May 13, 2014

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More than 200 physicians, nurses and operating room staff attended the 5th annual Edmond T. Gonzales Jr., Surgical Research Day at Texas Children’s Pavilion for Women on May 9. The event provided a forum for researchers to unveil their work highlighting remarkable advancements in the field of pediatric surgery.

“Surgical research, both basic and clinical, is central to our core values as academic surgeons at Texas Children’s Hospital,” said Charles Fraser, Jr., surgeon-in-chief at Texas Children’s Hospital. “Today’s presentations highlight the exciting and innovative work being done by our surgical colleagues, residents and students.”

The program featured six oral presentations and 86 poster presentations spotlighting the academic efforts of the surgical faculty, post graduate trainees, nursing personnel and operating room staff. Each year, physicians are asked to submit abstracts of their research to be considered for oral presentations for Surgical Research Day and a leadership committee makes the final selection.

This year’s keynote speaker, Dr. N. Scott Adzick, presented “Prospects for Fetal Surgery.” Dr. Adzick is the C. Everett Koop profession of pediatric surgery and surgeon-in-chief at The Children’s Hospital of Philadelphia.

Lynn Sessions, J.D., a health care privacy lawyer at BakerHostetler in Houston, delivered the ethics presentation, “Mobile Technology in Health Care: Convenience or High Risk.”

The annual event wrapped up with a special awards recognition ceremony. Here are this year’s winners:

Best Oral Presentation
Dr. Fariha Sheikh, Pediatric Surgery
“Anesthesia-Induced Neurotoxicity in the Mid-Gestation Fetal Sheep”

Best Poster
Dr. Scott Rosenfeld, Orthopaedics
“Evaluation of Talo-calcaneal Coalitions Using 3D Printed Models”

Samuel Stal Research Award
Dr. Irving Zamora, third year clinical research fellow, Pediatric Surgery
Dr. Yesenia Rojas, third year basic science research fellow, Pediatric Surgery

Click here to access all presentation slides (This link will only open internally)

Surgical Research Day Photo Gallery

May 6, 2014

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Texas Children’s first urgent care clinic will soon open to continue our commitment to providing high-quality, efficient and affordable care to all patients and families in the Houston community. Created to respond to the growing need for expert pediatric urgent care after hours, the clinics are conveniently located and open evenings and weekends.

The first location, Texas Children’s Urgent Care Cinco Ranch, will begin seeing patients on Tuesday, May 13, at 9727 Spring Green Blvd., Suite 900 in Katy. A second urgent care clinic is slated to open later this summer.

The clinics will be staffed by pediatricians who have privileges at Texas Children’s. They will diagnose and treat a variety of illnesses and conditions including: asthma, strep throat, fever, minor burns, flu, ear infections and allergic reactions. Patients needing fracture care and splinting, IV fluids, lab services, laceration repair and x-rays may also receive treatment at Texas Children’s Urgent Care.

The urgent care clinics will not perform routine physical exams for patients or administer vaccinations as those services should be obtained from a general pediatrician. Texas Children’s Urgent Care will accept major insurance plans and has self-pay rates, which are less than emergency center charges.

For more information, visit Texas Children’s Urgent Care’s website.

April 29, 2014

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In the summer of 2012, a then 6-year-old little girl, Mayah Villarreal, began to write with her left hand instead of her right. Her kindergarten teacher mentioned it to Mayah’s mom, Ashley, but told her not to worry as it was common in young children. A few weeks later while taking a bath, Ashley noticed that Mayah began to lean her body to the right and could not sit up straight. Soon she could not lift her right leg on her own to do simple, everyday tasks. Mayah, a formerly active young girl who loves gymnastics, had never shown any signs of a movement disorder and now her life had come to all but a halt, as she was unable to function normally.

