Search PubMed⌕ Search

Biomedical subjects

M I Rowe

Publications and source records attributed to M I Rowe.

At least 55 records · Page 3Linked to original sources
PubMed1990

Emergency endotracheal intubation in pediatric trauma.

The purpose of this study was to determine the effectiveness and associated problems of emergency intubation in 605 injured infants and children admitted to the Children's Hospital of Pittsburgh in 1987. We identified 63 patients (10.4%) undergoing endotracheal intubation at the scene of injury, at a referring hospital or in our emergency department. Injuries were to the head (90.5%), abdomen (12.7%), face (11.1%), chest (6.3%), neck (3.2%); or were orthopedic (19%) or multiple (39.7%). Indications for intubation included coma (74.6%), shock (28.6%), apnea (22.2%), and airway obstruction (3.2%). Of 16 complications (25.4%), 13 were immediately life threatening: right mainstem intubation (5), massive barotrauma (2), failure of adequate preoxygenation (2), esophageal intubation (1), attempt at nasotracheal intubation in an open facial fracture (1), and extubation during transport (1). Three were late complications: vocal cord paresis (2) and subglottic stenosis (1). Airway complications led to PO2 less than 90 mm Hg in 7 of 12 on first ABG, compared to 9 of 44 in uncomplicated cases (p less than 0.05). Intubation attempts at the scene of injury were more often multiple, unsuccessful, and associated with airway complications. All four complication-associated fatalities were life-threatening scene complications. Nearly one half (44.4%, 28 of 63) had one of the following problems in respiratory management: major airway complication, PaO2 less than 90, or PaCO2 greater than 45 on either the first or second ABG after arrival at our emergency department. Head injury with coma is the most common setting for emergency intubation. Airway complications are common, and are more frequent in treatment attempt at the scene. Despite endotracheal intubation, injured children in our series remain at high risk for hypoxemia, elevated arterial PCO2, and major airway complications, all of which contribute to secondary brain injury.

Adolescent↗
PubMed1989

Transplantation of multiple abdominal viscera.

Two children with the short-gut syndrome and secondary liver failure were treated with evisceration and transplantation en bloc of the stomach, small intestine, colon, pancreas, and liver. The first patient died perioperatively, but the second lived for more than 6 months before dying of an Epstein-Barr virus-associated lymphoproliferative disorder that caused biliary obstruction and lethal sepsis. There was never evidence of graft rejection or of graft-vs-host disease in the long-surviving child. The constituent organs of the homograft functioned and maintained their morphological integrity throughout the 193 days of survival.

Animals↗
PubMed1989

Breath hydrogen excretion as a screening test for the early diagnosis of necrotizing enterocolitis.

We measured breath H2 excretion in 122 neonates from birth to 1 month of age. The patients weighed less than 2000 g at birth and thus were at risk for developing necrotizing enterocolitis (NEC). Hydrogen excretion was normalized for the quality of the expired air by dividing by the carbon dioxide pressure of the gas sample. The mean (+/- SD) peak H2/CO2 ratio was significantly different between the seven patients who subsequently developed NEC (9.4 +/- 2.7 ppm/mm Hg) and the 115 patients who did not (5.0 +/- 3.5 ppm/mm Hg). The prevalence of NEC was 5.7% in the present study. Defining a positive test as one with a ratio value of greater than or equal to 8.0 ppm/mm Hg, the resulting screening test had a sensitivity of 86% and a specificity of 90%. The screening test yielded a 33% predictive value of a positive test and a 99% predictive value of a negative test. High H2 excretion occurred eight to 28 hours before the earliest clinical signs of NEC. Breath H2 excretion is a simple noninvasive test that may be useful in the management of the premature neonate at risk for the development of NEC.

Breath Tests↗
PubMed1989

Quality assessment in the pediatric trauma care system.

The goal of the pediatric trauma care system is to prevent death, disability, and suffering of injured children. Quality assessment (QA), the evaluation of clinical performance and quality, is essential not only for formal accreditation processes, but also for day-to-day trauma center operation. QA involves three basic types of performance measures: input, process, and outcome. Input measures are inventories of the resources of a given institution, such as the availability of a surgeon on a 24-hour-a-day in-house basis. They give baseline descriptions of facilities and do not monitor performance directly. Process measures attempt to verify that the system is using its resources appropriately in response to demands, which at Children's Hospital of Pittsburgh (CHP), involves tracking all admitted patients from injury to discharge with the assistance of a system of audit screens to help identify problem cases. The methodology of the Major Trauma Outcome Study (MTOS) provides basic outcome data by identifying unexpected survivors and deaths. However, the few cases identified (four of 316 patients submitted to MTOS; 1.3%) limit conclusions regarding trauma center performance. Performance measures, when applied to admitted trauma patients, allow timely recognition of individual complications and problem trends. QA provides necessary data for important clinical decisions and resource allocations that affect trauma center operation.

