Matthew S Clifton

Children's Healthcare of Atlanta, Atlanta, Georgia, United States

Are you Matthew S Clifton?

Claim your profile

Publications (34)94.63 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Total proctocolectomy (TPC) and ileal pouch anal anastomosis (IPAA) have become the standard of care for patients with ulcerative colitis refractory to medical management. The purpose of our study is to show our single-site approach and to identify maneuvers that improve efficiency. We retrospectively reviewed patients who underwent single-site three-stage TPC-IPAA for ulcerative colitis at our institution. Primary outcomes included operative time, conversion from single site to standard laparoscopy, time to oral intake and stoma function, postoperative complications, and length of stay. The GelPOINT™ Advanced Access Platform (Applied Medical, Santa Margarita, CA) was used. Eight patients were identified who had undergone single-site surgery with the GelPOINT platform. Six of the 8 patients underwent the first stage, total abdominal colectomy (TAC), and all 8 underwent the second stage (proctectomy/IPAA). The mean operating time for TAC was 242 ± 32 minutes. The mean time until tolerance of clear diet was 1.2 ± 0.4 days, and time until tolerance of regular diet was 3.3 ± 1.2 days. The mean time to stoma function was 1.5 ± 0.55 days, and that for postoperative opioid use was 4.0 ± 1.3 days. The median length of stay was 5 days (range, 3-10 days). There was one postoperative complication. The mean operating time for the proctectomy/IPAA was 283 ± 50 minutes. The mean time until tolerance of clear diet was 1.0 ± 0.5 days, and time until tolerance of regular diet was 3.3 ± 1.1 days. The mean time to stoma function was 1.6 days ± 0.52 days, and that for postoperative opioid use was 3.3 ± 1.4 days. Median length of stay was 4 days (range, 3-9 days). There was one postoperative complication. Technical adaptations that included extracorporeal mesenteric division, rectal eversion, and rotation of the GelPOINT device served to improve the ease and efficiency of the procedure. Single-site TPC-IPAA is both feasible and safe. Incorporation of adapted technical maneuvers can increase efficiency.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 08/2015; 25(9). DOI:10.1089/lap.2014.0368 · 1.34 Impact Factor
  • Matthew S. Clifton · Mark L. Wulkan ·
    [Show abstract] [Hide abstract]
    ABSTRACT: Pediatric surgical training in the United States remained basically unchanged from the model developed by Ladd and Gross in the 1930s until recently. Standardized curriculum and novel evaluation methods are now being implemented. Pediatric Surgical education is currently undergoing a transition to competency-based evaluation and promotion. Unfortunately, there is little data on the efficacy of these changes. This presents an opportunity for further study of how we conduct training, and how we evaluate and promote our trainees. Copyright © 2015 Elsevier Inc. All rights reserved.
    Seminars in Pediatric Surgery 02/2015; 24(3). DOI:10.1053/j.sempedsurg.2015.02.009 · 2.22 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Iatrogenic esophageal perforation in infants is an uncommon though recognized complication resulting from the insertion of a transesophageal echocardiogram (TEE) probe into the oropharynx. Infants requiring TEE are almost universally affected by underlying cardiac disease; thus, minimizing unnecessary interventions is the goal. We reviewed our institution’s experience with esophageal perforation resulting from TEE probes in order to define effective management strategies. After IRB approval, we conducted a 12-year retrospective review of our institution’s experience with esophageal perforation in infants resulting from TEE probes. During our study period, 3,322 infants had a TEE probe placed. Four infants (age range 2-120 days) sustained an esophageal perforation from a TEE probe, indicating that the incidence at our institution is 0.12%. Evaluation with contrast esophagram or direct laryngoscopy confirmed the presence of perforation in all cases. Management consisted of broad-spectrum antibiotics and nothing per os. One patient developed a pseudodiverticulum, which regressed spontaneously. There were no other complications resulting from perforation. Transesophageal echocardiogram probe insertion in infants with cardiac anomalies can lead to esophageal perforation. These patients can be managed non-operatively with broad-spectrum antibiotics and nothing per os. Oral feeding may resume once the perforation is healed on esophagram.
