PubMed Health⌕ Search

Biomedical subjects

A Koren

Publications and source records attributed to A Koren.

At least 19 recordsLinked to original sources
PubMed2007

Quick identification of febrile neonates with low risk for serious bacterial infection: an observational study.

OBJECTIVE: To examine the possible usefulness of simple and quick criteria for identifying febrile neonates with low risk for serious bacterial infection (SBI). DESIGN: All febrile neonates who were admitted between August 1998 and August 2003 to the Pediatric Emergency Department, HaEmek Medical Center, Afula, Israel, and to the Poriya Hospital, Tiberias, Israel, were included in the study. The recommended evaluation of each neonate included details of medical history and a complete physical examination, including blood culture, erythrocyte sedimentation rate (ESR), white cell count (WBC), and analysis and culture of urine and cerebrospinal fluid. Other tests were carried out as necessary. Patients who met all the following criteria were considered to have low risk for SBI: (1) unremarkable medical history; (2) good appearance; (3) no focal physical signs of infection; (4) ESR <30 mm at the end of the first hour; (5) WBC 5000-15 000/mm(3); (6) a normal urine analysis by the dipstick method. RESULTS: Complete data were available for 386 neonates. SBI was documented in 108 (28%) neonates, of whom 14% had a urinary tract infection, 9.3% had acute otitis media, 2.3% had pneumonia, 1.3% had cellulitis, 0.5% had bacterial meningitis and 0.5% had bacterial gastroenteritis. The overall incidence of SBI was 1 in 166 (0.6%) neonates who fulfilled the criteria compared with 107 in 220 (48.6%) in the neonates who did not fulfil the criteria (p<0.001). The negative predictive value for SBI of the combination of the low-risk criteria was 99.4% (95% confidence interval 99.35% to 99.45%). CONCLUSIONS: Fulfillment of the criteria for low risk might be a reliable and useful tool for excluding SBI in febrile neonates.

Bacterial Infections↗
PubMed2004

Rapid antibody response after vaccination with a virosomal hepatitis a vaccine.

BACKGROUND: This study was designed to assess the early antibody kinetics after a priming dose, and the extent of the antibody increase after a booster dose of an inactivated virosomal hepatitis A virus (HAV) vaccine (Epaxal). PATIENTS AND METHODS: This was an open, uncontrolled study in 30 healthy subjects. The vaccine was injected intramuscularly on day 1 and month 12. Serum antibody titers were measured by ELISA on day 1 (pre dose) and at various time points thereafter until month 12 (pre-booster dose). After the booster dose, antibody titers were measured at various intervals until month 24. Neutralizing antibody titers were measured in 12 subjects a number of times during the 1st month by an antibody neutralization assay. Titers > or = 10 mIU/ml were considered seroprotective. RESULTS: ELISA antibody titers showed a rapid increase post vaccination. By day 15, 96% of subjects were seroprotected, which increased to 100% by day 22 (n = 27 evaluable subjects, aged 18-43 years; 13 male, 14 female). All subjects achieved seroprotective HAV-neutralizing antibody titers by day 11 (n = 12). The booster vaccination at month 12 resulted in a strong response in all subjects, with a sustained anti-HAV antibody titer (1,155 mIU/ml) at month 24. Both the priming and booster doses were well tolerated. CONCLUSION: Primary vaccination with this virosomal HAV vaccine is well tolerated and induces a rapid HAV-neutralizing antibody response resulting in seroprotection in all subjects within 10 days. In addition, the booster vaccination results in prolonged seroprotective antibody levels.

Adolescent↗
PubMed2004

Urinary tract infection: is there a need for routine renal ultrasonography?

