Howard B. Ginsburg, M.D.

Well-differentiated Pancreatic Neuroendocrine Carcinoma in Tuberous Sclerosis-Case Report and Review of the Literature
Arva, Nicoleta C; Pappas, John G; Bhatla, Teena; Raetz, Elizabeth A; Macari, Michael; Ginsburg, Howard B; Hajdu, Cristina H
2012 Jan;36(1):149-153, American journal of surgical pathology
Neuroendocrine tumors of the pancreas are rare in children. They usually occur in the setting of genetic syndromes such as multiple endocrine neoplasia type 1, von Hippel-Lindau disease, and neurofibromatosis 1. These tumors have also been reported in the tuberous sclerosis complex (TSC), but the incidence is low in comparison with other syndromes. Only 9 cases have been described to date, and it is not yet well understood if any connection exists between TSC and pancreatic endocrine tumors. TSC is characterized by mutations in TSC1 and TSC2 genes, which activate the AKT-mTOR oncogenic cascade. Recent molecular studies in pancreatic endocrine tumors showed activation of the same pathway, which points toward a common molecular pathway between these two entities. We present a case of well-differentiated neuroendocrine carcinoma of the pancreas in a child with TSC and discuss the genetic aspects of this disease
— id: 147697, year: 2012, vol: 36, page: 149, stat: Journal Article,

Complicated peptic ulcer disease in three patients with familial dysautonomia
Wan, David W; Levy, Joseph; Ginsburg, Howard B; Kaufmann, Horacio; Axelrod, Felicia B
2011 Aug;45(7):611-613, Journal of clinical gastroenterology
Familial dysautonomia (FD) is an autosomal recessive disorder characterized by autonomic and sensory neuropathy. Owing to pervasive dysfunction, the disease has protean clinical manifestations, affecting the ocular, gastrointestinal, pulmonary, orthopedic, vasomotor, and neurologic systems. The gastrointestinal perturbations, including dysphagia, gastroesophageal dysmotility, gastroesophageal reflux, and vomiting crises, are among the earliest signs. Here, we present the first 3 instances of gastric ulcers in patients with FD and discuss their common presenting features and the special management that was required
— id: 138323, year: 2011, vol: 45, page: 611, stat: Journal Article,

Management and outcomes for children with pyloric stenosis stratified by hospital type
Finkelstein, Julia B; Stamell, Emily F; Zilbert, Nathan R; Ginsburg, Howard B; Nadler, Evan P
2010 Jan;158(1):6-9, Journal of surgical research
BACKGROUND: Access to health care has been a source of controversy and public attention in health policy. The issues of access to and utilization of the healthcare system by infants and children is less well documented. Moreover, the impact on outcomes of race, ethnicity, and economic status in infants is vaguely addressed. METHODS: We performed a retrospective analysis of children who had undergone pyloromyotomy from July 31, 1998 to July 31, 2008 at our public hospital and university teaching hospital. Data abstracted included gestational age at delivery, birth weight, gender, race, insurance status, age at presentation, symptom duration, preoperative ultrasound (US), operative date, laboratory evaluations, as well as preoperative, postoperative, and total length of stay (LOS). RESULTS: The mean total preoperative LOS was twice as long at our public hospital than our private hospital (1.78 d versus 0.85 d, P=0.003). Similarly, the mean total length of stay was 0.87 d longer at our public hospital (3.87 d versus 3 d), which trended toward significance (P=0.06). Significantly, 72% (27/33) patients at the private hospital had their US either as an out-patient or on the day of admission, while only 58% (28/48) had an US performed as expeditiously at the public hospital (P=0.03, chi(2) analysis). CONCLUSIONS: Care at our public hospital leads to delayed diagnosis and treatment, resulting in longer preoperative and total LOS in infants with pyloric stenosis, most likely related to the timing of the preoperative US. Efforts should be made to encourage patients to use the outpatient clinic facilities for their ill infants, or for physicians at public hospitals to expedite the US process once the diagnosis of pyloric stenosis is entertained
— id: 105922, year: 2010, vol: 158, page: 6, stat: Journal Article,

