All posts by CHOC Childrens

Radiology

CHOC Children’s Specialists pediatric radiologists provide the only specialized pediatric imaging services in the region. CHOC Children’s uses cutting-edge technologies to obtain the highest quality image, while at the same time reducing the patient’s exposure to radiation. This is especially important for children whose conditions require repeated studies over the years.

Our expert physicians and staff are dedicated to using the lowest dose of radiation necessary, without sacrificing the quality of images required for quick and accurate diagnoses. Many children are imaged in adult facilities where radiation doses can be up to 50 percent higher than at CHOC.

We are accredited by the American College of Radiology and follow the guidelines of the Image Gently® campaign, so you can rest assured that your child will receive the safest radiology services available.

The CHOC Children’s Radiology Department is one of only a handful of hospital radiology departments in the country to offer a child life specialist. Child life specialists have been shown to decrease the amount of sedation necessary for children undergoing imaging tests. From the imaging suites to our family lobby, the Imaging Department has been designed to be a calm and inviting unit for children of all ages—from infants to teens and young adults. The unit features a number of private areas that allow child life specialists, caregivers and doctors the opportunity to interact with patients as need before or after an exam. CHOC Children’s offers patients special goggles to use during MRI scans. These video goggles allow the patient to watch their favorite movie or television show while undergoing their MRI scan and have been proven to reduce the number of patients needing sedation for MRI procedures.

Services and State-of-the-art Equipment

  • 3T and 1.5T MRI
  • CT, X-ray, fluoroscopy, ultrasound, MRI
  • 3D modeling for cardiac, orthopaedic and brain imaging
  • Only hospital in Orange County that does pediatric brain mapping using functional MRI (fMRI)
  • 50 percent lower CT radiation dose than many community facilities. For example, American College of Radiology recommends a dose of no more than 50 CTDI for pediatric heads, and CHOC is averaging 8-15 CTDI for pediatric heads
  • 90 percent radiation reduction on fluoroscopic procedures by using pulse dose technique and image capture, compared to the more commonly used continuous fluoroscopy and full image acquisition
  • Techs on site 24/7
  • Board-certified pediatric radiologists and specially trained pediatric radiology technologists, nurses and child life specialists
  • Distraction techniques, toys and devices, such as iPads and MRI movie goggles, are used for patient’s comfort
  • ACR accredited – MRI, CT and ultrasound (pediatric accreditation)
  • CT Scans entire body in less than 5 seconds, drastically reducing the need for anesthesia and repeat scans due to motion

Neurology

The CHOC Children’s Specialists Neurology Specialty Division at CHOC Children’s is available for consultation 24-hours-a-day, 7 days a week and provides diagnostic services, medical treatment, and follow-up care to infants, children, and adolescents who have suspected or confirmed neurological disorders. Our pediatric neurologists manage and treat a variety of patients including those with epilepsy disorders, neuromuscular disorders and spasticity.

A pediatric neurologist has completed a residency in pediatrics and had additional training in adult and child neurology. All our pediatric neurologists have certification or are eligible for the American Board of Psychiatry and Neurology (with special qualifications in child neurology). Our group also has pediatric neurologists with Board certification in Clinical Neurophysiology (Epilepsy and Neuromuscular diseases), Palliative Care, and Neurodevelopmental Disabilities.

Pediatric neurologists combine the expertise in diagnosing and treating disorders of the nervous system (brain, spinal cord, muscles, nerves) with an understanding of medical disorders in childhood and the special needs of the child and their family. In many cases, pediatric neurologists work as a team with pediatricians or other primary care doctors. In addition, pediatric neurologists may work with other pediatric specialists to care for children with more complex or serious medical issues, such as epilepsy, birth defects, or developmental delay.

CHOC Children’s Hospital Comprehensive Epilepsy Program is recognized by the NAEC as a Level 4 epilepsy center. Level 4 epilepsy centers have the professional expertise and facilities to provide the highest level medical and surgical evaluation and treatment for patients with complex epilepsy.

