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Biomedical subjects

A Shapira

Publications and source records attributed to A Shapira.

At least 19 recordsLinked to original sources
PubMed2001

Acute mastoiditis--the antibiotic era: a multicenter study.

OBJECTIVES: To evaluate the clinical course and identify the causative organisms of acute mastoiditis in a community where most of the patients who develop acute otitis media are treated with antibiotics. METHODS: A multicenter retrospective review of a series of 223 consecutive cases of acute mastoiditis. SETTING: Nine secondary or tertiary academic or non-academic referral centers. RESULTS: Prior to the diagnosis of acute mastoiditis, 121 of the patients (54.3%) had been receiving oral antibiotic treatment for acute otitis media for periods ranging from 1 to 21 days (mean 5.3 days). Samples for bacterial culture were obtained from 152 patients. Cultures were negative in 60 patients. The organisms isolated in the 92 positive cultures were: Streptococcus pneumoniae (15 patients), Streptococcus pyogenes (14 patients), Staphylococcus aureus (13 patients), Staphylococcus coagulase negative (three patients), Pseudomonas aeruginosa (eight patients), Haemophilus influenzae (four patients), Proteus mirabilis (two patients), Escherichia coli (two patients), Klebsiella pneumoniae (one patient), Enterobacter (one patient), Acinetobacter (one patient), anaerobic gram-negative bacilli (one patient), and fungi (two patients). Ten patients had mixed flora. Sixteen patients presented with complications (cerebellar abscess, perisinus empyema, subdural abscess or empyema, extradural abscess, cavernous sinus thrombosis, lateral sinus thrombosis, bacterial meningitis, labyrinthitis, petrositis, or facial nerve palsy). CONCLUSIONS: Antibiotic treatment cannot be considered an absolute safeguard against the development of acute mastoiditis. Early myringotomy for acute otitis media seems to decrease the incidence of complications. The distribution of causative organisms in acute mastoiditis differs from that in acute otitis media. Intracranial complications in acute mastoiditis are not rare. Because of the diversity of causative organisms in acute mastoiditis and the growing resistance of bacteria to the various antibiotics, all means to obtain a sample for culture prior to antibiotic treatment, including general anesthesia.

Acute Disease↗
PubMed2000

[Rational use of albumin].

The use of albumin has been a matter of debate since its introduction in the 1940's. Albumin is not only expensive but may also be harmful when administered inappropriately. Until recently our use of albumin was controlled by a number of authorized physicians who signed all albumin prescriptions. In August 1998, a multidisciplinary team reviewed the indications for albumin use and introduced simple guidelines for its supply and administration. As a result, the use of albumin has decreased by almost 70%. This indicates that rational use of albumin can be achieved by appropriate guidelines, without requiring administrative limitations. We believe that this conclusion holds true for other diagnostic and therapeutic procedures as well.

Humans↗
PubMed1999

Odontogenic cysts related to pulpotomized deciduous molars: clinical features and treatment outcome.

OBJECTIVE: The purpose of this study was to assess the morbidity and outcomes associated with large cysts that developed in conjunction with pulpotomized deciduous molars. STUDY DESIGN: This retrospective study was based on the files of 18 patients who were referred to 2 oral surgery departments during a 10-year period (1986-1996). The inclusion criteria were large cyst lesions (>1 cm in diameter) and complete documentation. Data regarding symptoms at presentation, histologic and radiologic features, treatment modalities, morbidity, and outcomes were analyzed. RESULTS: An equal gender distribution of patients was found, as were a later development in males (12+/-2 years in boys, 9+/-2 years in girls) and a 5:1 ratio favoring the mandible over the maxilla. Treatment included enucleation (12 patients) and marsupialization (6 patients). The morbidity was high and included loss of permanent teeth (3 patients), extensive loss of alveolar bone (3 patients), use of flaps (2 patients), and adjuvant orthodontic treatment (9 patients). CONCLUSION: Failure of early detection and treatment of cysts that develop in conjunction with pulpotomized deciduous molars can cause considerable morbidity. Therefore, periodic clinical and radiologic follow-up until the eruption of succedaneous teeth is recommended.

Adolescent↗
PubMed1998

'Wrongful life' lawsuits for faulty genetic counselling: should the impaired newborn be entitled to sue?

