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Biomedical subjects

G Paret

Publications and source records attributed to G Paret.

At least 37 records · Page 2Linked to original sources
PubMed2000

[FK506 (tacrolimus) does not increase hepatic damage due to hypoperfusion].

Deterioration of hepatic function following liver transplantation is a known complication, sometimes attributed to the use of cyclosporin A. Reaction to tacrolimus (Prograf), a relatively new and effective immunosuppressant drug, is thought to result in a much lower grade of organ dysfunction, especially in the transplanted liver. Using the ex-vivo rat model of isolated perfused liver, we evaluated hepatocellular damage and oxygen extraction when tacrolimus was administered following liver hypoperfusion. Tacrolimus did not worsen hepatic dysfunction caused by the hypoperfusion. Therefore using tacrolimus in the perioperative period might be safer than cyclosporin A, which tends to worsen hepatic damage in the presence of hypoperfusion.

Animals↗
PubMed2000

The role of dextromethorphan in pain control.

PURPOSE: To review the clinical benefits of dextromethorphan (DM) in pain management, describe its neuropharmacological properties. SOURCE: A Medline search was made for experimental and clinical data on DM use from 1967 to date using keywords nociception, acute and chronic pain control, N-methyl-D-aspartate, antagonists, dextromethorphan. PRINCIPLE FINDINGS: The 930 DM citations mostly described its antitussive, metabolic and toxicological aspects, animal studies and its possible role in minimizing post-brain ischemia complications in humans. The use of DM in acute pain revealed eight original studies involving 443 patients, as well as two preliminary reports and our own unpublished data on 513 patients. Most of the 956 patients had general anesthesia. Eight studies (154 patients) and one case report dealt with chronic pain management. This N-methyl-D-aspartate (NMDA) receptor antagonist binds to receptor sites in the spinal cord and central nervous system, thereby blocking the generation of central acute and chronic pain sensations arising from peripheral nociceptive stimuli and enabling reduction in the amount of analgesics required for pain control. DM attenuated the sensation of acute pain at doses of 30-90 mg, without major side effects, and reduced the amount of analgesics in 73% of the postoperative DM-treated patients. Studies in secondary pain models in healthy volunteers and in various types of chronic pain showed DM to be associated with unsatisfactory pain relief. CONCLUSION: DM attenuates acute pain sensation with tolerable side effects. Its availability in oral form bestow advantages over other NMDA antagonists.

Animals↗
PubMed2000

Anaesthesia and critical care considerations in nerve agent warfare trauma casualties.

Nerve agents (NA) (tabun, sarin, suman, VX) have been stocked around the world for some time and still present a major threat to civilian as well as to military populations. Since NA can be delivered through both an aerial spray system and a ballistic system, victims could suffer both NA intoxication and multiple trauma necessitating urgent surgical intervention followed by intensive care. These patients can be expected to be extremely precarious neurologically, respiratorily and haemodynamically. Moreover, their clinical signs can be misleading. Further exacerbating the problem is the fact that interactions of NA with the pharmacological agents used for resuscitation and/or during anaesthesia can aggravate organ instability even more and possibly cause systemic collapse. There are no protocols for perioperative critical care and early assessment or for the administration of anaesthesia for surgical interventions in such combined multiple trauma and intoxicated casualties. We propose a scheme for the administration of critical care and anaesthesia based on the scant anecdotal reports that have emerged after the occurrence of local accidents involving NA intoxication and on the neuropharmacological knowledge of the pesticide organophosphate poisoning database, these compounds being related chemical substances.

Anesthetics↗
PubMed2000

Plasma-soluble E-selectin after cardiopulmonary bypass in children: is it a marker of the postoperative course?

OBJECTIVE: To investigate the relationship and possible role of soluble adhesion molecule E-selectin in the postoperative course in children undergoing cardiopulmonary bypass (CPB). DESIGN: Prospective cohort study. SETTING: Pediatric intensive care unit of a university hospital. PARTICIPANTS: Thirteen children who were candidates for cardiac surgery. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Serial blood samples of 13 CPB patients were collected from the arterial catheter or from the bypass circuits preoperatively; on initiation of CPB; on termination of CPB; and 1, 2, 4, 8, 12, 18, 24, and 48 hours postoperatively. Plasma was recovered immediately, aliquoted, and frozen at -70 degrees C until use. Circulating soluble selectin molecules were measured with a sandwich enzyme-linked immunosorbent assay technique. There were significant changes in plasma levels of soluble E-selectins in patients after CPB, and these levels were associated with patient characteristics, operative variables, and postoperative course. Soluble E-selectin correlated significantly with inotropic support and the use of anti-inflammatory drugs. There was a significant association between the development of postoperative sepsis and soluble E-selectin levels. No correlation was found between soluble E-selectins and duration of CPB, aortic cross-clamping, or hemodynamic variables, including heart rate and mean systemic arterial pressure. CONCLUSION: These results suggest a relationship between CPB-induced mediators and early and late clinical effects. Although the mechanism for the increase of soluble E-selectin remains to be elucidated, the upregulation of soluble E-selectin indicates neutrophil activation, and its inhibition may represent a target for reducing the inflammatory response associated with CPB.

