Myopathy from the combination of simvastatin and amiodarone.
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Letter↗
Biomedical subjects
M Elias
Publications and source records attributed to M Elias.
Systemic lupus erythematosus and inflammatory bowel disease.
We hereby summarize a case reported by the authors, as well as all of the previously reported cases, of patients suffering from both systemic lupus erythematosus (SLE) and inflammatory bowel disease (IBD) that have been published in the English literature. In most cases, SLE was diagnosed prior to IBD, and the latter was of the ulcerative colitis subtype. Interestingly, the first disease diagnosed was almost never active at the time the second disease manifested itself. Patients with both diseases tended to have less photosensitivity, less arthritis, and less serositis than patients with SLE alone. There were no cases with neurological disorders or overt nephritis. All of these patients had anti-dsDNA and there was a tendency towards more anemia and thrombocytopenia. These patients had a relatively benign course with no flare-ups of lupus during follow-up and a favorable course of their bowel disease as well.
Journal Article↗
[The risks of combining medicine and herbal remedies].
The risks of using herbal remedies, considered 'natural', should not be disregarded, as some have serious side effects and some interact with and influence conventional medical therapeutics. The effect may be pharmacokinetic by altering absorption or metabolism, and may be pharmacodynamic, by changing the final effect of the drug. St. John's wort, for example, an antidepressant herbal remedy, may pharmacodynamically interact with specific serotonin reuptake inhibitors (SSRI's), causing a serotonin syndrome. St. Johns wort also causes serious pharmacokinetic interactions by activating the cytochrome CYP3A4, dangerously decreasing blood levels of cyclosporin, warfarin, and theophylline, and reducing the efficacy of contraceptive pills and AIDS therapy. The article presents a review of a number of herbal remedies, commonly used in Israel, that have documented drug interactions, providing details of common indications, adverse reactions and drug interactions of each herbal remedy. Physicians should recognize the fact that patients use herbal remedies, purchased directly at pharmacies or health stores, and be aware of the potential interactions of these remedies with conventional drugs.
Antidepressive Agents↗
Closed system generation of dendritic cells from a single blood volume for clinical application in immunotherapy.
Dendritic cells (DC) used for clinical trials should be processed on a large scale conforming to current good manufacturing practice (cGMP) guidelines. The aim of this study was to develop a protocol for clinical grade generation of immature DC in a closed-system. Aphereses were performed with the Cobe Spectra continuous flow cell separator and material was derived from one volume of blood processed. Optimisation of a 3-phase collection autoPBSC technique significantly improved the quality of the initial mononuclear cell (MNC) product. Monocytes were then enriched from MNC by immunomagnetic depletion of CD19+ B cells and CD2+ T cells and partial depletion of NK cells using the Isolex 300I Magnetic cell selector. The quality of the initial mononuclear cell product was found to determine the outcome of monocyte enrichment. Enriched monocytes were cultured in Opticyte gas-permeable containers using CellGro serum-free medium supplemented with GM-CSF and IL-4 to generate immature DC. A seeding concentration of 1 x 10(6) was found optimal in terms of DC phenotype expression, monocyte percentage in culture, and cell viability. The differentiation pattern favours day 7 for harvest of immature DC. DC recovery, viability, as well as phenotype expression after cryopreservation of immature DC was considered in this study. DC were induced to maturation and evaluated in FACS analysis for phenotype expression and proliferation assays. Mature DC were able to generate an allogeneic T-cell response as well as an anti-CMV response as detected by proliferation assays. These data indicate that the described large-scale GMP-compatible system results in the generation of stable DC derived from one volume of blood processed, which are qualitatively and quantitatively sufficient for clinical application in immunotherapeutic protocols.
Adoptive Transfer↗
Sweet's syndrome and sarcoidosis.
In this review we summarize a number of cases of Sweet's syndrome (SS) associated with sarcoidosis that have been reported in the English literature. In all of the cases, the two disorders were diagnosed simultaneously. Patients with both disorders were younger and had a higher rate of fever than patients with SS alone. In this group of patients, we found a trend toward less skin involvement of the face and trunk, more involvement of the upper limbs, and more atypical skin lesions, particularly papules. The association of the two disorders seems to be more related to a subset of acute sarcoidosis (Lofgren's syndrome). All of the patients in this group had a benign course and self-limiting disease. Thus, SS in association with sarcoidosis could be considered a favorable prognostic factor. Although SS has a high rate of recurrence, no recurrence occurred in this group of patients during follow-up.
