Michael Wyman - Academia.edu (original) (raw)

Papers by Michael Wyman

Research paper thumbnail of A Caution About Using Photoillumination Devices

Research paper thumbnail of Nitrogen Washout (NW) Technique for the Treatment of Pulmonary Interstitial Emphysema (Pie) in Newborn Infants: 1208

Research paper thumbnail of Diagnosis of pneumothorax or pneumomediastinum in the neonate by transillumination

Pediatrics, 1975

Transillumination of the neonatal chest is described as an aid in the diagnosis of pneumothorax o... more Transillumination of the neonatal chest is described as an aid in the diagnosis of pneumothorax or pneumomediastinum. Sudden severe tension pneumothorax or pneumomediastinum can be localized for immediate treatment and the success of therapy can be immediately assessed using transillumination.

Research paper thumbnail of Vestibulo-ocular Reflexes in Neonates: The Problem of Defining Subject-axis Rotation During Examiner-axis Rotation. 591

Research paper thumbnail of 1208 Nitrogen Washout (NW) Technique for the Treatment of Pulmonary Interstitial Emphysema (Pie) in Newborn Infants

Pediatric Research, 1978

Fetal rabbits at 29 days gestation were delivered both from does made hypergl ycemic with IV stre... more Fetal rabbits at 29 days gestation were delivered both from does made hypergl ycemic with IV streptozotocin (5) (75rng/kg) pri or to conception & from control (C) does. Fasting maternal seru glucose levels at 29 days gestation were 153i43.7rng/dl in does & 99.4+19.7mg/dl in g. Fetal glucose levels imnediately after cesarean section were 84.8k10.3 5 & 75.3123.1 C. Lungs from

Research paper thumbnail of Computerized newborn intensive care data recording and reporting. II. An online system

The Journal of Pediatrics, 1979

Research paper thumbnail of Defective oxidative metabolic responses of neutrophils from stressed neonates

The Journal of Pediatrics, 1981

Research paper thumbnail of Unilateral pulmonary interstitial emphysema

The Journal of Pediatrics, 1976

Letters to the Editor The Journal ofPediatrics May1976 stances, the course of-thyrotoxicosis in t... more Letters to the Editor The Journal ofPediatrics May1976 stances, the course of-thyrotoxicosis in the newborn infant is predictable, since the clinical expression of the syndrome appears always after the first postnatal week. It will be interesting if, with the methodology now available to measure thyroid function, hyperthyroidism may indeed be documented at birth when the mother is treated with agents, such as propranolol, 1 which are different from the antithyroid drugs in their mechanism of action. Concerning the last point in the letter, recently we studied another patient born to a thyrotoxic mother who received 30 mg daily of methimazole and 0.4 nag daily of I-T4 during the last trimester. At birth, the cord TSH was 32 uU/ml, and the T4 was 10.5 ug/1..No goiter was felt but his bone age was delayed. A week later the baby was euthyroid by all biochemical measurements. This example shows how concomitant doses of thyroid hormone to the mother do not protect the fetus from hypothyroidism as previously implied. 2 In light of Drs. Mitchell and Shenfield's observations and our own, two facts stand out clearly in the appraisal of newborns of hyperthyroid mothers: (1) LATS or HTSI in the mother carries a significant risk for neonatal thyrotoxicosis and (2) elevated TSH levels in cord blood are diagnostic of intrauterine hypothyroidism and clearly reflect the effects of maternal antithyroid therapy on the conceptus.

Research paper thumbnail of Usefulness of soluble interleukin-2 receptor specificity

The Journal of Pediatrics, 1996

have used the more precise and correct term "earlier" to denote the relative timing of discharges... more have used the more precise and correct term "earlier" to denote the relative timing of discharges of study compared to conwol infants. The current American Academy of Pediatrics guidelines address this ambiguity at least for healthy newborn infants by removing the term entirely from this context. 1 Although we disagree with Dr. Grylack's methods for reaching his conclusions, we thank him for his interest in our work and for his response to our article.

Research paper thumbnail of Gastric air insufflation as an aid to placement of oroduodenal tubes

The Journal of Pediatrics, 1976

Table I, Laboratory and radiologic features of four patients who have upper urinary tract anomali... more Table I, Laboratory and radiologic features of four patients who have upper urinary tract anomalies in association with the adrenogenital syndrome Lowest serum 24 hr urinary 17 24 hr urinary Na in mEq/1 ketosteroids in mg pregnanetriot in Urinary Patient Sex (normal 135-14.5) (normal 1-4) mg (normal < 1) infection Upper urinary tract anomaly R.C. Female 120 24 19 E. cog K.P. Female 135 10.4 1.3" No A.J. Male 127 9.2 8.1 E. colt I.K. Male 127 31.6 33.0 No Partial duplication of the collecting system on the left Partial duplication of the collecting system on the right Ureteropelvic obstruction on the right Agenesis of the right kidney *Not obtained until after suppressive cortisone therapy begun. are operative in causing upper tract reduplication and stricture remains entirely speculative.