    Journal of Pediatric Surgery Case Reports 06/2014; 2(6). DOI:10.1016/j.epsc.2014.05.008
  • Sarah J Hill · Mark L Wulkan · Paul M Parker · Tram K Jones · Kurt F Heiss · Matthew S Clifton ·
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: The treatment algorithm for children with suspected choledocholithiasis is not well established because the breadth of minimally invasive surgery and endoscopic techniques continues to evolve. We reviewed our experience with common bile duct explorations (CBDEs) in order to detail the techniques used and describe the rate of complications of laparoscopic CBDE in children. Subjects and methods: As part of an Institutional Review Board-approved study, medical records were reviewed for all patients, 1 month to 21 years of age, undergoing a cholecystectomy at a large tertiary-care children's hospital over an 11-year period. Those undergoing an intraoperative cholangiogram (IOC) were documented, and operative reports and postoperative records were examined. Results: Over 11 years, 464 cholecystectomies were performed, and an IOC was attempted on 174 patients with a 97% success rate (n=168). Of the patients who underwent a cholangiogram, 30% (n=52) had an obstructing stone. Laparoscopic CBDE was attempted in 50 patients with a conversion rate of 8%. Postoperatively, 3 CBDE patients underwent endoscopic retrograde cholangiopancreatography (ERCP) for the following reasons: retained stone (n=1), persistent hyperbilirubinemia (n=1), and bile leak (n=1). Conclusions: Laparoscopic CBDE is a safe initial approach to choledocholethiasis and is successful at relieving the obstruction the majority of the time. The authors conclude that in situations where there is limited availability of ERCP, laparoscopic CBDE should be considered as a first step in the management of obstructive choledocholethiasis.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 01/2014; 24(1):38-42. DOI:10.1089/lap.2013.0306 · 1.34 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Neonatal obstructive jaundice is frequently explained by biliary atresia (BA) or the presence of a choledochal cyst (CC). Cystic biliary atresia (CBA) has been a proposed as a subtype of BA with projected improved outcomes. We aimed to characterize these lesions further. We conducted an Institutional Review Board-approved review of all patients treated for obstructive jaundice at our tertiary children's hospital over 10 years. Over the decade we evaluated 91 children with obstructive jaundice: 13 CBA, 52 BA, and 26 CC. Patients with isolated CBA and BA were diagnosed significantly earlier than those with CC (15.9, 54, and 281 days, respectively; P = 0.0001). There was a significant delay between diagnosis and surgical intervention for patients with CBA compared with BA: 17 days versus 5.7 days (P = 0.004). There was no difference in rate of transplant between CBA and BA (31 vs 50%; P = 0.35). The time from surgery until transplant was 13.9 and 18.6 months for CBA and BA, respectively (P = 0.62). Although radiographically similar to CC, CBA behaves similarly to isolated BA. Delay in recognition and surgical treatment may affect outcomes and lead to an increased incidence of liver failure. The presence of a cystic biliary malformation in the setting of neonatal jaundice should be regarded as CBA until proven otherwise.
    The American surgeon 09/2013; 79(9):870-2. · 0.82 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Noniatrogenic neonatal gastric perforation is a rare and life-threatening condition whose etiology is often unclear. Interstitial cells of Cajal act as gastrointestinal pacemaker cells and express the proto-oncogene c-Kit. Six new cases were identified at our institution which presented with no mechanical, pharmacologic, or otherwise medical-related intervention prior to rupture. The number of interstitial cells of Cajal in nonnecrotic muscularis propria from five random high-power fields per specimen was compared using immunohistochemical stains for c-Kit. The authors show that a lack of interstitial cells of Cajal in the stomach musculature may be implicated in the development of noniatrogenic gastric perforation (p = 0.008). Further large-scale studies, including molecular and genetic analysis, may help to better understand this phenomenon.
