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Biomedical subjects

Z Barzilay

Publications and source records attributed to Z Barzilay.

At least 73 records · Page 4Linked to original sources
PubMed1993

[Is lumbar puncture in bacterial meningitis necessary?].

3 children with the clinical picture of bacterial meningitis are described. Lumbar puncture was not done on admission due to increased intracranial pressure, cardiopulmonary shock, or petechial rash with suspected coagulopathy. Prompt treatment with broad spectrum antibiotics resulted in successful outcomes. The diagnosis of meningitis can usually be made clinically and the bacteriological diagnosis from blood cultures. We maintain that in fulminating cases lumbar puncture might prove fatal, and should therefore be deferred until the child's condition improves. However, if bacterial meningitis is suspected and lumbar puncture is delayed, intravenous antibiotics should be given immediately after blood is drawn for culture.

Anti-Bacterial Agents↗
PubMed1993

Ethnic differences in lung function in Israeli children.

BACKGROUND: The population of Israel consists of immigrants from many different countries. It is not known whether a single nomogram can be used for spirometric values of children of different ethnic descent. METHODS: Spirometry was performed in 753 second or third generation Israeli children (7-14 years) of different ethnic groups. Both parents of 503 of the children were of the same ethnic background. Subjects were allocated to six ethnic groups (European, Iraqi, North African, Indian, Yemenite, and Georgian). RESULTS: Standing height contributed most to the prediction of spirometric values (forced expiratory volume in one second, forced vital capacity), whereas sitting height did not contribute further. Statistical analysis showed significant ethnic differences. The Georgians had higher spirometric values for FEV1 than all the other ethnic groups, and higher FVC values than those of the Yemenite, North African, and Indian groups. FVC was lower among the Indian than all other groups. CONCLUSION: Differences in normal spirometric values were found among second or third generation Israeli children of different ethnic origins. European, North African, Iraqi, and Yemenite children could be characterised by single equation, whereas children of Georgian and Indian descent needed different predicting equations.

Adolescent↗
PubMed1993

Intracerebral hemorrhage in an infant with idiopathic thrombocytopenic purpura: approach to the surgical management.

We describe a 21-month-old female infant with severe idiopathic thrombocytopenic purpura (ITP), who presented in coma with signs of cerebral herniation. CT scan revealed a right temporo-parietal intracerebral hemorrhage. The patient underwent immediate craniotomy and the hematoma was drained. Marked improvement in her neurological status, as well as postoperative resolution of the intracranial hemorrhage, were noted. Three months after the operation she recovered from the ITP. We emphasize the option of performing craniotomy without splenectomy in ITP infant patients.

Cerebral Hemorrhage↗
PubMed1993

Patterns of unjustified pediatric hospital stay.

We examined the pattern of hospital stay in a pediatric division of a major teaching medical center in terms of justification of the hospital stay. Hospital stay days of all children admitted during 3 consecutive weeks were assessed prospectively according to predetermined criteria. Of the 2,048 hospital stay days 26% were unjustified, primarily due to unnecessary in-hospital follow-up and diagnostic evaluation that should have been carried out on an ambulatory basis. Logistic regression analysis revealed that neurological disorders and trauma, age younger than 3 years, specific ward, and the attending physician were significant predictors for unjustified hospital stay days. This method is proposed as a means for optimal reduction of redundant hospital stay and concomitant unnecessary economic burden.

Child↗
PubMed1992

Fibrothorax associated with a ventriculopleural shunt in a hydrocephalic child.

Ventriculopleural (VPL) shunts are considered a safe alternative to peritoneal shunts in the management of hydrocephalus. Occasionally, however, they are associated with persistent pleural effusion. We report a child, aged 3 1/2 years, who developed severe fibrothorax following the use of a VPL shunt. The shunt was removed and decortication had to be performed to alleviate his respiratory symptoms. This serious complication, never reported previously, should be borne in mind when the pleural cavity is chosen for deviation of the cerebrospinal fluid in hydrocephalic children.

