Biomedical subjects
Publications and source records attributed to I E Priel.
Pulmonary extralobar sequestration is a rare anomaly, usually diagnosed during the first months of life. A case of extralobar pulmonary sequestration in an adult, manifesting itself as massive hemothorax, is presented.
Theophylline is widely used by patients with asthma and chronic obstructive pulmonary disease as a bronchodilator. The therapeutic range is relatively narrow: 10-20 mcg/ml. In a survey of 344 blood samples from 290 patients over a period of 12 months, 60% had levels lower than 10 mcg/ml, and only 28% were within the therapeutic range. This was especially the case among those using oral preparations. Our data raise several questions concerning the individualization of theophylline dosage, the effectiveness of its routine blood monitoring, and the implications of these results for ambulatory patients who are possibly being under treated.
All cases of tuberculous lymphadenitis admitted over a 43-year period (1951-1993) were surveyed. The diagnosis was validated in 188 cases. The incidence was 2.74 cases per year, but there was a cluster of 94 cases in the first 20 years. 50.8% had local signs alone, while 36.4% had both local and systemic signs. Nodes affected showed either painless or painful swelling, and sometimes there was drainage. Cervical nodes were affected most frequently, and the commonest general symptom was fever, followed by fatigue. In 28.8% there was pulmonary tuberculosis, in 14.4% other forms of extrapulmonary tuberculosis, and in 9.3% only active tuberculous lymphadenitis. Most of the patients had immigrated to Israel from eastern Europe and the Yemen. Though tuberculous lymphadenitis has become infrequent, it is still the commonest form of extrapulmonary tuberculosis. A high index of suspicion is needed to diagnose accurately and treat this potentially curable condition.
Cat scratch disease (CSD) is usually manifested in children and young adults as a benign, chronic self-limited lymphadenopathy. However, various atypical presentations have been described, especially in immunocompromised hosts. 1 of 5 cases of CSD diagnosed here during 1985-1993 is presented. In 3 cases the diagnosis was supported by lymph node biopsy in which the organisms were visualized by Warthin-Starry silver impregnation staining. Recent publications indicate that Afipia felis and Rochalimaea henselae, both Gram-negative bacilli, were isolated from infected lymph nodes in CSD. The usual benign course does not necessitate antibiotic therapy. The antimicrobial agents effective in cases with systemic symptoms were rifampicin, ciprofloxacin, trimethoprim-sulfamethoxazole and gentamicin. In view of the increasing number of cats, an increased incidence of CSD may be expected. The mechanism of transmission from cat to man is still unknown. Fleas or ticks may be involved. Hopefully, recent advances in the identification of the causative organisms may lead to the development of serological tests, reducing the need for skin testing and lymph node biopsy.
Vivid descriptions of life-threatening asthma attacks have persisted into modern medicine since antiquity. Asthma is characterized by airway hyperresponsiveness--a condition of an exaggerated bronchoconstriction in response to a variety of stimuli (irritants and triggers). Over the past decade it has become clear that in asthma significant inflammation occurs in the airways. Airway hyperresponsiveness and the clinical asthma symptomatology may be at least in part dependent on the inflammation generated by cell mediated immune mechanisms, including T cells, macrophages as well as mast cells and eosinophils in the airways. However, the recent advances in the understanding of the pathogenesis and pathophysiology of asthma, new modes for the diagnosis of the disease and the development of various therapeutic options have not been accompanied by increased survival rate. On the contrary, a gradually rising death rate from asthma has been reported worldwide. The reasons for this are not completely understood. Controversy exists whether an increase in the prevalence or the case fatality rate or both are the main cause of the reported rise in asthma death rate. Genetic, environmental and psychological factors have also been implicated. One has to consider the poorly controlled state in which some patients arrive at emergency wards, the possible delay in adequate therapy due to psychological and socioeconomic factors and also the information implicating iatrogenic factors among the possible explanations for increased asthma mortality. It is imperative to improve patient and family education to increase awareness. Conflicting results in the medical literature regarding the medical therapy of asthma impose a great responsibility on the practising physician. It is necessary to improve physician knowledge of the modern therapeutic strategies in asthma to gain better control of the disease. Pending further clarification as to optimal management of asthma, and forthcoming new and novel treatment, management should rely on current guidelines, emphasizing the role of antiinflammatory therapy in severe asthma. It is desirable to improve emergency services to deliver expert care in life-threatening conditions as soon as possible.
While blunt trauma to the spleen may result in various clinical features, it sometimes may not cause symptoms. A 59-year-old man presented with fever 2 weeks after minor chest trauma. Initial investigation suggested a myeloproliferative disorder. However, abdominal ultrasonography established the diagnosis of subcapsular and intrasplenic hemorrhage. Management was conservative and he was discharged after 13 days.
A 24-year-old male with recurrent hemoptysis due to idiopathic pulmonary hemosiderosis and celiac sprue developed infranodal heart block necessitating implantation of a pacemaker. A possible common underlying mechanism is discussed.