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Biomedical subjects

Z Barzilay

Publications and source records attributed to Z Barzilay.

At least 19 recordsLinked to original sources
PubMed1995

Plain radiography for diagnosis of gastrointestinal perforation in immune-compromised children--is it enough?

Gastrointestinal perforation is a surgical emergency in the pediatric patient and any delay in diagnosis might be hazardous. In immunocompromised children, the clinical signs of perforation may be blunted. We describe a child with acute lymphoblastic leukemia (ALL) and a perforated appendix and ileum in whom computerized tomography (CT) revealed extraluminal air that was not initially identified on plain abdominal film. Our case demonstrates the importance of early abdominal CT and ultrasound examination in detecting these potentially lethal complications.

Acute Disease↗
PubMed1995

Apnea testing in suspected brain dead children--physiological and mathematical modelling.

OBJECTIVE: To study the validity and safety of the traditional apnea test in children, and to evaluate a mathematical equation estimating the hemodynamic response to the apnea test. DESIGN: A prospective clinical study. SETTING: Pediatric ICU. PATIENTS AND PARTICIPANTS: 38 pediatric patients suffering severe brain injury aged 2 months to 17 years, undergoing apnea testing for brain death. MEASUREMENTS AND RESULTS: Apnea tests were performed 61 times (once in 19 patients, twice in 15, and 3 times in 4 patients). Mean PaCO2 was 41.1 +/- 10.6 mmHg before apnea and increased to 68.0 +/- 17.6 at 5 min. PaCO2 increased to 81.8 +/- 20.1 and 86.0 +/- 25.6 at 10 and 15 min, respectively. There was a mean PaCO2 increase by 5.38 +/- 1.4 mmHg/min in the first 5 min, and 2.75 +/- 0.5 mmHg/min during the next 5 min. We found a statistically significant (p < 0.05) linear relationship between the natural logarithm of PaCO2, time, and the logarithm of the initial level of PaCO2. An inverse linear relationship (p < 0.05) was found between systemic mean arterial pressure (MAP) and initial level of PaCO2 presented as mathematical correlations and nomograms. CONCLUSIONS: By using our model for predicting MAP and PCO2 prior to apnea testing, hemodynamic embarrassment can be anticipated and prevented, thus allowing a safer procedure in the detection of brain death. Despite the fact that continuous cardiorespiratory monitoring is important, hemodynamic disturbances can be estimated before the apnea test, thus allowing a safer approach to brain death detection.

Adolescent↗
PubMed1995

Rhabdomyolysis due to hereditary torsion dystonia.

Following an acute dystonic crisis, a 6-year-old boy with hereditary torsion dystonia developed rhabdomyolysis. To our knowledge, hereditary torsion dystonia has never been reported as a cause of rhabdomyolysis. Early diagnosis and treatment of rhabdomyolysis should be considered in children with severe dystonia in order to prevent renal failure.

Acute Kidney Injury↗
PubMed1994

Acute acalculous cholecystitis in an infant after cardiac surgery.

Acute acalculous cholecystitis is a virulent disease that occurs most commonly in critically ill patients. Imaging studies may facilitate earlier diagnosis and may decrease the morbidity and mortality rates. The authors report on a 30-month-old child with acute acalculous cholecystitis after surgical repair of tetralogy of Fallot. A review of the clinical pathogenesis, diagnosis, and treatment is included.

Acute Disease↗
PubMed1994

Predictors of outcome of stroke in infants and children based on clinical data and radiologic correlates.

Outcome predictors were analyzed in 45 infants and children with cerebrovascular disorders (CVD), based on clinical features and radiological correlates. The clinical features at presentation could be categorized into three major groups: (1) generalized: alteration of consciousness with or without seizures--24 patients (54%); (2) focal: acute hemiplegia or monoplegia with or without focal seizures--18 patients (40%); (3) cerebellar disturbances--3 patients (6%). The underlying etiology was detected in 80% of children. Thirty-seven patients (82%) survived the initial debilitating event, of whom 11 (29.7%) recovered completely and the rest had either motor or cognitive handicaps during an average follow-up period of 4.2 years (range 1.5-11 years). A head CT performed in all children revealed ischemic infarction in 29 patients (64.4%), while the others had hemorrhagic infarction. Of those with an initial generalized neurological presentation, as many as 50% had multi-focal lesions on CT. All children with focal neurological findings had a solitary localized lesion on CT, mainly in the distribution of the middle cerebral artery. Statistical analysis for outcome prediction showed that the following variables were associated with increased risk of immediate death: (1) hemorrhagic infarction demonstrated by brain CT (p = 0.031); (2) patients who presented with a generalized neurological disorder, namely alteration of consciousness, with or without seizures (p = 0.036). No other clinical or laboratory variables were predictive of imminent death, motor or cognitive handicaps. These may therefore serve as outcome predictors of stroke in the pediatric age group.

Cerebellar Diseases↗
PubMed1993

[Rubella encephalitis].

Morbidity in rubella is generally mild, and neurological complications are rare, varying from 1:6000-1:24,000. We describe an 11-year-old girl with severe manifestations of rubella encephalitis. The onset of encephalitis most often occurs within 1-6 days after development of the typical rash. Neurological features vary and include encephalitis, carotid artery thrombosis, myelitis, optic neuritis, Guillain-Barre syndrome, and peripheral neuritis. Rubella should be considered in the differential diagnosis of encephalitis despite the current vaccination program in Israel. Such cases should be prevented by encouraging widespread early childhood vaccination.

Acyclovir↗
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↗
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↗