July 19, 2016

72016jrreporters640A team of nurses, surgeons, and anesthesiologists from Texas Children’s Hospital’s Main Operating Room recently participated in a medical mission in Antigua, Guatemala.

The mission was coordinated by Faith in Practice, a Houston-based organization dedicated to the medical care of indigent people in Guatemala. The 44-member team that went consisted of medical and surgical staff from hospitals in the Medical Center and out of state. Among the volunteers from Texas Children’s were Drs. Olutoyin Olutoye, Oluyinka Olutoye, Robert Power, David Mann and Stephanie Cruz; certified registered nurse anesthetists Nate Jones and Megan Koudelka; and registered nurses Karen Bustos, Debra Batiste and Juan Sale.

Focusing primarily on pediatric patients, the team performed nearly 140 surgeries in just four days, including inguinal and umbilical hernias, orthopedic surgeries, podiatric cases, and dental extractions conducted in support of the people of Antigua.

“It is always a humbling experience to go on this mission trip,” said Bustos, who has been on the mission five times now. “These people come from villages eight to 10 hours away and come to us full of trust that we will make their children well.”

Sale, a first-time volunteer, said the trip was “an amazing experience, especially when you get to help the children.”

Glass, the group coordinator for Texas Children’s, said she has been participating in similar mission trips since 2002 and has gone to Guatemala 15 times.

“This activity is open to all surgeons, operating room nurses, anesthesia staff, recovery room nurses, and especially bilingual people,” Glass said, adding that financial donations will help support the mission as well as donation of unused OR supplies.

According to the organization’s website, Guatemala is considered extremely impoverished in comparison to other South American countries. Half of Guatemala’s 14 million people live in poverty, which is defined as living on less than $2 per day. In addition, the vast majority of Guatemalans have virtually no access to public health care.

In spite of these deficiencies, The Faith in Practice organization has made a significant impact on the people of Guatemala. In 2015 alone, 1,200 US volunteers travelled to Guatemala to participate in the mission activities coordinated by Faith in Practice. As a result, a total of 2,400 surgical procedures were performed and 25,000 Guatemalan patients were seen by the medical mission teams. Texas Children’s Hospital is extremely proud of this team and their selfless dedication to service.

72016fetalconference640The International Fetal Medicine and Surgery Society (IFMSS) led by co-presidents Doctors Oluyinka and Olutoyin Olutoye, will convene for its annual meeting in Kasane, Botswana from August 2 to 7, 2016. This is the second time the meeting has been held on the African continent in the society’s 35-year history.

The IFMSS is an international gathering of fetal medicine practitioners from all over the world,” said Dr. Oluyinka Olutoye, co-director of Texas Children’s Fetal Center. “The annual meeting is the forum where innovations in fetal therapy are discussed even prior to general dissemination.”

Topics that will be discussed at the meeting include updates on the management of fetuses with spina bifida, innovative therapies for congenital diaphragmatic hernia (CDH), advances in the management of complex twin problems, as well as topics on ethics, anesthesia, genetics, cardiology, diagnostics, neonatal care and long-term outcomes amongst others.

Anesthesiologist-in-Chief Dr. Dean Andropoulos is one of the invited keynote speakers. The other keynote speaker is the Executive Director of the BIPAI Center of Excellence in Botswana, Prof. Gabriel Anabwani. Other Texas Children’s physician attendees include Dr. Darrell Cass, co-director of the Fetal Center, who will present the hospital’s experience with the management of CDH, Texas Children’s neurosurgeon Dr. William Whitehead who will deliver a presentation on the fetal management of spina bifida and Texas Children’s maternal-fetal medicine specialist Dr. Alireza Shamshirsaz who will present on fetal intervention for non-immune hydrops.

Other meeting attendees include Drs. Karolina Adam and Joanie Hare of Houston Perinatal Associates, and research fellows Drs. Stephanie Cruz and Patricio Lau who will also present at the meeting and are two of the seven recipients of the young investigator travel award. Kristen Kaiser, PhD, of Texas Children’s Pediatric Surgery Division together with Adam Gibson and Taylor Napier Earle of Texas Children’s Global Health have graciously provided administrative and logistical support for this international meeting.

In addition to the IFMSS meeting in Kasane, Botswana, a pre-meeting symposium will be held in conjunction with the Botswana Pediatric Association and the University of Botswana in the capital city, Gaborone, Botswana from July 31 to August 1. This symposium, also involving international speakers, will address issues in prenatal diagnosis, pediatric anesthesiology, obstetrics, pediatric surgery, cardiology and critical care, and is targeted at Botswana physicians not involved in fetal therapy.

