BILATERAL VAGOTOMY AND PULMONARY HYALINE MEMBRANE FORMATION

PEDIATRICS ◽  
1965 ◽  
Vol 36 (2) ◽  
pp. 173-182
Author(s):  
Paul S. Milley ◽  
Louis J. Casarett
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Recurrent Laryngeal Nerve ◽  
Distress Syndrome ◽  
Laryngeal Nerve ◽  
Recurrent Nerve ◽  
Nerve Section ◽  
Membrane Formation ◽  
Hyaline Membranes ◽  
Hyaline Membrane

Bilateral midcervical vagotomy in adult and newborn rabbits results in the formation of pulmonary hyaline membranes similar to those observed in newborn infants dying of the respiratory distress syndrome. There are, however, important differences in the histopathology of the two conditions. Twenty adult rabbits survived unilateral right-sided cervical vagotomy for 30 days, but the majority died with hyaline membranes soon after the remaining left vagus was cut. Survival times were generally longer in animals in which the right recurrent laryngeal nerve was intact. Bilateral recurrent laryngeal nerve section resulted in death and pulmonary edema, but no hyaline membrane formation. Ten rabbits survived section of distal vagal fibers. Subsequent recurrent nerve section in 5 of these resulted in hyaline membrane formation not seen in sacrificed controls. Vagotomy-induced hyaline membrane formation appears to depend on loss of both recurrent laryngeal and distal vagal fibers, the former being more important. While there may be no relationship between experimental vagotomy and the respiratory distress syndrome, these experiments raise the possibility of an upper airway disorder in the clinical disease.

STUDIES ON HYALINE MEMBRANE DISEASE

PEDIATRICS ◽  
1963 ◽  
Vol 32 (1) ◽  
pp. 10-24
Author(s):  
Clara M. Ambrus ◽  
David H. Weintraub ◽  
Donal Dunphy ◽  
John E. Dowd ◽  
John W. Pickren ◽  
...  
Keyword(s):  
Placebo Group ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Plasminogen Activator ◽  
Premature Infants ◽  
Distress Syndrome ◽  
Hyaline Membrane Disease ◽  
Blood Coagulation Factors ◽  
Plasminogen Activator Activity ◽  
Hyaline Membrane

In the serum of normal prematures and premature infants with respiratory distress syndrome, plasminogen was absent. In mature newborns plasminogen levels were low, as compared to adults. In the euglobulin fraction of plasma, plasminogen level was highest in mature newborns, lower in healthy prematures, and lowest in prematures with respiratory distress syndrome. Antiplasmin level was exceptionally high in about a fourth of the premature infants with or without respiratory distress syndrome. Plasminogen activator activity was found more often in the blood of infants with respiratory distress syndrome than in normal infants. This may be due to the liberation of tissue activators as a consequence of hypoxia. Because of the absence of the substrate (plasminogen), this activator level may have no significance. Tissue activator activity was found in the lungs of premature infants whether they died of hyaline membrane disease or from other causes. Forty-five infants with respiratory distress were treated in a therapeutic study. Twelve were treated in a preliminary series and 33 in a randomizd, double-blind investigation. Of the latter, 11 were treated with placebo, and 5 (45%) survived; 8 were treated with streptokinase activated human plasmin and 2 (25%) survived; 14 were treated with urokinase activated human plasmin and 12 (86%) survived. Among the infants who died, no definite hyaline membrane disease was found by histopathologic examination in two of the placebo group, one in the streptokinase-plasmin treated group, and the two who died in the urokinase-plasmin group. No significant side-effects of plasmin therapy were seen. Although considerable fibrinolytic and plasminogen-activator activity was generated in many treated patients, there was no significant fall in blood coagulation factors. Intracerebral hemorrhage, which appears to occur often in patients who die with hyaline membrane disease, was not more frequent in the plasmintreated group than in the placebo group.

Questions for Bauer et al.

