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Biomedical subjects

B W Goetzman

Publications and source records attributed to B W Goetzman.

At least 55 records · Page 3Linked to original sources
PubMed1980

Thrombocytopenia and pulmonary hypertension in the perinatal aspiration syndromes.

Thirty-three of 616 consecutively admitted newborn infants had trombocytopenia (platelet count less than 150,00/mm). Only 16 of these were among the 356 infants with lung disease. However, 12 of the 16 were among the 90 infants with a diagnosis of a perinatal aspiration syndrome. The 12 thrombocytopenic infants were the only infants with PAS considered to have pulmonary hypertension. The duration of significant right-to-left shunting of blood paralleled the duration of thrombocytopenia in these infants; PHN was not associated with thrombocytopenia in other neonatal lung diseases. Thus, platelets appear to be important in the pathogenesis of PHN complicating PAS.

Humans↗
PubMed1980

Pulmonary vascular histamine receptors in newborn and young lambs.

Histamine H1- and H2-receptor-mediated pulmonary vascular responses were evaluated in six newborn and three 4-wk-old lambs. Base-line pulmonary vascular resistance (PVR) was elevated via alveolar hypoxia. Changes in PVR were then determined over a range of 0.001-1.0 microgram/kg of histamine. Multiple phases of relaxation of PVR were observed in all lambs. Two distinct plateaus of relaxation occurred between 0.001 and 0.075 micrograms/kg of histamine. The response at the first and major plateau was abolished by the H1-receptor antagonist, diphenhydramine. The second and smaller relaxation appeared to be attenuated by the H2-receptor antagonist, metiamide. Qualitatively similar results were obtained in the older lambs. Larger doses of histamine, 0.1-1.0 microgram/kg, produced further, but variable decreases in PVR as well as changes in systemic blood pressure. Our findings in newborn lambs are in contrast to those in adults where less sensitive H1-receptors mediate pulmonary vasoconstriction.

Animals↗
PubMed1980

Tracheal asiration and its clinical correlates in the diagnosis of congenital pneumonia.

Tracheal aspirates were obtained from 320 newborns with respiratory distress and one or more perinatal risk factors for infection. Samples were obtained before 8 hours of age, either by direct aspiration or immediately following intubation. Twenty-five infants had bacteria present in the aspirate smear. In each case a pure culture of the organism suspected by smear morphology was grown. The same organism was isolated from blood in 14 of the 25 newborns suspected of having pneumonia. The remaining 11 infants had clinical courses, depressed mature neutrophil counts, and elevated band to total neutrophil ratios consistent with bacterial infection. Twenty-five infants without bacteria in the tracheal aspirate smear were randomly selected as a comparison group. Three of these infants had positive blood cultures, and one of the three also grew the same organism from the tracheal aspirate. The chest radiograph was abnormal in all infants but did not discriminate patients with or without pneumonia. We conclude that examination of the tracheal aspirate obtained within the first 8 hours of age is helpful in the early diagnosis of congenital pneumonia.

Bacteria↗
PubMed1980

Prognosis of intracranial hemnorrhage in neonates.

Eleven of 21 infants with intracranial hemorrhage documented by computerized axial tomography survived and have had serial developmental assessments. Six of nine infants with intraventricular hemorrhage (IVH) are developing normally, as is one of two infants with isolated subtentorial hemorrhage. According to our system for grading the severity of IVH, severe IVH correlated best with mortality and less well with developmental delay in survivors. Contrary to past impressions, IVH, even if severe, does not uniformly lead to a poor developmental outcome in surviving infants.

Age Factors↗
PubMed1979

Increased systemic vascular resistance in neonates with pulmonary hypertension.

