Detroit, MI, United States
Detroit, MI, United States

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Jeanty C.,Wayne State University | Frayer E.A.,Wayne State University | Page R.,Hutzel Womens Hospital | Langenburg S.,Childrens Hospital of Michigan
Journal of Pediatric Surgery | Year: 2010

We present a case of neonatal ovarian torsion complicated by bowel obstruction and perforation and review the literature regarding the incidence of bowel obstruction in neonatal ovarian cysts, the presentation, and treatment. A term neonate was prenatally diagnosed with a cystic abdominal mass palpable on physical examination. A postnatal abdominal x-ray showed paucity of gas in the left hemiabdomen with rightward displacement of bowel loops. Exploratory laparotomy on day 2 of life revealed a large cystic mass in the left lower quadrant consistent with a torsed left ovary, an omental band causing strangulation of the bowel mesentery, and a perforation of the distal ileum. Our literature search revealed 19 reported cases of neonatal ovarian cysts resulting in bowel obstruction. Infants may present with a palpable abdominal mass, respiratory distress, as well as signs and symptoms of intestinal obstruction. Two mechanisms exist for bowel obstruction: adhesions caused by a torsed necrotic ovary and mass effect of a large ovarian cyst, often measuring 9 to 10 cm in diameter. Options to treat ovarian cysts include antenatal or postnatal aspiration, laparoscopy, and laparotomy. Cysts less than 4 to 5 cm can be observed, whereas operative intervention is indicated in symptomatic cases and in persistent or enlarging ovarian cysts. © 2010 Elsevier Inc. All rights reserved.


McGrath E.J.,Wayne State University | Abdel-Haq N.,Wayne State University | Preney K.,Hutzel Womens Hospital | Preney K.,Detroit Medical Center | And 3 more authors.
Infection Control and Hospital Epidemiology | Year: 2011

Objective. To investigate the mode of transmission of and assess control measures for an outbreak of carbapenem-resistant (multidrugresistant) Acinetobacter baumannii infection involving 6 premature infants. Design. An outbreak investigation based on medical record review was performed for each neonate during the outbreak (from November 2008 through January 2009) in conjunction with an infection control investigation. Setting. A 36-bed level 3 neonatal intensive care unit in a university-affiliated teaching hospital in Detroit, Michigan. Interventions. Specimens were obtained for surveillance cultures from all infants in the unit. In addition, geographic cohorting of affected infants and their nursing staff, contact isolation, re-emphasis of adherence to infection control practices, environmental cleaning, and use of educational modules were implemented to control the outbreak. results. Six infants (age, 10-197 days) with multidrug-resistant A. baumannii infection were identified. All 6 infants were premature (gestational age, 23-30 weeks) and had extremely low birth weights (birth weight, 1000 g or less). Conditions included conjunctivitis (2 infants), pneumonia (4 infants), and bacteremia (1 infant). One infant died of causes not attributed to infection with the organism; the remaining 5 infants were discharged home. All surveillance cultures of unaffected infants yielded negative results. Conclusions. The spread of multidrug-resistant A. baumannii infection was suspected to be due to staff members who spread the pathogen through close contact with infants. Clinical staff recognition of the importance of multidrug-resistant A. baumannii recovery from neonatal intensive care unit patients, geographic cohorting of infected patients, enhanced infection control practices, and staff education resulted in control of the spread of the organism. © 2010 by The Society for Healthcare Epidemiology of America.


Sood B.G.,Hutzel Womens Hospital | Sood B.G.,Wayne State University | Sood B.G.,Childrens Hospital of Michigan | Rambhatla A.,Wayne State University | And 2 more authors.
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2016

