Israel journal of medical sciences最新文献

The current gold standard test for diagnosis of Helicobacter pylori involves histological staining and/or urease testing of antral biopsy specimens. However, these methods are invasive, and alternative non-invasive methods, i.e. the urease breath test and serological tests, are available. The test for H. pylori-specific serum immunoglobulin G (IgG) is now available commercially. The aim of this study was to compare the gold standard tests for diagnosis of H. pylori to the non-invasive method of detecting IgG antibody in the serum. Two hundred and twenty-five (225) subjects were tested for H. pylori by histological staining, urease testing, direct microscopy of antral biopsy specimens and quantification of serum IgG antibody. The population examined was divided into 2 groups--a group of 52 patients with no gastrointestinal symptoms and a group of 173 patients with dyspepsia. Out of 173 dyspeptic patients, 22 (12.7%) were false-positive to H. pylori. Out of 52 non-dyspeptic subjects, 30 (57.7%) were false-positive (p < 0.0001). The sensitivity and specificity were 91.6% and 51.7%, respectively. The specificity and positive predictive value increased by approximately 30% when the subjects examined were in the younger age group (< 30 years), while the sensitivity and the negative predictive value did not change significantly. This study indicates that serological testing is not recommended for diagnosis nor is it recommended for follow-up treatment, especially among the older age group (> 30 years).

Myotonic dystrophy (DM) is associated with an increased number of CTG repeats in the 3' untranslated region of the myotonin gene. Because DM has been observed more frequently in North African Jews than in Ashkenazic Jews in Israel, a study of the CTG repeat polymorphism was undertaken in these 2 groups. Alleles from 70 unrelated North African subjects and 70 unrelated Ashkenazic subjects were studied by PCR analysis of the trinucleotide repeat in the DM gene to determine the ethnic distribution of the number of CTG repeats. The alleles ranged in length from 5 to 26 repeats in the North Africans and 5 to 23 in the Ashkenazim. As has been seen in other populations, none of the chromosomes had a 9-repeat length. North African Jews were found to have significantly more repeats in the normal range than Ashkenazim (for over 14 repeats: 34/140 compared to 7/140; p < 0.0001). It is suggested that this more frequent occurrence of a large number of CTG repeats in the normal range may represent a greater predisposition to DM.

Hypertension is often associated with impaired glucose tolerance and high insulin levels, factors that contribute to insulin resistance. The present study evaluates the effect of acarbose, a hypoglycemic drug that inhibits carbohydrate digestion in sucrose-induced hypertension in rats. The effects of diets fed to 3 groups of rats for a 16-week period were studied: sucrose + NaCl (1% wet volume [w/v]) with acarbose (0.04% wet weight [w/w]), sucrose + NaCl (1% w/v) without acarbose, and a third diet of complex carbohydrates. There was no statistical difference in the body weight between rats fed with or without acarbose. Fasting glucose levels were significantly lowered when treated with acarbose. Postprandial blood glucose and insulin levels were attenuated in rats fed sucrose + acarbose. Systolic blood pressure increased significantly (p < 0.001) in rats fed sucrose + NaCl for 3 months, whereas systolic blood pressure of acarbose-fed rats remained at the initial level. Blood pressure changes in the complex carbohydrate-fed group were lower than in rats fed sucrose. The urinary volume, Na+, and K+ of rats fed acarbose tended to increase compared to the acarbose-free diet (p < 0.05). We conclude that high insulin levels, impaired glucose tolerance and Na+ retention may contribute to the development of sucrose-induced hypertension. Acarbose prevents sucrose-induced increases in plasma glucose and insulin levels. Increases in urinary Na + may contribute indirectly to this effect with resultant normal systolic blood pressures.

The purpose of this study was to compare the solid phase gastric emptying (GE) in hypothyreotic patients before treatment and after euthyreosis has been reached. Ten female patients (aged 44.8 +/- 9.5[SD] y) with recently diagnosed hypothyroidism were included in the study. Their thyrometabolic state and GE were examined before treatment and after a median of 5 1/2 months (range 2 1/2-12 1/2), i.e., when euthyreosis was achieved. The control group consisted of 12 healthy women (aged 34.5 +/- 8.1y). GE of a 390-kcal 99mTc-labelled solid meal was continuously recorded under a gamma camera during 90 min. A power-exponential model was used for the analysis of the GE course. Compared to the controls, the solid phase GE of the hypothyreotics was characterized by a significantly lower curve shape parameter S (0.745 +/- 0.217 vs. 1.032 +/- 0.223, p < 0.01) and slope of the curve K (4.8 +/- 2.2 min-1.10(-3) vs. 7.6 +/- 1.3 min-1.10(-3), p < 0.01). Restoration of euthyreosis resulted in an increase of both parameters, making the GE pattern no longer statistically significantly different from that encountered in healthy subjects. The treatment did not affect the gastric half emptying time T1/2 (median: 125 min and 130 min before and after the treatment, respectively; healthy controls: 94 min). A wide variation of individual GE data was found either before or after the treatment, and in a few cases delayed GE persisted despite an effective substitutive treatment. The GE kinetics was, however, in no way related to the severity of the disease. Further research on the pathogenesis of this phenomenon is warranted.