PEDIATRICS ◽  
1974 ◽  
Vol 54 (4) ◽  
pp. 518-518
Author(s):  
Stuart Shelton Stevenson
Keyword(s):  
Guinea Pig ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Amniotic Fluid ◽  
Human Disease ◽  
Recent Article ◽  
Distress Syndrome ◽  
Hyaline Membrane

The recent article by Bauer et al., which associates prolonged rupture of membranes with a decreased incidence of respiratory distress syndrome, is intriguing.1 Stevenson and Laufe theorized, on the basis of guinea pig experiments,2-4 that "... the human disease occurred when aspirated amniotic fluid reacted with pulmonary exudate in the lungs and the resulting film of fibrin coated the alveoli and alveolar ducts in the form of a hyaline membrane." The infants cited in Bauer's article obviously had less opportunity to aspirate amniotic fluid and their elevated corticosteroid levels might have mitigated the severity of their pulmonary exudates.

The Magnitude and Risk Factors of Acute Respiratory Distress Syndrome among Newborn Admitted To Neonatal Intensive Care Unit at Benghazi Medical Center

2021 ◽  
pp. 41-61
Author(s):  
Munera Awad Radwan ◽  
Najia Abdelati El-Mansori ◽  
Mufeda Ali Elfergani ◽  
Mohanad Abdulhadi Lawgali
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Birth Weight ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Medical Center ◽  
Female Gender ◽  
Hyaline Membrane Disease ◽  
Hyaline Membrane

Background: Hyaline Membrane Disease (HMD)/Respiratory Distress Syndrome (RDS) is the most common lung condition affecting premature babies. The inadequate amount of surfactant causes alveoli to collapse when the baby breathes out. It is hard for your baby to re-inflate the collapsed alveoli when he breathes. The lack of surfactant and resulting inflammation is called. Hyaline Membrane Disease (HMD)/Respiratory Distress Syndrome (RDS). Aim of the Study: To determine the magnitude of Hyaline membrane disease or respiratory distress syndrome and identify the risk factors and complication among newborn babies in neonatal intensive care unit at Benghazi medical center (BMC). Materials and Methods: Case series study. The study was conducted during the period between March 2017 to March 2018 of HMD cases at Benghazi medical center. A convenient sample of 120 cases diagnosed as HMD. Studied variables include the following; gestational age, birth weight, gender, type of pregnancy and type of delivery also the data for mothers such as (diabetes mellitus, preeclampsia hypothyroidism, receiving of Dexamethasone injection and premature rupture of membrane). Also investigation and treatment and finally the outcomes of babies. Statistical Methods: Data were analyzed with SPSS version 17, analysis of associations was made with application Chi - square test for categorical variables comparison, was applied for test of association P <0.25. P was considered statistically significant if ≤ 0.05. Results: Female gender was predominant (52%). Most of cases of HMD were between 1000 -2000 kg. Among the 120 cases we have (15%) sever HMD and the majority of cases have moderate –to sever Hyaline membrane disease 39 (32.5%) whereas very sever HMD were observed in nearly 27% of cases. The risk factors were history of maternal preeclampsia, maternal diabetes mellitus, prematurity and low birth weight babies and neonatal sepsis, all these were found to be very common risk factors of HMD. Pearson chi-square test p value highly significant of female gender with complications of HMD. Our results observed more than half of babies were died. Conclusion: The risk factors were history of maternal preeclampsia, maternal diabetes mellitus, prematurity and low birth weight babies and neonatal sepsis all these were found to be very common risk factors of HMD. Also we concluded that the cases had premature rupture of membrane, which identified as risk factors of hyaline membrane disease. Furthermore, we concluded that highly significant of female gender with complications of HMD, such as Pneumothorax, bronco pulmonary, dysplasia, intra ventricular hemorrhage and congenital heart diseases were common co- morbidities with respiratory distress syndrome, all these could be have an association with the development of hyaline membrane disease, finally we observed more than half of babies were died this is a warning sign for health services.