Background and objectives: Many observational studies reporting a temporal association between red cell transfusions (RBCTs) and necrotizing enterocolitis (NEC) in preterm infants fail to take into account RBCTs in infants without NEC. The objective of this study was to investigate the association between RBCTs and NEC in an analytical retrospective cohort study with minimization of selection and measurement bias and controlling for clinical covariates.Methods: Inborn preterm infants [23-32 weeks gestational age (GA)] without major congenital anomalies were eligible. Association of RBCT and modified Bells Stage ≥2A NEC was explored using bivariate analyses and verified using multivariable Cox regression.Results: Of 627 eligible infants, 305 neither received RBCT nor developed NEC and 12 developed NEC prior to RBCT. Of 310 infants with RBCT, 27 developed NEC. Compared to infants without NEC, infants with NEC received significantly lower number of RBCTs before diagnosis of NEC (p = 0.000). On multivariable Cox regression controlling for clinical covariates, dichotomous RBCT exposure was associated with 60% reduced hazard for NEC.Conclusions: RBCT exposure was associated with decreased hazards for NEC in preterm infants in this study; factors previously reported to be associated with NEC remained statistically significant predictors. © 2015 Informa UK Ltd.


Yeo L.,U.S. National Institutes of Health | Yeo L.,Wayne State University | Yeo L.,Hutzel Womens Hospital | Romero R.,U.S. National Institutes of Health | Romero R.,Hutzel Womens Hospital
Ultrasound in Obstetrics and Gynecology | Year: 2013

Objective: To describe a novel method (Fetal Intelligent Navigation Echocardiography (FINE)) for visualization of standard fetal echocardiography views from volume datasets obtained with spatiotemporal image correlation (STIC) and application of 'intelligent navigation' technology. Methods: We developed a method to: 1) demonstrate nine cardiac diagnostic planes; and 2) spontaneously navigate the anatomy surrounding each of the nine cardiac diagnostic planes (Virtual Intelligent Sonographer Assistance (VIS-Assistance®)). The method consists of marking seven anatomical structures of the fetal heart. The following echocardiography views are then automatically generated: 1) four chamber; 2) five chamber; 3) left ventricular outflow tract; 4) short-axis view of great vessels/right ventricular outflow tract; 5) three vessels and trachea; 6) abdomen/stomach; 7) ductal arch; 8) aortic arch; and 9) superior and inferior vena cava. The FINE method was tested in a separate set of 50 STIC volumes of normal hearts (18.6-37.2 weeks of gestation), and visualization rates for fetal echocardiography views using diagnostic planes and/or VIS-Assistance® were calculated. To examine the feasibility of identifying abnormal cardiac anatomy, we tested the method in four cases with proven congenital heart defects (coarctation of aorta, tetralogy of Fallot, transposition of great vessels and pulmonary atresia with intact ventricular septum). Results: In normal cases, the FINE method was able to generate nine fetal echocardiography views using: 1) diagnostic planes in 78-100% of cases; 2) VIS-Assistance® in 98-100% of cases; and 3) a combination of diagnostic planes and/or VIS-Assistance® in 98-100% of cases. In all four abnormal cases, the FINE method demonstrated evidence of abnormal fetal cardiac anatomy. Conclusions The FINE method can be used to visualize nine standard fetal echocardiography views in normal hearts by applying 'intelligent navigation' technology to STIC volume datasets. This method can simplify examination of the fetal heart and reduce operator dependency. The observation of abnormal echocardiography views in the diagnostic planes and/or VIS-Assistance® should raise the index of suspicion for congenital heart disease. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.


Bajaj M.,Hutzel Womens Hospital | Mody S.,Wayne State University | Natarajan G.,Hutzel Womens Hospital
Journal of Pediatrics | Year: 2014

In a retrospective review of infants with neonatal herpes simplex virus disease (n = 29), we found bilateral multilobar (n = 8), pontine (n = 3), thalamic (n = 6), and internal capsule and corticospinal tract (n = 5) involvement on magnetic resonance imaging (MRI). Diffusion-weighted imaging (n = 6) performed early revealed additional involvement than detected by conventional MRI. Neurodevelopmental sequelae were correlated with MRI abnormalities. Our findings demonstrate that MRI, including diffusion-weighted imaging, is a valuable prognostic adjunct in neonatal herpes simplex virus disease. Copyright © 2014 Elsevier Inc. All rights reserved.