Research paper thumbnail of A computerized single entry system for recording and reporting data on high-risk newborn infants

The Journal of Pediatrics, 1978

A computer-assisted system for data collection in an intensive care nursery is described. Materna... more A computer-assisted system for data collection in an intensive care nursery is described. Maternal history, infant history, diagnoses, and treatment are sequentially identified on a single form and then entered in batches into a computer at the time ofpatient discharge. Computer production of a discharge summary and leiters to referring and fa 110 IV-Up physicians from a single data-entry form account for an approximately 80%suvings in physician record-keeping lime per patient. Accuracy of the data is approximately /\lIo and one-half times greater than with existing methods of data gathering. Survey of disease occurrence and case fatality rates are rapidly available.

Research paper thumbnail of Fiberoptic transillumination: A new tool for the pediatric surgeon

Journal of Pediatric Surgery, 1977

Research paper thumbnail of Streptococcal Pneumonia in Neonatal Respiratory Distress

JAMA: The Journal of the American Medical Association, 1980

To the Editor.— We refer to the article by Miller et al (243:1176, 1980) concerning neonatal resp... more To the Editor.— We refer to the article by Miller et al (243:1176, 1980) concerning neonatal respiratory distress. We would like to add a note regarding the importance of streptococcal pneumonia. As greater strides have been made in the prevention and treatment of both respiratory distress syndrome (RDS) and meconium aspiration syndrome, we and others have found that streptococcal pneumonia persists and thus is becoming the most notable killer among the various causes of respiratory distress in the newborn. 1,2 It is treatable with penicillin early in its course but tragically is not often treated until too late, because the chest roentgenogram is interpreted as uncomplicated RDS. 1,3,4 We believe it is crucial that the roentgenographic appearance of neonatal streptococcal pneumonia is often indistinguishable from uncomplicated RDS, (ie, diffuse granular appearance with or without air bronchograms) and that trying to make the distinction can result in a lethal delay in

Research paper thumbnail of Functional residual capacity and severity of respiratory distress syndrome in infants

Critical Care Medicine, 1980

Infants with respiratory distress syndrome (RDS) have insufficient surfactant systems and decreas... more Infants with respiratory distress syndrome (RDS) have insufficient surfactant systems and decreased functional residual capacity (FRC). This study attempts to relate FRC with severity of disease course. Measurements were made on 36 newborn infants with clinically diagnosed RDS. All infants were intubated and breathing on continuous positive airway pressure (CPAP) at the time studied. Infant CPAP levels were adjusted to 10 cm H2O; then FRC and arterial blood gas measurements were made. The infants were grouped according to their FRC per birth weight (BW). Volumes larger than or equal to 2 SD (larger than or equal to 42 ml/kg) of normal term infants not on CPAP were placed in the &quot;large FRC&quot; group. Volumes within +/- 2 SD (15-41 ml/kg) were in the &quot;medium FRC: group, and infants smaller than or equal to 2 SD (&lt; 14 ml/kg) of normal were in the &quot;small FRC&quot; group. The severity of RDS disease course was judged by the time duration the infants were managed on CPAP and FIO2 &gt; 0.21 and by the maximum CPAP and FIO2 levels used. Twelve infants (33%) had small FRC, 18 (50%) medium FRC, and 6 (17%) large FRC. The time duration the infants with large FRC were on CPAP was significantly less than infants with medium FRC and the medium FRC group time was less than the small FRC group. The time duration on increased FIO2 and maximum FIO2 level used on the large FRC group was less than the medium and small FRC groups. Thus, FRC/BW appears related to the severity of RDS disease course. It is possible that the infants with FRC/BW larger than or equal to 42 ml/kg had pneumonia and were misdiagnosed as RDS. If so, FRC monitoring could have assisted in their diagnosis. BW and gestational ages of the groups were not different. Thus, variables other than these two play an important role in the degree of atelectasis occurring in infants with RDS. In patient management, where frequent changes in airway pressure and FIO2 are made, knowing the FRC/BW as well as blood gas values could aid the clinician in his choice of CPAP and FIO2 levels.