An unusual form of duplicate bladder exstrophy
Tomita, Sandra S; McTiernan, Tracy L; Ginsburg, Howard B
2010 Apr;45(4):834-836, Journal of pediatric surgery
Duplicate bladder exstrophy is a rare variant of the exstrophy/epispadic lesions in which an external patch of exstrophic bladder presents in addition to a closed bladder in a more normal anatomical position, diastasis of the pubis and rectus muscles, and often a form of epispadias. We describe an anomaly of this variant with a fistula to the closed bladder. Careful examination with fluoroscopy and cystoscopy is helpful in defining the anatomy in these variants
— id: 109048, year: 2010, vol: 45, page: 834, stat: Journal Article,

Management and Outcomes for Children With Acute Appendicitis Differ by Hospital Type: Areas for Improvement at Public Hospitals
Zilbert, Nathan R; Stamell, Emily F; Ezon, Isaac; Schlager, Avi; Ginsburg, Howard B; Nadler, Evan P
2009 Jun;48(5):499-504, Clinical pediatrics
Background. Access to health care is a well-recognized issue in health policy, but use once patients have entered the health care system is uncommonly addressed. Methods. We performed a retrospective review of children between 2 and 17 years of age with pathologically confirmed appendicitis at our public city hospital and private university hospital and compared management and outcomes. Results. Among patients with acute appendicitis, the median length of stay was a day longer in the public hospital (2 days vs 1 day, P = < .001) despite a similar complication rate (12% vs 11%). More computed tomography (CT) scans were performed at the public hospital (36% vs 21%, P = .02) with a trend toward less use of ultrasound (US) (54% vs 65%, P = .13). Conclusions. Children at the public city hospital have a longer length of stay and undergo more expensive imaging. These findings may provide areas for improvement to optimize the care of children with appendicitis at government-funded institutions
— id: 96767, year: 2009, vol: 48, page: 499, stat: Journal Article,

More than skin deep: a case of congenital lamellar ichthyosis, lymphatic malformation, and other abnormalities
Small, Katherine; Ginsburg, Howard; Greco, M Alba; Sarita-Reyes, Carmen; Kupchik, Gabriel; Blei, Francine
2008 ;6(1):39-44, Lymphatic Research & Biology
ABSTRACT Consanguinity allows for the expression of rare genetic disorders. We present the first case of an infant, born to consanguineous parents, with congenital lamellar ichthyosis, congenital lymphatic malformation, congenital hypothyroidism, bilateral megaureter, benign external hydrocephalus, and syrinx of the spinal cord. We review the disorders, examine their genetic causes, and explore the genetic connection among them
— id: 78369, year: 2008, vol: 6, page: 39, stat: Journal Article,

Splenic infarction due to concomitant hereditary spherocytosis and sickle cell trait
Dulman, Robin Yates; Buchanan, George R; Ginsburg, Howard; Fefferman, Nancy R; Greco, M Alba; Borys, Dariusz; Blei, Francine
2007 Dec;42(12):2129-2131, Journal of pediatric surgery
Concomitant hereditary spherocytosis and sickle cell trait, although extremely rare, could potentially lead to splenic sequestration or infarction. We report here the first case of splenic infarction in a child with hereditary spherocytosis and sickle cell trait while flying on a commercial aircraft. The presence of hypoxia, hemoconcentrated erythrocytes, and sickle hemoglobin created the perfect environment for clinical sequelae
— id: 75677, year: 2007, vol: 42, page: 2129, stat: Journal Article,

