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Biomedical subjects

D K Edwards

Publications and source records attributed to D K Edwards.

At least 55 records · Page 3Linked to original sources
PubMed1981

Newborn tracheal aspirate cytology: classification during respiratory distress syndrome and bronchopulmonary dysplasia.

Cytopathologic examinations of tracheobronchial aspirates from 108 infants sampled during mechanical ventilation demonstrated a well-defined progression of cytologic changes in bronchial cells that could be divided into three classes. Seventy percent of infants with respiratory distress syndrome who developed bronchopulmonary dysplasia had pulmonary effluent cytology designated Class III; no infants with RDS but without BPD had these cytologic findings. Additionally, a temporal progression of events involving polymorphonuclear leukocyte and macrophage populations occurred in the absence of infection; these events were associated with duration of assisted ventilation and oxygen exposure. The technique described provides a useful way to monitor the progression of lung injury and repair and offers a cytologic method to predict and diagnose the development of bronchopulmonary dysplasia.

Bronchi↗
PubMed1981

Acquired lobar emphysema in premature infants with bronchopulmonary dysplasia: an iatrogenic disease?

Five premature infants in whom bronchopulmonary dysplasia developed following prolonged neonatal respiratory support are presented. In all five patients, right middle and/or lower lobe emphysema related to focal obstructing endobronchial masses of granulation tissue subsequently developed. It is speculated that the granulation tissue formed in response to the repeated mechanical trauma of endotracheal tube suctioning.

Female↗
PubMed1981

The cardiothoracic ratio in newborn infants.

In order to provide improved techniques and standards for measuring radiographic heart size in infants, cardiothoracic ratios (C/T) using four different thoracic measures were calculated from anteroposterior supine chest radiographs of 175 normal infants who were a week or less in age, with gestational ages of 26.5-44 weeks, and birthweights of 765-4540 g. The lowest variation in C/T was observed when the thoracic measurement was either the chest width at the inner margins of the eighth ribs (normal range, 43.2%-56.5%) or the maximum internal chest width (normal range, 42.7%-56.4%); by these methods, a value of 57% or greater may be considered enlarged. Average C/T was above normal in 131 infants with respiratory distress syndrome and in 105 infants with various other parenchymal abnormalities. The presence of assisted ventilation did not significantly affect C/T measured as described above. In evaluating level of inspiration by the position of the right hemidiaphragm, posterior rib count proved more predictive of heart size than anterior rib count; the normal inspiratory range was 6.6-9.4 posterior ribs.

Birth Weight↗
PubMed1980

The metacarpal index in normal children.

The metacarpal index (MCI), a radiographic measure of the slenderness of the metacarpals used in screening for the Marfan syndrome, was measured in 185 normal children ranging from two to 18 years of age. The MCI increased from lower values in early childhood to the adult range by approximately 10 to 11 years.

Adolescent↗
PubMed1980

Prediction of gestational age of infants from the abdominal radiograph.

Measurements of lumbar spine elements on abdominal radiographs of 183 white infants were compared with the estimated gestational ages of these infants as determined by physical examination. Using the technique of multiple regression, an equation was derived to predict infant age from the measurements of the spine.

Gestational Age↗
PubMed1980

Assessment of patent ductus arteriosus in preterm infants by single lateral film aortography.

Differentiation of a hemodynamically significant cardiovascular abnormality from lung disease in the newborn infant may remain problematic after clinical, radiographic, and echocardiographic evaluation. Single-view aortography was performed in 38 preterm and one full term infant in the neonatal special care nursery. Special lateral views were obtained consisting of either a horizontal x-ray beam with oblique angulation of the supine patient or a vertical bean with 30 degree head-up angulation of the patient. These views projected the ductus caudal to the aortic arch and enabled visualization of the entire length of the ductus and focal constrictions of the ductus. The severity of patent ductus arteriosus was judged by anatomic (diameter of the ductus compared to the descending aorta) and physiologic (preferential opacification of the aortic arch or pulmonary circulation) criteria.

Aortography↗
PubMed1980

Size of gas-filled bowel loops in infants.

The width of the largest gas-filled bowel loop was measured and numerically divided by measurements of vertebral spine elements as seen on supine abdominal radiographs of 375 infants without suspected abdominal disease. This technique adjusts the bowel diameter for patient size, and permits numerical description of varying degrees of distension. Normal standards are presented, as are the larger values seen with suspected and proved necrotizing enterocolitis and congenital obstructions. The width of the first lumbar vertebral body provides a useful approximation of the upper limit of normal bowel diameter.

Age Determination by Skeleton↗
PubMed1980

The immature lung: radiographic appearance, course, and complications.

