Michael Wyman - Academia.edu (original) (raw)
Papers by Michael Wyman
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.
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
The Journal of Pediatrics, 1979
The Journal of Pediatrics, 1981
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.
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.
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.
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.
Journal of Pediatric Surgery, 1977
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
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 "large FRC" group. Volumes within +/- 2 SD (15-41 ml/kg) were in the "medium FRC: group, and infants smaller than or equal to 2 SD (< 14 ml/kg) of normal were in the "small FRC" group. The severity of RDS disease course was judged by the time duration the infants were managed on CPAP and FIO2 > 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.
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.
Clinical Pediatrics, 1977
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.
Journal of Pediatric Surgery, 1977
Journal of Pediatrics, 1977
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.
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
The Journal of Pediatrics, 1979
The Journal of Pediatrics, 1981
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.
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.
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.
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.
Journal of Pediatric Surgery, 1977
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
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 "large FRC" group. Volumes within +/- 2 SD (15-41 ml/kg) were in the "medium FRC: group, and infants smaller than or equal to 2 SD (< 14 ml/kg) of normal were in the "small FRC" group. The severity of RDS disease course was judged by the time duration the infants were managed on CPAP and FIO2 > 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.
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.
Clinical Pediatrics, 1977
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.
Journal of Pediatric Surgery, 1977
Journal of Pediatrics, 1977