A rare association of rhabdomyolysis and purpura fulminans in Strep. pneumoniae septicemia.
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Aged↗
Biomedical subjects
E L Marcus
Publications and source records attributed to E L Marcus.
Autosomal dominant carpal tunnel syndrome in a Karaite family.
A clinical examination and a history of 64 members belonging to four generations of a Karaite kindred revealed 11 patients with carpal tunnel syndrome (CTS). Bilateral involvement and early age of onset are salient features. The mutation may be traced in four generations. Hereditary primary CTS may be more prevalent than hitherto suspected.
Adult↗
An unusual case of POEMS syndrome.
A 58-year-old woman presented with a history of premature onset of menopause, longstanding hepatosplenomegaly, monoclonal gammopathy, lower limb polyneuropathy of recent onset, diabetes mellitus, excessive perspiration and leg edema. Polyneuropathy and excessive perspiration improved following a course of prednisone and melphalan. The clinical and pathophysiological features fit the rare entity known as POEMS syndrome.
Drug Therapy, Combination↗
Pharmacokinetics of vidarabine in the treatment of infants and children with infections due to herpesviruses.
The pharmacokinetics of vidarabine were studied on 22 occasions in nine infants and three older children with herpesvirus infection. The drug was administered for 10 days in doses of 15-30 mg/kg per day. Vidarabine was not detected in the serum of any patient, although small quantities were detected in the urine of two of the older children. Peak serum concentrations of arabinosyl hypoxanthine, the major metabolite of vidarabine, ranged from 2.3 to 11.4 micrograms/ml. Concentrations of this metabolite were higher in two preterm infants than in full-term infants receiving comparable doses. The mean elimination half-life estimated from cumulative urinary excretion was 2.4 hr in a preterm infant, 3.1 hr in full-term infants, and 2.8 hr in older children. Neither clearance nor half-life changed when multiple doses were administered. Vidarabine and arabinosyl hypoxanthine did not accumulate during therapy. The rates of recovery of drug from the urine and of renal clearance of arabinosyl hypoxanthine were directly related to the age and maturity of the patient. Arabinosyl hypoxanthine readily diffused into cerebrospinal fluid.
Arabinonucleosides↗
Light and electron microscopy of liver in hyperlipoproteinemic patients under long-term gemfibrozil treatment.
The effects of long-term gemfibrozil (Lopid) therapy on human liver structure are not known. Studies of this nature are becoming essential in determining the risk/benefit ratio since gemfibrozil is an effective agent for the control of hyperlipoproteinemia types IIa, IIb, and IV. Particularly, gemfibrozil is effective when dietary management or available therapeutic control fail to reduce serum cholesterol and triglycerides as well as normalizing the lipoprotein pattern. Percutaneous liver biopsies of 9 patients on long-term gemfibrozil therapy were evaluated by light microscopy, interference contrast optics and transmission electron microscopy. The distribution of patients according to lipoprotein phenotype was 3 Type IIa, 3 Type IIb, and 3 Type IV. Their lipoprotein patterns approached normal and the serum lipids were controlled during gemfibrozil therapy. By light microscopy, the lobular architecture and other parameters were within normal limits. Varying degrees of fatty change were found as would be expected. No preferential lobular disposition of the fat globules was evident. Coalescence of fat droplets, nuclear displacement and fatty cysts were noted. Differential interference contrast microscopy revealed several degrees of contrast amplitude in these droplets suggesting a heterogeneous lipid deposition in hepatocytes. The subcellular analysis revealed a moderate degree of glycogen deposition, absence of nuclear abnormalities and unremarkable mitochondria; the rough endoplasmic reticulum was not significantly altered and smooth surfaced membranes appeared proliferated. Detailed analysis of the peroxisome population showed matrix rarefaction, marginal plate formation and spurious densities though no significant proliferation occurred. Distribution of peroxisomes in hepatocytes varied widely from cell to cell and in different lobular areas. This study confirmed the association of hepatic fatty change with hyperlipoproteinemia irrespective of the pattern observed in circulating lipoproteins. Peroxisome proliferation, as seen in rodents when receiving gemfibrozil, did not occur and the structure of these subcellular organelles was not compromised. It was concluded that the long-term administration of this compound did not show adverse effects on the hepatocyte in hyperlipoproteinemia.
Gemfibrozil↗
Arabinosyladenine monophosphate in genital herpes: a double-blind, placebo-controlled study.
A double-blind, placebo-controlled study was performed in 55 male patients with recurrent herpes simplex genitalis. The 29 patients who received topical arabinosyladenine monophosphate (ara-AMP) showed no significant difference in viral shedding, duration of pain, healing time or development of new lesions as compared to 26 placebo-treated patients. Ara-AMP was well-tolerated when topically applied. Serum neutralizing antibody titers did not change significantly during the acute and convalescent periods of the patient's recurrent HSG attacks. We conclude that ara-AMP, when applied topically as a 10% gel five times a day within 24 h of onset of recurrent HSG, does not influence the virologic and clinical evolution of the recurrent episode.
