Robotic Repair of Congenital Paraesophageal Hiatal Hernia

Abstract Congenital paraesophageal hiatal hernias are rare and can be associated with gastric incarceration, volvulus, mucosal ulceration, and anemia. Primary repair of the hernia and fundoplication are recommended. In this paper, we report a case of a 3-year-old child with abdominal pain who was noted to have a paraesophageal hiatal hernia with partial gastric volvulus. A 5 mm robot platform was utilized to facilitate hernia sac dissection, hiatal repair, and fundoplication.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63210/1/lap.2008.0185.pd

Robotic resection of recurrent pediatric lipoblastoma

This case demonstrates successful resection of a rare, recurrent presacral‐pelvic lipoblastoma in a 19‐year‐old female patient. Because of the anatomical location of the mass and its proximity to vital structures, the robotic approach allowed for both optimal visualization and effective debulking of the mass. Furthermore, with the use of an articulating laparoscopic camera, key visualization of the posterior lateral pelvis was possible. Using a wide breadth of technologies and resources is essential to broadening the surgical armamentarium and achieving resectability in otherwise challenging cases.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147748/1/ases12493_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/147748/2/ases12493.pd

Land Surface Modeling and Data Assimilation to Support Physical Precipitation Retrievals for GPM

Objective: The objective of this proposal is to provide a routine land surface modeling and data assimilation capability for GPM in order to provide global land surface states that are necessary to support physical precipitation retrieval algorithms over land. It is well-known that surface emission, particularly over the range of frequencies to be included in GPM, is sensitive to land surface states, including soil properties, vegetation type and greenness, soil moisture, surface temperature, and snow cover, density, and grain size. Therefore, providing a robust capability to routinely provide these critical land states is essential to support GPM-era physical retrieval algorithms over land

A genome‐wide analysis of colorectal cancer in a child with Noonan syndrome

Noonan syndrome (NS) is a developmental syndrome caused by germline mutations in the Ras signaling pathway. No association has been shown between NS and pediatric colorectal cancer (CRC). We report the case of CRC in a pediatric patient with NS. The patient underwent whole genome sequencing. A germline SOS1 mutation c.1310T>C (p. Ile437Thr) confirmed NS diagnosis. No known hereditary cancer syndromes were identified. Tumor analysis revealed two mutations: a TP53 missense mutation c.481G>A (p. Ala161Tyr) and NCOR1 nonsense mutation c.6052C>T (p. Arg2018*). This report highlights the complexity of Ras signaling and the interplay between developmental syndromes and cancer.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146377/1/pbc27362_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146377/2/pbc27362.pd

Thoracoscopic Repair of Recurrent Bochdalek Diaphragmatic Hernias in Children

Abstract Background: Recurrent herniation is a well-known complication following the initial repair of congenital diaphragmatic hernias (CDHs). The role of minimally invasive surgical techniques in recurrent CDH remains undefined. The purpose of this study was to evaluate our early experience with thoracoscopic repair compared with traditional open repair in children with recurrent CDH. Subjects and Methods: We retrospectively reviewed all recurrent Bochdalek CDH cases (n=24) managed at a single tertiary-care referral center between January 1990 and March 2011. Children who underwent thoracoscopic repair for recurrent CDH were identified, and their data were compared by the unpaired t test and the two-sided Fisher's exact test, as appropriate, with those of children who underwent open repair. Significance was defined as P<.05. Results: Thoracoscopic repair was attempted in 6 (25%) children with recurrent CDH. Four (67%) repairs were successfully completed without conversion to an open procedure. The mean age at thoracoscopic repair was 11.5 months (range, 8.1?16.1 months). The mean operative time was 191 minutes (range, 94?296 minutes), and all children were extubated within 24 hours. The mean hospital length of stay was 3.75 days (range, 1?6 days). There were no deaths or subsequent recurrences after a mean follow-up of 26.5 months (range, 14.3?41.3 months). There were no statistical differences in any of the measured outcome variables when compared with the open repair group. Conclusions: Our initial experience suggests that thoracoscopic repair is a feasible alternative to open repair in selected children with recurrent Bochdalek diaphragmatic hernias.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98467/1/lap%2E2012%2E0048.pd

