Gary Hartman - Academia.edu (original) (raw)
Papers by Gary Hartman
Journal of perinatology : official journal of the California Perinatal Association
We report the clinical course and successful surgical treatment of hemopericardium resulting from... more We report the clinical course and successful surgical treatment of hemopericardium resulting from coronary artery (CA) laceration in two patients with congenital diaphragmatic hernia (CDH) undergoing extracorporeal membrane oxygenation (ECMO) bypass. Retrospective case review. Two neonates with CDH had needle aspiration for either pneumothorax or pericardial effusion before initiation of ECMO. While on bypass, progressive hemopericardium led to narrow pulse pressure and decreased venous return that limited bypass flow. Widened cardiac silhouette on chest radiographs suggested hemopericardium; echocardiography was confirmatory in one case. The underlying diagnosis of CA laceration was made during pericardiotomy and treated with surgical patching. Pre-ECMO history of cardiothoracic needle aspiration is important because complications such as hemothorax or hemopericardium may arise once ECMO bypass is initiated. Inadvertent CA laceration may lead to acute hemopericardium, compromising ...
The American journal of clinical nutrition, 1988
The enteric epithelium of suckling rat undergoes dramatic functional and cytokinetic changes (red... more The enteric epithelium of suckling rat undergoes dramatic functional and cytokinetic changes (redifferentiation) with maturation. Ileal epithelial maturation was studied in infant rats subjected to 60% proximal enterectomy at age 10 d in an effort to examine redifferentiation mechanisms. Two months after resection the residual ileal remnant was increased in diameter, weight, total protein, and DNA per unit length compared with ileal segments from control littermates that had laparotomy without resection. The residual ileum demonstrated increased sucrase activity per unit length but was indistinguishable from control ileal segments in activity per unit DNA or villus distribution. Lactase activity was negligible in all segments of the residual intestine. Villus height and crypt depth were increased in the residual ileum with slight increases in cell turnover and cell-migration rates. These results show the presence of an intrinsic program for regulation of ileal epithelial maturation ...
Pediatric Research, 1985
Red cell enzymes of three children with transient erythroblastopenia of childhood were measured a... more Red cell enzymes of three children with transient erythroblastopenia of childhood were measured and compared with those of age-matched normal children and children with hemolytic anemia. While the activity of "age-dependent" enzyme such as hexokinase, aldolase, glucose-6-phosphate dehydrogenase, glutamic-oxaloacetic transaminase, and pyruvate kinase were greatly increased in the red cells of children with hemolytic anemia, they were not decreased in the red cells of children with erythroblastopenia of childhood. Only the activity of pyrimidine 5'-nucleotidase was consistently low red cells of these children. These findings are inconsistent with the usual concept that red cell enzyme activities decline throughout red cell life span. Rather, they suggest that there may be very rapid loss in the activity of some red cell enzymes during the first few days of red cell life with little further decline in enzyme activity.
Journal of Pediatric Surgery, 2004
Fig 1. Intraoperative photograph of the urachal remnant at the base of the giant umbilical cord.
Journal of Pediatric Surgery, 1993
Journal of Pediatric Surgery, 1994
0 The incidence of inguinal hernia and incarceration is high among premature infants. Optimal tim... more 0 The incidence of inguinal hernia and incarceration is high among premature infants. Optimal timing, anesthetic technique, and long-term results of hernia repair in hospitalized premature infants remain undefined. The authors reviewed the records of 52 consecutively treated premature infants who underwent bilateral inguinal herniorrhaphy under general anesthesia before discharge from the intensive care nursery. There were no significant differences in gestational age, birth weight, age and weight at time of surgery, or presence of preoperative apnea or bradycardia in between infants extubated within 24 hours and those intubated for more than 24 hours. Twenty-four infants (46%) were available for follow-up of 24 months or more (mean follow-up period, 57 months). One recurrence was identified, representing 4% of the long-term follow-up group and 2% of the initial population. Two patients had asymmetric testicular volumes suggestive of unilateral atrophy. The short-and long-term results suggest that repair under general anesthesia can be safely performed before discharge from the intensive care nursery.
