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Biomedical subjects

G C Emmanouilides

Publications and source records attributed to G C Emmanouilides.

At least 37 records · Page 2Linked to original sources
PubMed1978

Pulmonary and circulatory function in preterm lambs treated with hydrocortisone in utero.

The effects of the in utero intravenous administration of hydrocortisone on postnatal lung function and pulmonary and systemic hemodynamics were studied in preterm fetal lambs and compared with those of non-treated animals of similar gestational ages. The results indicate that steroid-induced changes in lung pressure volume curves, although statistically significant, did not render the pretreated fetuses capable of surviving without ventilatory assistance. In addition, the ductus arteriosus in the steroid-treated lambs at 2 h of age was functionally closed or constricted regardless of gestational age. In contrast, in the untreated lambs the ductus arteriosus was widely patent and, especially in lambs of less than 120 days gestation, there was invariably a large left-to-right ductal shunt.

Animals↗
PubMed1977

Prolonged rupture of fetal membranes and decreased frequency of respiratory distress syndrome and patent ductus arteriosus in preterm infants.

Observations were made on 153 preterm infants (25 to 34 weeks' gestation) in an attempt to answer the following questions: dose prolonged rupture of the fetal membranes (ROM) correlate with a decreased frequency of respiratory distress syndrome (RDS) and patent ductus arteriosus, and, if so, what is the duration of ROM required? An analysis of the data indicates that as the duration of ROM is lengthened the incidence of RDS and patent ductus arteriosus decreases. In fact, after 48 hours of prolonged ROM (PROM), there is a virtual absence of RDS. In addition, after 72 hours of PROM, the frequency of patient ductus arteriosus was markedly reduced to only 12 per cent (three of 25 infants). PROM beyond 24 hours was also associated with a significant decrease in deaths (p less than 0.05). Amnionitis occurred in 33 per cent of pregnancies with PROM greater than 48 hours; however, only one infant died of sepsis. These findings support the hypothesis put forth by the others 1-5 that PROM is indeed associated with a decreased frequenct of RDS in preterm infants. Moreover, our findings suggest that PROM greater than 72 hours is associated with a relatively low frequency of patent ductus arteriosus. The question is then raised that perhaps pregnancies less than or equal to 34 weeks' gestation with PROM should be allowed to continue for 72 hours in the absence of amnionitis.

Birth Weight↗
PubMed1977

Early functional closure of the ductus arteriosus associated with decreased severity of respiratory distress syndrome in preterm infants.

It has been shown that a patent ductus arteriosus may complicate the course of the respiratory distress syndrome (RDS) in preterm infants. In this study, an attempt is made to answer the question: Is there any relationship between RDS and patency of the ductus arteriosus in preterm infants, that is, do preterm infants without the RDS have early functional closure of the ductus arteriosus? Clinical observations were made on 144 preterm infants 25 to 34 weeks' gestation. Infants were included in the study if the status of the ductus arteriosus (open or closed) could be established either by clinical examination or retrograde aortography. The ductus arteriosus was closed in 59 infants within 48 hours of birth and open in 85. None of the infants with a closed ductus had severe RDS and only three had mild RDS. In contrast, 50% (43 of 85) of infants with open ductus had severe RDS. These findings suggest that early functional closure of the ductus can occur even in very immature infants, and this early closure appears to be associated with a decreased incidence of RDS.

Aortography↗
PubMed1976

Ligation of patent ductus arteriosus in premature infants.

Twenty-four neonates at 25-34 weeks' gestation with a weight range of 570-1530 g underwent ligation of patent ductus arteriosus (PDA). The infants had mild to severe respiratory distress syndrome at birth and later developed signs of heart failure as a result of left-to-right shunting through a PDA. Surgical closure of the PDA was performed within 2-31 days after birth. In the period before operation the heart rate was monitored constantly and the arterial blood-gases were assessed frequently. The trachea was intubated and respiration was controlled with a ventilator. Surgery was performed under controlled ventilation and no anaesthesia was used. Care was taken not to overventilate the lungs. Nine infants died. Death was associated with higher peak inspiratory ventilator pressures at the time of operation and with complications occurring during or after the operation. The most common complication was tension pneumomediastinum which appears to be related to excessive ventilator pressures during surgery.

Acidosis↗
PubMed1976

Single film retrograde umbilical aortography in the diagnosis of hypoplastic left heart syndrome with aortic atresia.

Single film retrograde umbilical aortography was used successfully in confirming the diagnosis of hypoplastic left heart in three neonates. The method involves injecting Renografin 75% (1.25 cc/kg body weight) into the umbilical artery catheter according to the following sequence. First, the tip of the catheter is positioned at the level of the ductus arteriosus. The infant heart beats are then counted from one to three. The contrast media injection is begun manually on the count of one and an anterior-posterior chest film is taken on the count of three. Thus the film is taken one diastolic period after completion of the injection. The proper timing of the contrast media injection and filming is essential for obtaining a diagnostic film. This procedure was diagnostic in the three infants studied and eliminated the need of transferring two sick infants from affiliated hospitals.

