Henoch-Schönlein purpura in infants.
Explore the source record for details and available documents.
Ear, External↗
Biomedical subjects
Y Amitai
Publications and source records attributed to Y Amitai.
Red cell and plasma concentrations of fluoxetine and norfluoxetine.
To study the distribution of fluoxetine and norfluoxetine in blood compartments we determined their concentrations in red cells and plasma after the addition of 500 ng/ml of each compound to human blood in vitro. Red cell and plasma fluoxetine concentrations were 493 +/- 79 ng/ml and 454 +/- 53 ng/ml, respectively (P > 0.1). To assess the potential implications of this distribution on routine monitoring of these compounds in plasma, we determined fluoxetine and norfluoxetine concentrations in red cells and plasma in 6 patients receiving various doses of fluoxetine. While in 4 patients the concentrations of fluoxetine and norfluoxetine in red cells and plasma were comparable, 2 patients had higher concentrations of both compounds in red cells. Variations in the distribution of fluoxetine and norfluoxetine in blood compartments are relatively small. Plasma levels may reflect the drug concentration in whole blood more reliably for fluoxetine and norfluoxetine than for tricyclic antidepressants.
Chromatography, High Pressure Liquid↗
Atropine poisoning in children during the Persian Gulf crisis. A national survey in Israel.
OBJECTIVE: To evaluate the effects of high doses of atropine in children accidentally injected with automatic atropine injectors. These were distributed in Israel during the Persian Gulf Crisis as an antidote for chemical warfare agents. DESIGN AND SETTING: A national survey in pediatric emergency departments in Israel, involving 22 medical centers, with prospective data collection in 14 centers. PATIENTS: Children (n = 268) presenting to emergency departments following misuse of automatic atropine injectors. MAIN OUTCOME MEASURES: Documentation of atropine dose and clinical manifestations; determination of a clinical severity score and its correlation with atropine dose; measurements of serum atropine levels in six patients. RESULTS: Over a period of 4 months, 268 cases were reported, of which 240 were clinically evaluated. The most common site of injection (75%) was the finger or palm. Doses were up to 17-fold higher than standard doses for age. In 116 children (48%), systemic effects of atropine were observed, and 20 (8%) had severe atropinization. Seizures and life-threatening arrhythmias were not reported, and there were no fatalities. The severity of atropinization was correlated with the dose following a classic nonlinear, dose-response relationship. Serum atropine levels (6.2 to 61.0 ng/mL) were much higher than those observed after administration of therapeutic doses. CONCLUSIONS: The high incidence of injection in the hand implies accidental use of automatic atropine injectors among children. The lack of mortality or life-threatening complications from injection of large doses of atropine attests to its relative safety in children. The low risk from atropine injections weighed against expected benefit as a lifesaving antidote justifies the distribution of personal atropine injectors to children at risk of organophosphorus nerve agent attack.
Accidents↗
Visualization of ingested medications in the stomach by ultrasound.
The authors describe a potential application of ultrasound in detection of pills in the stomach, and report the first case of its use in a patient. Thirty pills were studied in vitro by ultrasound. All were clearly detected, with better imaging compared with plain radiography. Four pills with slow disintegration (sustained release or enteric coated) and two with fast disintegration (immediate release) were further studied by ultrasound, following their ingestion by human volunteers. All four pills with slow disintegration were clearly visualized in the stomach, while detection of the other two pills was inconsistent. A sustained-release phenytoin capsule was detected by ultrasound in the stomach of a patient 3 hours after its ingestion. Ultrasound is a potential diagnostic tool in detection of pills in the stomach following acute ingestion. Its use, however, seems to be limited to sustained-release or enteric-coated preparations.
Adult↗
Hypoglycemia following albuterol overdose in a child.