The following conditions may be best treated by a pediatric neurologist:

  • Epilepsy and seizures — including intensive long term video EEG monitoring for epilepsy and related disorders
  • Motor system disorders — including tics, Tourette’s Syndrome; neuromuscular diseases, including congenital myopathies, muscular dystrophy, hypotonia and other genetic muscular disorders; and cerebral palsy
  • Headaches with neurological findings or patients who have failed first line medications
  • Developmental and behavioral disorders — including learning disabilities, ADHD, developmental disorders and autism through the Thompson developmental center
  • Neurogenetic and neurometabolic disorders — including neurodegenerative diseases such as mitochondrial disorders, neurofibromatosis, tuberous sclerosis, Rett’s Syndrome and Down Syndrome
  • Neuroimmunological disorders — including dermatomyositis and post-infectious encephalopathy
  • Neurological aspects of head injuries, brain tumors, brain malformations, and hydrocephalus
  • Complications of central nervous system infection

Clinical services are complemented by the multidisciplinary care provided by other CHOC Children’s Specialists, nurses, pharmacists, EEG lab technicians, therapists, clinical dietitians, child psychologists and social workers at CHOC Children’s.

State-of-the-Art Pediatric Sleep Disorders & Neurophysiology Center

Directed by CHOC Children’s Specialists Neurologists, this center provides clinical care and electrophysiological monitoring for primary sleep disorders, including narcolepsy and sleep disorders secondary to neurological and other organ disorders. CHOC Children’s Specialists Neurology physicians also direct the Neuro-Diagnostic Center at CHOC, providing inpatient and outpatient 24-hour EEG videotelemetry.

Leading-Edge Neurodiagnostic Services

The CHOC Children’s Specialists Neurology team is fully equipped with advanced diagnostic equipment:

  • Routine and 24-hour EEG videotelemetry for monitoring of status epilepticus, pseudoseizures and neonatal seizures
  • Evoked potentials including intraoperative recording
  • MRI and MRA
  • Pediatric Intracranial Angiography
  • Transcranial doppler
  • Cranial ultrasound
  • EMG and nerve conduction studies
  • Polysomnography with or without epilepsy monitoring and intensive gastrointestinal cardiac or pulmonary evaluation
  • Neuropsychological and psychological evaluation

Cardiothoracic Surgery

CHOC Children’s Specialists Cardiothoracic Surgery provides cardiothoracic surgery, medical treatment and follow-up care to infants, children and adolescents to repair congenital heart defects. Our pediatric cardiothoracic surgeons have completed a residency in general surgery as well as thoracic or cardiothoracic surgery, and a fellowship in congenital cardiac surgery.

CHOC has long been a leader in cardiac surgical care. Our team was instrumental in the development of new systems used to protect children’s hearts during surgery and improve heart-lung machine technology. We worked with bioengineers at Quest Medical to develop techniques and instruments that could be used to bring cardiopulmonary bypass technology to children and infants, previously available only for adults. CHOC was the first institution to offer this lifesaving technology that is now used in more than 60 institutions around the globe.

CHOC’s cardiothoracic surgeons lead the way in raising the standard of care and surgical outcomes for neonates undergoing open heart surgery. CHOC Children’s heart surgery program has the only facility in Orange County that performs newborn and pediatric open-heart surgery, and has dedicated cardiovascular operating rooms with extracorporeal life support (ECLS) and a Cardiovascular Intensive Care Unit (CVICU).

Our cardiothoracic surgeons direct the ECLS program for the hospital.  The ECLS program at CHOC is a member of the International Extracorporeal Life Support Organization (ELSO) and has been designated an ELSO “Center of Excellence” .  CHOC’s ECLS program provides life saving technology  to neonates thru adolescents with heart and/or lung failure.

For more than a decade, CHOC has been a member of the Society of Thoracic Surgeons (STS) National Database, an international benchmarking organization that sets the highest standards for hospitals performing heart surgery. CHOC was among the first 15 institutions to join the registry and report surgical outcome data. Today, there are more than 130 premiere hospitals in the STS database.

