Posted here on 11th Nov 2017
Thoracoscopic repair of a long gap esophageal atresia
This baby was born with a long gap esophageal atresia, it means primary anastomosis was not possible at birth. so a gastrostomy was fashioned so that we could feed the baby. then we did anastomosis at 3 months of age, now child, doing well. Needed couple of esophageal dilatations.
Dr. Shanbhogue posted this on my FaceBook wall and has allowed me to run it here on my website
Delivered through amniotic fluid, stem cells could treat a range of birth defects
Posted 26 Oct 2017
The amniotic fluid surrounding babies in the womb contains fetal mesenchymal stem cells (MSCs) that can differentiate into many cell types and tissues. More than a decade ago, Dario Fauza, MD, PhD, a surgeon, and researcher at Boston Children’s Hospital, proposed using these cells therapeutically. His lab has been exploring these cells’ healing properties ever since.
Replicated in great quantity in the lab and then reinfused into the amniotic fluid in animal models — a reverse amniocentesis if you will — MSCs derived from amniotic fluid have been shown to repair or mitigate congenital defects before birth. In spina bifida, they have induced skin to grow over the exposed spinal cord; in gastroschisis, they have reduced damage to the exposed bowel. Fauza calls this approach Trans-Amniotic Stem Cell Therapy, or TRASCET.
New research findings, reported this month (As Above) in the Journal of Pediatric Surgery, could expand TRASCET’s therapeutic potential.
Hester Shieh, MD, a surgical research fellow in Fauza’s lab, conducted a study that injected amniotic-fluid MSCs (afMSCs) into fetal animals, then comprehensively screened the fetus to see where the cells landed. To the team’s surprise, large numbers turned up in the fetal bone marrow. “No one had ever described a communication between the amniotic fluid and the fetal circulation,” says Fauza. “That is not currently taught in medical school.” But more practically, the research suggests that afMSCs can treat a wider variety of congenital defects than originally thought since ordinary MSCs from the bone marrow are already known to be active in tissue repair throughout the body.
For more on this click link below.
Child is first American to survive birth without trachea
Jan. 6, 2017
Thomas did not appear to have a trachea, she explained. What air was reaching him was flowing down his esophagus and through a tiny fistula, a passageway, that opened to his lungs.
None of the three had ever seen such a thing. But, they decided, if they could get air to Thomas’ lungs by putting a breathing tube down his esophagus, then that’s what they would do.
Thomas was placed on a ventilator. Almost immediately, Dominguez was presented with a new problem.
In more than a century, medical literature has recorded fewer than 200 cases in which the fetal trachea fails to form. Babies born with this anomaly, called tracheal agenesis, die silently, having never drawn a breath.
Only five, and only due to extraordinary surgical intervention, have survived.
None in the United States.
None, until Thomas David Richards, born this spring at Ministry St. Joseph’s Children’s Hospital in Marshfield.
Read on how the Dr’s did this first op in the USA
Published on 21 Jun 2017
Thoracoscopic TEF repair was done by Dr. Rajan Garg.
8 days old baby underwent Thoracoscopic TEF repair in a total of 115 mins without using single lung ventilation or any stay sutures
New hope for treatment of sepsis May 2017
This video explains how sepsis induced by an overload of blood pathogens can be treated with the Wyss Institute’s pathogen-extracting device. Blood is flown through a cartridge filled with hollow fibres that are coated with a genetically engineered blood protein inspired by a naturally-occurring human molecule called Mannose Binding Lectin (MBL). As pathogens flow through the hollow fibres, they bind to the protein-coated tubes and are removed from the circulating blood. Credit: Wyss Institute at Harvard University.
Magnets used to pull two ends of esophagus together
Cook Medical’s Flourish™ receives authorization for paediatric esophageal atresia
Bloomington, Ind. – Cook Medical announced today that the U.S. Food and Drug Administration (FDA) has granted the Flourish™ Pediatric Esophageal Atresia device authorization under the Humanitarian Device Exemption (HDE) for the treatment of pediatric esophageal atresia.
Esophageal atresia is a birth defect of the esophagus, the tubular structure connecting the mouth to the stomach, in which the upper portion of the esophagus does not connect to the lower portion of the esophagus and stomach. Surgery has traditionally been the only treatment option to repair the malformation until Dr. Mario Zaritzky, a pediatric radiologist at the University of Chicago Medical Center, and Cook collaborated on the development of a minimally invasive, magnet-based approach.
