham
- Section of Pediatric Surgery, Children's Hospital of Georgia, Georgia Regents University, Augusta, Georgia
| | - Linda J. Wise
- Division of Neonatology, Children's Hospital of Georgia, Georgia Regents University, Augusta, Georgia
| | - John M. Daniel
- Division of Neonatology, Kentucky Children's Hospital, Lexington, Kentucky
| | - K. Christian Walters
- Section of Pediatric Surgery, Children's Hospital of Georgia, Georgia Regents University, Augusta, Georgia
| | - Walter L. Pipkin
- Section of Pediatric Surgery, Children's Hospital of Georgia, Georgia Regents University, Augusta, Georgia
| | - Brian Stansfield
- Division of Neonatology, Children's Hospital of Georgia, Georgia Regents University, Augusta, Georgia
| | - Robyn M. Hatley
- Section of Pediatric Surgery, Children's Hospital of Georgia, Georgia Regents University, Augusta, Georgia
| | - Jatinder Bhatia
- Division of Neonatology, Children's Hospital of Georgia, Georgia Regents University, Augusta, Georgia
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20
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Lalani A, Benson Ham P, Wise LJ, Daniel JM, Walters KC, Pipkin WL, Stansfield B, Hatley RM, Bhatia J. Management of Patients with Gastroschisis Requiring Extracorporeal Membrane Oxygenation for Concurrent Respiratory Failure. Am Surg 2016; 82:768-772. [PMID: 27670556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Treatment of gastroschisis often requires multiple surgical procedures to re-establish abdominal domain, reduce abdominal contents, and eventually close the abdominal wall. In patients who have concomitant respiratory failure requiring extracorporeal membrane oxygenation (ECMO), this process becomes further complicated. This situation is rare and only five such cases have been reported in the ECMO registry database. Management of three of the five patients along with results and implications for future care of similar patients is discussed here. Two patients had respiratory failure due to meconium aspiration syndrome and one patient had persistent acidosis as well as worsening pulmonary hypertension leading to the decision of ECMO. The abdominal contents were placed in a spring-loaded silastic silo while on ECMO and primary closure was performed three to six days after the decannulation. All three patients survived and are developmentally appropriate. We recommend avoiding aggressively reducing the abdominal contents and using a silo to conservatively reducing the gastroschisis while the patient is on ECMO therapy. Keeping the intra-abdominal pressure below 20 mm Hg can possibly reduce ECMO days and ventilator time and has been shown to decrease morbidity and mortality. Patients with gastroschisis and respiratory failure requiring ECMO can have good outcomes despite the complexity of required care.
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Affiliation(s)
- Alykhan Lalani
- Medical College of Georgia, Georgia Regents University, Augusta, Georgia, USA
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21
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Ham PB, Hwang B, Wise LJ, Walters KC, Pipkin WL, Howell CG, Bhatia J, Hatley R. Venovenous Extracorporeal Membrane Oxygenation in Pediatric Respiratory Failure. Am Surg 2016; 82:787-788. [PMID: 27670564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Conventional treatment of respiratory failure involves positive pressure ventilation that can worsen lung damage. Extracorporeal membrane oxygenation (ECMO) is typically used when conventional therapy fails. In this study, we evaluated the use of venovenous (VV)-ECMO for the treatment of severe pediatric respiratory failure at our institution. A retrospective analysis of pediatric patients (age 1-18) placed on ECMO in the last 15 years (1999-2014) by the pediatric surgery team for respiratory failure was performed. Five pediatric patients underwent ECMO (mean age 10 years; range, 2-16). All underwent VV-ECMO. Diagnoses were status asthmaticus (2), acute respiratory distress syndrome due to septic shock (1), aspergillus pneumonia (1), and respiratory failure due to parainfluenza (1). Two patients had severe barotrauma prior to ECMO initiation. Average oxygenation index (OI) prior to cannulation was 74 (range 23-122). No patients required conversion to VA-ECMO. The average ECMO run time was 4.4 days (range 2-6). The average number of days on the ventilator was 15 (range 4-27). There were no major complications due to the procedure. Survival to discharge was 100%. Average follow up is 4.4 years (range 1-15). A short run of VV-ECMO can be lifesaving for pediatric patients in respiratory failure. Survival is excellent despite severely elevated oxygen indices. VV-ECMO may be well tolerated and can be considered for severe pediatric respiratory failure.