The time necessary for aortic diastolic pressure to decrease to 50 percent of an initially selected value after dissipation of the dicrotic notch (T 1/2) was determined in newborn infants with and without pulmonary hypertension. The mean T 1/2 was 671 +/- 167 msec in seven infants with clinical evidence of pulmonary hypertension and documented right to left ductus arteriosus shunting; 849 +/- 243 msec in nine infants with clinical evidence of pulmonary hypertension but no documented right to left ductus arteriosus shunting; and 457 +/- 66 msec in eight infants with hyaline membrane disease and no clinical evidence of pulmonary hypertension or a patent ductus arteriosus. The mean T 1/2 values in the former two groups were significantly different from that in the group with no pulmonary hypertension (P less than 0.01). An evaluation of factors affecting T 1/2 leads to the conclusion that the patients with pulmonary hypertension had increased systemic vascular resistance as well. This finding has important diagnostic, etiologic and therapeutic implications.

Ductus Arteriosus↗
PubMed1979

Assessment of patent ductus arteriosus shunting using diastolic pressure analysis.

Ductal shunting significantly affected the time necessary for aortic diastolic pressure to fall to one-half an initially selected value (t1/2). Fourteen premature infants with clinical evidence of left-to-right ductal shunting had a mean t1/2 of 277 msec (range 133 to 383 msec) compared with a mean t1/2 of 455 msec (range 332 to 567 msec) in 14 neonates with no clinical evidence of ductal shunting (P less than 0.01). Seven older infants with ductal shunting confirmed at cardiac catheterization had a mean t1/2 of 360 msec (range 240 to 392 msec). Infant catheterization data and animal studies are suggestive of an inverse relationship between the magnitude of shunt and the t1/2. The t1/2 determined by diastolic pressure analysis is a useful method for serial evaluation of ductus arteriosus shunting.

Child, Preschool↗
PubMed1979

Pulmonary vasodilator action of tolazoline.

The pulmonary vasodilator action of tolazoline in newborn lambs was shown to be mediated via histamine receptors. Maximal changes in pulmonary vascular resistance, deltaPVR, were calculated as percents of the base line value, %deltaPVR. The mean %deltaPVR after tolazoline, 1 mg/kg, was -25 +/- 4% for eight lambs. Four lambs then received the histamine H1 receptor antagonist, diphenhydramine, and the mean %deltaPVR due to tolazoline was -12 +/- 4%. Four lambs received the H2 receptor antagonist, metiamide, and the mean %delta PVR due to tolazoline was -18 +/- 5%. After both H1 and H2 antagonists, the mean %deltaPVR due to tolazoline was +6 +/- 8%. Therefore, both histamine H1 and H2 receptors were involved in the vasodilator response to tolazoline.

Animals↗
PubMed1979

Effect of heparinization of fluids infused through an umbilical artery catheter on catheter patency and frequency of complications.

Heparinization of fluids (1 unit/ml) infused through an umbilical artery catheter (UAC) was efficacious in prolonging catheter patency in a double-blind, randomized, controlled clinical study. On the basis of life-table analysis, the half-life of catheter function was seven days in the heparinized group as compared with just over two days in the nonheparinized group (P less than .01). UAC occlusion occurred in 4 of 32 patients in the heparinized and 19 of 30 in the nonheparinized group (chi 2 = 17.6, P less than .01). Blood transfusions, number of arterial blood gases drawn through the UACs, and fluid infusion rates were not related to catheter occlusion. Heparinization of the UAC infusion did not alter the partial thromboplastin time or the incidence of catheter-related thromboembolic phenomena in the extremities. Heparinization of fluids infused through a UAC appears to be useful in the care of critically ill neonates.

Blood Gas Analysis↗
PubMed1978

Renovascular hypertension as a complication of umbilical arterial catheterization.

