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Biomedical subjects

L G Maxwell

Publications and source records attributed to L G Maxwell.

27 records · Page 2Linked to original sources
PubMed1989

Prediction of successful primary closure of congenital abdominal wall defects using intraoperative measurements.

To determine whether intragastric pressure (IGP) and central venous pressure (CVP) would reliably predict successful primary closure of congenital abdominal wall defects (omphalocele/gastroschisis) in newborn infants, we developed the following prospective intraoperative management protocol. Following a temporary trial of fascial closure, infants who had an IGP less than 20 mm Hg or an increase in CVP of less than 4 mm Hg were primarily closed. If IGP was greater than 20 mm Hg or if CVP increased by more than 4 mm Hg, the temporary closure of the abdomen was reopened and a prosthetic silo was placed. Ten infants who were less than 24 hours old and averaged 2.7 kg (range, 1.4 to 4.2 kg) and 37-weeks gestation (range, 32 to 41 weeks) were studied. Eight infants met criteria for primary closure. Their IGP averaged 14 +/- 4 mm Hg (+/- SD) (range, 8 to 19 mm Hg), and their increase in CVP averaged 1 +/- 2 mm Hg (range, -2 to 3 mm Hg). In the two infants who required staged repair, IGP averaged 25 +/- 1 mm Hg (+/- SD) (range, 24 to 25 mm Hg), and the increase in CVP averaged 7 +/- 1 mm Hg (range, 6 to 8 mm Hg). All patients were anesthetized with fentanyl (12.5 micrograms/kg) and paralyzed with metocurine (0.3 mg/kg) intraoperatively. There were no postoperative complications in either group of patients related to increased intraabdominal pressure, and all patients were extubated within 48 hours of the initial surgery. We conclude that the intraoperative measurement of changes in IGP and CVP can serve as a guide to the operative management of congenital abdominal wall defects and can reliably predict successful outcome following repair.

Abdominal Muscles↗
PubMed1989

The pharmacologic management of pain in children.

We have attempted to dispel many of the myths and misconceptions surrounding the use of narcotic analgesics in the treatment of childhood pain. Our hope is that an improved understanding and application of effective and safe therapies will minimize the suffering of the child with acute or chronic pain.

Analgesia, Epidural↗
PubMed1989

Separation of craniopagus Siamese twins using cardiopulmonary bypass and hypothermic circulatory arrest.

Occipitally joined craniopagus Siamese twins were separated with the use of cardiopulmonary bypass and hypothermic circulatory arrest. The 7-month-old infants shared a large sagittal venous sinus that precluded conventional neurosurgical approach because of risk of exsanguination and air embolism. After craniotomy and preliminary exposure of the sinus, each twin underwent sternotomy and total cardiopulmonary bypass with deep hypothermia. Hypothermic circulatory arrest allowed safe division and subsequent reconstruction of the sinus remnants. Several unusual problems were encountered, including transfusion of a large blood volume from one extracorporeal circuit to the other through the common venous sinus, deleterious warming of the exposed brain during circulatory arrest, and thrombosis of both pump oxygenators. Both infants survived, although recovery was complicated in each by neurologic injury, cranial wound infection, and hydrocephalus. This case demonstrates the valuable supportive role of cardiopulmonary bypass and hypothermic circulatory arrest in the management of complex surgical problems of otherwise inoperable patients.

Brain Injuries↗
PubMed1987

Monitoring the resuscitation of preterm infants in the delivery room using pulse oximetry.

The first few minutes after birth are a critical time of adaptation of the newborn infant to extrauterine life. The adequacy of that adaptation has been evaluated by means of the summed Apgar score. In preterm infants, Apgar score may correlate less with adequacy of cardiopulmonary function because of developmental immaturity. Measurement of arterial oxygen saturation by means of pulse oximetry offers a physiologic, real time method of monitoring the progress of cardiopulmonary adaptation by which the clinician can evaluate the need for and success of resuscitative efforts. Four preterm infants are reported in whom pulse oximetry was useful in assessing the changes in oxygen saturation during resuscitation.

Blood Gas Monitoring, Transcutaneous↗
PubMed1987

Penile nerve block for newborn circumcision.

Circumcision in neonates is performed, almost universally, without anesthesia or analgesia. It is associated with pain, crying, agitation, and physiologic stress. Twenty infants receiving penile nerve block for circumcision were compared with ten infants having circumcision without anesthesia. Heart rate and blood pressure rose 34 and 15%, respectively, in unblocked infants, and were unchanged in infants receiving local anesthesia. Oxygen saturation declined 16% in unanesthetized infants compared with 6% in blocked infants (P less than .03). Anesthetized infants were less agitated and cried less. Peak plasma concentrations of the local anesthetic lidocaine averaged 0.51 +/- 0.17 microgram/mL (range 0.1-1.6), well below accepted toxic levels. There were no local or systemic complications.

Blood Pressure↗
PubMed1977

Primary cutaneous phaeohyphomycosis caused by Drechslera spicifera.

A primary cutaneous lesion in a 5-year-old boy who had recently received chemotherapy for acute lymphocytic leukemia was found to be caused by a dematiaceous fungus, Drechslera spicifera. The lesion was an erythematous macule that rapidly developed necrotic ulcerations. The fungus, which is commonly found in soil and as a plant pathogen, was isolated from cultures of the lesion and from an excisional biopsy specimen. Hyphae and swollen hyphal cells resembling chlamydospores were observed in the biopsy specimen. Septate pigmented hyphae were found in the tissue, which is consistent with phaeohyphomycosis. Resolution of the infection occurred following excisional biopsy and systemic amphotericin B therapy. There was a concomitant recovery from neutropenia.

Child, Preschool↗