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Biomedical subjects

E Nussbaum

Publications and source records attributed to E Nussbaum.

At least 55 records · Page 3Linked to original sources
PubMed1985

Prognostic variables in nearly drowned, comatose children.

Prognostic variables were evaluated in 51 nearly drowned, comatose children, and they included values for age, estimated submersion time, initial arterial pH and core temperature, mean intracranial pressure (ICP), and mean cerebral perfusion pressure (CPP); the latter two values were obtained during the first 24 hours. There were 33 survivors (19 with intact neurologic survival and 14 with brain damage) and 18 deaths. Estimated submersion time and mean ICP and mean CPP determined survival but could not predict the neurologic outcome (intact survival or brain damage). Age, arterial pH, and core temperature were not useful variables in predicting outcome. This study discourages the use of these unreliable variables in predicting survival in nearly drowned, comatose victims and, in addition, cautions against the use of mean ICP, mean CPP, and submersion time as predictors of neurologic outcome. Since mean ICP and mean CPP measurements are reliable in predicting survival but not neurologic outcome, major efforts should be undertaken to explore neurophysiologic and metabolic prognostic factors that may either discourage or mandate early institution of aggressive cerebral resuscitative measures in nearly drowned victims.

Adolescent↗
PubMed1985

Radiographic-endoscopic correlations in the examination of airway disease in children.

The results of radiographic examinations and flexible fiberoptic endoscopy (FFE) of the airways were correlated in 100 pediatric patients. For the diagnosis of laryngomalacia, tracheal stenosis and tracheal granulomas. FFE proved to be more accurate than radiography. In epiglottitis and croup, the two methods were comparable. In bronchial and resulting parenchymal disease, the chest films served as the endoscopist's guide because the consequences of bronchial obstruction manifested rapidly on chest roentgenograms. FFE was particularly useful when the chest films did not reveal or lateralize a clinically suspected foreign body. FFE was not error-free; in a small number of cases, radiologic methods provided critical diagnoses, which were not arrived at by endoscopy.

Adolescent↗
PubMed1985

Coulometric titration of sweat collected with the Webster Collection System.

Presented here are chloride results obtained by direct titration of undiluted sweat collected with the Webster Sweat Collection System. Six hundred and thirty-two sweat chloride results were reported on 604 patients. Thirty-six of thirty-nine sweat chloride results of 60 mM or greater were from patients with cystic fibrosis. Three results (61, 63 and 64 mM) were from a 12-year-old female who had one episode of rectal prolapse but after one year does not have clinical evidence of cystic fibrosis. There was one patient with a cystic fibrosis variant with intermediate range sweat chloride. All others in the intermediate range (40-59 mM) did not have cystic fibrosis. One patient with a sweat chloride reported of less than 40 mM was subsequently found to have cystic fibrosis at another institution.

Chlorides↗
PubMed1985

Intracranial pressure monitoring by subarachnoid bolt in comatose children.

The safety of intracranial pressure (ICP) monitoring by the subarachnoid bolt was studied in 124 comatose children with global (103 patients) and focal (21 patients) cerebral lesions. None of the children developed cerebral hematoma, diffuse bleeding, epileptical focus, or local or systemic infection. Based on our experience, we advocate the use of the subarachnoid bolt for the purpose of ICP monitoring as a simple and safe modality.

Child↗
PubMed1985

Pediatric flexible bronchoscopy and its application in infantile atelectasis.

Forty-six pediatric flexible fiberoptic bronchoscopies were done on 29 infants under 1 year of age, including a 2.3-kg 1-week-old infant girl, and 17 small children between 1 and 2 years of age with persistent unilobar or multilobar atelectasis and declining PaO2 or rising PaCO2. Atelectasis resolved in all 29 infants (100%) and 10 of 17 (59%) small children after direct visualization, bronchial washing, and removal of mucous plugs and/or secretions using a flexible fiberoptic bronchoscope (FFB). The procedure was not associated with any mortality or significant morbidity. Only one infant experienced minor epistaxis and another had transient minimal stridor. None of the 17 small children developed complications. The procedure resulted in resolution of respiratory distress and cough within 24 hours, as well as early hospital discharge in all patients regardless of complete or partial radiographic expansion. Arterial blood gases were improved or normalized in 16 patients. When utilized for selective aspiration of mucous plugs or bronchial secretions, pediatric flexible bronchoscopy is particularly helpful in children with segmental or lobar atelectasis.