AIMS: To assess the yield of routine renal ultrasound (RUS) in the management of young children hospitalised with first uncomplicated febrile urinary tract infection (UTI). METHODS: All children aged 0-5 years who had been hospitalised over a two year period with first uncomplicated febrile UTI in a medium size institutional regional medical centre were included. Children with known urinary abnormalities and/or who had been treated with antibacterial agents within seven days before admission were excluded. All included children underwent renal ultrasonography during hospitalisation and voiding cystouretrography (VCUG) within 2-6 months. The yield of RUS was measured by its ability to detect renal abnormalities, its sensitivity, specificity, and positive and negative predictive values for detecting vesicoureteral reflux (VUR), and by its impact on UTI management. RESULTS: Of 255 children that were included in the study, 33 children had mild to moderate renal pelvis dilatation on RUS suggesting VUR, of whom only nine had VUR on VCUG. On the other hand, in 36 children with VUR on VCUG the RUS was normal. The sensitivity, specificity, positive predictive value, and negative predictive value of abnormal RUS for detecting VUR were 17.7%, 87.6%, 23.5%, and 83.2% respectively. In none of the patients with abnormal RUS was a change in the management at or following hospitalisation needed. CONCLUSION: Results show that the yield of RUS to the management of children with first uncomplicated UTI is questionable.

Bacterial Infections↗
PubMed2004

Severe lymphedema of the arm as a potential cause of shoulder trauma.

The aim of this study was to determine whether lymphedema of the arm is associated with traumatic injury to the shoulder and to assess the role of lymphatic physiotherapy in reducing disabling shoulder pain. The study group consisted of 10 women aged 58-81 years (mean 66.9) with arm lymphedema after surgery for breast cancer. The average interval between the operation and the appearance of lymphedema was 9.8 years. All patients complained of shoulder pain. Five patients had a tear in the supraspinatus muscle diagnosed by ultrasound examination, and 5 had chronic bursitis; the nonaffected arm showed no pathology. The mean volume of the affected arm was 568 ml greater. Treatment consisted of manual lymphatic drainage and intermittent sessions of pneumatic compression with the LymphaPress device. This led to an average decrease in arm volume of 170 ml, with improvement of arm mobility and a drastic reduction in shoulder pain. In conclusion, lymphedema of the arm can cause severe shoulder trauma, pain and disability. Proper physiotherapy can reduce these effects. Patients should be referred for early treatment and follow-up to avoid permanent damage to the shoulder muscles.

Aged↗
PubMed2003

[Community acquired urinary tract infection among hospitalized children in northern Israel: pathogens, susceptibility patterns and urinary tract anomalies].

BACKGROUND: Urinary tract infection (UTI) is one of the most common diseases in children. Vesicoureteral reflux (VUR) has been demonstrated in a substantial number of young children with UTI. Empiric antibacterial therapy is recommended before results of the urine culture are available in order to shorten the duration of the disease and prevent renal complications. OBJECTIVES: The aims of this study were to assess the prevalence and susceptibility patterns of UTI pathogens, and urinary anomalies in children admitted with UTI. METHODS: The study population included 151 children younger than 14 years admitted with first UTI. Renal ultrasound was performed in all the patients and voiding cystourethrography (VCUG) in children younger than 5 years. Dimercaptosuccinic acid (DMSA) scan was performed in children with vesicoureteral reflux. The data included age, sex, symptoms and signs, urinalysis, the pathogen and its sensitivity and the results of the imaging studies. RESULTS: A total of 119 patients (79%) were females. Gram negative rods caused 98% of the infections, of which Escherichia coli (87%) was the most prevalent pathogen, followed by Klebsiella pneumoniae (4%), and Proteus mirabilis (4%). The sensitivities to antibacterial agents were: Amikacin 100%, ceftazidime 97%, gentamicin 96%, ceftriaxone 96%, cefuroxime 95%, amoxicillin-clavulanate 84%, trimethoprim-sulfamethoxazole 63%, cephalexin 58%, and ampicillin 28%. Renal US showed minor abnormalities in 24/149 (16%) and VCUG demonstrated vesicoureteral reflux in 38/127 (30%) patients. DMSA revealed renal scars in 7/28 (25%) children with vesicoureteral reflux. CONCLUSIONS: Overall Gram negative rods cause 98% of the UTI in hospitalized children in our area. E. coli is the leading pathogen and aminoglycosides and second or third generation cephalosporins are the most suitable agents for empiric therapy in UTI. A high incidence of renal scars in young children with vesicoureteral reflux was found.

