Biomedical subjects
D K Edwards
Publications and source records attributed to D K Edwards.
Cytomegalovirus infection and bronchopulmonary dysplasia in premature infants.
During a five-year period, 32 preterm infants weighing less than 2000 g were diagnosed as having postnatally acquired cytomegalovirus (CMV) infection in a neonatal intensive care unit. These CMV-infected infants were matched with 32 uninfected controls for gestational age, birth weight, and birth date; the two groups did not differ in Apgar scores or the incidence of respiratory distress syndrome and patent ductus arteriosus. Roentgenographic evidence of bronchopulmonary dysplasia (BPD) developed in 24 (75%) of 32 CMV-infected infants, an incidence significantly greater than that observed in control infants (12/32; 38%). Infants with acquired CMV infection required more respiratory support and longer hospitalization than uninfected controls. This association between acquired CMV infection in premature infants and the development of chronic lung disease provides further evidence that vigorous efforts to prevent CMV infection in hospitalized neonates is warranted.
Vascular pathogenesis of unilateral craniofacial defects.
The term hemifacial microsomia refers to unilateral defects in development of structures derived from the first and second branchial arches. Recently we evaluated three unrelated children who had a similar pattern of unilateral craniofacial defects that was associated with other structural abnormalities having a disruptive vascular pathogenesis. The clinical findings in these patients suggest that one cause of hemifacial microsomia is in utero interruption of blood flow.
Percutaneous diagnostic and therapeutic interventional radiologic procedures in children: experience in 100 patients.
Diagnostic and therapeutic interventional radiologic procedures that provide many treatment options in adults are gaining acceptance in pediatric medicine. Diagnostic (69 patients) and therapeutic (31 patients) interventional experiences in 100 children are summarized, and the procedures of choice for various clinical problems are outlined. Procedures include percutaneous biopsy for benign and malignant diseases, transhepatic cholangiography and biliary drainage, genitourinary procedures (nephrostomy, stent placement, balloon dilation), aspiration of fluid for laboratory analysis, therapeutic drainage of abscesses and noninfected fluid collections, and percutaneous gastrostomy and gastroenterostomy. Diagnoses were accurate in 96% of cases, and therapeutic procedures were successful in 84% of patients, usually obviating operation. Complications occurred in six patients (6%); the most severe was hemoptysis causing respiratory distress. There was no procedure-related mortality. Interventional procedures have wide applications in pediatric patients.
Flat chest in chronic bronchopulmonary dysplasia.
In patients with chronic bronchopulmonary dysplasia, the anteroposterior dimension of the chest on the lateral radiograph is often relatively narrow compared with the chest width on the frontal radiograph. A prospective comparison was made of pediatric clinic outpatients who had chest radiography during a 1-month period. Chest widths and thicknesses were measured from the anteroposterior and lateral radiographs, respectively, and a dimensionless ratio of width to thickness was calculated. The chest thus measured was significantly flatter (p less than 10(-6] in 18 patients with chronic bronchopulmonary dysplasia than it was in 128 unaffected patients and in 18 unaffected age-matched patients; there was, however, considerable overlap in chest dimensions between patients with and without bronchopulmonary dysplasia. We speculate that the abnormality results from a combination of demineralized bones, prolonged recumbent positioning, and chronic sternal retraction. It is plausible, but remains to be proved, that this chest wall deformity may be clinically deleterious because it interferes with respiratory mechanics. This prospective comparison of patients with and without bronchopulmonary dysplasia shows that despite considerable overlap in chest dimensions, patients with bronchopulmonary dysplasia tend to have a distinctive chest deformity whose measured difference from control patients is statistically significant.
Meconium peritonitis masquerading as fetal hydrops.
Explore the source record for details and available documents.
Kinked catheters: radiographic appearance of functionally significant bends.
Several nonangiographic catheters commonly used in children were bent and kinked, radiographed, and perfused at different rates to identify appearances that corresponded to significant alterations in flow dynamics. Radiographic signs of catheter kinking (i.e., focal buckling) depended on the severity of bending and the angle of the radiographic beam relative to the plane of the bend. One or more straight lines appeared at the site of buckling; catheters that were not kinked did not demonstrate straight lines. Other signs were distortion of the round catheter lumen and bulging of the catheter material. Distortions short of sharp kinking did not compromise flow except in very small catheters.
Prenatal ultrasonographic diagnosis of congenital adenomatoid malformation of the lung. Correlation with pathology and implications for pregnancy management.
Congenital cystic adenomatoid malformation of the lung is an uncommon malformation. The solid type III variety is the rarest and carries the poorest prognosis. This report describes the prenatal diagnosis of a case of congenital cystic adenomatoid malformation type III at 24 weeks' gestation. The pathologic features of the malformation and the etiology and prognostic significance of hydramnios and anasarca are discussed. This case indicates that the malformation can be diagnosed early enough to allow for therapeutic intervention.