Journal of Pediatric Surgery, 2009
A new technique of gastroschisis closure in which the defect is covered with sterile dressings an... more A new technique of gastroschisis closure in which the defect is covered with sterile dressings and allowed to granulate without suture repair was first described in 2004. Little is known about the outcomes of this technique. This study evaluated short-term outcomes from the largest series of sutureless gastroschisis closures. A retrospective case control study of 26 patients undergoing sutureless closure between 2006 and 2008 was compared to a historical control group of 20 patients with suture closure of the abdominal fascia between 2004 and 2006. Four major outcomes were assessed: (1) time spent on ventilator, (2) time to initiating enteral feeds, (3) time to discharge from the neonatal intensive care unit, and (4) rate of complications. In multivariate analysis, sutureless closure of gastroschisis defects independently reduced the time to extubation as compared to traditional closure (5.0 vs 12.1 days, P = .025). There was no difference in time to full enteral feeds (16.8 vs 21.4 days, P = .15) or time to discharge (34.8 vs 49.7 days, P = .22) with sutureless closure. The need for silo reduction independently increased the time to extubation (odds ratio, 4.2; P = .002) and time to enteral feeds (odds ratio, 5.2; P < .001). Small umbilical hernias were seen in all patients. Sutureless closure of uncomplicated gastroschisis is a safe technique that reduces length of intubation and does not significantly alter the time required to reach full enteral feeds or hospital discharge.
Journal of Pediatric Surgery, 2002
Previous clinical practice has included evaluation for the presence of tethered cord in those chi... more Previous clinical practice has included evaluation for the presence of tethered cord in those children who have imperforate anus with a high lesion. To define the incidence in children with low lesions, the authors reviewed their experience with a protocol employing routine magnetic resonance imaging (MRI), regardless of the level of the lesion, to determine the presence of a tethered cord in all children with imperforate anus. A retrospective review of children with imperforate anus was conducted over the last 13 years at our institution. Lesions were categorized as high versus low based on the supralevator or infralevator position of the fistula. Sixty-three patients completed evaluation for a tethered cord. Twenty-two (34.9%) of these 63 patients had a tethered cord: 11 of 41 (26.8%) patients with high lesions and 11 of 22 (50.0%) of those with low lesions. Of those children with a low lesion, 83% of the boys had a tethered cord, whereas 38% of the girls had a tethered cord. Forty-five percent of the patients with low lesions and a tethered cord did not have any other lumbosacral anomalies. All 22 children with a tethered cord underwent surgical release. The incidence of tethered cord in children with low lesions of imperforate anus is not lower than those with high lesions. The authors advocate early evaluation of all children with imperforate anus for a tethered cord.
Journal of Pediatric Surgery, 2001
To optimize burn care for children, the authors introduced a protocol incorporating the use of a ... more To optimize burn care for children, the authors introduced a protocol incorporating the use of a bioactive skin substitute, TransCyte (Advanced Tissue Sciences, La Jolla, CA). This study was designed to determine whether this management plan was safe, efficacious, and decreased hospital inpatient length of stay (LOS) compared with conventional burn management in children.
Journal of Pediatric Surgery, 1981
One of the major remaining problems in the management of children with anterior chest wall deform... more One of the major remaining problems in the management of children with anterior chest wall deformities is the lack of a widely accepted objective method of evaluating the severity of the deformity. This deficiency has made it difficult to evaluate indications for operation or the results of operative repair. Moiré phototopography is a new method of accurately measuring human body contours utilizing recent developments in applied optics and has been used successfully in scoliosis screening programs. This technique has been applied to the evaluation of anterior chest wall deformities and the initial results of this study are presented. Moiré phototopography has proven to be a sensitive, reproducible, and easy to perform method of quantitating pectus deformities. While further evaluation is required, this early experience suggests this technique may provide a means of accurately and objectively measuring chest wall deformities so that their physiologic significance can be precisely investigated and the results of therapy critically reviewed.