Yeo L.,U.S. National Institutes of Health | Yeo L.,Wayne State University | Yeo L.,Hutzel Womens Hospital | Romero R.,U.S. National Institutes of Health | And 3 more authors.
Ultrasound in Obstetrics and Gynecology | Year: 2016

'Manual navigation' by the operator is the standard method used to obtain information from two-dimensional and volumetric sonography. Two-dimensional sonography is highly operator dependent and requires extensive training and expertise to assess fetal anatomy properly. Most of the sonographic examination time is devoted to acquisition of images, while 'retrieval' and display of diagnostic planes occurs rapidly (essentially instantaneously). In contrast, volumetric sonography has a rapid acquisition phase, but the retrieval and display of relevant diagnostic planes is often time-consuming, tedious and challenging. We propose the term 'intelligent navigation' to refer to a new method of interrogation of a volume dataset whereby identification and selection of key anatomical landmarks allow the system to: 1) generate a geometrical reconstruction of the organ of interest; and 2) automatically navigate, find, extract and display specific diagnostic planes. This is accomplished using operator-independent algorithms that are both predictable and adaptive. Virtual Intelligent Sonographer Assistance (VIS-Assistance®) is a tool that allows operator-independent sonographic navigation and exploration of the surrounding structures in previously identified diagnostic planes. The advantage of intelligent (over manual) navigation in volumetric sonography is the short time required for both acquisition and retrieval and display of diagnostic planes. Intelligent navigation technology automatically realigns the volume, and reorients and standardizes the anatomical position, so that the fetus and the diagnostic planes are consistently displayed in the same manner each time, regardless of the fetal position or the initial orientation. Automatic labeling of anatomical structures, subject orientation and each of the diagnostic planes is also possible. Intelligent navigation technology can operate on conventional computers, and is not dependent on specific ultrasound platforms or on the use of software to perform manual navigation of volume datasets. Diagnostic planes and VIS-Assistance videoclips can be transmitted by telemedicine so that expert consultants can evaluate the images to provide an opinion. The end result is a user-friendly, simple, fast and consistent method of obtaining sonographic images with decreased operator dependency. Intelligent navigation is one approach to improve obstetrical sonography. © Published 2015. This article is a U.S. Government work and is in the public domain in the USA.


Bajaj M.,Hutzel Womens Hospital | Koo W.,Hutzel Womens Hospital | Hammami M.,Hutzel Womens Hospital | Hockman E.M.,Wayne State University
Pediatric Research | Year: 2010

Bone quantitative ultrasound generated speed of sound (SOS) is a marker of bone strength. However, critical evaluation of its validity for use in small bones is extremely limited, and SOS data may not be consistent with data obtained from dual energy × ray absorptiometry, another marker of bone strength. We report the SOS values pre and postinjection of s.c. fat using a chicken bone model; and in large for gestation and appropriate for gestation neonates to determine the influence of s.c. fat. Average SOS were lowered for the chicken bones postfat injection by 36 m/s (CS probe) and 58 m/s (CR probe), and in large for gestation group by 75 m/s (CS probe) and 51 m/s (CR probe) (p = 0.03-0.004 paired t test) although SOS measurements from each probe are significantly correlated within the large (r = 0.78) and appropriate (r = 0.83) for gestation group. Failed SOS measurements occurred significantly more frequently in the postinjection studies regardless of the probe used in the chicken bone model and for the CS probe in large for gestation neonates. The lowered bone quantitative ultrasound measurements in large for gestation neonates is likely a measurement artifact from increased s.c. fat. Copyright © 2010 International Pediatric Research Foundation, Inc.


Lulic-Botica M.,Hutzel Womens Hospital | Rajpurkar M.,Wayne State University | Sabo C.,Wayne State University | Tutag-Lehr V.,Wayne State University | Natarajan G.,Wayne State University
Acta Paediatrica, International Journal of Paediatrics | Year: 2012