The Flourish Pediatric Esophageal Atresia device uses rare earth magnets that are inserted into the upper and lower ends of the infant’s esophagus. Over the course of several days, the magnets gradually stretch both ends of the esophagus, after which the tissue connects to form an intact esophagus. To date, 16 patients have been successfully treated with this device.
“The idea was to create a minimally invasive procedure that could possibly be an alternative to surgery in selective paediatric cases,” said Dr. Zaritzky. “Any procedure that can potentially replace major thoracic surgery with a less invasive method should be considered before deciding to go to the operating room.”
The Flourish Pediatric Esophageal Atresia Device received a Humanitarian Use Device (HUD) designation and was reviewed through the HDE pathway. A HUD treats or diagnoses a disease or condition affecting fewer than 4,000 individuals in the United States per year. In order to receive this type of authorization, a company must demonstrate, among other things, safety and probable benefit, i.e., that the device will not expose patients to an unreasonable or significant risk of illness or injury, and that the probable benefit of the device outweighs the risk of illness or injury. In addition, there can be no legally-marketed comparable devices, other than another HDE, available to treat or diagnose the disease or condition.
READ MORE HERE
frog chemical kills flu viruses
21 April 2017
A substance isolated from the skin of a frog can potently destroy influenza virus particles, scientists in the US have discovered. Appropriately dubbed urumin, after the Indian word “urumi“, which means a whip-like sword, the new agent slices, dices and deactivates flu.
Together with his colleagues, David Holthausen, from Emory University in Georgia, has been screening molecules known as “host defence peptides” – HDPs for short – secreted onto its skin surface by Hydrophylax bahuvistara, a species of red, black and yellow striped frog native to southern India. The role of HDPs is to protect the animal by neutralising a range of microbial threats. Holthausen and his team isolated 32 different HDP molecules which they set about screening for anti-flu activity.
Four of the chemicals potently destroyed flu, although three of them were also highly toxic to human cells. But one of the agents – urumin – which comprises a string of 27 amino acid building blocks, showed powerful anti-flu activity but was also apparently harmless at the same dose to human blood cells. The Emory team tested the substance against 12 different flu strains representing the common circulating types of the virus, including 8 forms of H1N1 and 4 isolates of H3N2 collected during the last 75 years of flu circulation.
While only marginally effective against H3N2 viruses, urumin nevertheless produced a 60-90% inhibition of the growth of all 8 strains of H1N1. Mice given a lethal dose of flu followed by an intranasal dose of urumin were significantly protected, with 70% of the animals surviving compared with 20% of controls. Studies on the animal’s lungs also showed that treated mice subsequently had 80-90% lower virus activity in their respiratory tissues compared with untreated mice.
At the moment the researchers do not know precisely how urumin works, but microscope studies show that contact causes viral particles to disintegrate.The peptide binds to part of the viral coat known as the HA in a region that is very heavily conserved across time, as evidenced by the fact that even viruses that were infecting people 75 years ago remain susceptible to its effects.
This broad spectrum of activity, say the researchers in their paper published in the journal Immunity this week, means that urumin “therefore has the potential to contribute to first-line antiviral treatments during influenza outbreaks.”
Read More on this Study:
The classic stethoscope has entered the digital age
April 17, 2017, posted here the same date.
New Electronic Stethoscope, Computer Program Diagnose Lung Conditions.
The classic stethoscope has entered the digital age. Medical researchers have created a computer program that connects to an electronic stethoscope to classify lung sounds into five common diagnostic categories. The Respiratory Sounds Visualizer computer program and the new electronic stethoscope with a high sensitivity for lung sounds were developed by a team of three physician-researchers at Hiroshima University and Fukushima Medical University, in collaboration with the industrial company Pioneer Corporation.
