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Biomedical subjects

D W Roloff

Publications and source records attributed to D W Roloff.

At least 37 records · Page 2Linked to original sources
PubMed1983

Venovenous extracorporeal membrane oxygenation in neonates with respiratory failure.

Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) has been successful in support of neonates with respiratory failure but requires right common carotid artery ligation. While no short-term neurologic complications have resulted from neonatal carotid ligation, late complications may occur. For both VA ECMO and venovenous (VV) ECMO, blood is drained from the right atrium via a right internal jugular cannula, oxygenated by a membrane lung, and returned to the patient. VV ECMO spares the carotid by perfusing the oxygenated blood into a vein. VV ECMO gave total respiratory support to three neonates with respiratory failure and each infant survived. In comparison with three similar VA ECMO patients, the VV patients required higher ECMO circuit flow rates and had lower systemic arterial Po2s. Length of time on ECMO, length of hospital stay, and neurologic outcome were similar in the VV and VA patients. Differences among the patients were related to their primary disease rather than to the mode of ECMO support. The VV patients had cannulation of the femoral vein for perfusion of oxygenated blood. Late complications may occur from femoral vein ligation as well as from carotid ligation so long-term follow-up is needed to assess these two ECMO techniques.

Female↗
PubMed1983

Calcified neonatal adrenal hemorrhage: diagnostic and therapeutic considerations.

We present the case of a premature infant in whom adrenal calcification was present at birth and postulate an etiology of in utero adrenal hemorrhage. The subject of neonatal adrenal hemorrhage is reviewed with respect to a reassessment of diagnostic and therapeutic considerations. Ultrasonography and intravenous urography confirm the diagnosis and differentiate other retroperitoneal lesions. Adrenal hemorrhage is most often a self-limited process, and medical management results in uneventful recovery of almost all patients.

Adrenal Gland Diseases↗
PubMed1983

Radionuclide cisternography in the preterm neonate.

A technique is presented for the bedside performance of radionuclide cisternography in the preterm neonate. Using a portable gamma camera, with a low energy, converging collimator, high quality diagnostic images were obtained in 31 infants, following the lumbar subarachnoid injection of 100 micro Ci In-111 DTPA. The technique is safe, and provides valuable information about CSF dynamics unavailable by any other method.

Humans↗
PubMed1983

Lumbar cisternography in evaluation of hydrocephalus in the preterm infant.

Radionuclide lumbar cisternography using indium 111-diethylenetriamine pentaacetic acid (111In-DTPA) and a mobile gamma-camera with a converging collimator was utilized as a bedside procedure to evaluate CSF dynamics and the patency of the cerebral ventricular system in 30 preterm infants with hydrocephalus. Serial images of the brain were obtained at 0, 1, 2, 6, 24, and 48 hours after instillation of the isotope in the lumbar subarachnoid space. Three distinct patterns were seen. Infants with posthemorrhagic hydrocephalus displayed prompt ventricular filling but markedly delayed emptying with minimal flow over the cerebral convexities. Infants with ventriculomegaly secondary to suspected brain atrophy or periventricular leukomalacia demonstrated a pattern of prompt ventricular filling, delayed emptying, but with flow present over the convexities. An infant with noncommunicating hydrocephalus secondary to an Arnold-Chiari malformation showed a pattern of complete obstruction with no ventricular filling. Radionuclide lumbar cisternography appears to be a safe, well-tolerated procedure which produces images of sufficient resolution to provide valuable information about CSF dynamics, delineating basal cisternae, ventricles, and subarachnoid flow paths.

Cerebral Ventricles↗
PubMed1982

Postextubation nasal continuous positive airway pressure. A prospective controlled study.

