Israel journal of medical sciences最新文献

Stimulation of the non-obese diabetic (NOD) mouse immune-system with a single bacillus Calmette-Guerin (BCG) vaccination can inhibit the development of diabetes. The optimal dose, and the time and number of vaccinations is still to be clarified. In this study we evaluated the protective effect of repeated BCG vaccinations on preventing diabetes in NOD mice. 17/32 (53%) of the control group, 8/31 (26%) of the single vaccine-treated (at age 35 days) mice, and 7/23 (30%) of the single vaccine-treated (at age 90 days) mice developed diabetes, and none of the repeated BCG vaccination (at age 35 & 90 days, n = 14) animals developed the disease, up to 250 days of age (p < 0.05, compared with controls and each of the single-vaccination groups). While the severity of insulitis was lower in repeatedly BCG-treated mice at age 120 days as compared with controls and single BCG-vaccination groups, we could not detect significant differences in the Intracellular adhesion molecule-1 (ICAM-1) expression between the various groups. There were no differences in weight gain and blood hematocrit between the different groups. Our report demonstrates that repeated BCG vaccination is safe and more effective than a single dose in preventing type I diabetes in NOD mice. This data should be considered in planning new human trials with BCG.

We describe the obstetric anesthetic management of a patient with complex congenital heart anomaly consisting of transposed great arteries, double inlet left ventricle and subpulmonic stenosis. Successful management of a patient with Fontan physiology mandates a thorough understanding of the hemodynamic consequences of this procedure and the alterations during pregnancy. The major considerations are related to the fact that the systemic venous return reaches the pulmonary vasculature without the augmentation of a functioning ventricle.

The primary objectives of this study were to assess the efficacy and safety of Lys(B28), Pro(B29) in the treatment of patients with diabetes mellitus and to compare Lys(B28), Pro(B29) to currently available regular insulin with respect to quality of life. This study was designed as an open-label, non-comparative one. The number of patients enrolled in the trial was 39. At Visit 1 (week 0), blood samples for fasting, 1- and 2-hour postprandial blood glucose, and HbA1c were taken. At Visit 2 (week 6) and Visit 3 (week 12), fasting, 1- and 2-hour postprandial blood glucose, and HbA1c levels were measured again. There was no significant change in HbA1c, fasting blood glucose and 1- and 2-hour postprandial blood glucose levels. The 1- and 2-hour postprandial blood glucose excursions decreased significantly from Visit 1 to Visit 3. There were no serious adverse events during the study. Half of the patients had less hypoglycemia with LysPro insulin, while 25% had an increase in episodes. Thirty percent of patients were more satisfied with LysPro insulin than with the short-acting insulin that they had previously used. In conclusion, LysPro therapy can be regarded as safe, since there were no unexpected adverse events and no changes in the usual physical parameters.

The majority of patients with any initial renal insult show progression of renal damage over time. The histological end-result is often the same, whatever the initial lesion, and consists of an increase in extracellular matrix (ECM) and ultimately glomerulosclerosis. The clinical rate of progression correlates mainly with the degree of interstitial, rather than with that of glomerular damage. The main culprits for the ultimate interstitial damage and the rate of progression of renal disease, are the type and degree of the initial (e.g. immunological) insult and the magnitude of the proteinuria. Hypertension (intraglomerular) is an independent risk factor. Control of hypertension with angiotension converting enzyme (ACE) inhibitors or angiotensin II (AII) receptor blockers, reduction of protein and fat intake, anti-oxidative therapy and a variety of experimental measures reduce the progression of renal damage in animal experiments. Some of these interventions have also been shown to be beneficial in a number of controlled clinical studies, in well-defined renal disease entities in humans. These new data provide insight into the pathogenesis of chronic renal damage and raise the hope that in the not too far future, effective strategies can be devised to attenuate the progression of acquired renal disease.

Although relatively uncommon among cardiac diseases, myocarditis may often have significant sequelea, including heart failure and death. The development of a murine model and the use of myocardial biopsy and Dallas criteria have broadened our understanding of myocarditis and its manifestations. Regrettably, little can still be done to alter the natural course of the disease. The results of the Myocarditis Treatment Trial do not support routine treatment with immunosuppressive drugs for all patients with myocarditis, however the study did not incorporate methods of viral (DNA or RNA) identification or immunohistochemical techniques. Specific viral myocarditis diagnosis, by polymerase chain reaction or in situ hybridization, together with immunohistochemical markers, may help classify patients according to acute or chronic myocarditis and by etiology, and possibly identify subgroups of patients who would be most likely to benefit from immunosuppression. Some important questions regarding therapy for myocarditis may be answered by the ongoing European Study of the Epidemiology and Treatment of Cardiac Inflammatory Disease, while others still await double-blind controlled confirmation. In the interim, therapy is being directed towards the management of symptoms and complications, using conventional medical regimens for heart failure.