Bronchoscopy↗
PubMed1984

Association of hemolytic anemia and early-onset pulmonary emphysema in three siblings.

Three of four siblings born to nonconsanguineous parents of Italian origin were affected with severe congenital hemolytic anemia of unknown cause, and early-onset pulmonary emphysema. Two of the three affected siblings died of septic shock after splenectomy, at the ages of 7 and 3 1/2 years, respectively. The remaining affected sibling was shown to have cutis laxa and severe pulmonary emphysema at 15 years of age. Assay of serum components indicated that alpha 1-antitrypsin and alpha 2-macroglobulin levels were normal or slightly elevated. However, there was markedly elevated activity of an elastase-like serum enzyme. The relation of the hemolytic anemia to the pulmonary findings in this family is not clear; pedigree analysis suggests a recessively inherited defect.

Adolescent↗
PubMed1984

Measurement of total respiratory resistance in children by a modified forced oscillation method.

Total respiratory resistance (RT) was measured in 11 normal children, 2-5.5 years of age (mean 4.16 years), and in 24 children with bronchial asthma, 2-10.5 years of age (mean 6 years), by oscillating the respiratory system from 2-32 Hz with a new microprocessor technique. Twenty-five children were less than or equal to 5 years of age. This technique was also compared with airway resistance (Raw) by body plethysmography both in terms of baseline values and response to bronchodilators. The absolute values for Raw are lower than RT with a mean percentage difference (+/- S.E.M.) of 30.3 +/- 5.0%; however, good correlation between the two techniques was obtained (r = 0.79). The changes of RT and Raw were not significantly different after aerosolized isoproterenol (P greater than 0.05). We determined the inverse relationship between height and RT with correlation coefficient r = -0.79 (P less than 0.01). In children, resonant frequency ranged from 6-24 Hz with a mean value of 16.57 +/- 0.78 Hz. The forced oscillation method utilized clinically in this study provides an alternative to total body plethysmography or an esophageal balloon, which are technically difficult and preclude their routine use in small children. In conclusion, RT utilized in this study is a rapid and reproducible approximation of Raw. It allows evaluation of RT over a wide range of frequencies including resonant frequency and requires less cooperation than body plethysmography.(ABSTRACT TRUNCATED AT 250 WORDS)

Aerosols↗
PubMed1983

Intracranial pressure monitoring as a guide to prognosis in the nearly drowned, severely comatose child.

During a 34-month-period, 55 nearly drowned, comatose children who were admitted to our pediatric intensive care unit were divided into C1 (decorticate), C2 (decerebrate), and C3 (flaccid) subgroups. Patients in subgroup C3 were selected for intracranial pressure (ICP) measurements by the subarachnoid bolt, and were reclassified according to clinical outcome into recovered (group A), fatality (group B), and brain damaged (group C) categories. Six children (29%) had complete recovery, 10 died (48%), and five (23%) demonstrated residual brain damage. There was a highly significant difference between the ICP in group A and group B (P less than 0.001), and between group B and group C (P less than 0.001). Both group A and group C had highly significant differences in mean cerebral perfusion pressure (CPP) values compared with group B (P less than 0.001). There were no significant differences in ICP or CPP between groups A and C. Finally, using a combination of ICP and CPP, we found that ICP less than or equal to 20 mm Hg and CPP greater than or equal to 50 mm Hg were associated with survival in 11 of 12 patients (92%), whereas ICP greater than 20 mm Hg and CPP less than 50 mm Hg were associated with death in seven patients cases (100%). The two other patients who died had either CPP less than 50 mm Hg or ICP greater than 20 mm Hg, but not both. We find that intracranial pressure monitoring is a safe, useful tool in predicting death or survival, but not residual brain damage, in the nearly drowned, severely comatose child.

Adolescent↗
PubMed1983

Early echocardiographic and pulmonary function findings in idiopathic scoliosis.