Mayah was originally diagnosed in her hometown of Alton with a chiari malformation, and doctors recommended that Mayah undergo a craniotomy surgery, which she had in October 2012. A few days prior to the surgery, Mayah had stopped walking completely and was suffering from debilitating headaches.

After the surgery, there was no improvement in Mayah’s condition. In fact, it continued to worsen and she landed in a local hospital where she was admitted for two days and was told her condition was psychological. One of the doctors on call at the time called Texas Children’s Hospital and after a brief conversation, the Kangaroo Crew team picked Mayah up and flew her to Houston.

Mayah was admitted to the Blue Bird Circle Clinic where they diagnosed her with an extremely rare pediatric movement disorder called dystonia. Dystonia from each individual genetic etiology is rare, and in DYT 1, which is what Mayah has, the disease frequency in Ashkenazi Jews is estimated at 1:3000-1:9000. Among non-Jews, the prevalence is lower.

The team at the Blue Bird Circle Clinic, including Dr. Amber Stocco, former director of the hospital’s movement disorder clinic and Dr. Daniel Curry, director of pediatric surgical epilepsy and functional neurosurgery, developed a course of care that included an aggressive and innovative treatment plan. Stocco recommended deep brain stimulation (DBS) to treat Mayah’s condition. Commonly used for Parkinson’s patients, the use of DBS in pediatric patients is still limited as there are only a few experienced centers worldwide and few patients meet the criteria to qualify for DBS.

“Until recently there have been only case reports of DBS in children,” said Stocco, of this innovative approach. “It is starting to gain acceptance in pediatric centers; however, to date, there are likely less than 300 cases of DBS in children internationally.”

In order to administer DBS to Mayah, Stocco, Curry and the team implanted a small, programmable battery in the upper chest region, near her shoulder. The battery connected to a series of electrodes that targeted specific parts of her brain to block the abnormal brain activity that prevented her from controlling her own muscle movements.

Soon after surgery, Ashley noticed a change in Mayah’s behavior. “Soon after surgery, before the device was even fully programmed to a higher level, we saw Mayah’s condition improving. Every day, we watched Mayah become more and more independent.”

On August 10, 2013, Mayah walked unassisted for the first time since the summer of 2012.

Thanks to Dr. Stocco and Dr. Curry’s innovative approach, Mayah’s case proved to be an extraordinary outcome and story of success. The DBS has returned Mayah’s motor skills to normal and she is happily back enjoying gymnastics. Her implant requires minimal maintenance, needing a charge for just a few minutes every week.

Mayah’s case is amongst the most remarkable of recoveries. Until recently there have only been case reports about using DBS in children and is now starting to gain acceptance among pediatric hospitals, with Texas Children’s at the forefront.

connect anywhere

Texas Children’s is a big place with lots going on, and sometimes it’s tough to keep a pulse on it all. With that in mind, Texas Children’s Internal and Corporate Communications team has launched a new website – www.texaschildrensnews.org – to put all of the organization’s top news at employees’ fingertips.

Texaschildrensnews.org launched in February and already has had nearly 18,000 views.

“The best thing about this site is that we finally have created a place where staff and employees can access Texas Children’s news easily,” said Angela Hudson, assistant director of Internal and Corporate Communications.

The site was launched to complement the team’s weekly news cycle. The team updates the Connect intranet site every Tuesday with five to six top news stories, which rotate in the homepage photo carousel. On Wednesdays, the team emails the Connect News enewsletter to all staff and employees featuring the week’s new headlines.

“Connect News now links you directly to the new texaschildrensnews.org, and you can get there from a mobile phone, tablet or computer at home or work,” Hudson said. “This was really important to us – It’s important to provide this access to our audience. There’s no logging in, no passwords, no firewalls. Just hop on, take a quick read and stay informed.”

In addition to the new site, the team also will debut a refreshed design for the weekly Connect News enewsletter this week. Connect News first launched in summer 2012 and was significant in helping decrease the amount of global email traffic within the organization. The new, cleaner look complements the Connect site and the new external news site and will continue to be emailed weekly.

