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Eitan Segev

Publications and source records attributed to Eitan Segev.

15 recordsLinked to original sources

Two regions in the N-terminal domain of ionotropic glutamate receptor 3 form the subunit oligomerization interfaces that control subtype-specific receptor assembly.

The N-terminal domain (NTD) of alpha-amino-3-hydroxy-5-methylisoxazolepropionate (AMPA) and kainate glutamate receptors plays an important role in controlling subtype specific receptor assembly. To identify NTD subdomains involved in this process we generated AMPA glutamate receptor 3 (GluR3) mutants having intra-NTD substitutions with the corresponding regions of the kainate receptor GluR6 and tested their ability to form functional heteromers with wild-type subunits. The chimeric design was based on the homology of the NTD to the NTD of the metabotropic GluR1, shown to form two globular lobes and to assemble in dimers. Accordingly, the NTD was divided into four regions, termed here N1-N4, of which N1 and N3 correspond to the regions forming lobe-1 and N2 and N4 to those forming lobe-2. Substituting N1 or N3 impaired functional heteromerization but allowed protein-protein interactions. Conversely, exchanging N2 or N4 preserved functional heteromerization, although it significantly decreased homomeric activity, indicating a role in subunit folding. Moreover, a deletion in GluR3 corresponding to the hotfoot mouse mutation of the glutamate receptor delta2, covering part of N2, N3, and N4, impaired both homomeric and heteromeric oligomerization, thus explaining the null-like mouse phenotype. Finally, computer modeling suggested that the dimer interface, largely formed by N1, is highly hydrophobic in GluR3, whereas in GluR6 it contains electrostatic interactions, hence offering an explanation for the subtype assembly specificity conferred by this region. N3, however, is positioned perpendicular to the dimer interface and therefore may be involved in secondary interactions between dimers in the assembled tetrameric receptor.

Alanine↗

Early experience with the Ponseti method for the treatment of congenital idiopathic clubfoot.

BACKGROUND: The preferred conservative treatment for congenital idiopathic clubfoot deformity remains a controversial issue. OBJECTIVES: To compare the outcomes of two groups of CICF patients who underwent two different treatment protocols. METHODS: The study cohort included 72 infants treated in our hospital from August 1998 to December 2002. Group 1 comprised 40 infants (61 clubfeet) who were treated by a traditional method (a modification of the Kite and Lovell technique), and group 2 consisted of 32 infants (48 clubfeet) treated with the Ponseti technique. Both groups were similar in age, gender and severity of the deformity (Dimeglio scoring system). RESULTS: After an average follow-up of 54.9 months (range 44-68), 35 (57%) clubfeet in group 1 required surgical intervention and 27 (44%) clubfeet had a residual deformity at last follow-up. In the Ponseti group, 45 (94%) clubfeet were fully corrected at last follow-up (average 29.2 months, range 16-45) while 3 (6%) clubfeet had residual deformity and required surgery. Achilles tendon tenotomy was performed with no complications in 47 clubfeet (in group 2) at an average age of 2.4 months (range 2-4 months). CONCLUSIONS: Even after a relatively short follow-up period, our success rate with the Ponseti approach already appears to be significantly higher and to bear fewer complications than the traditional treatment, in agreement with the results published by other medical centers. We now endorse the Ponseti technique of conservative manipulative treatment for congenital idiopathic clubfoot in our department.

Achilles Tendon↗

[Selective laser trabeculoplasty treatment for medication-refractory open angle glaucoma].

BACKGROUND: Selective laser trabeculoplasty (SLT) is a new method to reduce intraocular pressure in eyes with primary open angle glaucoma. The laser parameters are set to selectively target pigmented trabecular meshwork (TM) cells without damage to the adjacent non-pigmented tissue. PURPOSE: A clinical retrospective study was conducted to evaluate the 12 months results of SLT in the treatment of medically uncontrolled open angle glaucoma. PATIENTS AND METHODS: During the period March to September 2004, the authors performed a SLT in 50 patients (50 eyes) with open angle glaucoma uncontrolled on maximally tolerated medical therapy. Treatment was carried out with a frequency-doubled, Q-switched Nd:YAG laser 532 nm.(Selectra 7000 Laser Coherent, Inc., Palo Alto,CA). Approximately 85 to 90 non-overlapping laser spots were placed over 180 degrees of the trabecular meshwork at energy levels ranging from 0.6 to 1.4 mJ per pulse. In patients who required additional SLT therapy, the untreated 180 degrees was treated. During the follow-up period, patients were treated with antiglaucoma medications as required. The success rates were defined as decreases in intraocular pressure (IOP) of 3 mmHg or more with no additional medications, laser, or glaucoma surgery. RESULTS: The mean IOP reduction from baseline 6 months after treatment was 21% and 20% after 12 months. The success rates were 66% after 6 months and 55% after 12 months. Four eyes (8%) did not respond to SLT. One hour after SLT, an increase in IOP of more than 5 mm Hg was detected in 5 eyes (10%). Seven patients (14%) required additional SLT. CONCLUSIONS: SLT is efficient in lowering IOP in medication-refractory open angle glaucoma. It should be considered in such patients when surgery is contraindicated or refused.