    Fetal and pediatric pathology 06/2013; 32(6). DOI:10.3109/15513815.2013.799248 · 0.48 Impact Factor
  • Jeremy Fisher · Rohit Mittal · Sarah Hill · Mark L. Wulkan · Matthew S. Clifton ·
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: The aim of this study was to determine the benefit of routine postoperative chest radiography after removal of esophageal foreign bodies in children. Methods: Medical records were reviewed of all patients evaluated with an esophageal foreign body at a single children's hospital over 10 years. Operative records and imaging reports were reviewed for evidence of esophageal injury. Results: Of 803 records identified, 690 were included. All underwent rigid esophagoscopy and foreign body removal. The most common items removed were coins (94%), food boluses (3%), and batteries (2%). The rate of esophageal injury was 1.3% (9 patients). No injuries were identified on chest radiographs done as routine or for concern of injury. Patients with operative findings suggestive of an esophageal injury (n = 105) were significantly more likely to have an injury (8.6% vs 0%, P = .0001). Of the 585 children who did not have physical evidence of injury, 40% (n = 235) received a routine chest radiograph. Regardless of the indication, no injuries were identified on chest films. Conclusions: We conclude that intraoperative findings during rigid esophagoscopy suggestive of an injury are predictive of esophageal perforation. Routine chest radiography is not warranted in children who do not meet this criterion. In patients with a concern for injury, we suggest that chest radiography should be deferred in favor of esophagram.
    PEDIATRICS 04/2013; 131(5). DOI:10.1542/peds.2012-3676 · 5.47 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Enteritis caused by Clostridium difficile toxin (Tx) is a nosocomial disease of increasing clinical concern, but the local mediators of C. difficile TxA inflammation are unknown. The potent vasodilator calcitonin gene-related peptide mediates neurogenic inflammation via the calcitonin receptor-like receptor (CLR). Here we examined the ileum-specific effects of reducing CLR on TxA ileitis by local preinjection of double-stranded RNAs. Treatment with CLR dsRNA for 7 d decreased CLR immunoreactivity, whereas treatment with non-CLR dsRNA did not. Subsequent injection of TxA in the same location increased CLR in rats treated with non-CLR dsRNA but not in rats treated with CLR dsRNA, documenting that local injection of dsRNA is effective in preventing the increase in CLR immunoreactivity in response to local TxA. After non-CLR dsRNA pretreatment, TxA induced robust intestinal secretion, myeloperoxidase activity, and histopathologic indications of inflammation including epithelial damage, congestion, neutrophil infiltration, loss of mucin from goblet cells, and increase in mast cell numbers. After CLR dsRNA pretreatment, TxA-induced changes in intestinal secretion and histopathologic inflammation were improved, including normal mucin staining and fewer resident mast cells. Loss of CLR prevented TxA-mediated activation of NF-κB and concomitant increases in pERK1/2 and TNF-α mRNA. Locally produced CLR plays a proinflammatory role in TxA ileitis via MAPK signaling and TNF-α. The results reported here strongly suggest that a local injection of dsRNA targeting CLR could be an effective local therapeutic approach at the inflammation site in the treatment of a growing, clinically relevant hospital-acquired disease, C. difficile infection.
    Proceedings of the National Academy of Sciences 12/2012; 110(2). DOI:10.1073/pnas.1219733110 · 9.67 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Proteus syndrome (PS) is a rare, progressive disorder that manifests as asymmetric, disproportionate overgrowth affecting tissues derived from any germline layer. Cases of PS from 2005-2010 were retrieved from the pathology files at our institution. Two confirmed cases and one possible case of PS were identified. All patients came from different ethnic backgrounds. Patient 1 displayed classic skin and overgrowth lesions. Patient 2 displayed various features, particularly vascular malformations. Patient 3 demonstrated a cerebriform connective tissue nevus alone. These patients demonstrate the spectrum of presentations of PS. Much is left to learn about this disfiguring disease.
