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1.
Ultrasound Obstet Gynecol ; 58(5): 722-731, 2021 Nov.
Article in English | MEDLINE | ID: mdl-32898295

ABSTRACT

OBJECTIVES: Clinical assessment of uterine artery (UtA) hemodynamics is currently limited to Doppler ultrasound (US) velocimetry. We have demonstrated previously the feasibility of applying four-dimensional (4D) flow magnetic resonance imaging (MRI) to evaluate UtA hemodynamics during pregnancy, allowing flow quantification of the entire course of the vessel. In this study, we sought to further validate the physiological relevance of 4D flow MRI measurement of UtA blood flow by exploring its association with pregnancy outcome relative to US-based metrics. METHODS: Recruited into this prospective, cross-sectional study were 87 women with a singleton pregnancy who underwent 4D flow MRI between May 2016 and April 2019 to measure the UtA pulsatility index (MRI-PI) and blood flow rate (MRI-flow, in mL/min). UtA-PI was also measured using US (US-PI). The primary outcome was a composite (COMP) of pre-eclampsia (PE) and/or small-for-gestational-age (SGA) neonate, and secondary outcomes were PE and SGA neonate individually. We assessed the ability of MRI-flow, MRI-PI and US-PI to distinguish between outcomes, and evaluated whether MRI-flow changed as gestation progressed. RESULTS: Following 4D flow postprocessing and exclusions from the analysis, 74 women had 4D flow MRI data analyzed for both UtAs. Of these, 18 developed a COMP outcome: three developed PE only, 11 had a SGA neonate only and four had both. A comparison of the COMP group vs the no-COMP group found no differences in maternal age, body mass index, nulliparity, gravidity or race. For 66 of the 74 subjects, US data were also available. In these subjects, both median MRI-PI (0.95 vs 0.70; P < 0.01) and median US-PI (0.95 vs 0.73; P < 0.01) were significantly increased in subjects in the COMP group compared with those in the no-COMP group. The UtA blood-flow rate, as measured by MRI, did not increase significantly from the second to the third trimester (median flow (interquartile range (IQR)), 543 (419-698) vs 575 (440-746) mL/min; P = 0.77), but it was significantly lower overall in the COMP compared with the no-COMP group (median flow (IQR), 486 (366-598) vs 624 (457-749) mL/min; P = 0.04). The areas under the receiver-operating-characteristics curves for MRI-flow, MRI-PI and US-PI in predicting COMP were not significantly different (0.694, 0.737 and 0.731, respectively; P = 0.87). CONCLUSIONS: 4D flow MRI can yield physiological measures of UtA blood-flow rate and PI that are associated with adverse pregnancy outcome. This may open up new avenues in the future to expand the potential of this technique as a robust tool with which to evaluate UtA hemodynamics in pregnancy. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.


Subject(s)
Magnetic Resonance Imaging/methods , Multimodal Imaging/methods , Placental Circulation , Prenatal Diagnosis/methods , Uterine Artery/diagnostic imaging , Adult , Area Under Curve , Blood Flow Velocity , Cross-Sectional Studies , Female , Fetal Growth Retardation/diagnostic imaging , Hemodynamics , Humans , Infant, Newborn , Infant, Small for Gestational Age , Pre-Eclampsia/diagnostic imaging , Predictive Value of Tests , Pregnancy , Pregnancy Outcome , Pregnancy Trimester, Third/physiology , Prospective Studies , Pulsatile Flow , Reproducibility of Results , Uterine Artery/embryology
2.
Plant Pathol J ; 31(3): 245-51, 2015 Sep.
Article in English | MEDLINE | ID: mdl-26361472

ABSTRACT

Alternative hosts increase the difficulty of disease management in crops because these alternate hosts provide additional sources of primary inoculum or refuges for diversity in the pathogen gene pool. Agropyron cristatum (crested wheatgrass), Bromus inermis (smooth bromegrass), Pascopyrum smithii (western wheatgrass), Stipa viridula (green needlegrass), and Thinopyrum intermedium (intermediate wheatgrass), commonly identified in range, prairie, verge, and soil reclamation habitats, serve as additional hosts for Pyrenophora tritici-repentis, the cause of tan spot in wheat (Triticum aestivum L.). A. cristatum (five lines), B. inermis (seven lines), P. smithii (four lines), S. viridula (two lines), and T. intermedium (six lines) were tested for their reactions to 30 representative P. tritici-repentis isolates from races 1-5. Plants were grown until the two-three-leaf stage in a greenhouse, inoculated individually with the 30 isolates, held at high humidity for 24 h, and rated after 7 days. All lines developed lesion types 1-2 (resistant) based on a 1-5 rating scale. Also, leaves from an additional plant set were infiltrated with two host selective toxins, Ptr ToxA as a pure preparation and Ptr ToxB as a dilute crude culture filtrate. All lines were insensitive to the toxins. Results indicate that these grass hosts have a limited or nonsignificant role in tan spot epidemiology on wheat in the northern Great Plains. Additionally, the resistant reactions demonstrated by the grass species in this research indicate the presence of resistance genes that can be valuable to wheat breeding programs for improving wheat resistance to P. tritici-repentis.