Journal of Pediatric Surgery, 1988
Intestinal stenosis or stricture occurs in approximately one third of medically treated infants s... more Intestinal stenosis or stricture occurs in approximately one third of medically treated infants surviving the acute phase of necrotizing enterocolitis (NEC). Identification of these lesions by the use of routine contrast enemas has been advocated as a means of decreasing potential morbidity from delayed diagnosis. However, the significant incidence of spontaneous resolution and reluctance to submit asymptomatic infants to contrast enema have led recent researchers to reserve these studies for patients developing symptoms of obstruction during a period of close observation. From July 1984 to July 1986, symptomatic strictures developed in five infants (15%) responding to medical management at our institution. Contrast enemas were not routinely performed and four (80%) of these patients presented with life-threatening sepsis or perforation associated with intestinal obstruction. Two infants developed complete colonic obstruction 4 and 6 weeks after discharge from the Intensive Care Nursery, having initially tolerated oral feedings. Both infants were critically ill due to perforation or sepsis and underwent emergency colostomy at community hospitals. Two other infants developed abdominal distension with sepsis and cardiopulmonary decompensation while remaining hospitalized for prematurity and pulmonary insufficiency. These patients became symptomatic 5 and 7 weeks after cautious refeeding while closely monitored in the Intensive Care Nursery. The occurrence of such life-threatening complications suggests that clinical observation alone is not adequate in the management of many of these infants. Contrast enemas should be performed to identify those patients at risk of such potential morbidity or mortality, especially those infants not residing near pediatric surgical facilities.
Journal of Pediatric Surgery, 1994
@Advances in perinatal and neonatal care in the past decade have produced a change in the populat... more @Advances in perinatal and neonatal care in the past decade have produced a change in the population of infants with perforated necrotizing enterocolitis (NEC) treated at our institution: the majority are now of very low birth weight (VLBW, <l,OOO g). Peritoneal drainage has been reported as an initial resuscitative procedure for unstable infants who have complicated NEC. Initial success with peritoneal drainage prompted us to adopt an aggressive approach to its use in this patient population. Since 1987, peritoneal drainage has been the primary treatment for most infants weighing less than 1,500 g who have perforation, and for unstable infants weighing more than 1,500 g. Perforation was documented by pneumoperitoneum or aspiration of meconium by paracentesis. Intestinal resection was performed in most infants weighing more than 1,500 g and in those for whom drainage was ineffective. Twenty-nine infants with low or VLBW (mean gestational age, 27 weeks; mean birth weight, 994 g) were treated with one or two drains in the right lower quadrant. Broad spectrum antibiotics were continued until all drains were removed, usually within 10 to 14 days. Nasogastric suction was continued until patency of the gastrointestinal (GI) tract was confirmed by a nonionic upper GI series. Six (21%) infants died, although one of the deaths occurred 5 months after drainage; the patient had chronic lung disease and an intact GI tract. Seventeen of the 23 (74%) survivors required no further operative procedure, and 6 (26%) required laparotomy and resection because drainage had been ineffective. Peritoneal drainage provided definitive treatment in 18 of 29 (62%) infants in this series. The low mortality rate and the successful treatment without laparotomy in nearly two thirds of the infants suggest that peritoneal and systemic host defenses and wound healing are significantly different in the VLBW infant. These differences indicate the need to reevaluate treatment strategies for this patient population.
Journal of Pediatric Surgery, 1994
0 The mortality rate for infants severely affected with congenital dfaphragmatic hernia (CDH) rem... more 0 The mortality rate for infants severely affected with congenital dfaphragmatic hernia (CDH) remains high despite significant advances in surgical and neonatal intensive care including dobyed repair and extracorporeal membrane oxygenation (ECMO). Decause of the increasingly successful experience with dngle-lung transplantation in adults, this approach has been suggested as a potential treatment for CDH infants with unsalvageable pulmonary hypoplasia. The authors report on a newborn female infant who was the product of a pregnancy complicated by polyhydramnios. At birth, she was found to have a right-sided CDH and initially was treated with preoperative ECMO, followed by delayed surgical repalr. Despite the CDH repair and apparent resolution of pulmonary hypertension, the infant's condition deteriorated gradually after decannulation, and escalating ventilator settings were required as well as neuromuscular paralysis and pressor support because of progressive hypoxemia and hypercarbia. A lung transplant was performed 8 days after decannulation, using the right lung obtained from a S-weekold donor. The right middle lobe was excised because of the size discrepancy between the donor and recipient. After transplantation, the patient was found to have duodenal stenosis and gastroesophageal reflux, which required duodenoduodenostomy and fundoplication. The patient was discharged from the hospital 90 days posttransplantation, at 3% months of age. Currently she is 24 months old and doing well except for poor growth. This case shows the feasibility of single-lung transplantation for infants with CDH, and the potential use of ECMO as a temporary bridge to transplantation. Lobar lung transplantation allowed for less stringent size constraints for the donor lung.