    Fetal and pediatric pathology 03/2012; 31(3):145-53. DOI:10.3109/15513815.2012.656830 · 0.48 Impact Factor
  • Geoffrey Lam · Matthew S Clifton · Amina Mira Bhatia ·
    [Show abstract] [Hide abstract]
    ABSTRACT: Up to half of all internal hernias are caused by paraduodenal hernia, a rare congenital midgut malrotation that accounts for less than 1% of all intestinal obstructions. The diagnosis may arise from an incidental finding on abdominal imaging or the patient may present with abdominal pain, vomiting, and obstipation. Early recognition and management of this disease entity are keys because serious complications such as bowel ischemia and infarction may result from a delay in diagnosis. We present a case involving a 14-year-old boy with gangrenous small bowel secondary to right paraduodenal hernia.
    Journal of Pediatric Surgery 10/2011; 46(10):2032-4. DOI:10.1016/j.jpedsurg.2011.06.016 · 1.39 Impact Factor
  • Sarah J Hill · Samir Pandya · Matthew S Clifton · Amina Bhatia · Mark L Wulkan ·
    [Show abstract] [Hide abstract]
    ABSTRACT: We encountered 3 patients with severe gastroesophageal reflux disease and tubular stomachs precluding fundoplication. Here, we report the use of an innovative technique, cardiaplication, as an alternative approach for antireflux surgery. Three infants with medically refractory gastroesophageal reflux disease (GERD) were referred for fundoplication. In each case, the patient's anatomy prevented a traditional fundoplication from being performed. A cardiaplication was performed by invaginating the cardia of the stomach at the angle of His and securing the invaginated tissue with interrupted silk suture. The plication tubularized the cardia of the stomach, essentially increasing the intra-abdominal portion of the esophagus and altering the angle of His. The imbrication also creates a flapper valve over the distal esophagus, further limiting potential reflux. The charts for the infants who received cardiaplication were reviewed. Radiographic studies and clinical notes for the presence of persistent reflux were evaluated. Cardiaplication was completed in 3 patients with GERD. All cases were initiated laparoscopically and one was converted to an open procedure secondary to dense adhesive disease. Each child was initiated on feeds between postoperative day 2 and 3. Two of the 3 patients were tolerating goal feeds with-in 2 days. The third patient reached goal feeds on day 16. Postoperative imaging (upper gastrointestinal series [UGI]) was obtained in 2 of the 3 patients. At follow-up (13, 7, and 4 months), all 3 patients are clinically free of symptoms of GERD. Delayed radiographic imaging has confirmed that the patients are no longer refluxing. Based on preliminary findings, cardiaplication appears to be a safe and effective surgical technique for the management of severe GERD in infants. We performed cardiaplication out of necessity; however, after further testing this may prove to be an optimal approach, as it can be performed without disruption of the hiatus.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 09/2011; 21(9):873-5. DOI:10.1089/lap.2011.0124 · 1.34 Impact Factor
  • Sarah B Fisher · Matthew S Clifton · Amina M Bhatia ·
    [Show abstract] [Hide abstract]
    ABSTRACT: Unlike other sharp objects, pens and pencils are readily available to children both at home and school. Although case reports are published, no series of pen or pencil injuries have been reported in the recent literature. We therefore reviewed the incidence and injury profiles of writing instruments as compared with other sources of penetrating trauma. The trauma registry from a large urban pediatric hospital system was queried for nonmissile, nonbite penetrating injuries from 2005 through 2009. Retrospective data was collected on demographics, injuries, operations, admissions, and mortalities. Additionally, data regarding pen and pencil injuries from 2009 to 2010 were collected prospectively, and one case from 2003 was included retrospectively. Fourteen injuries from writing instruments were seen and involved the head and neck (9), chest (1), bladder/perineum (2), and extremities (2). Eleven children were admitted and eight required surgical intervention. One child died from a transhemispheric brain injury after intraorbital penetration by a pencil. Penetrating trauma from writing instruments is not an uncommon source of injury and often requires surgical intervention to remove the object. Injuries from pens and pencils can be severe or even fatal. Appropriate parent and teacher education regarding the potential risks may help to prevent such injuries.
