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Biomedical subjects

T R Thompson

Publications and source records attributed to T R Thompson.

At least 55 records · Page 3Linked to original sources
PubMed1983

Furosemide promotes patent ductus arteriosus in premature infants with the respiratory-distress syndrome.

Furosemide stimulates the renal synthesis of prostaglandin E2, a potent dilator of the ductus arteriosus. We administered this drug to 33 premature infants with the respiratory-distress syndrome, to determine whether it increased the incidence of patent ductus arteriosus. Chlorothiazide, a diuretic that does not stimulate prostaglandin E synthesis, was used as the control drug in 33 other infants. During the study, the incidence of patent ductus arteriosus was significantly higher (P less than 0.02) in the furosemide group (18 of 33 infants) than in the chlorothiazide group (8 of 33). Eleven infants in the furosemide group and seven in the chlorothiazide group required ductal ligation (P greater than 0.2). An additional six infants (all from the furosemide group) who did not have evidence of a patent ductus during the study were later found to have one. Overall survival was 76 and 61 per cent in the furosemide and chlorothiazide groups, respectively (P greater than 0.2). Small (less than twofold) increases in the urinary excretion of prostaglandin E were seen after the initial dose of both drugs. When the analysis was repeated after the fifth day of life, prostaglandin E excretion tripled after furosemide administration, whereas no increase occurred with chlorothiazide. We conclude that furosemide increases the incidence of patent ductus arteriosus in premature infants with the respiratory-distress syndrome, probably through a prostaglandin-mediated process.

Chlorothiazide↗
PubMed1983

Warburg syndrome: lethal neurodysplasia with autosomal recessive inheritance.

Warburg syndrome is a recently recognized autosomal recessive neurodysplasia characterized by ventricular dilation, agyria, disorganized cortical cytoarchitecture, and dysgenesis of multiple other central nervous system structures. Because the disorder is lethal, with a 25% recurrence risk, it is crucial to distinguish Warburg syndrome from nonheritable phenocopies (caused by infectious agents and other teratogens) as well as from genetic disorders with a better prognosis. The clinical presentation of a markedly depressed newborn infant with hydrocephalus or ocular anomalies should suggest the diagnosis; computed tomography may be useful to demonstrate agyria as well as ventricular dilation. However, the distinctive neuropathologic finding of absent cerebral cortical lamination associated with numerous heterotopias appears to be diagnostic. Thus brain biopsy should be considered, especially at the time of ventricular shunting, whenever the clinical presentation suggests Warburg syndrome.

Abnormalities, Multiple↗
PubMed1983

Diuresis and pulmonary function in premature infants with respiratory distress syndrome.

A prospective study of 99 premature infants with severe respiratory distress syndrome who were randomly assigned to receive diuretic treatment with either furosemide or chlorothiazide was analyzed to examine the relationship of diuretic administration and diuresis to survival and to the duration and degree of mechanical ventilatory support. Subjects were given a diuretic, usually beginning on the second or third day of life, if they had not initiated the expected spontaneous diuresis and did not show pulmonary improvement. Infants given furosemide experienced a postnatal weight loss nearly identical to that in infants who were deemed not to need a diuretic; infants given chlorothiazide lost weight more slowly and had significantly greater body weight on postnatal days 4 and 5. Four factors were independently correlated with improved survival: furosemide usage, high birth weight, low initial mean airway pressure, and the absence of intraventricular hemorrhage. Ventilator mean airway pressure on the seventh day of life and duration of mechanical ventilation were both related to diuresis. These data provide additional evidence for the importance of water homeostasis in determining the course of respiratory distress syndrome in premature infants and indicate that furosemide administration is beneficial when spontaneous diuresis does not occur. Furosemide may be particularly effective if combined with early closure of the ductus arteriosus.

Chlorothiazide↗
PubMed1983

Pulmonary vascular effects of amrinone in conscious lambs.

The direct pulmonary vascular effects of amrinone, a nonglycoside, noncatechole cardiotonic agent were studied in conscious newborn lambs using a double-flow probe preparation that allows separation of direct and indirect pulmonary vascular effects. Amrinone was found to be a direct pulmonary vasodilator with a threshold dose of 0.3 mg/kg. Amrinone also increased cardiac output and decreased aortic pressure at somewhat higher threshold doses (1.0 mg/kg and 3.0 mg/kg, respectively). Amrinone's peak effect on pulmonary resistance appeared greater than its peak systemic effects. These effects were noted in both normoxia and hypoxia, and were not changed by pretreatment with propranolol.