The CHOC Children’s Specialists Cardiothoracic team offers a full range of surgical procedures to correct heart and thoracic defects:

Heart Conditions

In addition to congenital heart defects, our cardiothoracic surgeons perform procedures to correct lung and chest wall defects as well as complex vascular procedures to place specialized lines for renal dialysis and chemotherapy.

Thoracic Conditions

  • Chest wall and lung malignancies
  • Lung defects – congenital pulmonary airway malformations, pulmonary sequestration, spontaneous pneumothorax
  • Lung infections
  • Pectus excavatum
  • Complex vascular access

Multidisciplinary Approach

CHOC’s multidisciplinary care complements these clinical services. Other members of the care team include additional specialists, interventionists, anesthesiologists, perfusionists, intensivists, cardiovascular nurse practitioners, respiratory therapists, dietitians, social workers, child life specialists and case managers, all of whom have specialized training and expertise.


Leading-Edge Cardiodiagnostic Services

The CHOC Children’s Specialists Cardiothoracic team is fully equipped with advanced cardiodiagnostic equipment:

 

Neurosurgery

While every effort is made for nonsurgical intervention, surgery can often be the answer to saving or improving a child’s life.

Our board certified neurosurgeons bring the highest levels of expertise and experience to even the most complex disorders of the brain, spine and central and peripheral nervous systems. They have been widely recognized for their innovation in advancing the field, including new or improved treatments for hydrocephalus, spasticity, dystonia and chronic pain. Our participation in clinical trials also provides new options for children who need more than conventional treatments.

We surgically treat the full spectrum of neurological conditions and injuries with the latest procedures:

Epilepsy

When medication isn’t enough, a number of different surgical options may help alleviate a child’s seizures. The most common procedure removes the part of the brain that is causing seizures or disconnects certain nerve pathways that spread the seizure impulses. Our neurosurgeons were among the first to perform a less invasive surgical option that places a vagus nerve stimulation device in a patient’s chest – much like a pacemaker – and sends pulses that minimize seizures.

Cerebral Palsy and Spasticity

Cerebral palsy may cause a child to have muscle weakness, poor motor control, shaking, or stiffness of the arms or legs. Our neurosurgeons have been at the forefront of treating these symptoms, and we were the first in the region to implant an intrathecal pump that delivers low-dose medication to the spinal cord and brain, causing the muscles to relax. Other surgical options include selective and non-selective dorsal rhizotomy, which involves cutting sensory nerve fibers in the spinal cord to balance out the messages of flexibility and stiffness that are sent to the muscles.

Hydrocephalus

We are the region’s leader in treating complex multicystic hydrocephalus, a condition that causes too much cerebrospinal fluid in parts of the brain. Our neurosurgeons have pioneered two unique treatments: a valve that is implanted in the brain and drains fluid, and an endoscopic third ventriculostomy, which involves making a tiny hole in the wall of the third ventricle, allowing fluid to move out of the blocked ventricle and eliminating the need for a valve.

Tumors of the Brain and Spine

Our neurosurgeons work closely with neurologists and neuro-oncologists to determine the most effective treatment plan for brain and spine tumors, including gliomas, medulloblastomas, meningiomas and pituitary gland tumors, which can often be removed endoscopically. Diagnosis and removal of a tumor are often done during the same procedure to increase the chances for a cure. Surgery may be used in combination with chemotherapy and radiation therapy to eliminate a tumor.

Moyamoya Disease

Surgery is the only option for long-term treatment of Moyamoya disease, which is a rare condition causing a narrowing of the arteries at the base of the brain and preventing blood flow to the brain. Surgery at the microvascular level requires extreme precision and expertise. Our neurosurgeons are highly experienced in treating Moyamoya disease with brain revascularization, which involves creating new vascular pathways that reroute blood flow to the brain from other areas.

Craniofacial Syndromes

At birth, a baby’s skull bones are still developing and fusing together, a process that takes about a year. Bones that fuse too early or too late can result in a craniofacial syndrome, which can damage the brain. Surgery can correct the malformations by removing, replacing or recontouring parts of the skull. We specialize in distraction osteogenesis, a method of moving two parts of a bone slowly so that new bone fills in the gap, as well as an endoscopic procedure that corrects a craniofacial problem using surgical instruments through the nasal passage, rather than opening a patient’s skull.