3.
Plant Dis ; 98(7): 864-875, 2014 Jul.
Article in English | MEDLINE | ID: mdl-30708845

ABSTRACT

Existing crop monitoring programs determine the incidence and distribution of plant diseases and pathogens and assess the damage caused within a crop production region. These programs have traditionally used observed or predicted disease and pathogen data and environmental information to prescribe management practices that minimize crop loss. Monitoring programs are especially important for crops with broad geographic distribution or for diseases that can cause rapid and great economic losses. Successful monitoring programs have been developed for several plant diseases, including downy mildew of cucurbits, Fusarium head blight of wheat, potato late blight, and rusts of cereal crops. A recent example of a successful disease-monitoring program for an economically important crop is the soybean rust (SBR) monitoring effort within North America. SBR, caused by the fungus Phakopsora pachyrhizi, was first identified in the continental United States in November 2004. SBR causes moderate to severe yield losses globally. The fungus produces foliar lesions on soybean (Glycine max) and other legume hosts. P. pachyrhizi diverts nutrients from the host to its own growth and reproduction. The lesions also reduce photosynthetic area. Uredinia rupture the host epidermis and diminish stomatal regulation of transpiration to cause tissue desiccation and premature defoliation. Severe soybean yield losses can occur if plants defoliate during the mid-reproductive growth stages. The rapid response to the threat of SBR in North America resulted in an unprecedented amount of information dissemination and the development of a real-time, publicly available monitoring and prediction system known as the Soybean Rust-Pest Information Platform for Extension and Education (SBR-PIPE). The objectives of this article are (i) to highlight the successful response effort to SBR in North America, and (ii) to introduce researchers to the quantity and type of data generated by SBR-PIPE. Data from this system may now be used to answer questions about the biology, ecology, and epidemiology of an important pathogen and disease of soybean.

4.
Plant Dis ; 97(1): 21-29, 2013 Jan.
Article in English | MEDLINE | ID: mdl-30722266

ABSTRACT

Wheat curl mite (WCM)-transmitted viruses-namely, Wheat streak mosaic virus (WSMV), Triticum mosaic virus (TriMV), and the High Plains virus (HPV)-are three of the wheat-infecting viruses in the central Great Plains of the United States. TriMV is newly discovered and its prevalence and incidence are largely unknown. Field surveys were carried out in Colorado, Kansas, Nebraska, and South Dakota in spring and fall 2010 and 2011 to determine TriMV prevalence and incidence and the frequency of TriMV co-infection with WSMV or HPV in winter wheat. WSMV was the most prevalent and was detected in 83% of 185 season-counties (= s-counties), 73% of 420 season-fields (= s-fields), and 35% of 12,973 samples. TriMV was detected in 32, 6, and 6% of s-counties, s-fields, and samples, respectively. HPV was detected in 34, 15, and 4% of s-counties, s-fields, and samples, respectively. TriMV was detected in all four states. In all, 91% of TriMV-positive samples were co-infected with WSMV, whereas WSMV and HPV were mainly detected as single infections. The results from this study indicate that TriMV occurs in winter wheat predominantly as a double infection with WSMV, which will complicate breeding for resistance to WCM-transmitted viruses.