Evaluation of a New Global Precipitation Analysis at the US Air Force 557th Weather Wing

No abstract availabl

Thoracoscopic Repair of Congenital Diaphragmatic Hernia in Neonates: Lessons Learned

Abstract Purpose: We sought to characterize our recent experience with thoracoscopic congenital diaphragmatic hernia (CDH) repair and identify patient selection factors. Methods: We reviewed the medical records of full-term neonatal (<1 month of age) patients who underwent thoracoscopic CDH repair between 2004 and 2008 (n=15). We obtained data on prenatal diagnosis, characteristics of the CDH and repair, complications, and outcome. Results: All patients were stabilized preoperatively and underwent repair at an average of 5.7+/-1.3 days. Six patients were prenatally diagnosed, including the 5 inborn. Thirteen defects were left-sided. All were intubated shortly after birth and 2 required extracorporeal membrane oxygenation (ECMO). Twelve of 15 (80%) patients underwent successful thoracoscopic primary repair, including 1 of the patients who required ECMO prior to repair. Conversion to open repair occurred in 3 of 15 (20%) patients because of the need for patch closure or intraoperative instability. Among those converted to open, all had left-sided CDH defects and 3 had stomach herniation (of 5 such patients). Patients spent an average of 6.9+/-1.0 days on the ventilator following repair. The average time until full-enteral feeding was 16.7+/-2.25 days, and average length of hospital stay was 23.8+/-2.73 days. All patients survived to discharge, and average length of follow-up was 15.3+/-3.6 months. Conclusions: Thoracoscopic repair of CDH is a safe, effective strategy in patients who have undergone prior stabilization. Stomach herniation is associated with, but does not categorically predict, conversion to open repair. ECMO use prior to repair should not be an absolute contraindication to thoracoscopic repair.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78119/1/lap.2009.0129.pd

Antiangiogenic therapy for a large splenic hemangioma

Hemangiomas involving the spleen are rare and seldom symptomatic. Treatment options for large lesions usually consist of splenectomy, embolization, or both. Antiangiogenic treatment has not been reported previously as an effective alternative for this type of lesion. We report our experience of successfully using glucocorticoids in an infant with a large hemangioma of the spleen.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47169/1/383_2005_Article_1533.pd

Dynamical Renormalization Group Approach to Quantum Kinetics in Scalar and Gauge Theories

We derive quantum kinetic equations from a quantum field theory implementing a diagrammatic perturbative expansion improved by a resummation via the dynamical renormalization group. The method begins by obtaining the equation of motion of the distribution function in perturbation theory. The solution of this equation of motion reveals secular terms that grow in time, the dynamical renormalization group resums these secular terms in real time and leads directly to the quantum kinetic equation. We used this method to study the relaxation in a cool gas of pions and sigma mesons in the O(4) chiral linear sigma model. We obtain in relaxation time approximation the pion and sigma meson relaxation rates. We also find that in large momentum limit emission and absorption of massless pions result in threshold infrared divergence in sigma meson relaxation rate and lead to a crossover behavior in relaxation. We then study the relaxation of charged quasiparticles in scalar electrodynamics (SQED). While longitudinal, Debye screened photons lead to purely exponential relaxation, transverse photons, only dynamically screened by Landau damping lead to anomalous relaxation, thus leading to a crossover between two different relaxational regimes. We emphasize that infrared divergent damping rates are indicative of non-exponential relaxation and the dynamical renormalization group reveals the correct relaxation directly in real time. Finally we also show that this method provides a natural framework to interpret and resolve the issue of pinch singularities out of equilibrium and establish a direct correspondence between pinch singularities and secular terms. We argue that this method is particularly well suited to study quantum kinetics and transport in gauge theories.Comment: RevTeX, 40 pages, 4 eps figures, published versio

Increased respiratory symptoms following surgery in children exposed to environmental tobacco smoke

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75635/1/j.1460-9592.2003.01100.x.pd