Research paper thumbnail of A method of estimating the functional residual capacity of infants with respiratory distress syndrome

Critical Care Medicine, 1980

This report describes and evaluates a new method of estimating the functional residual capacity (... more This report describes and evaluates a new method of estimating the functional residual capacity (FRC) of newborn infants receiving continuous positive airway pressure (CPAP). Standard nitrogen washout methods of measuring lung volume are time consuming, frequently interfere with patient care, and may be hazardous to prematurely born infants. The authors are using a four-breath nitrogen washout technique to estimate the FRC of infants. The method was evaluated using: (1) a mechanical lung model, and (2) results from 32 newborn infants with RDS. The actual volume of the mechanical lung model was 21.6 ml and the estimated volume was 21.4 +/- 2.3 (SD) n = 13. Using different volumes in the mechanical lung model and comparing with estimated FRCs yielded a correlation coefficient of 0.96 (n = 15). Comparing the FRC of infants determined by standard nitrogen washout with the estimated FRC yielded a correlation coefficient of 0.92, n = 145. Thus, the results of the two methods are in good agreement. The new method reduces the period of breathing pure oxygen from several minutes to just a few seconds, thus, decreasing the dangers of absorption atelectasis and oxygen toxicity. The new system also lends itself well to micro-processor automation.

Research paper thumbnail of Accuracy of Transillumination in the Recognition of Pneumothorax and Pneumomediastinum in the Neonate

Clinical Pediatrics, 1977

Research paper thumbnail of Morbidity Associated With Prolonged Use of Polyvinyl Feeding Tubes

Archives of Pediatrics & Adolescent Medicine, 1975

In two newborn infants, morbidity was associated with long-term use of polyvinyl chloride feeding... more In two newborn infants, morbidity was associated with long-term use of polyvinyl chloride feeding tubes. In one case, a hard, sharp catheter was thought to be responsible for peritonitis. In other, the polyvinyl tube hardened into a coil that could only be extricated by introduction of an intraluminal guide wire and prolonged manipulation under fluoroscopic control. The rigidity acquired by these tubes is thought to present serious potential for morbidity and mortality. Methods and materials appropriate for short-term alimentation should no be presumed appropriate for long-term use, and alternatives should be considered.

Research paper thumbnail of Fiberoptic transillumination: A new tool for the pediatric surgeon

Journal of Pediatric Surgery, 1977

Research paper thumbnail of Lobar opacification of the lung after tracheal extubation in neonates

Journal of Pediatrics, 1977

Research paper thumbnail of A Caution About Using Photoillumination Devices

Research paper thumbnail of Nitrogen Washout (NW) Technique for the Treatment of Pulmonary Interstitial Emphysema (Pie) in Newborn Infants: 1208

Research paper thumbnail of Diagnosis of pneumothorax or pneumomediastinum in the neonate by transillumination

Pediatrics, 1975

Transillumination of the neonatal chest is described as an aid in the diagnosis of pneumothorax o... more Transillumination of the neonatal chest is described as an aid in the diagnosis of pneumothorax or pneumomediastinum. Sudden severe tension pneumothorax or pneumomediastinum can be localized for immediate treatment and the success of therapy can be immediately assessed using transillumination.

Research paper thumbnail of Vestibulo-ocular Reflexes in Neonates: The Problem of Defining Subject-axis Rotation During Examiner-axis Rotation. 591

Research paper thumbnail of 1208 Nitrogen Washout (NW) Technique for the Treatment of Pulmonary Interstitial Emphysema (Pie) in Newborn Infants

Pediatric Research, 1978

Fetal rabbits at 29 days gestation were delivered both from does made hypergl ycemic with IV stre... more Fetal rabbits at 29 days gestation were delivered both from does made hypergl ycemic with IV streptozotocin (5) (75rng/kg) pri or to conception & from control (C) does. Fasting maternal seru glucose levels at 29 days gestation were 153i43.7rng/dl in does & 99.4+19.7mg/dl in g. Fetal glucose levels imnediately after cesarean section were 84.8k10.3 5 & 75.3123.1 C. Lungs from

Research paper thumbnail of Computerized newborn intensive care data recording and reporting. II. An online system

The Journal of Pediatrics, 1979

Research paper thumbnail of Defective oxidative metabolic responses of neutrophils from stressed neonates

