Congenital pigmented and vascular lesions in newborn infants.

The incidence of congenital cutaneous lesions was ascertained by a single dermatologist in each of 830 sequential newborn infants over a 3-month period at the Oklahoma Teaching Hospitals. Lesions were observed in 57% of infants (77% of blacks and 49% of nonblacks). Vascular lesions were the most frequent, occurring in 44% of neonates. Pigmented lesions other than mongolian spots were observed in 15.8% of blacks and in 1.6% of whites. Clinical criteria do not readily distinguish nevus cell nevi from other pigmented lesions. Wood's light examination did not enhance the identification of congenital lesions. Inadequate examination of infants and marked underreporting of congenital lesions in newborn infants are widespread.

Pulmonary microvascular leakage after microembolization and hemodilution.

This study examined the role of colloids versus crystalloids in pulmonary edema associated with the increased pulmonary microvascular permeability secondary to thrombin-induced pulmonary microembolism. Each of 23 healthy dogs received an intravenous injection of thrombin and a fibrinolysis inhibitor, which induced a microembolic state with increased (fivefold) pulmonary lymphatic flow and a lymph/plasma (L/P) protein ratio typical of a permeability change. Seven dogs received no treatment, eight received 15 ml/kg 10% dextran 40 (D40), and eight received 60 ml/kg Ringer's lactate solution (RL). Pulmonary water was measured serially by thermal conductivity and terminally by wet/dry weights. This preparation produced significant hemolysis; however, L/P ratios of hemoglobin approached unity in all groups. Initially there was hemoconcentration, which was reversed by RL and even more so by D40. Both D40 and RL temporarily raised the pulmonary artery and pulmonary artery wedge pressures to 15 mm Hg; D40 more than doubled the cardiac output of control or RL subjects--this was associated with a reduced pulmonary arteriolar resistance (P less than 0.05). In the early stage PaO2 was better maintained with D40 (P less than 0.02). Lymph flow increased and was comparable in all groups, as were lung water and lung weight, which tripled in all three groups. Results of this study indicated that in the presence of a pulmonary microvascular leak, colloids in doses that produced comparable microvascular pressures did not increase lung water and did not accumulate in the pulmonary interstitium. Colloids were superior to crystalloids in maintaining cardiac output, pulmonary vascular resistance, and oxygen tension in the early period after microembolism.U

Lung thermal volume as an indicator of pulmonary extravascular water.

Double-indicator dilution methods can be used for measurement of lung water. The thermal conductivity method is based on heat as a diffusible and conductivity as a non-diffusible indicator. In the present study we correlated lung thermal volume with gravimetrical measurement of extravascular lung water after thrombin-induced microembolization in dog lungs. The embolization was accompanied by significantly increased vascular permeability and accumulation of interstitial water. Under these conditions there was a close correlation between the two methods of measuring lung water (r = 0.78, p less than 0.01).

Studies on the pulmonary capillary permeability after induced microembolism.

Pulmonary microembolization was induced by infusion of thrombin during inhibition of the fibrinolytic system. After embolization cardiac output decreased, pulmonary vascular resistance and pulmonary arterial pressure increased. There was a transient decrease in PaO2. Immediately after embolization there was an increased permeability indicated by tremendous increase in lymph flow with a constant lymph/plasma protein ratio. The lymph/plasma ratio for hemoglobin and for FITC-Dextran (mw 150 000) also increased indicating leakage of large molecules. The increased permeability was accompanied by a significant increase in extra-vascular lung-water as measured both with the thermal conductivity and the dry/wet weight method.