Search PubMed⌕ Search

Biomedical subjects

M Perlman

Publications and source records attributed to M Perlman.

At least 73 records · Page 4Linked to original sources
PubMed1984

Effects of indomethacin on digoxin pharmacokinetics in preterm infants.

Indomethacin is commonly coadministered with digoxin for the treatment of patent ductus arteriosus (PDA) in preterm infants. The combination of digoxin that is eliminated almost exclusively by the kidney and indomethacin, which tends to reduce renal function, has potential hazards. We report 11 preterm infants (gestational age 25-33 week) treated with digoxin for PDA in whom a standard indomethacin therapy (mean of total dose = 0.32 mg/kg) resulted in a significant elevation of serum digoxin to potentially toxic levels (from 2.2 +/- 0.7 ng/ml to 3.2 +/- 0.7) (P less than 0.001). This phenomenon correlated well with decreased urine output (from 86 +/- 34 ml to 43 +/- 24 per 24 hour) (P less than 0.001) following indomethacin. No significant change was found in serum creatinine concentration pre- and post-indomethacin. Digoxin half-life was significantly prolonged (mean 97 +/- 17 hour) following indomethacin therapy as compared with an age matched control group (mean half-life 43 +/- 19 hour) (P less than 0.05). Our data suggest that when indomethacin is added to digoxin therapy, the digoxin dosage should be reduced by 50% until urine output and digoxin serum levels can be better assessed.

Digoxin↗
PubMed1983

Auditory nerve-brainstem evoked responses in hyperbilirubinemic neonates.

On the basis of the known predilection of the auditory brainstem pathway for bilirubin toxicity, we have examined auditory brainstem responses of neonates during the period of hyperbilirubinemia. The auditory brainstem responses of 24 infants with serum bilirubin values between 15 to 25 mg/dL were compared with the responses of 19 infants without hyperbilirubinemia, who had similar gestational and postnatal ages. Wave IV-V complex was absent in at least one recording of 10/24 jaundiced infants, whereas wave complex IV-V was consistently present in all of the 19 infants without hyperbilirubinemia (P less than .001). Jaundiced infants also had prolonged brainstem transmission time (P less than .01) which reflected increased latency at both lower and upper brainstem levels. The above changes were rapidly reversed in the majority of instances. Neonatal jaundice was associated with significant transient aberrations of auditory brainstem responses, suggestive of a transient brainstem encephalopathy. This evidence of bilirubin entry to the brain at conventionally acceptable serum concentrations raises questions about current concepts of the mechanism of transfer of bilirubin across the blood-brain barrier.

Bilirubin↗
PubMed1982

Serum copper and ceruloplasmin in preterm infants: prospective study.

The postnatal time courses in preterm infants (30.0 weeks mean gestational age) of serum copper and ceruloplasmin (Cp) are described and compared. Serum copper was measured by nonflame atomic absorption spectrophotometry and serum Cp was measured by both immunodiffusion (Cpi) and enzyme assay (Cpe). With the exception of Cpe between 7 and 11 weeks of age, correlations among the three laboratory parameters were excellent. Following an early rise in all values, a plateau was seen in copper and Cpi between 5 and 11 weeks; Cpe showed a discordant fall at 7 to 11 weeks of age. After 11 weeks a secondary and definitive rise in all values was seen. Examination of individual time courses indicates the existence of a subgroup of infants with falling values between 5 and 11 weeks of age. Preterm infants had significantly higher serum copper (0.53 +/- 0.05 micrograms/ml) at a mean postnatal age of 10 weeks (39-41 weeks postconception) than did full-term infants (0.44 +/- 0.04 microns/ml) of similar postconceptional age. Low serum copper values were correlated with parenteral nutrition deficient in copper, with increased growth rates, and with twin pregnancies. It is concluded that extrauterine life in preterm infants is associated with precocious rises in serum copper and Cp values. The subgroup of infants with falling values may represent subclinically copper-deficient infants. This subgroup may bias the results of grouped data downwards. A role for nutritional factors in the delayed postnatal rise of serum copper and Cp values in preterm infants cannot be excluded on the basis of current knowledge.

Ceruloplasmin↗
PubMed1982

Persistent neonatal hypoglycemia due to hyperinsulinism: medical aspects.