Acute overdose with beta-sympathomimetics results in transient elevation of blood glucose levels. Hypoglycemia has previously been reported in newborns of mothers following prolonged use of sympathomimetics used as tocolytic therapy. The authors report the first case of symptomatic hypoglycemia in a child, occurring 16 hours after acute albuterol overdose. Hypoglycemia may occur as a complication of acute beta-sympathomimetic overdose, probably as a reaction to acute elevation of blood sugar and resultant hyperinsulinemia. The authors suggest that in children with a large overdose of beta-sympathomimetics, blood glucose levels should be monitored for several hours. In those with marked hyperglycemia, monitoring should be extended until normalization of blood glucose levels.
Albuterol↗
Enhancement of theophylline clearance by oral albuterol.
The possible effect of albuterol on theophylline clearance was studied in ten adult volunteers. Subjects received intravenous aminophylline loading dose (5.6 mg/kg), with oral albuterol (4 mg every 6 h), or inhaled albuterol (200 micrograms every 6 h), or alone (control). Theophylline levels were determined for 12-h periods. Theophylline clearance and elimination t 1/2 were calculated. Theophylline clearance was significantly higher when given with oral albuterol, in comparison with control (0.83 +/- 0.05 vs 0.73 +/- 0.06 ml/kg/min, p less than 0.02). Theophylline elimination t 1/2 was shorter with the coadministration of oral albuterol, compared with control (7.1 +/- 0.3 vs. 8.1 +/- 0.6 h, p less than 0.02). These alterations in theophylline clearance and elimination were greater in subjects who had lower control theophylline clearance. Theophylline clearance and elimination t 1/2 recorded with inhaled albuterol were not significantly different from control values. Coadministration of oral albuterol and theophylline resulted in enhancement of theophylline clearance, particularly in subjects with initially slow theophylline elimination. Such patients may require theophylline dosage adjustment as a result of this interaction.
Administration, Inhalation↗
Chronic models of cortical epilepsy: experimental manipulations leading to long-term reorganization of local neocortical circuitry.
Explore the source record for details and available documents.
Animals↗
[Overdosage of glibenclamide presenting with lethargy and seizures in a child].
Management of accidental overdosage with oral hypoglycemic agents in toddlers may be difficult when the history of ingestion is overlooked. We report a 21-month-old girl who presented with lethargy and generalized seizures 12 hours after ingestion of an unknown number of glibenclamide pills. The blood glucose on admission was 0.5 mM/l. Symptoms resolved promptly after an intravenous bolus of glucose. Metabolic and infectious causes of hypoglycemia were ruled out. The parents denied drug ingestion initially, but further investigation revealed that she had ingested several glibenclamide pills used by her diabetic father 12 hours prior to admission. This case illustrates the problem involved in diagnosis and management of accidental drug overdosage in children when no such history is elicited and symptoms are delayed.
Drug Overdose↗
[Effect of workload on physicians' drug prescribing].
The possible effect of workload on the prescribing of drugs by physicians was studied in 10 primary care pediatricians during a 1-month period. The intraphysician variability revealed a positive correlation (p less than 0.05) between workload and prescription of antibiotics in the case of 2 of the physicians and a negative correlation (p less than 0.05) between workload and prescription of all drug items in another physician. The prescribing of the other 7 was not affected by changes in daily workload. The interphysician variability study revealed a significantly increased rate of prescription of analgesics/antipyretics by physicians with increased monthly workload (r = 0.91, p less than 0.001). These results suggest that although the prescribing habits of a minority of physicians may be affected by their workloads, prescription rates remain stable for the individual physician on most occasions. However, physicians with high workloads tend to prescribe more analgesics/antipyretics than those with low workloads.
Analgesics↗
Neonatal brucellosis possibly transmitted during delivery.
Explore the source record for details and available documents.
Adult↗
Intrinsic oscillations of neocortex generated by layer 5 pyramidal neurons.
