Christopher S Muratore

Boston Medical Center · Department of Surgery

Extracorporeal membrane oxygenation (ECMO) is a form of extracorporeal life support (ECLS) that involves the use of prolonged cardiopulmonary bypass for patients with severe, acute, and reversible cardiac or respiratory failure who are failing maximal conventional medical management and have an expected mortality in excess of 80 %. ECMO is not a cu...

The decision to offer extracorporeal membrane oxygenation (ECMO) is based on a risk/benefit assessment and the likelihood of a treatable underlying condition or the feasibility of destination therapy (durable mechanical support or thoracic organ transplantation) should heart-lung function fail to improve. Patients who present following suspected su...

Infantile hemangiomas are benign tumors of vascular endothelial cells (ECs), characterized by three distinct stages: proliferating phase, involuting phase, and involuted phase. The mechanisms that trigger involution of hemangioma into fibro-fatty tissue remain unknown. We report a novel mechanism by which M1-polarized macrophages induce endothelial...

The previous edition of this book was based on a simple but essential philosophy: provide a practical and up-to-date resource for the practicing surgeon detailing the specific needs and special considerations surrounding the surgical care of children. The second edition of Fundamentals of Pediatric Surgery stays true to the philosophy of the origin...

Purpose: Nonoperative treatment of acute appendicitis appears to be feasible in adults. It is unclear whether the same is true for children. Methods: Children 5-18years with <48h symptoms of acute appendicitis were offered nonoperative treatment: 2 doses of piperacillin IV, then ampicillin/clavulanate ×1 week. Treatment failure (worsening on the...

A previously healthy 10-year-old girl with a 2-day history of upper respiratory illness and fever rapidly developed respiratory failure and sepsis with leukopenia, and expired despite attempts at resuscitation. Postmortem examination revealed bilateral necrotizing pneumonia and evidence of disseminated intravascular coagulation. Nasopharyngeal swab...

Dear Editor,The activated clotting time (ACT) is the most commonly used test to assess anticoagulation during extracorporeal membrane oxygenation (ECMO). Unlike the ACT or the activated partial thromboplastin time (aPTT), anti-factor Xa (antiXa) is a direct measure of heparin activity [1]. ACT is poorly correlated to heparin dose and to aPTT in adu...

Introduction: To describe the incidence and risk factors for iatrogenic premature preterm rupture of membranes (iPPROM) after fetoscopic laser surgery for the twin-to-twin-transfusion syndrome. Materials and methods: This is a retrospective review of all patients who have undergone fetoscopic laser surgery at a single fetal treatment center sinc...

Extracorporeal life support (ECLS) has become increasingly popular as a salvage strategy for critically ill adults. Major advances in technology and the severe acute respiratory distress syndrome (ARDS) that characterized the 2009 influenza A (H1N1) pandemic have stimulated renewed interest in the use of veno-venous extracorporeal membrane oxygenat...

To review our experience with general anesthesia in endoscopic fetal surgery for twin-to-twin transfusion syndrome (TTTS), and to compare fetomaternal outcome before and after protocol implementation. Retrospective impact study. University-affiliated medical center. Data from 85 consecutive patients who underwent endoscopic laser ablation of placen...

Severe twin-to-twin transfusion syndrome (TTTS) leads to 80% to 100% dual mortality. Endoscopic laser coagulation of connecting vessels improves outcome to 80% survival of at least 1 twin. There is limited long-term follow-up of surviving TTTS patients. The aim of this study was to analyze gestational age-stratified, long-term morbidity in these pa...

Endoscopic fetal surgery is most commonly used for the treatment of twin-to-twin transfusion syndrome (TTTS), but the surgical techniques can be applied to other forms of fetal surgery. We present our experience with endoscopic fetal surgery over the past 10 years. From 2000 to 2010, 70 endoscopic laser ablations of placental vessels for TTTS were...

Survival (> or =1 twin) after laser surgery for patients with twin-to-twin transfusion syndrome (TTTS) ranges from 65 to 93%. However, most studies are noncontrolled and retrospective, and have included a limited number of patients. The aim of this study was to perform a systematic review of outcomes after laser surgery in patients with TTTS. We co...

Biliary obstruction results in a well-characterized cholestatic inflammatory and fibrogenic process; however, the mechanisms and potential for liver repair remain unclear. We previously demonstrated that Kupffer cell depletion reduces polymorphonuclear cell (neutrophil) (PMN) and matrix metalloproteinase (MMP)8 levels in repairing liver. We therefo...

The objective of the study was to develop a noninvasive technique to determine hemoglobin (Hb) content through spectral analysis of diffusely reflected broadband visible illumination from individual blood vessels during endoscopic fetal surgery for twin-to-twin transfusion syndrome (TTTS). The reflection of an incoming xenon endoscopic light source...

To evaluate the outcome of twin-to-twin transfusion syndrome (TTTS) treated using a combination of endoscopic fetal surgery-specific techniques and surgical restraint. TTTS is a condition of identical twins that, if progressive and left untreated, leads to 100% mortality. The best treatment option is obliteration of the intertwin placental anastomo...

We report a 15-year-old girl with a recent diagnosis of type 2 diabetes mellitus who presented in malignant hypertensive crisis (BP 210/120 mm Hg). Abdominal CT showed an 8.2 x 4.7 x 7.0 cm mass in the region of the organ of Zuckerkandl. MIBG scan showed a single paraganglioma without metastatic foci. Plasma total metanephrines were 232,176.4 pmol/...

