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Biomedical subjects

W F Friedman

Publications and source records attributed to W F Friedman.

At least 91 records · Page 5Linked to original sources
PubMed1978

Tympanic neurectomy and chorda tympanectomy for the control of drooling.

Seventeen patients suffered from drooling that either occurred as a sequelae of extensive head and neck cancer resections or was due to neurological disorders. In these patients, a tympanic neurectomy and/or chorda tympanectomy was performed in an attempt to eliminate the drooling. The conditions in five of 12 (41%) patients with head and neck cancer were improved following such surgery. Two of four children with cerebral palsy initially had a good result. However, the long-term follow-up of the patients demonstrated that the drooling recurred. An additional patient suffering from bulbar weakness and drooling owing to a cerevrobascular accident had less problems with salivary secretions. The results were relatively disappointing; there are several possible explanations for this.

Adolescent↗
PubMed1978

Echocardiographic diagnosis: pitfalls in the premature infant with a large patent ductus arteriosus.

Thirty-one infants with clinical and radiographic evidence of a large left-to-right shunt across a patent ductus arteriosus underwent echocardiographic study to determine the magnitude of shunting. Seven patients were found to have a normal-left atrial dimensions and a normal left atrial/aortic root dimension at the time when physical and roentgenographic findings of a large PDA were most pronounced. In contrast, left ventricular end diastolic dimensions were excessive in these infants. After ductal closure (four, surgery; two, indomethacin, one, spontaneous) the left ventricular end diastolic dimension fell to the normal range. Optimal echocardiographic accuracy in infants with PDA should combine analysis of both atrial and ventricular dimensions; the former, used alone, may be misleading.

Ductus Arteriosus, Patent↗
PubMed1978

Closure of the patent ductus arteriosus with ligation and indomethacin: a consecutive experience.

This report summarizes a consecutive experience with 59 preterm infants with clinical, radiographic, and echocardiographic findings of a large patent ductus arteriosus. Thirty-five infants who met defined criteria received indomethacin, and 24 infants underwent PDA ligation. Analysis of the clinical course of these infants revealed no selective indomethacin morbidity and suggests that infants undergoing ligation require more prolonged ventilator therapy with increased exposure to FiO2 greater than or equal to 0.3. Mortality rates between ligated and pharmacologically treated groups were similar. This study documents that inhibition of prostaglandin synthesis to constrict and close the PDA in the premature infant is an effective alternative to operative closure.

Ductus Arteriosus, Patent↗
PubMed1978

Critical aortic stenosis in neonates.

Twelve infants with valvular aortic stenosis manifested symptoms of heart failure during the first 2 months of life. Nine became symptomatic and demonstrated cardiomegaly and pulmonary vascular congestion during the first week of life. The other 3 infants became symptomatic at 3-8 weeks. Echocardiograms revealed normal or enlarged left atrial and ventricular dimensions excluding hypoplastic left heart. Left ventriculography demonstrated segmental dysfunction in 7 infants and generalized hypokinesis in 2 others. Trabecular effacement corresponded with the sites of left ventricular dysfunction. Postoperative studies revealed a decrease in cardiac size and improvement in segmental dysfunction in most infants.

Aortic Valve Stenosis↗
PubMed1978

Radiographic and echocardiographic evaluation of newborns treated with indomethacin for patent ductus arteriosus.

A series of 33 consecutive preterm newborns who were treated with indomethacin, a drug which acts to close the patent ductus arteriosus, were studied retrospectively to examine the efficacy of chest radiography and echocardiography in diagnosing the presence of a significant patent ductus arteriosus. Radiographic changes in pulmonary vascular engorgement, pulmonary edema, and cardiac size on the anteroposterior film tended to precede the clinical changes of shunt appearance and resolution. The echocardiographic left atrial to aortic ratio (LA/Ao) supplemented the radiographic findings. The time of disappearance of the ductus arteriosus shunt, as judged by clinical findings, was identified accurately by radiographic and echocardiographic findings in the majority of cases; errors of under- and overestimation occurred in a minority of patients. In assessing both the presence and the resolution of the shunt, greater reliability was possible by using both radiographic and echocardiographic findings than by using either method alone.

Diagnostic Errors↗
PubMed1978

Prostaglandins: physiological and clinical correlations.

This review has necessarily been incomplete. We have not considered the potentially important interplay between PGs and male and female reproductive functions or the well-documented relationships between PGs and inflammation. We have examined the evidence for the influence of PGs on the pulmonary and peripheral vascular circulations and the interaction between PGs and the kidney and the autonomic nervous system. Emphasis has been placed on the role of PGs in the control of the circulation of the ductus arteriosus, and our recent experiences with indomethacin in sick, preterm infants with large left-to-right ductal shunting have been outlined. Existing information has been reviewed concerning PGs and the fetal-placental and fetal-maternal units. It should be clear that a host of proposed functions exists for PGs; many remain tentative in light of the conflicting and often bewildering results of animal experimentation.

Animals↗
PubMed1977

Cross-sectional echocardiographic features of Ebstein's anomaly of the tricuspid valve.