Cerebrospinal Fluid Shunts↗
PubMed1992

Epinephrine blood concentrations after peripheral bronchial versus endotracheal administration of epinephrine in dogs.

BACKGROUND AND METHODS: Emergency endotracheal drug administration has become an acceptable route for drug delivery during cardiopulmonary resuscitation. The purpose of the present study was to determine whether the site of endotracheal epinephrine injection is an important factor in its absorption. Epinephrine (1:1000), in a dose of 0.02 mg/kg diluted in 2 mL of saline, was given to ten anesthetized mongrel dogs. Each dog was studied twice: once when the epinephrine was injected into the endotracheal tube, and on another day, through the endotracheal tube via a flexible catheter wedged into a peripheral bronchus. Arterial blood samples for plasma epinephrine concentration determinations were collected, before and at 1, 2, 5, 10, 15, and 30 mins after each intratracheal drug administration. RESULTS: Both routes of epinephrine administration significantly increased plasma concentrations within 1 min of injection. Higher plasma epinephrine concentrations were achieved after peripheral bronchial epinephrine administration (maximal concentration 8.9 +/- 3.2 vs. 2.0 +/- 0.4 ng/mL), and the total dose absorbed was significantly (76.5 +/- 13.5 vs. 36.7 +/- 6.5 ng/min/mL, p < .05) higher. The time interval to reach maximal concentration was significantly shorter with the peripheral bronchial dosing than with the endotracheal route (1.3 +/- 0.2 vs. 2.7 +/- 0.5 min, p < .05). Neither group demonstrated a significant change in heart rate, and both had similar, minor decreases in BP for > 2 to 5 mins. There were no significant differences between the arterial blood gases of the two groups at various stages of the experiment. CONCLUSIONS: In dogs, epinephrine administered via the peripheral bronchial route has a clear pharmacologic advantage over the endotracheal route. This advantage may be more important during cardiopulmonary resuscitation conditions and other low flow states, and may account for the failure observed with the endotracheal route in recently published clinical reports.

Animals↗
PubMed1991

Postoperative unilateral diaphragmatic paralysis in children, a plea for early plication.

Unilateral diaphragmatic paralysis (UDP) is not an uncommon occurrence after cardiovascular operations. Its incidence in the pediatric age group is at least 1.5%, and severely symptomatic (for example: requiring mechanical ventilation) patients account for about one third of the cases. We have encountered four such cases among 850 children (0.5%) undergoing cardiovascular procedures, and have treated two additional patients. All required prolonged intubation and mechanical ventilation. Diaphragmatic plication in five was performed rather late in the course of their illness, after 21-120 days mechanical ventilation, and was successful in three who survived, allowing weaning from ventilation within 3-6 days. The procedure itself is simple and safe. We recommend that diaphragmatic plication be performed early in children with UDP and weaning difficulties.

Adolescent↗
PubMed1990

Management of upper airway obstruction in the Pierre Robin syndrome.

Eight patients with Pierre Robin syndrome (PRS), were treated according to our management protocol. All our patients initially were given a trial of conservative, positional treatment, with high caloric gavage feeding. In five patients this therapeutic approach resulted in a good weight gain, with no significant respiratory distress. The remaining three patients showed no improvement, failed to thrive and therefore underwent the tongue to lip adhesion (TLA) procedure. Two patients then improved dramatically; whereas one continued with respiratory distress and failure to thrive and required tracheostomy. We conclude that when symptoms of respiratory distress and failure to thrive coexist in patients with PRS despite conservative management, surgical intervention to the airway is mandatory. TLA should be the first surgical procedure considered and if the ultimate goals of weight gain and respiratory comfort are still not achieved then tracheostomy seems inevitable.

Airway Obstruction↗
PubMed1990

Varicella and perforation of the stomach.

Involvement of the gastrointestinal tract is rare in varicella. We report a previously healthy young girl with perforation of the stomach that appeared to be a complication of varicella. Varicella inclusion bodies were demonstrated at the site of gastric perforations. On surgery, an organoaxial volvulus of the stomach was demonstrated.