Aminopyridines↗
PubMed1983

Estimation of volume and weight of the perinate: relationship to morphometric measurement by ultrasonography.

A method of determining fetal weight in utero was developed by use of real-time ultrasonography. A volume model representing trunk and limbs as cylinders with dimensions related to morphometric parameters was tested on 60 neonates. Head volumes in these 60 neonates were determined from equations relating head morphometric measures to head volume in 30 neonatal autopsy specimens. Head density and trunk and limb density were determined separately on the 60 neonates by study of the variation in overall density with body proportions. From these density and volume values, total body mass was estimated. The deviation of neonatal weight estimates from actual weights at three days postpartum was +/- 4.1 per cent (1 SD). The validity of this method for fetal weight determination was tested by in utero ultrasonographic measurement of 31 fetuses before delivery by cesarean section. The deviation of the weight estimate from the actual weight at three days postpartum was +/- 8.1 per cent (1 SD), or +/- 7.4 per cent (absolute mean error).

Biophysical Phenomena↗
PubMed1983

Correction of esophageal atresia with distal tracheoesophageal fistula.

Correction of the full spectrum of esophageal atresia with tracheoesophageal fistula (TEF) remains controversial. Circular myotomy and other lengthening procedures have shown promise to reduce tension when a relatively wide gap exists between esophageal segments; nevertheless a relatively high complication rate persists. We believe anastomotic tension is commonly found with repair of this anomaly. Therefore, the construction of the anastomosis will be a primary determinant of success. Twenty-four infants with TEF were admitted, 12 (50%) weighing 2.5 kg, nine (37%) 1.8 to 2.5 kg, and three (13%) 1.8 kg. All underwent gastrostomy and end-to-end single-layer anastomosis. Gaps of up to 4.5 cm were encountered, and in one case a cervical incision was necessary for mobilization of the upper pouch. For eight patients (33%) the gap was at least 2.5 cm and significant anastomotic tension was generated. For the series, there were no anastomotic leaks (all confirmed by barium swallow), reoperations, or surgical complications (there were two late, unrelated deaths). Prophylactic dilation was routinely performed 6 weeks and 3 months postoperatively. Subsequently, seven of the 24 (29%) required additional (one to five) dilatations but are now asymptomatic at least 2 years later. Follow-up for the entire series is 5 months to 5 years. Three infants (13%) required fundoplication for reflux without stricture and two infants (8%) an aortopexy. For successful esophageal anastomosis we consider the following technical points important: (1) no-touch technique to minimize tissue damage, (2) generous (5 to 7 mm) full-thickness suture depth, (3) fine (6/0) monofilament suture to reduce tissue reactivity, and (4) in cases of significant tension, the sutures are preplaced and used to provide traction to eliminate tension during tying. Tension is often unavoidable in TEF, yet a carefully constructed anastomosis will withstand this stress. This approach provides results at least as satisfactory as the reported experience with a variety of techniques.

Dilatation↗
PubMed1982

Uncinariasis in kennelled foxhounds.

Uncinariasis was diagnosed as the cause of unthriftiness in kennelled foxhound pups. Post mortem examination of two pups revealed large numbers of Uncinaria stenocephala embedded in the mucosa of the distal small intestine. The worms were associated with blunting and thickening of villi in this region. The stereoscopic appearance of U stenocephala as seen by scanning electron microscopy is described.

Ancylostomatoidea↗
PubMed1982

Intraventricular hemorrhage in the full-term neonate.

Intraventricular hemorrhage (IVH) can occur in full-term newborns with a variety of clinical pictures. We studied five full-term infants who suffered IVH in the neonatal period and survived. No apparent cause for hemorrhage could be found in four. All had normal results of neurologic examinations at birth, and four had no major antecedent perinatal or postnatal difficulties. In 19 previously described full-term infants with IVH, no perinatal problems were noted in 45% of those who survived. Although more common in premature infants, IVH can occur in full-term infants and should be suspected when there is a sudden change in the neurologic status. In subsequent examinations, three of our five infants had mild spasticity and two appeared to be normal. The grading system developed for IVH in premature infants, while indicating severity of the hemorrhage, does not predict clinical outcome in full-term infants. A more definitive statement of outcome will require a longer period of observation.

