Biomedical subjects

C Corman

Publications and source records attributed to C Corman.

4 recordsLinked to original sources

PubMed2000

Generic substitution for brand name antiepileptic drugs: a survey.

BACKGROUND/OBJECTIVE: There are presently 26 different generic preparations for five brand name antiepileptic drugs (AEDs) on the Canadian market with others likely to be released in the near future. The purpose of this review is to examine the basis for the controversy surrounding generic substitution for brand name antiepileptic drugs, to present the results of a survey of neurologists' and patients' attitudes toward generic substitution and to increase neurologists' awareness of the issues. METHODS: The current federal and provincial regulations pertaining to generic drug approval and substitution are reviewed. Published anecdotal and survey reports of the effectiveness and tolerability of generic substitution for AEDs are reviewed. A pilot questionnaire survey of 83 patients from four adult epilepsy clinics and 46 neurologists from across Canada was undertaken to determine attitudes toward generic substitution. RESULTS AND CONCLUSIONS: Several authors have suggested that some AEDs, particularly those with a narrow therapeutic index, may pose problems with generic substitution. Although generic AEDs are lower in price, possible increased side effects and morbidity and the need for closer monitoring could partially offset the cost savings. The results of our survey highlight significant unawareness of the process of generic substitution among both patients and neurologists and reveal a general level of discomfort among neurologists to prescribe generic AEDs. Further data should be obtained about the potential consequences of generic substitution in epilepsy patients.

Adult↗

PubMed1998

Clobazam in partial status epilepticus.

Clobazam is the first and only 1,5-benzodiazepine to be used in the management of epilepsy. The use and effectiveness of oral clobazam in patients with status epilepticus has only been previously described in one study of 16 cases, seven of whom were in complex partial status. We have used clobazam in four patients with EEG-proven partial status epilepticus refractory to standard antiepileptic drugs. In all cases, except one, the seizure activity was controlled within 2 hr of administering clobazam. Our four patients responded promptly to an oral loading of clobazam which was approximately twice the usual daily maintenance dose. The drug was well tolerated and no adverse effects were seen. Clobazam's effectiveness as a first-line agent remains to be studied. Further controlled studies are recommended.

Administration, Oral↗

PubMed1986

[Thromboses of the right atrium: echocardiographic aspects, practical management. Apropos of 8 cases].

Right atrial (RA) thrombosis is rare. The aim of this study was to determine their clinical and echocardiographic features and therapeutic implications. In the last 7 years, 16 RA masses were detected by 2D echocardiography. The diagnosis of thrombosis was made in 8 cases based on anatomo-pathological examination (6 cases) or their disappearance with medical treatment (2 cases). The clinical presentations were: pulmonary embolism (4 cases), anterior myocardial infarction (2 cases), Ebstein's anomaly (1 case), thrombosis of a Leveen catheter (1 case). Only 1 patient had atrial fibrillation. Two echocardiographic appearances were observed: 1) a long, very mobile thrombus floating between the RA and right ventricle (4 cases), 2) a relatively immobile mass (4 cases). The 4 patients with relatively immobile thrombi survived: 2 underwent surgery and 2 were treated medically. All cases of floating thrombi had pulmonary embolism: 2 patients underwent surgery but the postoperative course was complicated; 2 patients died suddenly before surgery. These cases show that 2D echo is the diagnostic method of choice for detection of RA thrombosis. The floating RA thrombus is a therapeutic emergency and has a poor prognosis.

Adult↗

PubMedDate not supplied

Intracardiac myxomas: twenty-year echocardiographic experience with review of the literature.

We reviewed the echocardiograms of 35 patients with intracardiac myxomas. Patient data were combined from two geographically distant laboratories. No significant variations in the patient profiles were encountered. Most patients were white (33 of 35) with a mean age of 45 years. The diagnosis was suspected on clinical grounds alone in only six of 35 patients before the echocardiogram was done. M-mode recordings were the primary echocardiographic modality available in the first 16 patients, whereas two-dimensional studies were also done in the others. Continuous and pulsed wave Doppler echocardiography were added in eight of the most recent studies. In one patient color flow imaging from both transthoracic and esophageal approaches was possible to better visualize a large left atrial tumor. Thirty-three patients had solitary tumors (29 left atrial, three right atrial, and one left ventricular), and two had multiple tumors. The most characteristic finding, as expected, was the demonstration of abnormal mass echoes produced by the myxoma tissue. Several interesting features not previously emphasized in the literature included abnormal notching of the interventricular septum and posterior left ventricular wall probably produced by displacement from the larger mobile left atrial tumors dropping into the mitral sleeve. This was best appreciated by the M-mode recordings. In one patient with an associated atrial septal defect, movement of the tumor into the defect appeared to alter the expected downward displacement into the mitral orifice. In the patients who were studied by two-dimensional, Doppler, or color flow imaging, tumor movement was evidenced by abnormal frequency shifts, and dispersion of flow around the tumor mass was readily appreciated. Surgical removal was performed in all patients. Follow-up echocardiograms were done postoperatively ranging up to 17 years. Recurrent tumors occurred in two patients, both of whom had congenital myxomas. Echocardiography is proving to be an unparalleled tool in the diagnosis of intracardiac tumors.

Adult↗