Biomedical subjects
Publications and source records attributed to E Greenberg.
Herpes zoster oticus produces facial paralysis with a low recovery rate. Acyclovir, a specific virostatic drug, was given intravenously in five herpes zoster oticus patients, and in three of them was followed by oral therapy. In follow-ups of 1 to 24 months, one patient had grade I recovery, three patients grade II, and one grade III. These good results encourage the use of acyclovir in herpes zoster oticus patients.
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Diving-related inner ear barotrauma (IEB) and inner ear decompression sickness (IEDS) most often result in permanent severe cochleovestibular deficits, unless immediate diagnosis is reached and the correct treatment is commenced early. Nine cases of sport-diving-induced inner ear injuries that were referred to the Israeli Naval Hyperbaric Institute between October 1987 and September 1989 are presented with regard to evaluation, treatment, and follow-up. The diagnosis was IEB in five divers and IEDS in four. Explorative tympanotomy was carried out with remarkable results in two patients with IEB, while the remaining three were relieved by bed rest alone. Three of the four IEDS patients were recompressed according to the extended US Navy Table 6 with good short-term results. The role of complete otoneurological evaluation in the decision-making process leading to the correct diagnosis and treatment is emphasized.
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This study examined the antibiotic resistance patterns of group B streptococci (GBS) isolated from gravid women. A total of 156 vaginal and cervical isolates of GBS were examined for resistance to penicillin, ampicillin, clindamycin, cefoxitin, gentamicin, and erythromicin. No resistance to penicillin or ampicillin was found, nor was penicillinase production demonstrated. A high level of resistance to gentamicin was noted (91%). Of the isolates examined, 9, 9.5, and 15.3% exhibited either resistance or intermediate susceptibility to erythromycin, clindamycin, and cefoxitin, respectively. Thirty strains (19%) exhibited a multiple antibiotic resistance pattern. Given the high penicillin and ampicillin treatment failure rates when attempting to eradicate vaginal GBS colonization and our findings of higher and multiple drug resistance patterns of GBS, the selection of an alternative antibiotic regimen is of considerable clinical importance. We recommend that routine reporting of GBS susceptibilities by clinical laboratories be adopted.
Neuroendocrine carcinoma (carcinoid), is a rare laryngeal malignancy with aggressive behavior. The 5-year survival rate is only about 10%, mainly because of distant metastases. We describe a patient with neuroendocrine carcinoma of the larynx, large cell type, without evidence of regional or distant metastases. Treatment included total laryngectomy and adjuvant radiotherapy to the neck. There was no evidence of disease at 6-month follow-up.
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Two patients with extensive necrotizing otitis externa have been treated by hyperbaric oxygenation. One patient had facial nerve palsy and the other suffered from skull base involvement. Due to severe side effects, the preferred combined intravenous antibiotic therapy was changed to monotherapy in one case and completely withdrawn in the second. This was done before the commencement of hyperbaric oxygenation, while the necrotizing infection was still active. Hyperbaric oxygenation therapy was followed by complete resolution of the necrotizing otitis externa, which did not recur. The pathogenesis of the disease and mechanisms by which hyperbaric oxygenation might be of benefit are described. We conclude that hyperbaric oxygenation should be considered as adjuvant therapy for necrotizing otitis externa whenever a therapeutic pressure chamber is available.
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The purpose of this investigation was to compare the effect of body posture on gastric emptying measurements of radiolabeled meals. Eight healthy male subjects were studied on four separate days. During each study subjects were fed a standardized meal of beef stew labeled with technetium-99m sulfur colloid, and orange juice. Measurements of solid-phase gastric emptying rates were obtained by a gamma camera. Subjects were studied in the lying, sitting, standing, or combined sitting-standing postures. The results demonstrated that the lying position significantly slowed gastric emptying compared to all other positions. Conversely, a decrease in emptying times of 51% and 35% occurred in the combined sitting-standing position compared to the lying and sitting position. These results support a marked effect of body posture on the radionuclide measurement of gastric emptying.
Circadian changes in drug absorption have been documented for several orally administered drugs in humans. To determine whether gastric emptying could account for these changes, morning (8 AM) and evening (8 PM) gastric emptying rates were measured in 16 healthy male subjects synchronized with diurnal activity and nocturnal rest. Gastric emptying half-times for the evening meal were significantly (p less than 0.001) longer for solids but not liquids when compared with morning emptying half-times. The increase in evening meal emptying time (53.6%) may account for the evening delay in reaching peak plasma concentrations documented for several drugs.
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Tumors of smooth muscle origin are rare in the oral cavity. To date, only eighty-three cases of oral leiomyomas have been reported. A first case of tonsillar leiomyoma in a 73-year-old male is presented. The theories of origin and the various histologic types of oral leiomyomas are discussed. Leiomyoma can easily be confused with other spindle-cell tumours. Special stains are necessary to reach a correct diagnosis. It is sometimes difficult to differentiate benign leiomyoma from malignant leiomyosarcoma. The use of mitotic figure count to indicate malignant behaviour is not always reliable. The need for wide surgical excision of the tumour, complete sectioning and examination of the specimen and meticulous follow-up of the patient for evidence of recurrence are emphasized.