5.
J R Army Med Corps ; 154(1): 47-50, 2008 Mar.
Article in English | MEDLINE | ID: mdl-19090388

ABSTRACT

Femoral neck stress fractures (FNSF) are uncommon, representing 5% of all stress fractures. In military personnel, FNSF represents one of the more severe complications of training, which can result in medical discharge. Clinical examination findings are often non-specific and plain radiography may be inconclusive--leading to missed or late diagnosis of FNSF This paper highlights the significance of FNSFs in military personnel and alerts physicians to the potential diagnosis. We identified all military recruits, aged 17 to 26, who attended the Infantry Training Centre (Catterick, U.K.), over a four-year period from the 1st July 2002 to 30th June 2006, who had suffered a FNSF. The medical records, plain radiographs, bone scans and MRIs of the recruits were retrospectively reviewed. Of 250 stress fractures 20 were of the femoral neck; representing 8% of all stress fractures and an overall FNSF rate of 12 in 10,000 military recruits. FNSFs were most prevalent amongst Parachute Regiment recruits (1 in 250, p < 0.05). Onset of symptoms was most commonly between weeks 13-16 of training. The majority (17/20, 85%) of FNSFs were undisplaced, these were all treated conservatively. Three FNSFs were displaced on presentation and were treated surgically. Overall, the medical discharge rate was 40% (8/20). FNSFs are uncommon and the diagnosis remains a challenge to clinicians and requires a high index of suspicion in these young athletic individuals. In such individuals early referral for MRI is recommended, to aid prompt diagnosis and treatment and to prevent more serious sequelae.


Subject(s)
Femoral Neck Fractures/diagnosis , Fractures, Stress/diagnosis , Military Personnel , Adolescent , Adult , Femoral Neck Fractures/epidemiology , Fractures, Stress/epidemiology , Humans , Physical Education and Training , Prevalence , Young Adult
6.
Transplant Proc ; 37(2): 1161-3, 2005 Mar.
Article in English | MEDLINE | ID: mdl-15848656

ABSTRACT

Retransplantation of the liver (re-OLTx) accounts for approximately 10% of all liver transplants in the United States. The decision to offer a patient a second liver transplant has significant financial, ethical, and outcome implications. This large, single-center experience describes some outcome and financial data to consider when making this decision. One thousand three liver transplants were performed in 921 patients at our center. Patients were divided into adult and pediatric groups, and further by whether they received a single transplant or more than one. Overall survival, variation in survival by timing of re-OLTx, and survival in adults with hepatitis C were investigated, as were hospital charges and cost of re-OLTx. Adults, but not children, had a significant decrement in survival following a second transplant. Second transplants more than double the cost of the initial transplant, but there is a significantly higher cost associated with early retransplantation compared to the cost associated with late retransplantation (costs of first and second transplants included in both cases). This difference is due to a longer length of stay and associated cost in the ICU. Adult patients retransplanted early have the same overall survival compared to those done late. The sample size of the adult HCV re-OLTx population was too small to reach statistical significance despite their observed poorer outcome.


Subject(s)
Liver Transplantation/economics , Liver Transplantation/physiology , Adult , Child , Costs and Cost Analysis , Florida , Hepatitis C/surgery , Humans , Liver Transplantation/mortality , Recurrence , Reoperation/economics , Reoperation/statistics & numerical data , Retrospective Studies , Survival Analysis
7.
Am Surg ; 67(11): 1081-7; discussion 1087-8, 2001 Nov.
Article in English | MEDLINE | ID: mdl-11730225

ABSTRACT

Involvement of the inferior vena cava (IVC) by hepatic tumors, although uncommon, is considered to be unresectable by standard surgical techniques. Recent advances in hepatic surgery have made combined hepatic and vena caval resection possible. The purpose of this study is to describe the surgical techniques and early results of combined resection of the liver and IVC. From 1997 to 2000, 11 patients underwent resection of the IVC along with four to seven liver segments. Resections were carried out for hepatocellular carcinoma (four); colorectal metastases (four); and hepatoblastoma, gastrointestinal stromal tumor metastases, and squamous cell carcinoma in one patient each. Ex vivo procedures were performed twice, and total vascular isolation was used in the nine other cases. The IVC was reconstructed with ringed Gore-Tex tube graft (five), primarily (five), or with Gore-Tex patches (one). There were two early deaths: one from liver failure at 3 weeks and one from sepsis secondary to a perforated segment of small bowel 4 months postresection. One patient with a gastrointestinal stromal tumor died at 32 months of recurrent tumor and one patient with hepatocellular carcinoma is alive with recurrent tumor at 16 months. The remaining patients are alive and disease free with follow-up ranging from 3 to 40 months without evidence of IVC occlusion. Combined resection of the liver and IVC is a formidable undertaking with substantial surgical risk. However, this aggressive surgical approach offers a chance for cure in patients with tumors involving the IVC that would otherwise have a dismal prognosis.