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Affiliation(s)
- P Benson Ham
- Sections of Pediatric Surgery and Neonatology, Departments of Surgery and Pediatrics, Children's Hospital of Georgia, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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22
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Ham PB, Poorak M, King RG, Mentzer CJ, Walters KC, Pipkin WL, Hatley RM. Occult Injury in the Context of Selective Use of Computed Tomography (CT) in Pediatric Thoracic Trauma. Am Surg 2015; 81:e340-e341. [PMID: 26350653] [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: 06/05/2023]
Affiliation(s)
- P Benson Ham
- Department of Surgery, Children's Hospital of Georgia, Medical College of Georgia, Georgia Regents University, Augusta, Georgia, USA
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23
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Cunningham AJ, Ham PB, King RG, Rahardja A, Toscano M, Hatley RM, Pipkin WL. Congenital Jejunal Tubular Duplication in a Patient with a Congenital Thoracic Meningocele. Am Surg 2015; 81:e332-e333. [PMID: 26350649] [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: 06/05/2023]
Affiliation(s)
- Aaron J Cunningham
- Department of Surgery, Children's Hospital of Georgia, Medical College of Georgia, Georgia Regents University, Augusta, Georgia, USA
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24
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Ham PB, Poorak M, King RG, Mentzer CJ, Walters KC, Pipkin WL, Hatley RM. Occult Injury in the Context of Selective Use of Computed Tomography (CT) in Pediatric Thoracic Trauma. Am Surg 2015. [DOI: 10.1177/000313481508100909] [Citation(s) in RCA: 4] [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: 11/17/2022]
Affiliation(s)
- P. Benson Ham
- Department of Surgery Children's Hospital of Georgia, Medical College of Georgia Georgia Regents University Augusta, Georgia
| | - Mitra Poorak
- Department of Surgery Children's Hospital of Georgia, Medical College of Georgia Georgia Regents University Augusta, Georgia
| | - Ray G. King
- Department of Surgery Children's Hospital of Georgia, Medical College of Georgia Georgia Regents University Augusta, Georgia
| | - Caleb J. Mentzer
- Department of Surgery Children's Hospital of Georgia, Medical College of Georgia Georgia Regents University Augusta, Georgia
| | - K. Christian Walters
- Department of Surgery Children's Hospital of Georgia, Medical College of Georgia Georgia Regents University Augusta, Georgia
| | - Walter L. Pipkin
- Department of Surgery Children's Hospital of Georgia, Medical College of Georgia Georgia Regents University Augusta, Georgia
| | - Robyn M. Hatley
- Department of Surgery Children's Hospital of Georgia, Medical College of Georgia Georgia Regents University Augusta, Georgia
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25
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Gay DA, Ham PB, Yon JR, Pipkin WL, Heger I, Hatley RM. A Novel Technique for Laparoscopically Treating Chronic Pelvic Pain due to Extended Length Ventriculoperitoneal Shunts. Am Surg 2015. [DOI: 10.1177/000313481508100902] [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)
- David A. Gay
- Department of General Surgery Georgia Regents University Augusta, Georgia
| | - P. Benson Ham
- Department of General Surgery Georgia Regents University Augusta, Georgia
| | - James R. Yon
- Department of General Surgery Georgia Regents University Augusta, Georgia
| | - Walter L. Pipkin
- Division of Pediatric Surgery Department of General Surgery Georgia Regents University Augusta, Georgia
| | - Ian Heger
- Department of Neurosurgery Georgia Regents University Augusta, Georgia
| | - Robyn M. Hatley
- Division of Pediatric Surgery Department of General Surgery Georgia Regents University Augusta, Georgia
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26