Cerebral Hemorrhage↗
PubMed1982

Measurement of esophageal pressure in newborn infants using an esophageal balloon gastric catheter.

This report describes a new standard technique for the measurement of esophageal pressure (Pes) in mechanically ventilated neonates. A neonatal esophageal balloon was positioned in the distal esophagus and inflated with a volume of air determined by static pressure volume curves. Different waveforms demonstrating cardiac contractions, mechanical inspiration, spontaneous breathing, and myoclonic jerks were observed. Measurements made in the supine position were higher than those made in either the right or left lateral position (p less than 0.005). Pes measurements increased notably with barotrauma (p less than 0.025).

Calibration↗
PubMed1982

Factors affecting attachment between infants and mothers separated at birth.

A sample of 24 healthy Neonatal Intensive Care Unit (NICU) survivors separated from their mothers for a period of more than 10 days after birth were studied at approximately 1 year postconceptional age to assess mother-infant attachment. The 24 infants were classified into secure-attached (N = 17) and insecure-attached (N = 7) groups according to Ainsworth categories. No differences were found between the groups in birth weight, gestation, length of NICU hospitalization, Bayley developmental scores, and 1-year physical measurements. Secure-attached infants, however, tended to be from younger, working mothers and had more day-care experiences. The data do not support the hypothesis that prolonged neonatal separation has detrimental effects on later mother-child interaction.

Adult↗
PubMed1982

Pulmonary neuroendocrine cells in hyaline membrane disease and bronchopulmonary dysplasia.

The number and distribution of bombesin immunoreactive pulmonary neuroendocrine cells (PNEC) in fetuses and infants up to 6 months of age was determined on postmortem lung specimens. Individual cells and clusters of cells (neuroepithelial bodies) were found in airways of all sizes, although greater than 95% of the positive cells were located in bronchioles, terminal bronchioles, and respiratory bronchioles. These infants were separated into two groups. In control infants, who died primarily from noncardiopulmonary causes, bombesin immunoreactive neuroendocrine cells were identified throughout the latter half of gestation. As gestation advanced, progressively more positive bronchioles/cm2 of lung tissue and cells/bronchiole were identified. In these control infants, the number of positive bronchioles/cm2 and cells/bronchiole were at the highest level at or near the time of delivery and then gradually declined throughout the first 6 months of life. In contrast, infants who died of acute hyaline membrane disease (1-7 days of life) or bronchiopulmonary dysplasia (2 wk to 6 months of life) demonstrated marked differences in the number of identifiable bombesin immunoreactive neuroendocrine cells when compared to control infants. In early hyaline membrane disease, the number of positive bronchioles/cm2 and cells/bronchiole was markedly decreased. During the transition to chronic bronchopulmonary dysplasia, there appeared to be a marked increase in the number of bombesin immunoreactive cells. The peak number of cells occurred at 2-3 months of life, when substantially more bombesin-immunoreactive cells could be identified in children with bronchopulmonary dysplasia than control infants of similar age.

Bombesin↗
PubMed1982

Management of esophageal and pharyngeal perforation in the newborn infant.

Perforation of the esophagus or pharynx may occur during placement of endotracheal or nasogastric tubes in the newborn infant. Controversy exists, however, whether medical or surgical therapy is better in the management of these perforations. Nine patients who had esophageal or pharyngeal perforation in the neonatal period and were treated medically with antibiotics, nutritional support, and closed chest-tube drainage of pneumothoraces are described. All perforations healed without surgical repair. No mortality or morbidity occurred secondary to these perforations. This study, together with a review of the 73 patients described in the literature, indicate that perforations of the pharynx and esophagus can be satisfactorily managed medically. There is no apparent advantage to routine early surgical exploration. Only complications such as mediastinitis and mediastinal mass formation seem to require surgical treatment. Medical therapy with close observation for signs of sepsis and/or mediastinal changes will enable most newborn infants to avoid an operation and will identify those infants for whom surgery is definitely indicated.

Ampicillin↗