A reinforced suture line prevents recurrence after fundoplication in patients with familial dysautonomia
Nadler, Evan P; Leung, Sam; Axelrod, Felicia B; Ginsburg, Howard B
2007 Apr;42(4):653-656, Journal of pediatric surgery
BACKGROUND/PURPOSE: Long-term follow-up of fundoplication in patients with familial dysautonomia (FD) has revealed a high rate of recurrent gastroesophageal reflux. This may be because of the unique characteristics of patients with FD which include autonomic denervation accompanied by cyclic vomiting and retching. We reviewed our results with adaptations to the Nissen fundoplication to determine which would be most effective in preventing the need for reoperation. METHODS: We reviewed the records of 108 patient with FD who underwent fundoplication by a single pediatric surgeon from November 1978 to July 1, 2004. Patients were divided into 4 groups based on the operative technique: standard Nissen fundoplication, Nissen with a posterior gastropexy, Nissen with posterior gastropexy and a superior anchoring suture, and Nissen with a reinforced suture line in addition to the previous modifications. Demographic data and surgical outcomes were abstracted. RESULTS: Patients who underwent a Nissen fundoplication with a reinforced suture line were significantly less likely to require a reoperation for recurrent reflux than any other patients (P = .05, Fisher's Exact test) despite the fact that they were younger than patients who underwent a standard Nissen alone. CONCLUSION: The addition of a reinforced suture line to the standard Nissen fundoplication decreases the failure rate for patients with gastroesophageal reflux and FD. A reinforced suture line may be an attractive modification for patients where the fundoplication may be under continued physical stress caused by autonomic perturbations, or other conditions such as uncontrolled seizures or progressive neurologic decline
— id: 72541, year: 2007, vol: 42, page: 653, stat: Journal Article,

Short-term results in 53 US obese pediatric patients treated with laparoscopic adjustable gastric banding
Nadler, Evan P; Youn, Heekoung A; Ginsburg, Howard B; Ren, Christine J; Fielding, George A
2007 Jan;42(1):137-141, Journal of pediatric surgery
BACKGROUND: Obesity in the adolescent population has reached epidemic proportions. Although diet and behavior modification can help a minority of teenagers, most of these patients go on to become obese adults. Recently, surgical intervention for morbid obesity has gained increasing support. To date, this has only included gastric bypass procedures. However, this procedure carries at least a 1% mortality rate even in the hands of the most experienced surgeons. Therefore, our center has been using laparoscopic adjustable gastric banding (LAGB) to treat adolescents with morbid obesity. This analysis is a report of our short-term results in our first 53 patients. METHODS: All adolescents aged 13 to 17 years who had undergone LAGB at our institution and had been entered into our prospectively collected database since 2001 were reviewed. Data collected preoperatively included age, sex, race, and body mass index (BMI). Postoperatively recorded data included length of stay, operative morbidity, need for reoperation, as well as percentage of excess weight loss (%EWL) and BMI at 3-month intervals. RESULTS: Fifty-three teenagers aged 13 to 17 years (mean, 15.9 years) underwent LAGB at our institution since September 2001. Of these, 41 were female and 12 were male. The mean preoperative weight was 297 +/- 53 lb and the mean initial BMI was 47.6 +/- 6.7 kg/m2. The %EWL was 37.5 +/- 17.0 at 6 months, 62.7 +/- 27.6 at 1 year, and 48.5 +/- 15.6 at 18 months of follow-up. There were no intraoperative complications. Two patients had band slips that required laparoscopic repositioning, and 2 patients developed a symptomatic hiatal hernia that required laparoscopic repair. All of these procedures were performed as outpatient procedures. A fifth patient developed a wound infection requiring incision and drainage. Other complications included mild hair loss in 5 patients, iron deficiency in 4 patients, nephrolithiasis and cholelithiasis in 1 patient, and gastroesophageal reflux in 1 patient. CONCLUSIONS: Laparoscopic adjustable gastric banding is not only a safe operation for morbidly obese pediatric patients, but also represents an effective treatment strategy with a %EWL of approximately 50% at both 1 year and 18 months of follow-up. Because of the minimal morbidity and complete absence of mortality of the LAGB, it is the optimal surgical option for pediatric patients with morbid obesity
— id: 70319, year: 2007, vol: 42, page: 137, stat: Journal Article,

