TY - JOUR T1 - Does the Application of Heat Gel Pack After Eutectic Mixture of Local Anesthetic Cream Improve Venipuncture or Intravenous Cannulation Success Rate in Children? A Randomized Control Trial. JF - Pediatr Emerg Care Y1 - 2018 A1 - Schreiber, Silvana A1 - Cozzi, Giorgio A1 - Patti, Giuseppa A1 - Taddio, Andrea A1 - Montico, Marcella A1 - Pierobon, Chiara A1 - Barbi, Egidio KW - Anesthetics, Local KW - Child KW - Child, Preschool KW - Female KW - Hot Temperature KW - Humans KW - Lidocaine KW - Lidocaine, Prilocaine Drug Combination KW - Male KW - Pain KW - Pain Management KW - Phlebotomy KW - Prilocaine KW - Prospective Studies AB -

OBJECTIVE: Needle-related procedures are the most common sources of pain for children in the hospital setting. The most used topical anesthetic, eutectic mixture of local anesthetic (EMLA) cream, may cause transient vasoconstriction. It has been postulated that this vasoconstriction may decrease vein visualization. The application of heat gel pack after removal of EMLA cream in the site of venipuncture counteracts the vasoconstriction, improving vein visualization. We assessed using a prospective randomized controlled trial whether the application of heat gel pack increases the needle procedure success rate. The primary study outcome was procedural success rate at the first attempt.

METHODS: The study enrolled 400 children, 200 of whom applied heat gel pack after removing EMLA (treatment group) and 200 did not (control group). Procedural success rate at the first attempt, vein perception before procedure, procedural pain, and adverse events were recorded in both groups.

RESULTS: Eighty-eight percent of the procedures were successful at the first attempt in the treatment group and 89% in the control group (P = 0.876). Vein perception was not significantly different in the 2 groups (P = 0.081). Pain score after the procedure was similar in the 2 groups.

CONCLUSIONS: This study shows that the application of heat gel pack after removal of EMLA cream does not improve venipuncture or intravenous cannulation success rate.

VL - 34 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28719485?dopt=Abstract ER - TY - JOUR T1 - Sirolimus Therapy in Congenital Hyperinsulinism: A Successful Experience Beyond Infancy. JF - Pediatrics Y1 - 2015 A1 - Minute, Marta A1 - Patti, Giuseppa A1 - Tornese, Gianluca A1 - Faleschini, Elena A1 - Zuiani, Chiara A1 - Ventura, Alessandro AB -

Congenital hyperinsulinism (CHI) due to diffuse involvement of the pancreas is a challenging and severe illness in children. Its treatment is based on chronic therapy with diazoxide and/or octreotide, followed by partial pancreatectomy, which is often not resolutive. Sirolimus, a mammalian target of rapamycin inhibitor, was reported to be effective in treating CHI in infants. We report here the case of an 8-year-old boy affected by a severe form of CHI due to a biallelic heterozygous ABCC8 mutation who responded to sirolimus with a dramatic improvement in his glucose blood level regulation and quality of life, with no serious adverse events after 6 months of follow-up. To the best of our knowledge, this is the first report of a successful intervention in an older child. It provides a promising basis for further studies comparing sirolimus with other treatments, particularly in older children.

VL - 136 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26504125?dopt=Abstract ER -