The Journal of Pediatrics, 1981

Research paper thumbnail of Unilateral pulmonary interstitial emphysema

The Journal of Pediatrics, 1976

Letters to the Editor The Journal ofPediatrics May1976 stances, the course of-thyrotoxicosis in t... more Letters to the Editor The Journal ofPediatrics May1976 stances, the course of-thyrotoxicosis in the newborn infant is predictable, since the clinical expression of the syndrome appears always after the first postnatal week. It will be interesting if, with the methodology now available to measure thyroid function, hyperthyroidism may indeed be documented at birth when the mother is treated with agents, such as propranolol, 1 which are different from the antithyroid drugs in their mechanism of action. Concerning the last point in the letter, recently we studied another patient born to a thyrotoxic mother who received 30 mg daily of methimazole and 0.4 nag daily of I-T4 during the last trimester. At birth, the cord TSH was 32 uU/ml, and the T4 was 10.5 ug/1..No goiter was felt but his bone age was delayed. A week later the baby was euthyroid by all biochemical measurements. This example shows how concomitant doses of thyroid hormone to the mother do not protect the fetus from hypothyroidism as previously implied. 2 In light of Drs. Mitchell and Shenfield's observations and our own, two facts stand out clearly in the appraisal of newborns of hyperthyroid mothers: (1) LATS or HTSI in the mother carries a significant risk for neonatal thyrotoxicosis and (2) elevated TSH levels in cord blood are diagnostic of intrauterine hypothyroidism and clearly reflect the effects of maternal antithyroid therapy on the conceptus.

Research paper thumbnail of Usefulness of soluble interleukin-2 receptor specificity

The Journal of Pediatrics, 1996

have used the more precise and correct term "earlier" to denote the relative timing of discharges... more have used the more precise and correct term "earlier" to denote the relative timing of discharges of study compared to conwol infants. The current American Academy of Pediatrics guidelines address this ambiguity at least for healthy newborn infants by removing the term entirely from this context. 1 Although we disagree with Dr. Grylack's methods for reaching his conclusions, we thank him for his interest in our work and for his response to our article.

Research paper thumbnail of Gastric air insufflation as an aid to placement of oroduodenal tubes

The Journal of Pediatrics, 1976

Table I, Laboratory and radiologic features of four patients who have upper urinary tract anomali... more Table I, Laboratory and radiologic features of four patients who have upper urinary tract anomalies in association with the adrenogenital syndrome Lowest serum 24 hr urinary 17 24 hr urinary Na in mEq/1 ketosteroids in mg pregnanetriot in Urinary Patient Sex (normal 135-14.5) (normal 1-4) mg (normal < 1) infection Upper urinary tract anomaly R.C. Female 120 24 19 E. cog K.P. Female 135 10.4 1.3" No A.J. Male 127 9.2 8.1 E. colt I.K. Male 127 31.6 33.0 No Partial duplication of the collecting system on the left Partial duplication of the collecting system on the right Ureteropelvic obstruction on the right Agenesis of the right kidney *Not obtained until after suppressive cortisone therapy begun. are operative in causing upper tract reduplication and stricture remains entirely speculative.

Research paper thumbnail of A computerized single entry system for recording and reporting data on high-risk newborn infants

The Journal of Pediatrics, 1978

A computer-assisted system for data collection in an intensive care nursery is described. Materna... more A computer-assisted system for data collection in an intensive care nursery is described. Maternal history, infant history, diagnoses, and treatment are sequentially identified on a single form and then entered in batches into a computer at the time ofpatient discharge. Computer production of a discharge summary and leiters to referring and fa 110 IV-Up physicians from a single data-entry form account for an approximately 80%suvings in physician record-keeping lime per patient. Accuracy of the data is approximately /\lIo and one-half times greater than with existing methods of data gathering. Survey of disease occurrence and case fatality rates are rapidly available.

Research paper thumbnail of Fiberoptic transillumination: A new tool for the pediatric surgeon

Journal of Pediatric Surgery, 1977

Research paper thumbnail of Streptococcal Pneumonia in Neonatal Respiratory Distress

JAMA: The Journal of the American Medical Association, 1980

To the Editor.— We refer to the article by Miller et al (243:1176, 1980) concerning neonatal resp... more To the Editor.— We refer to the article by Miller et al (243:1176, 1980) concerning neonatal respiratory distress. We would like to add a note regarding the importance of streptococcal pneumonia. As greater strides have been made in the prevention and treatment of both respiratory distress syndrome (RDS) and meconium aspiration syndrome, we and others have found that streptococcal pneumonia persists and thus is becoming the most notable killer among the various causes of respiratory distress in the newborn. 1,2 It is treatable with penicillin early in its course but tragically is not often treated until too late, because the chest roentgenogram is interpreted as uncomplicated RDS. 1,3,4 We believe it is crucial that the roentgenographic appearance of neonatal streptococcal pneumonia is often indistinguishable from uncomplicated RDS, (ie, diffuse granular appearance with or without air bronchograms) and that trying to make the distinction can result in a lethal delay in

