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Biomedical subjects

A Vardi

Publications and source records attributed to A Vardi.

At least 37 records · Page 2Linked to original sources
PubMed1998

Ventilation index and outcome in children with acute respiratory distress syndrome.

The purpose of this investigation was to determine the predictive value of the ventilation index (VI) in children with acute respiratory distress syndrome (ARDS). We performed a 10-year retrospective chart review of children who were admitted to the Pediatric Intensive Care Unit with a diagnosis of ARDS. Acute respiratory distress syndrome was defined as acute onset of diffuse, bilateral pulmonary infiltrates of noncardiac origin, and severe hypoxemia, defined as the ratio of the arterial partial pressure of oxygen to the fraction of inspired oxygen of <200 and a positive end expiratory pressure of 6 cmH2O or greater. Records of daily arterial blood gas results and ventilator settings were reviewed, and the ventilation index (VI=partial pressure of arterial CO2 x peak airway pressure x respiratory rate/1,000) was calculated each time the measurements were made. These values were correlated with outcome (survival or nonsurvival). The VI was not different at the time of diagnosis of ARDS in the patients who lived, compared with those who subsequently died. However, by 3 to 5 days after study entry, the VI of nonsurvivors was significantly higher than for survivors (P < 0.05). The VI for survivors remained between 30 and 35 throughout the study period, whereas the VI of nonsurvivors continued to increase with time. A VI of >65 predicted death with a specificity and positive predictive value of >90% on days 3 through 9. We conclude that the VI provides a reliable prognostic marker in children with ARDS, and its increase above 65 indicates a need for orderly intervention with alternative modalities of care.

Adolescent↗
PubMed1998

Severe acute asthma in a community hospital pediatric intensive care unit: a ten years' experience.

BACKGROUND: The clinical literature on the incidence and subsequent mortality of asthma has come primarily from the experiences of large tertiary referral centers, particularly in Western Europe and North America. Consequently, very little has been published on the incidence, management, and outcome of asthma in smaller, community-based intensive care units. OBJECTIVES: The purpose of this study was to explore the course and outcome of children with acute severe asthma treated within a community hospital PICU compared with those described in the literature from larger tertiary referral centers. DESIGN: A retrospective analysis of 49 asthmatic children admitted to the Pediatric Intensive Care Unit (PICU) over a 10-year period was performed. MEASUREMENTS AND RESULTS: The mean age was 5.2 years (range 2 months to 16 years), and the male:female ratio was 3:1. Duration of symptoms prior to admission to hospital was less than 24 hours in 60.4% of the patients. The majority of patients was not treated with either inhaled or oral steroids before admission. Drugs used in the PICU included nebulized beta2-agonists, theophylline, steroids, intravenous salbutamol, and intravenous isoproterenol. Although a pharmacologic approach was successful in the majority of patients, intubation and mechanical ventilation were necessary for progressive hypercapnea, exhaustion, and cardiorespiratory arrest in 11/49 of these patients. The average stay in the ICU for our patient group was 2.4 days. Intubated patients had a mean average stay of 3.5 days. Two patients had pneumothorax related to positive pressure ventilation, requiring chest tube insertion for drainage. There were no deaths among the 49 patients admitted to our PICU. CONCLUSIONS: These data show that for acute severe asthma, outcome is comparable in a community PICU to a tertiary referral institution. We conclude that early ICU admission along with close monitoring is important in reducing morbidity and mortality in children with severe asthma.

Acute Disease↗
PubMed1998

Local application of honey for treatment of neonatal postoperative wound infection.

Honey has been described in ancient and modern medicine as being effective in the healing of various infected wounds. In this report we present our experience in nine infants with large, open, infected wounds that failed to heal with conventional treatment. Conventional treatment was defined as having failed if after > or = 14 d of intravenous antibiotic and cleaning the wound with chlorhexidine 0.05% W/V in aqueous solution and fusidic acid ointment the wound was still open, oozing pus, and swab cultures were positive. All infants showed marked clinical improvement after 5 d of treatment with topical application of 5-10 ml of fresh unprocessed honey twice daily. The wounds were closed, clean and sterile in all infants after 21 d of honey application. There were no adverse reactions to the treatment. We conclude that honey is useful in the treatment of post-surgical wounds that are infected and do not respond to conventional systemic and local antibiotic treatment.

