Israel journal of medical sciences最新文献

Heart rate variability (HRV) is increasingly being used to evaluate the function of the autonomic nervous system. Although autonomic dysfunction has been described in primary amyloidosis patients, this has not been established for patients with secondary amyloidosis. This study examines the autonomic function of 23 biopsy-proven secondary amyloidosis patients (10 male, 13 female) and compares it with 19 healthy (8 male, 11 female) sex- and age-matched controls (Group III), using frequency- and time-domain HRV analysis. The study group was further divided according to renal function; Group I (14 nonuremic patients with serum creatinine level < 1.4 mg/dl) and Group II (9 uremic patients with serum creatinine level > 1.4 mg/dl). In time domain analysis, standard deviation and mean of the standard deviation of all normal R to R intervals, and standard deviation of the average normal R to R interval were significantly lower in Groups I and II as compared to Group III. In frequency domain analysis, low frequency power (LF), representing sympathetic function, was significantly lower in Groups I and II as compared to Group III, but high frequency power (HF), representing parasympathetic function, and the LF/HF ratio, as an index of sympathovagal balance, were not different among the groups. In conclusion, in patients with secondary amyloidosis, sympathetic components of heart rate variables decreased before the onset of uremia and the change became more prominent with the appearance of uremia despite not reaching statistical significance.

In order to compare activated clotting time (ACT) sampled from an arterial (heparin-flushed) line with the control, a venous (heparin-free) line, arterial and venous ACT values were assessed before and after cardiopulmonary bypass in 150 patients while undergoing open-heart surgery. ACT was measured by Hemochron 801 automatic analyzer. Baseline arterial ACT was significantly higher than baseline venous ACT (14%; p < 0.001, using one-way analysis of variance and Bonferroni multiple comparisons test). The differences between the values of arterial and venous ACT after protamine reversal, between arterial ACT at baseline and after protamine reversal, and between venous ACT at baseline and after protamine reversal were not statistically significant. We conclude that arterial-sampled ACT measurement is suitable and reliable for monitoring heparin reversal by protamine after cardiopulmonary bypass.

Penicillin-resistant Streptococcus pneumoniae (PRP) is of worldwide concern. Treatment failures and fatalities of meningitis caused by PRP have been reported in other locations but not yet in Israel. We describe an 11-month-old infant with meningitis caused by PRP who failed to respond to initial treatment with cefotaxime. Vancomycin treatment caused a prompt cure. The minimal inhibitory concentrations of the isolate to penicillin, cefuroxime and cefotaxime were 1.0, 4.0 and 1.0 micrograms/ml, respectively. New guidelines for the treatment of meningitis in Israel are suggested.

During the 4-year period 1989-1992, 18,227 neonates were born at Kaplan Hospital and 614 (3.4%) were admitted to the neonatal intensive care unit. During this period, 120 episodes (6.6/1000 live births) of neonatal sepsis were recorded in 109 neonates (6/1000 live births). The incidence of early-onset sepsis was 19/109 (17%). The main pathogens of early-onset sepsis were S. agalactiae (42%) and E. coli (32%). Seven of the 8 S. agalactiae cases were recorded during 1989-1990. The main pathogens of late-onset sepsis were Klebsiella spp. (31%), coagulase-negative staphylococci (18%) and Candida spp (16%). There were 11 cases (10%) of meningitis, 5 due to Klebsiella spp. The overall fatality rate due to sepsis was 14% (0.8/1000 live births) with an early-onset sepsis death rate of 37%. The mortality from S. agalactiae sepsis was 63%. The main trends recorded during the period of the study were 1) the emergence of S. agalactiae as the main pathogen of early-onset sepsis, followed by a sharp decrease in its incidence during the last part of the study, 2) the emergence of extremely virulent, multi-antibiotic-resistant Klebsiella organisms, and 3) the persistent high incidence of Candida sepsis.

Knowing the negative effect of depression on lymphocyte number and activity in humans, we investigated the effect of antidepressant therapy on various lymphocyte subgroups. Cancer patients receiving treatment for at least 6 months were asked to take the antidepressant, fluvoxamine, for 28 days. Before and at the end of the study, physical and psychiatric examinations were performed, and the severity of depression was assessed by the Hamilton Scale for Depression (HAM-D). In addition, a sample of blood was withdrawn from the patients to quantify the following parameters: total leukocyte and lymphocyte counts, T4, T8, and Natural Killer (NK) cells, and lymphocyte response to the mitogens phytohemagglutinin (PHA) and pokeweed (PWM). Ten adult patients completed the study. Five of the 10 responded favorably to fluvoxamine treatment. Mean improvement was 50% from the score on day one. There was a significant correlation between the change in the HAM-D score of the "responders" and the change in NK cell counts (p = 0.02). The mean increment in NK cell number was 53%. In 4 of the 5 "non-responders", NK cell number dropped by 65% (mean). No correlation between the change in HAM-D score and any other immunological parameters was detected. Fluvoxamine increases NK cell counts in cancer patients, probably by its antidepressant effect.

There are limited data about false-positive reactions against hepatitis C virus (HCV) in syphilitic patients and false-positive reactions against syphilis in the patients with HCV infection. The aim of this study was to demonstrate the false-positivity of syphilis in patients with HCV infection, the false-positivity of anti-HCV in patients with syphilis and the validity of the serological tests in such patients. Fifty patients with positive anti-HCV, 21 patients with positive VDRL and 50 healthy subjects were studied. Syphilis serology was determined by the Venereal Disease Research Laboratory (VDRL) test and microhemagglutination for T. pallidum (MHA-TP) test. Hepatitis C serology was determined by a second generation ELISA (Ortho Diagnostics) test for HCV antibody, and anti-HCV positive patients were tested for HCV RNA by polymerase chain reaction (PCR). All assays were performed on all subjects. Not only the false-positive VDRL reaction in the patients with HCV infection but also false-positive anti-HCV tests in syphilitic patients have been observed. Four patients with syphilis had positive anti-HCV and negative HCV-RNA, whereas 10% (5 of 50) of patients with hepatitis C infection had positive VDRL and these patients were negative for MHA-TP test. The rates of false-positivity of VDRL and anti-HCV were higher than within the control group (p < 0.05). According to these data, positive anti-HCV in syphilitic patients and positive VDRL in chronic hepatitis C may be false-positive results with regard to the reaginic tests. Therefore, therapeutic measures should not be initiated without confirmation with a treponemal test or PCR. VDRL and HCV-ELISA tests may be interacted with IgM or IgG antibodies. This relationship should be investigated in further studies.

Intubation of the multiple trauma patient with suspected cervical spine injury has been the focus of much recent debate. Data demonstrating the safety of orotracheal intubation with manual in-line stabilization (1-4), has caused the emphasis to shift from use of a specific technique to operator skill and comfort (5). We present and discuss the management of a multiple trauma patient with suspected cervical spine injury.

We reported a case of spontaneous uterine rupture in the first trimester of a woman who had had a traditional myomectomy operation 2.5 years earlier. Although uterine rupture is very rare in early pregnancy, it should be taken into consideration--in the differential diagnosis of acute abdomen--in all terms of pregnancy, especially when a predisposing factor exists.

The clinical symptoms of a tick toxicosis caused by Ixodes redikorzevi in northern Israel are described. The patient was a nine-year-old Arab boy from an agricultural village who was admitted to a local hospital and had been suffering for 4 days from fever and torticollis. A partially engorged female tick was removed from the nuchal area of the scalp, and the symptoms disappeared within 2 hours. Morphometrical measurements indicated that the tick was attached to the skin for 3-4 days.