Eight neonates with persistent hypoglycemia were seen over a four-year period and a ninth infant with neonatal onset was treated from 9 months of age. Seven infants had high absolute insulin levels (range 12 to 50 microunits/ml) during hypoglycemia whereas two patients had normal levels which were, however, inappropriate for the low blood glucose levels. Six patients with severe intractable hypoglycemia resistant to intensive medical therapy (including high dose diazoxide) had partial or total pancreatectomy, whereas three with relatively controllable hypoglycemia eventually had spontaneous remissions. In one of the medically treated patients, remission occurred at the unusually early age of 4 months. In the six surgically treated patients and in a seventh patient who had a biopsy only, the pancreas showed characteristic pathologic changes compatible with those described as nesidioblastosis or "endocrine-cell dysplasia." Of the six patients followed up for greater than or equal to 24 months, four have normal psychomotor development, despite periods of arrested head growth in early infancy in three of them.

Female↗
PubMed1981

Urinary polyamines in preterm infants.

Polyamines were determined in urine of 22 preterm infants (mean 30.0 weeks gestation) from birth to 22 weeks of age, and in full-term infants in the first week of life. A significant decline in urine putrescine and spermidine levels occurred with increased postnatal age in preterm infants. At expected term preterm infants had significantly higher levels of polyamines in urine than full-term infants at the same postconceptional age. No constant correlations between weight or linear growth velocity and urinary polyamine excretion could be established in this group of infants. Altered urine polyamine values were detected in two clinical situations: hyperbilirubinemia was associated with increased urine spermidine (and with increased spermidine/putrescine ratio), and liver disease was associated with increased levels of both putrescine and spermidine in urine.

Female↗
PubMed1981

Orbital meningocele presenting as periorbital cellulitis.

A case of orbital meningocele in a 15-day-old infant presenting as periorbital cellulitis, followed by meningitis, is described. Unlike other cases with the same anomaly, signs were not noted in the involved eye, neither before the cellulitis nor after recovery following antibiotic treatment. Preoperative, diagnosis was confirmed by tomography of the orbit. On operation a bony defect was found in the orbital roof, which was repaired. Recovery was uneventful.

Cellulitis↗
PubMed1981

Absorbable suture materials for vascular anastomoses. Tensile strength and axial pressure studies using polyglycolic acid sutures.

This study attempted to evaluate how vascular healing itself is sufficient enough to provide adequate strength to autogenous vein grafts in small arteries without the use of nonabsorbable sutures. The absorbable suture, Dexon, was used in small canine femoral vein graft anastomoses over a two-month trial period with nonabsorbable Prolene as a control. Tensile strength and resistance to axial leak were measured. Results show that Dexon had 93 per cent of the tensile strength of Prolene immediately; 76 per cent at 14 days, 111 per cent at 21 days, and 110 per cent at 30 days, and 124 per cent at 60 days as an average for all suture lines. The per cent mean resistance to leakage that Dexon had compared to Prolene for all suture lines was 102 per cent at seven days, 97 per cent at 14 days, 107 per cent at 21 days, and 97 per cent at 30 days. There is no evidence of aneurysms, suture line disruptions, dilations, or infections of any anastomoses. Our ultimate conclusion is that the integrity of small autogenous vein graft is dependent on healing rather than on the permanent strength of the suture material and that Dexon maintains vascular integrity long enough to permit this healing to occur.

Absorption↗
PubMed1981

Bilirubin binding and neonatal acidosis.

Plasma of neonates with severe metabolic acidosis secondary to fetal hypoxia bound less bilirubin than that of neonates without acidosis, as determined by Sephadex gel filtration. There was a significant correlation between the amount of bilirubin adsorbed by Sephadex and the base deficit. The method used ruled out any influence of plasma pH per se on binding. Our results suggest that organic anions that accumulate in the plasma of asphyxiated acidotic neonates may compete with bilirubin for binding sites on albumin.

Acidosis↗
PubMed1980

Congenital cystic adenomatoid malformation in bilateral renal agenesis. Its mitigation of Potter's syndrome.

Potter's syndrome develops secondary to a deficiency of amniotic fluid, such as occurs in renal agenesis. Congenital cystic adenomatoid malformation (CCAM), on the other hand, is frequently accompanied by polyhydramnios. We describe a newborn with both renal agenesis and CCAM who had only mild features of Potter's syndrome. The pathogenesis of polyhydramnios in CCAM is discussed with regard to the ultrastructural findings of numerous type 2 pneumocytes lining the cysts. The association between CCAM and bilateral renal anomalies is emphasized.