Rhythmic activity in the neocortex varies with different behavioral and pathological states and in some cases may encode sensory information. However, the neural mechanisms of these oscillations are largely unknown. Many pyramidal neurons in layer 5 of the neocortex showed prolonged, 5- to 12-hertz rhythmic firing patterns at threshold. Rhythmic firing was due to intrinsic membrane properties, sodium conductances were essential for rhythmicity, and calcium-dependent conductances strongly modified rhythmicity. Isolated slices of neocortex generated epochs of 4- to 10-hertz synchronized activity when N-methyl-D-aspartate receptor-mediated channels were facilitated. Layer 5 was both necessary and sufficient to produce these synchronized oscillations. Thus, synaptic networks of intrinsically rhythmic neurons in layer 5 may generate or promote certain synchronized oscillations of the neocortex.
Animals↗
Chronic epileptic foci in neocortex: in vivo and in vitro effects of tetanus toxin.
Injection of 0.2 - 3.0 ng of tetanus toxin into rat parietal neocortex resulted in permanent (> 7 months) changes in the local circuit properties of this tissue. It caused excessive synchronization of neuronal activity. This was seen as spontaneous paroxysmal field potentials and/or evoked all-or-none population burst discharges. Such activity was recorded widely over the parietal and temporal areas of both the injected and the contralateral hemispheres from as little as 16 h after injection up to the maximum survival time of 7 months. Several observations suggest that the speed with which the hypersynchronous activity spread to the opposite hemisphere reflects transport of the toxin through corticocortical axons, and consequent blockade of synaptic inhibition. However, from what is known of the half life of the peptide in brain, it is unlikely that the persistent, widespread distribution of epileptiform discharge several months after injection was due to the continued presence of toxin. Thus, intracortical application of tetanus toxin provides a good experimental model of chronic focal epilepsies, and raises fundamental questions regarding the long term regulation of local circuit properties in the neocortex.
Journal Article↗
Residential deleading: effects on the blood lead levels of lead-poisoned children.
Acute elevations of venous blood lead levels (PbB) are periodically reported in children with chronic lead poisoning, during deleading of their houses. To evaluate this phenomenon 114 preschool children who entered the Massachusetts Childhood Lead Poisoning Prevention Program case management system during 1984 and 1985 were retrospectively studied. PbB increased from a mean (+/- SE) of 1.76 +/- 0.03 mumol/L (36.4 +/- 0.6 micrograms/dL) prior to deleading to 2.03 +/- 0.07 mumol/L (42.1 +/- 1.5 micrograms/dL) during deleading (P less than .001). Among 41 subjects for whom deleading was done by dry scraping and sanding, the mean mid-deleading PbB was higher than the pre-deleading PbB by 0.44 +/- 0.12 mumol/L (9.1 +/- 2.4 micrograms/dL). However, when deleading was done by covering or replacement of painted surfaces in the residences of 12 subjects, mid-deleading PbB decreased 0.11 +/- 0.12 mumol/L (2.25 +/- 2.4 micrograms/dL) (P less than .005). In a subset of 59 subjects who had no chelation therapy and were available for follow-up 250 +/- 14 days after completion of deleading, PbB had decreased from 1.72 +/- 0.04 mumol/L (35.7 +/- 0.9 micrograms/dL) to 1.24 +/- 0.04 mumol/L (25.5 +/- 0.9 micrograms/dL) (P less than .001). The long-term effect of deleading is a significant reduction in PbB. However, deleading resulted in a significant, albeit transient, increase in PbB.
Age Factors↗
Additional causes of priapism.
Explore the source record for details and available documents.
Animals↗
Serum lidocaine concentrations in children during bronchoscopy with topical anesthesia.
