Publications
We work hard to attract, retain, and support the most outstanding faculty, and are proud of their accomplishments, in areas ranging from clinical care to research, from systems improvement to medical education, and in locations that include our clinical sites in San Francisco and others around the globe. Since 2008, over 1600 articles have been published.
2012
BACKGROUND
The influenza A (H1N1) pandemic swept across the globe from April 2009 to August 2010 affecting millions. Many WHO Member States relied on antiviral drugs, specifically neuraminidase inhibitors (NAIs) oseltamivir and zanamivir, to treat influenza patients in critical condition. Such drugs have been found to be effective in reducing severity and duration of influenza illness, and likely reduced morbidity during the pandemic. However, it is less clear whether NAIs used during the pandemic reduced H1N1 mortality.
METHODS
Country-level data on supply of oseltamivir and zanamivir were used to predict H1N1 mortality (per 100,000 people) from July 2009 to August 2010 in forty-two WHO Member States. Poisson regression was used to model the association between NAI supply and H1N1 mortality, with adjustment for economic, demographic, and health-related confounders.
RESULTS
After adjustment for potential confounders, each 10% increase in kilograms of oseltamivir, per 100,000 people, was associated with a 1.6% reduction in H1N1 mortality over the pandemic period (relative rate (RR) = 0.84 per log increase in oseltamivir supply). While the supply of zanamivir was considerably less than that of oseltamivir in each Member State, each 10% increase in kilogram of active zanamivir, per 100,000, was associated with a 0.3% reduction in H1N1 mortality (RR = 0.97 per log increase).
CONCLUSION
While there are limitations to the ecologic nature of these data, this analysis offers evidence of a protective relationship between antiviral drug supply and influenza mortality and supports a role for influenza antiviral use in future pandemics.
View on PubMed2012
PURPOSE
We report our experience and present our technique with the robot-assisted laparoscopic ipsilateral ureteroureterostomy (IUU) in the management of ureteral duplication with ectopia in children.
PATIENTS AND METHODS
We reviewed our institutional experience for all patients who underwent a robot-assisted laparoscopic IUU at the University of Minnesota Amplatz Children's Hospital between December 2010 and October 2011. An intraoperative, three-port technique was used after a ureteral stent was placed into the ipsilateral lower pole. Demographic information, diagnosis, operative time, hospital course, complications, and follow-up were all evaluated.
RESULTS
Our series included four female patients and one male patient with a mean age of 61 months (6 to 182 mos). All five had a diagnosis of upper pole ectopic ureters, one of which was associated with an ureterocele. Mean total operative time was 225 minutes (181 to 253 min), and mean hospital stay was 1.2 days (1-2 days). There were no intraoperative complications. In follow-up, at the time of ureteral stent removal, pyelonephritis developed in one patient, but all patients had resolution of their presenting symptoms including urinary tract infections and incontinence. A significant reduction in upper pole hydronephrosis was seen in all patients.
CONCLUSIONS
Our experience indicates that robot-assisted laparoscopic IUU is safe and effective in the management of ureteral duplication anomalies in children.
View on PubMed2012
PURPOSE
Severe hemorrhagic cystitis is a major complication in the pediatric population undergoing hematopoietic stem cell transplantation. Percutaneous nephrostomy tube drainage as a treatment for severe hemorrhagic cystitis has rarely been investigated. We examined children undergoing hematopoietic stem cell transplantation for risk factors associated with severe hemorrhagic cystitis, as well as our experience with percutaneous nephrostomy tube placement as an adjunctive management strategy.
MATERIALS AND METHODS
Using prospectively collected data from the Blood and Marrow Transplant Database at the University of Minnesota, we reviewed 40 pediatric patients with severe hemorrhagic cystitis from 1996 to 2010. Specific treatment for each patient was administered at the discretion of the attending physician and generally included bladder irrigation before bladder fulguration or percutaneous nephrostomy tube placement. A percutaneous nephrostomy tube was placed in 11 patients due to the intractable nature of the hemorrhagic cystitis.
RESULTS
Of the 11 patients who underwent percutaneous nephrostomy tube drainage 5 (45%) had improvement of the hemorrhagic cystitis within 30 days and the same number had long-term resolution. Among the patients with long-term resolution hemorrhagic cystitis resolved an average of 12.4 days after percutaneous nephrostomy tube placement, and the tubes were removed an average of 8.8 weeks after placement. Through September 2011 mortality among patients with percutaneous nephrostomy tubes was 55% (6 of 11 patients), which was identical to the overall mortality in the severe hemorrhagic cystitis group (22 of 40). No death could be directly attributed to hemorrhagic cystitis or percutaneous nephrostomy tube placement.
CONCLUSIONS
Placement of percutaneous nephrostomy tubes for treatment of severe hemorrhagic cystitis results in long-term improvement in intractable hemorrhagic cystitis, and is a safe and viable option for the majority of patients.
View on PubMed2011