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Biomedical subjects

G Koren

Publications and source records attributed to G Koren.

At least 523 records · Page 29Linked to original sources
PubMed1990

The feasibility of using EMLA (eutectic mixture of local anaesthetics) cream in pediatric outpatient clinics.

EMLA is a eutectic mixture of local anaesthetics, lidocaine and prilocaine, effective in alleviating the pain of venous puncture in children. The lag time of 60 minutes, which is necessary to achieve effective anaesthesia after skin application, may be an important obstacle to the use of EMLA. In this study we recorded the routine practice of six pediatric outpatient clinics which may use EMLA. Our data show a large variability in the feasibility of using EMLA: In the Hematology-Oncology clinics 85% of the patients could benefit from EMLA without prolonging their hospital stay; in the Neurology clinic the mean waiting time is 60.2 +/- 45 minutes, and an additional 15 minutes would be required for only 26 percent of the patients. In four other clinics where the blood work is performed at the phlebotomy station, the waiting time before venous puncture ranges from five to 12 minutes and the use of EMLA would require major changes in the organization of the clinic, or a longer waiting time. In children suffering from chronic diseases, for whom painful medical procedures are a major cause of anxiety, the additional waiting time may be acceptable by both patients and their parents.

Anesthetics, Local↗
PubMed1990

Home-based palliative care for children--Part 2: The benefits of an established program.

Thirty-four patients have been admitted to our palliative care program since its institution in March 1986. Five were unsuitable and were withdrawn soon after admission. Of the remainder, 22 (75.9%) had central nervous system (CNS) tumors, 5 (17.2%) had myelomeningocoele, 1 (3.45%) had an arteriovenous (AV) malformation, and 1 (3.45%) had a storage disease. Twenty-five (86.2%) have since died and 17 (68%) of these have died at home. In comparison with a similar group of 30 patients studied in a feasibility study prior to the institution of our program, patients admitted to our palliative care program were hospitalized for significantly fewer days during the terminal phase of their illness (p less than 0.05) and a significantly higher proportion died at home (p less than 0.001). Following a survey of the parents of 14 children diagnosed with CNS tumors who died while under our care, we determined that the overall level of satisfaction with the program was high compared to care provided prior to admission to the program (p less than 0.01). Components of the program deemed most satisfactory were (1) being able to care for the child at home (p less than 0.01), (2) having access to a palliative care nurse (p less than 0.05), and (3) having access to a pediatric clinical pharmacologist (p less than 0.05). The most troublesome symptoms occurring in this group of patients were pain, gastrointestinal symptoms, and seizures. Most problems were adequately managed by the parents under the supervision of the team. Eighty percent of the terminal care for these patients was provided at home.(ABSTRACT TRUNCATED AT 250 WORDS)

Central Nervous System Diseases↗
PubMed1990

Obstetric and neonatal effects of drugs of abuse.

With an increase in illicit drug use in North America, more fetuses are exposed to cocaine, cannabinoids, alcohol, cigarettes, and opioids. Whereas the adverse fetal effects of some agents have been established (for example, ethanol), those of other compounds are still controversial (for example, cocaine, THC). Two important trends may hamper our understanding of the potential reproductive risks of recreational drugs: 1. The clustering of many other risk factors in the same women. 2. A tendency to publish studies showing adverse reproductive fetal effects while discouraging reports of no effects by drugs and chemicals. Although short-term research has addressed some of the immediate postnatal physical and behavioral performance of these babies, much more work is needed to address the difficult questions of long-term neurobehavioral outcome in babies exposed to recreational drug abuse in utero.

Female↗
PubMed1990

Vancomycin-induced red man syndrome.

A total of 11 cases of red man syndrome collected among 650 children who had received vancomycin in our hospital between 1986 and 1988 (estimated prevalence 1.6%) were retrospectively analyzed. These 11 children were compared with 11 age-matched children who received vancomycin in whom red man syndrome did not develop. Of the patients with red man syndrome, 73%, and of the patients with no reaction, 45.4% received vancomycin for penicillin-resistant Staphylococcus epidermidis-positive cultures, or because of history of penicillin allergy. No difference was observed in the dose per kilogram given to both groups (12.9 +/- 3.5 mg/kg per dose in those with red man syndrome vs 12.3 +/- 6.9 mg/kg per dose in control children. The duration (mean +/- standard deviation) of vancomycin infusion was 45.9 +/- 16.7 minutes (range 10 to 90 minutes) in patients with red man syndrome and 54.5 +/- 7.6 minutes (range 45 to 65 minutes) in the control group (P = .07). In the 5 children with red man syndrome rechallenged with vancomycin, slower infusion rates prevented or reduced the syndrome, which emphasized the fact that the rate of administration is the important determinant of red man syndrome in susceptible cases. Clinically, the syndrome developed at the end of the infusion in most patients, but appeared as early as 15 minutes after initiation of the infusion. It was mostly manifested as a flushed, erythematous rash on the face, neck, and around the ears. Less frequently, the rash was distributed all over the body. Pruritus was usually localized to the upper trunk but was also generalized (2 of 11 children).(ABSTRACT TRUNCATED AT 250 WORDS)

Body Weight↗
PubMed1990

Methotrexate-nonsteroidal antiinflammatory drug interaction in children with arthritis.

