Biomedical subjects

E Hardee

Publications and source records attributed to E Hardee.

4 recordsLinked to original sources

PubMed2000

Extracorporeal membrane oxygenation. Saving tiny lives.

Infants with CDH require a dedicated nursing team that often comes from three different critical care areas: neonatal ICU, the ECMO unit, and the operating room. The team works together to directly affect the outcome of these infants through their preoperative, intraoperative, and postoperative care. The physiologic status of the patient and the psychosocial aspects of the family unit are of prime concern to the nursing team involved. Controversy still surrounds the use of ECMO because long-term effects on its survivors are unknown. It will be important for members of the team that manages the infant diagnosed with CDH to understand the benefits and limitations of ECMO. Even with its controversial aspects, ECMO offers the infant with CDH an alternative when conventional therapy fails. The collaborative efforts of the multidisciplinary team that manages these neonates must continue to evaluate treatment modalities and update techniques to maintain quality of care for this challenging population.

Critical Care↗

PubMed1998

A new technique for laparoscopic splenectomy with massively enlarged spleens.

Splenectomy is indicated in several hematological disorders and it can be particularly challenging in children with sickle cell disease, splenomegaly, and recurrent sequestration. Over the last 6 months, we have developed a new technique for laparoscopic splenectomy (LS) for hypersplenism and splenomegaly in five children with sickle cell disease. The average age of our patients was 6 years (range, 2-11), and the average weight was 18.7 kg (range, 13.2-30.1). On preoperative ultrasound, spleen size index ranged from 0.42 to 0.76. For the LS, four trochars were placed. One patient, who also underwent a laparoscopic cholecystectomy, had six trochars placed, two of which were used for both cholecystectomy and splenectomy. After laparoscopic mobilization of the spleen and hilar vascular stapling, a Steiner electromechanical morcellator was inserted through the 12-mm port to extract cores of splenic tissue until complete splenectomy was achieved. No patient required conversion to an open procedure or creation of a larger incision to remove the massively enlarged spleen. Operative time averaged 190 minutes; the combined LS and cholecystectomy took 245 minutes. Postoperative length of stay was <2 days for all patients. There were no complications, and no patient required postoperative transfusion. Based on these early findings, we conclude that intracorporeal coring of splenic tissue allows for safe and complete laparoscopic removal of very large spleens in small children. It provides expedient recovery and minimal postoperative pain and scarring. This new technique should enable surgeons to perform LS even in patients with massive splenomegaly, eliminating the need for large and cumbersome intracorporeal bags or the creation of additional incisions to remove the spleen.

Child↗

PubMed1989

Effect of ATP and amiloride on ANF binding and stimulation of cyclic GMP accumulation in rat glomerular membranes.

We investigated ANF binding and stimulation of cGMP accumulation in isolated rat glomerular membranes in the presence and absence of amiloride and ATP. Amiloride enhanced high affinity binding of ANF without affecting its stimulation of cGMP. In contrast ATP decreased binding and decreased basal cGMP accumulation without affecting the ability of ANF to stimulate cGMP. These data indicate that ANF binding and stimulation of cGMP accumulation can be regulated independently supporting further the concept of receptor heterogeneity in renal glomerular membranes.

Adenosine Triphosphate↗

PubMedDate not supplied

Amiloride enhances atrial natriuretic factor stimulation of cGMP accumulation in rat glomeruli.

The effects of amiloride on ANF binding and ANF stimulation of cGMP were evaluated in rat glomeruli. Amiloride increased ANF binding to whole glomeruli and to glomerular membrane preparations. In contrast, amiloride enhanced ANF-stimulated cGMP accumulation only at 37 degrees C in whole glomeruli, but not at 4 degrees C in whole glomeruli or at 37 degrees C in membrane preparations. These data suggest that under physiological conditions amiloride augments ANF-stimulated intracellular cGMP accumulation. The discrepancies between amiloride augmentation of ANF binding and failure to increase ANF-stimulated cGMP accumulation may result from ANF receptor heterogeneity. This is the first report of an amiloride augmentation of ANF-stimulated cGMP accumulation in renal tissue.

Amiloride↗