“Serving as co-presidents of an international society is an honor and privilege,” said Dr. Olutoyin Olutoye, director of the Fetal Anesthesia Service at Texas Children’s. “It acknowledges our participation in the society’s activities over the years, reflects our contributions to the field, and places Texas Children’s and Baylor College of Medicine amongst elite institutions whose faculty have led such a prestigious organization.”

The logo for the 35th IFMSS meeting was designed by Beth Sumner of Texas Children’s Department of Surgery, with inspiration from the co-presidents. The elephant acknowledges the region of Botswana where the meeting will be held, which is home to the largest concentration of elephants in the world. The fetus encased in the elephant trunk acknowledges the care of the fetus that is the focus of the meeting.

72016Wadhwa175All Department of Surgery researchers have an in-house resource available for tissue banking. The Children’s Surgery Biobank (CSB) is an experienced tissue banking resource set up for surgery researchers interested in banking tissue specimens for their specific research projects in collaboration with the Texas Children’s Research Tissue Support Services. The biobank is supported by the Texas Children’s Hospital Department of Surgery.

The CSB provides services for consenting, tissue collection, banking and database management. The biobank can store blood (for DNA, plasma and serum), urine, tissue and other biofluid specimens, along with fully annotated clinical and phenotypic data from patients undergoing surgery at Texas Children’s Hospital.

This central repository was developed to save surgery researchers time and effort in collecting and storing specimens. It also serves as an important means of tracking research samples across all divisions of surgery, helping to accelerate pediatric research and to promote collaborations within and outside the institution.

For information on the program or protocols around tissue banking, contact Dr. Lalita Wadhwa at lxwadhwa@texaschildrens.org.

June 7, 2016

6816surgery640In the span of just a few months last year, experts at Texas Children’s Pavilion for Women delivered two babies with extremely large and rare cervical teratomas. The cases represent a growing collaboration between Otolaryngology and the Fetal Center. They also demonstrate the high quality care and expertise Texas Children’s provides patients and families across the globe.

“We tend to take it for granted that a case like this just rolls through the door, and we are able to handle it,” Fetal Center Surgeon Dr. Timothy Lee said about the November 10, 2015, birth of Keisy Cruz Carbajal. “It’s a testament to Texas Children’s and the Fetal Center that we have this team of experts – from the ultrasound technician to the MFM to the radiologists, surgeons and pediatric and adult anesthesiologists – assembled and ready to deploy at any given moment.”

Otolaryngologist Dr. Binoy Chandy agreed and said, “It’s so beneficial to have the exact right type of specialist on hand not just for the delivery, but for the earliest stages of planning and the follow-up care as well.”

The cases of Arya Hill and Keisy are outlined below and have inspired other families like themselves to come to Texas Children’s for medical care.

Arya’s story
At 28 weeks, Maggie Dozler went into early labor due to a build-up of amniotic fluid. She was referred to Texas Children’s Pavilion for Women, where Arya’s teratoma was diagnosed. A multidisciplinary team of experts from Texas Children’s Fetal Center monitored mother and baby closely for the next two months. At 36 weeks, on August 12, 2015, Arya was born with a 180 g tumor blocking her airway internally and protruding from her mouth and nose. A medical team delivered Arya via an EXIT procedure, a cesarean section that leaves the placenta and umbilical cord intact, buying time before the baby has to breathe on its own.

Fetal Center Co-Director Dr. Darrell Cass and Chandy led the procedure, examining the mass, attempting to intubate, and eventually performing a tracheostomy on an airway approximately 3.5 mm wide. Arya was sedated and stabilized while the surgical team planned their approach. When they went in to remove the tumor 16 days later, they found that it was attached to Arya in just one small spot in her throat.

Chandy was able to remove it entirely by endoscope, avoiding external scars. Since then, Arya has recovered almost fully without any additional surgeries or procedures. Her nostrils and lips, once badly misshapen and unable to close, have reverted to normal shape. Arya is being transitioned off her tracheostomy and is working on swallowing normally and transitioning off her g-tube.

Keisy’s story
Shortly after Arya was discharged, the Fetal Center team received a referral for an even larger and rarer type of teratoma. Yesenia Carbajal was 32 weeks along when her daughter Keisy was diagnosed with a cervical “fetus in fetu” teratoma, a condition so rare that only four cases have been identified in medical literature. Maternal fetal medicine specialist Dr. Jimmy Espinoza performed an immediate amnio reduction to stop her from going into labor. Lee was called in to lead the case, and he called in otolaryngologist Dr. Deepak Mehta.