Child↗
PubMed1989

Dura versus Gore-Tex as an abdominal wall prosthesis in an open and closed infected model.

Occasionally, it is necessary to use prosthetic material to close large abdominal wall defects in infected, potentially infected, or open wounds. We compared the effectiveness of Gore-Tex (PTFE, W.L. Gore & Associates, Flagstaff, AZ) and dura for closing large, full thickness abdominal wall defects in terms of resistance to infection, patch separation, and intraperitoneal adhesion formation. Ninety guinea pigs had full thickness, 2 cm2, abdominal defects patched with either PTFE or dura. The skin was (A) left open (B) closed over the patch under aseptic conditions, or (C) closed after wound contamination with 10(5) CFU of staphylococcus aureus. Wounds were examined daily and the wound and peritoneal cavity examined at necropsy (day 45). Patch separation, patch retention, and adhesions were similar in both open (A), and clean closed (B) wounds patched with PTFE or dura. In the infected closed wounds (C) of the PTFE animals, the incision remained intact significantly longer, the time of patch separation and overall patch retention were significantly increased, and bowel adhesions were significantly reduced compared to dura animals.

Abdominal Muscles↗
PubMed1989

In vivo transmural potential difference: an early monitor of rejection in small bowel transplantation.

To determine if serial measurements of transmural potential difference (TMPD) can serve as an early monitor of rejection in small bowel transplantation, three groups of rats were studied. The groups are defined as follows: (1) group 1, isolated loop (N = 5): 20 cm of distal jejunum was defunctionalized (Thiry-Vella loop); (2) group 2, isotransplant (N = 5): 20 cm of distal jejunum was isotransplanted between inbred Lewis rats, as a Thiry-Vella loop; the native bowel remained in continuity; (3) group 3, allotransplant (N = 8): allotransplantation as in group 2 but between outbred Sprague-Dawley rats. Using luminal and peritoneal electrodes, TMPD was measured serially every third day. Biopsies of the stoma were taken on the same days for histologic examination of rejection. Group 1 animals (isolated loop) did not show a significant decrease in TMPD from day 1 to day 20. Group 2 (isotransplant animals) had a significant decrease in TMPD as compared with group 1 on day 5 (P less than .01), but by day 8, TMPD returned to baseline. Biopsies in groups 1 and 2 showed no signs of rejection. Group 3 (allotransplant animals) showed a significant decrease in TMPD as compared with group 1 on day 5 (P less than .01). The severity of the histologic signs of rejection parallelled the TMPD decrease throughout the remainder of the study. Monitoring TMPD is a sensitive method of detecting early rejection in small intestine transplantation.

Animals↗
PubMed1989

Chest injuries in childhood.

Differences in anatomy and mechanisms of injury are believed to contribute to the unique response of children to thoracic trauma. To characterize the scope and consequences of childhood chest injury, we reviewed the records of 105 children (ages 1 month to 17 years, mean 7.6 years) with chest injuries admitted to a level I pediatric trauma center from 1981 to 1988. Nearly all injuries (97.1%) were due to blunt trauma, and more than 50% were traffic related. Rib fractures, commonly multiple, and pulmonary contusions occurred with nearly equal frequency (49.5% and 53.3%, respectively), followed by pneumothorax (37.1%) and hemothorax (13.3%). One fourth of all pneumothoraces were under tension. Significant intrathoracic injuries occurred without rib fractures in 52% of cases with blunt trauma. Associated head, abdominal, and orthopedic injuries were present in 68.6% of children reviewed. One in five received endotracheal intubation and ventilatory support for 1 to 109 days. Presence or absence of head injury neither increased the need for respiratory support (29.4% vs. 17.2%, respectively; p = 0.24) nor affected the duration of support for those who were ventilated (6.8 +/- 8.9 days vs. 3.3 +/- 2.6 days, excluding one ventilator-dependent head-injured patient and five early deaths). The presence of associated injuries, intubation, and pneumothorax or hemothorax all resulted in significantly longer hospitalizations and more severe injury as measured by Injury Severity Score (ISS). Age, rib fracture, and contusion had no effect. Rarely encountered were ruptured diaphragm (2 cases), transection of the aorta (1), major tracheobronchial tears (3), flail chest (1), and cardiac contusion (2). Only two of the three children with penetrating injuries and three of the 83 (3.6%) with blunt injuries underwent chest operations. Six children (7%) died, one from a penetrating injury and five from blunt mechanisms. Chest Abbreviated Injury Scale (AIS) and ISS correlated significantly with mortality; age and head AIS did not. Rib fractures, lung contusions, and associated head, abdominal, and skeletal injuries are common because of the predominance of blunt-injury mechanisms. Nearly one half of chest injuries occurred without rib fractures. The need for ventilatory support is uncommon; when required, its duration is generally brief. Aortic transection, flail chest, and penetrating injuries more frequently encountered in adults and are uncommon in children. Thoracotomy generally is not required.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1989

