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Biomedical subjects

B W Goetzman

Publications and source records attributed to B W Goetzman.

65 records · Page 4Linked to original sources
PubMed1976

Neonatal hypoxia and pulmonary vasospasm: response to tolazoline.

Forty-six neonates with hypoxemia were treated with tolazoline, a pulmonary vasodilator, within the first two days of life. Eight of ten (80%) infants without apparent lung disease responded with a mean increase in PaO2 of 116 torr within one hour of beginning tolazoline infusions. One of the responding infants and two nonresponders died. Thirty-six additional infants with a variety of pulmonary disorders had severe hypoxemia which was refractory to mechanical ventilation. Twenty-one (58%) responded with a mean increase in PaO2 of 130 torr within one hour after beginning tolazoline and 13 (62%) of these survived. Fifteen patients had little or no improvement in PaO2 following tolazoline and only three (20%) of these infants survived. Responders could not be distinguished from nonresponders by clinical or laboratory features prior to therapy with tolazoline. Fourteen infants experienced complications possibly related to tolazoline.

Female↗
PubMed1975

A walking donor program for an intensive care nursery.

Repeated transfusions of small increments of blood are frequently required for the sick newborn infant to correct endogenous hypovolemia and/or to replace blood obtained repeatedly for monitoring purposes. Current practices of blood banks are rarely geared to supply the small amounts of blood used for these individual transfusions. To provide a more efficient system, a walking donor program was established in which an appropriate hospital-based individual is cross matched as a donor for an infant for the duration of the infant's hospital stay. The program eliminates wastage of blood and donors and reduces the number of infectious agents to which the infant may be exposed.

ABO Blood-Group System↗
PubMed1975

Thrombotic complications of umbilical artery catheters: A clinical and radiographic study.

Catheterization of the aorta via the umbilical artery provides a convenient route for monitoring arterial blood pressure, for obtaining blood specimens for measurement of blood gas tensions and chemistries, and for the infusion of fluids and pharmacologic preparations in sick newborn infants. Use of this technique may be accompanied by a number of complications of which thrombotic phenomena are the most common. Twenty-three of 98 (24%) newborn infants undergoing umbilical artery catheterization were found to have thrombotic complication determined by aortography. No correlation was present between the duration of time that the umbilical artery catheters were in place and the occurrence of thrombotic complications. From paired aortographic or aortographic and autopsy studies in 24 patients, it was concluded that if a thrombotic complication did not occur early, none was likely to occur subsequently. One patient was considered to have died as a direct result of a thrombotic complication. Aortography is a safe, simple, and reliable technique for the early detection of thrombotic complications of umbilical artery catheters. Umbilical artery catheterization is not without risk and careful selection of patients for this procedure is indicated.

Aortography↗
PubMed1969

The effects of alloxan and histamine on the permeability of the pulmonary alveolocapillary barrier to albumin.

1. [(131)I]albumin transport from alveolus to perfusion fluid was evaluated in an isolated dog lung lobe preparation perfused at constant pressure with homologous plasma. The alveoli were filled with a 1:1 mixture of Ringer-Tyrode solution and plasma.2. For twenty-three lung lobes, an average control permeability coefficient of the alveolocapillary membrane for albumin was found to be 1.9 x 10(-9) cm/sec with a range of (0.3-5.5) x 10(-9) cm/sec.3. Alloxan in concentrations of 0.22-2.50 mg/ml. perfusate was observed to increase the alveolocapillary membrane permeability to [(131)I]albumin with a positive correlation between dose and effect. The larger doses of alloxan increased the permeability by a factor of ten or more.4. Glutathione (GSH), administered intravascularly 2 min before alloxan in an 8:1 molar ratio of GSH:alloxan, delayed the onset of the permeability increase due to alloxan by 40-60 min but did not influence the maximum increase in permeability.5. Histamine administered intravascularly in concentrations from 0.02 to 0.50 mug/ml. perfusate had no significant effect on the alveolocapillary membrane permeability to [(131)I]albumin.

Albumins↗
PubMedDate not supplied

Normocarbic hyperventilation fails to induce pulmonary vasodilation.

The pulmonary vasodilator effect of increased rate of mechanical ventilation, with and without respiratory alkalosis, was studied in chronically instrumented newborn lambs. Pulmonary hypertension was first induced by ventilating with a hypoxic gas mixture. Subsequent respiratory alkalosis caused significant decreases in pulmonary arterial pressure and pulmonary vascular resistance. When normocarbia was re-established by adding carbon dioxide to the inspired gas, with the ventilator rate being held constant, the pressure and resistance returned to the baseline hypertensive state. Therefore, mechanical factors, either direct or indirect, appear to be of minor importance in the mechanism of pulmonary vasodilation secondary to frequency-induced hyperventilation.