Multicrystal real time-motion echocardiographic studies of 10 patients with Ebstein's anomaly of the tricuspid valve are reported. Eight patients also underwent hemodynamic and angiographic study. All but one of the patients had inferior and leftward displacement of the tricuspid valve. In seven patients multiple echoes were obtained from the tricuspid valve, all seven manifested elongated tricuspid valve leaflets, and in six the leaflets were thickened. Excessive excursion of the tricuspid valve was noted in five patients and a "whipping" motion seen in three. Nonspecific findings in nine patients included an increased right ventricular dimension and systolic anterior septal motion. Thus, cross-sectional echocardiography provides distinctive diagnostic findings that are specific for Ebstein's anomaly.

Adolescent↗
PubMed1977

Patent ductus arteriosus in preterm infants with idiopathic respiratory distress syndrome. Radiographic and echocardiographic evaluation.

Clinical, radiographic, echocardiographic and operative findings were evaluated in 55 preterm infants with idiopathic respiratory distress syndrome (IRDS) complicated by patent ductus arteriosus (PDA). Pulmonary plethora was detected prior to age seven days in 52 infants, and prior to murmur detection in 42 infants. In those with large shunts, only 35% had cardiomegaly while 78% had a significant increase in cardiothoracic ratio (C/T) on sequential radiographs. Moreover, within 48 hours after ligation, 91% of infants had a significant decrease in C/T. Echocardiographic left atrial to aortic ratio (LA/Ao) was elevated in 71% with large shunts. In one patient with a large shunt there was neither a sequential increase in C/T nor an increased LA/Ao. Severity of left-to-right shunting across a PDA in the newborn was reliably gauged by combined radiographic and echocardiographic evaluation. Either modality alone failed to reflect the presence of a large volume shunt in a number of infants.

Ductus Arteriosus, Patent↗
PubMed1977

Contractile and biochemical responses of cardiac and skeletal muscle to isoproterenol covalently linked to glass beads.

The effects of (-)-isoproterenol covalently linked to glass beads on inotropic state, cyclic AMP concentration, and phosphorylase b to a conversion was studied in cat and guinea pig papillary muscles. Biochemical responses also were measured in mouse diaphragm sections. In cat papillary muscles under normal conditions and in guinea pig muscles partly depolarized with 22 mM K+ an increased inotropic state and phosphorylase activation could be dissociated from the formation of cyclic AMP. This contrasts with close correlation reported between isometric tension and cyclic AMP concentration in guinea pig papillary muscles exposed to varying concentrations of isoproterenol dissolved in the bath medium. The cyclic nucleotide did increase in guinea pig papillary muscles exposed to a freshly prepared batch of isoproterenol beads and in the mouse diaphragms. The type and age of the bead preparation had marked effects on all responses that were measured and on the rate of leakage of biologically active products from the beads. Nevertheless, experimental conditions could be obtained under which the initiation of the contractile and biochemical responses was probably limited to intense stimulation of receptors at or near the points of contact between beads and muscle and not due to gross leakage into the bath. The results indicate that cyclic AMP is probably involved in the initiation but not the propagation of the inotropic response of papillary muscles exposed to isoproterenol glass beads.

Animals↗
PubMed1977

Renal responses of the fetal lamb to fetal or maternal volume expansion.

Fetal and maternal glomerular filtration rate (GFR), renal plasma flow (RPF), urine volume, sodium excretion, and fractional sodium reabsorption were measured in a chronically instrumented sheep preparation. Fetal GFR was essentially stable between 110 and 135 days of gestation (term = 147 days). There was a significant increase in GFR after 135 days. After the infusion of 50 ml of normal saline over a 30-minute period, fetal GFR and sodium excretion increased significantly. Fractional sodium reabsorption was significantly decreased. Thus, the fetus is capable of responding to volume expansion with saline with an increase in GFR and a decrease in fractional sodium reabsorption. After the infusion of 1000 ml of normal saline into the ewe in 1 hour, maternal GFR and RPF rose significantly. Sodium excretion rose 6-fold and fractional sodium reabsorption fell significantly. After the infusion of saline into the ewe, there was no change in fetal GFR, RPF, sodium excretion, urine volume, or fractional sodium reabsorption. Since there were no changes in fetal renal function after maternal volume expansion with saline there was no evidence for the transplacental passage of a natriuretic factor from ewe to fetus.

Animals↗
PubMed1976

Acute effects of maternal ethanol infusion on fetal cardiac performance.

In adult animals and man, both acute and chronic ethanol intake is associated with depression of myocardial performance. Accordingly, the cardiac effects of maternal ethanol infusions, in a manner comparable to common obstetric practice of inhibition of premature labor with ethano mighte for inhibition of premature labor, were evaluated in six chronically instrumented fetal sheep. Fetal and ewe arterial PO2, PCO2, and pH values remained within normal limits with infusion rates of 15 c.c. per kilogram of 10 per cent ethanol over two hours (blood ethanol = 110 mg. per cent) and 15 c.c. per kilogram over one hour (blood ethanol = 210 mg. per cent). Fetal instrument evaluation (for 14 to 30 days after operation) provided data concerning pressures and cardiac dimensions which allowed analysis of left ventricular performance. Ethanol produced a significant depression of the extent (p less than 0.01) and velocity (p less than 0.001) of left ventricular myocardial fiber shortening as well as in the mean rate of left ventricular myocardial fiber shortening as well as in the mean rate of left ventricular circumferential fiber shortening (p less than 0.01). These indices of cardiac contractility were depressed in the absence of changes in end diastolic diameter, left atrial pressure, and systemic arterial pressure. Thus, the practice of inhibition of premature labor with ethano6 might contribute to depressed myocardial performance in the neonatal period.

Animals↗