Failure of tumor necrosis factor to produce hypotensive shock in the absence of endotoxin.

Tumor necrosis factor (TNF) is reported to cause a shock syndrome similar to that produced by endotoxin (LPS). The purpose of this study was to determine the relationship between TNF and LPS in causing shock. Eighty rats received infusions of either TNF, LPS, or TNF plus LPS, as compared with saline solution. Temperature, blood, and tissue specimens were obtained at 2 hours. Blood pressure was measured over 4 hours in a separate group of awake rats. Mortality was assessed over 24 hours. Neither TNF (1 mg/kg) nor LPS (1 mg/kg) altered hematocrit, blood gases, temperature, or caused hypotension or mortality. If the same dose of TNF was combined with LPS, however, there was significant (p less than 0.05) hemoconcentration and metabolic acidosis associated with hypotension and 100% mortality by 4 hours. Pathologic changes were restricted to the small intestine and occurred in this group only. It was concluded that TNF does not cause hypotension or shock in the rat. TNF will cause lethal shock, however, if combined with a sublethal dose of endotoxin. This suggests that synergy between TNF and endotoxin is important in septic shock.

Animals↗
PubMed1988

Inappropriate fluid response in congenital diaphragmatic hernia: first report of a frequent occurrence.

Safe management of the newborn infant with congenital diaphragmatic hernia (CDH) requires precise fluid administration to avoid hypovolemia or fluid overload. Twenty-two CDH patients and 12 infants who underwent abdominal operations were studied for three postoperative days to determine whether the postoperative neonatal renal response to fluid administration was appropriate or inappropriate. Each response was categorized, on the basis of urine and blood measurements, as: (1) appropriate urine output and concentration, (2) inappropriate urine output and concentration with fluid retention or (3) renal failure. Fluid intake was similar in all groups. The CDH group had a significantly lower urine output, higher urine osmolarity, and lower serum osmolarity. All of the control group (100%) responded appropriately to intake. Sixty-four percent of the CDH group inappropriately retained water during the first 16 hours (appropriate, 27%; renal failure, 9%). By 24 hours, 34% still had inappropriate urine output and fluid retention. The majority of patients with CDH initially responded inappropriately to postoperative fluid intake. If this response is not recognized and fluid intake is not adjusted, serious fluid overload will result.

Cyclic AMP↗
PubMed1988

Pancreatic injuries in childhood due to blunt trauma.

The records of 22 children who suffered pancreatic injury in whom laparotomy confirmed the diagnosis were reviewed. First, we wished to define diagnostic factors that would distinguish transections and injuries that resulted in pseudocysts (which we termed major injuries) from contusions and lacerations that required no specific operation (minor injuries). Second, we wanted to determine how the timing of diagnosis and treatment of major injuries influenced hospital course. There were 13 major injuries (ten transections, three pseudocysts) and nine minor injuries. Abdominal tenderness (present in 83%) failed to distinguish major from minor injuries. Major injuries appeared to be associated with rising values of serum amylase taken serially over 24 to 48 hours (P = .05). Computerized tomography and ultrasound obtained in the first days after injury gave nonspecific findings and failed to give a definitive diagnosis. Of 13 patients with major injuries, seven underwent laparotomy within 24 hours of injury; six, two days or more. The mean hospital stay in the early group (16.7 days) was significantly shorter than that in the late group (38.8 days). Our review suggests that timely diagnosis of major pancreatic injuries and prompt surgical treatment can shorten hospitalization without increasing morbidity. The diagnosis of surgically significant pancreatic injuries continues to be a primary clinical challenge.