Birth Defects

Birth defects of the head and spine can include: encephaloceles, when a baby is born with a part of his or her brain protruding from the skull; a Chiari malformation, when brain tissue extends into the spinal canal; syringomyelia, when a cyst or hole forms in the spinal cord; spina bifida, when the spinal bones don’t close properly; and a tethered spinal cord, when the spinal cord becomes attached to the spinal column rather than floating freely. Our neurosurgeons are adept at a number of surgical procedures to repair and improve a host of congenital birth defects, including the rarest cases.

Brain Cysts

Cysts in the brain, such as a dermoid or arachnoid cyst, are tumor-like spheres filled with liquid. Surgery can be used to remove all or part of a cyst so that vital functions of the brain are not impaired. We specialize in an endoscopic procedure that corrects the problem using surgical instruments through the nasal passage, rather than opening a patient’s skull.

Concussion and Head/Spinal Cord Trauma

A traumatic injury to the head or spine requires immediate care and may require a surgical procedure such as surgical decompression, craniotomy and surgical drainage, surgical debridement and evacuation, surgical elevation and decompressive craniotomy with duraplasty.

Mistry, Pankaj – M.D.

Pankaj Mistry, MD, is a Neonatologist with the CHOC Children’s Specialists. Dr. Mistry is board certified in pediatrics and neonatal-perinatal medicine. Dr. Mistry attended medical school at Goa Medical College, Goa, India. He completed his residency training program in pediatrics at Interfaith Medical Center, SUNY/Downstate Medical Center, Brooklyn, New York. Dr. Mistry served his fellowship in neonatal–perinatal medicine at UCLA Medical Center, Los Angeles, California.

Physician Profile

Singh, Harjinder – M.D.

Harjinder Singh, MD, is a Neonatologist with the CHOC Children’s Specialists. Dr. Singh is board certified in pediatrics and neonatal-perinatal medicine. Dr. Singh attended medical school at the University College of Medical Sciences, Delhi University, India. He completed his residency training program in pediatrics and served his fellowship in neonatal –perinatal medicine at Loyola University Medical Center, Maywood, Illinois.

Physician Profile

Krishnan, Ravi – M.D.

Ravi Krishnan, MD, is a Neonatogist with the CHOC Children’s Specialists. Dr. Krishnan is board certified in Pediatrics and Neonatal-Perinatal Medicine. He attended medical school at Madnras Medical College & Government General Hospital, Madras, India. He completed his residency training in pediatrics at St. Lukes – Roosevelt Hospital Center, New York, New York. Dr. Krishnan served his fellowship in neonatology at Children’s Hospital of Michigan, Detroit.

Physician Profile

Arpan Global Charities – 2013 Mission Suyay to Latacunga, Ecuador

Arpan Global Charities is a nonprofit organization established in 2005 by one of the members of the CHOC Children’s Specialists, Dr. Sudeep Kukreja. The goal of AGC is to bring health and hope to medically underserved populations around the world while providing humanitarian assistance and medical education to those who need it the most.

 

Arpan Global Charities’ 13th international medical volunteer mission took place in the city of Latacunga, Ecuador and a team of 52 dedicated medical and non-medical volunteers participated. Team members had diverse backgrounds and many years of experience in their respective fields and among them were: five nurses; five pediatric residents from CHOC Children’s; an Echo Tech; three Anesthesiologists; seven Pediatricians; one Cardiologist; one Dentist; one Geneticist; one Gynecologist; one CT surgeon; one ENT surgeon; one Ophthalmologist; one Plastic surgeon; two General Pediatric surgeons; one Pediatric Orthopedic surgeon; one Orthopedic surgeon for adults; one Radiologist; one Pharmacist, and 10 non-medical volunteers.