Cardiopulmonary Bypass↗
PubMed2000

Repeat computed tomographic scan within 24-48 hours of admission in children with moderate and severe head trauma.

OBJECTIVE: To asses the yield and contribution of a routine predetermined repeat head computed tomographic (CT) scan within 24-36 hrs in pediatric patients with moderate to severe head trauma. DESIGN: Records review. SETTING: Five pediatric intensive care units. PATIENTS: We reviewed the charts of 173 consecutive pediatric patients with moderate to severe head trauma (Glasgow Coma Scale score of < or = 11) that survived the first 24 hrs after being admitted to five Israeli trauma centers. Clinical data collected included status at admission, at the time between the first and second CT scans, and after the second scan. Head details of the first, second, and, if performed, third CT scan were collected. Treatment strategy during each period was recorded, including any change in treatment after each CT scan. MEASUREMENTS AND MAIN RESULTS: A total of 47 (27%) of the second CT scans showed new lesions including six intracranial hemorrhages, 17 cases of worsening brain edema, and 18 newly diagnosed brain contusions. However, none of these findings necessitated surgical intervention or any change in therapy. Of the 67 patients who underwent a third CT scan, two cases required surgical intervention because of new findings in the third CT. CONCLUSIONS: A second routine prescheduled head CT scan within 24-36 hrs after admission in pediatric patients with moderate to severe head trauma is unlikely to yield any change in therapy. Clinically and intracranial pressure-oriented CT scan may better select and diagnose patients who require changes in therapy, including surgery. Studies aimed to determine the ideal timing for the second are warranted.

Adolescent↗
PubMed2000

Metabolic and clinical markers of prognosis in the era of CT imaging in children with acute epidural hematomas.

Acute epidural hematoma (AEH), a relatively common complication of head injury in children, persists in bearing high morbidity and mortality. Early establishment of prognosis could guide optimal patient allocation, and early identification of predictive signs could assist in choosing appropriate therapeutic interventions. This study aimed to delineate expeditiously obtainable prognostic markers for determining outcome in a subset of children with AEH. We reviewed our 11-year experience with 61 consecutive children <16 years old with head trauma and isolated AEH. Treatment followed a standard advanced trauma life support protocol. A medical history was obtained, and all patients underwent neurosurgical and physical evaluations. CT scans were performed, as were laboratory tests which included arterial blood gases, glucose, electrolytes (K(+), Na(+)), hemoglobin and coagulation studies. Evaluation of the data collected on cause of injury, interval between trauma occurrence and presentation, clinical symptoms, Glasgow Coma Scale (GCS) scores, vital signs, laboratory test results, physical findings and surgical versus conservative management revealed that the best single predictors of outcome following AEH were the GCS and focal neurological deficits. Of all laboratory data obtained on admission, the blood potassium, pH and glucose test results correlated significantly with prognosis. Prognosis can be adequately and expeditiously estimated by selected markers within a comprehensive evaluation of children with AEH.

Acute Disease↗
PubMed2000

Triage for Leiurus quinquestriatus scorpion envenomation in children--is routine ICU hospitalization necessary?

(1) Leiurus quinquestriatus scorpion (LQS) envenomation is a common public health problem with a similar clinical presentation in the Middle East and worldwide: localized reactions occur in up to 97% of the victims. (2) LQS envenomation in children is potentially fatal since the severity of symptoms is weight-dependent. (3) A common policy is to hospitalize all children stung by the LQS-regardless of clinical severity-in the pediatric intensive care unit (PICU). (4) Seventeen of 18 children treated at two Israeli medical centers during an 8-year period developed mild to moderate clinical manifestations (antivenin was given in the one severe case; all children survived): all 18 had been transferred to an ICU for surveillance. Since patient care in PICUs is far more costly and manpower-intense than in general emergency rooms, we propose that a protocol of 6 h of surveillance in the emergency department is adequate and safe for most children who had been stung by LQS. Only children who develop systemic manifestations should be hospitalized and transferred to the intensive care unit. (5) Further prospective studies should be conducted to define specific subgroups that may benefit from these recommendations.