Amylases↗
PubMed1988

Stoma-related variceal bleeding: an under-recognized complication of biliary atresia.

The medical records of 52 children with biliary atresia treated by portoenterostomy and evaluated for liver transplantation were reviewed to determine the frequency of stoma variceal bleeding and the optimal strategies for prevention and treatment. Eighteen patients had had prior stoma closure, four by preperitoneal closure without takedown from the abdominal wall. Three of the four developed occult variceal bleeding from the stoma closure site. Twenty-two patients had a stoma present at evaluation. All 22 patients with stomas (100%) had at least one bleeding episode requiring transfusion. Treatment included transfusion and local pressure (9), suture ligation of the bleeding site (5), and stoma closure and/or takedown (11). Local treatment led to recurrences in eight of 14 (57%) of the cases. To reduce the high mortality in patients with biliary atresia awaiting liver transplantation, multiple variceal bleeding episodes should be prevented. To eliminate one source, stoma variceal bleeding, the stoma, whether functioning or nonfunctioning should be taken down and closed. Preperitoneal closure alone does not prevent stoma bleeding.

Biliary Atresia↗
PubMed1988

Intrathoracic tracheobronchial injuries in childhood.

Trauma to the intrathoracic tracheobronchial tree is a rare but usually fatal injury. Patients with pneumothorax, subcutaneous emphysema, and a history of blunt or penetrating injury to the lower neck or chest must undergo early bronchoscopy to evaluate the lower airway. Thoracotomy should be performed as soon as the patient's condition allows an attempt at primary repair. The diagnosis is frequently missed because it is so uncommon and its symptoms may resolve after chest tube drainage of the pneumothorax. Airway stenosis or occlusion usually follows. Still, local resection of the stricture and reanastomosis frequently result in recovery of lung function. Neglected cases complicated by infection usually require lung resection.

Adolescent↗
PubMed1986

Is the refractometer specific gravity a reliable index for pediatric fluid management?

Serial measurement of urinary output has been one of the mainstays to gauge adequacy of hydration of the newborn surgical patient. Urine output, however, is dependent not only on circulating blood volume but also on osmolar load and the ability of the kidney to excrete solute and water. Therefore, a second measurement is necessary for more accurate monitoring urine concentration. The purpose of this study is to determine the capacity of the kidneys of the newborn surgical patient to dilute and concentrate, and to excrete solute and water; and the accuracy of the refractometer to determine the tonicity of urine. To determine renal capacity, 24 newborn patients were studied during the first 48 hours following major surgical procedures. Analysis of 823 urine samples demonstrated a range of specific gravity between 1.002 and 1.040, and of osmolality between 67 and 582 mosm/kg. The lowest urine output was 0.1 mL/kg/hr and the highest 14.9 mL/kg/hr (mean 3.54 +/- 1.97 mL/kg/hr). The osmolar load excreted by the kidney ranged from 3.7 to 33.4 mosm/kg/24 hr (15.3 +/- 6 mosm/kg/24 hr). To determine the accuracy of the refractometer, 2,007 urine samples from 900 newborn infants were studied. The correlation coefficient for refractometer derived specific gravity and osmolality ranged from 0.7347 to 0.9061. Refractometer specific gravity measurements of 1.008 or below predict hyposmolality as defined as an osmolality below 270 mosm/kg with an accuracy of 70.6% to 95.4%. Accuracy is significantly less in the TPN and the glucose groups. A specific gravity of 1.012 to 1.020 is accurate in predicting hyperosmolality as defined as a urine osmolality above 290 mosm/kg.(ABSTRACT TRUNCATED AT 250 WORDS)

Diuresis↗
PubMed1985

The postoperative response of the term and preterm newborn infant to sodium administration.