“We’re committed to telling and sharing the Texas Children’s story internally,” Hudson said. “After all, our ‘story’ revolves around our staff and employees and their amazing work. Our team’s goal is to get them information they want and need, when they need it, as easily as possible.”

Get Connect News sent to your home email
If you don’t have access to your Texas Children’s email on your phone or don’t typically have time to check your email at work, we can send the weekly Connect News enewsletter to a home email address. Just email us at connectnews@texaschildrens.org.

April 22, 2014

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Dr. Henri Justino, director of the C.E. Mullins Cardiac Catheterization Laboratory, is something of a magician when it comes to repairing a child’s heart in the least invasive way possible. He and his colleagues in the cath lab can remove a blockage, close a hole in the heart, and replace a defective heart valve using thin, flexible catheters and some deft flicks of the wrist, leaving no trace of their efforts other than a tiny incision near the patient’s hip.

One thing that has consistently bothered him, however, is the lack of available options for children with defective heart valves.

“Compared to the adult market, the pediatric market is simply too small for companies to invest in,” Justino said. “Seventy-five percent of children who need a valve replacement need a pulmonary valve, but there’s only one kind available today that can be delivered by a catheter approach and is approved for use in the pulmonary position. It’s expensive and hard to come by. We need another option.”

Justino and his partners – Daniel Harrington, Ph.D., at Rice University, and Kwonsoo Chun, Ph.D., at Baylor College of Medicine – are on a mission to create an artificial pediatric pulmonary valve that can be delivered by a catheter-based approach into the heart.

“Right now, we are working on getting the mechanics right,” Justino said. “We need a solid valve that works well, opens and closes well with every heartbeat, and is designed to last.”

Getting the valve’s mechanics right is no small feat. It must be small, thin and flexible enough to snake through a young child’s veins and through the chambers of the heart. Once it’s in the right place, it needs to expand to full size, anchor in place with no sutures or adhesive, and be durable enough to last many millions of cycles in a child’s heart, which beats up to twice as fast as an adult’s. They’re also trying to design the valve so that it can grow with a child over time.

“We’ve definitely got some challenges,” said Justino, who compares catheterization to a mechanic trying to fix the motor on a car while it’s still running. “We’re doing all sorts of procedures on the heart without ever having to stop the heart or put the patient on a heart-lung machine.”

And that’s the point – to fix the heart with as little disruption as possible.

“Open heart surgery does work very well, and it is a very good option if it’s your only option,” Justino said. “If you can get the very same result without having the chest opened, without a long scar, without using an artificial machine to circulate blood through your brain, and if you can go home the very same day instead of staying in the hospital for several days – even go to school the next day – why would you not want that?”

After three years of development, Justino, Harrington and Chun have a working prototype and are very close to completing their first milestone, which is to prove that it works in the lab setting and meets the criteria the FDA requires of valves. The next phase is animal testing: How does this device perform when it’s placed in a living organism, in contact with organs, tissue and blood? The final step, human testing, may be several years away depending on funding and how well the first two stages go.

“Our long-range goal, after all of this is complete, is to see if we can coat the valve with living tissues and various kinds of cells to make the device more biocompatible with the patient, similar to what Dr. Jacot and his team are doing,” Justino said. “But that’s a long way away. For now, our main goal is to get the best performance we can from this valve and then get it on the market – helping children – as quickly as possible.”

Cutline: Drs. Henri Justino, Daniel Harrington and Kwonsoo Chun examine the prototype valve in a high-cycle tester.

Dr. Huda Zoghbi, director of the Jan and Dan Duncan Neurological Research Institute (NRI), will receive the 2014 March of Dimes Prize in Developmental biology at a ceremony held in Vancouver on May 5. The award, given annually, honors investigators whose research has profoundly advanced the science that underlies the understanding of birth defects.