A "wrongful life" suit is based on the purported tortious liability of a genetic counsellor towards an infant with hereditary defects, with the latter asserting that he or she would not have been born at all if not for the counsellor's negligence. This negligence allegedly lies in the failure on the part of the defendant adequately to advice the parents or to conduct properly the relevant testing and thereby prevent the child's conception or birth (where unimpaired life was not possible). This paper will offer support for the thesis that it would be both feasible and desirable to endorse "wrongful life" compensation actions. The genetic counsellor owed a duty of due professional care to the impaired newborn who now claims that but for the counsellor's negligence, he or she would not have been born at all. The plaintiff's defective life (where healthy life was never an option) constitutes a compensable injury. A sufficient causal link may exist between the plaintiff's injury and the defendant's breach of duty of due professional care and an appropriate measure of damages can be allocated to the disabled newborn. Sanctioning a "wrongful life" cause of action does not necessarily entail abandoning valuable constraints with regard to abortion and euthanasia. Nor does it inevitably lead to an uncontrolled slide down a "slippery slope".

Compensation and Redress↗
PubMed1998

Antineurofilament antibodies in postpolio syndrome.

We determined the levels of antineurofilament antibodies in 29 patients with postpolio syndrome (PPS), 26 stable postpolio (PP) patients, 22 patients with ALS, and 20 normal controls (NCs). Patients with PPS had higher antibody levels to cholinergic neurofilaments than did all other groups. PP patients and those with ALS had antibody levels similar to those of NCs. The antibody binding level showed no relation to the age of the patients, duration of disease, or motor score.

Adult↗
PubMed1996

A prospective cohort study of the effect of vincristine on audition.

We conducted a prospective cohort study of the possible ototoxic effect of vincristine among patients treated for lymphoproliferative malignancies. No deleterious effect of moderate doses of vincristine on pure tone audiometry for air and bone conduction and on speech audiometry could be found. Nevertheless, the isolated finding of sensorineural hearing loss in the only patient who received a high dose of vincristine raises the issue of ototoxicity as a possible dose-related and dose-limiting side effect of vincristine.

Adult↗
PubMed1994

Improving regulation of care.

The JDC-Brookdale Institute of Gerontology, in collaboration with Israel's Ministry of Labor and Social Affairs and Ministry of Health, has developed a program to improve government regulation of long-term care institutions for the elderly, and thus the quality of institutional care. The aim of the program was to introduce greater uniformity and objectivity into the existing surveillance system, increase the participation of institution residents, and ensure public access to instruments and criteria. The tracer methodology was used and tracers representing the medical, nursing, psychosocial and environmental-operational areas were developed in consultation with specialists in each field. The program was welcomed by surveillance personnel, and implemented on a nation-wide basis. Although there have been difficulties with its implementation, these have largely been resolved through discussion, workshops and supplementary training for surveyors. Due to the program's success, new programs are being developed to improve the regulation of other kinds of institution.

Aged↗
PubMed1991

[Extracorporeal shock wave lithotripsy for cystine urolithiasis].

We present 31 patients with cystine urolithiasis referred to our extracorporeal shock wave lithotripsy (ESWL) center since 1985. This group differed statistically from the other 3000 patients treated by us for urolithiasis with regard to age, stone burden, number of previous operations, and known duration of urolithiasis. The average known duration in those with cystine stones was 15 years. Of 26 patients with such a history, 22 had an average of 2 operations each. At referral, 14 had bilateral stones and among the others there were 5 nonfunctioning kidneys. Of 26 referred with a diagnosis of cystine nephrolithiasis, only 11 were being treated medically. At presentation, 31 had no stones and 1 was being treated medically. In the other 29 patients, 44 renal-ureteral units had urolithiasis. During follow-up 2 ureteral stones were discharged spontaneously and the other units were treated by ESWL, surgery and/or ureteroscopy, and percutaneous irrigation. 36/42 units were free of significant stone residue, but in 4 there were large gravel remains; 1 kidney was removed primarily and 1 kidney lost its function following prolonged obstruction after ESWL. During follow-up, of 11 patients unable to tolerate D-penicillamine and treated by urinary alkalinization alone, 3 have already formed new stones.

