Biomedical subjects
Publications and source records attributed to J A Menke.
This program provides the nonprogrammer a tool to develop easily modified computer assisted tutorials, tests, and simulations with a word processor. In addition, by using the branching and query features of this program, one can easily develop text files that provide rapid access to information related to patient care such as neonatal formularies and patient care algorithms.
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A semi-automated system for evaluation of Doppler cerebral blood flow studies obtained from newborn infants is described. A low cost digitizer is used to convert the graphic data from the flow tracing to digital data. A small business computer is used to analyze the data and produce a chartable report. The reliability of the digitizer is also evaluated.
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The use of a modified pneumotonometer as a noninvasive method to measure intracranial pressure through the fontanel was evaluated in the animal laboratory and in the clinical setting. Pressure measured with the tonometer from a surgically created fontanel in an adult mongrel dog demonstrated good correlation with pressure measured from an epidural balloon catheter. Pressure recorded with the tonometer was compared with direct measurements in a single infant. There were 20 paired measurements with a correlation coefficient of 0.91. Fontanel pressure was measured in 72 healthy infants. The mean pressure was 7.0 mm Hg with a standard deviation of 1.75. This result compares favorably with previous reports utilizing other methods. The machine is safe and simple to use.
We examined the clinical significance of noninvasive intracranial pressure measurements and pulsatility indices in 74 infants with confirmed IC-IVh. The intracranial pressure measurements were obtained using the applanation principle, and the pulsatility indices were calculated from the Doppler flow velocity tracings of the anterior cerebral artery. Fifty-three infants (71.6%) who died had a significantly lower birth weight and gestational age than those who survived. Survival rate decreased significantly with increased intracranial pressure (P less than 0.0002) and increased pulsatility indices (P less than 0.0001). We found no significant relationship between outcome and the size of IC-IVH demonstrated by CT scan. Birth weight, intracranial pressure measurements, and cerebral arterial pulsatile flow changes appear to be major prognostic indicators in neonatal IC-IVH.
We have previously described the relationships of serum and saliva concentrations of caffeine, theophylline and total methylxanthines in premature infants. We have now extended the previous studies in order to validate the previously derived relationships with new data. The new serum to saliva relationships, derived using regression and ratio models, are cross validated against the relationships from the previous data, and vice versa. A good cross validation was observed for caffeine and total methylxanthine concentrations in infants treated with caffeine. In the theophylline treatment group, theophylline concentrations did not cross validate well, whereas the total methylxanthine concentrations did. Since in vivo conversion of theophylline to caffeine and vice versa may affect the individual methylxanthine relationships, the total methylxanthine equations are recommended for predicting serum concentrations from salivary concentrations.
A low-cost microcomputer system is used to calculate cardiac parameters from echocardiographic (Echo) measurements and produce a chartable report. The system is simple, uses Basic language, and provides for data storage.
The clinical features of 27 patients with early onset group B beta hemolytic streptococcus sepsis were reviewed. Fifteen presented with a clinical pattern indistinguishable from the idiopathic respiratory distress syndrome and were compared with 15 patients with IRDS. Rupture of membranes for greater than 12 hours prior to delivery occurred more often in patients with GBS (33%) than in the patients with IRDS (16%). Hypotension was more commonly seen in the patients with GBS (56%) than in the patients with IRDS (36%). There was no difference in the incidence of apnea or the respirator peak inspiratory pressure requirements between the two groups of patients, but there was a tendency for a decline in the total white blood cell count in the first 24 hours of life in those patients with GBS sepsis.
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Ten premature infants with respiratory distress developed a type of pulmonary lobar emphysema that is clinically and histologically distinct from interstitial or congenital lobar emphysema. In eight patients emphysema was noted in the right lower lobe, while in two the left upper lobe was affected. Five infants exhibited nonresolution of the emphysema and an inability to be weaned from ventilator support. Lung scans in these five infants showed absent or markedly decreased perfusion of the involved lobe. Lobectomy was necessary. Postoperatively, their respiratory status improved and they were successfully weaned from the ventilator. Five premature infants with identical radiographic emphysematous changes had normal lung scans. These infants did not require lobectomy and were also successfully weaned from the ventilator. Radiographic changes of lobar emphysema in these five infants completely resolved. Pathologic changes in the excised lobes were characteristic of bronchopulmonary dysplasia and obstructive intraalveolar emphysema. The long-term effects of positive pressure ventilation, oxygen, and suctioning techniques directed toward the right lower lobe may play an important role in the etiology of "acquired" lobar emphysema.
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A premature infant who developed Budd-Chiari syndrome as a complication of total parenteral nutrition through an inferior vena cava catheter is presented. A novel approach to the treatment of this otherwise lethal condition is described. This very unusual complication in pediatric patients may be seen with increased frequency as more premature infants are treated with central vein total parenteral nutrition.
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