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Biomedical subjects

W H Franklin

Publications and source records attributed to W H Franklin.

13 recordsLinked to original sources
PubMed1998

Oral fluid therapy. A promising treatment for vasodepressor syncope.

OBJECTIVE: To investigate the predictive value of an intravenous fluid bolus during tilt table testing on clinical outcome and to evaluate of oral therapy is an effective treatment for patients with vasodepressor syncope. DESIGN: Retrospective cohort. SETTING: Regional pediatric cardiology outpatient clinic. PATIENTS: Patients (N = 58) with a positive baseline tilt table testing result who were treated with oral fluid therapy between February 1991 and March 1996. INTERVENTIONS AND MAIN OUTCOME MEASURES: Patients with a positive tilt table test result were given an intravenous bolus of isotonic saline solution. Responders were identified as having a negative tilt table test result after the bolus. Patients were prescribed a protocol of oral fluid therapy. Data were obtained from the medical record and a mailed survey. RESULTS: Of the 58 subjects, 90% had no recurrent syncope while receiving oral fluid therapy. During tilt table testing, the mean decrease in mean arterial pressure seen with symptomatic events was lower after the intravenous fluid. The heart rate, which dropped during the initial test, increased during the rests after the intravenous bolus. In the nonresponders, symptomatic episodes occurred significantly later in the tilt table test when given fluids. The response to intravenous fluid bolus had positive predictive value of 92% and negative predictive value of 11% of clinical outcome. CONCLUSIONS: Our data suggest that oral fluid therapy is an effective treatment for vasodepressor syncope in our population. Fluid bolus response during tilt table testing has a high positive but a low negative predictive value of response to oral fluid therapy. We now recommend oral fluid therapy as a primary intervention and reserve tilt table testing for oral fluid therapy failures.

Adolescent↗
PubMed1998

Effect of prenatal diagnosis of critical left heart obstruction on perinatal morbidity and mortality.

We sought to determine the effect of prenatal diagnosis of congenital heart disease, specifically critical left heart obstructive (LHO) lesions, on postnatal morbidity and mortality. Several studies have found no significant improvement in mortality in infants with prenatally detected heart disease compared to infants diagnosed postnatally. Few reports have focused on the specific effects of prenatal diagnosis on the perinatal course. All newborns with LHO seen between July 1993 and July 1996 were identified and divided into two groups based on prenatal vs. postnatal diagnosis. Hospital records were reviewed for demographic and outcome variables. The outcome variables included degree of metabolic acidosis, hemodynamic instability, noncardiac organ dysfunction, delayed surgical intervention, and surgical mortality. Twenty-three fetuses were diagnosed with LHO lesions. Postnatally, 45 newborns presented with LHO anomalies. Prenatal diagnosis resulted in avoidance of hemodynamic compromise, reduced organ dysfunction, and reduced surgical delays. There was no significant difference in surgical mortality. Prenatal diagnosis significantly decreases postnatal morbidity in infants with LHO lesions. Although surgical results are similar, the reduced morbidity decreases surgical delays and potentially may impact on neurodevelopmental outcomes.

Echocardiography, Doppler↗
PubMed1997

Common cardiovascular problems in the young: Part I. Murmurs, chest pain, syncope and irregular rhythms.

Cardiovascular signs and symptoms in young people are common and usually represent variants of normal physiology. However, these signs and symptoms can also indicate the presence of important cardiovascular disorders. Innocent heart murmurs can be distinguished from pathologic murmurs by the lack of associated symptoms, as well as their loudness, timing and location. Although most chest pain in this age group is of musculoskeletal or psychogenic origin, cardiac causes can include pericarditis, aortic stenosis and coronary anomalies. Syncope is usually vasovagal in origin and has a benign prognosis. Sinus arrhythmia and isolated extrasystoles are the most common causes of irregular cardiac rhythms in the young. Multiform premature ventricular contractions, couplets and ventricular tachycardia may indicate underlying cardiac disease.

Adolescent↗
PubMed1997

Acute pulmonary toxicity in an infant from intravenous amiodarone.

Intravenous amiodarone is an effective treatment for supraventricular and ventricular tachyarrhythmias. We report a case of acute pulmonary toxicity in an infant from intravenous amiodarone and describe the clinical evaluation and laboratory studies leading to the diagnosis.

Acute Disease↗
PubMed1997

Common cardiac diseases in adolescents.

Adolescent patients frequently present with symptoms potentially referable to the cardiovascular system; however, patients rarely have true cardiovascular disease. In many patients, the history is the key to determining whether additional testing or referral is necessary. Even though the history, physical examination, and preliminary laboratory data may indicate a benign cause, occasionally a referral to a cardiologist is necessary because of patient or parental anxiety. Patients with true cardiac pathology should be followed by a cardiologist in conjunction with the primary care physician.

Adolescent↗
PubMed1994

Intraosseous adenosine. As effective as peripheral or central venous administration?

OBJECTIVE: The purpose of this study was to determine if intraosseous administration of adenosine is effective and, if so, to establish therapeutic dosage criteria for the intraosseous route compared with peripheral or central intraosseous route compared with peripheral or central venous routes. RESEARCH DESIGN: Randomized, unblinded, cross-over, within-animal control study. SETTING: University hospital in Ohio. SUBJECTS: Thirty newly weaned piglets. SELECTION PROCEDURE: Consecutive sample. INTERVENTIONS: Thirty newly weaned pigs were transesophageally (n = 26) or transvenously (n = 4) paced at a cycle length that was 10% longer than the Wenckebach threshold. The minimum effective dose of adenosine necessary to induce atrioventricular block during pacing was recorded for peripheral venous, central venous, and intraosseous routes. MEASUREMENTS AND RESULTS: The baseline resting heart rate and Wenckebach thresholds were not statistically different between subjects or between different routes of administration. The intraosseous route required a minimum effective dose of 127 micrograms/kg. Using a log transformation, the difference between central venous and peripheral venous doses was found to be statistically significant. The intraosseous dose was not statistically different from the central venous or peripheral venous doses. CONCLUSION: The intraosseous route is an effective way of administering adenosine. The peripheral venous dose required to achieve atrioventricular block is higher than the central venous dose and the intraosseous dose is intermediary to the central venous and peripheral venous doses.

