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
Roggin K K, 2000, Ambruso
DR 2000, Roggin
KK 2001, Kurkchubasche AG 1998
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.
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
One or more undergraduate and medical students from Brown
University are given the opportunity each year to participate
in the various fetal research projects.
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.
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 1997, Luks 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.