Nasal continuous positive airway pressure (N-CPAP), applied immediately after extubation, was prospectively evaluated in 18 neonates recovering from respiratory distress syndrome. Patients were randomly assigned to N-CPAP (group 1, N=9) or a control group given oxygen by hood (group 2, N=9). Groups were comparable in birth weight and duration of intubation. In the 24-hour period following extubation, group 1 showed a significantly lower mean respiratory rate (46 +/- 2 vs 74 +/- 4), alveolar-arterial oxygen gradient (94 +/- 9 vs 134 +/- 12 mm Hg), PCO2 (45 +/- 1 vs 50 +/- 1 mm Hg), higher pH (7.33 +/- 0.01 vs 7.30 +/- 0.01), and less atelectasis by roentgenographic scores. This was associated with considerably better clinical courses in group 1 when compared with group 2, in which six patients required a late trial of N-CPAP because of respiratory deterioration and two patients needed reintubation. Postextubation N-CPAP has a striking beneficial effect on respiratory function and prevention of atelectasis.

Clinical Trials as Topic↗
PubMed1981

Prevention of intraventricular haemorrhage in preterm infants by phenobarbitone. A controlled trial.

Sixty infants with birth-weights less than 1500 g and who were less than 6 h old were randomly assigned to a group given phenobarbitone or a control group. Intravenous phenobarbitone was given in doses sufficient to achieve anticonvulsant serum levels within 12-18 h. Maintenance therapy was continued for one week. Periventricular/intraventricular haemorrhage (IVH) occurred in 13.3% (4/30) of the phenobarbitone group and in 46.7% (14/30) of the control group. The occurrence of risk factors related to IVH was similar in the two groups. Phenobarbitone may reduce the incidence of IVH in small preterm infants.

Cerebral Hemorrhage↗
PubMed1978

Failure of serial chest radiographs to predict recovery from respiratory distress syndrome.

Chest radiographs of 29 patients with the clinical and radiographic diagnosis of RDS during the 5 days of the illness were graded according to a modification of the classification of Bomsel. There was no significant difference between the radiographs of surviving neonates and those who died of RDS. Mean L/S ratios were also collected from 26 of the 29 patients. Those who survived had significantly more mean L/S ratios greater than 2.5 than did the nonsurvivors (p less than 0.01). This difference did not correlate with the staging of the chest radiographs. The mean L/S ratio is a better predictor of survival than chest radiographs during the first 5 days of RDS.

Humans↗
PubMed1976

Tracheal aspirate lecithin/sphingomyelin ratios as predictors of recovery from respiratory distress syndrome.

In thirty infants with severe respiratory distress syndrome who required endotracheal intubation, serial tracheal aspirate lecithin/sphingomyelin ratios were determined. There was 19 survivors and 11 nonsurvivors. The L/S ratios were plotted as a function of postnatal age; the ratios of the survivors demonstrated a significant increase between 24 and 96 hours. Nonsurvivors did not show this change. There was a significant difference on Days 3, 4, and 5 between survivors and nonsurvivors in the percentage of L/S ratios greater than 2.5. Daily mean L/S ratios correctly identified the outcome of 23 of 24 infants alive on Days 4 and/or 5 and were a more accurate prediction of survival than a single L/S ratio. The changes in the L/S ratios of the tracheal aspirates were not related to gestational age.

Female↗
PubMed1976

Treatment of apnea of prematurity with aminophylline.

The effectiveness of aminophylline in the treatment of apnea of prematurity was evaluated in 13 premature infants (mean birthweight, 1.13 kg; mean gestational age, 29 weeks). Apnea was recorded by direct observation in combination with impedance monitoring. Rectal suppositories of aminophylline (5 mg) were given at six-hour intervals. The average dose was 4.1 mg/kg. No toxicity or complications were noted. The parents became free of apneic episodes during therapy. The response for each eight-hour interval of treatment over 72 hours when compared to pretreatment was significant (P less than .01; paired t-test), after the first eight hours. Only one patient required mechanical ventilation for apnea. Treatment was continued for 2 to 14 days (mean, 5 days). A recurrence of apnea was noted in nine patients after discontinuing aminophylline. All patients except one survived. No change in Po2, Pco2, pH, mean heart and respiratory rates, and blood pressure was noted. A direct effect on the respiratory center is postulated.

Aminophylline↗