Transurethral thermal treatment has been used to relieve obstructive voiding symptoms in 10 patients with prostate cancer. All patients failed previous endocrine treatment for the relief of obstructing urinary symptoms. Temperature ranging from 46 degrees C to 47 degrees C was applied transurethrally using Thermex II thermal system. Treatment was given in a single session for a duration of 180 minutes on an outpatient basis without sedation. Mean duration of follow-up was 8.5 months (range 4-13 months). Maximal urine flow rate, post-voiding residual volumes and changes in subjective symptoms were used to assess treatment response. Removal of an indwelling catheter was possible in all 3 patients with chronic retention. Urinary infection (2 patients) and temporary retention (3 patients) were the only complications recorded. The preliminary results suggest that transurethral hyperthermia is a well-tolerated, safe and effective procedure for obstructive voiding symptoms in patients with hormone refractory prostate cancer. Longer follow-up and a larger group of patients is required to assess this alternative modality.

Over the past few years, we have observed a substantial increase in the number of patients followed at our hospital who have undergone renal transplantation from living unrelated donors (LURD). These transplants were all performed in one of two centers: Bagdad, Iraq or Bombay, India. We have observed a parallel increase in the number of cases of Pneumocystis carinii pneumonia (PCP) post-renal transplant. We conducted a ten-year retrospective analysis (1986-1995) of patients who developed PCP post-renal transplant to determine the risk factors associated with the development of this infection, with particular reference to the type of transplant and the center in which the transplant was performed. Over this period, 270 renal transplant patients were followed at this hospital and 10 episodes of PCP were documented (3.7%). Six of these cases occurred within the last 2 years, as compared to only 4 cases in the preceding 8 years. All of the cases observed in the last 2 years occurred in patients who had undergone renal transplantation from LURD in Iraq or in India. During the same period, we observed no cases of PCP in patients who had undergone transplantation in Israel (cadaver or related living donor transplants). We could find no difference between patients undergoing transplant from LURD and those undergoing other transplants in terms of immuno-suppressive therapy, frequency of organ rejection episodes or coexistent CMV infection. All patients were of Arab descent and live in the West Bank. Although we cannot identify any obvious explanation for this association, we believe that these cases represent a true cluster phenomenon. We therefore feel it is warranted for all recipients of renal transplants from living unrelated donors seen in our hospital to receive prophylactic therapy for Pneumocystis carinii pneumonia.

The aim of this study is to describe the first 3 years of functioning of a home hospice care unit in an urban community in Israel. This home hospice unit is the only palliative care facility available in the Negev area, the southern region of Israel. During the first 3 years, the team took care of 139 cancer patients, age range 28-92 years, mean 64.1 and median 67 years. The mean duration of care was 53.1 days. Every patient had on average 42.7 home visits and telephone contacts. About 8% of all contacts were beyond regular working hours. More than three quarters of the patients were suffering pain on admission. In 50% of the patients pain was controlled by 120 mg morphine daily, and in 73% of the patients pain was controlled with doses up to 320 mg morphine in 24 h. Altogether there were 438 hospitalization days for these patients with an average of 3.6 days per patient since admitted to the unit. The rate of death at home was 88.5%. As a result of the team's experience, new approaches to patient care were implemented in the fourth year of operation of this care facility, of which one of the most important is inclusion of palliative medicine in the curriculum for Family Medicine residents.

Dry eye patients present with instability of the precorneal tear film which breaks up much earlier than normally. The instability of the precorneal tear film leads to dry eye symptoms such as the sensation of sand in the eye, recurrent blurred vision, itching, smartness, and the sensation of dryness. The stability of the precorneal tear film can be evaluated by the break-up-time test (BUT). The aim of treatment of dry eye is to increase the precorneal tear film stability. Tear substitutes are the most frequent medication for dry eye patients, who request life-long treatment. Therefore, we estimated the influence of tear substitutes on the precorneal tear film stability. The influence of unpreserved artificial tear substitute containing 0.1% sodium hyaluronate (Healon 0.1%) was compared with that of 7 different available tear substitute preparations containing preservatives. The results of the present study show that Healon 0.1% has the best influence on the precorneal tear film stability. These data were found to be independent of the viscosity property of Healon 0.1%.