Chickenpox↗
PubMed1990

Calcium blocking agents in pediatric emergency care.

Blocking calcium ion entry into tissue cells appears to have therapeutic benefits in various diseases and symptoms. In the emergency department, as well as in the pediatric intensive care unit, the pediatrician often encounters life-threatening clinical episodes for which the safest, quickest, and most efficient treatment is required. Thus, being familiar with a large variety of emergency therapeutic options, including the use of CBAs, is important. In many medical centers, CBAs have already become the first line of drugs for converting PSVT into normal sinus rhythm (verapamil) and for ameliorating malignant hypertension (nifedipine). The increasing evidence that nimodipine effectively decreases the cerebral damage after head trauma and intracranial hemorrhage will also probably turn this compound into one of the drugs readily available in the emergency department. CBAs will continue to be thoroughly investigated, allowing more new therapeutic applications in pediatric emergency care.

Adolescent↗
PubMed1990

A method of macro-auditing and assessing the preventability of infant mortality using large volume computerized files.

We present a method for auditing and evaluating infant mortality with the aid of a preventability grading system, based on national computerized files of livebirths and infant deaths. Diagnostic categories and specific causes of deaths were classified into one of the following three preventability grades: Preventable (P), Possibly Preventable (PP) and Non Preventable (NP). This classification was then applied to two different scales: Preventability of Condition (PC) and Preventability of Death (PD) from which a third scale--Preventability of Mortality (PM)--was derived. The method was then applied to matched records of 39,786 livebirth and 452 infant death certificates between 1977 and 1984, in a semi-urban region in Israel encompassing 220,000 inhabitants. Comparison of mortality rates, according to the proposed preventability scores, demonstrated that higher infant mortality rate in non-Jewish population, or in Jewish mothers with a lower educational, was present only in the preventable categories (P or PP), while death rates due to non preventable causes were identical for all groups. The suggested macro-auditing method facilitates the assessment of large scale infant mortality rates in terms of preventability.

Congenital Abnormalities↗
PubMed1989

Multifocal necrotizing fasciitis in varicella.

We describe a two-year-old patient who developed severe necrotizing fasciitis in three nonadjacent sites of his extremities during varicella. The recovery of purulent material by aspiration of deep soft tissues after seven days of fever, leukocytosis, and no response to antimicrobial therapy raised the suspicion of this diagnosis. The patient recovered following surgical drainage, debridement, and subsequent skin grafts. It is emphasized that early diagnosis of this severe complication is important since early surgical intervention decreases morbidity and facilitates recovery.

Chickenpox↗
PubMed1989

Branhamella catarrhalis pneumonia in non-immunocompromised pediatric patients: report of three cases and review of the literature.

Branhamella catarrhalis (B.c.) is found as a commensal in the upper respiratory tract of a healthy individual. We report three pediatric patients with bronchopneumonia allegedly caused by B. catarrhalis. All of them were intubated and on a mechanical ventilation (following either elective surgery or trauma) while the infection developed. Although B. catarrhalis has been thought to be penicillin sensitive, an increased frequency of beta-lactamase producing B. catarrhalis has been noted recently. beta-lactamase positive B. catarrhalis is uniformly resistant to ampicillin and its susceptibility to the cephalosporins is quite variable. All the isolated strains were found susceptible to vancomycin. The three patients improved while being on therapy with vancomycin and peripheral airway cultures became sterile.

Adolescent↗
PubMed1989

Effectiveness of vitamin E and colchicine in amelioration of paraquat lung injuries using an experimental model.