    The American surgeon 08/2011; 77(8):1076-80. · 0.82 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Ciliated hepatic foregut cysts (CHFCs) are rare congenital legions that arise from the embryonic foregut. The cysts are formed during fetal development by evagination from their respective portions of the foregut, and are characterized by a ciliated epithelial lining. Approximately 100 cases of CHFC have been reported, of which only 13 were in children. Although CHFC is typically benign, malignant transformation to squamous cell carcinoma (SCC) has been reported in 3 cases. Survival rate after progression to malignancy is poor, as SCC in this setting is biologically aggressive. We present 4 new cases of CHFC in children between 5 months and 17 years old. Our cases are unusual, as some of the cysts exhibit multilocularity and biliary communication, and 2 of our patients were diagnosed under the age of 1. Additionally, 1 of the cysts was 19.3 cm in diameter, making it the largest reported CHFC to our knowledge. Ciliated hepatic foregut cysts should be included in the differential diagnosis of hepatic lesions.
    Pediatric and Developmental Pathology 04/2011; 14(5):418-21. DOI:10.2350/10-08-0886-CR.1 · 0.87 Impact Factor
  • Matthew S Clifton · Rene Romero · Richard R Ricketts ·
    [Show abstract] [Hide abstract]
    ABSTRACT: Progressive familial intrahepatic cholestasis syndromes are characterized by impaired bile acid secretion resulting in pruritus, coagulopathy, diarrhea, and malnutrition leading to progressive liver failure and death in childhood. Partial internal or external biliary drainage can relieve symptoms and slow the progression of the disease. Objections to partial external biliary drainage include the need for a permanent biliary stoma with all the inherent complications of a stoma. We propose a novel approach to these diseases--placement of a "button" cholecystostomy tube. Under general anesthesia and through a small right subcostal incision, a MIC-KEY button (Kimberly-Clark Worldwide, Inc, Draper, UT) is inserted into the mobilized fundus of the gallbladder and secured with 2 purse-string sutures. Time of drainage is adjusted to relieve pruritus. Three children with progressive familial intrahepatic cholestasis achieved adequate bile drainage via the cholecystostomy button to relieve pruritus for 1, 2, and 2 ½ years postoperatively, with drainage periods of 12 to 14 hours per day. There were no episodes of cholangitis. Dislodged tubes can be replaced, or stones can be retrieved via the tract that is formed. Patient (parent) acceptance has been excellent. Button cholecystostomy is simple to perform, relieves pruritus with intermittent (nighttime) drainage, avoids complications of a permanent stoma, avoids an enteric anastomosis, and is accepted by parents.