Cystine↗
PubMed1991

Persistent and progressive parkinsonism after discontinuation of chronic neuroleptic therapy: an additional tardive syndrome?

Drug-induced parkinsonism is usually reversible, except in a small percentage of elderly patients. We describe two relatively young patients, who developed drug-induced parkinsonism during chronic treatment with neuroleptics for a psychotic disorder. Parkinsonism persisted, and markedly and progressively deteriorated after discontinuation of neuroleptic drugs. One patient had tremor as the most prominent sign and the other had mainly an akinetic-rigid syndrome. Neither had ever developed tardive dyskinesia. Both responded to levodopa therapy. Persistent drug-induced parkinsonism in our, and other reported on, elderly patients may be due to unmasking of preexisting subclinical idiopathic Parkinson's disease by neuroleptics. Theoretically, these drugs may precipitate degeneration of vulnerable, nigrostriatal neurons by generating cytotoxic free radicals or by attrition, due to accelerated neuronal firing rates.

Adult↗
PubMed1990

Sensorineural hearing loss associated with vincristine treatment.

We describe a 64-year-old patient with multiple myeloma who developed a sudden sensorineural hearing loss shortly after receiving chemotherapy with vincristine. Ototoxicity is not a known side effect of this drug. It would be of interest to perform repeated audiograms on patients receiving vincristine, in order to appreciate the actual ototoxicity of this drug.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

[Thyroglossal duct cyst].

Thyroglossal duct cysts are embryologic anomalies arising from epithelial remnants of the duct left after the descent of the developing thyroid. Clinical, operative and pathological findings in 124 patients operated on in the past 14 years were analyzed. There were 60 males and 64 females. 69 (56%) were under 10 years of age and the youngest was 6 months old. 26 (21%) were over the age of 30, and the oldest was 72 years old. All excisions were performed in accordance with the Sistrunk procedure, which includes removal of the body of the hyoid bone. Overall recurrence was 6.4%, but in infected cysts or cysts with a fistula to the skin, it was 3.5 times greater. In 20% the cyst was located off the midline. The lining of the cysts was cuboidal, columnar, pseudostratified or stratified squamous epithelium, and varied according to the location of the cyst. There were no malignant changes.

Adolescent↗
PubMed1988

Bilateral Baker's cyst as the presenting symptom of paraneoplastic syndrome.

Paraneoplastic syndrome is defined as a systemic malignancy producing prostaglandins or other substances that lead to various manifestations, syndromes or diseases. In the following report we present a case of a young patient complaining of bilateral Baker's cysts who ultimately was diagnosed as suffering from gastric lymphoma. Following subtotal gastrectomy the Baker's cysts disappeared with no specific treatment.

Adult↗
PubMed1988

In vitro response of cervical cancer cell lines CaSki, HeLa, and ME-180 to the antiestrogen tamoxifen.

The effect of tamoxifen, a nonsteroidal antiestrogenic drug, on the in vitro growth of three cell lines derived from carcinoma of the uterine cervix (HeLa, CaSki, ME-180) was studied using the breast cancer cell line MCF-7 as a tamoxifen-sensitive control. Logarithmically growing cells were fed daily with medium containing 5% dextran-charcoal-treated fetal bovine serum (D5) and 0, 1, 2.5, 5, 7.5, or 10 microM tamoxifen. The cell number in replicate cultures was assessed every other day by cell counts. Growth inhibition was expressed as the percentage of the cell number in control cultures fed with D5. At a concentration of 5 microM tamoxifen, a clear decrease in cell proliferation, resulting in 66-74% inhibition of growth, was observed with MCF-7, HeLa, and ME-180 after 6 days of exposure to tamoxifen. Doses greater than 5 microM resulted in cytotoxicity and progressive cell loss. With the CaSki cell line, 2.5 microM tamoxifen induced more than 60% growth inhibition and 5 microM tamoxifen was cytotoxic. Tamoxifen-induced growth inhibition was reversed by removing tamoxifen from the cell cultures, and the cells resumed logarithmic growth after a lag period of 24-48 hr. MCF-7, but not the cervical carcinoma, lines required estradiol for complete and rapid recovery of logarithmic growth. Our results indicate that tamoxifen inhibits cell growth of these cervical carcinoma cell lines by a mechanism different from that in MCF-7.

Breast Neoplasms↗