Aged↗

Treatment of severe late onset Perthes' disease with soft tissue release and articulated hip distraction: early results.

Sixteen children with late onset Perthes' disease were surgically treated at an average age of 12 years 1 month (9 years 4 months to 15 years) by soft tissue release and articulated hip distraction. Two patients had additional diagnosis of Down syndrome and one suffered from geleophysic epiphyseal dysplasia. Fifteen hips were graded Catterall IV and Herring C and one hip was graded Catterall III Herring B. On preoperative arthrograms, 14 patients had a saddle-shape subluxating femoral head with hinge abduction. The distraction discontinued when Shenton line was corrected. The fixation lasted 4-5 months. At a mean follow-up of 2 years 7 months (1-5 years), an improvement of hip range of motion was found in all patients. Hip joint arthrograms upon removal of the fixator showed disappearance of the saddle-shape femoral head in 10 of the 14 patients with this deformation. Shenton line breakage improved from 7.6 mm to 2.1 mm at last follow-up. The epiphyseal index improved by 14%. The average pain score on an analog scale dropped from a preoperative 7.0 to 1.6 at last follow-up (filled in by patients or parents in case of Down syndrome). Separate analysis of data from the group having only Perthes disease (13 children) showed better results. These preliminary data suggest that soft tissue release combined with unloading of the femoral head and restoration of joint space can improve the function and epiphyseal height.

Adolescent↗

A combined vertical and horizontal pelvic osteotomy approach for repair of bladder exstrophy: the Dana experience.

BACKGROUND: Bladder exstrophy is a severe congenital defect that requires a multidisciplinary treatment approach. Soft tissue repair may be successful during the first few days after birth, but a combination of pelvic osteotomies and bladder reconstruction is necessary later in life. The combination of externally fixed anterior and posterior osteotomies has biomechanical advantages over previous techniques for achieving primary bladder closure. OBJECTIVES: To describe our experience with a combined vertical and horizontal pelvic osteotomy approach for the repair of bladder exstrophy. METHODS: Four children underwent bladder exstrophy closure; the mean age at surgery was 19 months (range 9-33 months)... We stabilized the osteotomies with a small Synthes AO external fixator, 4.0 mm rod diameter. RESULTS: All four patients had successful bladder repair with no dehiscence; two of them achieved partial continence, and bladder neck reconstruction is planned for the other two. Three of the four patients sustained neurologic injury; two completely recovered, and the third continues to suffer from right drop foot. The average follow-up was 39 months (range 10-60 months). CONCLUSIONS: Vertical and horizontal pelvic osteotomies stabilized by external fixator and bladder repair is an effective treatment for bladder exstrophy.

Bladder Exstrophy↗

The prevalence of glaucoma in patients with sleep apnea syndrome: same as in the general population.

PURPOSE: An association of glaucoma and sleep apnea syndrome (SAS) has been widely reported. We investigated the largest group of patients with SAS thus far to determine the prevalence of glaucoma among these patients. DESIGN: Cross-sectional study. METHODS: An institutional study. STUDY POPULATION: A total of 228 patients with SAS. OBSERVATION PROCEDURES: Sleep studies determined the respiratory disturbance index (RDI) during night sleep. Ocular examination included intraocular pressure (IOP) measurement, optic disk evaluation, and Humphrey visual field examination. MAIN OUTCOME MEASURES: The SAS was diagnosed as an RDI > 10. The RDI was graded to determine the severity of SAS: mild (RDI, 10-19), moderate (RDI, 20-39), and severe (RDI > 40). Open-angle glaucoma was diagnosed when a glaucomatous visual field defect matched the optic disk changes, irrespective of IOP levels. RESULTS: Nineteen participants had mild SAS (mean +/- standard deviation, RDI = 15 +/- 3), 129 had moderate SAS (RDI = 28 +/- 5), and 80 had severe SAS (RDI = 54 +/- 11). Open-angle glaucoma was found in five SAS subjects, a prevalence of 2% (95% confidence interval, 0.7% to 5%). There was no correlation between RDI and the presence of glaucoma (chi-square = 1.18; degrees of freedom = 2; P =.6) or between the RDI and the IOP (r = -0.067; P =.316). CONCLUSION: The prevalence of glaucoma in SAS patients was similar to that in the general Caucasian population.

