Biomedical subjects
Publications and source records attributed to D W Roloff.
Transillumination of the neonatal chest is described as an aid in the diagnosis of pneumothorax or pneumomediastinum. Sudden severe tension pneumothorax or pneumomediastinum can be localized for immediate treatment and the success of therapy can be immediately assessed using transillumination.
Morphine was injected subcutaneously in doses of 2.5 to 10 mg/kg every 6 hours into pregnant rabbits from early pregnancy until delivery by hysterotomy on the 27th, 28th or 29th day. Pregnant control animals received 0.9% NaC1 injections. Abortions occurred in 34% of the morphine-treated does as a doserelated effect and in 6.5% of the controls. In preserved pregnancies the prevalence of intrauterine death was identical in both samples. Fetuses of treated animals weighed significantly less than those of the controls.However, the normally present effect of intrauterine position on fetal growth was not altered in fetuses of treated animals, so that growth-retarded as well as normal fetuses weighed more when located in the ovarium rather than the cervical portion of the uterus. The fetal lungs were inflated to 35 cm H2O and the remaining air at a deflation pressure of 10 cm H2O (V10) was determined as a measure of lung stability. There were no differences in this indicator of fetal lung maturity between fetuses of treated and control animals. It was found that the lecithin/sphingomyelin (L/S) ratio in the amniotic fluid of rabbits does not correlate with lung maturity; there were no differences between fetuses of treated and control animals. Morphine, when administered to pregnant rabbits does not accelerate fetal lung development. Therefore, the observed reduction in the incidence of respiratory distress syndrome in infants of heroin-addicted women has no direct equivalent in this animal model.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
We have extended our controlled study to a total of 129 patients. Infants treated with phenobarbital confirm to have a significant lower incidence of IVH of all degrees. We now give phenobarbital to all prematures under 1800 g birthweight.
Radionuclide lumbar cisternography with 111In-DTPA was utilized as a bedside procedure to evaluate CSF dynamics and the patency of the ventricular system in 29 preterm infants with hydrocephalus. Serial images of the brain were obtained at 0, 1, 2, 6, 24 and 48 hours after instillation of the isotope in the lumbar subarachnoid space. Three distinct patterns were seen. Infants with posthemorrhagic hydrocephalus displayed prompt ventricular filling but markedly delayed emptying with minimal flow over the cerebral convexities. Infants with ventriculomegaly secondary to suspected brain atrophy or periventricular leukomalacia demonstrated a pattern of prompt ventricular filling, delayed emptying, but with flow present over the convexities. An infant with noncommunicating hydrocephalus secondary to an Arnold-Chiari malformation showed a pattern of complete obstruction with no ventricular filling. Radionuclide lumbar cisternography appears to be a safe, well-tolerated procedure which produces images of sufficient resolution to provide valuable information about CSF dynamics, delineating basal cisternae, ventricles, and subarachnoid flow paths.
Clinicians reserve ECMO for neonates at > 80% predicted mortality risk. The authors hypothesized that ECMO instituted at lower (50%) mortality risk would result in fewer intensive care unit days and a lower hospital cost compared with conventional therapy (including ECMO at high mortality risk). This was a randomized control trial, cost-benefit analysis in an academic newborn intensive care unit. The patients were a prospectively studied, consecutive sample of 41 term neonates with 1) age 24-72 hours, 2) "maximal medical management" for > 6 hours, 3) oxygenation index (OI) values > 25 but < 40. (Severity of illness measured by OI = ((mean airway pressure x FiO2 x 100) PaO2)). All eligible patients entered. Thirty-two of 37 survivors were evaluated at 1 year. Intervention occurred when OI = 25. Patients were randomized to ECMO or continued medical management (ECMO possible at OI = 40). Planned primary outcome measures were ICU days and hospital charges. Secondary measures were pulmonary and neurologic outcomes at discharge and 1 year. Twenty-two early ECMO patients, 19 controls, 14/19 met late ECMO criteria. Four patients died (two each group). No statistically significant difference was seen in hospital charges (early ECMO = $49,500 versus control = $53,7000), (95% confidence intervals = -$3200 to +$5100 more for controls) or ICU days (early = 14 + 5 days versus control = 19 + 12 days) (95% CI = -0.8 to +10 more for controls). At 1 year the early group had a higher mental developmental index score (115 + 11) versus (103 + 18), (p = 0.07).(ABSTRACT TRUNCATED AT 250 WORDS)
After it was reported in 1981 that phenobarbital reduced the incidence of intraventricular hemorrhage from 46.7% in control infants to 13.3% in treated premature infants, routine phenobarbital prophylaxis (loading dose, 20 mg/kg; maintenance, 5 mg/kg per day for 5 days) was introduced at the hospital of the original trial for all premature infants with birth weights of < or = 1800 gm. To assess continued efficacy, we reviewed all records of these infants from 1985 through 1989. The overall incidence of intraventricular hemorrhage was 27.5% (168/612); the proportion of severe intraventricular hemorrhage (grade 3 and 4) was 41.1% (69/168). The incidence of intraventricular hemorrhage was lower when loading occurred at < 4 hours: 25.9% (124/478) versus 32.8% (44/134). Outborn infants had a higher incidence of intraventricular hemorrhage than inborn infants (45.3% vs 23.0%). In addition to already known risk factors (gestational age, vaginal delivery, outborn status, pneumothorax, birth asphyxia, patent ductus arteriosus), intraventricular hemorrhage occurred more often in infants with hyperoxia (PO2 > 180 mmHg), hypocarbia (PcO2 > 28 mmHg), hypercarbia (PcO2 > 55 mmHg), and hypotension and hypertension (blood pressure > norm +/- 15 mmHg). These results support the hypothesis that phenobarbital has a role in the prophylaxis against intraventricular hemorrhage. Differences in the efficacy of phenobarbital prophylaxis between various studies may be caused by variations of age at loading and differences in the proportion of very low birth weight infants.(ABSTRACT TRUNCATED AT 250 WORDS)