Thirty-six children and adolescents with early stages of idiopathic scoliosis underwent evaluation by echocardiography and pulmonary function testing. Mildly increased pulmonary vascular resistance was inferred from an elevated ratio of right preejection period to right ventricular ejection time, an increased right ventricular dimension, and a decreased left ventricular dimension. Since neither decreased arterial oxygen saturation nor increased end-tidal expired carbon dioxide partial pressure was seen, desaturation and hypoventilation should not account for these abnormalities. Pulmonary function parameters showed no distinct patterns of abnormality. Even though the patients were divided into two groups by severity of spinal curvature, the cardiopulmonary measures did not correlate with thoracic deformity. Billowing of the mitral leaflets, termed mitral valve prolapse, was demonstrated in 25% of the subjects. Our findings suggest that cardiopulmonary and thoracic changes in idiopathic scoliosis may develop in parallel and may be expressions of a common collagen defect. However, study of sleep and exercise arterial saturation may be required to rule out intermittent hypoxemia as a precipitating factor of cor pulmonale in scoliosis.

Adolescent↗
PubMed1983

Adult-type respiratory distress syndrome in children. Experience with seven cases.

Adult respiratory distress syndrome (ARDS) is not well recognized in children. We report seven individuals, ranging in age from 1.5 to 16 years. The clinical picture of ARDS reached a peak in 72 hours from admission and was associated with a 28.5 per cent death rate (2/7). In no case was an organism isolated, either from bronchial washings via a flexible bronchoscope or from open lung biopsy specimen. ARDS is characterized by severe damage to the alveolar-capillary unit and probably inadequate production of lung surfactant, resulting in severe hypoxia, hypoxemia, intrapulmonary shunting, and marked decline in pulmonary compliance. The prognosis remains poor in the pediatric age group. The pathophysiology of this entity is outlined, with guidance for monitoring and therapy.

Adolescent↗
PubMed1983

Flexible fiberoptic bronchoscopy and laryngoscopy in infants and children.

A pediatric flexible fiberoptic bronchoscope was employed in the examination and/or therapy of 164 infants and children ranging in age from 1 day to 16 years. Ninety-two bronchoscopies and 72 laryngoscopies were performed without any mortality or significant morbidity; 78% of laryngoscopies and 35% of bronchoscopies were performed in children under 2 years of age. The instrument was helpful in terms of diagnosis, as a tool for aspirating secretions and resolving atelectasis, and as a guide for surgical intervention. It is concluded that flexible fiberoptic bronchoscopy is a safe procedure in small infants and children and serves as an important aid in the diagnosis and therapy of disorders of the respiratory tract in this age group. However, caution should be expressed in its use in children with compromised ventilation, bradycardia or bleeding diathesis. Moreover, in suspected foreign body aspiration, the rigid-open tube bronchoscopy should be employed.

Adolescent↗
PubMed1983

Increased IgD milk antibody responses in a patient with Down's syndrome, pulmonary hemosiderosis and cor pulmonale.

IgD antibody responses to cow's milk were investigated in a two-year-old black boy with evidence of pulmonary hemosiderosis and pulmonary hypertension. Initially a broad spectrum of immunologic responses to cow's milk were observed including IgD, IgE, and precipitin antibodies. Specific IgD antibody responses to cow's milk could be modulated in terms of challenge or elimination and correlated with the clinical course. It is possible that IgD antibodies may be important in milk-related pulmonary hemosiderosis.

Animals↗
PubMed1982

Flexible fiberoptic bronchoscopy and laryngoscopy in children under 2 years of age: diagnostic and therapeutic applications of a new pediatric flexible fiberoptic bronchoscope.

The new flexible fiberoptic bronchoscope (Olympus BF Type 3C4, Tokyo, Japan) was employed for diagnostic and therapeutic purposes in 96 children below 2 yr of age. Sixty-two laryngoscopies and 34 bronchoscopies were performed without any mortality or significant morbidity. The bronchoscope was helpful in establishing diagnosis and also served as a tool for aspirating secretions and resolving atelectasis. It is concluded that flexible fiberoptic bronchoscopy and laryngoscopy in children 2 yr or younger is a safe procedure and may aid in the diagnosis and therapy of disorders of the respiratory tract in this age group.

Bronchoscopes↗