Journal Article↗
Genetic control of susceptibility to Candida albicans in susceptible A/J and resistant C57BL/6J mice.
The importance of host factors in determining susceptibility to systemic Candida albicans infections is evident in both humans and mice. We have used a mouse model to study the genetic basis of susceptibility, using the inbred strains A/J and C57BL/6J, which are susceptible and resistant, respectively, based on different parameters of the response to infection. To identify genes responsible for this differential host response, brain and kidney fungal load were measured in 128 [A/J x C57BL/6J] F(2) mice 48 h after infection with 5 x 10(4) C. albicans blastospores. Segregation analysis in this informative population identified complement component 5 (C5/Hc) as the major gene responsible for this differential susceptibility (LOD of 22.7 for kidney, 19.0 for brain), with a naturally occurring mutation that causes C5 deficiency leading to enhanced susceptibility. C5 was also found to control heart fungal load, survival time, and serum TNF-alpha levels during infection. Investigation of the response to C. albicans challenge in a series of AcB/BcA recombinant congenic strains validated the importance of C5 in determining the host response. However, the strains BcA67 and BcA72 showed discordant phenotypes with respect to their C5 status, suggesting additional complexity in the genetic control of the inter-strain difference in susceptibility observed in A/J and C57BL/6J following systemic infection with C. albicans.
Analysis of Variance↗
Multimodal in vivo optical imaging, including confocal microscopy, facilitates presurgical margin mapping for clinically complex lentigo maligna melanoma.
Knowledge of the accurate margins of a lentigo maligna melanoma (LMM) is crucial in the presurgical evaluation of the patient. Towards this end clinicians have utilized the Wood's lamp and dermoscopy to help delineate the borders of the LMM. However, many LMMs arise on photodamaged skin, making it difficult to determine the border of the LMM and separate it from the background lentiginous skin. We present a case of a patient with a recurrent LMM on the scalp that developed in a background of photodamage with diffuse melanocytic atypia and lentigines, making it virtually impossible to determine the precise margins of the LMM by clinical, Wood's lamp or dermoscopic examination. To avoid subjecting the patient to multiple staged excisions we attempted to determine the margins of the LMM by utilizing in vivo confocal laser scanning reflectance microscopy. Using this, it was apparent that there were increased numbers of atypical/dendritic intraepidermal melanocytes in all layers of the epidermis within the LMM. In contrast, skin not involved with the LMM, as viewed under confocal laser examination, had normal honeycomb architecture and no abnormal melanocytes. The confocally determined border was further confirmed by obtaining multiple punch biopsies that were evaluated by haematoxylin and eosin histology and immunohistochemistry. Based on this information, the presurgical margins were marked and the tumour excised accordingly. The excised tissue was examined with multiple-step sections and the margins were determined to be clear. There has been no evidence of tumour recurrence after 1 year. In conclusion, this case illustrates that confocal reflectance microscopy, in conjunction with other in vivo optical instruments, can be utilized to enhance the accuracy for the presurgical margin mapping of LMM.
Aged↗
Cytomegalovirus encephalitis in an immunocompetent pregnant woman.
Presented here is the case of an immunocompetent pregnant woman with probable cytomegalovirus encephalitis. The clinical picture was characterized by diffuse headache, drowsiness and the development of an acute confused state. Diagnosis was based on the documentation of recent cytomegalovirus seroconversion with low avidity for the immunoglobulin G class antibodies. Initially, the diagnosis of encephalitis was challenging due to the subtle findings in cerebrospinal fluid and the normal electroencephalograph results. However, repeated tests revealed findings compatible with the diagnosis of encephalitis. Due to the suspicion of herpes simplex encephalitis the patient was treated with acyclovir. Within a few days rapid resolution of the fever and complete recovery were observed. Cytomegalovirus encephalitis should be considered early in the evaluation of pregnant women if appropriate clinical symptoms are present.
Acyclovir↗
Pneumococcal sepsis due to functional hyposplenism in a bone marrow transplant patient.