Subject(s)
Blood Vessel Prosthesis Implantation , Carcinoma, Hepatocellular/surgery , Liver Neoplasms/surgery , Vena Cava, Inferior/surgery , Adolescent , Adult , Carcinoma, Hepatocellular/pathology , Child , Child, Preschool , Colorectal Neoplasms/pathology , Female , Humans , Liver Neoplasms/pathology , Liver Neoplasms/secondary , Male , Middle Aged , Neoplasm Invasiveness , Vena Cava, Inferior/pathology
8.
J Pediatr Surg ; 36(8): 1205-9, 2001 Aug.
Article in English | MEDLINE | ID: mdl-11479857

ABSTRACT

BACKGROUND/PURPOSE: Liver transplantation is standard therapy for children with a variety of liver diseases. The current shortage of organ donors has led to aggressive use of reduced or split grafts and living-related donors to provide timely liver transplants to these children. The purpose of this study is to examine the impact of these techniques on graft survival in children currently treated with liver transplantation. METHODS: Data were obtained on all patients less than 21 years of age treated with isolated liver transplants performed after January 1, 1996 in an integrated statewide pediatric liver transplant program, which encompasses 2 high-volume centers. Nonparametric tests of association and life table analysis were used to analyze these data (SAS v 6.12). RESULTS: One hundred twenty-three children received 147 grafts (62 at the University of Florida, 85 at the University of Miami). Fifty-two (36%) children were less than 1 year of age at time of transplant, and 80 (55%) were less than 2 years of age. Patient survival rate was identical in the 2 centers (1-year actuarial survival rate, 88.4% and 87.1%). Twenty-five (17%) grafts were reduced, 28 (19%) were split, 6 were from living donors (4%), and 88 (60%) were whole organs. One-year graft survival rate was 80% for whole grafts, 71.6% for reduced grafts, and 64.3% for split grafts (P =.06). Children who received whole organs (mean age, 6.1 years) were older than those who received segmental grafts (mean age, 2.5 years; P <.01). Multifactorial analysis suggested that patient age, gender, and use of the graft for retransplant did not influence graft survival, nor did the type of graft used influence patient survival. CONCLUSIONS: The survival rate of children after liver transplantation is excellent independent of graft type. Use of current techniques to split grafts between 2 recipients is associated with an increased graft loss and need for retransplantation. Improvement in graft survival of these organs could reduce the morbidity and cost of liver transplantation significantly in children.


Subject(s)
Graft Survival , Liver Diseases/mortality , Liver Diseases/surgery , Liver Transplantation/adverse effects , Liver Transplantation/methods , Age Distribution , Cadaver , Child , Child, Preschool , Cohort Studies , Female , Florida , Follow-Up Studies , Graft Rejection , Humans , Infant , Liver Diseases/diagnosis , Living Donors , Male , Multivariate Analysis , Probability , Reoperation , Retrospective Studies , Survival Analysis , Treatment Outcome
9.
J Pediatr Surg ; 36(6): 951-2, 2001 Jun.
Article in English | MEDLINE | ID: mdl-11381436

ABSTRACT

Gastrointestinal bleeding in Turner's syndrome can represent vascular lesions that are frequently beyond standard endoscopic reach and often life threatening. This report describes the successful use of intraoperative endoscopy to identify the souce of bleeding in an adolescent with Turner's syndrome and significant intestinal hemorrhage. J Pediatr Surg 36:951-952.


Subject(s)
Endoscopy, Gastrointestinal , Gastrointestinal Hemorrhage/diagnosis , Intestine, Small , Turner Syndrome/complications , Adolescent , Female , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/surgery , Humans , Intraoperative Care , Laparotomy
10.
Am J Transplant ; 1(2): 152-6, 2001 Jul.
Article in English | MEDLINE | ID: mdl-12099363

ABSTRACT

Liver grafts are more resistant to damage by HLA antibodies than other organ allografts, but it is not clear if the antibodies are associated with graft rejection or graft loss, or if different antibody concentrations have different effects. To explore potential associations between antibody concentrations and outcome, preformed IgG antibodies against donor cells were quantified by flow cytometry in 465 consecutive liver transplant recipients. Antibody-positive patients were classified according to whether they had high or low antibody concentrations and analyzed for possible correlation with graft rejection or graft loss. The results showed that the incidence of rejection was not significantly different between antibody-positive and negative patients. However, patients with high antibody concentrations had a higher incidence of steroid-resistant rejections (31% at 1 year) than patients with low antibody (4%) or no antibody (8%, p < 0.0004). These effects were mainly due to T-cell (HLA class 1) antibodies. The overall incidence of rejection at 1 year was 69% for high antibody patients, 51% for patients with low antibodies and 53% for patients with no antibodies (p not significant). In an apparent paradox, antibody-positive patients underwent fewer early graft losses. Thus, the associations of preformed antibodies and outcome depend, on the one hand, on antibody concentrations, and on the other hand on whether the outcome measured is steroid-sensitive rejection, steroid-resistant rejection or graft survival. These complex interactions may explain the controversial results observed in previous studies.


