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D K Edwards

Publications and source records attributed to D K Edwards.

At least 19 recordsLinked to original sources
PubMed1992

The olive on end: a useful variant of the "shoulder" sign in the barium X-ray diagnosis of idiopathic hypertrophic pyloric stenosis.

We describe a radiographic sign of infantile hypertrophic pyloric stenosis. This sign, elicited during firm compression of the barium-coated pyloric region, is a round or avoid filling defect caused by the hypertrophied pyloric muscle protruding en face into the gastric lumen. This filling defect typically reveals a barium-containing central depression or stellate indentation, representing the proximal end of the obstructed pyloric channel. This sign, like the closely related "shoulder sign", appears to establish the diagnosis of hypertrophic pyloric stenosis without need for filling of the pyloric channel or for additional radiographic maneuvers.

Barium Sulfate↗
PubMed1992

Improving the prediction of surfactant deficiency in very low-birthweight infants with respiratory distress.

With the availability of exogenous surfactant therapy, distinguishing between surfactant deficiency and other causes of respiratory distress soon after birth is critical. Of 149 very low-birthweight (VLBW) infants of 24 to 30 weeks' gestation, 107 (72%) had both clinical and radiographic features of respiratory distress syndrome (RDS). Analysis of amniotic fluid obtained within 24 hours before birth or of the initial tracheal aspirate after birth for phosphatidylglycerol (PG) showed that absence of PG had a positive predictive value (PPV) of 80% for predicting RDS, while an immature lecithin/sphingomyelin (L/S) ratio had a PPV of 86% with a 68% specificity. When PG was absent and the L/S ratio was immature, the PPV for RDS increased to 89% (97% specificity). Phospholipid analysis was superior to gestational age alone in predicting RDS (P less than or equal to .02). Receiver operating characteristic (ROC) analysis detected different thresholds for immature L/S ratios for amniotic fluid (2.0) and initial tracheal aspirate (3.0) for predicting RDS. A tracheal aspirate L/S ratio less than or equal to 3.0 predicted RDS with 91% accuracy, while an amniotic fluid L/S ratio less than or equal to 2.0 predicted RDS with 90% accuracy. ROC curve thresholds for either tracheal aspirate or amniotic fluid permit selection of VLBW infants most likely to benefit from surfactant treatment. These analyses improve the accuracy of diagnosing surfactant-deficiency-associated RDS using only clinical and radiographic diagnoses, and may permit a more focused approach for rescue surfactant therapy in infants presenting with clinical symptoms of respiratory distress.(ABSTRACT TRUNCATED AT 250 WORDS)

Amniotic Fluid↗
PubMed1991

Randomized, placebo-controlled trial of human surfactant given at birth versus rescue administration in very low birth weight infants with lung immaturity.