Twenty surgical newborn infants aged less than 5 days were selected for study to determine the quantity of sodium administered during operation and the subsequent 48 hours, and to determine their response to this sodium load. There were 6 preterm infants with gestational age 35 weeks or less and 14 full-term infants aged more than 35 weeks. Measurements calculated at 12 hourly intervals for 48 hours after operation included sodium intake, sodium excretion, fractional excretion of sodium, and serum sodium. No special guidelines were utilized for fluid management. The mean sodium intake during the 48-hour study period for the term infants was 15.7 mEq/kg, of which 46% was given during the first 12 hours, and for the premature infants was 17.1 mEq/kg, of which 56% was given during the first 12 hours. In the two groups of patients, the amount of sodium given during the first 12 hours was 470% and 480% of their estimated maintenance requirements, respectively. The mean sodium output during the first 12 hours was low in the term group (1.2 mEq/L) and the premature group (1.3 mEq/L), and subsequently increased reaching maximum levels of 2.3 and 2.1 mEq/L, respectively, by 36 hours. The fractional excretion of sodium exceeded 1.0% in 53% of the term and 94% of the preterm infants. During the study period, the mean serum sodium levels exceeded 145 mEq/L (hypernatremia) in 64% of the term and 67% of the preterm infants.(ABSTRACT TRUNCATED AT 250 WORDS)

Fluid Therapy↗
PubMed1985

A dynamic approach to fluid and electrolyte management of the newborn.

The most constant feature of neonatal physiology and pathophysiology is change. To meet the needs of each individual baby we must first arm ourselves with knowledge of neonatal physiology and pathophysiology. Next, the effects of the applied fluid program are continually monitored and the program accordingly readjusted. We must "read the book" and then "read the baby." This paper discusses the results of "reading the book" and proposes a tentative dynamic fluid and electrolyte program. The "reading of the baby" is beyond the scope of this paper, but should be simple, utilizing commonly available methods that can safely be done as frequently as every four to eight hours including repeated physical examinations, simple laboratory tests in blood and urine, and the determination of the body weight.

Extracellular Space↗
PubMed1984

An experimental model to study thermogenesis in the neonatal surgical patient.

The nonshivering thermogenic response of the newborn to cold exposure and the potentially detrimental effects of the resultant hypermetabolic state have been documented by numerous animal and clinical studies. It is standard practice to protect the newborn infant from cold stress by controlling environmental temperature and preventing heat loss. Although these measures are well accepted, little attention has been paid to the effect of surgical factors, such as operative trauma, anesthetic agents, and muscle relaxants on nonshivering thermogenesis. The purpose of this investigation is to develop an experimental model to study the effect of surgical factors on the neonatal thermogenic response. Newborn rabbits were chosen as the experimental subject because these animals rely solely on nonshivering thermogenesis. One-hundred-eleven animals were studied. In the newborn rabbit, there was an inverse relationship between age and the percentage of brown fat. Body weight doubled in the first week of life, while the quantity of brown fat fell from a maximum of 2.9% of body weight in the first day of life to 1.56% at 7 days of age. It was possible to maintain the newborn rabbit in a warm environment for periods of up to 2 hours without changes in blood flow to the brown fat or oxygen consumption. The thermogenic response to cold did not appear to be altered in terms of oxygen consumption when the animals were lightly anesthetized with pentobarbital or paralyzed with metocurine and locally anesthetized. The rise in oxygen consumption was similar in awake, intact animals and those that received pentobarbital or metocurine and xylocaine.(ABSTRACT TRUNCATED AT 250 WORDS)

Adipose Tissue, Brown↗
PubMed1984

Analysis of patients with biliary atresia coming to liver transplantation.

Seventy-two patients with end-stage liver disease underwent liver transplantation between March 1981 and March 1984; 35 (49%) with biliary atresia, the remainder with other disorders. This provided us with a unique opportunity to analyze factors leading to liver failure in patients who had undergone biliary drainage procedures for "uncorrectable" biliary atresia. Four patients in the biliary atresia group were excluded (no corrective procedure done, 3; "correctable" biliary atresia, 1), leaving 31 patients for study. Transplantation survival was 84% for the study group and 73% in children with other primary liver disorders. Most patients were less than 3 months old at the time of initial surgery, had minimal liver disease, and had accepted corrective operations by experienced surgeons. Despite these "favorable" factors, bile drainage was rarely achieved. All patients with continued bile drainage at the time of transplantation had repeated episodes of cholangitis, and cholangitis was associated with cessation of bile drainage in half of those with transient function. Findings at hepatectomy suggested that in four cases where bile drainage was never achieved, reexploration may have been successful. Complications included those associated with hepatic failure and portal hypertension. Of note were a high incidence of bone disease and a 43% incidence of stomal hemorrhage in patients with stomas. The short-term survival after transplantation was comparable in the biliary atresia group and the children with other disorders. This suggests that while the presence of a previous biliary drainage procedure may increase the technical difficulty of transplantation, it does not decrease survival.

Age Factors↗