 

Volunteers arrived from the United States to Quito in waves and landed in Quito’s new airport which is located approximately 90 minutes away from the city. Although team members faced multiple challenges due to delayed airport pick-ups, lost luggage, and late arrival to hotel in Quito at 2:30 a.m.; the volunteers were eager to start working so they rushed to their rooms to get some rest and were ready at 6 AM the next morning for the bus ride to their final destination, the small town of Latacunga. After a two-hour trip, the team arrived to a government clinic named Patronato where they immediately examined hundreds of patients and pre-screened them for treatments and/or surgery. Arpan Global Charities rented two facilities with operating rooms in Latacunga for surgeries: Clinica Continental and Instituto de la Mujer. Also some surgeries were performed by Pediatric Orthopedic surgeon and the Geneticist at Baca Ortiz Children’s Hospital in Quito. Furthermore, Arpan’s Genetic doctor took the initiative to collaborate with local physicians to organize a genetic conference scheduled to take place at the Sheraton hotel in Quito for the “Rare Diseases Day.” While reaching out and collaborating with local physicians, our medical team established a promising relationship with Quito’s medical faculty to discuss the development of a partnership between CHOC Children’s and Baca Ortiz Children’s Hospital in Quito to promote international collaboration and exchange programs.

 

Volunteers of Arpan Global Charities also visited four different orphanages in Latacunga and Quito where they examined every orphan residing in those centers and facilitated treatment, distributed clothes, and donated toys. Mission volunteers also had the opportunity to visit two schools located in very poor areas of their town where they examined every student and discovered some children who had undiagnosed serious medical conditions for which treatment was facilitated. The team of Anesthesiologists and Nursing staff provided supportive services to patients in the recovery room which allowed skilled surgeons to perform more than one hundred major surgical procedures. With the help of an Echo Technician, the Cardiologist volunteer was able to examine and treat hundreds of patients. Even the Dentist surgeon was kept extremely busy from 8 a.m. to 6 p.m. everyday with long lines of patients eagerly waiting to see him.

 

The help and support of the nursing members, pediatric residents, pharmacist, non-medical volunteers, Ecuadorian volunteers and Ecuadorian medical students was phenomenal. This mission would have not been possible without them. Besides providing free medical care to the most underserved population in Ecuador, Arpan Global team members were also involved in education of local nurses, medical students, and doctors in both Latacunga and Quito.

 

Considering that team members had limited equipment and very scarce medical supplies, it is important to acknowledge their caring attitude and sense of commitment for these qualities enabled them to work long hours on a daily basis to provide humanitarian healing to all their patients. Indeed, the team’s dedication and hard work enabled Arpan Global Charities to touch the lives of more than 1,500 Ecuadorian children and adults. A lot was accomplished during this missionary trip which makes it one of the most exciting and successful medical volunteer mission of Arpan Global Charities.

 

A very special thanks to the Baum Family (Paulina, Carlos, Monica, Jose and grandparents) from Quito for their relentless help and support to make this mission a big success.

 

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Reyna, Troy – MD

Troy Reyna, MD, FACS, FAAP is a CHOC Children’s Specialist Pediatric Surgeon, board certified in Pediatric Surgery and General Surgery by the American Board of Surgery. Dr. Reyna is a graduate of the United States Military Academy at West Point, New York where he majored in chemistry. He received his medical degree from Georgetown University Medical School, Washington, D.C. He completed his surgical internship at Walter Reed Army Medical Center, Washington, D.C. and his surgical residency at Tripler Army Medical Center, Honolulu, Hawaii. Dr. Reyna served his Pediatric Surgery fellowship at Columbus Children’s Hospital, Columbus, Ohio.

 

Dr. Reyna retired from the U.S. Army after serving as an officer for 21 years. He was stationed in Germany, Central America, and Iraq during “Operation Desert Storm”. He is a faculty member and instructor of Advanced Trauma Life Support with the American College of Surgeons. He is a fellow of the surgical section, the section on critical care, and the section on child abuse and neglect with the American Academy of Pediatrics. Dr. Reyna is a certified diplomate of the American Board of Forensic Examiners.

 

With his private practice in Las Vegas, Nevada, Dr. Reyna was one of the first to introduce minimally invasive surgery for children. The first laparoscopic cholecystectomy (gallbladder removal) was performed by Dr. Reyna in 1993. The first laparoscopic Nissen fundoplication was done in 1996. Through the years, his methodology has advanced and changed with the times, but his goal remains unchanged: ”To provide the best care for our children.”