Renovascular hypertension (RVH) in the neonatal period is frequently associated with thromboembolic complications of umbilical artery catheterization. Seven newborn infants with RVH were studied by angiography and/or radionuclide examination. Aortography and, in one case, selective angiography showed variable degrees of renal artery occlusion or attenuation. Thromboembolic defects were frequently present in other vessels. Radionuclide flow studies, renograms, and computer analysis of data (ADAC) demonstrated defects in renal function, indicative of renal ischemia. There was a high degree of correlation between angiographic and radionuclide studies. Successful medical management suggests a more conservative alternative to nephrectomy in the hypertensive newborn.

Angiography↗
PubMed1978

Nonsurgical management of renovascular hypertension in the neonate.

Over an 18-month period nine infants in a neonatal intensive care unit developed hypertension (blood pressure, 115/88 to 280/140 mm Hg) at 2 to 45 days of age. Eight of the nine infants had indwelling umbilical artery catheters prior to onset of hypertension; six of the nine infants had evidence of a patent ductus arteriosus. Peripheral plasma renin activity was greater than 300 ng/ml/3 hr in six of eight infants. Angiograms were abnormal in six of seven infants and computerized renal scans were abnormal in all nine infants. One infant had congenital renal artery stenosis. Eight of nine infants had evidence of unilateral or bilateral renal artery thrombi which were felt to have emanated from an umbilical artery catheter or a ductus arteriosus. Hypertension in all infants was successfully controlled medically (follow-up of 3 to 27 months; mean, 14.4 months). Blood pressures remained normal when medication was discontinued. In our experience, neonatal renovascular hypertension is no longer uncommon, responds to aggressive medical management, and rarely requires early nephrectomy. Neonatal renovascular hypertension was usually associated with umbilical artery catheters positioned above the level of the renal arteries.

Adult↗
PubMed1977

Persistent fetal circulation: an evolving clinical and radiographic concept of pulmonary hypertension of the newborn.

The roentgenographic presentations of 11 newborn infants with hypoxemia secondary to pulmonary vasospasm and subsequent right-to-left shunting of blood through the foramen ovale and/or ductus arteriosus (persistent fetal circulation) are described (P. F. C. Syndrome). One infant had radiographically normal lungs, while ten had pulmonary parenchymal abnormalities including hyaline membrane disease [4], meconium aspiration syndrome [4], or an ill defined pattern of retained lung fluid [2]. The roentgenographic appearance of the lungs, however, was discordant with the severe hypoxemia observed in most. Heart size was variable but some degree of cardiomegaly was commonly present. Tolazoline, a potent vasodilator, was useful diagnostically and may have resulted in increased survival. An expanded clinical and roentgeonographic concept of the PFC syndrome is suggested.

Female↗
PubMed1977

Neonatal listeriosis.

Five cases of neonatal listeriosis were diagnosed and treated in a 13-month period. Maternal fever and "greenish discoloration" or meconium staining of amniotic fluid complicated all deliveries. Amniotic membranes were intact until artificial rupture shortly before delivery. One infant, with the "granulomatous" form of the disease, died. Four infants required mechanical ventilation. Two survivors with pneumonia, who required mechanical ventilation and 100% inspired oxygen for persistent hypoxemia, responded to tolazoline hydrochloride therapy. Early institution of antibiotics and aggressive ventilatory and pharmacological support were considered to be important factors in survival.

Adolescent↗
PubMed1977

Computerized axial tomography of the brain in neonates and young infants.

Twenty critically ill infants with abnormal head growth and/or seizures underwent CAT of the brain. Signs of birth asphyxia or respiratory distress were present in all. Six out of ten infants with abnormal size of the head had abnormal CAT scans. Nine out of ten infants with seizures had abnormal scans. Abnormalities included hydrocephalus, intraventricular hemorrhage, cerebral edema, subarachnoid hemorrhage and porencephaly. Six infants required neurosurgical procedures. Development at two to 15 months of age in the 19 surviving infants was normal in nine, suspect in eight, and severely delayed in two patients. Until the prognosis of the various CNS disorders discussed is clearly defined, aggressive management appears indicated.

Asphyxia Neonatorum↗