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Division of Pediatric Surgery
Department of Surgery
Brown University School of Medicine
FACULTY
Thomas Tracy, M.D.
Chief, Division of Pediatric Surgery
Professor of Surgery
Arlet Kurkchubasche, M.D.
Assistant Professor of Surgery
Francois I. Luks, M.D.
Associate Professor of Surgery
Conrad W. Wesselhoeft, Jr., M.D.
Clinical Professor of Surgery
OVERVIEW
Brown University School of Medicine and Hasbro Children’s Hospital has developed one of the finest children’s surgical services regionally and nationally. All Pediatric Surgical Subspecialties are represented by leaders in the surgical care of infants and children. Specific programmatic development in all of the areas of Pediatric Surgery has allowed the expansion and growth of surgical volume to reach greater than 6,000 operative cases per year with corresponding increases in regional and national referrals for surgical consultation. Progressive specialization has provided measurable advances in children’s perioperative care in one of the most attractive children’s operating rooms in the country.
The Division has its roots in the earliest foundations of the relatively young subspecialty of Pediatric Surgery. In 1967, Frank G. DeLuca, MD returned to his roots in Providence and the Rhode Island Hospital following his training with, Orvar Swenson, MD. For 30 years Dr. DeLuca shepherded the growth of Pediatric Surgery nationally as one of the original founders of its national organization in 1970 and regionally, with heightened local awareness of the unique surgical needs of infants and Children. The Division was responsible for the first pediatric intensive care unit in the former children's hospital in the Potter building. The Division now continues that tradition of excellence and achievement through service of the clinical and academic goals of the new Hasbro Children's Hospital and Women and Infants Hospital of the Academic Medical Center.
Strong alliances and collaborative development with other pediatric surgical subspecialties has led to a rich environment of care and inquiry within the Children's hospital surgical services. There has been extensive growth in Pediatric Neurosurgery for specialized management of brain tumors and trauma in infants and children. Endoscopic sinus and airway surgery is a main component of Pediatric Otolaryngology along with an outstanding expertise in airway reconstruction to contribute to a Multidisciplinary Airway Program with its strength coming from ENT, Cardiac And Pediatric General and Thoracic Surgery. The Congenital Cardiac Surgical Program has assembled one of the finest teams to palliate, reconstruct and rehabilitate the most complex congenital cardiac lesions soon to be complemented by the addition of Extracorporeal Membrane Oxygenation for cardiorespiratory failure. Pediatric Orthopedics applies the latest technology including video-assisted spinal reconstruction. Through microports, major spinal reconstruction is accomplished with much less pain than previous incisions induced, along with much greater functional recovery over a short period. Pediatric Urology has also employed the latest endoscopic techniques to enhance reconstruction and correction of numerous congenital urologic anomalies. There are outstanding Pediatric Plastic and Craniofacial Surgery, as well as Ophthalmology and Strabismus programs.
Several important areas within Pediatric General and Thoracic Surgical have been designed and fostered to place Hasbro Children’s Hospital among the leading Pediatric Surgery centers in the country. Endosurgical techniques have been extended to newborn infants as well as children and are universally applied through abdominal and thoracic surgical procedures. Cooperation with Women & Infants has yielded an extensive expansion of the Fetal Diagnosis and Management Group for regional and national referrals for the management of prenatally diagnosed fetal anomalies. Hasbro Children’s Hospital remains an important component of the Rhode Island Hospital level-I trauma system. Significant advances have been made through collaboration with the Pediatric Critical Care Division for severe head trauma and the ability to manage extensive pediatric burns. Pediatric Surgery is actively involved in the pediatric solid tumors presenting at Hasbro in collaboration with Pediatric Hematology/Oncology. As one of the national sites for the Pediatric Oncology Group, Hasbro is able to apply the latest protocols for the advanced operative management of pediatric tumors. Reconstruction of severely deforming chest wall deformities is an active initiative with methods for rapid recovery and functional outcomes to return these children with devastating anomalies to their fullest athletic and academic potential. Surgery has a special interest in the medical management and operative therapy of infants and children with short-bowel syndrome. For this devastating loss of intestine, we employ the latest techniques to preserve liver function and enhance intestinal adaptation.
EDUCATION
The educational goals of the Division extend throughout The Brown Medical community. Pediatric Surgery has received full ACGME approval for its specialty residency program. One Resident is selected every two years through the National Residency Matching Program for a two-year program that follows the completion of General Surgery and additional research training. The program attracts the finest surgery candidates having received the third highest level of first ranked programs of the 32 programs in North America, and was fifth overall in desired ranking. The Division of Pediatric Surgery has always been an active partner in resident education for the Departments of Surgery and Pediatrics as well as the Neonatology program at W&I. The Pediatric Surgery resident leads a team of rotating Surgery and Pediatric house officers for the clinical service. The operative experience is extensive with greater than 2000 cases per year available for the resident. This service is the cornerstone for all of the active consultations for surgery from W&I to RIH as well as the Level 1 Trauma program and the joint Antenatal Fetal consultation program. The pediatric surgery, pediatric, and general surgical residents attend and take an active role in presentations at the interdisciplinary conferences throughout the Academic Medical Center which make important contributions to the extent and richness of Pediatric and Surgery training. Pediatric Surgery is proud of its important contributions to the comprehensive quality of resident and fellowship training through its seamless integration into the academic and clinical life of Surgery and Pediatrics at Brown and Hasbro.