The major cause of death in paraquat poisoning is a rapidly progressive respiratory failure due to an oxidative insult to the alveolar epithelium with subsequent fulminant obliterating fibrosis. The present study evaluates the effectiveness of vitamin E in combination with colchicine in ameliorating paraquat lung injuries in rats. Vitamin E is a biologic antioxidant interfering with lipid peroxidation, and colchicine reduces collagen synthesis which is significantly augmented in pulmonary fibrosis. Eight normal rats were given a single i.p. dose of paraquat at 15 mg/kg. The treated group included eight animals that received, in addition to i.p. paraquat (15 mg/kg), daily doses of vitamin E (100 mg/kg i.p.) and colchicine (0.1 mg/kg i.p.). All the rats in the paraquat group died within 42 to 96 h, six of them within 60 h, following severe respiratory failure. The treated rats developed a somewhat milder form of respiratory insufficiency, six of them dying within 48 to 72 h. Less severe intra-alveolar hemorrhages were observed in this group. Two rats survived, and these had only mild emphysema on autopsy at 21 days. Our preliminary results suggest that the combination of vitamin E with colchicine may be effective in ameliorating lung injuries caused by paraquat, and warrant further studies.

Animals↗
PubMed1988

The admission cardiorespiratory performance in relation to outcome in pediatric ICU patients.

We tested the hypothesis that the admission cardiorespiratory performance determines the outcome in pediatric intensive care unit (PICU) patients. We studied 331 patients who were assigned to one of the three commonly encountered PICU clinical entities: respiratory disease, cardiovascular disease and head trauma. All patients were evaluated by a simple cardiorespiratory scoring system which we named "Rule of 60" (RO60), and their highest score within the first 24 h of arrival in the PICU was used for the study. This scoring system includes 6 cardiorespiratory parameters where a value of 60 represents a cut-off point above or below which 0 points (low risk) or 10 points (high risk) are assigned. The relationship between score and mortality rate revealed that the higher the score the higher is the mortality rate. We determined two categories of severity of illness in our patients. Patients at severity level A had scores ranging from 0 through 30 and the mortality rate in this category ranged from 2% to 5%. Patients at severity level B had scores ranging from 40 through 60 and had a higher mortality rate: 30% to 80%. The overall mortality rates for patients at severity level A and B were 2% and 54% respectively. Patients with respiratory disease at severity level B had the lowest mortality rate (20%), whereas patients with cardiovascular disease and head trauma had mortality rates of 52% and 80% respectively. We found that our cardiorespiratory scoring system was as good as the Glasgow Coma Scale for indicating prognosis and outcome in head trauma patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Variables affecting outcome from severe brain injury in children.

This study evaluates the outcome of 56 severely brain injured children (mean age 6.2 +/- 2.1 years) and relates the Initial Glasgow Coma Scale (IGCS), initial intracranial pressure (ICP int), maximal intracranial pressure (ICP max) and minimal cerebral perfusion pressure (CPP min) to quality of survival. Forty-one children sustained head trauma, five severe central nervous system infections and 10 were of miscellaneous etiology. Therapy consisted of mechanical hyperventilation, moderate fluid restriction, dexamethasone and diagnosis specific measures when indicated. Outcome was categorized according to the Glasgow outcome scale at discharge from the hospital. An IGCS of 3 was associated with 100% mortality, 7 and above resulted in 72% good recovery, 28% poor outcome and no mortality. ICP int of less than 20 torr was noted in (67%) of the patients, and did not correlate with ICP max or outcome. Conversely, ICP int in excess of 40 torr correlated well with ICP max and outcome. ICP max of less than 20 torr resulted in 57% good recovery, 36% poor outcome and 7% mortality. ICP max greater than 40 torr resulted in 7% poor outcome and 93% mortality (p less than 0.001). In head trauma, 32 patients (78%) were alive with mean ICP max 16.9 +/- 3.1 and CPP min 65.5 +/- 8.5 torr compared to 9 patients (22%) who died with mean ICP max 53.7 +/- 10.8 and CPP min 6 +/- 3.9 torr, (p less than 0.01). In children with infectious etiology 60% survived with mean ICP max 16 +/- 3 and CPP min 96 +/- 16 torr.(ABSTRACT TRUNCATED AT 250 WORDS)

Brain Injuries↗