Zoghbi’s best known for her pioneering work on Rett syndrome, a cause she first became passionate about after encountering children with the disease during her residency. She’s since been tireless in her efforts to find the genetic cause of the syndrome. In 1999, she was successful in identifying the Rett gene, providing a definitive genetic diagnoses for the condition and allowing a biological understanding and search for treatment.

“Dr. Zoghbi’s contributions to our understanding of several entirely different neurological disorders, including her finding of the genetic basis of Rett syndrome, have opened new areas of research,” says Dr. Joe Leigh Simpson, senior vice president for Research and Global Programs at the March of Dimes. “Her work influences the entire field of autism and other neuropsychiatric disorders.”

Rett syndrome is a genetic neurological disease that affects young girls who are born with the disease and develop normally for one to two years until they show progressive loss of motor skills, speech and cognitive abilities. Males with the condition usually die in infancy.

Zoghbi will deliver the 19th annual March of Dimes Lecture titled “Rett Syndrome and MECP2 Disorders: From the Clinic to Genes and Neurobiology,” during the Pediatric Academy Societies annual meeting. She will receive the March of Dimes Prize in Developmental Biology in a special award ceremony held during the meeting. Given annually, the March of Dimes Foundation created the prize in 1995 as a tribute to Dr. Jonas Salk, a pioneer in the development of the polio vaccine.
The March of Dimes Foundation is the leading nonprofit organization for pregnancy and baby health.

April 15, 2014

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The Texas Children’s Fetal Center proudly announces the birth of baby Cabellotrejo, a boy born healthy at Texas Children’s Pavilion for Women following a complex pregnancy that included open fetal surgery. Early in the pregnancy, doctors diagnosed baby boy Cabellotrejo with a large lung mass, called congenital cystic adenomatoid malformation, or CCAM. Mom and baby were transferred from their hometown of Austin, where the team at the Fetal Center intervened with an open fetal surgery that saved the baby’s life.

During the procedure, which took place on January 16, 2014, the Fetal Center team partially removed the baby from her mother’s womb, opened the baby’s chest and removed the giant mass, returning him safely back into his mother’s womb less than 30 minutes later. The fetal heart failure resolved, and the baby and mother subsequently recovered smoothly; mom remained pregnant for 11(+) weeks before she delivered her health baby boy.

A CCAM is an abnormal growth of malformed lung tissue that is the result of abnormal organ development. The adenomatous overgrowth of terminal bronchioles and reduced number of normal alveoli may cause significant pulmonary effects. It is incredibly rare for these malformations to grow to such a large size as to lead to fetal heart failure, a condition that is very difficult to treat prenatally. The fetus continued to deteriorate despite medical treatment.

“Fetal surgery was the only hope for this baby boy who was sure to die without surgical intervention. The good outcome achieved in this case is the result of great teamwork, including the contributions by our expert fetal radiologists, cardiologists and maternal fetal surgery team. I am so pleased this baby has recovered fully and now has the hope of a completely normal life,” said Dr. Cass, co-director of Texas Children’s Fetal Center, and lead surgeon on this case.

In addition to an expert OR team, nurse coordinators and pediatric anesthesiologists, a multidisciplinary team of specialists, including: Dr. Darrell Cass, Dr. Oluyinka O. Olutoye, Dr. Wesley Lee, Dr. Michael Belfort, Dr. Nancy Ayres, Dr. Rodrigo Ruano, Dr. Christopher Cassady and Dr. Alireza Shamshirsaz worked together on the case.

To date, only two other centers in the world have been successful at treating this rare and complex medical condition. Texas Children’s Hospital has performed 59 open fetal surgeries since 2003, but seeing that healthy baby enter the world never gets old.

“Baby Cabellotrejo is a fighter and a survivor. We are ecstatic that his parents have delivered a healthy baby boy,” said Cass, of the Fetal Center’s latest patient success.