RESEARCH PROGRAMS
The Division of Pediatric Surgery is at the forefront of some of the most pressing research issues in contemporary pediatric surgical research. The growth of extramural funding in the Division has allowed the faculty to remain competitive contributors within important areas of cell biology and fetal development. The fetal research program is headed by, Dr. François Luks. This project done in collaboration with Neonatology and Pathology coinvestigators has received a new grant by the American Lung Association and made recent presentations at international forums such as the Nobel Symposia. Over the past three years, Dr. Luks has published outstanding basic science and clinical observations in fetal lung development and cellular pathophysiology in numerous national and international journals.
With the successful transfer of Dr. Tracy’s NIH Grant, the institution has extended a generous level of new direct support and renovation of an additional 1000 sq. ft of laboratory space. A Senior Research Assistant has completed the transfer of the lab and instituted new protocols. An instructor-level Post Doctoral Fellow has been funded and is currently being recruited. Residents and Fellows have joined this basic science research activity in the molecular and cellular aspects of liver injury and repair. Collaborative discussions have begun with an eye to the development of Program Project Grants that can bridge Surgery and Pediatrics in the areas of hepatic gene transcription and liver stem cells.
The growth of the Division to four faculty members that now include Dr. Arlet Kurkchubasche has introduced a new potential for cutting edge programs in short gut syndrome and the clinical growth of a pediatric liver program. Through a combined clinical and basic science approach, she will seek to define the cellular and molecular determinants that lead to the inflammatory processes that lead to cirrhosis and end stage liver disease.
The heightened development of the Division of Pediatric General and Thoracic Surgery has brought about the opportunity and challenges to provide regional and national leadership in the surgical care of infants and children. In addition to the accomplishment of the significant clinical, educational and research goals that have been presented, the Division will continue to work with all members of the Brown community to represent and advocate for its most important responsibility - children and their families.
PUBLICATIONS
Tracy TF Jr, Dillon P, Fox E, Minnick K, and Vogler C: The inflammatory response in pediatric biliary disease: Macrophage phenotype and distribution. J Pediatr Surg 1996;31:121-126
Tracy TF Jr, Silen ML, Graham MA: Delayed rupture of the abdominal aorta following suspected handlebar injury. J Trauma 1996;40:119-120
Fox ES, Tracy TF Jr. Alterations in tomor necrosis factor-a expression by hepatic macrophages following acute cholestatic liver injury. Shock 1996;5:112-115
Fortuna RS, Weber TR, Tracy TFJr, Silen ML, Cradock TV:Critical analysis of the operative treatment of Hischprung’s Disease. Arch of Surg 1996; 13:520-525
Fox ES, Wang L, Tracy TF Jr.: Lipopolysaccharide and tumor necrosis factor-a synergy potentiate serum-dependent responses of rat macrophages. Shock 1996;5:429-433.
Neuschwander-Tetri BA, Nicholson C, Wells LD, Tracy TF Jr.: Cholestatic liver injury down-regulates hepatic glutathione synthesis J Surg Res 1996;63:447-451
Dillon P, Belchis D, Minnick K, Tracy TF Jr: Differential expression of the major histocompatibility antigens and ICAM-1 on bile duct epithelial cells in biliary atresia Tohoku J Exp Med 1997; 8:33-40
Sadiq H, Tracy T, Khan Y, Devaskar S: Effict of intrauterine growth restriction upon brain glucose transporter proteins. Pediatr Res 1997 (in press)
Silen ML, Fendya DG, Kurkchubasche AG, Weber TR, Tracy TF Jr: Vehicular trauma in residential driveways:Is it Preventable? J pediatr Surg 1997 (in review)
Ramm GA, Carr SA, Li L, Vogler CA, Britton RS, Bacon BR, Tracy TF Jr: Regression of myofibroblasts during hepatic repair following chronic cholestatic liver injury in rats. Hepatology 1997 (in review)
Fox ES, Kim JC, Tracy TF jr: NF - kappa B activation and moderation in hepatic macrophages during cholestatic injury. J Surg Res 1997;72:129-134
Kurkchubasche AG, Fendya DG, Tracy TF Jr, Silen ML, Weber TR. Blunt intestinal injury in children:Diagnostic & therapeutic considerations Archives of Surgery 1997; 132:652-657, discussion 657-658
Chen EA, Luks FI, Gilchrist BF, Wesselhoeft CWJr, Deluca FG. Pyloric stenosis in the age of ultrasonography:fading skills, better patients? J Pediatr Surg 1996;31:829-830
DeLuca FG, Gilchrist BF, Paquette E, Wesselhoeft CW, Luks FI. External compression as initial management of giant omphaloceles. J Pediatr Surg 1996;31:965-967
Gilchrist BF, Shroff V, DeLuca FG, Woodworth C, Wesselhoeft CW. Management of thoracolaryngopelvic dysplasia. Eur J Pediatr Surg 1996;6:231-232
Guleserian KJ, Gilchrist BF, Luks FI, wesselhoeft CW, DeLuca FG. Child abuse as a cause of traumatic chylothorax. J Pediatr Surg 1996;31:1696-1697
Ng T, Lessin MS, Luks FI, Wallach MT, Wesselhoeft CW Jr. Wandering spleen presenting as duodenal obstruction after repair of congenital diaphragmatic hernia. 1997;32:1790-1792
Gilchrist BF, Luks FI, DeLuca FG, Wesselhoeft CW Jr. A modified feeding Roux-en-Y jejunostomy in the neurologically damaged child. J Pediatr Surg 1997;32:588-589
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