RESPIRATORY DISTRESS SYNDROME

2008 ◽  
Vol 19 (3) ◽  
pp. 203-225 ◽  
Author(s):  
ANNE GREENOUGH ◽  
VADIVELAM MURTHY
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Management Strategies ◽  
Hyaline Membrane Disease ◽  
Evidence Base ◽  
Diagnostic Techniques ◽  
Antenatal Corticosteroids ◽  
Hyaline Membranes ◽  
Respiratory Outcomes

Respiratory Distress Syndrome (RDS) is due to immaturity of the lungs, primarily the surfactant synthesising system; hence, the risk of RDS is inversely proportional to gestational age. The incidence of RDS has been reduced by the routine use of both antenatal corticosteroids and postnatal surfactant, but still approximately one per cent of babies develop RDS. Hyaline membranes, formed from plasma proteins which have leaked onto the lung surface through damaged capillaries and endothelial cells, line the terminal airways. Hence, RDS has also been called hyaline membrane disease, but RDS is the preferred name as the presence of hyaline membranes can only be confirmed histologically. The aim of this review is to emphasize the pathophysiology of RDS and the clinical presentation and relevance of diagnostic techniques in the current population of very prematurely born infants, highlighting the differential diagnosis. In addition, the evidence base for prophylactic and management strategies including whether new therapies and techniques of respiratory support have positively impacted on outcomes are discussed. The mortality and long term morbidity associated with very premature birth are described. Our increasing understanding that the so-called new bronchopulmonary dysplasia (BPD) and associated chronic adverse respiratory outcomes in such infants can reflect antenatal events resulting in abnormal lung growth is highlighted.

scholarly journals Complicated delivery in a patient with acute respiratory distress syndrome on Coronavirus disease 2019 infection

2020 ◽  
Author(s):  
Alexis Bikfalvi ◽  
Aleksandar Dabetic ◽  
Moira Robertson
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Caesarean Section ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Hyaline Membrane Disease ◽  
Invasive Ventilation ◽  
Hyaline Membrane ◽  
Return Home

A 39-year-old parturient contracted COVID-19 at 28 weeks of gestation and later developed ARDS requiring emergent caesarean section, intubation and 11 days of invasive ventilation. Her infant also required intubation due to hyaline membrane disease, he was not infected by COVID-19. Both evolved well and could return home.

scholarly journals Air Leak in Neonatal Respiratory Distress Syndrome

1984 ◽  
Vol 12 (1) ◽  
pp. 41-45 ◽  
Author(s):  
P. D. Sly ◽  
J. H. Drew
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Hyaline Membrane Disease ◽  
Maternity Hospital ◽  
Assisted Ventilation ◽  
Air Leak ◽  
Mechanical Ventilators ◽  
Hyaline Membrane ◽  
Neonatal Respiratory Distress

A review of 9401 consecutive live births at the Mercy Maternity Hospital, Melbourne, was performed to determine the incidence of air leak in those with respiratory distress syndrome. Respiratory distress was detected in 552 (5.9%) infants and hyaline membrane disease was the most common cause occurring in 238 (2.5%) infants. Air leak developed in 22% of infants with respiratory distress, 8% had pulmonary interstitial emphysema alone, 14% had pneumomediastinum or pneumothorax and 7% had emphysema with pneumomediastinum or pneumothorax. Mortality increased from 12% in infants without air leak to 31% (p < 0.001) in infants with air leak. Ninety-five per cent of air leak developed in infants with hyaline membrane, and these were smaller, less mature and sicker than those without air leak. Eighty-seven per cent of air leak developed in infants treated with assisted ventilation and was commoner with mechanical ventilators with a more rapid rise in inspiratory pressure.

scholarly journals Endothelial glycocalyx shedding in the acute respiratory distress syndrome after flu syndrome

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Maira Nilson Benatti ◽  
Alexandre Todorovic Fabro ◽  
Carlos Henrique Miranda
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Cell Injury ◽  
Endothelial Glycocalyx ◽  
Control Group ◽  
Soluble Thrombomodulin ◽  
Alveolar Septum ◽  
Hyaline Membrane