Calcified catheter "cast" masquerading as a retained catheter fragment after removal of an implanted venous access device
Sabbaghian, M Shirin; Rivera, Rafael; Ginsburg, Howard B; Nadler, Evan P
2007 Sep;23(9):927-930, Pediatric surgery international
Calcified catheter 'cast' found on radiologic studies after central venous catheter removal is a rare complication that has been reported twice. Both cases were associated with thrombus. In this case report, we present a 15-year-old boy with acute lymphoblastic leukemia who demonstrated on CT scan a radiopacity in his left brachiocephalic vein after removal of an implanted venous access device. This was initially thought to be a retained catheter fragment. Diagnostic studies, including venogram, excluded the presence of a retained catheter fragment. Additional procedures to retrieve a nonexistent catheter fragment were thus avoided. Therefore, a catheter 'cast' should be considered as part of the differential diagnosis when calcification is found on an imaging study after removal of an implantable venous access device to prevent an unwarranted surgical exploration
— id: 75649, year: 2007, vol: 23, page: 927, stat: Journal Article,

Hepatic artery transection after blunt trauma: case presentation and review of the literature
Miglietta, Maurizio A; Moore, Jason A; Bernstein, Mark P; Frangos, Spiros G; Ginsburg, Howard; Pachter, H Leon
2006 Sep;41(9):1604-1606, Journal of pediatric surgery
Hepatic artery injuries sustained as a result of blunt abdominal trauma are rare. This case represents the first reported hepatic artery transection and the second hepatic artery injury described in children. Hepatic artery injuries are associated with high mortality, and their management is complex and controversial
— id: 68784, year: 2006, vol: 41, page: 1604, stat: Journal Article,

Laparoscopic neo-os creation in an adolescent with uterus didelphys and obstructed hemivagina
Patterson, Danielle; Mueller, Claudia; Strubel, Naomi; Rivera, Rafael; Ginsburg, Howard B; Nadler, Evan P
2006 Oct;41(10):E19-E22, Journal of pediatric surgery
Uterus didelphys is a rare congenital anomaly with a well-documented association with obstructed hemivagina and ipsilateral renal agenesis. Treatment of this anomaly includes drainage of hematocolopos and excision of the vaginal septum, which has traditionally used a scalpel or scissors, often with hymenotomy. Recently, a less invasive approach using hysteroscopic resection has been reported, allowing improved visualization with preservation of the hymenal ring. In this article, we present an alternative minimally invasive approach using a combination of laparoscopy and vaginoscopy in the case of a 10-year-old girl. This approach allows for treatment in cases wherein vaginoscopy provides inadequate visualization with the advantage of enabling full evaluation for associated complications affecting future fertility including endometriosis, pelvic infection, and pelvic adhesions
— id: 69029, year: 2006, vol: 41, page: E19, stat: Journal Article,

Splenic infarction due to concomitant hereditary spherocytosis and sickle cell trait
Yates, R; Buchanan, GR; Ginsburg, H; Fefferman, N; Greco, MA; Borys, D; Blei, F
2006 NOV 16 ;108(11):8B-9B, Blood
— id: 71216, year: 2006, vol: 108, page: 8B, stat: Journal Article,

Thymoma in children: report of two cases and review of literature
Dhall, Girish; Ginsburg, Howard B; Bodenstein, Lawrence; Fefferman, Nancy R; Greco, M Alba; Chang, Mary W; Gardner, Sharon
2004 Oct;26(10):681-685, Journal of pediatric hematology/oncology
Thymoma is an uncommon tumor of childhood. Stage of the tumor is an independent prognostic factor for survival. Surgery is the treatment of choice for stage I and stage II tumors. Chemotherapy is reserved for patients with refractory or metastatic disease. Thymomas are moderately radiosensitive. However, radiation therapy is not an attractive option for children due to its side-effects on developing organs. The authors describe 2 children with completely encapsulated thymoma who were successfully treated with surgery alone. Both patients remain free of disease 3 years after surgery. One of the patients also has nevus sebaceous. The authors also discuss the possible association between the two disease entities
— id: 95965, year: 2004, vol: 26, page: 681, stat: Journal Article,

