Biomedical subjects

B H Ackerman

Publications and source records attributed to B H Ackerman.

43 records · Page 3Linked to original sources

PubMedDate not supplied

Toxic epidermal necrolysis after initiation of felbamate therapy.

A 33-year-old woman with a 13-year history of partial complex seizures experienced toxic epidermal necrolysis requiring management in a regional burn treatment center after 16 days of single-agent treatment for epilepsy with felbamate 3600 mg/day. Within 24 hours the target lesions involved 45% of her total body surface area. They coalesced and progressed to exfoliation involving the mucosa and the conjunctiva. The patient was hospitalized for 25 days. Reports in the literature describe life-threatening rashes after treatment with felbamate in combination with other anticonvulsant agents. We believe this to be the first reported case of felbamate-induced toxic epidermal necrolysis induced by single-agent therapy. Although felbamate provides many advantages as an anticonvulsant, its structure can be arranged to a conformation in space similar to that of hydantoins and barbiturates, and thus warrants careful patient monitoring for life-threatening rashes.

Adult↗

PubMedDate not supplied

Low-volume whole bowel irrigation and salicylate absorption: a comparison with ipecac-charcoal.

STUDY OBJECTIVE: To evaluate two methods of gastrointestinal decontamination, low-volume whole bowel irrigation (WBI) and activated charcoal, for their ability to prevent absorption of salicylate. DESIGN: Randomized, two-phase crossover study. SETTING: A clinical research unit in a university-based teaching hospital. PATIENTS: Six healthy, volunteer men. INTERVENTIONS: Subjects were assigned to receive 3000 ml WBI or syrup of ipecac 30 ml followed by activated charcoal 50 g in sorbitol, and were crossed over to the other treatment phase after 1 week. All treatments began 30 minutes after ingestion of 3.25 g aspirin. Urine was collected over 24 hours for analysis of total urinary excretion of salicylate. Serial blood samples were collected for salicylate determination and were subjected to pharmacokinetic analysis. MEASUREMENTS AND MAIN RESULTS: Mean +/- SD recovery of salicylate were WBI 48.6 +/- 5.4% and ipecac-charcoal 37.0 +/- 2.6% from urine (p < 0.01). CONCLUSION: Ipecac-charcoal produced a significantly lower salicylate absorption (peak concentration, AUC) than WBI (p < 0.01) and thus was superior to low-volume WBI.

Adult↗

PubMedDate not supplied

The use of delta osmolality to predict serum isopropanol and acetone concentrations.

We investigated whether serum delta osmolality will predict the total serum concentration of isopropanol and acetone metabolite. Three isopropanol ingestions were monitored by delta osmolality determinations followed by quantification of serum isopropanol and acetone concentrations. The delta osmolality was established by routine chemical analysis and standard freezing point depression osmometry. Serum isopropanol and acetone levels were quantified by gas chromatography-head space analysis (GC-HS). Patients were initially suspected of having isopropanol intoxication secondary to an elevated delta osmolality discrepancy (measured - calculated > 10 mOsm). Serum concentrations versus delta osmolality were analyzed by linear regression (correlation coefficient r = 0.713; p < 0.05). The delta osmolality paralleled and decreased relative to the total low molecular weight of volatile concentration in each case. In emergencies, delta osmolality may be a screening test to identify rapidly patients at risk for complications associated with isopropanol ingestion when GC-HS is not available.

1-Propanol↗

PubMedDate not supplied

Intravenous ketorolac for pain management in a ventilator-dependent patient with thermal injury.

A patient with a long-standing history of chronic obstructive pulmonary disease suffered a thermal injury over 20% of his total body surface area. He required opiates for pain management and benzodiazepines for anxiety associated with dressing changes. The narcotics compromised his pulmonary function and level of consciousness, and interfered with several attempts to wean him from ventilator support. Intravenous ketorolac instead of narcotics before dressing changes alleviated the respiratory depression and returned his partial pressure of carbon dioxide-mediated respiratory drive to normal. With these changes, including changes in respiratory rate to tidal volume, he was successfully weaned from ventilatory support. In addition, the patient's level of consciousness improved. These changes increased his participation in his daily physical therapy sessions.

Aged↗

PubMedDate not supplied

In vitro testing of antibiotics.

To enhance knowledge in the area of in vitro testing of antibiotics and to understand the limitations of available methods for susceptibility testing, we conducted a MEDLINE literature search in the English language to accumulate relevant articles. Headings searched included microbial sensitivity tests; Kirby-Bauer; laboratory tests; antiinfective agents; antibiotics, combined; microbiological techniques; blood bactericidal assay; and pharmacology, clinical. The management of patients with serious life-threatening infections can be complicated by recent changes in organism nomenclature, newly marketed antibiotics, and new isolation and sensitivity testing methods. With the addition of formulary constraints, many problems and controversies arise regarding interpretation of antibiotic sensitivity results. Comprehensive care for infected patients requires assessment of current antibiotic therapy and options for alternative therapy. By applying pharmacodynamic and pharmacokinetic knowledge to known limits of in vitro testing results, the clinician is able to select the most efficient antibiotic or antibiotic combination.

Anti-Bacterial Agents↗

PubMedDate not supplied

Disturbances of taste and smell induced by drugs.

We reviewed the current literature (1980-1990, 1991-1996) concerning drugs associated with anosmia, hyposmia, dysgeusia, parageusia, and ageusia, and the impact of these adverse effects. Case reports of patients with sudden and delayed onset of one of these disorders with evidence for implication of a drug were included. Disturbances of taste and smell among the elderly and chronically ill, including those with thermal injury, decreases interest in eating and secondarily impairs healing of wounds. Mechanisms involved with these sensory disturbances include deposition of silver sulfate in nerves after use of topical agents containing silver, altered influx of calcium and other ions, chelation or depletion of tissue-bound zinc, disturbed bradykinin catabolism and second messenger synthesis, catabolism, and altered prostaglandin systems. Other mechanisms, particularly prolonged chemosensory disorders after early drug discontinuation, remain unknown.

Drug-Related Side Effects and Adverse Reactions↗

PubMedDate not supplied

The fluconazole era: management of hematogenously disseminated candidiasis in the nonneutropenic patient.

Hematogenously disseminated candidiasis arising from nosocomial fungal infection is a life-threatening complication in critically ill, nonneutropenic patients. The overall nosocomial fungal infection rate in United States hospitals doubled from 1980-1990. Until recently, amphotericin B was the only agent available for the treatment of life-threatening candidal infections, but its use is plagued by toxicities including nephrotoxicity and infusion-related reactions such as rigors and hypotension. The availability of fluconazole, which is regarded as much less toxic than amphotericin B, prompted a surge in research to determine if it is as efficacious in the management of candidemia and hematogenously disseminated candidiasis. Complicating the interpretation of studies is the broad range of infection severity, from candidemia that may be transient and self-limiting to life-threatening hematogenously disseminated candidiasis. Clinical trials comparing fluconazole and amphotericin B demonstrate the efficacy of fluconazole for catheter-associated candidemia in critically ill patients when the likely pathogen is Candida albicans. Amphotericin B should remain the first-line agent for the management of candidemia and hematogenously disseminated candidiasis in all other patients.

Amphotericin B↗