Adult↗

Stabilization of post-trabeculectomy flat anterior chamber with Healon and sulfur hexafluoride.

We present the management of 2 cases of post-trabeculectomy flat anterior chamber with hypotony due to an overflowing fistula. When separate attempts to reform the anterior chamber by intracameral injection of sulfur hexafluoride (SF(6)) and sodium hyaluronate 1.0% (Healon) failed, we injected SF(6) 100% with Healon into the anterior chamber. This stabilized the anterior chamber without compromising the integrity of the filtering bleb. No complications were observed. This simple, safe, and effective procedure offers another option for the management of a flat anterior chamber due to overfiltration.

Anterior Chamber↗

[Diode laser cyclophotocoagulation in refractory glaucoma].

PURPOSE: To evaluate the effect of contact transscleral diode cyclophotocoagulation for refractory glaucoma. METHODS: Thirty-three patients with intractable glaucoma were treated with contact diode cyclophotocoagulation. Laser radiation (810-nm) was delivered to the eye by a fiberoptic (G-probe) placed 1.2 mm behind the limbus. Laser setting used was 2 W power for the duration of 2 seconds. Forty to 45 laser spots were applied over 360 degrees. Intraocular pressure (IOP), the number of glaucoma medications, visual acuity and complications were all assessed at last follow-up visit 12 months after laser treatment. Success was defined as IOP of less than 22 mmHg with medications at the last follow-up visit. RESULTS: The mean IOP decreased from 37.8 +/- 8.0 mmHg pre-diode treatment to 18.2 +/- 9.2 mmHg at last follow-up visit after treatment (p < 0.05). About 73% of patients achieved IOP of between 2 and 22 mmHg at final follow-up. The mean number of medications required decreased from 3.4 +/- 1.1 before to 2.4 +/- 1 after treatment (p < 0.05). Fifty five percent of the patients had a deterioration in visual acuity. Other complications were few and included transient hyphema, uveitis, choroidal detachment and hypotony. CONCLUSION: Contact transscleral diode cyclophotocoagulation is effective in lowering IOP and reducing the number of glaucoma medications in refractory glaucoma. The deterioration in visual acuity post-laser is a limitation of the treatment.

Aged↗

Perthes-like changes in geleophysic dysplasia.

Geleophysic dysplasia is a rare skeletal dysplasia characterised by 'happy natured' facies, short stature with short limbs, brachydactyly, and joint contractures. This report describes a case of a patient with unilateral Legg-Calvé-Perthes-like changes associated with dysplastic proximal capital femoral epiphysis, typical to geleophysic dysplasia.

Child↗

Primary subacute epiphyseal osteomyelitis: role of conservative treatment.

Primary subacute epiphyseal osteomyelitis is a rare disease. Owing to its insidious onset, mild symptoms, and inconsistent supportive laboratory data, diagnosis and treatment are usually delayed. The authors report a retrospective review of 16 patients with hematogenous osteomyelitis primarily affecting the epiphysis. In all of these patients an osteolytic lesion developed. In eight patients it was confined to the epiphysis or apophysis alone; in the other patients there was contiguous involvement of the adjacent metaphysis. Complete clinical and radiologic healing was observed in all patients after antibiotic therapy alone. Based on this experience, in view of the controversy in the literature, the authors recommend a conservative treatment policy in the management of both epiphyseal and epiphyseal-metaphyseal subacute osteomyelitis as the treatment of choice. Surgery should be reserved for persistent infection that does not respond to appropriate antibiotic therapy or when bone lesions cannot be distinguished from bone tumors by use of all available imaging modalities.

Anti-Bacterial Agents↗

Epiphyseal involvement of simple bone cysts.

Epiphyseal involvement of a simple bone cyst (SBC) is uncommon. Eight patients are reported in whom an SBC was found to cross the growth plate, involving the epiphysis in seven patients and the apophysis in one. All patients had more than two pathologic fractures. In seven patients growth disturbance was found. Functional impairment did not develop in any patient. Radiographically, all lesions presented a characteristic involvement of the epiphysis and metaphysis in various proportions. Only one of four cysts treated with methylprednisolone acetate injections showed incomplete healing; the others failed to respond. After percutaneous grafting of autologous bone marrow, three of seven cysts healed and the others attained incomplete healing. Epiphyseal involvement of SBC should be considered a more aggressive form of an active lesion.

Adolescent↗