    Journal of Pediatric Surgery 02/2011; 46(2):304-7. DOI:10.1016/j.jpedsurg.2010.11.007 · 1.39 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Urocortins (UCNs) and their receptors are potent immunoregulators in the gastrointestinal (GI) tract, where they can exert both pro- and anti-inflammatory effects. We examined the contribution of Ucn1 and its receptors to the pathogenesis, progression, and resolution of colitis. Trinitrobenzene sulfonic acid was used to induce colitis in rats. Ucn1 mRNA and immunoreactivity (IR) were ubiquitously expressed throughout the GI tract under basal conditions. During colitis, Ucn1 mRNA levels fell below basal levels on day 1 then increased again by day 6, in association with an increase in the number of Ucn1-IR inflammatory cells. Ucn1-IR cells were also numerous in proliferating granulation tissue. In contrast to Ucn1 expression, average phosphorylated ERK1/2 (pERK1/2) expression rose above controls levels on day 1 and was very low on day 6 of colitis. Knockdown of corticotropin-releasing factor 2 (CRF(2)) but not CRF(1) by RNA interference during colitis significantly decreased the macroscopic lateral spread of ulceration compared with uninjected controls or animals with CRF(1) knockdown. After knockdown of CRF(2), but not of CRF(1) during colitis, edema resolution assessed microscopically was slowed, and myeloperoxidase activity remained elevated even at day 6. Ucn1 and TNF-α mRNA peaked earlier, whereas pERK1/2 activation was attenuated after CRF(2) knockdown. Thus we conclude that local CRF(2) and pERK1/2 activation is pivotal for macroscopic spread of colitis and resolution of edema. Elimination of CRF(2), but not CRF(1), results in uncoordinated immune and pERK1/2 signaling responses.
    AJP Gastrointestinal and Liver Physiology 02/2011; 300(5):G884-94. DOI:10.1152/ajpgi.00319.2010 · 3.80 Impact Factor
  • Matthew S Clifton · Kurt F Heiss · Jane J Keating · Greg Mackay · Richard R Ricketts ·
    [Show abstract] [Hide abstract]
    ABSTRACT: Closure of abdominal wall defects in children poses a challenge for pediatric surgeons. We describe a technique using tissue expanders placed either intraperitoneally or in the abdominal wall to aid in the reconstruction of a variety of complex abdominal wall defects. The tissue expanders are inserted under general anesthesia. Initial expansion is done in the operating room with attention to peak airway pressure, urine output, and end-tidal carbon dioxide. The expanders are inflated in the outpatient setting via percutaneous access until the calculated inflation volume is achieved. They are then removed; and definitive closure is accomplished using a combination of native tissue flaps, abdominal component separation techniques, biomaterials, and synthetic material. Six children underwent tissue expansion for treatment of abdominal wall defects (omphalocele, n = 3), trauma (n = 1), and thoracopagus twins (n = 1 pair). One to 4 expanders were used per patient, with all having a successful reconstruction of their abdominal walls. Two to 3 operations were required to restore abdominal domain and consisted of expander insertion, removal with reconstruction, and possible revision of the reconstruction. Tissue expanders possess a broad range of applications for abdominal wall reconstruction and can be used in patients of all ages.
    Journal of Pediatric Surgery 02/2011; 46(2):372-7. DOI:10.1016/j.jpedsurg.2010.11.020 · 1.39 Impact Factor

  • Gastroenterology 05/2010; 138(5). DOI:10.1016/S0016-5085(10)62652-2 · 16.72 Impact Factor
  • Conrad Cole · Cole Conrad · Alessandrina Freitas · Matthew S Clifton · Megan M Durham ·
    [Show abstract] [Hide abstract]
    ABSTRACT: Intestinal atresias are a common cause of newborn bowel obstruction (Dalla Vecchia LK, Grosfeld JL, West KW, et al, Intestinal atresia and stenosis: a 25-year experience with 277 cases. Arch Surg 1998; 133[5]:490-496). Hereditary multiple intestinal atresias, first reported by Guttman et al in 1973, is the rarest form of multiple atresias (Guttman FM, Braun P, Garance PH, et al, Multiple atresias and a new syndrome of hereditary multiple atresias involving the gastrointestinal tract from stomach to rectum. J Pediatr Surg 1973;8:633-640; Bass J, Pyloric atresia associated with multiple intestinal atresias and immune deficiency. J Pediatr Surg 2002;37:941-942.). It has been proposed to be autosomal recessive, to involve atresias in a variable combination of sites from stomach to rectum, and to be universally fatal (Bilodeau A, Prasil P, Cloutier R, et al, Hereditary multiple intestinal atresia: thirty years later. J Pediatr Surg 2004;39:726-730; Moreno LA, Gottrand F, Turck D, et al, Severe combined immunodeficiency syndrome associated with autosomal recessive familial multiple gastrointestinal atresias: study of a family. Am J Med Genet 1990;37:143-146). Patients have significant intestinal dysfunction and unrelenting sepsis stemming from a poorly defined, severe immunologic defect. Our case report presents 2 full siblings to nonconsanguineous parents with pyloric atresia, multiple small bowel and colonic atresias, and severe immune dysfunction. Care was withdrawn within 3 months of life on both siblings after multiple bouts of sepsis. Data suggest that the immune defect may not be primary, but in fact be secondary to intestinal dysfunction. Although the subjects in this article ultimately had fatal outcomes, a comprehensive immunologic/physiologic picture is presented in hopes of furthering the understanding of this grave disease.