Journal of Pediatric Gastroenterology and Nutrition, 2004
Pediatric Endosurgery & Innovative Techniques, 2004
Journal of Experimental Medicine, 1976
Journal of Electrocardiology, 1995
The authors have hypothesized that low-level, electrocardiographic changes may accompany transien... more The authors have hypothesized that low-level, electrocardiographic changes may accompany transient ischemia induced by percutaneous transluminal coronary angioplasty. Altered repolarization may manifest as subclinical changes in ST-T morphology. Changes in depolarization may manifest as low-amplitude notches and slurs, a phenomenon the authors term abnormal intra-QRS potentials. The initial aim of this study was to characterize changes in high-resolution electrocardiograph signals that might be linked to ischemic involvement of the ventricular myocardium.
Journal of Electrocardiology, 1996
26. Bigger JT Jr, Fleiss JL, Rolnitzky LM, Steinman RC: The ability of several short-term measure... more 26. Bigger JT Jr, Fleiss JL, Rolnitzky LM, Steinman RC: The ability of several short-term measures of RR variability to predict mortality after myocardial infarction. Circulation 88:927, 1993 27. Hayano J, Yamada A, Mukai Set al: Severity of coronary atherosclerosis correlates with the respiratory HR and Standard ECG During PTCA • Lander et a{. 167 28. 29. component of heart rate variability. Am Heart J 121:1070, 199I Woo MA, Stevenson WG, Moser DK, Middlekauff tIR: Complex heart rate variability and serum norepinephrine levels in patients with advanced heart failure. J Am Coll Cardiol 23:565, 1994 Lindvall K, Erhardt L, Sj6gren A: Serial M-mode echocardiographic mapping in myocardial infarction: a quantitive evaluation of left ventricular wall motion abnormalities.
Journal of perinatology : official journal of the California Perinatal Association
We report the clinical course and successful surgical treatment of hemopericardium resulting from... more We report the clinical course and successful surgical treatment of hemopericardium resulting from coronary artery (CA) laceration in two patients with congenital diaphragmatic hernia (CDH) undergoing extracorporeal membrane oxygenation (ECMO) bypass. Retrospective case review. Two neonates with CDH had needle aspiration for either pneumothorax or pericardial effusion before initiation of ECMO. While on bypass, progressive hemopericardium led to narrow pulse pressure and decreased venous return that limited bypass flow. Widened cardiac silhouette on chest radiographs suggested hemopericardium; echocardiography was confirmatory in one case. The underlying diagnosis of CA laceration was made during pericardiotomy and treated with surgical patching. Pre-ECMO history of cardiothoracic needle aspiration is important because complications such as hemothorax or hemopericardium may arise once ECMO bypass is initiated. Inadvertent CA laceration may lead to acute hemopericardium, compromising ...
The American journal of clinical nutrition, 1988
The enteric epithelium of suckling rat undergoes dramatic functional and cytokinetic changes (red... more The enteric epithelium of suckling rat undergoes dramatic functional and cytokinetic changes (redifferentiation) with maturation. Ileal epithelial maturation was studied in infant rats subjected to 60% proximal enterectomy at age 10 d in an effort to examine redifferentiation mechanisms. Two months after resection the residual ileal remnant was increased in diameter, weight, total protein, and DNA per unit length compared with ileal segments from control littermates that had laparotomy without resection. The residual ileum demonstrated increased sucrase activity per unit length but was indistinguishable from control ileal segments in activity per unit DNA or villus distribution. Lactase activity was negligible in all segments of the residual intestine. Villus height and crypt depth were increased in the residual ileum with slight increases in cell turnover and cell-migration rates. These results show the presence of an intrinsic program for regulation of ileal epithelial maturation ...