 

Dr. Reyna’s clinical interests include Hirschsprung disease, pectus excavatum and carinatum surgery, and the care and management of childhood cancers. He speaks fluent German and Spanish.

 

Physician’s Profile

Pechulis, Georgie – MD

Georgie Pechulis, M.D. is a CHOC Children’s Specialist Hospitalist. Dr. Pechulis received her medical degree from the University of Illinois, Chicago, Illinois. She completed her residency in Pediatrics at CHOC Children’s, Orange, California, and was then Chief Resident. Dr. Pechulis is licensed by the Medical Board of California and is affiliated with the American Academy of Pediatrics.

 

Dr. Pechulis enjoys outdoor activities, including running, biking surfing, hiking, snowboarding and traveling. She speaks fluent Spanish.

 

Kim, Sharon – M.D.

Dr. Sharon Kim is a CHOC Children’s Specialist in Neurology, board certified in Pediatrics by the American Board of Pediatrics and board certified in Neurology with Special Qualification in Child Neurology by the American Board of Psychiatry & Neurology.

 

Dr. Kim received her medical degree from Drexel University College of Medicine, Philadelphia, Pennsylvania. She completed her residency in pediatrics at New York University Medical Center in New York, New York. She served her fellowship in clinical neurophysiology at UC Irvine Medical Center in Orange, California and her fellowship in pediatric neurology at CHOC Children’s and UC Irvine Medical Center, Orange, California.

 

Dr. Kim’s clinical interests include neuromuscular medicine and epilepsy. She is well-versed in Electromyography (EMG) and nerve conduction studies. Dr. Kim is affiliated with the American Academy of Neurology and the American Medical Association.

 

Tran, Lily – M.D.

Lily Tran, M.D. is a CHOC Children’s Specialist in Neurology, specializing in Pediatric Neurology and Pediatric Epilepsy. Dr. Tran is board certified in Child Neurology by the American Board of Psychiatry and Neurology.

 

Dr.Tran attended medical school at the University of Rochester, New York. She completed her internship and residency training at Rainbow Babies and Children’s Hospital in Cleveland, Ohio. She served her fellowship in child neurology at Rainbow Babies and Children’s Hospital and her fellowship in clinical neurophysiology at University Hospitals in Cleveland, Ohio.

 

Dr. Tran is a current member of the American Academy of Neurology. She speaks fluent Vietnamese. Dr. Tran’s philosophy of care centers on teamwork.

 

“It’s teamwork between myself and the family/primary caregiver to provide the best care for my patients.” – Dr. Lily Tran

 

Lebel, Sylvie – M.D.

Sylvie Lebel, M.D. is a CHOC Children’s Specialist in Gastroenterology. She is board certified in Pediatric Gastroenterology and Hepatology & Transplantation with the American Board of Pediatrics. Dr. Lebel received her medical degree at McGill University, Montreal, Canada. She completed her internship , residency and fellowship training in Pediatrics and Pediatric Gastroenterology at the University of Manitoba, Winnipeg, Canada. She served her fellowship in Pediatric Gastroenterology, Pediatric Liver Transplantation and Immunology Research at the University of Toronto, Canada. Dr. Lebel also received her Masters in Physiology at the Royal College of Physicians and Surgeons of Canada – Clinician Investigator Program at the University of Toronto, Canada.

Nelson Mandela Hospital Executives Visit CHOC Children’s

CHOC Children’s was recently honored to host a visit from Nelson Mandela Children’s Hospital Leaders. Visitors included Sibongile Mkhabela, CEO, and Nana Magomola, Hospital Trustee.

 

The purpose of the visit was to gain insight and clinical information in preparation for the new Nelson Mandela Children’s Hospital currently under construction in Johannesburg, South Africa, scheduled to open in 2014.

 

 

From left to right: Dr. Paul Lubinsky, Dr. Leonard Sender, Nana Magomola, Sibongile Mkhabela, Jennifer Trubenbach, Kim Cripe, Joyce Morell, Dr. Nick Anas