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Biomedical subjects

C M Cottrill

Publications and source records attributed to C M Cottrill.

50 records · Page 3Linked to original sources
PubMed1981

Pediatric Legionnaires' disease: diagnosis by direct immunofluorescent staining of sputum.

Legionnaires' disease occurred in a 3-year-old boy with Down's syndrome. His illness was characterized by bilateral pneumonia, high fever, and response to erythromycin. The diagnosis was made by demonstrating Legionella pneumophila, serogroup 1, in sputum with a direct fluorescent antibody stain. L pneumophila antigen was detected in urine by an enzyme-linked immunospecific assay. The diagnosis was confirmed by a more than fourfold rise in serum antibody titer. Although Legionnaires' disease appears to be uncommon in children, it should be included in the differential diagnosis of pneumonia in the immunocompromised child.

Antibodies, Bacterial↗
PubMed1981

Echocardiographic mitral valve deformity in the mucopolysaccharidoses.

Previously reported echocardiographic abnormalities in patients with mucopolysaccaridosis and the Hunter-Hurler phenotype have stressed the similarity to calcific mitral stenosis despite the fact that mitral stenosis is a relatively uncommon manifestation of this disease. The purpose of this report is to describe the echocardiographic abnormalities in five patients with the Hunter-Hurler phenotype who had no clinical evidence of mitral stenosis. All had abnormal thickening of the mitral valve leaflets and one had echoes suggestive of calcification of the mitral annulus. All patients had normal electrocardiograms and roentgenographic cardiothoracic ratios, and two patients had no cardiac murmur. The high frequency of valvular deformity in this disease and the sensitivity of echocardiography in detecting these deformities suggest that echocardiography should be performed in the evaluation of patients with mucopolysaccharidosis. When echocardiographic evidence of valvular deformity is obtained, consideration should be given to bacterial endocarditis prophylaxis.

Adolescent↗
PubMed1980

Echocardiography in hypoxemic neonatal pulmonary disease.

Sixteen newborn infants with severe pulmonary parenchymal disease and profound hypoxemia were treated with mechanical ventilation, alkalinization, and intravenous tolazoline. Eight infants responded within two hours of initiation of tolazoline therapy with a rise in Pao2 by at least 100% of pretreatment values (mean = 188%, range = 103 to 427%). Eight infants showed little or no change in Pao2 with administration of tolazoline. Echocardiographic evaluation prior to therapy demonstrated marked elevation in both left (LPEP/LVET = 0.52 +/- 0.13) and right (RPEP/RVET = 0.56 +/- 0.08) ventricular systolic time intervals in the eight infants who subsequently responded to tolazoline. Systolic time intervals in nonresponders were within the normal range (LPEP/LVET = 0.37 +/- 0.03, RPEP/RVET = 0.33 +/- 0.04) and were not significantly different from those observed in a control group of 15 infants with pulmonary disease requiring mechanical ventilation but without hypoxemia. Following tolazoline therapy, systolic time intervals in all eight responders fell to normal values. Echocardiography can provide a safe, noninvasive method for identifying those infants with primary pulmonary disease and severe hypoxemia who could be expected to benefit from tolazoline therapy, thereby avoiding tolazoline side effects in infants for whom tolazoline therapy can be predicted to be of little benefit.

Echocardiography↗
PubMed1980

Cardiovascular responses to exercise following adolescent hypertensive pregnancy.

With the establishment of hypertension as a risk factor for the development of coronary artery disease, more attention is being given to hypertension in youth. Hypertension during pregnancy has been associated with an increased incidence of hypertension in later years. To determine if this could be identified early, a group of adolescents who had been hypertensive during pregnancy and a control group who had normotensive pregnancies were studied by stress exercise testing and compared 4--6 years post partum. At rest, during each phase of graded exercise, and during the postexercise observation period, mean heart rate was significantly higher in the previously hypertensive group. Double product (heart rate x blood pressure), an index of myocardial oxygen consumption, was also significantly greater in the previously hypertensive group. When corrected for body weight and race, the amplitude of the R wave in lead V5 as well as a change in R-wave height with exercise were significantly greater in the group of adolescents who had been hypertensive during pregnancy. The observation of group differences 4--6 years post partum suggests a continuing abnormality that may predispose this group to develop early hypertensive cardiovascular disease.

Adolescent↗
PubMed1980

Effect of respiration on the echocardiogram in children with cystic fibrosis.

Respiration-related cyclic variation was noted in echocardiographic measurements of right and left ventricular end-diastolic dimension. D-E amplitude of the anterior mitral leaflet, and mitral valve E-F slope in 26 children with cystic fibrosis. The observed echographic changes seem to be an exaggeration of the normal physiologic variation seen with respiration. In children with advanced respiratory disease, airway obstruction, rather than cor pulmonale, may be responsible for this exaggeration.

Adolescent↗
PubMed1977

Propranolol therapy during pregnancy, labor, and delivery: evidence for transplacental drug transfer and impaired neonatal drug disposition.

The administration of 160 mg of propranolol during pregnancy, labor, and delivery was associated with profound hypoglycemia and respiratory depression in a newborn infant. The neonate's plasma propranolol level rose from 40 ng/ml at the time of birth to 90 ng/ml four hours later. This increase in plasma propranolol concentration might be due to redistribution of the drug in the neonate as well as to different elimination mechanisms than in adults. The elevated propranolol level four hours after delivery was not associated with any signs or symptoms of drug toxicity, but drug effect was apparent on the electrocardiogram. The administration of propranolol during pregnancy in doses capable of producing therapeutic maternal blood levels may be dangerous to the neonate.