Adolescent↗
PubMed2001

Steroid responsive nephrotic syndrome associated with bilateral renal dysplasia.

Renal dysplasia is characterized by hypoplastic kidneys that contain elements of primitive tubules. Patients may develop end-stage renal failure early in life. Nephrotic syndrome is one of the most common renal diseases in childhood and may occur in association with renal dysplasia. We report a case of a child with bilateral dysplastic kidneys and steroid responsive nephrotic syndrome (SRNS). An association between renal dysplasia with chronic renal failure and SRNS has not previously been reported in the English literature.

Child, Preschool↗
PubMed2001

Saphenous vein harvesting for coronary artery bypass grafting. Retrospective analysis of possible causes of major wound complications in patients with peripheral arterial disease.

OBJECTIVES: to retrospectively evaluate the possible reasons for major wound complications at the saphenous vein harvesting site in patients with peripheral arterial disease (PAD). DESIGN: retrospective study. MATERIALS AND METHOD: fifteen consecutive patients admitted to the vascular department for impaired healing at the saphenous vein harvesting site after successful coronary bypass artery grafting (CABG) (Group A) were evaluated for medical, perioperative, laboratory and pathological factors and outcome. Findings were compared with those in 15 matched controls followed in the outpatient clinic after CABG (Group B). RESULTS: absence of pedal pulses in the affected leg was noted in 13 patients in group A and 3 patients in group B. Ankle brachial index ranged from 0.4--0.7 in group A and 1.7--1.1 in group B; corresponding ankle pressures were 40--100 mmHg (mean 60 mmHg) and 80--160 mmHg (mean 110 mmHg). All patients in group A had PAD, whereas none did in group B, and all patients in group A required intervention to save the leg. Wound healing was noted in 11 group A patients; four patients underwent below-knee amputation. CONCLUSION: saphenous vein harvesting from limbs with severe PAD can lead to significant morbidity, including limb loss. In patients lacking a palpable pedal pulse, we recommend harvesting only the proximal saphenous vein.

Aged↗
PubMed2001

[Treatment of traumatic false aneurysm of the thoracic aorta with stent graft].

UNLABELLED: The treatment of traumatic false aneurysm of the thoracic aorta by endovascular stent graft may have advantages over conventional surgery. This is a case study of two women suffering from false aneurysm of the thoracic aorta caused in one by a knife injury and in the other by a car accident. After the patients became hemodynamically stable, a commercially available endothelial stent graft (Talent, Gor) was deployed. Recovery was rapid in the first patient. The second patient required emergency laparotomy for venous bleeding one day after stent placement; she died two weeks later, mainly from organ failure. CONCLUSIONS: Endovascular techniques can be used in selected cases to treat thoracic false aneurysms thereby avoiding the complexity and morbidity of conventional surgery.

Accidents, Traffic↗
PubMed2001

[Hemoglobin level among infants in Akko sub-district].

OBJECTIVES: To determine the prevalence of anemia among infants born in 1995 within the Akko sub-district and to investigate the association between anemia and socio-demographic variables. SUBJECTS AND METHODS: In 1995, 7920 children were born in the Akko sub-district. Recommendations for prophylactic doses of iron preparations were given to all the infants aged 4-12 months screened by the "Mother and Child" clinic's team. Procedures at the "Mother and Child" clinic require the clinic's nurses to perform a routine hemoglobin test for each child at the age of 12 months. Anemia was defined as a level of hemoglobin less than 11 g/dl. The chi-square test was used for statistical analyses. RESULTS: A hemoglobin test was performed on 5703 infants. The finding showed that 30.8% of these infants had a hemoglobin level below 11 g/dl, 24% had a hemoglobin level between 10.0-10.9 g/dl, 6%--between 9.0-9.9 g/dl and less then 1% of the infants had a level of hemoglobin below 9.0 g/dl. Statistical analysis was performed on the results obtained from 5535 infants of non-Jewish origin. An association was found between the rate of anemia and ethnicity (Arabs more than Druze, p = 0.02) and between the rate of anemia and the type of settlement (p = 0.001). Arab settlements of higher socio-economic level showed a lower rate of anemia than those of low socio-economic level. The highest rate of anemia was found within Bedouin settlements. The number of children in the family was significantly associated with anemia rates (p = 0.0005), showing dose response effect. There was inverse correlation between maternal education and anemia rate (p = 0.001). No association was found between birth weight and anemia rates. CONCLUSIONS: A high rate of anemia was found among non-Jewish infants in the Akko sub-district. This finding indicates the necessity for an intervention program to reduce this high rate of anemia and its associated damage in order to facilitate the optimal psychomotor development of the children.