Abnormalities, Multiple↗
PubMed1980

Extramembranous pregnancy: maternal, placental, and perinatal implications.

The case of a patient who survived extramembranous pregnancy is presented, and the maternal, fetal, placental, and neonatal features of the condition are described and delineated. Previously underscribed phenomena include clinical evidence of fixed fetal position and a unique pattern of hemosiderin and hematoidin staining of the fetal membranes. The patient described had an intermediate form of the oligohydramnios tetrad following premature rupture of the membranes; the infant survived with respiratory support therapy in spite of apparent partial lung hypoplasia. On the basis of this and previous observations of the outcome of pregnancy complicated by prolonged amniotic fluid leakage, preliminary recommendations for the management of such pregnancies are made.

Abruptio Placentae↗
PubMed1979

Pulmonary hypoplasia: lung weight and radial alveolar count as criteria of diagnosis.

A working definition of pulmonary hypoplasia (PH) was established by retrospective assessment of lung growth both in recognised and hypothetical PH-associated conditions. Lung weight: body weight ratios (LW:BW) were calculated, and morphometry was determined by the radial alveolar count (RAC) (Emery and Mithal, 1960). Both parameters were reduced compared with those of normal controls in diaphragmatic hernia, anencephalus, anuric renal anomalies, chondrodystrophies, and osteogenesis inperfecta. Comparison of LW:BW ratio and RAC indicated that the RAC was the more reliable criterion of PH, LW:BW ratio of less than or equal to 0.012 (67%) of mean normal ratio) and/or RAC of less than or equal to 4.1 (75% of mean normal count) are suggested as diagnostic criteria of PH. Evidence of PH was incidentally discovered in a number of clinically unsuspected cases and retrospectively clarified the clinical and radiological findings. Routine assessment of lung growth should be an essential part of the neonatal necropsy.

Anthropometry↗
PubMed1979

Neonatal diagnosis of familial dysautonomia.

The serious prognostic implications of familial dysautonomia (FD) for the affected individual and his family make early definitive diagnosis mandatory. Familial dysautonomia has rarely been diagnosed in the neonatal period in hitherto unaffected families. We describe here three such newborn patients to reinforce the limited data available on this subject. In spite of the variability of expression and the incompleteness of the manifestations of FD in the neonatal period, as well as the presence of a number of "dysautonomic" features in normal newborns, we believe that it is possible to establish a diagnosis of FD neonatally. We pay particular note to the altered state of consciousness and behavior in neonatal FD, the unusual posture and limb movements, and the swallowing disorder with tendency to neonatal aspiration. In addition, the incidental finding of bile pigment in the amniotic fluid of an affected fetus without hemolytic disease may hint at a possible approach to fetal diagnosis of this condition.

Diagnosis, Differential↗
PubMed1978

Prolonged hyperprolactinemia in preterm infants.

Serum PRL levels were followed serially in full term (FT; 39-41 weeks) and preterm (PT; 30-32 weeks) infants, from birth to 12 and 20 postnatal weeks, respectively. Values were higher in FT infants than in PT infants on day 1 after birth (267 +/- 20 vs. 156 +/- 8 ng/ml) but were similar in both by the age of 2-4 weeks (69 +/- 8 vs. 69 +/- 6 ng/ml). Between the ages of 4-12 weeks, the serum PRL in FT infants fell to near adult levels (24 +/- 2 ng/ml), but this fall was seen much later in PT infants, between 12-20 weeks postnatally (23 +/- 2 ng/ml). When values in FT and PT infants were compared at parallel postmenstrual ages in contradistinction to postnatal ages, a similar course of PRL was discernable in both groups. These data may provide indirect evidence for the establishment and maturation of inhibition of PRL secretion (i.e. PRL-inhibitory factor production) postnatally, between 44-52 weeks postmenstrually.

Aging↗
PubMed1978

Decreased fetal movements and polyhydramnios.

It was previously demonstrated that in high-risk pregnancies, pronounced reduction of fetal movements until cessation, with audible fetal heart sounds, indicates severe fetal distress and impending death. Immediate delivery is indicated provided the fetus is viable. Three instances of cessation of fetal movements associated with polyhydramnios are reported; the fetuses proved to have malformations lethal for the newborn infant. These cases of polyhydramnios with diminished fetal movements stress the importance of investigating fetal morphology in this condition. Antenatal diagnosis of congenital anomalies may influence decisions about intervening in cases of decreased fetal movements.

Abnormalities, Multiple↗