A randomized, placebo-controlled trial of human surfactant given intratracheally at birth (prophylactic) versus rescue administration after the onset of severe respiratory distress syndrome (RDS) was conducted among preterm infants born at 24 to 29 weeks of gestation. Singleton fetuses were randomly assigned to receive (1) placebo (air), (2) prophylactic surfactant treatment, or (3) rescue surfactant treatment; infants of multiple births received either (1) prophylactic or (2) rescue treatment. Of 282 potentially eligible fetuses, 246 infants received treatments at birth and 200 infants had RDS. Outcomes are presented both as an intention-to-treat analysis (including infants who met exclusion criteria at or after birth) and as a full treatment protocol analysis for those infants with RDS and likely to benefit from surfactant. Preterm infants (mean 1.0 kg birth weight, 27 to 28 weeks of gestational age) randomly assigned to receive prophylactic treatment received surfactant soon after birth; those assigned to receive rescue surfactant had instillation at a mean age of 220 minutes if the lecithin-sphingomyelin ratio was less than or equal to 2.0 and no phosphatidylglycerol was detected in either amniotic fluid or initial airway aspirate, oxygen requirements were a fraction of inspired oxygen of greater than 0.5, and mean airway pressure was greater than or equal to 7 cm H2O from 2 to 12 hours after birth. Up to four treatment doses (or air) were permitted within 48 hours; approximately 60% of surfactant-treated infants required two or more doses. Surfactant-treated infants had significantly less pulmonary interstitial emphysema than placebo-treated infants (p = 0.02), but there were no other significant differences in mortality rates or morbidity. Indexes of oxygenation and ventilation were improved in surfactant recipients during the first 24 hours. An intention-to-treat analysis found no significant differences between infants given placebo and surfactant-treated infants or between prophylactic- and rescue-treated infants; an improved total mortality rate (p = 0.002) was found among surfactant-treated infants in Helsinki but not in San Diego. Among infants with RDS, the total mortality rate was significantly improved (p = 0.004) with surfactant treatment but not the proportion alive and without bronchopulmonary dysplasia at 28 days (p = 0.052), or the proportion alive and without bronchopulmonary dysplasia at 38 weeks of postconceptional age (p = 0.18) to adjust for differences in prematurity. Deaths caused by RDS or bronchopulmonary dysplasia were significantly reduced among surfactant recipients (p = 0.0001). Neither among singletons nor among multiple-birth infants was there a selective advantage to prophylactic versus rescue treatment.(ABSTRACT TRUNCATED AT 400 WORDS)

Bronchopulmonary Dysplasia↗
PubMed1991

Hyperthermia treatment for malignant brain tumors: nursing management during therapy.

Interstitial hyperthermia therapy, the application of heat to control or destroy tumor tissue, is under investigation as an adjuvant treatment for recurrent intracranial malignancies. A brief review of the biologic effects and detailed information of one technique used to treat brain tumors are presented. Management of patients receiving hyperthermia is both challenging and complex. Neuroscience nurses must become knowledgeable about this form of therapy as it is more widely used in brain tumor management.

Adolescent↗
PubMed1991

Synthetic vs human surfactants in the treatment of respiratory distress syndrome: radiographic findings.

Exosurf, a synthetic surfactant, was instilled endotracheally in 49 neonates as treatment for respiratory distress syndrome. The radiologic courses of these neonates were compared with the courses of 18 neonates previously treated with human surfactant and of 18 untreated neonates. The radiologic severity of respiratory distress syndrome decreased significantly in neonates treated with Exosurf compared with that in untreated neonates. Radiologic improvement in those treated with Exosurf was slightly delayed when compared with the improvement of age-matched neonates treated with human surfactant. Otherwise no significant difference was noted between Exosurf and human surfactant in radiologic severity of respiratory distress syndrome or in the prevalence of pulmonary interstitial emphysema, pneumothorax, and bronchopulmonary dysplasia. These findings support the thesis that artificial surfactant is an acceptable substitute for surfactants of biological origin, with possible benefits of safety and ease of use.

Bronchopulmonary Dysplasia↗
PubMed1991

Volumetric interstitial hyperthermia: role of the critical care nurse.

Although statistical survival of patients with malignant brain tumor is dismal and their care can be emotionally exhausting, it is hopeful and rewarding to the critical care nurse to participate in a clinical investigation that will improve the future of these patients. Each therapy cycle administered, each patient treated, and each family member is different; each is a challenge for the critical care nurse. The quality and success of a clinical investigation requires the commitment of many people working together in close team effort. With effective communication, insight, and cooperation the critical care nurse working in this research setting shares in the patient's and family's hope and determination for the future of improved medical and nursing management of malignant brain tumors.

Brain Neoplasms↗
PubMed1991

The BPD problem.

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Bronchopulmonary Dysplasia↗
PubMed1988

Trisomy 21 in newborn infants: chest radiographic diagnosis.