As it turned out, they did not need to deploy right away. Carbajal was able to make it to her scheduled EXIT procedure at 36 weeks, giving Keisy important time for her lungs to develop. During the delivery, Mehta was able to locate Keisy’s tiny airway, avoiding the need for a tracheostomy. Keisy was intubated and sedated for a week while the surgical team carefully studied the teratoma that was attached to the inside and outside of Keisy’s throat and mouth. Composed of different types of tissue, bone and body parts, teratomas of the head and neck are rarer than sacrococcygeal teratomas located near a baby’s tailbone, and removing them is considerably more complex.

“You can’t just go in and remove the tumor right away,” Mehta said. “You need to know exactly where it is and where all the other important structures are, because a teratoma like this moves everything around. You have to make sure there aren’t any surprise elements.”

Keisy’s teratoma went from the base of her throat to the base of her skull, coming through the floor of her mouth and wrapping precariously around her carotid artery. On November 17, Mehta and Lee successfully removed it in a three and a half hour procedure. There was no way to avoid making an incision in Keisy’s throat, but all important structures were preserved and blood loss was minimal. Before closing, Mehta was able to repair the defect in Keisy’s mouth and throat. Today, she is doing extremely well. As was expected, she had difficulty swallowing and feeding and needed a g-tube, but she is in therapy to improve her swallowing and is expected to make a full recovery soon.

“This is a great example of where medicine is heading, and that’s using everyone’s individual expertise, but ultimately working as a unified team,” Mehta said. “This is not something we were able to do because we’ve got one amazing surgeon,” echoed Lee. “It’s a full integrated system of care that has to work in concert.”

June 1, 2016

6116scottrosenfeld175Orthopedic surgeon Dr. Scott Rosenfeld has been elected to serve on the Pediatric Orthopaedic Society of North America (POSNA) Board of Directors as a Junior Member-at-Large for the term 2016-2018.

Rosenfeld is director of the Texas Children’s Hip Prevention Program, which is a multidisciplinary program focused on the care of hip problems in patients from birth through adulthood. He also is an assistant professor in the Department of Orthopedic Surgery at Baylor College of Medicine.

Rosenfeld specializes in pediatric orthopedics, hip disorders, scoliosis and sports medicine. His major area of interest and expertise is in childhood, adolescent and young adult hip disorders and hip preservation.

Board certified in orthopedic surgery, Rosenfeld received an undergraduate degree from Duke University and earned his medical degree from the University of Texas Health Science Center at San Antonio. He completed an internship in general surgery and a residency in orthopedic surgery at UT Southwestern Medical School in Dallas and a fellowship in pediatric orthopedic surgery at Boston Children’s Hospital.

6116distinguishedsurgeonsinside640The Texas Children’s Hospital Department of Surgery recently announced the recipients of the 2016 Distinguished Surgeon Award. The award is given to those who have forged a path of innovation in surgical excellence, research and education within the hospital’s Department of Surgery. Leaders in the department chose the recipients and announced this year’s winners on May 6 at the department’s annual dinner event. Each of these distinguished surgeons has significantly contributed to the legacy of the Texas Children’s Hospital Department of Surgery.

This year’s Distinguished Surgeon Award winners are:

Dr. Ellen Friedman

Friedman was one of few women in the field when she began her career as a pediatric otolaryngologist, becoming a role model for not only for female academic otolaryngologists, but for academic surgeons in general. Currently, Friedman is a pediatric otolaryngologist at Texas Children’s Hospital and the director for the Center for Professionalism in Medicine at Baylor College of Medicine. Prior to that, for 24 years from 1991 until 2014, she served as Chief of Otolaryngology at Texas Children’s Hospital and held the Bobby Alford Endowed Chair in Pediatric Otolaryngology at Baylor College of Medicine.

Friedman regularly contributes to research, recently completing an online video abstract that was published on the New England Journal of Medicine website. She is highly active in professional societies at a national level and has served as president of several organizations. She was the first woman to serve as the president of the American Society of Pediatric Otolaryngology (ASPO) and the third woman to serve as president for the American Broncho-Esophagological Association (ABEA). She also served as president of the medical staff at Texas Children’s Hospital from 2011-2012.