Pediatric Research, 1985
Red cell enzymes of three children with transient erythroblastopenia of childhood were measured a... more Red cell enzymes of three children with transient erythroblastopenia of childhood were measured and compared with those of age-matched normal children and children with hemolytic anemia. While the activity of "age-dependent" enzyme such as hexokinase, aldolase, glucose-6-phosphate dehydrogenase, glutamic-oxaloacetic transaminase, and pyruvate kinase were greatly increased in the red cells of children with hemolytic anemia, they were not decreased in the red cells of children with erythroblastopenia of childhood. Only the activity of pyrimidine 5'-nucleotidase was consistently low red cells of these children. These findings are inconsistent with the usual concept that red cell enzyme activities decline throughout red cell life span. Rather, they suggest that there may be very rapid loss in the activity of some red cell enzymes during the first few days of red cell life with little further decline in enzyme activity.
Journal of Pediatric Surgery, 2004
Fig 1. Intraoperative photograph of the urachal remnant at the base of the giant umbilical cord.
Journal of Pediatric Surgery, 1993
Journal of Pediatric Surgery, 1994
0 The incidence of inguinal hernia and incarceration is high among premature infants. Optimal tim... more 0 The incidence of inguinal hernia and incarceration is high among premature infants. Optimal timing, anesthetic technique, and long-term results of hernia repair in hospitalized premature infants remain undefined. The authors reviewed the records of 52 consecutively treated premature infants who underwent bilateral inguinal herniorrhaphy under general anesthesia before discharge from the intensive care nursery. There were no significant differences in gestational age, birth weight, age and weight at time of surgery, or presence of preoperative apnea or bradycardia in between infants extubated within 24 hours and those intubated for more than 24 hours. Twenty-four infants (46%) were available for follow-up of 24 months or more (mean follow-up period, 57 months). One recurrence was identified, representing 4% of the long-term follow-up group and 2% of the initial population. Two patients had asymmetric testicular volumes suggestive of unilateral atrophy. The short-and long-term results suggest that repair under general anesthesia can be safely performed before discharge from the intensive care nursery.
Journal of Pediatric Surgery, 2009
A new technique of gastroschisis closure in which the defect is covered with sterile dressings an... more A new technique of gastroschisis closure in which the defect is covered with sterile dressings and allowed to granulate without suture repair was first described in 2004. Little is known about the outcomes of this technique. This study evaluated short-term outcomes from the largest series of sutureless gastroschisis closures. A retrospective case control study of 26 patients undergoing sutureless closure between 2006 and 2008 was compared to a historical control group of 20 patients with suture closure of the abdominal fascia between 2004 and 2006. Four major outcomes were assessed: (1) time spent on ventilator, (2) time to initiating enteral feeds, (3) time to discharge from the neonatal intensive care unit, and (4) rate of complications. In multivariate analysis, sutureless closure of gastroschisis defects independently reduced the time to extubation as compared to traditional closure (5.0 vs 12.1 days, P = .025). There was no difference in time to full enteral feeds (16.8 vs 21.4 days, P = .15) or time to discharge (34.8 vs 49.7 days, P = .22) with sutureless closure. The need for silo reduction independently increased the time to extubation (odds ratio, 4.2; P = .002) and time to enteral feeds (odds ratio, 5.2; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). Small umbilical hernias were seen in all patients. Sutureless closure of uncomplicated gastroschisis is a safe technique that reduces length of intubation and does not significantly alter the time required to reach full enteral feeds or hospital discharge.
Journal of Pediatric Surgery, 2002
Previous clinical practice has included evaluation for the presence of tethered cord in those chi... more Previous clinical practice has included evaluation for the presence of tethered cord in those children who have imperforate anus with a high lesion. To define the incidence in children with low lesions, the authors reviewed their experience with a protocol employing routine magnetic resonance imaging (MRI), regardless of the level of the lesion, to determine the presence of a tethered cord in all children with imperforate anus. A retrospective review of children with imperforate anus was conducted over the last 13 years at our institution. Lesions were categorized as high versus low based on the supralevator or infralevator position of the fistula. Sixty-three patients completed evaluation for a tethered cord. Twenty-two (34.9%) of these 63 patients had a tethered cord: 11 of 41 (26.8%) patients with high lesions and 11 of 22 (50.0%) of those with low lesions. Of those children with a low lesion, 83% of the boys had a tethered cord, whereas 38% of the girls had a tethered cord. Forty-five percent of the patients with low lesions and a tethered cord did not have any other lumbosacral anomalies. All 22 children with a tethered cord underwent surgical release. The incidence of tethered cord in children with low lesions of imperforate anus is not lower than those with high lesions. The authors advocate early evaluation of all children with imperforate anus for a tethered cord.