Biliary atresia is characterized by extrahepatic bile duct obliteration along with persistent intrahepatic portal inflammation. Steroids are standard in the treatment of cholangitis following the Kasai portoenterostomy, and were advocated for continued suppression of the ongoing immunologic attack against intrahepatic ducts. Recent reports, however...

Severe, progressive twin-to-twin transfusion syndrome (TTTS) is associated with near-100% mortality if left untreated. Endoscopic laser ablation of placental vessels (ELA) is associated with 75% to 80% survival of at least one twin. The actuarial risk of fetal demise after ELA has not yet been described. A retrospective cohort study from 2 centers...

Giant omphaloceles present a unique challenge to pediatric surgeons because of the difficulty in obtaining timely, tension-free closure of tissues over the defect. Reports of the use of tissue expanders in the subcutaneous space, intramuscular space, or intraabdominal cavity have illustrated the usefulness of this technique to provide biologic clos...

Background: Biliary atresia is characterized by extrahepatic bile duct obliteration along with persistent intrahepatic portal inflammation. Steroids are standard in the treatment of cholangitis following the Kasai portoenterostomy, and were advocated for continued suppression of the ongoing immunologic attack against intrahepatic ducts. Recent repo...

Pearls and PitfallsPolyhydramnios is highly suggestive of esophageal, gastric, or very proximal small bowel obstruction.Antenatal ultrasound (US) diagnosis of bowel obstruction is suspected by dilated loops, fetal ascites and polyhydramnios.Bilious emesis is a cardinal manifestation of obstruction. Always think malrotation with midgut volvulus unti...

Thoracoscopic wedge resection has gained widespread acceptance as a method of resecting pulmonary metastases in pediatric cancer patients. This is most successful for lesions on the pleural surface that can be identified without palpation. Deeper lesions can be marked by preoperative computed tomography (CT)-guided techniques, but neither needle lo...

The difficulties of laparoscopic surgery include two-dimensional image projection and loss of alignment between the surgeon's hands and visual field. Head-mounted displays (HMDs) allow freedom from gazing at a stationary overhead monitor, thus improving ergonomics. Modern HMDs offer greatly improved image quality and reduced bulk and weight. We com...

The effects of immaturity and hypoplasia of the premature lung can be affected by proinflammatory stimuli in late gestation or the postnatal period from acute lung injury secondary to intensive ventilatory management or the metabolic consequences of surgery. These stimuli alter alveolarization and contribute to bronchopulmonary dysplasia. While pri...

Postoperative bowel obstruction (PBO) plagues patients of all ages after intraabdominal surgery. We examined the incidence, risk factors, and the need for operative intervention of PBO. We reviewed all children who underwent a laparotomy or laparoscopy. Parameters included age, diagnosis, type and number of procedures, complications, time interval...

— Advances in the technology of optical displays have changed the way surgeons are able to manage different illnesses. Minimally invasive surgery encompasses a wide range of endoscopic procedures, whereby the body cavity (abdomen, thorax, gastrointestinal tract, and joint spaces) is accessed through small incisions and the use of telescopes and fin...

Head and neck masses are a common clinical concern in infants, children, and adolescents. The differential diagnosis for a head or neck mass includes congenital, inflammatory, and neoplastic lesions. An orderly and thorough examination of the head and neck with an appropriate directed workup will facilitate the diagnosis. The most common entities o...

The purpose of this report is to detail the nutritional sequelae seen in survivors of congenital diaphragmatic hernia (CDH) followed in a multidisciplinary clinic. Data on 121 surviving CDH patients seen between 1990 and 2000 were collected. Regression analysis was used to determine the impact of factors such as Apgar score, birth weight, extracorp...

In 1990, the authors began a multidisciplinary follow-up clinic for congenital diaphragmatic hernia (CDH) patients. Although the nonpulmonary complications associated with CDH have been reported previously from this clinic, the purpose of this report is to detail the pulmonary outcome in survivors of CDH with severe pulmonary hypoplasia. Between 19...

The infant born with congenital diphragmatic hernia (CDH) remains one of the most complex patients to manage. Pulmonary hypoplasia and immaturity of the CDH lung are well recognized as the definitive limitation leading to the high mortality rates. Based on the knowledge that CDH is more a physiological disease than a surgical disease, we have shift...

The authors' have shown pulmonary alveolarization (capillary and alveolar growth) both after fetal tracheal occlusion and postnatal pulmonary distension. The trophic and developmental mechanisms responsible for this growth remain largely unknown; however, experimental systems have defined an enhanced expression of angiogenic proteins in response to...

Urine collection for analysis is commonly done in premature infants in sterile adhesive bags. Leakage due to poor adherence of the bag and irritation of the skin are frequent drawbacks with this technique. Urine retrieved from the fiber padding of disposable diapers has been shown to be reliable for biochemical analysis. However, the previous studi...

Plastic microvascular casts have been used primarily to study the three-dimensional distribution of small blood vessels in soft tissues, but in the two studies reported in bone, one investigated the vascular distribution of rat vertebrae and the other the micro-vascular distribution to both teeth and bone in the dog mandible. To this point the tech...