Thirty-six premature newborn infants of a very low birthweight (1,500 g or less) are described who did not have respiratory distress syndrome (RDS) by clinical criteria or by biochemical analysis of pulmonary effluent phospholipid (surfactant). Such patients seem to be protected against the development of RDS by intrauterine stress, which results in accelerated maturation of the surfactant system. Chest radiographs in these patients show a pattern of fine, diffuse granularity together with mild congestion suggesting excessive lung fluid, without significant air bronchograms, underaeration, or cardiomegaly. The most frequent complications are apnea with bradycardia and/or a significant left-to-right shunt through a patent ductus arteriosus. The serious complications of intraventricular hemorrhage, bronchopulmonary dysplasia, and death are more common in the smaller (1,000 g or less) infants; necrotizing enterocolitis, observed in 25% of patients, was not related to birthweight. The radiographic and clinical presentation of "immature lung" should be distinguished from that of RDS, because the prognosis in this birthweight range is considerably better (83% survival).

Apnea↗
PubMed1980

Radiology of neonatal heart disease.

The diagnosis of heart disease in newborn infants presents numerous radiologic difficulties because of a variety of factors, including the frequent absence of specific radiographic signs, the confusing effects of parenchymal disease, and the difficulties encountered in identifying specific locations of chamber enlargement and even in distinguishing between arterial and venous plethora. Definitive anatomic diagnoses can only rarely be made from plain chest films. Nevertheless, with adequate clinical information, lesions can be assigned to pathophysiologic categories, permitting intelligent planning of subsequent diagnostic maneuvers. Echocardiographic evaluation permits investigation on internal cardiac architecture and motion, which is very useful in diagnosing not only congenital cardiac malformations but also extracardiac lesions such as patent ductus arteriosus and persistent neonatal pulmonary hypertension.

Animals↗
PubMed1979

The hemodynamic significance of massive pneumopericardium in preterm infants with respiratory distress syndrome. Clinical and experimental observations.

Radiographic and clinical data were evaluated in 12 preterm infants with pneumopericardium complicating ventilator therapy of respiratory distress syndrome. Eight infants had massive or tension pneumopericardium, reflected by bradycardia, hypotension, and cyanosis of abrupt onset; cardiac size decreased dramatically but returned to approximately the former size after aspiration of the pneumopericardium. In puppies, pneumopericardium large enought to reduce heart size by 32 +/- 3% caused decreased mean arterial pressure (-22 +/- 7%) and right ventricular peak systolic pressure (-11 +/- 2%) and increased right ventricular diastolic and intrapericardial pressures. These findings suggest that pneumopericardium per se causes severe hemodynamic compromise. When it is large enought to reduce heart size, drastic circulatory impairment is produced and pericardiocentesis should be performed immediately.

Animals↗
PubMed1979

Pulmonary pseudocysts in newborn infants with respiratory distress syndrome.

Twelve neonates who developed intrathoracic cystlike structures ("pseudocysts") are described. All infants had clinical and radiographic respiratory distress syndrome and all were treated with assisted ventilation. Pulmonary interstitial emphysema preceded the development of the pseudocysts in all cases. The pseudocysts appeared between 0 and 6 days of life (average, 2.4 days), and radiographically documented disappearance occurred in 10 patients at 3--18 days old (average, 7.0 days). Two patients had persisting pseudocysts at 8 and 25 days of age, and no subsequent radiographs. In no case did these structures persist symptomatically or require surgical intervention such as has been described with patients in other series. In two cases, abrupt disappearance of the pseudocysts was accompanied by increased extraalveolar gas in other locations. Eight patients developed radiographic bronchopulmonary dysplasia, which was severe in two of the cases.

Cysts↗
PubMed1978

Radiographic and echocardiographic evaluation of newborns treated with indomethacin for patent ductus arteriosus.

A series of 33 consecutive preterm newborns who were treated with indomethacin, a drug which acts to close the patent ductus arteriosus, were studied retrospectively to examine the efficacy of chest radiography and echocardiography in diagnosing the presence of a significant patent ductus arteriosus. Radiographic changes in pulmonary vascular engorgement, pulmonary edema, and cardiac size on the anteroposterior film tended to precede the clinical changes of shunt appearance and resolution. The echocardiographic left atrial to aortic ratio (LA/Ao) supplemented the radiographic findings. The time of disappearance of the ductus arteriosus shunt, as judged by clinical findings, was identified accurately by radiographic and echocardiographic findings in the majority of cases; errors of under- and overestimation occurred in a minority of patients. In assessing both the presence and the resolution of the shunt, greater reliability was possible by using both radiographic and echocardiographic findings than by using either method alone.

Diagnostic Errors↗