Journal of Pediatric Surgery, 2001
To optimize burn care for children, the authors introduced a protocol incorporating the use of a ... more To optimize burn care for children, the authors introduced a protocol incorporating the use of a bioactive skin substitute, TransCyte (Advanced Tissue Sciences, La Jolla, CA). This study was designed to determine whether this management plan was safe, efficacious, and decreased hospital inpatient length of stay (LOS) compared with conventional burn management in children.
Journal of Pediatric Surgery, 1981
One of the major remaining problems in the management of children with anterior chest wall deform... more One of the major remaining problems in the management of children with anterior chest wall deformities is the lack of a widely accepted objective method of evaluating the severity of the deformity. This deficiency has made it difficult to evaluate indications for operation or the results of operative repair. Moiré phototopography is a new method of accurately measuring human body contours utilizing recent developments in applied optics and has been used successfully in scoliosis screening programs. This technique has been applied to the evaluation of anterior chest wall deformities and the initial results of this study are presented. Moiré phototopography has proven to be a sensitive, reproducible, and easy to perform method of quantitating pectus deformities. While further evaluation is required, this early experience suggests this technique may provide a means of accurately and objectively measuring chest wall deformities so that their physiologic significance can be precisely investigated and the results of therapy critically reviewed.
Journal of Pediatric Surgery, 1988
Intestinal stenosis or stricture occurs in approximately one third of medically treated infants s... more Intestinal stenosis or stricture occurs in approximately one third of medically treated infants surviving the acute phase of necrotizing enterocolitis (NEC). Identification of these lesions by the use of routine contrast enemas has been advocated as a means of decreasing potential morbidity from delayed diagnosis. However, the significant incidence of spontaneous resolution and reluctance to submit asymptomatic infants to contrast enema have led recent researchers to reserve these studies for patients developing symptoms of obstruction during a period of close observation. From July 1984 to July 1986, symptomatic strictures developed in five infants (15%) responding to medical management at our institution. Contrast enemas were not routinely performed and four (80%) of these patients presented with life-threatening sepsis or perforation associated with intestinal obstruction. Two infants developed complete colonic obstruction 4 and 6 weeks after discharge from the Intensive Care Nursery, having initially tolerated oral feedings. Both infants were critically ill due to perforation or sepsis and underwent emergency colostomy at community hospitals. Two other infants developed abdominal distension with sepsis and cardiopulmonary decompensation while remaining hospitalized for prematurity and pulmonary insufficiency. These patients became symptomatic 5 and 7 weeks after cautious refeeding while closely monitored in the Intensive Care Nursery. The occurrence of such life-threatening complications suggests that clinical observation alone is not adequate in the management of many of these infants. Contrast enemas should be performed to identify those patients at risk of such potential morbidity or mortality, especially those infants not residing near pediatric surgical facilities.
Journal of Pediatric Surgery, 1994
@Advances in perinatal and neonatal care in the past decade have produced a change in the populat... more @Advances in perinatal and neonatal care in the past decade have produced a change in the population of infants with perforated necrotizing enterocolitis (NEC) treated at our institution: the majority are now of very low birth weight (VLBW, <l,OOO g). Peritoneal drainage has been reported as an initial resuscitative procedure for unstable infants who have complicated NEC. Initial success with peritoneal drainage prompted us to adopt an aggressive approach to its use in this patient population. Since 1987, peritoneal drainage has been the primary treatment for most infants weighing less than 1,500 g who have perforation, and for unstable infants weighing more than 1,500 g. Perforation was documented by pneumoperitoneum or aspiration of meconium by paracentesis. Intestinal resection was performed in most infants weighing more than 1,500 g and in those for whom drainage was ineffective. Twenty-nine infants with low or VLBW (mean gestational age, 27 weeks; mean birth weight, 994 g) were treated with one or two drains in the right lower quadrant. Broad spectrum antibiotics were continued until all drains were removed, usually within 10 to 14 days. Nasogastric suction was continued until patency of the gastrointestinal (GI) tract was confirmed by a nonionic upper GI series. Six (21%) infants died, although one of the deaths occurred 5 months after drainage; the patient had chronic lung disease and an intact GI tract. Seventeen of the 23 (74%) survivors required no further operative procedure, and 6 (26%) required laparotomy and resection because drainage had been ineffective. Peritoneal drainage provided definitive treatment in 18 of 29 (62%) infants in this series. The low mortality rate and the successful treatment without laparotomy in nearly two thirds of the infants suggest that peritoneal and systemic host defenses and wound healing are significantly different in the VLBW infant. These differences indicate the need to reevaluate treatment strategies for this patient population.