Honey↗
PubMed1998

Gunshot wounds in brains of children: prognostic variables in mortality, course, and outcome.

A retrospective study of 51 children presenting with craniocerebral gunshot lesions was carried out to identify predictors of outcome. The patients ranged in age from 2 months to 17 years, with a mean of 14.5 years. The outcome was good in 20 patients, and seven and four were moderately and severely disabled, respectively. Twenty patients died. Statistical analysis showed prognostic significance of the admission Glasgow Coma Score (GCS), computerized tomographic findings of intraventricular hemorrhage and midline shift, and metabolic abnormalities, including hypokalemia and hyperglycemia. These prognostic factors may have implications regarding counseling of families, utilization of resources, and organ transplantation.

Adolescent↗
PubMed1997

Extubation failure due to post-extubation stridor is better correlated with neurologic impairment than with upper airway lesions in critically ill pediatric patients.

The incidence of post-extubation stridor (PES) in a pediatric intensive care unit (PICU) and the need for reintubation is not known. Predictors of success on a subsequent extubation attempt and the efficacy of dexamethasone treatment prior to a subsequent extubation attempt are not established. In a prospective randomized double blind-controlled study in two PICU's in a university children's hospital setting, of 5,566 admissions over 35-months, we identified 32 patients who failed primary extubation and were reintubated for PES. Twenty-six patients were enrolled in the study and three subsequently excluded. Twelve were randomized to receive dexamethasone and 11 received sodium chloride placebo. Fifteen patients succeeded study extubation and eight failed. Of those receiving dexamethasone, nine patients succeeded and three failed. Of those receiving placebo, six patients succeeded and five failed. There was a poor correlation between anatomical abnormalities of the airway and failure of study extubation. Extubation failure was better correlated with neurologic impairment in the patients. We present a stridor score and demonstrate that it is an excellent predictor of success versus failure for the study extubation. Dexamethasone pre-treatment did not reduce stridor score. We are unable to conclude if dexamethasone pre-treatment reduces extubation failure. We speculate that neurologic impairment leads to extubation failure in critically ill pediatric patients.

Adrenal Cortex Hormones↗
PubMed1997

Epinephrine pharmacokinetics and pharmacodynamics following endotracheal administration in dogs: the role of volume of diluent.

OBJECTIVE: to define the optimal volume of dilution for endotracheal(ET) administration of epinephrine (EPI). DESIGN: prospective, randomized, laboratory comparison of four different volumes of dilution of endotracheal epinephrine (1, 2, 5, and 10 ml of normal saline). SETTING: large animal research facility of a university medical center. SUBJECTS AND INTERVENTIONS: epinephrine (0.02 mg/kg) diluted with four different volumes (1, 2, 5, and 10 ml) of normal saline was injected into the ET tube of five anesthetized dogs. Each dog served as its own control and received all four volumes in different sequences at least 1 week apart. Arterial blood samples for plasma epinephrine concentration and blood gases were collected before and 0.25, 0.5, 0.75, 1, 2, 3, 4, 5, 10, 15, 20, 25, 30 and 60 min after drug administration. Heart rate and arterial blood pressure were continuously monitored with a polygraph recorder. MEASUREMENTS AND MAIN RESULTS: higher volumes of diluent (5 and 10 ml) caused a significant decrease of PaO2, from 147 +/- 8 to 106 +/- 10 torr, compared with the lower volumes of diluent (1 and 2 ml), from 136 +/- 10 to 135 +/- 7 torr (P < 0.05). These effects persisted for over 30 min. Mean plasma epinephrine concentrations significantly increased within 15 s following administration for all the volumes of diluent. Mean plasma epinephrine concentrations, maximal epinephrine concentration (Cmax) and the coefficient of absorption (Ka) were higher in the 5 and 10 ml groups. The time interval to reach maximal concentration (Tmax) was shorter in the 5 and 10 ml groups. Yet these results were not significantly different. Heart rate, systolic and diastolic blood pressures did not differ significantly between the groups throughout the study. CONCLUSIONS: Dilution of endotracheal epinephrine into a 5 ml volume with saline optimizes drug uptake and delivery without adversely affecting oxygenation and ventilation.

