Biomedical subjects

J Pfenninger

Publications and source records attributed to J Pfenninger.

64 records · Page 4Linked to original sources

PubMed1981

Fatal adult respiratory distress syndrome in a scalded child after immunization with attenuated virus (measles, mumps and rubella).

A fatal adult respiratory distress syndrome (ARDS) occurred in a 15-month-old child who had suffered minor scalding during the febrile response to combined attenuated virus immunization (measles, mumps and rubella [MMR]). Despite vigorous efforts the child died 26 days after the accident. It is suggested that the scalding suppressed the normal immune response to the viremia and that the latter (i.e. most likely the measles viremia) caused the lung damage which, in turn, led to the ARDS. Histologically the lung presented a peculiar change with fibroblastic nodules, vessel wall inflammation and signs as observed in ARDS.

Burns↗

PubMed1979

[Continuous monitoring of intracranial pressure and new aspects of neurologic intensive care for children].

A new concept of neurointensive care is presented which is based on earily measured parameters such as intracranial pressure (ICP), mean arterial pressure (MAP) and cerebral perfusion pressure (CPP) (CPP = MAP - ICP). ICP should preferably be measured by a subarachnoid hollow screw (Richmond screw). Of chief importance in neurointensive care (after adequate neurodiagnosis) is the avoidance or treatment of cerebral edema and maintenance of sufficient CPP, which should be above 50 mm Hg in older children. This is achieved by controlled hyperventilation under curare, generous oxygenation, control of body temperature, dexamethasone and possibly barbiturates in very high doses (phenobarbital and thiopentone). This kind of neurointensive care should be administered in all types of severe CNS accidents which are followed by substantial cerebral edema (head injuries, near drowning, Reye's syndrome, hypoxic encephalopathy, encephalitis, meningitis and intracranial bleeding). To obtain the indication for ICP monitoring, the depth of the disturbance of consciousness is measured by the Glasgow Coma Scale. Children with the aforementioned affections and a Glasgow Coma Scale below 6 to 8 should be treated as outlined above. The data published in the literature and our own experience point very much in this direction, especially for severe head injury, Reye's syndrome and near drowning.

Barbiturates↗

PubMed1977

Intermittent positive pressure breathing (IPPB) versus incentive spirometer (IS) therapy in the postoperative period.

The increase of the inflationary lung volume created by a respiratory maneuver is critical for preventing postoperative alveolar collapse. We measured this volume as achieved with IPPB or incentive spirometry (IS) in 20 postoperative surgical patients. Using IPPB, with gas flow and peak airway pressures carefully adjusted for each patient, a value of 2240 +/- 630 cc (mean +/- 1 SD) was obtained compared to 1960 +/- 650 cc with IS. This difference is highly significant (p less than 0.0005 by the Wilcoxon test). We conclude that IPPB, by careful application, and with monitoring of tidal volumes, is likely to provide better prophylaxis of postoperative pulmonary complications, particularly in patients with compromised lung function and in an intensive care unit, where enough trained personel are available.

Adult↗

PubMed1977

Powder aspiration in children. Report of two cases.

Two cases of powder aspiration are reported. A 7 1/2-month-old girl showed a classical course with an asymptomatic period of 3-4 hours, then severe respiratory distress developed. Acute respiratory insufficiency made tracheal intubation and mechanical ventilation necessary for 10 days. Complications included insufficient alveolar ventilation, atelectasis, pneumothorax, and superinfection. But the baby recovered with some residual radiological changes in the lungs. A 13-month-old boy was treated immediately after massive powder aspiration by tracheal intubation and bronchial wash-out. The postoperative course was unevetful and no respiratory distress developed. Powder aspiration leads to severe bronchiolar obstruction with a delay of several hours and has a high mortality rate. The best results in treatment are obtained by immediate intubation and bronchial wash-out, even in the absence of respiratory symptoms. Artifical ventilation may be necessary with the special problem of overcoming very high airway resistance. Corticosteroids and bronchodilators may be helpful.

Female↗

PubMed1977

Thiamphenicol in treatment of Haemophilus influenzae meningitis.

17 infants and children with pyogenic meningitis (14 Haemophilus influenzae, 2 Diplococcus pneumoniae, 1 Neisseria meningitidis) were treated with thiamphenicol, 100 mg/kg body weight/day in 4 doses i.v., as single drug. In the H. influenzae group 10 patients were cured, 4 had relapses of meningitis, 3 with documented subdural effusions. This group is compared with 14 children matched for age, initial leucocyte and CSF cell count treated with ampicillin: all of these were cured, 1 had a subdural effusion. Thiamphenicol concentrations were determined in the serum and CSF 2 h after administration. The mean serum levels were between 10-12 mcg/ml, the mean CSF levels varied from 5.4 mcg/ml at the beginning to 1-1.9 mcg/ml at the end of meningitis. The MIC of H. influenzae was 0.6-12 mcg/ml. A significant, acute, and dose related bone marrow toxicity of thiamphenicol could be documented, but was always rapidly fully reversible. We conclude that thiamphenicol cannot replace chloramphenicol in the treatment of pyogenic meningitis as single systemic antibiotic. Special indications for thiamphenicol in this disease are discussed.

Adolescent↗

PubMed1975

[Chemotherapy treatment of infectious diseases in infancy and early childhood].

Some specific pediatric aspects of therapy with antibiotics and other chemotherapeutic agents (dosage based on age, body weight and body surface area) are discussed. In early infancy problems such as the "immaturity" of enzyme systems and excretion mechanisms must be considered. Tetracycline staining is discussed as an example of age-dependent vulnerability of organs. A selection of antibiotics suitable for use in ambulatory pediatrics is proposed.