Drug-resistant tuberculosis (TB) has emerged as a worldwide problem. The annual incidence of TB has increased in Israel in the last decade, mainly due to successive waves of immigration. Few data are available on drug-resistant TB in Israel A 10-year retrospective review was conducted on all patients who had been infected with culture-proven Mycobacterium tuberculosis and had been admitted to our hospital. Forty-seven patients had culture-positive TB; 27 (57%) were male, 20 (43%) were female; mean age (+/- SD) was 56 +/- 23 years. Twenty patients (43%) had pulmonary TB. Three patients (6.4%) had single-drug resistance; 4 patients (8.5%) had multi-drug resistance. Six of the seven patients (86%) with drug-resistant TB had been diagnosed after 1990. Six of the 20 patients (30%) with pulmonary TB had drug-resistant organisms. Six of the 7 patients (86%) with drug-resistant TB had pulmonary infection, as compared to 15/40 (37%) of the patients with drug-susceptible TB (p < 0.001). Six of the 7 patients (86%) with drug-resistant TB had a history of TB. Fifteen percent (14.9%) of all new cases diagnosed with TB in our hospital in the last 10 years had drug-resistant M. tuberculosis. Thirty percent of patients with pulmonary TB had drug-resistant organisms. Drug-resistant TB has evidently emerged in Israel and poses a serious clinical and social threat. A strong case for directly-observed treatment in Israel should be made, especially since the incidence of TB here is still small.

Direct self-referrals to a consultant, especially on an urgent basis, has not been widely explored before. The health insurance system in Israel permits elective direct self-referrals to various specialists, but the range and reasons of urgent self-referrals has not yet been evaluated. Our aim was to evaluate urgent self-referrals to ambulatory consultants and to see to what extent a qualified family physician can triage and treat those patients. The setting was an urban ambulatory multi-disciplinary consultation center in the city of Ashdod in central Israel, serving a population of approximately 150,000. Over a three-month period, all patients who made urgent self-referrals for an ambulatory consultant in Ophthalmology, Ear, Nose and Throat (ENT) and Dermatology were triaged by an on-duty qualified family physician. The physician was instructed to take care of the patient in one of three ways: 1) immediate referral to a specialist; 2) begin treatment and schedule the patient for a specialist consultation; 3) administration of definitive treatment. Eight hundred and ninety-eight patients aged 46 +/- 22 years were treated by the triaging family physician. Forty-six percent had ophthalmological symptoms, 26% had dermatological symptoms and 20% had ENT-related symptoms. A symptom duration of less than 24 hours was reported by 36% of the patients. Eye problems were more commonly of short duration (p < 0.001). Sixty percent of the patients were given a definitive treatment, another 19% were given immediate treatment and scheduled for elective consultation with a specialist and 21% were referred for an immediate specialist consultation. Of the immediate consultations, 73% were ophthalmological and 27% came from a range of other complaints (p < 0.001). Our conclusion was that a family physician can treat most of the urgent self-referrals to ambulatory consultations in the three domains that were evaluated. A triage system is particularly suitable for urgent self-referrals to ENT as well as dermatological problems.

A 47-year-old female was admitted for severe pain of 1 month's duration in the third and fourth toes of the right foot, culminating in gangrene. Laboratory findings revealed liver enzyme abnormalities, and anti-mitochondrial, anti-phospholipid and antinuclear and doubtful anti-DNA antibodies. Systemic lupus erythematosus (SLE) was excluded on clinical grounds after a 6-year follow-up. Therefore, a diagnosis was made of the primary antiphospholipid syndrome, complicated by microvasculopathy, and associated with primary biliary cirrhosis.

A 67-year old patient, operated for closure of ileostomy 3 days before, developed E. coli sepsis with suspected peritonitis. Two days later, pain and weakness in the shoulder girdle, scapula and proximal upper limb muscle appeared simultaneously, followed by marked atrophy. Electromyography (EMG) examination manifested bilateral active denervation of upper brachial plexus. Any trial to isolate a pathogenic factor other than the E. coli failed. Due to the bilateral proximal upper limb's paralysis, grooming and upper-body dressing obliged the patient to ask for complete assistance. In other daily living activities he was partially independent.