Aorta, Thoracic↗
PubMed1976

Improving the results of ligation of patent ductus arteriosus in small preterm infants.

Thirty-two consecutive preterm infants with birth weights under 1,500 grams and with respiratory distress syndrome (RDS) complicated by a patent ductus arteriosus (PDA) underwent ligation of PDA. The indications for operation were massive left-to-right shunting associated with heart failure (cardiomegaly and pulmonary edema) unresponsive to medical treatment. The clinical manifestations of heart failure were related to the severity of RDS. Infants with mild-to-moderate RDS (21) often recovered and later developed typical findings of PDA (bounding pulses, hyperactive precordium, and murmur). They are now operated upon as soon as respiratory support is required. Infants with severe RDS (11) develop cardiomegaly earlier, and retrograde aortography may show massive left-to-right shunting before the presence of a murmur. Ligation is indicated when blood-gas values deteriorate despite medical treatment. Nineteen (59 per cent) of these extremely preterm infants survived to be discharged and 16 (50 per cent) are developing normally. Three have neurologic impariment. None of the survivors has clinical respiratory disease, and their radiologic findings of bronchopulmonary dysplasia are improving.

Birth Weight↗
PubMed1975

Placenta to lamb fetus transfusion in utero during acute hypoxia.

Maternal and fetal hemodynamics, placental blood flow, fetal-placental blood volume, placental blood volume, and fetal blood volumes were measured in six chronic sheep prepartions to evaluate their changes during acute fetal hypoxia induced by maternal hypoxia. During fetal hypoxia, the maternal and fetal arterial blood pressure and heart rate were essentially unchanged. The placental blood flow (control equal to 325 ml.per kilogram per minute) was also unchanged during the hypoxia period. However, the placental blood volume decreased significantly from 65 to 60 and 51 ml. per kilogram at 15 and 30 minutes of hypoxia period, respectively. The fetal blood volume increased reciprocally and significantly from 86 to 109 and 102 ml. per kilogram at the same periods of hypoxia since the fetal-placental blood volumes were unchanged. These blood volume changes persisted for 30 to 60 minutes following the stoppage of hypoxia experiments. The placental vascular resistance measured in six experiments showed a significant increment during hypoxia, suggesting placental vasoconstriction as the responsible mechanism for the reduction of placental blood volume and reciprocal increase in fetal blood volume. The data suggest that significant placental transfusion to the lamb fetus may occur in utero during fetal hypoxia resulting in a higher fetal blood volume before birth.

Acute Disease↗
PubMed1975

Progressive pulmonary vascular disease after surgical correction (Mustard procedure) of transposition of great arteries with intact ventricular septum.

Severe pulmonary vascular disease developed 1 year after a Mustard operation in a 2 1/3 year old boy with transposition of the great arteries and intact ventricular septum. The possible etiologic factors responsible for the development of pulmonary vascular disease are discussed, and it is suggested that this disturbing late postoperative complication may occur more frequently than is recognized.

Cardiac Catheterization↗
PubMed1975

Patent ductus arteriosus complicating the respiratory distress syndrome in preterm infants.

In 46 preterm infants with RDS the patency of the ductus arteriosus was established by single film aortography or by clinical diagnosis and confirmation at surgery. The estimated left-to-right shunt through the PDA by aortogram correlated well with the heart size and the clinical diagnosis of heart failure. In 14 infants massive cardiomegaly and heart failure with a PDA occurred before the appearance of a heart murmur. Twelve infants had severe RDS and 34 had mild or moderate RDS. Massive cardiomegaly occurred significantly earlier in infants with severe RDS. It is suggested that ductal ligation is indicated when an infant with massive cardiomegaly requires IPPV and whose aortagram shows that all of the contrast material is in the pulmonary arteries and none in the aortic arch. A heart murmur may or may not be present.

Aortography↗
PubMed1975

Umbilical blood flow and glucose uptake in lamb fetus following single umbilical artery ligation.

Umbilical blood flow (UBF) and fetal glucose uptake were measured in 5 lamb fetuses 4-20 days following single umbilical artery ligation (SUAL). The ligation was performed at 108-119 days gestation (sheep pregnancy = 145-150 days), and the blood flow and glucose uptake studies were performed as chronic preparation at 120-137 days of gestation. In comparison with 9 control subjects at matched gestation, the SUAL fetuses had significantly lower UBF (mean plus or minus SEM, 735 plus or minus 70 vs. 475 plus or minus 24 ml/min, p less than 0.01) and fetal glucose uptake (2190 plus or minus 1.6 vs. 14.8 plus or minus 1.9 mg/min, p less than 0.05). When the values were expressed per kilogram fetal weight, the UBF decreased with increasing gestational age in SUAL fetuses. In the control fetuses, the UBF increased with increasing gestational age. The fetal glucose uptake (FGU), when expressed per kilogram fetal weight, was essentially similar to that of the control subjects. The glucose gradients across the placenta were similar in both groups of fetuses. These data suggest that in lamb fetuses with placental vascular insufficiency induced by SUAL, the reduction of UBF and FGU may account for growth retardation in utero. It was also suggested that placental transfer of substrate other than glucose may also be impaired as a result o

Animals↗