Animals↗
PubMed1997

Vipera palaestinae snake envenomations: experience in children.

In Israel, Vipera palaestinae (V. palaestinae) is the most common venomous snake, accounting for 100-300 reported cases of envenomation every year. However, V. palaestinae snakebites in children have not been extensively investigated. The demographic features, treatment and outcome of V. palaestinae envenomation in 37 children treated in two medical centers over a 9 year period were retrospectively reviewed. The victims age ranged from 2-18 years with a mean age of 8.9 years. Twenty-nine children were males and eight were females. Twenty-one patients resided in rural areas, and 16 children were living in urban areas. Twenty-three (63%) of the patients were bitten on the lower limb; Twelve (33%) on the upper limb, and two on the head or neck (4%). Using a grading scale of one to three from minimal to severe envenomation, 15 (40.5%), 15 (40.5%) and 7 (19%) patients had mild, moderate and severe envenomation, respectively. Major complications of envenomation that were manifested after arrival consisted of compartment syndrome (two patients) and respiratory dysfunction (two patients). Specific monovalent antiserum for the treatment of V. palaestinae bite was given to 16 children (43%) of whom, four patients were in the severe group, seven and five in the moderate and mild groups respectively. No patient suffered a significant infection, tissue loss, permanent disability or death. We conclude that early ICU admission along with close monitoring and antivenom therapy is important in reducing morbidity and mortality in children systemically envenomed by V. palaestinae.

Adolescent↗
PubMed1997

Urine samples from disposable diapers: an accurate method for urine cultures.

BACKGROUND: The method of collection of the urine sample is of paramount importance in making a diagnosis of urinary tract infection in infants and children. Squeezing urine out of disposable diapers can provide a urine sample that can be used to detect chemical abnormalities as well as a specimen suitable for microscopic examination. To date there have been no reported studies on the use of this technique for urine culture as compared with samples collected by suprapubic aspiration and catheterization. METHODS: Urine was obtained from 38 infants aged under 2 years who presented with fever with no obvious cause. All infants had urine collected either by catheterization or suprapubic aspiration and by extraction from a disposable diaper. The urine samples were cultured using standard bacteriologic techniques. RESULTS: Five infants had a urinary tract infection, as shown by a pure growth of more than 10(5) colonies/mL of a single species of bacterium. In all the cases the same result was obtained from both the diaper urine sample and the sample obtained by suprapubic aspiration or catheter. In 31 infants the urine samples collected by both techniques (diaper and catheter or suprapubic aspiration) were negative, and in only 2 infants did the diaper specimen yield a positive result, while the urine obtained by suprapubic aspiration or catheter was sterile. CONCLUSIONS: Urine obtained from a disposable diaper can provide a valid sample for diagnosing urinary tract infection. The technique is simple, and can be carried out readily in ambulatory settings with minimal equipment and expense.

Disposable Equipment↗
PubMed1996

[Chloral hydrate--is it safe?].

Chloral hydrate is widely used as a sedative or hypnotic, especially in geriatric and pediatric patients. In therapeutic doses blood pressure and respiration are only minimally affected. We describe a 9-year-old boy in whom a life-threatening cardiac arrhythmia dominated the clinical presentation of chloral hydrate intoxication. In spite of its widespread use, the dangers of chloral hydrate overdosage, especially cardiac arrhythmias, are not sufficiently appreciated.

Arrhythmias, Cardiac↗
PubMed1996

Spontaneous pneumomediastinum in children: clinical and natural history.

UNLABELLED: Investigation of the clinical characteristics and natural history of nine children with spontaneous pneumomediastinum (SPM) was conducted at the Tel Aviv University Sheba Medical Centre between 1984 and 1994. Most cases occurred in the setting of a valsalva-type manoeuvre, while symptoms and signs on admission were mainly chest pain, dyspnoea, neck pain, subcutaneous emphysema, and Hamman's sign. Three clinical patterns concerning longterm sequelae were identified: patients without any long-term sequelae, patients with a tendency to airway hyperreactivity and subclinical asthma, and patients in whom SPM was the presenting feature of their asthma. CONCLUSION: Close personal follow up, including pulmonary function tests, should be designed for all children with Spontaneous pneumomediastinum.