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Gay DA, Ham PB, Yon JR, Pipkin WL, Heger I, Hatley RM. A Novel Technique for Laparoscopically Treating Chronic Pelvic Pain due to Extended Length Ventriculoperitoneal Shunts. Am Surg 2015; 81:e325-e327. [PMID: 26350646] [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: 06/05/2023]
Affiliation(s)
- David A Gay
- Department of General Surgery Georgia Regents University Augusta, Georgia, USA
| | - P Benson Ham
- Department of General Surgery Georgia Regents University Augusta, Georgia, USA
| | - James R Yon
- Department of General Surgery Georgia Regents University Augusta, Georgia, USA
| | - Walter L Pipkin
- Division of Pediatric Surgery Department of General Surgery Georgia Regents University Augusta, Georgia, USA
| | - Ian Heger
- Department of Neurosurgery Georgia Regents University Augusta, Georgia, USA
| | - Robyn M Hatley
- Division of Pediatric Surgery Department of General Surgery Georgia Regents University Augusta, Georgia, USA
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27
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Cunningham AJ, Ham PB, King RG, Rahardja A, Toscano M, Hatley RM, Pipkin WL. Congenital Jejunal Tubular Duplication in a Patient with a Congenital Thoracic Meningocele. Am Surg 2015. [DOI: 10.1177/000313481508100905] [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)
- Aaron J. Cunningham
- Department of Surgery Children's Hospital of Georgia Medical College of Georgia Georgia Regents University Augusta, Georgia
| | - P. Benson Ham
- Department of Surgery Children's Hospital of Georgia Medical College of Georgia Georgia Regents University Augusta, Georgia
| | - Ray G. King
- Department of Surgery Children's Hospital of Georgia Medical College of Georgia Georgia Regents University Augusta, Georgia
| | - Andy Rahardja
- Department of Pathology Medical College of Georgia Georgia Regents University Augusta, Georgia
| | - Michael Toscano
- Department of Pathology Medical College of Georgia Georgia Regents University Augusta, Georgia
| | - Robyn M. Hatley
- Department of Surgery Children's Hospital of Georgia Medical College of Georgia Georgia Regents University Augusta, Georgia
| | - Walter L. Pipkin
- Department of Surgery Children's Hospital of Georgia Medical College of Georgia Georgia Regents University Augusta, Georgia
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28
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Ham PB, Patel P, Wise LJ, Walters C, Stansfield BK. Severe myocardial injury and extracorporeal membrane oxygenation following perinatal asphyxia. Journal of Pediatric Surgery Case Reports 2015. [DOI: 10.1016/j.epsc.2015.03.010] [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] Open
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29
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Affiliation(s)
- Daria Keyser
- Department of Surgery Georgia Regents University Augusta, Georgia
| | - Mohamad Masoumy
- Department of Surgery Georgia Regents University Augusta, Georgia
| | - P. Benson Ham
- Department of Surgery Georgia Regents University Augusta, Georgia
| | - Paul Biddinger
- Department of Pathology Georgia Regents University Augusta, Georgia
| | - Andy Rahardja
- Department of Pathology Georgia Regents University Augusta, Georgia
| | - Anna Legostaev
- Medical College of Georgia Georgia Regents University Augusta, Georgia
| | - Steven Holsten
- Department of Surgery Georgia Regents University Augusta, Georgia
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30
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Keyser D, Masoumy M, Ham PB, Biddinger P, Rahardja A, Legostaev A, Holsten S. Angiosarcoma of the colon. Am Surg 2015; 81:E169-E171. [PMID: 25831168] [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: 06/04/2023]
Affiliation(s)
- Daria Keyser
- Department of Surgery, Georgia Regents University, Augusta, Georgia, USA
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31