    Journal of Pediatric Surgery 04/2010; 45(4):E21-4. DOI:10.1016/j.jpedsurg.2010.01.017 · 1.39 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the ability of a tumor-head volume ratio to predict outcome and incidence of hydrops in fetuses with sacrococcygeal teratoma. Seventy-one sonograms were reviewed retrospectively from 28 fetuses with sacrococcygeal teratoma managed in our institution. Head volume (HV) and total tumor volume were calculated from sonograms. Amount of cystic tumor was estimated to determine solid tumor volume (STV) for the STV/HV ratio. Twenty percent of sonograms with STV/HV <1 and 97.3% with STV/HV >1 were associated with 1 or more abnormal sonographic signs (p = 0.000). Overall mortality was 11/27 (41%). There was no mortality in fetuses with a ratio of <1, while 11/18 (61%) of fetuses with ratio >1 died (p = 0.003). The STV/HV ratio may be used to identify fetuses with a high risk of a poor outcome due to high-output cardiac failure and hydrops, and may help guide management.
    Fetal Diagnosis and Therapy 09/2009; 26(2):75-80. DOI:10.1159/000238113 · 2.94 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To determine the intra- and interobserver reproducibility of human amniotic fluid metabolite concentration measurements (including potential markers of fetal lung maturity) detectable by MR spectroscopy. (1)H high-resolution magic angle spinning (HR-MAS) spectroscopy was performed at 11.7 T on 23 third-trimester amniotic fluid samples. Samples were analyzed quantitatively using 3-(trimethylsilyl)propionic-2,2,3,3-d(4) acid (TSP) as a reference. Four observers independently quantified eight metabolite regions (TSP, lactate doublet and quartet, alanine, citrate, creatinine, choline, and glucose) twice from anonymized, randomized spectra using a semiautomated software program. Excellent inter- and intraobserver reproducibility was found for all metabolites. Intraclass correlation as a measure of interobserver agreement for the four readers ranged from 0.654 to 0.995. A high correlation of 0.973 was seen for choline in particular, a major component of surfactant. Pearson correlation as a measure of intraobserver reproducibility ranged from 0.478 to 0.999. Quantification of choline and other metabolite concentrations in amniotic fluid by high-resolution MR spectroscopy can be performed with high inter- and intraobserver reproducibility. Demonstration of reproducible metabolite concentration measurements is a critical first step in the search for biomarkers of fetal lung maturity.
    Journal of Magnetic Resonance Imaging 12/2008; 28(6):1540-5. DOI:10.1002/jmri.21592 · 3.21 Impact Factor

Publication Stats

354 Citations
94.63 Total Impact Points


  • 2011-2014
    • Children's Healthcare of Atlanta
      Atlanta, Georgia, United States
  • 2010-2014
    • Emory University
      Atlanta, Georgia, United States
  • 2005-2011
    • University of California, San Francisco
      • • Department of Surgery
      • • Division of Pediatric Surgery
      San Francisco, California, United States