Journal of Pediatric Surgery, 1994
0 The mortality rate for infants severely affected with congenital dfaphragmatic hernia (CDH) rem... more 0 The mortality rate for infants severely affected with congenital dfaphragmatic hernia (CDH) remains high despite significant advances in surgical and neonatal intensive care including dobyed repair and extracorporeal membrane oxygenation (ECMO). Decause of the increasingly successful experience with dngle-lung transplantation in adults, this approach has been suggested as a potential treatment for CDH infants with unsalvageable pulmonary hypoplasia. The authors report on a newborn female infant who was the product of a pregnancy complicated by polyhydramnios. At birth, she was found to have a right-sided CDH and initially was treated with preoperative ECMO, followed by delayed surgical repalr. Despite the CDH repair and apparent resolution of pulmonary hypertension, the infant's condition deteriorated gradually after decannulation, and escalating ventilator settings were required as well as neuromuscular paralysis and pressor support because of progressive hypoxemia and hypercarbia. A lung transplant was performed 8 days after decannulation, using the right lung obtained from a S-weekold donor. The right middle lobe was excised because of the size discrepancy between the donor and recipient. After transplantation, the patient was found to have duodenal stenosis and gastroesophageal reflux, which required duodenoduodenostomy and fundoplication. The patient was discharged from the hospital 90 days posttransplantation, at 3% months of age. Currently she is 24 months old and doing well except for poor growth. This case shows the feasibility of single-lung transplantation for infants with CDH, and the potential use of ECMO as a temporary bridge to transplantation. Lobar lung transplantation allowed for less stringent size constraints for the donor lung.
Journal of Pediatric Gastroenterology and Nutrition, 2004
Pediatric Endosurgery & Innovative Techniques, 2004
Journal of Experimental Medicine, 1976
Journal of Electrocardiology, 1995
The authors have hypothesized that low-level, electrocardiographic changes may accompany transien... more The authors have hypothesized that low-level, electrocardiographic changes may accompany transient ischemia induced by percutaneous transluminal coronary angioplasty. Altered repolarization may manifest as subclinical changes in ST-T morphology. Changes in depolarization may manifest as low-amplitude notches and slurs, a phenomenon the authors term abnormal intra-QRS potentials. The initial aim of this study was to characterize changes in high-resolution electrocardiograph signals that might be linked to ischemic involvement of the ventricular myocardium.
Journal of Electrocardiology, 1996
26. Bigger JT Jr, Fleiss JL, Rolnitzky LM, Steinman RC: The ability of several short-term measure... more 26. Bigger JT Jr, Fleiss JL, Rolnitzky LM, Steinman RC: The ability of several short-term measures of RR variability to predict mortality after myocardial infarction. Circulation 88:927, 1993 27. Hayano J, Yamada A, Mukai Set al: Severity of coronary atherosclerosis correlates with the respiratory HR and Standard ECG During PTCA • Lander et a{. 167 28. 29. component of heart rate variability. Am Heart J 121:1070, 199I Woo MA, Stevenson WG, Moser DK, Middlekauff tIR: Complex heart rate variability and serum norepinephrine levels in patients with advanced heart failure. J Am Coll Cardiol 23:565, 1994 Lindvall K, Erhardt L, Sj6gren A: Serial M-mode echocardiographic mapping in myocardial infarction: a quantitive evaluation of left ventricular wall motion abnormalities.