Subject(s)
Graft Rejection/epidemiology , Isoantibodies/blood , Liver Transplantation/immunology , Adolescent , Adult , Ethnicity , Florida , Flow Cytometry , Follow-Up Studies , Histocompatibility Antigens Class I/immunology , Histocompatibility Testing , Humans , Immunoglobulin G/blood , Incidence , Liver Transplantation/mortality , Postoperative Complications/classification , Postoperative Complications/mortality , Reoperation , Retrospective Studies , Survival Rate , T-Lymphocytes/immunology , Time Factors , Transplantation, Homologous/immunology , Treatment Outcome
11.
J Pediatr ; 137(4): 575-7, 2000 Oct.
Article in English | MEDLINE | ID: mdl-11035842

ABSTRACT

This report describes the unique development of pulmonary vascular dilatation and hypoxemia associated with a portosystemic shunt in a pediatric liver transplant recipient. Ligation of the shunt resulted in resolution of hypoxemia. The outcome suggests that hepatic venous return to the pulmonary circulation is important in maintaining normal pulmonary vascular caliber.


Subject(s)
Hypoxia/therapy , Liver Transplantation , Portasystemic Shunt, Surgical/adverse effects , Postoperative Complications/therapy , Child , Female , Humans , Hypoxia/etiology , Ligation , Postoperative Complications/etiology , Remission Induction
12.
Chest ; 116(5): 1247-50, 1999 Nov.
Article in English | MEDLINE | ID: mdl-10559082

ABSTRACT

OBJECTIVE: Intraoperative transesophageal echocardiography (TEE) has evolved as an essential technique for use during pediatric cardiac surgery; however, few studies have evaluated the safety of TEE in children. This series reports endoscopic examination of the esophagus following intraoperative TEE in pediatric patients. METHODS: Fifty children undergoing congenital heart surgery underwent flexible esophagoscopy that was performed after completion of their heart surgery and after the removal of the transesophageal echo probe. The patients' ages ranged from 4 days to 10 years old, and their weight ranged from 3.0 to 39.8 kg, with a mean weight of 12.6 kg. RESULTS: Thirty-two of 50 patients (64%) had abnormal results shown on esophageal examinations; this occurred more frequently in the subset of patients weighing < 9 kg. No long-term feeding or swallowing difficulties were noted in any of the 48 patients who survived. CONCLUSIONS: Intraoperative TEE in infants and children frequently caused mild mucosal injury. Care must be exercised in the insertion and manipulation of the probes.


Subject(s)
Echocardiography, Transesophageal/adverse effects , Esophagoscopy , Esophagus/pathology , Monitoring, Intraoperative/methods , Wounds and Injuries/diagnosis , Cardiac Surgical Procedures , Child , Child, Preschool , Esophagus/injuries , Female , Heart Defects, Congenital/diagnostic imaging , Heart Defects, Congenital/surgery , Humans , Infant , Infant, Newborn , Intestinal Mucosa/injuries , Intestinal Mucosa/pathology , Male , Video Recording , Wounds and Injuries/etiology
13.
Ann Surg ; 230(3): 340-8; discussion 348-51, 1999 Sep.
Article in English | MEDLINE | ID: mdl-10493481

ABSTRACT

OBJECTIVE: To evaluate the impact of a nonstandard ventilation strategy on survival in congenital diaphragmatic hernia (CDH). BACKGROUND: Despite recent advances, including nitric oxide, CDH remains an unsolved problem with a mortality rate of 35% to 50%. Hyperventilation and alkalization remain common therapies. METHODS: In 1992, the authors prospectively abandoned hyperventilation and alkalization. Patients are lightly sedated and ventilated with the lowest pressure providing adequate chest movement, and the rate is set to patient comfort. Nitric oxide and extracorporeal membrane oxygenation (ECMO) are reserved for life-threatening instability. Surgical repair is delayed 1 to 5 days. Sixty consecutive patients are compared with 29 previous patients treated with hyperventilation and alkalization, 13 before and 16 after the availability of ECMO. RESULTS: Overall, 47 of 60 patients (78%) in study era 3 survived compared with 2 of 13 (15%) in the hyperventilation era and 7 of 16 (44%) in the hyperventilation/ECMO era (p < 0.0001). The disease severity and the incidence of associated anomalies did not differ between groups. To compare management strategies, patients who had treatment withheld because of lethal associated conditions were then removed from analysis. Peak inspiratory pressure and arterial pH were lower (p < 0.0001) and Paco2 was higher (p < 0.05) in era 3 than in the previous eras. The rate of pneumothorax (1.9%) decreased (p < 0.0001). In era 3, survival was 47 of 53 (89%) treated patients, and 23 of 25 inborn patients with isolated CDH survived (92%). CONCLUSIONS: Nonstandard ventilatory support of patients with CDH has led to significantly improved survival rates. This study sets a survival benchmark and strongly suggests the negative effects of hyperventilation and alkalization.