Anemia↗
PubMed2000

Relation of nonobstructive aortic valve calcium to carotid arterial atherosclerosis.

Recently it was shown that subjects with aortic valve calcium (AVC) are at increased risk for future cardiovascular disease including stroke. We hypothesized that the increased risk of stroke may be due to an association with carotid artery atherosclerotic disease. Between 1995 and 1999 our laboratory made a diagnosis of AVC without significant stenosis in 3,949 patients. Of those, 279 patients without other cardiac structural exclusion criteria (148 men and 131 women; mean age 73 +/- 9 years, range 45 to 90) underwent carotid artery duplex ultrasound for various indications, and formed the study group. Age- and sex-matched patients without AVC (n = 277), who underwent carotid artery duplex ultrasound during the same period and for the same indications, served as the control group. Compared with the control group, the AVC group had a significantly higher prevalence of carotid stenosis (> 40% to 60%, 89% vs 78% [p < 0.001]; >60% to 80%, 43% vs 23% [p <0.001];and > 80% to 100%, 32%vs 14% [p < 0.001]). The AVC group had a similar, significantly higher prevalence of > or = 2-vessel disease and bilateral carotid stenosis (stenosis levels of > 20% to 40%, >40% to 60%, > 60% to 80%, and > 80% to 100%). In multivariate analysis, AVC, but not traditional risk factors, was the only independent predictor of severe carotid atherosclerotic disease (stenosis > 80% to 100%; p = 0.0001). Thus, there is a significant association between the presence of AVC and carotid atherosclerotic disease.

Aged↗
PubMed2000

Femorofemoral bypass, even in pregnancy--a case report.

A 29-year-old pregnant woman sustained blunt, left lower abdominal trauma, with hip and pelvic fractures, and progressive dissection of an intimal flap in the left iliac artery, which manifested two days later as profound ischemia of the left leg. The patient underwent distal thromboembolectomy, fasciotomies and revascularization of the leg by femorofemoral polytetrafluoroethylene bypass. The patient recovered completely and gave normal birth three months later to a healthy child. Four years after the operation she gave uneventful birth to another child. Various considerations pertinent to this complex traumatic-vascular-gestational state are discussed.

Abdominal Injuries↗
PubMed2000

System for measuring isolated rat soleus muscle belly response to tetanic stimulation.

A novel system for simultaneous measurements of isotonic muscle contraction and transversal muscle belly displacement in the isolated rat soleus muscle was designed. The system simultaneously records tetanic contraction of the muscle and transversal displacements of the muscle belly. The tetanic rise times (TRT) and muscle belly displacement times (BDRT) were measured at different proton loads induced by CO2 at 1%, 5% and 30%. The measurements of muscle belly displacement enabled us to follow the water shift into the muscle tissue during the tetanic activity. Acidosis provoked by 30% CO2 irreversibly increased the BDRT, however the TRT were not changed.

Acidosis↗
PubMed2000

Lipedema complicated by lymphedema of the abdominal wall and lower limbs.

We describe a 52 year-old woman in whom lymphedema primarily of the abdominal wall was superimposed on lipedema resulting in an abdomen of enormous dimensions with marked impairment of ambulation. Treatment consisted of preoperative compression of the legs by an external pneumatic device (Lympha-Press) followed by excision of the lymphedematous abdominal fat pad in conjunction with "debulking" of the right leg. The patient illustrates the extremes of lipedema complicated by lymphedema and the technical difficulties associated with its management.