Abstract Background Scientific evidence indicates that endothelial glycocalyx (EG) shedding contributes to the pathophysiological installation of acute respiratory distress syndrome (ARDS) after bacterial sepsis. The aim was to evaluate the EG shedding in ARDS installation after flu syndrome. Methods This cross-sectional study included patients with flu syndrome during the influenza outbreak divided into two groups: patients with and without ARDS. Healthy subjects without flu syndrome were included in a control group. We measured EG damage biomarkers (hyaluronan, syndecan-1) and endothelial cell injury biomarker (soluble thrombomodulin) during the first medical evaluation. Histological assessment of the perimeter of the hyaline membrane and the number of neutrophils infiltrated in the alveolar septum was performed in patients who died. Results ARDS group had 30 patients (44 ± 16 years old, 57% men), the non-ARDS group had 36 patients (39 ± 17 years old, 42% men), and the control group had 35 individuals (44 ± 9 years old, 51% men). Hyaluronan levels were significantly higher in the ARDS group than the two groups [31 ng/ml (interquartile range-IQR 12–56) vs. 5 ng/ml (IQR 3–10) vs. 5 ng/ml (IQR 2–8); p < 0.0001]. Hyaluronan levels above 19 ng/ml in patients with flu syndrome were associated with a significant increase in 28-day mortality rate: relative risk (RR): 6.95; (95% confidence interval 1.88–25.67); p = 0.0017. A positive correlation was observed between hyaline membrane perimeter and soluble thrombomodulin levels (r = 0.89; p = 0.05) as well as between the number of neutrophils in the alveolar septum and hyaluronan levels (r = 0.89; p = 0.05). Conclusions Evidence of EG shedding was found in ARDS established after flu syndrome.

Botulinum Toxin Management of Adductor Spasmodic Dysphonia after Failed Recurrent Laryngeal Nerve Section

2003 ◽  
Vol 112 (6) ◽  
pp. 499-505 ◽  
Author(s):  
Lucian Sulica ◽  
Mitchell F. Brin ◽  
Andrew Blitzer ◽  
Celia F. Stewart
Keyword(s):  
Botulinum Toxin ◽  
Recurrent Laryngeal Nerve ◽  
Group Treatment ◽  
Botulinum Toxin Type A ◽  
Laryngeal Nerve ◽  
Spasmodic Dysphonia ◽  
Recurrent Nerve ◽  
Nerve Section ◽  
Adductor Spasmodic Dysphonia ◽  
Botulinum Toxin Therapy

This study examined botulinum toxin type A (BTX-A) treatment of adductor spasmodic dysphonia patients who had previously undergone recurrent laryngeal nerve section that failed to control symptoms. Information was retrieved from records of patients treated by our group between 1984 and 1999. Complete records with standardized outcome measurements were available for 181 BTX-A injection sessions in 16 patients who had had nerve section. These were compared to previously published information regarding 4,621 sessions in 639 adductor spasmodic dysphonia patients also treated by our group. Treatment with BTX-A resulted in significant improvement in voice function in the studied patients (change, 38.2% ± 24.5%; p < .0001). The onset of effect took place approximately 2.3 days after treatment, and the peak effect about 10.0 days after treatment. The therapeutic effect lasted 14.1 weeks on the average. These features were not significantly different from those observed in adductor spasmodic dysphonia patients as a whole. The incidence of complications was also comparable. However, lower baseline and peak posttreatment perceptions of voice function in the nerve section group were statistically significant (baseline, 45.6% ± 23.0% versus 52.4% ± 22.0%; peak, 83.8% ± 16.4% versus 89.7% ± 13.0%; both p < .001). We conclude that BTX-A is effective in the treatment of adductor spasmodic dysphonia in patients who have had recurrent nerve section. However, nerve section may adversely affect perceived voice function and may make botulinum toxin therapy less satisfactory. Because of this finding, and because of the unusual pathological features of the focal dystonias, irreversible means of treating adductor spasmodic dysphonia should be approached with caution.

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