Among many professional honors, Friedman was named a 2010 recipient of the Arnold P. Gold Foundation Award for Humanism in Medicine. She has also received the Fulbright and Jaworski Faculty Excellence Award in Teaching and Evaluation from the Baylor College of Medicine Academy of Distinguished Educators. As a singular honor, the ABEA renamed a national award for Dr. Friedman. The Ellen M. Friedman Award for Excellence in Foreign Body Management is given for excellence in innovation, skill and education in the management of aero-digestive foreign bodies.

Dr. William J. Pokorny

Pokorny was a skilled technical surgeon dedicated to surgical education, research and excellence in patient care. He led the Pediatric Surgery Division as Chief of Pediatric Surgical Services at Texas Children’s Hospital from 1988 to 1994, served as Chief of the Section of Pediatric Surgery at Baylor College of Medicine and led the Pediatric Surgery Service at Ben Taub General Hospital.

He left his mark on Texas Children’s Hospital by establishing the ACGME Pediatric Surgery Residency Program and worked collaboratively with other program directors, always keeping a quality educational experience, along with the welfare of all the trainees, in mind.

Pokorny also was involved in advancing pediatric surgery and pediatric surgical oncology on a national level by participating and leading committees and workgroups in national surgical organizations. He was held in the highest esteem by his peers and professional community. During his career, he authored more than 50 journal articles and contributed to more than 20 medical textbooks.

Drs. Friedman and Pokorny join the list of previous honorees, which includes: Dr. William Cheek, Dr. Denton Cooley, Dr. O.H. “Bud” Frazier, Dr. Edmond Gonzales, Jr, Dr. Franklin Harberg and Dr. David Wesson.

6116SurgicalResearch640More than 300 members of the Texas Children’s Hospital Department of Surgery attended the sixth annual Edmond T. Gonzales, Jr., Surgical Research Day on May 6. The event provided a forum for researchers across the department to showcase their work.

“I really look forward to this day every year where we get a chance to highlight some of the important research being conducted in the department,” said Dr. Charles D. Fraser, Jr., surgeon-in-chief at Texas Children’s Hospital. “Creating new knowledge is central to our core values as academic surgeons at Texas Children’s Hospital.”

This year 122 abstracts were submitted for review. Eleven of these abstracts were chosen for oral presentations on Surgical Research Day and 111 were accepted for poster presentations. This year eight students vied for the Best Presentation award and three faculty members were chosen to present their research.

The 2016 keynote speaker was Dr. Rebecca Richards-Kortum from Rice University. She is the Malcolm Gillis University Professor, a professor of Bioengineering and a professor of Electrical and Computer Engineering. Richards-Kortum is also director of two institutes – Rice 360° Institute for Global Health and the Institute of Biosciences and Bioengineering – and the founder of Beyond Traditional Borders. She spoke about “Technologies to Improve Pediatric and Surgical Care in Low-Resource Settings.”

Payal Cramer, a health care attorney from Baker Hostetler, LLP gave an ethics presentation on “Patient Privacy and Research” specifically discussing extracting research from electronic medical records.

Awards presented at the event were the Samuel Stal Research Award for outstanding research by a resident or fellow, the Research Mentor Award, and Best Oral Presentation and Best Poster Presentation.

The Samuel Stal Research Award was presented to pediatric and adolescent gynecology fellow Dr. Julie Hakim for her work in pediatric device development. The award is named after Dr. Samuel Stal, former chief of Plastic Surgery at Texas Children’s.

Dr. Jed Nuchtern, chief of Pediatric Surgery, was honored with the Research Mentor Award. The award is given on an annual basis to honor a Department of Surgery faculty member who serves as a research mentor through career development, professional guidance or cultivation of research interests.

Dr. Yangyang Yu, a researcher in Pediatric Surgery, received the Best Oral Presentation award for her presentation on “Time-Driven, Activity-Based Costing to Identify Opportunities for Cost Reduction in Pediatric Appendectomy.”

Best Poster award was given to Chi-Han Lu from Pediatric Surgery for his work “Pseudotyped AAV Vector-Mediated Gene Transfer in a Human Fetal Trachea Xenograft Model: Implications for In Utero Gene Therapy for Cystic Fibrosis.”

The Surgical Research Day Planning Committee included Dr. Jed Nuchtern (chair), Melinda Mathis (co-chair), Dr. Swathi Balaji, Dr. Jennifer Dietrich, Dr. Chester Koh, Dr. Lingkun Kong, Dr. Sandi Lam, Dr. Liz McCullum, Dr. Scott Rosenfeld, Kathy Carberry, RN, Matthew Girotto, Angie Rangel, Veronica Victorian, Anissa Quiroz, Stacey Staples, Shon Bower and Laura Higgins.