Adenosine↗
PubMed1994

Use of cardiac catheterization in pediatric cardiac surgical decisions.

Current practice patterns relating to pediatric cardiac catheterization (Cath) have considerable economic implications. The decreased cost and risk of noninvasive methods such as echocardiography (ECHO) and magnetic resonance imaging (MRI) make them attractive alternative diagnostic methods if they can sufficiently define cardiac anatomy and the need for surgical intervention. We reviewed a recent cardiac surgical series of 465 cases in 1.5 years to determine how often a Cath was performed prior to surgery. Overall, 59.4% of the procedures were preceded by a Cath (76% of open heart operations, and 26.7% of closed heart operations). We specify the situations where we feel enough information is available for preoperative decision making from non-invasive testing, and we present some diagnostic pitfalls that have been encountered.

Cardiac Catheterization↗
PubMed1993

Changes in ventricular geometry early after Fontan operation.

Acute removal of a ventricular volume overload, in the face of relatively unchanging ventricular mass, results in geometric alterations that can impair diastolic ventricular performance after Fontan operation. We investigated whether geometric alterations were (1) more severe after Fontan operation than after hemi-Fontan operation, (2) more severe in infants than in children, and (3) more severe in the morphologic right ventricle than in the morphologic left ventricle. We studied 22 patients, 11 with hypoplastic left heart syndrome and 11 with a functionally single morphologic left ventricle. After Fontan operation, right ventricular end-diastolic volume declined by 52% from 36.6 +/- 12.2 to 17.5 +/- 9.3 mL. Right ventricular wall thickness increased from 6.8 +/- 1.3 to 7.5 +/- 1.8 mm. Left ventricular end-diastolic volume diminished by 40% from 57.6 +/- 23.3 to 34.8 +/- 17.6 mL. Left ventricular wall thickness increased from 7.0 +/- 2.1 to 8.7 +/- 1.9 mm. The alterations in right ventricular geometry are more marked early after Fontan operation than early after the hemi-Fontan procedure. Geometric alterations in the left ventricle appear to be more severe in infants than in children. Finally, alterations in the morphologic right ventricle appear to be of similar magnitude to those in the morphologic left ventricle.

Body Surface Area↗
PubMed1992

Anomalous left coronary artery masquerading as infantile bronchiolitis.

Four infants less than six months of age with anomalous left coronary artery from the pulmonary artery who present with symptoms of wheezing are described. All had cardiomegaly on chest radiographs and because of wheezing received beta-agonist agents (albuterol alone or with epinephrine). One developed cardiopulmonary collapse secondary to supraventricular tachycardia after administration of these agents. The literature is reviewed for utility of chest radiographs in infants presenting with wheezing and for the efficacy of beta-adrenergic agents in infants less than six months of age. The authors suggest that physicians have a low threshold for obtaining a chest radiograph prior to treating a first-time wheezing infant less than six months of age with a beta-agonist agent.

Bronchiolitis↗
PubMed1990

Accuracy of prospective two-dimensional/Doppler echocardiography in the assessment of reparative surgery.

Between January 1987 and January 1989, all 129 patients (aged 11 days to 25 years, median 39 months) undergoing both an echocardiographic examination and cardiac catheterization after reparative surgery were prospectively included in a study to assess the accuracy of combined two-dimensional and Doppler color flow imaging. The patient diagnoses were transposition of the great arteries (n = 20), tetralogy of Fallot (n = 38), coarctation of the aorta (n = 24), complete atrioventricular (AV) canal (n = 15), atrial septal defect (n = 8), ventricular septal defects (n = 3), pulmonary stenosis (n = 4), aortic stenosis (n = 8) and subaortic stenosis (n = 9). In arterial tract stenosis, there was high correlation between Doppler estimates and catheterization-derived measurements of residual right ventricular outflow tract obstruction in patients after the arterial switch operation for transposition of the great arteries (r = 0.95) as well as in patients after corrective repair of tetralogy of Fallot (r = 0.84). In semilunar/AV valve regurgitation, graded as none, mild, moderate or severe, echocardiographic estimates correlated exactly with angiographic grading in 84% and differed by one angiographic grade in the other 16%. In residual left to right shunting, no hemodynamically significant shunt was missed by echocardiography. For residual shunts at the ventricular level (n = 32), addition of Doppler color flow imaging improved the sensitivity (from 63% to 94%) and the negative predictive value (from 88% to 98%). In elevated right ventricular pressure, Doppler-derived right ventricular-right atrial pressure estimates in 24 patients correlated well with catheterization measurements (r = 0.93). Combined two-dimensional and Doppler color flow echocardiography was highly accurate in the prospective evaluation of these four types of postoperative residual.

Cardiac Catheterization↗
PubMed1977

Temetex in the treatment of steroid-responsive dermatoses.

Five hundred and seventy-five patients with various steroid-responsive dermatoses were studied for up to six weeks in eighty-eight separate general practices using a new topical corticosteroid. Temetex (diflucortolone valerate 0-1%). It was concluded that Temetex is both effective and well tolerated in a wide variety of conditions, especially eczema and psoriasis. It was also shown that a large-scale general practice trial can be carried out efficiently with a very high compliance rate.

Administration, Topical↗