Wednesday, November 18, 2020

An Overview of Iatrogenic Vascular Lesions in LBW and ELBW



Based in Staten Island, Dr. Brian Gilchrist is a pediatric surgeon with over 30 years of experience. Dr. Brian Gilchrist has published numerous articles in medical journals on topics including pilonidal disease, necrotizing enterocolitis, and the treatment of iatrogenic vascular lesions.

Iatrogenic conditions are adverse effects or states of illness resulting from medical treatment. Such a condition might be caused by a mistake made during treatment or diagnosis by any of the health care team members. Iatrogenic vascular lesions are abnormalities of the tissues and skin in babies, and often involve acquired damage or injuries in the tissue or organs such as tumors and ulcers.

Iatrogenic complications are becoming more frequent due to the increased number of minimally invasive therapeutic and diagnostic procedures performed. Although typically these complications have no real clinical impact, they may result in negative outcomes. When treating vascular lesions such as pseudoaneurysm (PA), a medical condition involving an injured blood vessel wall with leaking blood collecting around the surrounding tissue, experts recommend using transarterial embolization (TAE). This procedure entails blocking the blood supply to an abnormal tissue area or tumor.

Low birth weight (LBW) and extremely low birth weight (ELBW) neonates (newborn babies under four weeks old) are at even greater risk of developing iatrogenic vascular lesions. Experts advocate for aggressive medical treatment, microsurgery, or a combination of both to prevent late sequelae.

Aggressive and increased treatment in hospitals' neonatal intensive care units (NICUs) has significantly improved LBW and ELBW neonates' long-term outcomes. However, it has led to an increase in the risk of iatrogenic vascular lesions such as gangrene, thromboses, and aneurysms due to arterial blood sampling or repeated venipuncture. As such, these lesions need a correct, noninvasive clinical diagnosis and treatment using microvascular techniques. 

Saturday, November 7, 2020

About Iatrogenic Vascular Lesions

 

Friday, October 30, 2020

The Presentation of Iatrogenic Vascular Lesions in Infants



Pediatric surgeon Brian Gilchrist, MD, is the former chief of pediatric surgery at a reputable hospital in the New York metropolitan area. As such, he oversaw the expansion of pediatric surgery service and performed numerous pediatric operations. Throughout his career, Dr. Brian Gilchrist has written and edited over six dozen publications, including an article about iatrogenic vascular lesions.

In infants and children, iatrogenic vascular lesions may present themselves either immediately or well after the original vascular trauma has occurred. Typically, patients with vascular injury display signs straightaway. These signs include the “five Ps”: paralysis, pallor, pulselessness, pain, and paresthesia (a burning sensation in the extremities).

Some of these signs, such as pulselessness and paresthesia, are difficult to determine in infants, but Doppler technology can assist with monitoring flow and comparing pressures to the uninvolved limb. Further, not every sign results from vascular compromise, or the absence thereof. In children, vascular spasms, for example, can result from sources other than lesions, and the presence of a pulse does not rule out vascular injury since roughly 25 percent of patients with vascular injuries presented with distal pulses.

The presentation of the signs of vascular injury is delayed in patients with certain vascular injuries. Those with mycotic aneurysms, renal vascular occlusion, and arteriovenous fistulas, for instance, all display subtle or delayed signs of iatrogenic vascular lesions. 

Thursday, October 15, 2020

A Brief Introduction to Iatrogenic Vascular Lesions

 

Wednesday, July 15, 2020

Necrotizing Entercolitis - Neonatal Disease Impacting Smaller Infants


An established medical researcher and practitioner, Dr. Brian Gilchrist most recently served as chief of pediatric surgery at NYU-Winthrop University. Extensively published in his field, Dr. Brian Gilchrist edited a widely utilized book on the neonatal disease necrotizing enterocolitis.

Associated with premature infants, necrotizing enterocolitis occurs in approximately seven percent of infants with a birth weight of between one and three pounds. The associated death rate is between 20 and 30 percent, with those infants who receive surgery having the highest risk of mortality.

Necrotizing enterocolitis centers on a highly immunoreactive intestine that causes inflammation. This results in death of part of the bowel, which can systematically impact distant organs beyond the gastrointestinal tract, such as the brain. Infants who recover from necrotizing enterocolitis are susceptible to neurodevelopmental delays and microcephaly.

Traditionally, treatment often involves enteral feeding, via a gastrointestinal tract feeding tube. Unfortunately, this is linked with the development of necrotizing enterocolitis. This has resulted in protocol involving extended periods of intravenous nutrition, which causes longer infant hospital stays, and it also increases the possibility of infectious complications.

Tuesday, June 23, 2020

Possible Causes of Congenital Diseases


An experienced surgeon with in-depth knowledge of pediatric surgery, Dr. Brian Gilchrist is currently a private practitioner in New York who serves the Staten Island community. Dr. Brian Gilchrist has performed more than 250 minimally-invasive pilonidal proceduressince 2009 and has been researching and treating congenital diseases for years.

About three to four percent of babies in the United States are born with a congenital disease. These conditions are present before or at birth and can affect aspects of the baby’s life, such as development, function, or physical appearance.

Most congenital conditions have unknown causes. However, when the cause is determined, it can be genetic, environmental, or a combination of both. Genetic congenital diseases appear during conception when the unborn baby receives chromosomes from the mother and father. If an error occurs during this process, the unborn baby can receive a damaged chromosome, an abnormal gene inside of a chromosome, or the wrong number of chromosomes.

An environmental congenital disease can occur if the unborn baby is exposed to chemicals or an infection during the first nine weeks of gestation. Alcohol ingestion is one such example: It can cause fetal alcohol syndrome, which may lead to growth problems and brain damage for the unborn baby. Other examples of maternal infections that can cause congenital diseases are rubella and chickenpox.

Wednesday, May 13, 2020

Treatments for Necrotizing Entercolitis


Brooklyn resident Dr. Brian Gilchrist has been a pediatric surgeon for close to 30 years. Dr. Brian Gilchrist was editor for the book The Basic Science of Necrotizing Entercolitis (NEC), published 20 years ago but still used in many neonatal units around the country.

NEC is a gastrointestinal condition that affects one in between 2,000 and 4,000 babies at birth in the US. The condition is very serious because it is a patho-physiology causing an inflammation of the intestinal wall. This inflammation leads to a bacterial invasion, which leads to cell damage and then cell death. If the condition persists, the intestines can become perforated, causing sepsis and peritonitis.

The condition commonly affects babies who were born prematurely. Babies who weigh 4.5 pounds or less make up more than 80 percent of the cases, but there have been cases of full-term newborns having this condition. The condition manifests within the first few weeks after birth, usually after milk feedings have begun.

Medical professionals believe there are a few causes of the condition. Some believe that the content of the baby’s formula or the rate of delivery could be catalysts for causing the condition. Another cause could be the immaturity of the mucus membrane. However, it is believed that children who are breast fed are at lower risk for developing the condition.

There are a variety of treatments for this condition. Typically, all feedings are discontinued and babies are fed intravenously. Physicians might also place a naso-gastric tube (extends from the nose to the stomach) to suction air and fluid from the stomach to relieve swelling. If this does not work, the physician might provide an oxygen mask to assist with breathing. Doctors might initiate an antibiotic therapy, and if the case is serious enough, a platelet and red blood transfusion might be required.