Recorded lung sounds of 878 patients were classified by respiratory specialist doctors. The researchers then turned these diagnoses into templates to create a mathematical formula that evaluates the length, frequency, and intensity of lung sounds. The computer program can a patient has multiple lung problems at the same time will benefit student doctors as they develop their own expertise. The results from the computer program are simple to interpret and can be saved and shared electronically. In the future, this convenience may allow patients to track and record their own lung function during chronic conditions, like chronic obstructive pulmonary disease (COPD) or cystic fibrosis.
recognise the sound patterns consistent with different respiratory diagnoses. The program analyses the lung sounds and maps them on a five-sided chart. Each of the five axes represents one of the five types of lung sounds. Doctors and patients can quickly look at the chart and see that when more of the length of the axis is covered in red, that diagnosis is more likely. Medical professionals listening to heart and lung sounds on a stethoscope need to overcome any background noise and recognise if a patient has one or multiple irregularities.
Any doctor working in less-than-ideal circumstances, from a busy emergency room to a field hospital, could rely on the computer program to “hear” what they might otherwise miss. The computer program’s ability to recognise when
The Respiratory Sounds Visualizer will soon be publically accessible. Dr Shinichiro Ohshimo, MD, PhD, is one of the researchers involved in developing the technology and works with patients in the Department of Emergency and Critical Care Medicine at Hiroshima University Hospital. “We plan to use the electronic stethoscope and Respiratory Sounds Visualizer with our own patients after further improving [the mathematical calculations]. We will also release the computer program as a downloadable application to the public in the near future,” said Dr Ohshimo.
Possible New Drug for bronchitis, and CF
A new treatment for Pseudomonas aeruginosa infection in patients with lung diseases such as cystic fibrosis (CF) and non-cystic fibrosis bronchitis, will be evaluated in an open-label Phase 1/2 clinical trial.
Released April 11th 2017
Mast’s subsidiary, Aires Pharmaceuticals, has entered into an agreement in which the University of Pittsburgh Medical Center will conduct the trial and Aires will be responsible for providing the drug and nebulizers for the study. The company will have the rights to use the study’s results for potential regulatory submissions. AIR001 is a sodium nitrite solution designed to be inhaled via a nebulizer. Nitrite is a vasodilator, and it can form nitric oxide (NO), which ultimately results in a dilation of blood vessels and a reduction in inflammation.
Bronchiectasis is an abnormal and irreversible dilation of the airways of the lung. (Click here to find out about Symptoms) typically include a chronic cough with mucus, shortness of breath, coughing up blood, and chest pain. Those with the disease often get frequent lung infections, including those caused by the Pseudomonas aeruginosa pathogen.
March 9th 2016
The cause of bronchiectasis is often unclear, but the disorder can be due to inherited conditions, inhaled objects, and severe lung infections. Bronchiectasis patients are known to have an increased risk for bacterial infections.
The scientists, led by first author Sermin Borekci, studied 121 patients between 1996 and 2013 who had noncystic fibrosis bronchiectasis. The investigators accessed already-collected information in what is known as a retrospective study. They examined images of the lungs that had been taken using either high-resolution computed tomography (CT) or multi-slice CT. The team further evaluated bacterial cultures that had been taken from the patients. Pseudomonas aeruginosa in 25 patients (20.6 percent) and Haemophilus influenzae in 14 patients (11.5 percent). The presence of either of these bacteria caused a low forced vital capacity (FVC) and the presence of cystic bronchiectasis. Cystic bronchiectasis is the most severe form of the disease.
This article seems to be the first report of this technique
Endoscopic treatment of tracheo-oesophageal fistulae: an innovative procedure
Published on Feb 9, 2017 (on youtube)
Tracheo-oesophageal fistulas represent a major complication of prolonged intubation and may cause death. Surgical repair is a complex procedure that can be challenging in compromised patients. In this study, we describe a simple endoscopic technique that resulted in the effective palliation of symptoms.
This article seems to be the first report of this technique, which is safe, relatively simple and effective in achieving palliation of symptoms. A prolonged follow-up period will be necessary to confirm the long-term results indicated by the promising preliminary data. Because the time necessary for the surgical procedure is short and the impact on the patient minimal, and the procedure, if necessary, may be repeated without problems. A 20-year-old patient with chromosomal trisomy 21 was admitted to a hospital in southern Italy because of repeated pulmonary infections and chronic cough. A computed tomographic scan disclosed an abnormal communication between the trachea and the oesophagus. The thoracic surgeon suggested a surgical repair, including tracheal resection and interposition of a muscular limb. The parents refused the surgical approach and asked for a second opinion. ( The endoscopic repair is shown in Video )
Found on youtube first. https://www.youtube.com/watch?v=dqfCLPiJzVo
Main Site below, with much more writing about what you see above, I found it all very interesting, PLEASE click the link below and read much more than I have put here.