Respiratory distress syndrome treated with human surfactant: radiographic findings.
Chest radiographs of 18 newborns treated with endotracheal instillation of human surfactant for respiratory distress syndrome (RDS) were compared with those of 18 similar but untreated infants. In the treated infants, severity of RDS significantly improved after surfactant administration. Most treated infants (16/18) exhibited a left-to-right shunt, presumably through a patent ductus arteriosus; similar findings were noted in untreated infants (17/18). Complications of respiratory assistance in the treated infants included transient pulmonary interstitial emphysema (n = 1), pneumothorax (n = 1), and mild (n = 4) to moderate (n = 2) bronchopulmonary dysplasia; the incidences of these complications did not exceed those in untreated infants. In three treated infants, a transient interstitial lung disease developed 3-4 days after surfactant administration.
Fibroadhesive meconium peritonitis: in utero sonographic diagnosis.
Explore the source record for details and available documents.
Music takes the heart 'home'.
Explore the source record for details and available documents.
Clinical and roentgenographic scoring systems for assessing bronchopulmonary dysplasia.
Because investigation of bronchopulmonary dysplasia (BPD) has been hampered by imprecise methods for diagnosis and grading of severity, we evaluated new clinical and roentgenographic scoring systems in neonates with severe respiratory distress. The study population included 110 premature neonates who were admitted consecutively over a two-year period and who required mechanical ventilation. The clinical scoring system used measures of gas exchange, respiratory distress, and growth rate; roentgenographic scoring involved numerical assessment of features characteristic of BPD. A significant correlation was noted at 21 days of age between clinical and roentgenographic scores. In a linear stepwise multiple regression, we found that the best predictors of clinical score were birth weight (ie, degree of prematurity) and roentgenographic score. With further development and validation, BPD scoring should be helpful by improving our understanding of the epidemiology of this disease, providing a means for evaluation of treatment, and facilitating multicenter investigations.
Heart size in newborn infants with birth asphyxia.
Cardiomegaly is believed to be an important and relatively common radiographic finding in infants asphyxiated at birth. However, the true incidence of cardiomegaly in such infants has not been previously assessed. Accordingly, heart size was estimated using the cardiothoracic ratio (CTR) in 67 consecutive neonates with birth asphyxia (Apgar score below 6 at 1 and 5 min). The average CTR on the first postnatal film was 52.8%, significantly higher than that of unasphyxiated infants published previously. Subsequent CTR values did not differ significantly from the initial value. Of the 67 patients studied, 13 (19%) had significant cardiomegaly (CTR more than 2 SD above normal). Of these, 10 had conditions other than asphyxia that probably contributed to the cardiomegaly observed. Although relative heart enlargement is common in asphyxiated infants, absolute cardiomegaly is relatively uncommon, and in such infants causes other than asphyxia should be sought.
Elastase and alpha 1-proteinase inhibitor activity in tracheal aspirates during respiratory distress syndrome. Role of inflammation in the pathogenesis of bronchopulmonary dysplasia.
Pulmonary effluent samples were obtained from 26 preterm or term infants throughout the period of endotracheal intubation. Infants with respiratory distress syndrome, infants with this disorder developing bronchopulmonary dysplasia, and intubated infants without lung disease were compared daily in terms of lung effluent cellularity, albumin, elastase activity, alpha 1-proteinase content and activity, and elastase inhibitory capacity. The elastase activity was determined to be neutrophilic in origin. Polyacrylamide gel electrophoresis of pulmonary effluents from two infants with respiratory distress syndrome and exposed to FiO2 greater than or equal to 0.6 up to 6 d revealed cleavage of alpha 1-proteinase inhibitor to a 47,000-mol weight fragment suggestive of oxidation. Pulmonary effluent neutrophils, macrophages, and elastase activity were increased by day 3 of life in infants with respiratory distress syndrome eventually developing bronchopulmonary dysplasia. Elastase inhibitory capacity and alpha 1-proteinase inhibitor activity were reduced in infants developing chronic lung disease. Bronchopulmonary dysplasia developed in infants with enhanced inflammatory response, but with less or inhibited antiprotease activity.
Reduction of lung injury by human surfactant treatment in respiratory distress syndrome.
Explore the source record for details and available documents.
Isolation of human surfactant from amniotic fluid and a pilot study of its efficacy in respiratory distress syndrome.
Explore the source record for details and available documents.
Radiological case of the month. Neonatal fracture of the femur: iatrogenic?
Explore the source record for details and available documents.