Encapsulated bacteria can cause severe infections following bone marrow transplantation, usually in patients with chronic graft-versus-host disease (GVHD). Presented here is the case of an allogenic bone marrow transplantation recipient with chronic GVHD who developed overwhelming pneumococcal sepsis 3 years following transplantation. One year earlier the male patient had developed non-meningococcal, non-gonococcal neisseria infection. The infection recurred repeatedly despite monthly replacement immunoglobulin prophylaxis. These infections were attributed to functional hyposplenism after a prominent number of Howell-Jolly bodies was noticed in a peripheral blood smear during the patient's most recent admission. The case report is followed by a discussion of the policy of administering antibiotic prophylaxis to patients with chronic GVHD.
Adult↗
Extended lower limb venous ultrasound for the diagnosis of proximal and distal vein thrombosis in asymptomatic patients after total hip replacement.
OBJECTIVE: To assess the performance of extended lower limb venous ultrasound (US) for the diagnosis of asymptomatic deep vein thrombosis (DVT) and to estimate a 3-month DVT incidence on repeated US after total hip replacement. DESIGN: Diagnostic performance study and prospective cohort study. MATERIALS AND METHODS: US was compared to phlebography in 70 consecutive patients and interobserver agreement was assessed in the last 48 patients at day 8. US was repeated in these 48 patients at day 13 and day 90. RESULTS: Phlebography demonstrated a DVT in 18/70 (26%) patients, with five proximal and 13 distal and US in 23/70 (33%) patients, with eight proximal and 15 distal. Sensitivity and specificity of US with 95% CI were 94% (73-100) and 89% (76-96), respectively. Sensitivity in isolated distal vein thrombosis was 92% (67-99). The Kappa coefficient for agreement between observers was 0.84 (0.66-1.00). Follow-up showed a DVT in 15/48 (31%) patients on day 8, in 20/48 patients (42%) on day 13. DVT recurred in two patients during follow-up. CONCLUSIONS: The incidence of asymptomatic DVT is still significant despite prophylaxis but most DVTs remain distal and occur in the first 2 weeks. Extended US could replace phlebography for systematic screening in clinical trials using surrogate endpoints in view of its high accuracy and reliability.
Arthroplasty, Replacement, Hip↗
Comparison of patient-controlled and operator-controlled conscious sedation for restorative dentistry.
BACKGROUND AND OBJECTIVE: The use of midazolam for conscious sedation is an accepted method of anxiety control in restorative dentistry. A lack of predictability in its effects requires the dose of midazolam to be adjusted to individual patient's requirements. We determined whether patient-controlled sedation was a suitable alternative to operator-controlled sedation in restorative dentistry. METHODS: A randomized crossover clinical trial involving 35 consecutive patients undergoing similar dental procedures. Patients were randomly given midazolam, administered either by the patient or by the operator at the first visit and the alternative option on the second visit. All patients were ASA I-II and their ages ranged between 20 and 48 yr. Blood pressure, heart rate, oxygen saturation and patient satisfaction were recorded. RESULTS: The onset time and initial dose for sedation were similar with the two methods of administration and the sedation scores and vital signs were satisfactory. In the patient-controlled group the mean total dose of midazolam was 7.9 (+/- 4.2 SD) mg cf. 4.2 (+/- 1.8 SD) mg in the operator-controlled group (P < 0.05). The time to fitness for discharge (15.4 (+/- 11.9 SD) min) was greater in the patient-controlled group cf. the operator-controlled group (8.5 (+/- 9.5 SD) min), P < 0.05. CONCLUSION: This study shows that patient-controlled sedation is a suitable alternative to operator-controlled sedation in the management of anxious dental patients.
Adjuvants, Anesthesia↗
Cord blood from collection to expansion: feasibility in a regional blood bank.
This article reviews the various aspect of the experimental phase preceding the establishment of an umbilical cord blood (UCB) bank within a regular blood bank, a situation totally different from that of de novo establishing a cord blood bank having human and financial resources. An ethically approved two-year study has been conducted to determine the technical feasibility, and the practical problems that might be encountered such as public compliance, the additional workload, introduction of new activities ranging from collection and processing to progenitor expansion, infectious disease testing, development of a quality control system, record keeping and documentation, development of specific procedures and definitions of requirements. The cost benefit aspect, which will ultimately depend on the frequency of units release, was not considered in this study.