Controlled study of primary repair 2016-17
Role of glycopyrrolate in healing of anastomotic dehiscence after primary repair of esophageal atresia in a low resource setting-A randomised controlled study, 2016-17
AIMS: To investigate the role of glycopyrrolate in decreasing oral secretions in patients of esophageal atresia (EA) with anastomotic leak and evaluate its effect on healing of anastomotic dehiscence.
METHODS: The study comprised consecutive neonates of esophageal atresia, who had undergone primary surgery and developed anastomotic leak. The patients were randomised into two groups with the observer blinded to the group. The patients in the treatment group were administered glycopyrrolate in the dose of 8 μg/kg 8 hourly, whereas placebo group patients were injected normal saline only. Neonates, in both the groups, were managed conservatively based on the clinical and radiological parameters. The endpoints of the study were either resolution or progression of the leak. The study was approved by the institute ethics committee.
RESULTS: There were 21 patients each in two groups with comparable preoperative characteristics. All the cases had anastomotic leaks clinically detectable in the chest tube. Saliva alone constituted the leaked material in 18 cases in the treatment group and 10 in the placebo group. The cumulative total of mean chest tube output per patient for all patients in the treatment group was 124.15ml as compared to 370.27ml in the placebo group (p=0.001). Anastomotic leak stopped in 16 cases (76%) in the treatment group, as compared to 6 cases (29%) in the placebo group (p=0.004). The postoperative ventilation was required in 8 cases (8/21, 38%) in the treatment group and 17 cases (17/21, 81%) in the placebo group (p=0.010). In the treatment group, the diversion procedures were carried out in 2 out of 21 cases (10%), whereas in the placebo group, 52% of the patients (11/21) required such an intervention (p=0.003). At the time of discharge, the oral feeds could be started in 15 cases (15/21, 71%) in the treatment group, as compared to 3 (3/21, 14%) in the placebo group (p=0.0004).
CONCLUSIONS: Administration of glycopyrrolate in patients of anastomotic leak after primary repair of esophageal atresia resulted in reduced oral secretions, which helped in the healing of the anastomotic dehiscence in a significant number of patients.
EA/TEF Research 2017
New hope for babies born without esophagus
Added to Website 14-2-17
HOUSTON – A new breakthrough in the use of stem cells. This time it could help patients without an esophagus.
Whether it’s from cancer or a birth defect, many people need a new esophagus and current operations can have many complications, including death.
The condition some babies are born with is called esophageal atresia.
The babies are born without an esophagus and therefore no way to eat.
Eleven-month-old Lincoln from Santa Fe was born without an esophagus and required emergency surgery at Clear Lake Regional almost immediately after he was born.
“He had to have a chest tube in for about a week, so we couldn’t hold him for a week,” his mother, Ashley Pratt, said.
It’s a complicated condition that will have to be monitored for the rest of his life so he does not choke.
“It will grow, but it will stricture. So as he grows, there’s a potential for where they repaired it to get really narrow,” Pratt said. “They made us take an infant CPR class. You have to watch for symptoms and signs of choking, of a lot of extra reflux or pain.”
The chief medical officer at Biostage, Dr. Saverio La Francesca, said that’s because the standard treatments for this condition require surgeons to reshape a person’s stomach into a tube or remove part of the intestine to create a mock esophagus.
“The problem with the current surgery is when you attach together the esophagus of the patient to the stomach of the patient, you can have fluid leaking … and then you can have an infection,” Dr. La Francesa said.
La Francesca said something better is on the horizon, because he says he can create an esophagus by putting the patient’s own stem cells around a paper tube and surgically implanting that tube. By doing that, he says, it can grow and attach itself in patients, eliminating many complications in people with esophageal cancer and esophageal atresia.
“The cells are stimulating your own esophagus to grow and three weeks later your own esophagus is grown over this tube and has reconstituted its own integrity. By then, a different paradigm than what has been done before, [the paper] is ready to be taken out,” La Francesca said.
TO READ FULL REPORT click link below, and to watch the video.
