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Biomedical subjects

K Fellows

Publications and source records attributed to K Fellows.

15 recordsLinked to original sources
PubMed1988

Use of the postductal PaO2 as a predictor of pulmonary vascular hypoplasia in infants with congenital diaphragmatic hernia.

Infants with congenital diaphragmatic hernia (CDH) demonstrate a wide range of anatomic and physiologic abnormalities that result in decreased pulmonary perfusion. We have used the patients' ability to achieve at least one postductal PaO2 greater than 100 torr while on maximal ventilation with 100% oxygen during the first 24 hours of life as the clinical marker to identify the degree of pulmonary perfusion. Patients were grouped as follows: group 1 had at least one postductal PaO2 greater than 100 torr, and group 2 patients never had a postductal PaO2 above 100 torr. To see if this classification did reflect pulmonary vascular abnormalities, we compared the pulmonary arteriograms of these two groups of CDH infants for size of the main pulmonary arteries (PAs), size of the lungs, and degree of peripheral vascular obstructive disease (PVO). Infants in group 2 had significantly smaller ipsilateral and contralateral main PAs, as well as smaller ipsilateral lungs with more severe PVO. We propose the postductal PaO2 as the clinical marker for identification of the degree of pulmonary perfusion.

Hernias, Diaphragmatic, Congenital↗
PubMed1983

Noninvasive tests in the initial evaluation of heart murmurs in children.

We prospectively examined the usefulness of electrocardiography, chest radiography, and M-mode echocardiography in discriminating between the presence and absence of heart disease in 280 children older than one month and newly referred for evaluation of a heart murmur. After taking a history and performing a physical examination but before reviewing diagnostic tests, we categorized the children as having "no heart disease" (142), "possible heart disease" (34), or "definite heart disease" (104). Among the children initially thought to have no heart disease, the diagnosis was changed after a review of diagnostic tests in eight--three with mitral-valve prolapse, two with possible cardiomyopathy, and three with no heart disease on follow-up. Among those initially thought to have possible heart disease, the tests changed the diagnosis to definite heart disease in four, of whom only one had heart disease (mitral-valve prolapse) on follow-up. In no case did a review of tests change the diagnosis of definite heart disease. We conclude that the results of diagnostic tests are unlikely to change the clinical diagnosis of no heart disease or definite heart disease, when made by a qualified pediatric cardiologist in children newly referred for evaluation of a heart murmur.

Adolescent↗
PubMed1980

Prospective identification of ventricular septal defects in infancy using subxiphoid two-dimensional echocardiography.

The objective of this study was to establish a dependable technique for imaging the interventricular septum and ventricular septal defects in infants. Subxiphoid two-dimensional echocardiograms were performed on 81 infants who were 1 day to 12 months (median 43 days) old and weighed 1.6-8.6 kg (median 3.4 kg). A short-focus, 5-MHz crystal with a 13-mm active element diameter was used in all studies. The interventricular septum was visualized in 80 of 81 infants. Defects in the membranous, atrioventricular canal, conoventricular and muscular segments of the sentum were identified using three standard transverse subxiphoid projections. All defects in the membranous and atrioventricular canal segments, as well as malalignment type conoventricular communications, were correctly identified when compared with selective angled cineangiocardiography. Only two of the three subpulmonic and four of 11 muscular defects were identified successfully. Limitations in imaging defects in the muscular septum reflected the varied morphology of these interventricular communications and the tangential orientation of the echo beam to the extreme apical and anterior segments of the muscular septum.

Airway Obstruction↗
PubMed1978

Wandering spleen in three children.

Three children with wandering spleen are presented. Liver-spleen technetium99m sulphur colloid scintigraphy is a helpful diagnostic tool that will demonstrate the abnormally located spleen or absent splenic activity when the blood supply is interrupted by a twisted pedicle. The diagnosis can also be made by angiography, but this relatively elaborate procedure is usually not necessary. Absence of the normal ligamentous attachments of the spleen associated with a long splenic pedicle may well be the cause of the wandering spleen and its torsion.

Adolescent↗
PubMed1978

Chylous reflux syndrome involving the pericardium and lung.

A ten-year-old boy with symptom-free pulmonary interstitial edema and pericardial effusion was found to have a chylous reflux syndrome involving the pericardium and lung. Evidence suggests that unlike patients with isolated primary chylopericardium in whom pericardial window and/or ligation of the thoracic duct is curative, those with chylous reflux should be managed medically since the morbidity and mortality of surgical treatment is high in this syndrome.

Child↗
PubMed1975

Pulmonary artery sling.

Pulmonary artery sling is an uncommon and potentially lethal vascular anomaly that can produce airway obstruction. Despite the availability of a corrective operation, the mortality rate remains very high (50 per cent of surgically treated children) due to the high incidence of associated obstructive anormaliies of the tracheobronchial tree. The survivors of corrective operation have done well symptomatically. However, when restudied, most have been found to have no pulmonary blood flow to the left lung. Successful treatment requires early recognition of the anomaly, adequate preoperative investigation for associated anormalies (especially those of the tracheobronchial tree), a technically perfect vascular reconstruction, and meticulous postoperative respiratory therapy.

Airway Obstruction↗