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Biomedical subjects

W A Engle

Publications and source records attributed to W A Engle.

At least 19 recordsLinked to original sources

The use of bronchotomy and retrograde dilatation to repair acquired obliterative bronchial obstruction.

A case is presented of acquired obliterative mainstem bronchial obstruction with total ipsilateral lung atelectasis and contralateral lung hyperexpansion. The condition failed to improve after a suitable trial of positive airway pressure and medical management. Penetration of the obstructing lesion bia bronchotomy and a distal retrograde approach successfully opened the airway and the patient has been symptom-free for more than 9 months. This unique approach may be useful in other selected patients with similar acquired lesions.

Airway Obstruction↗

Delayed surgical repair and ECMO improves survival in congenital diaphragmatic hernia.

One hundred ten infants with congenital diaphragmatic hernia (CDH) developed life-threatening respiratory distress in the first 6 hours of life. Associated anomalies were present in 33%. Twenty-eight of 65 infants (43%) treated before 1987 (pre-extracorporeal membrane oxygenation [ECMO] era) survived after immediate CDH repair, and mechanical ventilation with or without pharmacologic support. Only two of 16 (12.5%) infants requiring a prosthetic diaphragmatic patch survived. Since 1987, 31 of 46 (67.4%) infants with birth weight, gestational age, and severity of illness similar to the pre-1987 group survived. All patients were immediately intubated and ventilated. Seven (four with lethal chromosomal anomalies) infants died before treatment, and 30 stabilized (partial pressure of carbon dioxide [PCO2] < 50; partial pressure of oxygen [PO2] > 100; pH > 7.3) and underwent delayed CDH repair at 5 to 72 hours. Fifteen did well on conventional support and survived. Fifteen infants deteriorated after operation: 11 were placed on ECMO with eight survivors, and four infants were not considered ECMO candidates. Nine babies failed to stabilize initially and were placed on ECMO before CDH repair (alveolar-arterial gradient > 600 and oxygenation index > 40), and seven survived. The overall survival rate was 80% at 3 months in this ECMO-treated group. Early mortality was due to inability to wean from ECMO (one), intracranial hemorrhage (one), liver injury (one), and pulmonary hypoplasia (one). Nine of 11 babies requiring a prosthetic patch in the post-1987 ECMO group survived (81.8%). There were three late post-ECMO deaths (3 to 18 months) of right heart failure (two) and sepsis (one). Symptomatic gastroesophageal reflux occurred in nine cases, six requiring a fundoplication in the bypass babies. Recurrent diaphragmatic hernia occurred in nine cases (five ECMO). The overall survival rate was significantly improved in the delayed repair/ECMO group (67% versus 43%; p < 0.05) and was most noticeable in infants requiring a prosthetic diaphragm (81.2% versus 12.5%; p < 0.005). These data indicate that early stabilization, delayed repair, and ECMO improve survival in high-risk CDH. Early deaths are related to pulmonary hypertension and can be reversed by ECMO.

Extracorporeal Membrane Oxygenation↗

Pulmonary hypoplasia and persistent pulmonary hypertension: favorable clinical response to high-frequency jet ventilation.

Pulmonary hypoplasia in the neonate is frequently fatal. This article reports two neonates with a clinical diagnosis of pulmonary hypoplasia complicated by persistent pulmonary hypertension (PPHN). Though both infants were progressively worsening while receiving conventional mechanical ventilatory support, they survived when treated with high-frequency jet ventilation.

High-Frequency Jet Ventilation↗

Rapid analysis of lymphocyte subsets in cord blood.

Several investigators have enumerated cellular populations in neonatal cord blood with variable results. In this study, the authors established reference ranges for lymphocyte subsets in cord blood from healthy newborns using a whole blood lysis technique on the Coulter Immunoprep Epics Leukocyte Preparation System (Coulter Immunology, Hialeah, FL). All analyses were performed on a flow cytometer by gating on forward angle versus 90 degrees light scatter. Lymphocytes demonstrated all surface markers examined, including T4, T8, T3, T11, B1, NKH-1, I3, and 4B4; 2H4 suppressor inducer lymphocytes were prominent in neonatal blood. The authors think this standardized system may be suitable for use in neonatal and pediatric patients because it quickly processes small aliquots of whole blood with minimal sample manipulation.

Fetal Blood↗

Update on legal processes for adoption in Indiana.