To evaluate the safety of topical lidocaine anesthesia in children undergoing bronchoscopy, we determined SLC in 15 children aged 3 months to 9.5 years during flexible fiberoptic bronchoscopy. A total lidocaine dose of 3.2 to 8.5 (mean +/- SEM = 5.7 +/- 0.5) mg/kg was administered to nose, larynx and bronchial tree over 9 to 45 (mean +/- SEM = 20 +/- 2.7) minutes. No complication occurred during the procedure. Peak SLC were 1-3.5 (mean +/- SEM = 2.5 +/- 0.2) micrograms/ml. The Vd beta was 1.79 +/- 0.19 L/kg, the t1/2 beta was 109 +/- 12 minutes, and the total body clearance 12.2 +/- 1.1 ml/min/kg. Peak SLC correlated well with the dose expressed as mg/kg (r = 0.59, p less than 0.025), and even better when related to body surface area (r = 0.63, p less than 0.01). Lidocaine doses up to 8.5 mg/kg proved safe and resulted in therapeutic SLC in our patients. Lidocaine dose up to 7 mg/kg appears to be safe provided that it does not exceed an upper limit of 175 mg/m2 and is gradually administered over a minimum of 15 minutes. Doses of 7-8.5 mg/kg appear to be safe when administered over longer periods.
Anesthesia, Local↗
Hypokalemia in acute theophylline poisoning.
The frequency, severity, and time of occurrence of hypokalemia and their relationship with vomiting was studied in 40 patients with acute theophylline poisoning. The mean peak theophylline concentration was 58 micrograms/mL (range, 21 to 115), and the mean nadir of serum potassium was 3.0 mEq/L (range, 2.1 to 3.9). In 85% of the patients, the nadir of serum potassium was less than 3.5 mEq/L; 45% had potassium concentrations of less than 3 mEq/L. The severity of hypokalemia correlated with peak serum theophylline concentrations (p less than 0.001). Hypokalemia was observed early in the course of the overdose (mean, 5 hours after ingestion or administration of theophylline). The nadir in serum potassium concentrations was more severe among 25 patients who presented to the emergency department within 6 hours of the overdose than among 13 patients who presented later (mean +/- SE, 3.0 +/- 0.1 mEq/L vs 3.4 +/- 0.1 mEq/L, p less than 0.01), despite similar admission serum theophylline concentrations in both groups (49 +/- 5 and 55 +/- 5 micrograms/mL, respectively; p = not significant). Spontaneous or ipecac-induced emesis occurred in 95% of the patients; however, hypokalemia preceded vomiting in 13 patients. Its severity was similar whether patients did or did not vomit before its occurrence. Hypokalemia is a frequent manifestation of acute theophylline poisoning, has a very early onset, and occurs independently of vomiting, suggesting an intracellular shift of potassium.
Acute Disease↗
Enhancement of theophylline clearance by intravenous albuterol.
Co-administration of intravenous albuterol and theophylline resulted in increased theophylline clearance in a child with severe asthma. This required a threefold increase in theophylline dosage to maintain therapeutic serum theophylline concentrations. The possible effect of intravenous albuterol on theophylline metabolism was further supported by a 50 percent decrease in theophylline clearance upon discontinuation of albuterol and a second increase in its clearance when albuterol was readministered. To the best of our knowledge, this is the first documentation of enhanced theophylline clearance by albuterol.
Albuterol↗
Patterns of calling time and ipecac availability among poison center callers.
Over a one-month period all telephone calls from the public (n = 3828) to a regional poison center were analyzed. The proportion of early calls (within ten minutes of exposure) decreased with age. Late calls (greater than 30 minutes) were significantly associated with higher hospital referral rates when compared with earlier calls in children younger than 5 years (4.6% vs 1.8%) and adults (33% vs 15%). Ipecac was available in 59% of the homes of callers with children younger than 5 years. Hospital referrals were significantly less common among children who had ipecac at home (1%) compared with children who did not (3%). While the availability of ipecac was similar among callers and a matched sample of households who previously called the poison center (58%), ipecac was much less frequently available (24%) among households whose members had not previously called the center. These data infer that educating the public to call the poison center promptly may result in reduction of hospital referrals. Poison education efforts should be targeted to populations with low ipecac availability and low utilization of the poison center.
Adolescent↗