Administration, Topical↗
Hypoxanthine-arabinoside pharmacokinetics after adenine arabinoside administration to a patient with renal failure.
Hypoxanthine arabinoside pharmacokinetics were measured during an adenine arabinoside continuous intravenous infusion and during hemodialysis in a patient with renal failure. Therapeutic guidelines for adenine arabinoside in renal failure are provided based on an elimination half-life of 4.7 h and a plasma clearance of 87.9 ml/min for the hypoxanthine metabolite.
Acute Kidney Injury↗
Ribonuclease as antiviral agent in milk.
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Animals↗
Hepatitis C virus infection among elderly patients in a geriatric hospital.
The aim of the study was to determine the prevalence of anti-hepatitis C virus (HCV) antibodies and HCV viremia among elderly patients in a geriatric hospital in Jerusalem, Israel. Serum samples from 273 patients were analyzed for the presence of anti-HCV antibodies. Serum samples of anti-HCV positive patients were analyzed for HCV RNA after amplification with the polymerase chain reaction (PCR). The samples were also analyzed for the presence of HBsAg and the HBsAg positive samples were analyzed for the presence of hepatitis B virus (HBV) DNA. Anti-HCV antibodies were found in 5 patients (1.8%). HCV RNA was detected in one of the 5 patients. HbsAg was found in 2 patients (0.7%). None had detectable HBV DNA. The findings of the study indicate that seropositivity for hepatitis C virus is relatively common among the elderly population studied. Most of those patients are probably not HCV carriers.
Journal Article↗
Epidemiology of hepatitis C virus infection in the elderly.
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Aged↗
Antimicrobial resistance patterns among urine isolates from patients in a geriatric hospital and from older patients in a general hospital in Jerusalem.
INTRODUCTION AND RATIONALE: Urinary tract infection is the most common cause of nosocomial infections in patients hospitalized in chronic care facilities. The changing spectrum of microorganisms involved in urinary tract infections and the emerging resistance require continuous monitoring to provide crucial information to guide empirical therapy and encourage prudent use of antibiotics. The aim of this survey was to assess the antimicrobial resistance profile of urine isolates from patients hospitalized in a geriatric hospital and from elderly patients hospitalized in an acute care hospital in order to guide empirical therapy of urinary tract infections. METHODS: The survey was performed in two hospitals in Jerusalem: a university-affiliated geriatric hospital- Herzog -and an acute secondary- and tertiary-care university hospital- Hadassah. We performed a retrospective analysis of antimicrobial resistance of all positive urine cultures obtained from patients in the geriatric division of Herzog Hospital and from patients aged 65 years and older hospitalized in the Internal Medicine departments in Hadassah Hospital during a 1-year period. RESULTS: The most common bacteria isolated from urine specimens in Herzog Hospital were, in order of frequency, Escherichia coli, Proteus mirabilis, and Pseudomonas aeruginosa. We demonstrated a high rate of antimicrobial resistance of those bacteria in both hospitals. The pattern we observed necessitates recommending ceftazidime as the most appropriate empirical therapy for urinary tract infection in Herzog Hospital. In Hadassah Hospital we recommend cefuroxime for those patients in good general condition and ceftazidime for those who present with clinical sepsis. Antimicrobial resistance patterns should be assessed periodically and recommendations modified accordingly. Infection control guidelines should be implemented in order to try to decrease the rate of antimicrobial resistance. Further research is requested to assess the efficacy of such interventions in long-term care facilities.
Journal Article↗
Determination of serum albumin in older adults. A need for specification of the assay method.
OBJECTIVES: To assess the difference between two colorimetric methods for serum albumin determination, bromocresol purple (BCP) and bromcresol green (BCG), in patients hospitalized in a geriatric hospital. DESIGN: Prospective study of consecutive blood samples. SETTING: A 200-bed Geriatric Division of a university-affiliated geriatric-psychiatric hospital. PARTICIPANTS AND MEASUREMENTS: All serum albumin determinations were obtained from patients hospitalized in the geriatric division during a 3-month period, November 1999 through January 2000. All albumin determinations were performed by two methods: BCP and BCG. RESULTS: A total of 326 serum albumin determinations were performed during the study period. The average serum albumin levels observed were 28.2+/-7.5 g/L and 37.6+/-7.2 g/L for the BCP and BCG methods, respectively. Using the BCP method, 80.1% of serum albumin levels were below 35.0 g/L (cutoff point for hypoalbuminemia) versus 41.1% using the BCG method. CONCLUSIONS: The widespread use of both BCG and BCP and the marked clinical implications of their alternative use underscores the importance of specifying the method employed in determination of serum albumin in routine laboratory analyses. Moreover, physicians need to be aware of which procedure is being used in their hospital.
Journal Article↗