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Biomedical subjects

Yaron Finkelstein

Publications and source records attributed to Yaron Finkelstein.

At least 19 recordsLinked to original sources
PubMed2005

Pretreatment with corticosteroids attenuates the efficacy of colchicine in preventing recurrent pericarditis: a multi-centre all-case analysis.

AIMS: Effective prevention of recurrent pericarditis remains an important yet elusive goal. Corticosteroid therapy often needs to be continued for a prolonged period and causes severe side effects. We performed a multi-centre all-case analysis to investigate the efficacy of colchicine in preventing subsequent relapses of pericarditis, and addressed the hypothesis that pretreatment with corticosteroids may attenuate the beneficial effect of colchicine. METHODS AND RESULTS: One hundred and forty published and unpublished cases of patients treated with colchicine after at least two relapses of pericarditis were aggregated from European centres. Of those, 119 were included in the study group. Only 18% of the patients had relapses under colchicine therapy, and 30% after its discontinuation. There were significantly more relapses among male patients after colchicine treatment (36 vs. 17%, P=0.046), and those with previous corticosteroid treatment (43 vs. 13%, P=0.02). Multivariate logistic regression analysis identified previous corticosteroid therapy (OR 6.68, 95% CI: 1.65-27.02) and male gender (OR 4.20, 95% CI: 1.16-15.21) as independent risk factors for recurrence following colchicine therapy. CONCLUSION: Treatment with colchicine is highly effective in preventing recurrent pericarditis, while pretreatment with corticosteroids exacerbates and extends the course of recurrent pericarditis.

Adolescent↗
PubMed2005

Clopidogrel use in children.

OBJECTIVES: To review a pediatric experience with the antiplatelet agent clopidogrel and suggest a dosage regimen. STUDY DESIGN: A retrospective chart review of all infants and children treated with clopidogrel at The Hospital for Sick Children, Toronto between January 2001 and April 2004. Clopidogrel dosages, duration of therapy, complications, and adverse effects in a pediatric population were explored. RESULTS: Fifteen infants and children with congenital and acquired heart disease were treated with clopidogrel (median age, 3.5 years; range, 6 weeks to 16 years). Dosages ranged from 1 to 6 mg/kg/day for periods between 1 month and 6 months. Although no thrombotic events were reported, 1 child had a bleeding complication (gastrointestinal) while on triple antithrombotic therapy. Other complications reported in adults, including rash and clinical thrombocytopenia, were not noted in this pediatric series. CONCLUSIONS: Clopidogrel was well tolerated. We suggest a starting dose of 1 mg/kg/day for children.

Adolescent↗
PubMed2005

Pregnant "DES daughters" and their offspring.

QUESTION: I am a 34-year-old woman in my second trimester of pregnancy. My mother took diethylstilbestrol when she was pregnant with me. Could my expected child be affected by this? ANSWER: Animal studies suggest the child could be affected, but little data on humans strongly support this. You could plan to have your child monitored for a potential, though unlikely, effect.

Adult↗
PubMed2005

Pregnancy after stem cell transplantation.

QUESTION: A married woman under my care underwent successful bone marrow transplantation as part of treatment for a malignancy. She wishes to start a family. What are her chances? Are there risks? ANSWER: Success in becoming pregnant after stem cell transplantation depends on such factors as cumulative doses of chemotherapy and radiation and mother's age at time of transplant. There is increased risk of prematurity, low birth weight, and spontaneous abortion. Pregnancy should be managed as high risk.

Female↗
PubMed2004

Recurrent parotitis in selective IgA deficiency.

Recurrent parotitis is an uncommon condition in children. In most cases the etiology is unknown, although the disease is occasionally associated with viral infections, autoimmune disorders and immunodeficiency. We describe, for the first time, a child with recurrent parotitis and isolated immunoglobulin A (IgA) deficiency, without autoimmune disease. As IgA is the main immunoglobulin secreted into the mucosal surfaces, including that of the respiratory and gastrointestinal tracts, and into the saliva, the lack of IgA may be involved in the pathogenesis of recurrent parotitis. We recommend that IgA and other immunoglobulins be tested in all cases of recurrent parotitis.

Child↗
PubMed2004

Adenovirus infection in hospitalized immunocompetent children.

This study investigated the clinical features of immunocompetent children with adenovirus infection requiring hospitalization. The files of 78 children (mean age 17 +/- 10 months) with community-acquired adenovirus infection admitted over a 2-year period were reviewed. The children were referred after 5.7 +/- 3.4 days of illness, all with fever (mean peak 39.8 +/- 0.8 degrees C). Temperature normalized after 3.5 +/- 2 days. Duration of hospitalization (mean, 7.0 +/- 3.9 days) correlated with lethargy, lung crackles, cracked lips, hypoxia, impaired liver tests, and high serum lactic dehydrogenase (LDH) concentration at admission. Serum LDH concentrations and hypoxemia predicted 70% of the variance in hospital stay. All patients recovered. Adenovirus infection may cause considerable morbidity, even in immunocompetent children. Disease severity, defined by duration of hospitalization, correlates with serum LDH concentrations and oxygen saturation at admission.

Adenovirus Infections, Human↗
PubMed2003

Heat stroke in familial dysautonomia.