Aim: To evaluate fluctuations in anti-Xa concentrations in infants treated with enoxaparin for thrombosis and describe clinical outcomes. Methods: A retrospective chart review was performed on infants treated with enoxaparin in the Neonatal Intensive Care Unit, and data on enoxaparin doses, anti-Xa concentrations, clinical characteristics and outcomes were abstracted. Results: Our cohort (n = 26) had a median gestation of 36 (range, 23-41) weeks, birthweight of 2522 (510-3912) grams and 5-min Apgar score of 8(4-9). Fifteen (57.7%) infants were males. Thromboses was diagnosed at a median age of 22 (range, 1-97) days; enoxaparin was initiated at 27.5 (range, 4-98) days at a mean (SD) dose of 1.4 (0.3) mg/kg every 12 h. Therapeutic anti-Xa concentrations (0.5-1 U/mL) were achieved at a mean (SD) dose of 2.1 (0.6) mg/kg at 12.5 (12.2) days of treatment. Of the 143 anti-Xa concentrations, 39 (27%) were within the therapeutic range. During maintenance therapy following initial therapeutic anti-Xa concentration, 40% concentrations were therapeutic. Minor bleeding was noted in four infants and intracranial bleed in one infant; four infants died. During treatment, thrombocytopenia, renal and hepatic impairment during treatment were noted in 7, 2 and 4 infants, respectively. Clot resolution was observed in 21 (81%) infants. Conclusions: Anti-Xa concentrations fluctuate during maintenance enoxaparin therapy, with therapeutic levels being achieved only sporadically in young infants. Despite this, enoxaparin appears efficacious in thrombosis resolution. Further studies on the impact of stringent control of concentrations on outcomes in this population are warranted. © 2011 The Author(s)/Acta Pædiatrica.


Kaddoum R.,American University of Beirut | Motlani F.,Hutzel Womens Hospital | Kaddoum R.N.,Hutzel Womens Hospital | Srirajakalidindi A.,Hutzel Womens Hospital | And 2 more authors.
Journal of Anesthesia | Year: 2014

One of the controversial management options for accidental dural puncture in pregnant patients is the conversion of labor epidural analgesia to continuous spinal analgesia by threading the epidural catheter intrathecally. No clear consensus exists on how to best prevent severe headache from occurring after accidental dural puncture. To investigate whether the intrathecal placement of an epidural catheter following accidental dural puncture impacts the incidence of postdural puncture headache (PDPH) and the subsequent need for an epidural blood patch in parturients. A retrospective chart review of accidental dural puncture was performed at Hutzel Women's Hospital in Detroit, MI, USA for the years 2002-2010. Documented cases of accidental dural punctures (N = 238) were distributed into two groups based on their management: an intrathecal catheter (ITC) group in which the epidural catheter was inserted intrathecally and a non-intrathecal catheter (non-ITC) group that received the epidural catheter inserted at different levels of lumbar interspaces. The incidence of PDPH as well as the necessity for epidural blood patch was analyzed using two-tailed Fisher's exact test. In the non-ITC group, 99 (54 %) parturients developed PDPH in comparison to 20 (37 %) in the ITC [odds ratio (OR), 1.98; 95 % confidence interval (CI), 1.06-3.69; P = 0.03]. Fifty-seven (31 %) of 182 patients in the non-ITC group required an epidural blood patch (EBP) (data for 2 patients of 184 were missing). In contrast, 7 (13 %) of parturients in the ITC group required an EBP. The incidence of EBP was calculated in parturients who actually developed headache to be 57 of 99 (57 %) in the non-ITC group versus 7 of 20 (35 %) in the ITC group (OR, 2.52; 95 % CI, 0.92-6.68; P = 0.07). The insertion of an intrathecal catheter following accidental dural puncture decreases the incidence of PDPH but not the need for epidural blood patch in parturients. © 2013 Japanese Society of Anesthesiologists.


Al-Safi Z.,Hutzel Womens Hospital
Obstetrics and Gynecology | Year: 2011

Background: Although known nickel hypersensitivity is a contraindication to intratubal microinsert placement in the United States, this case demonstrates that nickel hypersensitivity to intratubal microinserts can occur. Case: A young woman developed an allergic reaction after placement of intratubal microinserts. Nickel hypersensitivity was confirmed with skin patch testing. The microinserts were removed hysteroscopically, and the patient improved. Conclusion: If a patient experiences symptoms of an allergic reaction after hysteroscopic sterilization, referral to an allergy specialist is recommended. If nickel hypersensitivity is confirmed, the microinserts should be removed; this may be performed under hysteroscopic guidance. © 2011 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins.

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