Alkalosis, Respiratory↗
PubMedDate not supplied

Effect of pulmonary hypertension on lung compliance in newborn lambs.

We studied the effects of increased pulmonary arterial pressure and vascular resistance on lung compliance in 12 anesthetized newborn lambs. Lung compliance was unaffected by large changes in pulmonary artery pressure and pulmonary vascular resistance (80% increase) that were induced by either hypoxia or acidosis. We conclude that contraction of the pulmonary vascular smooth muscle in normal newborn lambs does not affect the stiffness of the lung in the parenchymal regions undergoing volume change during ventilation.

Animals↗
PubMedDate not supplied

Brain injury and protective effects of hypothermia using triphenyltetrazolium chloride in neonatal rat.

Colorless 2,3,5-triphenyltetrazolium chloride (TTC) is reduced by enzymes in functioning mitochondria to a red-colored compound, and has been used to differentiate areas of viable tissue from areas of infarction in adult animals. TTC was used to study the central nervous system protective effects of hypothermia on the neonatal rat exposed to hypoxia and ischemia. The effect of hypothermia on survival and weight gain was also determined. Seven-day-old Wistar rats with right carotid artery ligation were exposed to 3 hours of 8% oxygen and maintained at either 37 degrees C (n = 22) or 30 degrees C (n = 18). The survivors were sacrificed 2 days later and brain slices exposed to TTC. These slices were photographed and the percentage of damage to the right brain was estimated gravimetrically from the stained and unstained areas of enlarged images. The mean weight gains were 4.2 +/- 1.2 gm in the 30 degrees C group and -1.0 +/- 2.8 gm in the 37 degrees C group (P < .001). The survival in the 37 degrees C group was 77% and in the 30 degrees C group 100% (P < .025). The mean percentage damage to the right side of the brain in the 37 degrees C group was 45.5% (range: 0-87.5%); there was no detectable damage in any of the 30 degrees C group pups (P < .0001). In our study, TTC proved to be a rapid and simple method for assessing central nervous system injury in the neonatal rat. This study also confirms that moderate hypothermia is protective against hypoxic-ischemic brain injury.

Animals↗
PubMedDate not supplied

A walking blood donor program for seriously ill premature infants.

Premature infants with hyaline membrane disease and related disorders are frequently hypovolemic. Furthermore, they frequently require repeated phlebotomies for laboratory evaluation of electrolytes, pH, oxygen tension, and other parameters. Adequate care of such infants is aided by small transfusions of heparinized blood. The walking donor program at the Sacramento Medical Center premature nursery furnishes these transfusions without exposing the infants to the hazards of receiving blood from many different donors. The program is described in detail, and the shortcomings of some of the alternative programs are pointed out.

Blood Donors↗
PubMedDate not supplied

Percutaneous and surgical placement of fine silicone elastomer central catheters in high-risk newborns.

Percutaneous insertion of fine silicone elastomer catheters (0.6 millimeters outside diameter) have been used for central parenteral nutrition of very low birth weight and other high risk infants. Because peripheral venous access can be limited in the newborn, we report the previously undescribed surgical cannulation of the superficial arm veins with this catheter, and compare our experience with this technique and the percutaneous method in neonates. A central catheter position was attained in 88% of surgical (38 of 43) and 74% of percutaneous (17 of 23) cannulations. The two groups did not differ in birth weight or gestational age. The mean duration of catheterization was similar in the two groups (combined means = 21.8 +/- 2.3 days SEM). There was no difference in weight gain (combined means = 16.9 +/- 1.0 grams SEM per day) or head growth (combined means = 1.1 +/- 0.1 millimeters per day) between the groups and these rates approximated known fetal growth rates for our mean gestational age. Disseminated candidiasis, in a 770-gram infant with thymic hypoplasia, caused the only systemic infection and death among our 49 patients. The most commonly encountered problem was catheter occlusion secondary to a blood clot at the tip of these fine catheters (8 of 55). No thromboembolic events were recognized, and minor complications were not different with the two techniques. Surgical cannulation of the superficial arm veins offers a safe alternative to percutaneous central silicone elastomer catheter placement if superficial venous access is not available. Both methods provided early, adequate parenteral nutrition without excessive fluid intake in our high-risk infants, and undoubtedly contributed to a favorable neonatal outcome.

Catheterization↗