Pediatric Surgery @ Brown
WARREN ALPERT MEDICAL SCHOOL OF BROWN UNIVERSITY

 

Clinical and Research Interests


Arlet G. Kurkchubasche, M.D.

Francois I. Luks, M.D.
Christopher L. Muratore, M.D.

Hale E. Wills, M.D.

Recent publications

 

   The surgical laboratories of the Division of Surgical Research are well equipped with the latest analytical tools and animal surgery areas, and the technical personnel are very attuned to interactions with surgical resident investigators. Under the direction of Dr. Padbury, the Neonatology basic science laboratory facilities, in the Kilguss building, are also available to resident projects (Dr. Padbury is the principal investigator for a Center of Biomedical Reasearch Excellence (COBRE) grant from the National Institutes of Health). In addition, the perinatal physiology laboratory has been the center for investigations by the Pediatric Surgical Faculty. The extent and content of the residency period precludes the initiation of a basic science program by the resident. However, we will accommodate any visiting resident interested in Pediatric Surgery or allow a matched pediatric surgery resident to start the program early to begin a research program which will be designed and mentored for completion during a three-year period.

 

 

 

 

 

 

 

Arlet G. Kurkchubasche, M.D.

Interests focus on the management of disorders of GI function, particularly as related to the Short Bowel Syndrome, and originated during the research years at the University of Pittsburgh, Children's Hospital. The basic science research on transmucosal bacterial passage in an in vitro (Ussing) model provided some of the fundamental principles involved in protecting a compromised intestinal barrier, both in premature neonates at risk for NEC and the older infant with intestinal dysfunction. The clinical responsibilites in caring for infants and children with short bowel syndrome spurred ongoing interest in this field. This was expanded, through mentoring from Dr. Tracy at St. Louis University and subsequently here at Brown Medical School, to the impact of sepsis and intestinal dysfunction on hepatic function. For a brief period of time this involved direct participation in the NIH-funded laboratory activities in Dr. Tracy's lab, leading to some joint publications on quantification of hepatic fibrosis. An endotoxin vaccine was investigated in terms of its effect on hepatic fibrosis after bile duct ligation. The nutritional management of the surgical infant remains focused on the prevention and/or reversal of cholestatic jaundice. As part of this ongoing interest, Dr. Kurkchubasche has currently become involved in the research committee of the American Society for Parenteral and Enteral Nutrition (ASPEN). She continues to be involved in advances in the care of infants with SBS and has offered the serial transverse enteroplasty procedure with successful enteral adaptation.

References:

Roggin K K, 2000, Ambruso DR 2000, Roggin KK 2001, Kurkchubasche AG 1998

 

Christopher S. Muratore, M.D.   

Dr. Muratore was recently recruited to become the Chief of Pediatric Surgery at Stonybrook Medical Center (NY)

Dr. Muratore's basic science activities an investigator in the Division of Surgical Research involved work with Dr. Tracy and others to study the intrinsic capacity of the liver to repair itself and recover from inflammatory insults that result in matrix deposition and collagen fibrosis.

Dr. Muratore was the Director of ECMO at Hasbro Children's Hospital and Rhode Island Hospital and maintains active interest in the outcomes of patients with congenital diaphragmatic hernia, pulmonary hypertension and adults with ARDS who require ECMO. To this end, Dr. Muratore works in collaboration with others both locally and nationally as members in the CDH study group and ELSO. Recently, the ECMO program has developed a simulation curriculum to improve interdisciplinary team performance and protect patient outcomes. These novel ECMO simulation scenarios, which complement individual and team ECMO training, combine the current life-like medical simulation models with the ultra-specialized circumstances of extracorporeal life support. This project demonstrates ECMO Simulation's potential to improve team performance and patient outcome.

Dr. Muratore was a core member of the Fetal Treatment Program and is active in the fetal management of twin-to-twin transfusion syndrome (TTTS) and fetal surgery for patients with severe CDH. He is a key investigator on the FDA sponsored investigational device exemption (IDE) for in utero tracheal occlusion for severe CDH.

Clinical responsabilities also included the Vascular anomalies Clinic. This program offers a multidisciplinary approach to complex vascular and lymphatic malformations (commonly known as hemangiomas, cystic hygromas, lymphangiomas, vascular malformations, venous malformations or cavernous hemangiomas). The team is composed of pediatric surgeons, pediatric plastic surgeons, dermatologists and interventional radiologists. Patients are seen in the Pediatric Surgery Office, and can undergo a variety of treatments, ranging from close observation (if the lesion is expected to go away over time) to radiologic, minimally invasive or surgical intervention.

 

Francois I. Luks, M.D.   

Previous research has focused on endoscopic fetal surgery and access to the fetal trachea, in a large animal model (sheep). Projects have mainly centered around fetal lung development and mechanisms of accelerated lung growth after fetal tracheal occlusion. This was done in conjunction with the Pathology Department (Monique E. De Paepe, M.D.) and has been funded by the American Lung Association. In addition to the ovine model, a small animal model (fetal rabbit) and in vitro studies have been conducted into the fate of type II pneumocytes and the role of apoptosis in normal and accelerated fetal lung development.

One or more undergraduate and medical students from Brown University are given the opportunity each year to participate in the various fetal research projects.

Ffetal research has focused on the pathophysiology of twin-to-twin transfusion syndrome (TTTS). Following the development of a clinical program in fetal surgery and our participation (as the only North-American center) in the randomized trial on treatment for TTTS, we are now pursuing more basic research in the mechanisms of TTTS, and are developing an animal model for the condition. Clinical research in this field includes the search for markers of outcome in TTTS.

In 2009, the Program in Fetal Medicine received an Investigational Device Exemption (IDE) from the FDA for the in utero treatment of congenital diaphragmatic hernia, using endoscopic tracheal occlusion.

New collaborations with the Division of Engineering have yielded research projects in non-invasive monitoring during fetal surgery and the development of advanced image display systems for laparoscopic surgery, in a partnership with Brown and the industry. The research is conducted with graduate students in Engineering and Economics, medical students and surgical residents, and grant support is being sought from the Science and Technology Advisory Committee of Rhode Island and the Food and Drug Administration.

References:

Luks FI 2009, Chang J 2006, De Paepe ME 1999, Papadakis K, 1998(a), Papadakis K 1998(b), De Paepe ME 1998, Luks FI 1997,   Papadakis K 1997Luks FI 1996(a), Luks FI 1996(b)

 

Hale E. Wills, M.D.

Dr Wills's clinical focus is the establishment of a state-wide pediatric trauma system that seamlessly integrates all the emergency medical services and other prehospital systems with Hasbro Chidlren's Hospital's Level I Trauma Center. Rhode Island may be the smallest state, but its Emergency Medical Services have been fractionated for decades. Newly implemented state legislation now makes it possible to electronically track individual trauma patients throughout the region, and Dr. Wills is spearheading a project to further consolidate this system, and integrate it with the care of injured children at Hasbro Children's Hospital.

 

 

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