Subject(s)
Extracorporeal Membrane Oxygenation , Hernia, Diaphragmatic/therapy , Hernias, Diaphragmatic, Congenital , Respiration, Artificial , Acid-Base Equilibrium , Blood Gas Analysis , Cohort Studies , Hernia, Diaphragmatic/blood , Hernia, Diaphragmatic/mortality , Humans , Infant, Newborn , Intermittent Positive-Pressure Breathing , Survival Rate
14.
Arch Ophthalmol ; 116(12): 1667-9, 1998 Dec.
Article in English | MEDLINE | ID: mdl-9869802

ABSTRACT

We report a case of posttransplantation lymphoproliferative disorder manifesting as an isolated, unilateral iris tumor. A 2-year-old boy who had undergone liver transplantation for biliary atresia at age 4 months was seen with a 2-month history of an enlarging iris nodule. Histopathologic examination of the iris lesion demonstrated a mixed population of lymphoid cells. To our knowledge, this is the youngest patient with posttransplantation lymphoproliferative disorder isolated to the eye.


Subject(s)
Iris Neoplasms/etiology , Leukemia, Lymphocytic, Chronic, B-Cell/etiology , Liver Transplantation/adverse effects , Biliary Atresia/surgery , Child, Preschool , Humans , Immunosuppression Therapy , Iris Neoplasms/pathology , Iris Neoplasms/surgery , Leukemia, Lymphocytic, Chronic, B-Cell/pathology , Leukemia, Lymphocytic, Chronic, B-Cell/surgery , Lymphoproliferative Disorders/etiology , Lymphoproliferative Disorders/pathology , Lymphoproliferative Disorders/surgery , Male
15.
J Pediatr Surg ; 33(7): 1004-9, 1998 Jul.
Article in English | MEDLINE | ID: mdl-9694085

ABSTRACT

BACKGROUND: Repair of congenital diaphragmatic hernia (CDH) has changed from an emergent procedure to a delayed procedure in the last decade. Many other aspects of management have also evolved since the first successful repair. However, most reports are from single institutions. The lack of a large multicenter database has hampered progress in the management of congenital diaphragmatic hernia (CDH) and makes determination of the current standard difficult. METHODS: The CDH study group was formed in 1995 to collect data from multiple institutions in North America, Europe, and Australia. Participating centers completed a registry form on all live-born infants with CDH during 1995 and 1996. Demographic information, data about surgical management, and outcome were collected for all patients. RESULTS: Sixty-two centers participated, with 461 patients entered. Overall survival was 280 of 442 patients (63%) where survival was recorded. The defect was left-sided in 78%, right-sided in 21%, and bilateral in 1%. A subcostal approach was used in 91% of patients, with pleural drainage used in 76%. A patch of some kind was used in just over half (51%) of the patients, with polytetrafluoroethylene being the most commonly used material (81%) in those patients with a patch. The mean surgical time was 102 minutes, with an average blood loss of 14 mL (range, 0 to 500 mL). The overwhelming majority of patients underwent repair between 6:00 AM and 6:00 PM (289 of 329, 88%). Nineteen percent of patients had surgical repair on extracorporeal membrane oxygenation (ECMO) at a mean time of 170 hours into the ECMO course (range, 10 to 593 hours). The mean age at surgery in patients not treated with ECMO was 73 hours (range, 1 to 445 hours). CONCLUSIONS: The multicenter nature of this report makes it a snapshot of current management. The data would indicate that prosthetic patching of the defect has become common, that after-hours repair is infrequent, and that delayed surgical repair has become the preferred approach in many centers. Furthermore, the mean survival rate of 63% indicates that despite decades of individual effort, the CDH problem is far from solved. This highlights the need for a centralized database and cooperative multicenter studies in the future.