Paraganglioma (pheochromocytoma) of the posterior mediastinum: a case report and review of the literature
Spector, Jason A; Willis, David N; Ginsburg, Howard B
2003 Jul;38(7):1114-1116, Journal of pediatric surgery
Pheochromocytoma is an uncommon tumor in the pediatric population. Paraganglioma, or extra-adrenal pheochromocytoma, accounts for only a small fraction of pediatric pheochromocytomas, with most of these tumors presenting within the abdominal cavity. Herein the authors report the extremely rare case of a biochemically active paraganglioma presenting as a posterior mediastinal mass in an 8-year-old boy
— id: 39142, year: 2003, vol: 38, page: 1114, stat: Journal Article,

Obstructive jaundice caused by placement of a nasoenteric feeding tube
Rinker B; Ginsburg HB; Genieser NB; Gittes GK
2000 Apr;35(4):619-620, Journal of pediatric surgery
Nasoenteric feeding tubes are a safe and effective means for providing nutritional support to the critically ill patient. Serious complications have been reported, but usually are the result of an improper path of the tube during placement. The authors report a case of ampullary obstruction and jaundice caused by a nasoenteric feeding tube, presumably caused by coiling of the tube in the duodenum. This report represents the first such case in the literature
— id: 11744, year: 2000, vol: 35, page: 619, stat: Journal Article,

Adenomyoma arising in a meckel diverticulum: case report and review of the literature
Yao JL; Zhou H; Roche K; Bangaru BS; Ginsburg H; Greco MA
2000 Sep-Oct;3(5):497-500, Pediatric & developmental pathology
We report a case of adenomyoma of the small intestine arising in a Meckel diverticulum. The patient was a 22-month-old boy who presented with signs and symptoms of intussusception. At surgery, a Meckel diverticulum was found and removed. On histologic examination, a tumor consisting of dilated cystic glands and smooth muscle bundles was identified. A diagnosis of adenomyoma arising in a Meckel diverticulum was made. A review of the literature showed that only six other pediatric cases of adenomyoma of the small intestine have been reported. The presence of an adenomyoma in a young patient within a Meckel diverticulum favors the view that adenomyomas are a variant of pancreatic heterotopia
— id: 11603, year: 2000, vol: 3, page: 497, stat: Journal Article,

Fetal midgut volvulus presenting at term
Crisera CA; Ginsburg HB; Gittes GK
1999 Aug;34(8):1280-1281, Journal of pediatric surgery
This report describes a rare case of intrauterine midgut volvulus that presented at term. The pregnancy was uncomplicated. There were no signs of fetal distress or polyhydramnios, and the child was delivered vaginally. This patient had the unusual presentation in that at the time of delivery, the patient was distended and acidotic. She immediately required an extensive resection of gangrenous small bowel. Comparing this case to the 10 other cases of fetal intestinal volvulus that have been reported, it seems this child was particularly fortunate that the volvulus occurred at a point in gestation when she was mature enough to tolerate birth and surgery. This case is also the first demonstration that volvulus can present with abdominal distension in the immediate newborn period
— id: 56470, year: 1999, vol: 34, page: 1280, stat: Journal Article,

Repair of pediatric pectus deformity and congenital heart disease as a combined procedure
Gittes GK; Crisera CA; Ginsburg HB; Galloway AC; Colvin SB
1999 Aug;34(8):1282-1283, Journal of pediatric surgery
Coexisting pectus deformity and congenital heart disease is not uncommon. Traditionally, the approach to this problem has been to repair each one with a separate surgical procedure because of fear of increased complications from bleeding, infections, and anesthesia. More recently, many reports of successful combined repair have been published, particularly in adults with coronary artery or aortic pathology. The authors wished to determine the feasibility of this combined procedure in younger patients, particularly those with a severe pectus deformity. Three patients underwent repair, including a 17 year old with Marfan's syndrome and a severe pectus excavatum deformity. The postoperative course was smooth for these patients, and all had good short- and long-term (over 18 months) results
— id: 56471, year: 1999, vol: 34, page: 1282, stat: Journal Article,