Adolescent↗
PubMed2000

Problematic intubation in soldiers: are there predisposing factors?

Attempts by a combat medical officer to secure the airway of a multiple-injury patient in the field may frequently end in failure. The recurrence of such failures, despite Advanced Trauma Life Support training, is perplexing; therefore, we studied the prevalence of clinical criteria that could predispose active soldiers to difficult intubation. Such known anatomical features and the Mallampati classification were assessed by experts in 250 soldiers at a military outpatient clinic of the Israel Defense Forces. It was found that most soldiers had normal airways. Limitations of head and neck movement, or in opening the mouth, were not observed. Other risk factors were noted in only a small percentage of the study population. Mallampati classes I and II were noted in 40% and 31%, respectively. No statistically significant differences between young (18-21 years) and older (40-44 years) soldiers were found. It was concluded that difficult intubations among soldiers are unlikely to be associated with anatomical causes. Complicated scenarios and deficient skills of the physicians are the most important factors that contribute to in-field failures to secure airway control. Several recommendations to remedy this situation are offered.

Adolescent↗
PubMed2000

Pediatricians and the Advanced Trauma Life Support (ATLS): time for reconsideration?

BACKGROUND: General pediatricians in Israel are actively involved in the initial evaluation, resuscitation and management of traumatized children. However, pediatric trauma care is not a part of pediatric specialty training in Israel, and the few Advanced Trauma Life Support courses per year are insufficient for most pediatricians working in accident and emergency care. OBJECTIVE: To examine the value of the course in relation to the limited resources available for such training. METHODS: A telephone survey of 115 pediatricians who had taken the course between 1990 and 1994 was conducted. The responding physicians (67%) were asked to complete a specially designed questionnaire on life-saving procedures that were taught in the course. In addition, they were asked to subjectively assess the practical utility of the course. RESULTS: Forty-three (56%) pediatricians reported that they routinely treated both adult and pediatric trauma cases. Of these, 81% performed 27 life-saving ATLS procedures. Pediatric trauma was treated by only 22 (28%), of whom 72.3% performed 18 life-saving ATLS procedures. These pediatricians ranked the courses as being "very high" to "high" in impact. CONCLUSIONS: These figures indicate that an ATLS course designed specifically for pediatricians can markedly improve pediatric trauma care. To ensure standard education and patient care, such a course should be developed and made a mandatory component of residency training. Further studies to examine the objective impact of the courses on pediatric trauma care should be carried out.

Adolescent↗
PubMed2000

[The sixth vital sign: end-tidal CO2 in pediatric trauma patients during transport].

Transport of pediatric trauma victims, within as well as between medical centers, has become a frequent event and an integral activity of pediatric critical care units. Monitoring patients during transport is of utmost importance, as an unstable environment poses an increased threat to the patient's stability. The level of monitoring and care should approximate that of the critical care unit. Monitoring end-tidal CO2 (EtCO2) has become routine for many pediatric intensive care unit patients but technical problems have limited its use during transport. Our transport team uses a transportable EtCO2 monitor of the side-stream type (NPB 75), requiring very small samples; midstream sampling overcomes humidity interference. The monitor is small and lightweight, operates on a rechargeable battery and is especially designed for the demanding environment of transport. From October 1997 through January 1999, 187 pediatric patients, 62 of whom were trauma victims, were transported for a total of 45 hours, including 2 hours of in-flight transport. Age range was 3 months to 16 years. Of the 53 monitored for EtCO2, in 9 (17%) monitoring resulted in a significant, immediate change of treatment during transport. We find EtCO2 an important adjunct in monitoring pediatric trauma patients during transport. In addition to conventional monitoring of heart rate, blood pressure, respiratory rate, body temperature and blood oxygen saturation, we suggest EtCO2 as the sixth vital sign that should be monitored.

Adolescent↗
PubMed1999

[Head injuries in children--clinical characteristics as prognostic factors].

An unselected series of 200 consecutive cases of major head trauma in children aged 6 months to 16 years, seen during 4 years, was studied. Injuries were due to road accidents (40%), falls (30.5%) and other causes (29.5%), and were assessed clinically and by cranial CT. On admission the Glasgow Coma Score ranged from 4.72-11.65 and in addition to pupillary responses and brain stem reflexes, was a significant predictor of outcome. Brain edema, midline shift, intracranial hemorrhage and also hyperglycemia, hypokalemia and coagulopathy, were associated with poor outcome. While 17% died, 53% were discharged in good functional condition. Early identification of clinical features related to prognosis can help the caring team provide maximal support for patient and family.

Accidental Falls↗