Age Factors↗

PubMedDate not supplied

Administration of steroids in pediatric cardiac surgery: impact on clinical outcome and systemic inflammatory response.

Cardiopulmonary bypass (CPB) is associated with a systemic inflammatory response. Pre-bypass steroid administration may modulate the inflammatory response, resulting in improved postoperative recovery. We performed a prospective study in the departments of cardiovascular surgery and pediatric intensive care medicine of two university hospitals that included 50 infants who underwent heart surgery. Patients received either prednisolone (30 mg/kg) added to the priming solution of the cardiopulmonary bypass circuit (steroid group) or no steroids (nonsteroid group). Clinical outcome parameters include therapy with inotropic drugs, oxygenation, blood lactate, glucose, and creatinine, and laboratory parameters of inflammation include leukocytes, C-reactive protein, and interleukin-8. Postoperative recovery (e.g., the number, dosage, and duration of inotropic drugs as well as oxygenation) was similar in patients treated with or without steroids when corrected for the type of cardiac surgery performed. After CPB, there was an inflammatory reaction, especially in patients with a long CPB time. Postoperative plasma levels of interleukin-8 were correlated with the duration of CPB time (r = 0.62, p < 0.001). Administration of steroids had no significant impact on the laboratory parameters of inflammation. Administration of prednisolone into the priming solution of the CPB circuit had no measurable influence on postoperative recovery and did not suppress the inflammatory response.

Anti-Inflammatory Agents↗

PubMedDate not supplied

An extended experience with cefuroxime therapy of childhood bacterial meningitis.

Eighty-four pediatric patients with bacterial meningitis were prospectively evaluated while receiving cefuroxime (200 mg/kg/day in four equal intravenous doses) as single-drug therapy for 9 to 13 days. Six cases were admitted in extremis and died within a few hours because of irreversible central nervous system damage or shock. The remaining 78 patients were cured, and prompt bacteriological and clinical responses were noted. The pathogens were Haemophilus influenzae b (43 cases), Neisseria meningitidis (20 cases), Streptococcus pneumoniae (10 cases) and unknown (five cases). All pathogens were susceptible in vitro to cefuroxime including two strains of beta-lactamase producing H. influenzae. Time to defervescence, incidence and cause of both prolonged and secondary fever, as well as type and frequency of complications and sequelae compared favorably to other series. It is concluded that cefuroxime is effective and safe single-drug therapy for childhood bacterial meningitis beyond the neonatal age group.

Cefuroxime↗

PubMedDate not supplied

Racial differences in newborn intensive care morbidity in Alaska.

Birthweight-specific neonatal mortality for Alaska Natives is higher than for non-natives for the years 1987-1996. We investigated the reasons for this based on Level III Neonatal Intensive Care Unit information available from 1991-1996. We also investigated whether differences in mortality extended to measures of morbidity. There were less Native patients born at the tertiary care center for babies with birthweight < 1500 grams and 1500-2499 grams (64% for Natives and 87% for non-natives, p = .000). Differences in antenatal referral were only apparent for the population residing within the Anchorage/Mat-Su area. There were also less cesarean deliveries for Native infants that were born outside of the tertiary care center for both birthweight categories (25% for Native vs. 53% for non-native infants < 1500 grams, p = .01; 27% for Native vs. 48% for non-native infants 1500-2499 grams, p = .01). For Alaska Native babies < 1500 grams there was more necrotizing enterocolitis (13% in Native vs. 4.9% in non-native, p = .01), more severe retinopathy of prematurity (12% in Native vs. 4.6% in non-native, p = .01), and more bronchopulmonary dysplasia (49% in Native vs. 34% in non-native, p = .04). For Alaska Native babies 1500-2499 grams that needed ventilatory assistance there was more intraventricular hemorrhage (19% in Native vs. 7.4% in non-native, p = .003), more severe (grade 3-4) intraventricular hemorrhage (9.5% in Native vs. 0.9% in nonnative, p = .001), and more acquired sepsis (7.1% in Native vs. 1.7% in non-native, p = .02). Differences in access to Level III perinatal care and intrapartum care (cesarean delivery rates) are likely factors that contribute to the worse outcomes in the Alaska Native population.

Alaska↗

PubMedDate not supplied

The next challenge for newborn intensive care in Alaska: improving the survival of the larger neonate.

Using information from our database, a review of mortality for the Newborn Intensive Care Unit at Providence Alaska Medical Center was conducted for 1987-1996. There has been a significant decline in mortality over the last decade (p = 0.003). An analysis of mortality by birthweight and gestational age groups demonstrated a decline in mortality (p = 0.005) for infants with birthweight < 2 kg and infants < or = 34 weeks gestation, but no change for infants > or = 2 kg and > or = 35 weeks gestation. As a result, larger and more mature babies now account for an increasing proportion of NICU deaths. For 1995 and 1996 the major contributors to mortality for the smaller neonates were respiratory distress syndrome and congenital and nosocomial sepsis/pneumonia. The major contributors to mortality for larger neonates were persistent pulmonary hypertension of the newborn, congenital heart disease, congenital diaphragmatic hernia, and primary birth asphyxia. A majority of deaths in the larger neonates were due to non-lethal causes. We contend that improved survival in the larger neonate is an important and achievable goal. The introduction of ECMO (Extracorporeal Membrane Oxygenation) for the NICU and a focused review of the neonatal cardiac program offers the best possible potential for achieving this goal.

Alaska↗