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Biomedical subjects

B Hirshberg

Publications and source records attributed to B Hirshberg.

24 records · Page 2Linked to original sources
PubMed1998

Hypoglycaemia following pancreatic allograft transplantation.

Pancreatic transplantation is an established treatment for patients with insulin-dependent diabetes mellitus. Side-effects are mainly related to surgical complications, immunosuppressive therapy and graft rejection. We report on two patients having recurrent hypoglycaemic events following pancreatic transplantation. The cause of hypoglycaemia in our patients remained obscure. Hypoglycaemia following pancreatic transplantation has been described. Hypoglycaemic events may appear years after transplantation. In the article we review three possible mechanisms of hypoglycaemia: hyperinsulinaemia, secondary to systemic drainage (due to loss of first pass hepatic insulin clearance), presence of anti-insulin antibodies and persistence of counter-regulatory abnormalities. Physicians and patients should be aware of possible hypoglycaemia events following transplantation.

Adult↗
PubMed1997

The syndrome of inappropriate antidiuretic hormone secretion in the elderly.

OBJECTIVE: To determine clinical characteristics of elderly patients presenting with the syndrome of inappropriate antidiuretic hormone secretion (SIADH), their outcome, and the extent of evaluation that is warranted. DESIGN: A retrospective study. SETTING: An 800-bed primary and tertiary care center in Jerusalem, Israel. PATIENTS: Fifty elderly patients, hospitalized with serum sodium levels below 130 mmol/L consistent with a diagnosis of SIADH. MEASUREMENTS: Data collection of the medical history, functional status, physical examination, laboratory evaluation, length of hospital stay, treatment, and outcome. RESULTS: The neurological clinical presentation on admission ranged widely: 48% were fully alert, 42% were stuporotic, and 10% had seizures. Sensorial impairment was significantly associated only with sodium values of less than 110 mmol/L. The majority of patients underwent a comprehensive work-up including chest x-ray, computerized tomography (CT) scans, and thyroid and adrenal function tests. The cause of SIADH in most of the patients remained obscure (60% of cases were idiopathic). The 2 main causes identified were pneumonia in 9 cases (18%) and medication in 6 cases (12%). Most of the patients survived the event; only two patients died, both because of sepsis and not due to hyponatremia. The average hospital stay was 12.8 +/- 9 days. CONCLUSIONS: Elderly patients with SIADH usually have an idiopathic form of this condition and a benign course. Extensive routine diagnostic procedures are not warranted. Simple measures like medical history taking with special emphasis on medications, physical examination, and chest x-rays can lead to a treatable diagnosis in most patients who do not have the idiopathic form of SIADH.

Aged↗
PubMed1997

Yellow nail syndrome.

The yellow nail syndrome was defined as a clinical entity in the 1960s. Although nail abnormalities were the first sign to be noticed, this syndrome is now known to involve multiple organ systems and its association with other diseases is well described. A review of the medical literature is provided.

Humans↗
PubMed1997

Hemoptysis: etiology, evaluation, and outcome in a tertiary referral hospital.

OBJECTIVES: Hemoptysis, an important and alarming symptom, often indicates serious disease. This study was designed to assess the different causes of hemoptysis, the relative importance of the different diagnostic modalities employed, and the outcome in an Israeli population cohort. DESIGN: A retrospective analysis of 208 patients with hemoptysis at the Hadassah University Hospital, Jerusalem, Israel between January 1980 and August 1995. RESULTS: Bronchiectasis (20%), lung cancer (19%), bronchitis (18%), and pneumonia (16%) accounted for most causes of hemoptysis. In contrast to older studies, active tuberculosis was a rare finding (1.4%). Bronchiectasis and bleeding diathesis were major causes of moderate to severe hemoptysis while bronchitis and lung cancer were commonly associated with milder degrees of bleeding. CT scan was the most sensitive diagnostic test when employed alone, with a positive yield of 67%. However, it failed to locate at least three cases of lung cancer. When combining a CT study together with a bronchoscopy, the positive yield increased to 93%. The mortality rate for patients with mild to moderate hemoptysis was low (2.5% and 6%, respectively), while patients with massive hemoptysis had high mortality rates (38%). Patients with lung cancer or bleeding diathesis had higher mortality rates compared with the rest of the cohort. CONCLUSIONS: Hemoptysis is a common symptom with a good prognosis in most cases. However, patients exhibiting massive bleeding or those with lung malignancy and patients with bleeding diathesis had a poorer prognosis. Patients older than 50 years with a positive smoking history need an extensive evaluation and follow-up to exclude lung carcinoma. The combined use of bronchoscopy and chest CT has the best yield in evaluating hemoptysis.

Bronchiectasis↗