Tracheomalacia and complex congenital airway problems released 11 Jan 2017
Added to Website 12th Jan 2017
By Dr Jennings
Surgical Grand Rounds Jan 11 2017 on Complex Congenital Airway Treatment by Dr Jennings and colleagues. In detail discussion of current treatments for tracheomalacia, tracheal compression, tracheal anomalies and vascular rings including aberrant subclavian artery, circumflex aorta and double aorta. He also discusses treatment for tracheal strictures with resection and slide tracheoplasty and slide bronchoplasty.
Released 1st January 2017
added to this Website on the 2nd
New Variant of Esophageal Atresia
Esophageal atresia with tracheoesophageal fistula (EA/TEF) associated with distal congenital esophageal stenosis (CES) is a well-known entity. We encountered three patients of EA/TEF associated with long and unusual CES.
A 2.5 kg full term baby presented to us with history of drooling of saliva and intolerance to feed with choking and coughing at the time of feeds. Inability to pass the red rubber catheter into stomach confirmed the diagnosis of esophageal atresia. The chest and abdominal x-ray revealed red-rubber catheter in upper pouch at vertebral level D4. The chest x-ray also revealed right upper lobe consolidation. There was presence of gas in the abdomen confirming the diagnosis of EA/TEF. The Ultrasound KUB was normal. The echocardiography revealed the presence of small VSD. The blood investigations were normal. Right thoracotomy showed wide TEF which was divided and repaired. The upper esophageal pouch was mobilised and esopago-esophageal anastomosis was started. After the anastomosis of posterior wall, a 5 Fr. infant feeding tube was tried to pass across the anastomosis into the stomach, but the feeding tube couldn’t be passed into the stomach due to the presence of stenosis about 2 cm distal to the proximal end of distal esophageal pouch.
Two stay sutures were taken at the narrowed part of esophagus and longitudinal incision was made between the stay sutures to find the lumen but there was no negotiable lumen ………………..
For the rest of this Report click on this link below
Nissen fundoplication 31-03-2017
Date of Web Publication 31-03-2017
Added to this Site on 2nd-04-2017
Preoperative workup, patient selection, surgical technique and follow-up for a successful laparoscopic Nissen fundoplication
Some experienced surgeons have reported good and excellent results in more than 90% of patients submitted to laparoscopic Nissen fundoplication for gastroesophageal reflux disease (GERD). Others, however, associate this operation to unacceptable rates of morbidity, mortality and inferior outcomes. Results are certainly linked to an appropriate patient selection, work up, technical details and follow-up.
This paper focuses on the proper preoperative workup, patient selection, surgical technique and follow-up for a successful laparoscopic Nissen fundoplication.
Experienced surgeons have reported excellent results for laparoscopic Nissen fundoplication to treat gastroesophageal reflux disease (GERD). Others, however, associate this operation with unacceptable rates of morbidity, mortality and inferior outcomes. Results are certainly linked to an appropriate patient selection, work up, technical details and follow-up. This review focuses on the proper preoperative workup, patient selection, surgical technique, and follow-up for a successful laparoscopic Nissen fundoplication. Certainty of the diagnosis of GERD and the esophageal physiology is essential. An extensive dissection of the esophagus and crus in the abdomen and mediastinum, an adequate hiatoplasty, and a short-floppy fundoplication are important technical points. New onset or persistent symptoms after the operation must be carefully studied. Excellent outcomes may be reproducible if a proper preoperative workup, patient selection, surgical technique and follow-up are rigorously observed. Following the example of any other elective surgical procedure, patients planned to undergo an antireflux operation should be carefully clinically evaluated. Patients under high anesthetic risk or those with uncontrolled co-morbidities should not be offered this kind of therapy.
An adequate preoperative workup should bring several pieces of information in order to allow a clinical judgement for a better diagnosis since diagnostic tests individually (laryngoscopy, endoscopy, and even pH- or pH-impedance monitoring) may not be sufficient to make the definitive diagnosis of GERD.
This Paper is very long and has graphic photo’s within it
Keywords: Gastroesophageal reflux disease, surgery, fundoplication, outcomes
Neto RML, Herbella FAM. Preoperative workup, patient selection, surgical technique and follow-up for a successful laparoscopic Nissen fundoplication. Mini-invasive Surg 2017;1:6-11.
Rafael Melillo Laurino Neto,
Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo 04037-003, Brazil.