Percutaneous peritoneal drainage in the management of acute intestinal perforation
Atakent YS; Wasserman-Hoff R; Ozek E; Oygur N; Ginsburg HB
1997 Jan-Feb;17(1):46-51, Journal of perinatology
This case series describes the use of percutaneous peritoneal drainage when it is performed as the definitive treatment for acute intestinal perforation. Seven extremely low birth weight neonates who were admitted to a neonatal intensive care unit of a regional center between March 1987 and October 1992 had acute intestinal perforation. Six neonates were initially treated with percutaneous peritoneal drainage while they were under local anesthesia. Despite reports that percutaneous peritoneal drainage alone can be curative in intestinal perforation, this approach without adjunctive surgery can delay the recovery of bowel integrity
— id: 7104, year: 1997, vol: 17, page: 46, stat: Journal Article,

Primary extrarenal Wilms' tumor in the inguinal canal: case report and review of the literature
Arkovitz MS; Ginsburg HB; Eidelman J; Greco MA; Rauson A
1996 Jul;31(7):957-959, Journal of pediatric surgery
Inguinal and scrotal Wilms' tumors are extremely rare; only 15 cases have been reported to date. The authors report a case of inguinal Wilms' tumor (stage III), which occurred in a previously healthy 3 1/2-year-old boy who was staged and treated according to currently accepted National Wilms' Tumor Study III criteria. The exact embryological origin of this tumor has not been determined. However, there is evidence that the origin is more primitive than that of intrarenal Wilms' tumor
— id: 56860, year: 1996, vol: 31, page: 957, stat: Journal Article,

Fundoplication and gastrostomy in familial dysautonomia
Axelrod FB; Gouge TH; Ginsburg HB; Bangaru BS; Hazzi C
1991 Mar;118(3):388-394, Journal of pediatrics
Fundoplication with gastrostomy has become a frequent treatment for patients with familial dysautonomia, so we evaluated the use of both procedures in 65 patients. Although patients differed widely in presenting signs and age, from 5 weeks to 40 years, gastroesophageal reflux was documented in 95% of patients by cineradiography or pH monitoring. Panendoscopy was a useful adjunct. Preoperative symptoms of gastroesophageal reflux included vomiting, respiratory infections, and exaggerated autonomic dysfunction. Severe oropharyngeal incoordination frequently coexisted and resulted in misdirected swallows with aspiration, dependence on gavage feedings, or poor weight gain and dehydration. Follow-up after surgical correction ranged from 3 months to 11 years; 55 patients (85%) were available for a 1-year postoperative assessment. We had no instances of surgical death. The long-term mortality rate was 14%, primarily related to severe preexisting respiratory disease. Beyond the first postoperative year, 30 patients had pneumonia attributed to continued aspiration, exacerbation of preexisting lung disease, or recurrence of gastroesophageal reflux. Of 11 patients who vomited postoperatively, six had recurrence of reflux. Recurrence of gastroesophageal reflux was documented in eight patients (12%), and we revised the fundoplication in three patients. The number of patients with cyclic crises was reduced from 18 to 7; retching replaced overt vomiting in all but two of these seven patients, neither of whom had recurrence of reflux. Because oropharyngeal incoordination was prominent, concomitant use of gastrostomy and an antireflux procedure was especially effective in the treatment of younger patients with familial dysautonomia, before the development of severe respiratory disease. Despite the development of severe morning nausea in 15 patients, the combination procedure resulted in significantly improved nutritional status, decreased vomiting, and decreased respiratory problems. Appropriate use of gastrostomy feedings also contributed to success of the operation. The generally good outcome of fundoplication with gastrostomy confirms the benefit of this procedure in familial dysautonomia
— id: 14114, year: 1991, vol: 118, page: 388, stat: Journal Article,

Ultrasound diagnosis of jugular venous ectasia
Gribbin, C; Raghavendra, B N; Ginsburg, H B
1989 Sep;89(9):532-533, New York state journal of medicine
— id: 124445, year: 1989, vol: 89, page: 532, stat: Journal Article,

BABIES WHO VOMIT
Ginsburg, H
1982 ;14(2):73-7?, Emergency medicine
— id: 30334, year: 1982, vol: 14, page: 73, stat: Journal Article,