Blood Banking↗
The exocyst complex in plants.
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Arabidopsis↗
Syncope in a patient with relapsing polychondritis.
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Adult↗
Duodenal necrosis as the presenting manifestation of polyarteritis nodosa.
Polyarteritis nodosa involves necrotising vasculitis of small and medium-sized arteries. Multiple organ systems are involved. A non-specific and slow course of disease is common. Gastrointestinal involvement is characterised by abdominal pain, nausea and vomiting. Bowel infarction and perforation, cholecystitis and hepatic infarction are well known complications. However, bowel infarction as the presenting symptom of the disease is rare. The case of a 20-year-old male with necrosis of the duodenum heralding polyarteritis nodosa is reported. The patient made a slow recovery after extensive abdominal surgery and a stormy course. The postoperative management and treatment of polyarteritis nodosa are discussed. A high index of suspicion and prompt multidisciplinary approach are needed in order to improve survival in these rare but potentially fatal conditions.
Adult↗
C-terminal periplasmic domain of Escherichia coli quinoprotein glucose dehydrogenase transfers electrons to ubiquinone.
Membrane-bound quinoprotein glucose dehydrogenase (GDH) in Escherichia coli donates electrons directly to ubiquinone during the oxidation of d-glucose as a substrate, and these electrons are subsequently transferred to ubiquinol oxidase in the respiratory chain. To determine whether the specific ubiquinone-reacting site of GDH resides in the N-terminal transmembrane domain or in the large C-terminal periplasmic catalytic domain (cGDH), we constructed a fusion protein between the signal sequence of beta-lactamase and cGDH. This truncated GDH was found to complement a GDH gene-disrupted strain in vivo. The signal sequence of the fused protein was shown to be cleaved off, and the remaining cGDH was shown to be recovered in the membrane fraction, suggesting that cGDH has a membrane-interacting site that is responsible for binding to membrane, like peripheral proteins. Kinetic analysis and reconstitution experiments revealed that cGDH has ubiquinone reductase activity nearly equivalent to that of the wild-type GDH. Thus, it is likely that the C-terminal periplasmic domain of GDH possesses a ubiquinone-reacting site and transfers electrons directly to ubiquinone.
Amino Acid Sequence↗
[Venous thrombosis from central venous catheterization in oncology].
OBJECTIVES: The aim of this review article is to assess the epidemiology, diagnosis and treatment of deep venous thrombosis of the upper limbs which are becoming more common with the use of central catheterizations in oncology. RISK FACTORS: The incidence is differently estimated. The catheterization is the main risk factor which is added to the proper patient's risk factors in a highly thrombogenic context (cancer, chemotherapy, infection,...). The outcome can be limited to the catheter (thrombotic) dysfunction or can progress towards vein thrombosis, pulmonary embolism, most often asymptomatic or to a superior vena cava syndrome. Ultrasounds and CT scan have an important role although their efficacy have not been demonstrated yet. TREATMENT: Prophylactic anticoagulation with unfractionated heparin, low molecular weight heparin or oral anticoagulant seems to be effective. Low dose thrombolysis by bolus of urokinase or tissue plasminogen activator allows restoring the patency of the catheter in 70 to 90% cases of thrombotic dysfunction. The modalities of treatment of the vein thrombosis are much discussed.
Anticoagulants↗
Gram-Negative anaerobic endocarditis: two case reports and review of the literature.
The rarity of anaerobic gram-negative endocarditis limits the ability of physicians to define its prognosis. Two cases of endocarditis due to Bacteroidesfragilis are described, and a review of the English literature for all cases of anaerobic gram-negative endocarditis reported since 1940 is presented. The disease predominantly affects males. Clinical features are similar to those of endocarditis due to nonanaerobic organisms, but underlying heart disease is less common and the rate of thromboembolic complications is high. All deaths reported were due to Bacteroides spp.; no deaths due to Fusobacterium spp. have been reported. Treatment with metronidazole has dramatically improved the prognosis of patients with endocarditis due to anaerobic gram-negative bacilli.
Aged↗