Abdominal Muscles↗
PubMed2000

Association between mitral annulus calcification and peripheral arterial atherosclerotic disease.

The authors previously demonstrated a significant association between the presence of mitral annulus calcification (MAC) and aortic atheroma, carotid atherosclerotic disease, and coronary artery disease. The present study was designed to determine whether an association exists between MAC and peripheral arterial atherosclerotic disease. Of the 805 patients in whom the diagnosis of MAC was made by transthoracic echocardiography between 1995 and 1997, 77 patients (40 men and 37 women; mean age, 73.1 +/- 11.4 years; range, 44-90 years) underwent peripheral arterial testing for various indications, and comprised the study group. They were compared with 58 age-matched and sex-matched patients without MAC (30 men and 28 women; mean age, 73.2 +/- 11.8 years; range, 31-93 years) who underwent peripheral arterial testing during the same period for the same indications (control group). MAC was defined as a dense, localized, highly reflective area at the base of the posterior mitral leaflet detected by transthoracic echocardiography. An ankle/brachial systolic pressure index (ABI) was calculated by dividing the higher dorsalis pedis or posterior tibial Doppler-derived pressures by the higher of the 2 upper extremity systolic pressures. ABI was graded as follows: normal > or = 1, abnormal < 1, mild 0.71 to 0.99, moderate 0.41 to 0.7, and severe < or = 0.4. No differences were found between the groups in indications for referral for peripheral arterial testing and in risk factors for atherosclerosis except for hypertension, which was found to be significantly more prevalent in the study group (66% vs 41%, p = 0.004). The study group included 151 limbs, and the control group included 113 limbs. The mean ABI was significantly lower for all limbs in the MAC group (0.56 +/- 0.27 vs 0.87 +/- 0.24, p = 0.0001), abnormal ABI < 1 (94% vs 68%, p = 0.001), moderate peripheral arterial disease (44% vs 25%, p = 0.001), and a severe disease (27% vs 1%, p = 0.001). Of the 77 patients with MAC, 73 (95%) had a disease (right and/or left limbs) compared with 40 of 58 (69%) in the control group (p = 0.001). Bilateral disease (Doppler index < 1 for both right and left limbs), and severe bilateral disease (Doppler index < or = 0.4 for both right and left limb) were also found to be significantly more prevalent in the MAC group (87% vs 60%, p = 0.001; and 12% vs 0%, p = 0.007, respectively). There is a significant association between the presence of MAC and peripheral arterial disease. This information strengthens our hypothesis that MAC may be an important marker for generalized vascular atherosclerotic disease.

Adult↗
PubMed1999

Campylobacter bacteremia and pneumonia in two splenectomized patients.

Two patients with beta thalassemia who had undergone splenectomy for hypersplenism were admitted to the hospital with high fever and lobar pneumonia. Neither patient had gastrointestinal symptoms. Campylobacter bacteremia was diagnosed in both patients. Campylobacter jejuni was identified in the first patient and Campylobacter fetus in the second. Both patients were treated with broad-spectrum antibiotics and recovered fully.

Adult↗
PubMed1998

[Popliteal vascular trauma].

6 cases of popliteal vascular trauma are presented, 3 due to posterior dislocation of the knee and 3 due to crush injury. The patients were referred from another hospital and some had undergone unnecessary angiography when ischemia was present, leading to delay in surgery. All patients presented with distal ischemia and underwent reconstructive surgery; 2 subsequently underwent below-knee amputation because of irreversible ischemia and sepsis. Urgent operation for popliteal vascular trauma is necessary whenever there is ischemia and intraoperative angiography may be necessary. There should be reconstruction of the artery and vein when there is concomitant venous damage, and fasciotomy and debridement are important. The harmful potential of occult popliteal vascular injuries and their ostensible mild presentation present a challenge for the emergency room surgeon.

Adult↗