A 14-month-old female with familial dysautonomia was referred to the pediatric department with high fever (41.6 degrees C), watery diarrhea, and vomiting. A few hours later, signs of encephalopathy appeared. Laboratory tests revealed elevated levels of lactate dehydrogenase (3500 U/L), aspartate aminotransferase (640 U/L), alanine aminotransferase (320 U/L), and creatine kinase (28,420 U/L). The diagnosis was heat stroke. Impaired autonomic nervous system function may be another risk factor for the development of heat stroke in young children.

Autonomic Nervous System↗
PubMed2002

Whole blood platelet deposition on extracellular matrix under flow conditions in preterm neonatal sepsis.

UNLABELLED: Platelet function in preterm infants with sepsis was evaluated by measuring their adhesion and aggregation properties using the Cone and Plate(let) Analyser. This may lead to earlier detection of bleeding tendency in septic infants. Platelet function was investigated in 54 preterm infants, of whom 32 had proven neonatal sepsis and 22 were healthy matched controls. Citrated whole blood was subjected to shear stress (1300 s(-1)) for 2 min on tissue culture plates precoated with subendothelial extracellular matrix (ECM). The percentage of ECM surface covered with platelets and the average size of the ECM-bound platelet particles were determined with an image analyser. Assays for von Willebrand factor (vWF) antigen, ristocetin co-factor, and vWF collagen binding activity (CBA) were performed on samples from an additional 47 preterm infants: 38 healthy and 9 septic. Platelets of the preterm infants with sepsis displayed lower adhesion than those of the healthy controls. Mean surface coverage was 16.9+/-8.2% for the septic infants, 15.4+/-7.9% for the septic infants after exclusion of those with coagulase-negative staphylococci sepsis, and 20.8+/-9.6% for the healthy group ( P<0.05). Platelet aggregation, vWF antigen, ristocetin co-factor, and CBA levels were similar between the septic and healthy groups. The most significant factor influencing surface coverage was the presence of sepsis. CONCLUSION: platelet adhesion to extracellular matrix is significantly lower in septic preterm infants than in healthy preterm infants. Intrinsic platelet properties, rather than the concentration or activity of plasma von Willebrand factor, may be responsible for this difference. Surface coverage obtained by the collagen binding activity test under flow conditions, which represents platelet adhesion, may be an earlier, more sensitive indicator of bleeding tendency in neonatal sepsis than decreased platelet count.

Blood Platelets↗
PubMed2002

Colchicine for the prevention of postpericardiotomy syndrome.

BACKGROUND: Postpericardiotomy syndrome (PPS) is a troublesome complication of cardiac surgery, occurring in 10-45% of cases. Accepted modalities of treatment include nonsteroidal anti-inflammatory drugs, corticosteroids, and pericardiectomy in severe cases. The optimal method for prevention of PPS has not been established. Recent trial data have shown that colchicine is efficient in the secondary prevention of recurrent episodes of pericarditis. The aim of the present study was to evaluate the possible benefit of colchicine for the primary prevention of PPS in patients after cardiac surgery. To the best of our knowledge, this is the first study addressing this issue. PATIENTS AND METHODS: A prospective, randomized, double-blind design was used. The initial study group included 163 patients who underwent cardiac surgery in two centers in Israel between October 1997 and September 1998. On the 3rd postoperative day, the patients were randomly assigned to receive colchicine (1.5 mg/day) or placebo for 1 month. All were evaluated monthly for the first 3 postoperative months for development of PPS. RESULTS: 52 of the 163 patients were excluded because of postoperative complications, noncompliance, or gastrointestinal side effects of treatment. Of the 111 patients who completed the study, 47 (42.3%) received colchicine and 64 (57.7%) placebo. There was no statistically significant difference between the groups in clinical or surgical characteristics. PPS was diagnosed in 19 patients (17.1%), 5/47 cases (10.6%) in the colchicine group and 14/64 (21.9%) in the placebo group. The difference showed a trend toward statistical significance (p < 0.135). CONCLUSIONS: Colchicine may be efficacious for the prevention of PPS in patients after cardiac surgery. Further evaluations in larger clinical trials are warranted.

Adult↗
PubMed2002

Large T-cell lymphoma in a 13-year-old girl with hyperimmunoglobulinemia E syndrome.

Large T-cell lymphoma was diagnosed in a 13-year-old girl with hyperimmunoglobulinemia E syndrome (HIES). Her past medical history included severe dermatitis, recurrent pneumonia, urinary tract infections, mucocutaneous herpetic infections, fungal skin infections, and staphylococcal sepsis. The diagnosis of HIES, based on the clinical features and a serum IgE level of >20000 IU/ml, was established when the girl was 6 years old. This is the eighth case of lymphoma in a patient with HIES reported in the English-language medical literature. HIES has not usually been considered a predisposing factor for malignancy, but in view of the rarity of HIES and the young age of the patients, this association seems to be more than coincidental. A link between lymphoma and Epstein-Barr virus (EBV) infection in patients with HIES has been proposed. Serological tests for EBV in our patient were positive 6 years prior to the development of the lymphoma; however, examination for EBV DNA in the lymph node biopsy failed to detect EBV in the tumor.

Adolescent↗
PubMed2002

Topical treatment of tinea capitis in a neonate.

Tinea capitis is the most common fungal skin infection in children. Given that this infection invades the hair shaft and the pilosebaceous unit, systemic antifungal therapy is the gold standard of treatment. Despite the neonate's increased susceptibility to infections, tinea capitis is rare in this population. We present the case of a 16-day-old infant with tinea capitis caused by Microsporum canis and effectively treated with topical bifonazole 1%.

Administration, Topical↗