Subject(s)
Hernia, Diaphragmatic/surgery , Hernias, Diaphragmatic, Congenital , Chi-Square Distribution , Extracorporeal Membrane Oxygenation , Female , Hernia, Diaphragmatic/mortality , Humans , Infant, Newborn , Male , Polytetrafluoroethylene , Prospective Studies , Prostheses and Implants , Survival Rate , Treatment Outcome
16.
Am J Surg Pathol ; 21(10): 1248-54, 1997 Oct.
Article in English | MEDLINE | ID: mdl-9331300

ABSTRACT

We report the case of a hepatic undifferentiated (embryonal) sarcoma (UES) arising within a mesenchymal hamartoma (MH) in a 15-year-old girl. Mapping of the tumor demonstrated a typical MH transforming gradually into a UES composed of anaplastic stromal cells. When evaluated by flow cytometry, the MH was diploid and the UES showed a prominent aneuploid peak. Karyotypic analysis of the UES showed structural alterations of chromosome 19, which have been implicated as a potential genetic marker of MH. The histogenesis of MH and UES is still debated, and reports of a relationship between them, although suggested on the basis of histomorphologic similarities, have never been convincing. The histologic, flow cytometric, and cytogenetic evidence reported herein suggests a link between these two hepatic tumors of the pediatric population.


Subject(s)
Hamartoma/pathology , Liver Neoplasms/pathology , Mesoderm/pathology , Neoplasms, Germ Cell and Embryonal/pathology , Sarcoma/pathology , Adolescent , Biomarkers, Tumor/analysis , Female , Flow Cytometry , Hamartoma/chemistry , Hamartoma/diagnostic imaging , Humans , Immunohistochemistry , Karyotyping , Liver Neoplasms/chemistry , Liver Neoplasms/diagnostic imaging , Mesoderm/chemistry , Mesoderm/diagnostic imaging , Neoplasms, Germ Cell and Embryonal/chemistry , Neoplasms, Germ Cell and Embryonal/diagnostic imaging , Ploidies , Sarcoma/chemistry , Sarcoma/diagnostic imaging , Tomography, X-Ray Computed
17.
Gastroenterology ; 113(4): 1390-401, 1997 Oct.
Article in English | MEDLINE | ID: mdl-9322535

ABSTRACT

BACKGROUND & AIMS: Arterioportal fistulas (APFs) are rare vascular disorders of the mesenteric circulation. The aim of this study was to determine the etiology, anatomical location, and main symptom at presentation of APFs, and analyze the various modes of treatment. METHODS: The etiology, clinical presentation, radiographs, and treatment of 12 patients with APFs are reported in detail, and another 76 cases published since 1980 are reviewed. RESULTS: APFs result from trauma (n = 25, 28%), iatrogenic procedures (n = 14, 16%), congenital vascular malformations (n = 13, 15%), tumor (n = 13, 15%), aneurysm (n = 12, 14%), and other causes (n = 11, 12%). The origin of APFs is the hepatic artery in the majority of patients (n = 56, 65%). The main symptoms at presentation are lower or upper gastrointestinal bleeding (n = 29, 33%), ascites (n = 23, 26%), heart failure (n = 4.5%), or diarrhea (n = 4.5%). Radiological intervention provides definitive treatment in 42% (n = 33) of patients, whereas the remainder are treated by surgery alone (n = 27, 31%) or a combination of radiological intervention and surgery (n = 8, 9%). CONCLUSIONS: APFs result in a protean syndrome variously combining portal hypertension and other hemodynamic imbalances (heart failure, intestinal ischemia). Single or multiple interventional radiological procedures using arterial and/or venous approaches allow definitive treatment of most APFs. With increasing technological advances, it is anticipated that surgery will only be indicated in rare instances after failure of radiological intervention(s).


Subject(s)
Arteriovenous Fistula/physiopathology , Arteriovenous Fistula/therapy , Hepatic Artery/abnormalities , Portal Vein/abnormalities , Adolescent , Adult , Aged , Arteriovenous Fistula/diagnosis , Child, Preschool , Female , Humans , MEDLINE , Male , Middle Aged , Syndrome , Wounds, Nonpenetrating
18.
J Pediatr Surg ; 32(6): 923-7, 1997 Jun.
Article in English | MEDLINE | ID: mdl-9200103

ABSTRACT

Gastroschisis is frequently associated with intestinal atresia and alterations in gastrointestinal function. The authors studied gastric and small bowel myoelectric activity in a child who had a complex course and prolonged inability to tolerate oral intake after staged repair of gastroschisis and an associated ileal atresia. The child remained unable to tolerate oral intake after repair of the atresia and was reexplored 3 months later to rule out a partial small bowel obstruction, with simultaneous placement of serosal electrodes on the stomach and proximal small bowel. Persistent gastric dysrhythmias were observed postoperatively, and the child was unable to tolerate gastrostomy tube feedings. Abnormalities were also seen in small bowel motility, including retrograde propagation of activity fronts of the migrating myoelectric complex. However, the intestine converted to a fed myoelectric pattern with tube feedings, and the child was subsequently able to tolerate feedings via a tube placed directly into the small bowel. The authors conclude that myoelectric recordings via implanted electrodes are safe and feasible in children, and may give information regarding underlying motility alterations. The ultimate clinical role of myoelectric recordings in treating children with suspected motility disorders will require further study.