Adolescent↗
PubMed1996

A controlled intervention in reduction of redundant hospital days.

BACKGROUND: Inappropriate use of hospital services, in the form of unjustified hospital stay days (HSD), constitutes a major burden on a health budget. Reduction of unjustified HSD was achieved in a medical ward in a previous intervention study. METHODS: A controlled intervention aimed at reducing unjustified hospital stay was performed on 155 paediatric inpatients and 248 controls, by applying pre-set criteria for hospitalization and comparing to results in previous studies. RESULTS: Unjustified stay was decreased from 32.6% to 14.8% on the study ward, and from 25.7% to 19.3% on the control ward. The children on both wards did not differ significantly in rates of subsequent out of hospital mortality, re-admission, and the subjective evaluation of health by their parents one month following discharge. CONCLUSIONS: This study demonstrates that despite the fact that the per cent of unjustified HSD on a paediatric wars is much lower than on medicine or surgery, a significant reduction in unjustified stay can be achieved by intervention programme.

Child↗
PubMed1996

Pediatric craniocerebral wounds from plastic bullets: prognostic implications, course, and outcome.

OBJECTIVE: To review our experience with craniocerebral injuries caused by plastic bullets, and to delineate prognostic factors for outcome. DESIGN: Retrospective case series of 29 patients presenting with plastic bullet-induced craniocerebral lesions. SETTING: Pediatric intensive care department of a tertiary care center. MEASUREMENTS AND MAIN RESULTS: Outcome was poor in 10 patients, good in 11, and two and six patients were moderately and severely disabled, respectively. Statistical analysis showed prognostic significance of the admission Glasgow Coma Scale score, computed tomographic findings of intraventricular hemorrhage and midline shift, and metabolic studies including hypokalemia and hyperglycemia. CONCLUSIONS: Plastic bullet-induced craniocerebral injuries carry a lower morbidity and mortality rate compared with other gunshot wounds. However, plastic bullets do incur a significant risk of injury. Their use should be carefully regulated.

Adolescent↗
PubMed1996

Intrathecal baclofen for severe torsion dystonia in a child.

The successful use of intrathecal baclofen, a structural analogue of gamma-aminobutyric acid, is described in the treatment of a 9-year-old boy with intractable torsion dystonia, not responding to conservative treatment. To our knowledge, this is the first reported case of continuous intrathecal baclofen for hereditary torsion dystonia. This case suggests that a continuous intrathecal infusion of baclofen may facilitate remission of intractable torsion dystonia, and provides a basis for further investigation of the treatment of intractable childhood dystonia.

Baclofen↗
PubMed1996

Torticollis: an unusual presentation of spontaneous pneumomediastinum.

Torticollis is a common clinical sign encountered by pediatricians in a wide variety of childhood illnesses including those from traumatic, neurologic, infectious, inflammatory, and psychogenic causes. We describe a case of spontaneous pneumomediastinum (SPM) manifested as acute torticollis. To the best of our knowledge, torticollis as a result of spontaneous pneumomediastinum has not yet been described. Pneumomediastinum should be included in the differential diagnosis of torticollis.

Acute Disease↗
PubMed1995

Plain radiography for diagnosis of gastrointestinal perforation in immune-compromised children--is it enough?

Gastrointestinal perforation is a surgical emergency in the pediatric patient and any delay in diagnosis might be hazardous. In immunocompromised children, the clinical signs of perforation may be blunted. We describe a child with acute lymphoblastic leukemia (ALL) and a perforated appendix and ileum in whom computerized tomography (CT) revealed extraluminal air that was not initially identified on plain abdominal film. Our case demonstrates the importance of early abdominal CT and ultrasound examination in detecting these potentially lethal complications.

Acute Disease↗
PubMed1995

Rhabdomyolysis due to hereditary torsion dystonia.

Following an acute dystonic crisis, a 6-year-old boy with hereditary torsion dystonia developed rhabdomyolysis. To our knowledge, hereditary torsion dystonia has never been reported as a cause of rhabdomyolysis. Early diagnosis and treatment of rhabdomyolysis should be considered in children with severe dystonia in order to prevent renal failure.

Acute Kidney Injury↗