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Biomedical subjects

A J Tomassoni

Publications and source records attributed to A J Tomassoni.

7 recordsLinked to original sources
PubMed2001

Herbal medicines for children: an illusion of safety?

Herbal medicaments are in common use. In general, the judicious use of carefully selected and prepared herbal medications seems to cause few adverse effects and may be beneficial. However, toxic effects of these products have been reported with increasing frequency. Infants and children may be even more susceptible to some of the adverse effects and toxicity of these products because of differences in physiology, immature metabolic enzyme systems, and dose per body weight. Although information promoting the use of herbal medicine is widespread, true evidence-based information about the efficacy and safety of herbal medications is limited. Although the most conservative approach is to recommend against use of herbal medicine until such evidence is available, some patients are not receptive to this approach. A reasonable approach for health care providers may be to follow such use closely, assist in herbal therapeutic decisions, and monitor for adverse effects and interactions. This manuscript discusses general concepts about herbal medicines, public health implications, and a framework for mechanisms of adverse effects from the use of botanicals. Adverse effects and toxicity of selected herbal products, including Chinese herbal medicines, are presented. The authors propose a risk reduction approach in which physicians actively seek information about the use of complementary or alternative medicine while taking medical histories.

Child↗
PubMed1999

Usefulness of the total iron binding capacity in the evaluation and treatment of acute iron overdose.

The ingestion of iron-containing products is a potential toxicologic emergency. The total iron binding capacity (TIBC) has been used widely as a predictor of end-organ toxicity and a guide to the need for deferoxamine therapy. When the TIBC is greater than the serum iron concentration (SIC), it is held that no free iron is present to cause toxicity. The TIBC fails as a marker of toxicity for several reasons. First, the laboratory methods used to measure TIBC are inaccurate in the setting of iron overload. Second, the presence of deferoxamine, the antidote for iron poisoning, has been shown to make the TIBC measurement inaccurate. Third, TIBC measurements have been shown to be variable. Finally, studies and case reports demonstrate toxicity even when the TIBC is greater than the SIC. These shortcomings of the TIBC invalidate it as a predictor of toxicity in iron poisoning.

Acute Disease↗
PubMed1997

Report on envenomation by a Gila monster (Heloderma suspectum) with a discussion of venom apparatus, clinical findings, and treatment.

Human envenomations by Heloderma species are a rare but clinically important medical problem. We report a case of an adult male bitten on the left hand by a 50-cm male, captive specimen of Heloderma suspectum (Gila monster). Immediate signs and symptoms included pain at the bite site radiating into the arm and axilla and swelling of the hand and forearm. Systemic complaints of nausea, diaphoresis, and dizziness (without a decrease in blood pressure) lasted approximately 1 hour, and laboratory studies were normal. The patient's course was uneventful except for persistent hyperesthesia, which eventually abated. Two types of helodermatid bites produce distinct clinical pictures. The chewing bite potentially causes more envenomation than the slashing bite. The venom contains a number of protein and nonprotein components including serotonin, a bradykinin-releasing substance, protease, hyaluronidase, helodermin, and gilatoxin. The clinical presentation of a helodermatid bite can include pain, edema, hypotension, nausea, vomiting, weakness, and diaphoresis. No antivenin is commercially available. Treatment is supportive, and although first aid measures such as suction or compression may impede venom movement, they are unproved. Cryotherapy, tourniquet, and excision are dangerous and should not be used.

Adult↗
PubMed1995

Cardiac problems associated with dysbarism.

Patient salvage rates depend on the extent of injury, speed and appropriateness of treatment, and the patient's age and state of health in addition to other variables. Undertreatment of DII may result in significant morbidity and associated costs. If there is any doubt regarding whether a patient might benefit from treatment, a trial at pressure is indicated. Among those with AGE who reach recompression within 5 minutes, the death rate may be only 5%, and those who survive have little morbidity. Among those whose recompression delay increases to 5 hours, however, mortality approaches 10%, and more than 50% of the survivors experience residua. All dive accidents should be thoroughly investigated by professionals. Sport divers who manifest any symptoms of DII should refrain from further diving because response to therapy for future episodes is generally relatively poor. Victims of DII must have long-term follow-up.

Decompression Sickness↗
PubMed1993

Safety assessment of high-dose narcotic analgesia for emergency department procedures.

STUDY OBJECTIVE: To evaluate the safety of high-dose IV narcotics in patients requiring analgesia for painful emergency department procedures. DESIGN: Prospective multicenter clinical trial. SETTING: Five adult urban EDs. METHODS AND MEASUREMENTS: All patients received IV meperidine (1.5 to 3.0 mg/kg) titrated to analgesia followed by a painful procedure. Vital signs and alertness scale were recorded at regular intervals, and patients were observed for four hours. Adverse events were monitored and documented. Comparisons between baseline and postanalgesia intervals were made with a repeated measures ANOVA (Dunnett's test). RESULTS: Although statistically significant changes in vital signs and alertness scale occurred, they were not clinically significant. Opiate reversal with naloxone was not needed in any patient, and no significant respiratory or circulatory compromise occurred. CONCLUSION: This study of 72 patients demonstrates that high-dose narcotic analgesia is appropriate, well tolerated, and safe when used in selected patients before painful procedures in the ED. Narcotic antagonists and resuscitation equipment nonetheless should be available to maximize safety.

Adolescent↗