In order to assess the interaction between methotrexate (MTX) and nonsteroidal antiinflammatory drugs (NSAID), we studied the pharmacokinetics of oral MTX alone and in the presence of the usually prescribed NSAID in 7 children with chronic arthritis. The NSAID studied included tolmetin, indomethacin, naproxen, and aspirin. Six patients were treated with multiple NSAID. The mean MTX elimination half-life was prolonged when NSAID were coadministered (1.7 +/- 0.5 vs 1.2 +/- 0.1 h; p = 0.03). However, neither the apparent MTX clearance (CI) (10.6 +/- 5.5 vs 13.1 +/- 3.5 l/h; p = 0.19), the area under the serum MTX concentration-time curve (Auc) (2.1 +/- 1.0 vs 1.5 +/- 0.6 mumol/l/h; p = 0.08) or the apparent volume of distribution (Vd) (23.0 +/- 6.2 vs 21.9 +/- 6.4 l; p = 0.53) was significantly altered by the administration of NSAID. Although the differences between the mean Cl and Auc were not statistically significant, a wide variation in the impact of NSAID on MTX Cl was observed. In 6 of 7 patients, the Auc increased during NSAID administration from 19 to 140%. This degree of increase may be clinically significant in some individuals. It is consequently recommended to closely monitor patients who are receiving MTX and NSAID for MTX toxicity until these results can be verified in a larger population.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1990

Methodological issues in studying the effect of the new oral chelator 1,2-dimethyl-3-hydroxypyrid-4-one (L1) on absorption of iron.

Although deferoxamine is currently the drug of choice for iron chelation, there is more and more evidence of its toxicity. As a replacement for deferoxamine, 1,2-dimethyl-3-hydroxypyrid-4-one (L1), a new oral iron chelator, is undergoing clinical studies in thalassemic patients. Iron handling in experimental acute iron intoxication is being studied in a multiphase study. Preliminary results suggest that the L1-iron complex is not absorbed from the gastrointestinal tract. Methodological issues in studying iron chelation in the context of acute iron intoxication are presented.

Administration, Oral↗
PubMed1990

Home-based palliative care for children--Part 1: The institution of a program.

To assess the necessity and feasibility of introducing a home-based palliative care program for children admitted to our neurosurgical unit and diagnosed as being terminally ill, we conducted an analysis of all such patients admitted to our unit over an 18-month period. Of a total of 30 patients, 22 (73.4%) had central nervous system tumors, 6 (20.0%) had myelomeningocele/hydrocephalus, and 2 (6.6%) had arteriovenous malformations. The mean duration +/- SEM of hospitalized days prior to death and the proportion of time spent hospitalized during the terminal phase of illness were 28.8 +/- 4.77 and 0.327 respectively, for the 23 patients who died and on whom adequate data were available. Sixteen (70.6%) of these 23 patients died in hospital. Nine (30.0%) of the total group of patients were studied prospectively during the last 6 months of this study to determine the extent of their symptoms and to ascertain whether it would be feasible for them to be managed at home. The most troublesome symptoms in this subgroup were feeding difficulties, gastrointestinal symptoms, breathing difficulty, and seizures. These symptoms were managed either by (a) medications administered orally or by feeding tube or rectally, or by (b) noninvasive procedures carried out by a nurse under the direction of the admitting neurosurgeon. This study suggests that prolonged hospitalization for children diagnosed as being terminally ill can be avoided by introducing a home-based palliative program with involvement from a nurse and a physician familiar with drug therapy for terminally ill children.

Adolescent↗
PubMed1989

Bias against the null hypothesis: the reproductive hazards of cocaine.

To examine whether studies showing no adverse effects of cocaine in pregnancy have a different likelihood of being accepted for presentation by a large scientific meeting, all abstracts submitted to the Society of Pediatric Research between 1980 and 1989 were analysed. There were 58 abstracts on fetal outcome after gestational exposure to cocaine. Of the 9 negative abstracts (showing no adverse effect) only 1 (11%) was accepted, whereas 28 of the 49 positive abstracts were accepted (57%). This difference was significant. Negative studies tended to verify cocaine use more often and to have more cocaine and control cases. Of the 8 rejected negative studies and the 21 rejected positive studies, significantly more negative studies verified cocaine use, and predominantly reported cocaine use rather than use of other drugs. This bias against the null hypothesis may lead to distorted estimation of the teratogenic risk of cocaine and thus cause women to terminate their pregnancy unjustifiably.

Adult↗
PubMed1989

Determination of gestational cocaine exposure by hair analysis.

Drug self-reports are often unreliable and standard blood and urine tests detect only recent cocaine use. Since cocaine is deposited in hair, we have applied a radioimmunoassay to hair extract to detect past cocaine use. Hair from 16 adult users was positive for benzoylecgonine, in the presence of negative findings from urine screening tests. Benzoylecgonine in admitted heavy users averaged 8775 ng/g of hair (range, 640 to 29,089 ng/g of hair), whereas in occasional users it averaged 624 ng/g of hair (range, 32 to 1210 ng/g of hair). Benzoylecgonine was not detected in hair of 21 adults who reported no use of cocaine ever and whose urine samples were negative for the metabolite. Neonatal hair from seven infants whose mothers were known cocaine users averaged 5430 ng of benzoylecgonine per gram of hair (range, 200 to 27500 ng/g of hair). Hair from two infants 2.5 and 3.5 months of age averaged 6050 ng of benzoylecgonine per gram of hair. However, values were negative for infants 1 year and older, corresponding to loss of fetal hair in the few months after birth. Because studies reporting reproductive risks of cocaine compare exposed and nonexposed groups, validation of drug-free status of control subjects is extremely important. Hair analysis may remedy the disadvantages of currently used methods and may identify intrauterine exposure to cocaine in babies when a maternal drug history is not available or of doubtful truthfulness.

Adult↗