Ulf Rudhe

Hemodynamic Studies of Induced Acute Hypo- and Hypervolemia in the Newborn Infant

The following investigation was undertaken as part of a study directed toward a better understanding of the pathogenesis of the sometimes fatal complications of exchange transfusions in erythroblastotic infants. Regarding the circulatory consequences of this therapeutic procedure, it was considered of interest to elucidate the mode of response of the circulatory system to changes in blood volume considerably bigger than those normally induced during replacement transfusions in order to obtain more detailed information about the adaptive capacity of the cardiovascular apparatus of the newborn. As the blood pressure response to changes in blood volume is related to the compliance of the vascular bed as well as to its ability to redistribute the available blood volume, information regarding the vasomotor characteristics of the newborn infant might be gained in this manner. Although our concept of circulatory regulation in the newborn infant is largely based on studies in animals 11s well as on inference from our knowledge of circulatory regulation in adult man, some basic

Late Stages of Pulmonary Hyaline Membranes of the Newborn

In neonates suffering from pulmonary hyaline membranes and surviving the first few days i t has been observed that the membranes become infiltrated by histiocytes, fragmented and detached from the alveolar walls. This has been interpreted as evidence that the membranes are being removed [3, 10, 15, 181. In these cases a cellular reaction has also been described in the alveolar walls proper: proliferation of the alveolar epithelium and accumulation of fibroblasts. These latter features have been interpreted as a process of reparation, following previous damage to the alveolar ualls, and i t has been postulated, that such a damage probably is related to the development of hyaline membranes [3, 151. Studies with the electron microscope have revealed destruction of the alveolar lining and swelling of the endothelium in capillaries beneath the membranes in an early stage of the disease [5. 61. No permanent sequelae, however, have been recognized in the surviving cases [ll]. The reports hitherto published on the structure of pulmonary hyaline

Left-heart volumes in coarctation of the aorta

Abstract Arvidssons method of estimating volumes of the left-heart chambers by angiocardiographic techniques has been found to be practical in application. The method has been applied in 10 studies of seven patients with compensated coarctation of the aorta. Left ventricular stroke volumes were found to average 46 ml./M. 2 (range, 34 to 59), and the end-systolic volume in the left ventricle to average 19 ml./M. 2 (range, 10 to 30). This evidence indicates that left ventricular ejection is highly efficient. Changes in left atrial stroke volume were much less marked, averaging only 15 ml./M. 2 (range, 10 to 21) during any cardiac cycle. No significant differences in changes of left-heart volume were found in three patients who were studied both before and 4 to 5 years after surgical correction of the coarctation.

Micturition urethrocystography in children with myelomeningocele. A radiologic and clinical investigation.

The purpose of the present paper is to describe the urethrocystographic findings in children with myelomeningocele and to endeavour to correlate the variations observed with certain clinical variables such as neurologic changes, the incidence of urinary tract infections, residual urine volumes, and different patient ages. The material includes two patients with adequate bladder function and unilateral neurologic functional defects who have already been described in an earlier report (ERICSSON et colI. 1970a). The clinical parameters having significance as continence-promoting factors, both as regards bladder and anal function, have been analyzed in another investigation (ERICSSON et coll. 1970b), also based on the present material. Recent investigations (COOPER 1968, STARK 1968, and others) of bladder functions with electromanometric pressure-flow measurements and electromyographic recordings in cases of myelomeningocele, have demonstrated that detrusor function and the activity of the striated muscle of the sphincter and pelvic floor

Decreased Left Lung Vascularity in Congenital Left to Right Shunts

Reports of diffuse or partial hypovascularity of the left lung associated with congenital heart disease have appeared in the literature in the last two or three years. FLEMING (1959) reported decreased vascularity of the left lung in 15 cases of atrial septal defect. A similar finding was reported in 3 cases of patent ductus arteriosus by GARFUNKEL & KIRKPATRICK (1961), who initially attributed it to overaeration of the left lung, and more recently (1963) proposed a combination of overaeration and decreased vascularity as being etiologic. Observations of similar disparities have been made at this institution in cases of atrial septal defect and patent ductus arteriosus as well as in ventricular septal defect and certain other conditions. In an effort to elucidate some of the roentgenologic aspects of this condition roentgenograms of the chest as well as angiocardiograms and heart catheterization data, when available, were reviewed in 104 cases of isolated ventricular septal defect, 70 cases of isolated patent ductus arteriosus and 83 cases of atrial septal defect, isolated or associated with partial abnormal venous return.

ROENTGENOGRAPHIC DIAGNOSIS OF OBSTRUCTIVE DISORDERS OF THE LOWER URINARY TRACT IN INFANCY AND CHILDHOOD.

In obstructive uropathy in infants and children, voiding cystourethrography is of considerable value for the detection and analysis of abnormalities of the bladder, bladder neck and urethra. Voiding cystography permits both anatomic and functional evaluation of the lower urinary tract and is often helpful in renal assessment.

Roentgenologic examination of rectum in ulcerative colitis.

In the roentgenologic examination of ulcerative colitis, the main interest has been focused on the lesions localized to the colon. On the other hand, only brief mention has generally been made in current literature of the roentgenologic aspects of the inflammatory process in the rectum. I n the present investigation, the rectum and the perirectal tissue have been studied from the roentgen-diagnostic point of view, in the series of ulcerative colitis of which a n account is given elsewhere in this imue by Ehrenpreis et al. (1). The object was to correlate the changes demonstrated at roentgenologic examination with those observed at proctoscopy, a t operation and in excised specimens. In addition, an attempt has been made to analyze the value of roentgenologic studies of the rectum, regarding both the choice of operative method, and evaluation of the effect on the rectum when, after colectomy, it has been anastomozed to the ileum, or isolated.

Nocturnal enuresis in twins. II. Urethro-cystographic examinations.

1. A study by means of micturition urethro‐cystography of changes in the lower urinary tract and of the effective bladder capacity in children with nocturnal enuresis was performed on the basis of a randomly selected twin series. The material comprised 40 same‐sexed twin pairs in which a t least one of the partners suffered from persistent nocturnal enuresis, i.e. 49 affected twins and 31 unaffected partners who were used as controls.

The diagnosis of mitral insufficiency

Abstract When the clinical findings and the left-heart catheterization suggest a dominating mitral insufficiency we can perform an angiocardiography by injection of contrast medium through the needle into the left atrium in order to visualize the mitral valves. By this method it is possible to prove the diagnosis of a mitral insufficiency and avoid an exploratory cardiotomy.

Pneumomediastinum and pneumothorax in the newborn.

Recent therapeutic advances have done much to reduce peri-natal infant mortality. This applies especially to the infectious diseases and those due to mechanical respiratory embarrassment, such as diaphragmatic hernia and pneumothorax. Roentgenologic investigation in neonatal respiratory distress has been accepted as the best one of the single diagnostic methods available, and a large amount of experience has been accumulated. The result of this has been the recognition that pneumomediastinum and pneumothorax can no longer be regarded as uncommon entities of obscure etiologic origin. As many authors (EVANS & SMALLDON 1950, LYON 1963, HAN et colI. 1963) have discussed the probable pathogenesis; this will now not be further considered except to emphasize that the experience of the present authors has been similar to that of others. Most of the cases were referred to us due to respiratory distress in the neonatal period. This report will deal with the specific aspects of roentgen techniques and the use of certain principles in distinguishing pneumomediastinum from pneumothorax in the newborn.