The nucleotide sequence of the glg B gene, coding for branching enzyme (EC 2.4.1.18), was elucidated. It consists of 2181 base pairs specifying a protein of 727 amino acids. The deduced amino acid sequence was consistent with the amino acid analysis that was obtained with the pure protein as well as with the molecular weight determined from sodium dodecyl sulfate-gel electrophoresis. The deduced amino acid sequence was also consistent with the amino-terminal amino acid sequence and the amino acid sequence analysis of various peptides obtained from CNBr degradation of purified branching enzyme.
A mutant strain of Escherichia coli K-12, designated 618, accumulates glycogen at a faster rate than wild-type strain 356. The mutation affects the ADPglucose pyrophosphorylase regulatory properties (N. Creuzat-Sigal, M. Latil-Damotte, J. Cattaneo, and J. Puig, p. 647-680, in R. Piras and H. G. Pontis, ed., Biochemistry of the Glycocide Linkage, 1972). The enzyme is less dependent on the activator, fructose 1,6 bis-phosphate for activity and is less sensitive to inhibition by the inhibitor, 5'-AMP. The structural gene, glgC, for this allosteric mutant enzyme was cloned into the bacterial plasmid pBR322 by inserting the chromosomal DNA at the PstI site. The glycogen biosynthetic genes were selected by cotransformation of the neighboring asd gene into an E. coli mutant also defective in branching enzyme (glgB) activity. Two recombinant plasmids, pEBL1 and pEBL3, that had PstI chromosomal DNA inserts containing glgC and glgB were isolated. Branching enzyme and ADPglucose pyrophosphorylase activities were increased 240- and 40-fold, respectively, in the asd glgB mutant, E. coli K-12 6281. The E. coli K-12 618 mutant glgC gene product was characterized after transformation of an E. coli B ADPglucose pyrophosphorylase mutant with the recombinant plasmid pEBL3. The kinetic properties of the cloned ADPglucose pyrophosphorylase were similar to those of the E. coli K-12 618 enzyme. The inserted DNA in pEBL1 was arranged in opposite orientation to that in pEBL3.
This study is an examination of the economic consequences of invasive electrophysiologic (EP) evaluation for recurrent supraventricular tachycardia (SVT) and ventricular tachycardia (VT) on a tertiary health care facility during 1980 and 1981. The average cost of hospitalizations for EP evaluation was substantial (SVT, $6,990; VT, $13,897), as was the length of hospital stay (SVT, 12 +/- 8 days; VT, 24 +/- 8 days). The cost of a single EP procedure in the study period averaged $695 (range $200 to $1,206). During follow-up (1 to 3 years), there was substantial improvement in arrhythmia control on EP-based therapy in SVT and VT compared with prior empirical therapy. Cost:benefit analysis strongly favored EP-based therapy over empirical therapy (SVT, 6:1; VT, 18:1) in this follow-up period. Comparison with cost of noninvasive techniques for VT evaluation showed that EP evaluation had comparable cost. Current prospective reimbursement schedules have no DRG category for EP evaluation and do not fairly compensate hospitals for invasive or noninvasive arrhythmia studies. Invasive EP evaluation is both clinically effective and cost-effective in the management of patients with recurrent SVT and VT. Prospective reimbursement plans should include a specific DRG category for these studies.
Elliptinium (2-N-methyl-9-hydroxyellipticinium), a chemotherapeutic agent whose mechanism of action has not been completely elucidated, intercalates into DNA. In this Phase I clinical trial, the schedule of drug administration consisted of weekly intravenous infusions. Twenty-nine patients were evaluable for toxicity. The initial dose level was 40 mg/m2 and was escalated to 150 mg/m2 through six levels. The dose-limiting side effects were emesis, xerostomia, and azotemia. The lack of myelosuppression was the most striking feature. Objective responses (partial remission, minor response) were seen in one patient each with Hodgkin's disease, non-Hodgkin's lymphoma, breast cancer, and nasopharyngeal carcinoma. We recommend a Phase II evaluation of elliptinium at a dose of 100 mg/m2 on a weekly schedule.
The delayed images of the four-phase 99mTc phosphonate bone scan are compared with the delayed images of the three-phase study in patients with diabetes mellitus and/or peripheral vascular disease and suspected osteomyelitis. Three-phase bone imaging includes an immediate postinjection radionuclide angiogram, a blood-pool image, and delayed static images to 7 hr. The four-phase study adds a 24-hr static image. The scan is positive for osteomyelitis if images show progressively increasing lesion to background activity ratios over time. The results of analyzing 21 three- and four-phase bone scans in 17 patients were correlated with clinical course, cultures, and/or x-rays, gallium scans, and CT scans. The accuracy of four-phase bone imaging for diagnosing osteomyelitis was 85%; for three phase, 80%. Sensitivity for four phase was 80%; specificity was 87%. Sensitivity for three phase was 100%; specificity was 73%. Since overall accuracy of the four-phase study is slightly better than three phase, in these patients with diabetes mellitus and/or peripheral vascular disease, the addition of a 24-hr image, creating a four-phase bone scan, is recommended.