Research paper thumbnail of Functional residual capacity and severity of respiratory distress syndrome in infants

Critical Care Medicine, 1980

Infants with respiratory distress syndrome (RDS) have insufficient surfactant systems and decreas... more Infants with respiratory distress syndrome (RDS) have insufficient surfactant systems and decreased functional residual capacity (FRC). This study attempts to relate FRC with severity of disease course. Measurements were made on 36 newborn infants with clinically diagnosed RDS. All infants were intubated and breathing on continuous positive airway pressure (CPAP) at the time studied. Infant CPAP levels were adjusted to 10 cm H2O; then FRC and arterial blood gas measurements were made. The infants were grouped according to their FRC per birth weight (BW). Volumes larger than or equal to 2 SD (larger than or equal to 42 ml/kg) of normal term infants not on CPAP were placed in the &quot;large FRC&quot; group. Volumes within +/- 2 SD (15-41 ml/kg) were in the &quot;medium FRC: group, and infants smaller than or equal to 2 SD (&lt; 14 ml/kg) of normal were in the &quot;small FRC&quot; group. The severity of RDS disease course was judged by the time duration the infants were managed on CPAP and FIO2 &gt; 0.21 and by the maximum CPAP and FIO2 levels used. Twelve infants (33%) had small FRC, 18 (50%) medium FRC, and 6 (17%) large FRC. The time duration the infants with large FRC were on CPAP was significantly less than infants with medium FRC and the medium FRC group time was less than the small FRC group. The time duration on increased FIO2 and maximum FIO2 level used on the large FRC group was less than the medium and small FRC groups. Thus, FRC/BW appears related to the severity of RDS disease course. It is possible that the infants with FRC/BW larger than or equal to 42 ml/kg had pneumonia and were misdiagnosed as RDS. If so, FRC monitoring could have assisted in their diagnosis. BW and gestational ages of the groups were not different. Thus, variables other than these two play an important role in the degree of atelectasis occurring in infants with RDS. In patient management, where frequent changes in airway pressure and FIO2 are made, knowing the FRC/BW as well as blood gas values could aid the clinician in his choice of CPAP and FIO2 levels.

Research paper thumbnail of A method of estimating the functional residual capacity of infants with respiratory distress syndrome

Critical Care Medicine, 1980

This report describes and evaluates a new method of estimating the functional residual capacity (... more This report describes and evaluates a new method of estimating the functional residual capacity (FRC) of newborn infants receiving continuous positive airway pressure (CPAP). Standard nitrogen washout methods of measuring lung volume are time consuming, frequently interfere with patient care, and may be hazardous to prematurely born infants. The authors are using a four-breath nitrogen washout technique to estimate the FRC of infants. The method was evaluated using: (1) a mechanical lung model, and (2) results from 32 newborn infants with RDS. The actual volume of the mechanical lung model was 21.6 ml and the estimated volume was 21.4 +/- 2.3 (SD) n = 13. Using different volumes in the mechanical lung model and comparing with estimated FRCs yielded a correlation coefficient of 0.96 (n = 15). Comparing the FRC of infants determined by standard nitrogen washout with the estimated FRC yielded a correlation coefficient of 0.92, n = 145. Thus, the results of the two methods are in good agreement. The new method reduces the period of breathing pure oxygen from several minutes to just a few seconds, thus, decreasing the dangers of absorption atelectasis and oxygen toxicity. The new system also lends itself well to micro-processor automation.

Research paper thumbnail of Accuracy of Transillumination in the Recognition of Pneumothorax and Pneumomediastinum in the Neonate

Clinical Pediatrics, 1977

Research paper thumbnail of Morbidity Associated With Prolonged Use of Polyvinyl Feeding Tubes

Archives of Pediatrics & Adolescent Medicine, 1975

In two newborn infants, morbidity was associated with long-term use of polyvinyl chloride feeding... more In two newborn infants, morbidity was associated with long-term use of polyvinyl chloride feeding tubes. In one case, a hard, sharp catheter was thought to be responsible for peritonitis. In other, the polyvinyl tube hardened into a coil that could only be extricated by introduction of an intraluminal guide wire and prolonged manipulation under fluoroscopic control. The rigidity acquired by these tubes is thought to present serious potential for morbidity and mortality. Methods and materials appropriate for short-term alimentation should no be presumed appropriate for long-term use, and alternatives should be considered.

Research paper thumbnail of Fiberoptic transillumination: A new tool for the pediatric surgeon

Journal of Pediatric Surgery, 1977

Research paper thumbnail of Lobar opacification of the lung after tracheal extubation in neonates

Journal of Pediatrics, 1977