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Biomedical subjects

R F Robinson

Publications and source records attributed to R F Robinson.

6 recordsLinked to original sources
PubMed2004

Use of "Near Middle East Antivenom" to treat African bush viper envenomation.

Venom from an African bush viper is primarily hemotoxic and potentially life threatening. Existing, commercialy available antivenoms may not neutralize venom of this genus. A 25-y-old male was brought to the emergency room diaphoretic and hypotensive (70/40 mmHg) after a bite from a pet African bush viper. A puncture wound on the left thumb was leaking slightly, but there was no evidence of blood loss, edema or bruising. Approximately 100 min after exposure, the patient experienced a small amount of proximal swelling. Six h after envenomation, he was admitted to the intensive care unit for monitoring. At 10 h after the bite prothrombin time (PT > 100 sec) and international ratio (INR = 9.2) were elevated. The patient was unable to coagulate. He received fresh frozen plasma, cryoprecipitate, and Near Middle East Antivenom. Improvement in clinical status and laboratory parameters were observed after each of 3 doses of antivenom (d-dimer > 1000 and fibrinogen = 137 mg/dL). The patient was monitored overnight, did not require additional antivenom and was discharged as laboratory parameters, vital signs and spread of the necrotic lesion stabilized. Near Middle East Antivenom appears effective in treatment of the hematologic sequelae secondary to African bush viper envenomation.

Adult↗
PubMed2001

Safety of intravenous bolus administration of gentamicin in pediatric patients.

OBJECTIVE: To determine the safety of gentamicin administered intravenously as a bolus. METHODS: All patients (n = 123, ages: up to 18y, 121; 21y, 1; 31y, 1) who received gentamicin intravenously as a bolus over a four-month period were studied retrospectively. Patient demographics, type of infection, dosing regimen, length of therapy, peak and trough serum concentrations, blood urea nitrogen, serum creatinine, and urine output were reviewed. Patients were stratified into four groups and data analyzed statistically. RESULTS: Mean initial dose (5.32 +/- 2.38 mg/kg/d) was consistent with established guidelines for age and kidney development, with subsequent adjustments based on serum concentrations. Susceptible organisms were eradicated with a mean length of therapy of 6.9 +/- 6.9 days (range 1-35). Patients received a median of nine doses: 42% received doses every eight hours and 33% received doses every 24 hours. No relationship between dosing and abnormal serum creatinine were found (p = 0.69). The estimated cost savings mainly from less nursing time and lower equipment and supply use were $50/patient with bolus administration of gentamicin. CONCLUSIONS: Intravenous bolus administration was safe in pediatric patients and was associated with lower costs.

Adolescent↗
PubMed2000

Respiratory syncytial virus (RSV) immune globulin and palivizumab for prevention of RSV infection.

The efficacy, safety, administration, and advantages and disadvantages of respiratory syncytial virus (RSV) immune globulin and palivizumab for preventing RSV infection are discussed. Prevention of RSV infection has attracted considerable attention because of its dinical and economic impact. Studies have shown respiratory syncytial virus immune globulin intravenous (RSV-IGIV) and palivizumab to be effective in decreasing the number of hospitalizations and hospital days attributable to RSV. The number of intensive-care-unit admissions and the severity of RSV infection in high-risk children decreased with the use of these agents. Both agents have been well tolerated, with few adverse effects; however, their high cost necessitates strict guidelines on use. The patient populations at greatest risk are those with bronchopulmonary dysplasia, those with congenital heart disease, those with a history of apnea or respiratory arrest, immunocompromised patients, those with pulmonary consolidation on chest radiography, and those born prematurely. American Academy of Pediatrics guidelines do not preferentially recommend use of either agent; each has advantages and disadvantages. Prophylactic therapy with RSV-IGIV or palivizumab may reduce the likelihood of RSV infection in high-risk patients.

Antibodies, Monoclonal↗
PubMed2000

Syncope associated with concurrent amitriptyline and fluconazole therapy.

OBJECTIVE: To report on a 12-year-old white male with prostatic rhabdomyosarcoma who experienced episodes of syncope attributed to concurrent amitriptyline and fluconazole therapy, confirmed by readministration. CASE REPORT: The patient began experiencing syncopal episodes periodically over a seven-month period. These repeated episodes occurred when fluconazole was administered for periodic mucositis secondary to chemotherapy. The patient had received fluconazole in the past with no difficulty and had been receiving a stable dose of amitriptyline for neuropathic pain. On discontinuation of amitriptyline, no further episodes were noted. DISCUSSION: Concurrent administration of fluconazole with amitriptyline likely resulted in the decreased metabolism of amitriptytine. Three case reports presented in the literature of adults receiving concurrent amitriptyline and fluconazole have shown an increase in serum amitriptyline concentrations with concurrent administration of fluconazole; however, none of these patients were rechallenged. Literature available on amitriptyline overdose confirms that syncope and the adverse events noted in the case studies may result from elevated amitriptyline plasma concentrations. CONCLUSIONS: The consistent presentation of syncope in our patient during readministration of amitriptytine and fluconazole strongly suggests a drug-drug interaction.

Amitriptyline↗
PubMed1999

A comparative review of conventional and lipid formulations of amphotericin B.

Over the past 15 years, factors suh as corticosteroid treatment, cytotoxic chemotherapy, excessive use of broad spectrum antibiotics and HIV have led to an increased risk of serious fungal infections in both adults and pediatric patients. This increase in invasive fungal infections poses increasing difficulty in their treatment. Three new lipid formulations of amphotericin B are now available in the U.S.: amphotericin B lipid complex (Abelcet), amphotericin B colloidal dispersion (Amphotec), and liposomal amphotericin B (AmBisome). These newer formulations are substantially more expensive, but allow patients to receive higher doses for longer periods of time with decreased renal toxicity than conventional amphotericin B. The properties of these new agents are summarized in this review. Discussion of current national guidelines as well as those used at our institution are presented to provide guidance for the development of institution specific guidelines for the most cost-effective drug for most patients, some may benefit more from one of the newer lipid formulations.

Amphotericin B↗