In this article, we review the process of adoption in Indiana. Comments about the legal process, the right to know issue and the process of adoption from the viewpoint of the potential adoptive parents are discussed.

Adoption↗

Congenital candida pneumonia and sepsis: a case report and review of the literature.

A term newborn with Candida albicans infection of the lungs and blood is described. Although no maternal risk factors were identified, this patient's rapid clinical deterioration and postmortem findings suggest congenital infection. Related cases in the literature are reviewed. This case suggests that a diagnosis of fungal pneumonia should be considered in any infant presenting with severe respiratory distress.

Adult↗

Culture medium oxygen tension affects fibronectin production in human adult and cord blood macrophages.

Varying culture medium oxygen tension from one-half to twice the normal concentration did not alter adult or cord blood monocyte-derived macrophage secretion of lysozyme or total protein. Lowering oxygen tension did result in significant increases in fibronectin concentration in both adult and cord blood macrophage culture supernatants. Dexamethasone (10(-7) M) completely blocked adult macrophage but had no effect on cord blood macrophage fibronectin release in response to lowering oxygen tension. These results indicate that human macrophages selectively regulate fibronectin production in response to changes in oxygen tension in vitro.

Adult↗

Vitamin E decreases superoxide anion production by polymorphonuclear leukocytes.

Pharmacologic serum levels of vitamin E administered to low birth weight infants predispose them to infectious complications. We studied in vitro the effect of vitamin E, its vehicle and buffer (Krebs Ringers phosphate glucose) on the ability of human polymorphonuclear leukocytes (PMN) to produce superoxide anion, an oxygen radical important for bacterial killing. We found that superoxide anion production after a 5-min exposure to phorbol myristate acetate was significantly decreased in vitamin E-treated PMN (76 +/- 15 nM/10(7) PMN) compared to vehicle-treated PMN (289 +/- 109 nM/10(7) PMN). We also found that significantly decreased superoxide anion production was associated with 5.0 and 10.0 mg/dl but not with 3.5 mg/dl vitamin E. Our results support the hypothesis that pharmacologic concentrations of vitamin E depress PMN oxidative activity.

Adult↗

Neonatal sepsis.

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Bacterial Infections↗

Neonatal tracheobronchomegaly.

Tracheobronchomegaly is rarely reported in neonates. We present five cases of tracheobronchomegaly occurring in neonates receiving intensive ventilatory and oxygen support. Barotrauma is speculated to be the primary pathophysiologic factor in these cases.

Diseases in Twins↗

Neonatal bacterial endocarditis of the pulmonary valve: report of two cases.

Bacterial endocarditis in the neonate is rare and fatal in the majority of reported cases. This article reports two neonates who survived bacterial endocarditis. One patient was infected with group B beta-hemolytic streptococcus (GBBS) while the second grew Streptococcus saluvarius from the blood.

Ampicillin↗

Composition of the fetal and maternal guinea pig throughout gestation.

The guinea pig is a small animal species in which the conceptus constitutes a large proportion of maternal weight at term, thereby imposing a major metabolic demand on the mother during pregnancy. In addition the neonatal fat concentration is similar to the human making the guinea pig an interesting model for comparative physiologic study. The purpose of our study was to describe the fetal and maternal physical/chemical growth characteristics of the Hartley albino guinea pig throughout the latter half of gestation. Forty-eight pregnant adult and 122 fetal guinea pigs were sacrificed at intervals throughout gestation and the carcasses analyzed for a variety of growth parameters. The fetal growth rate during the last 8 days of gestation (5.8 g/day) was 9.7 times faster than from 30 to 40 days of gestation (0.6 g/day). The fetal mass comprised 55.4% of the maternal weight gain at term. Fetal energy increased from 403 cal/g at 30 days to 1950 cal/g at term and was paralleled by an increase in fetal fat concentration from 0.3 to 9.8% (wet weight). Nitrogen concentration increased from 0.9% wet weight at 30 days to 2.6% at term. An increasing carbon concentration and carbon:nitrogen ratio was also evident. Fetal water concentration declined from 91.6 to 67.8% during latter gestation. On a wet weight basis, the concentration of fetal sodium remained stable throughout the latter half of pregnancy; potassium, magnesium, iron, calcium, and phosphorus concentrations increased. In contrast to the changes in fetal composition, maternal energy, fat, protein, water, sodium, potassium, calcium, phosphorus, magnesium, and iron concentrations remained relatively constant throughout pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adipose Tissue↗