Adult↗
PubMedDate not supplied

Tetralogy of Fallot with absent pulmonary valve and bronchial compression: treatment with endobronchial stents.

Absent pulmonary valve syndrome (APVS) is a rare congenital cardiac lesion. The lesion includes ventricular septal defect, overriding aorta, and absence of the pulmonary valve, with resultant pulmonary incompetence. It has been suggested that the pulmonary incompetence induces intrauterine dilatation of the pulmonary artery, which leads to tracheobronchial compression. One of the presenting features in infants with APVS is severe airway obstruction, which may be difficult to manage. We report an infant who benefited from bilateral endobronchial endoscopic stent placement.

Bronchial Diseases↗
PubMedDate not supplied

Primary cardiac lipoblastoma.

Lipoblastoma is a benign adipose tumor in children that has been described in various anatomic locations, most commonly the extremities. We describe the case of a 17-month-old boy diagnosed with cardiac lipoblastoma, a previously unreported primary cardiac tumor in children. Our patient presented with symptoms of coughing, wheezing, and hoarseness and was found to have a large mediastinal mass, which narrowed the left mainstem bronchus and compressed the right atrium and superior vena cava, causing superior vena cava syndrome. Surgical exploration revealed an intrapericardial soft tissue mass arising from the area of the posterior interatrial septum. Grossly, the resected mass was lobulated, pale yellow, and fatty with focal areas of gray myxoid tissue. Microscopically, the tumor consisted of both immature and mature adipocytes, with focal vascular myxoid areas containing lipoblasts, diagnostic of lipoblastoma. Two months after surgery, the patient was in good health without evidence of recurrence.

Heart Neoplasms↗
PubMedDate not supplied

Plasma renin activity, reactivity, concentration and substrate following hypertension during pregnancy. Effect of oral contraceptive agents.

Plasma renin activity is suppressed in approximately 25% of patients with essential hypertension, and the rate of in vitro angiotensin I production after addition of exogenous renin (renin reactivity) is increased in plasma of hypertensive patients. We have recently observed that blood pressure (116 +/- 1.5/68 +/- 1.7 mm Hg) of young women who had hypertension during a first pregnancy 3--6 years earlier (n = 63) was higher (p less than 0.005) than blood pressure (109 +/- 1.4/61 +/- 1.7 mm Hg) of women who remained normotensive during pregnancy (n = 52). To determine if alterations of the renin-angiotensin axis observed in patients with established hypertension also occur in young adults with relatively high blood pressure, plasma renin activity (PRA), plasma renin concentration (PRC), plasma renin substrate (PRS) and plasma renin reactivity (PRR) were compared in these two groups of subjects. Overall, PRA and PRC were inversely related to systolic blood pressure (p less than 0.02). Excluding women on oral contraceptive agents, the PRA response to standardized treadmill exercise was suppressed (less than 1.0 ng/ml/hr) in 19% of women with a history of hypertension during pregnancy and in no women who remained normotensive throughout a previous pregnancy; PRR did not differ (p greater than 0.8) in the two groups of young mothers (27.1 ng/ml/30 min +/- 1.2 SE VS 26.2 ng/ml/30 min +/- 0.9 SE). Thus, renin suppression, but not increased PRR, precedes the onset of hypertension. Oral contraceptive usage was associated with higher systolic blood pressures, increased PRS, and low PRC. Highest blood pressures and lowest PRA occurred in women with a history of hypertension during pregnancy who were taking oral contraceptive agents at the time of study.

Adolescent↗
PubMedDate not supplied

Low renin in young mothers and their children following hypertension in pregnancy.

Young women who became pregnant as adolescents and developed hypertension during their first pregnancies had higher blood pressures than women who had remained normotensive throughout pregnancy. These young mothers served as subjects for a study to evaluate the relationship between different levels of "normal" blood pressure and renin-aldosterone. Overall, plasma renin activity (PRA), but not plasma aldosterone, was inversely related to systolic blood pressure both before (r = -0.28; p less than 0.003) and after (r = -0.24, p less than 1.01) treadmill exercise. Unrelated to blood pressure, PRA was also lower in blacks and in women using oral contraceptive agents (p less than 0.01). Of women with a history of hypertension in pregnancy, 30% (9 of 30) had low PRA after exercise. Low renin was associated with higher blood pressures. At the time of a second exercise test 3 years later, these women still showed elevated arterial pressure and low renin. PRA was also suppressed in the children of mothers with low renin, and there were significant correlations between maternal and child PRA (r = +0.55; p less than 0.003) and between maternal and child aldosterone (r = +0.60; p less than 0.001). In conclusion, low renin may be an appropriate response to higher arterial pressures, and within families may be a marker of "pre-hypertension."

Adolescent↗
PubMedDate not supplied

Correlates of adolescent blood pressure at five-year follow-up.

In 1973, standardized measurements of blood pressure (BP), height, and weight were obtained on all adolescents attending high school in a rural Kentucky county. In 1978, a 5-year follow-up BP study was undertaken of all adolescents who were 14-15 years old at the time of the initial survey (n = 310), and of selected 16-19 year olds who were in the high, intermediate, and low ranges of the initial sex-specific BP distributions (n = 198). Follow-up measurements included height, weight, and BP on all subjects and, in addition, overnight sodium (Na) excretion, serum cholesterol, glucose, triglyceride, and uric acid concentrations on the older group. Our findings indicate that BP in young adults is related to BP in adoleslcence, change in relative weight since adoleslcence, and current relative weight. Relative rank order of initial BP levels were maintained over the 5-year period in both the younger and older groups. Additional cardiovascular disease risk factors were found to cluster in young adults with high BP, and clustering of risk factors may, in part, be related to high relative weight.

Adolescent↗