Subject(s)
Abdominal Muscles/abnormalities , Gastrointestinal Motility/physiology , Ileum/abnormalities , Intestinal Atresia/surgery , Myoelectric Complex, Migrating/physiology , Postoperative Complications/diagnosis , Abdominal Muscles/surgery , Electromyography , Humans , Ileum/surgery , Infant, Newborn , Male
19.
Transplantation ; 63(1): 84-8, 1997 Jan 15.
Article in English | MEDLINE | ID: mdl-9000666

ABSTRACT

The significance of a positive cross-match in liver transplantation remains controversial, as documented by a number of recent conflicting reports. In this study, we evaluated 195 consecutive orthotopic liver transplant recipients in whom the cross-match was either negative or positive for T or B cells. Special emphasis was placed on the outcome of patients with high levels of preformed IgG antibodies directed against donor T cells. IgG anti-donor antibodies were confirmed by flow cytometry in all cases. Of 10 patients with strong T-cell antibodies, there was one early death due to nonimmunological causes. Transplantation was successful in 9/10 patients followed for 3 months to 3 years. Graft survival, incidence of acute rejection, and number of liver biopsies in patients with a positive cross-match (strong T, weak T, or B cell) were not significantly different from those of patients with a negative cross-match. In the strong T cell antibody group, one patient had early graft dysfunction, with extensive hepatic necrosis and histological signs of antibody-induced damage. Two other patients also showed some evidence of possible antibody-mediated events, such as neutrophil infiltration and hepatocyte swelling. These lesions were reversible, and the patients had uneventful recoveries. Thus, in our experience, preformed antibodies did not preclude good graft survival.


Subject(s)
Antibodies/blood , Liver Transplantation/immunology , Adolescent , Adult , Child, Preschool , Female , Histocompatibility Testing , Humans , Infant , Liver/pathology , Male , Middle Aged , T-Lymphocytes/immunology
20.
Plant Dis ; 81(6): 696, 1997 Jun.
Article in English | MEDLINE | ID: mdl-30861873

ABSTRACT

Summer squash (Cucurbita pepo L.) exhibiting strong mosaic symptoms and leaf deformations were found in Brookings County during the summers of 1994 and 1995. Four isolates were mechanically transmitted to C. pepo cv. Early Prolific Straightneck. Ouchterlony double diffusion tests (conducted both in Arkansas and South Dakota) and protein-A enzyme-linked immunosorbent assays (ELISAs) with squash mosaic virus (SqMV) antisera provided by R. C. Gergerich were positive for SqMV. Pumpkin mosaic virus, a strain of SqMV, was previously reported infecting pumpkin in South Dakota (1). The pumpkin strain was differentiated from other strains of SqMV by its ability to infect lentil (Lens esculenta Moench), garden pea (Pisum sativum L.), and fenugreek (Trigonella foenum-graecum L.). The South Dakota isolates in this study did not infect these hosts, although the Arkansas isolate was found to infect Pisum sativum cvs. Little Marvel and Dwarf Gray Sugar Pod when tested serologically. The presence of adult Diabrotica undecimpunctata howardii Barber and D. barberi (Smith and Lawrence) was noted on infected plants in the area. Transmission tests were conducted with D. barberi provided by the USDA-ARS Northern Grain Insect Research Laboratory, Brookings, SD. The beetles had been previously reared on artificial diet media and germinated corn seed. Individual beetles were given a 48-h acquisition access period on infected or healthy detached squash leaves in petri dishes followed by a 48-h inoculation access period on Early Prolific Straightneck squash plants (1 beetle per plant). Beetles were removed at the end of this period, and the plants were grown under greenhouse conditions for 3 weeks. Plants were assayed for SqMV by protein-A ELISA. Transmission percentages of SqMV were as follows: SqMV (Arkansas isolate), 16.7%; and four South Dakota isolates, 12.5, 11.4, 14.6, and 5.1%. Beetles fed on healthy plants did not transmit virus. The rate of transmission found in this study indicates that D. barbari serves as an efficient vector for the transmission of SqMV in field plantings. Reference: (1) W. N. Stoner. Proc. S. D. Acad. Sci. 56:178, 1977.

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