Chest radiographs of 30 infants with trisomy 21 and 881 unaffected infants were evaluated for the following findings common in trisomy 21: multiple manubrial ossification centers, 11 rib pairs, and a bell-shaped chest. Radiographs were obtained in the first 48 hours of life. Of the 881 unaffected infants, 85 (9.6%) exhibited multiple manubrial ossification centers; 46 (5.2%), 11 rib pairs; and 208 (23.6%), bell-shaped chest. Of the 30 infants with trisomy 21, 24 (80%) exhibited multiple manubrial ossification centers; ten (33%), 11 rib pairs; and 24 (80%), bell-shaped chest. The probability of trisomy 21 in routinely radiographed newborn infants is 0.05% when none of the three findings is present, 1.6% with multiple manubrial ossification centers alone, 0.2% with 11 rib pairs alone, and 0.7% with bell-shaped chest alone. The probability of trisomy 21 increases in patients with two findings and reaches 58.4% in patients with all three findings.

Down Syndrome↗
PubMed1988

X-Ray Gogs: preliminary evaluation of a "new" imaging modality.

"X-Ray Gogs," which apparently reveal internal anatomy without radiation, ultrasound, or magnetic fields, were compared with conventional imaging modalities in evaluating a variety of pediatric conditions. Conventional techniques were preferable in terms of diagnostic accuracy and image quality, and are thus recommended in most settings. Because of low cost and lack of ionizing radiation, "X-Ray Gogs" are recommended in cases where radiography is not indicated, or where the results of radiographic study will not influence patient management, or where the diagnosis has already been established by other means.

Radiology↗
PubMed1988

Cystic fibrosis.

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Cystic Fibrosis↗
PubMed1987

Cytomegalovirus infection and bronchopulmonary dysplasia in premature infants.

During a five-year period, 32 preterm infants weighing less than 2000 g were diagnosed as having postnatally acquired cytomegalovirus (CMV) infection in a neonatal intensive care unit. These CMV-infected infants were matched with 32 uninfected controls for gestational age, birth weight, and birth date; the two groups did not differ in Apgar scores or the incidence of respiratory distress syndrome and patent ductus arteriosus. Roentgenographic evidence of bronchopulmonary dysplasia (BPD) developed in 24 (75%) of 32 CMV-infected infants, an incidence significantly greater than that observed in control infants (12/32; 38%). Infants with acquired CMV infection required more respiratory support and longer hospitalization than uninfected controls. This association between acquired CMV infection in premature infants and the development of chronic lung disease provides further evidence that vigorous efforts to prevent CMV infection in hospitalized neonates is warranted.

Bronchopulmonary Dysplasia↗
PubMed1987

Vascular pathogenesis of unilateral craniofacial defects.

The term hemifacial microsomia refers to unilateral defects in development of structures derived from the first and second branchial arches. Recently we evaluated three unrelated children who had a similar pattern of unilateral craniofacial defects that was associated with other structural abnormalities having a disruptive vascular pathogenesis. The clinical findings in these patients suggest that one cause of hemifacial microsomia is in utero interruption of blood flow.

Adolescent↗
PubMed1987

Percutaneous diagnostic and therapeutic interventional radiologic procedures in children: experience in 100 patients.

Diagnostic and therapeutic interventional radiologic procedures that provide many treatment options in adults are gaining acceptance in pediatric medicine. Diagnostic (69 patients) and therapeutic (31 patients) interventional experiences in 100 children are summarized, and the procedures of choice for various clinical problems are outlined. Procedures include percutaneous biopsy for benign and malignant diseases, transhepatic cholangiography and biliary drainage, genitourinary procedures (nephrostomy, stent placement, balloon dilation), aspiration of fluid for laboratory analysis, therapeutic drainage of abscesses and noninfected fluid collections, and percutaneous gastrostomy and gastroenterostomy. Diagnoses were accurate in 96% of cases, and therapeutic procedures were successful in 84% of patients, usually obviating operation. Complications occurred in six patients (6%); the most severe was hemoptysis causing respiratory distress. There was no procedure-related mortality. Interventional procedures have wide applications in pediatric patients.

Adolescent↗