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Gross CM, Rafikov R, Kumar S, Aggarwal S, Ham PB, Meadows ML, Cherian-Shaw M, Kangath A, Sridhar S, Lucas R, Black SM. Endothelial nitric oxide synthase deficient mice are protected from lipopolysaccharide induced acute lung injury. PLoS One 2015; 10:e0119918. [PMID: 25786132 PMCID: PMC4364989 DOI: 10.1371/journal.pone.0119918] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 01/18/2015] [Indexed: 01/11/2023] Open
Abstract
Lipopolysaccharide (LPS) derived from the outer membrane of gram-negative bacteria induces acute lung injury (ALI) in mice. This injury is associated with lung edema, inflammation, diffuse alveolar damage, and severe respiratory insufficiency. We have previously reported that LPS-mediated nitric oxide synthase (NOS) uncoupling, through increases in asymmetric dimethylarginine (ADMA), plays an important role in the development of ALI through the generation of reactive oxygen and nitrogen species. Therefore, the focus of this study was to determine whether mice deficient in endothelial NOS (eNOS-/-) are protected against ALI. In both wild-type and eNOS-/- mice, ALI was induced by the intratracheal instillation of LPS (2 mg/kg). After 24 hours, we found that eNOS-/-mice were protected against the LPS mediated increase in inflammatory cell infiltration, inflammatory cytokine production, and lung injury. In addition, LPS exposed eNOS-/- mice had increased oxygen saturation and improved lung mechanics. The protection in eNOS-/- mice was associated with an attenuated production of NO, NOS derived superoxide, and peroxynitrite. Furthermore, we found that eNOS-/- mice had less RhoA activation that correlated with a reduction in RhoA nitration at Tyr34. Finally, we found that the reduction in NOS uncoupling in eNOS-/- mice was due to a preservation of dimethylarginine dimethylaminohydrolase (DDAH) activity that prevented the LPS-mediated increase in ADMA. Together our data suggest that eNOS derived reactive species play an important role in the development of LPS-mediated lung injury.
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Affiliation(s)
- Christine M Gross
- Pulmonary Disease Program, Vascular Biology Center, Georgia Regents University, Augusta, Georgia, United States of America
| | - Ruslan Rafikov
- Pulmonary Disease Program, Vascular Biology Center, Georgia Regents University, Augusta, Georgia, United States of America
| | - Sanjiv Kumar
- Pulmonary Disease Program, Vascular Biology Center, Georgia Regents University, Augusta, Georgia, United States of America
| | - Saurabh Aggarwal
- Pulmonary Disease Program, Vascular Biology Center, Georgia Regents University, Augusta, Georgia, United States of America
| | - P Benson Ham
- Pulmonary Disease Program, Vascular Biology Center, Georgia Regents University, Augusta, Georgia, United States of America
| | - Mary Louise Meadows
- Pulmonary Disease Program, Vascular Biology Center, Georgia Regents University, Augusta, Georgia, United States of America
| | - Mary Cherian-Shaw
- Pulmonary Disease Program, Vascular Biology Center, Georgia Regents University, Augusta, Georgia, United States of America
| | - Archana Kangath
- Pulmonary Disease Program, Vascular Biology Center, Georgia Regents University, Augusta, Georgia, United States of America
| | - Supriya Sridhar
- Pulmonary Disease Program, Vascular Biology Center, Georgia Regents University, Augusta, Georgia, United States of America
| | - Rudolf Lucas
- Pulmonary Disease Program, Vascular Biology Center, Georgia Regents University, Augusta, Georgia, United States of America
| | - Stephen M Black
- Pulmonary Disease Program, Vascular Biology Center, Georgia Regents University, Augusta, Georgia, United States of America
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32
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Romine M, Ham PB, Yon JR, Pipkin WL, Howell CG, Hatley RM. Multiple magnet ingestion in children. Am Surg 2014; 80:e189-e191. [PMID: 24987880] [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: 06/03/2023]
Affiliation(s)
- Matthew Romine
- Section of Pediatric Surgery, Department of General Surgery, Georgia Regents University, Augusta, Georgia, USA
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