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Biomedical subjects

M Erlichman

Publications and source records attributed to M Erlichman.

18 recordsLinked to original sources
PubMed2000

Evaluation of the approach of primary care physicians to the management of streptococcal pharyngotonsillitis. IPROS Network.

BACKGROUND: Streptococcal pharyngotonsillitis remains a common illness in children and can lead to serious complications if left untreated. OBJECTIVE: To evaluate the diagnostic and management approach of a sample of primary care physicians in the largest sick fund in Israel to streptococcal pharyngotonsillitis in children. METHODS: A questionnaire was mailed to all physicians who treat children and are employed by the General Health Services (Kupat Holim Klalit) in the Jerusalem District. The questionnaire included data on demographics, practice type and size, and availability of throat culture and rapid strep test; as well as a description of three hypothetical cases followed by questions relating to their diagnosis and treatment. RESULTS: Of the 188 eligible physicians, 118 (62.5%) responded, including 65 of 89 pediatricians (73%) and 53 of 99 family and general practitioners (53.5%). Fifty-six physicians (47.4%) had more than 18 years experience, and 82 (70%) completed specialization in Israel. Mean practice size was 950 patients. Fifty-three physicians (43%) worked in Kupat Holim community clinics, 25 (21%) worked independently in private clinics, and 40 (34%) did both. A total of 91 (77%) had access to laboratory facilities for daily throat culture. The time it took for the results to arrive was 48 to 72 hours. For the three clinical scenarios, 90% of the physicians accurately evaluated case A, a 1-year-old with viral pharyngotonsillitis, and 100 (85%) correctly diagnosed case C, a 7-year-old with streptococcal infection. As expected, opinions were divided on case B, a 3-year-old child with uncertain diagnosis. Accordingly, 75 (65.3%) physicians did not recommend treatment for case A, compared to 109 (92.5%) for case C. For case B, 22 (19%) said they would always treat, 43 (36%) would sometimes treat, and 35 (30%) would await the result of the throat culture. For 104 (88%) physicians the antibiotic of choice for case C was penicillin, while only 9 (7.5%) chose amoxicillin. However, the recommended dosage regimens varied from 250 to 500 mg per dose, and from two to four doses daily. For case C, 110 physicians (93%) chose a 10 day duration of treatment. CONCLUSIONS: The primary care physicians in the sample (pediatricians, general practitioners and family physicians) accurately diagnosed viral and streptococcal pharyngotonsillitis. However, there was a lack of uniformity regarding its management in general, and the dosage regimen for penicillin in particular.

Child↗
PubMed1999

Cryosurgery for recurrent prostate cancer following radiation therapy.

Patients with prostate cancer are commonly treated medically or undergo radical prostatectomy and/or radiation therapy. Radiation therapy is usually selected for patients with local or regional disease and patients for whom traditional surgery has failed. The local recurrence of cancer in patients treated with radiation therapy presents a difficult challenge regarding the selection of further treatment options. A commonly applied treatment is salvage prostatectomy, but it can be difficult and complicated, with positive surgical margins occurring in as many as 50 percent of patients and with significant postoperative morbidity. Hormonal therapy, which is not curative, has served as an alternative to surgery in patients who have failed to respond to radiation therapy. Cryosurgery, the destruction of diseased tissue by freezing, is increasingly used both as a first-line therapy and as a second-line therapy (salvage therapy) in patients for whom radiation therapy has failed. Recent reports suggest that cryosurgery may be a useful alternative procedure for treating some of these patients with recurrent cancers. Outcomes of cryosurgery are improving through better instrumentation, surgical technique, and experience. The available data suggest that some patients with radioresistant cancer appear to benefit from the use of cryosurgery as a salvage therapy. Use of this technique has resulted in biochemical disease-free survival for varying periods of some patients who had recurrent prostate carcinoma following radiation therapy; however, morbidity remains high and relatively few patients have had adequate followup. Salvage cryosurgery prospective clinical trials are warranted and would help determine long-term survival benefits and make possible the comparison of cryotherapy patient survival rates with those of untreated biopsy-positive patients.

Cryosurgery↗
PubMed1996

Bone densitometry: patients with end-stage renal disease.

Bone mass loss and osteoporosis are associated with various conditions, such as end-stage renal disease (ESRD), and treatments, such as prolonged steroid therapy. Bone densitometry is used to measure bone mass density to determine the degree of osteoporosis and to estimate fracture risk. Bone densitometers measure the radiation absorption by the skeleton to determine bone mass of the peripheral, axial, and total skeleton. Common techniques include single-photon absorptiometry (SPA) of the forearm and heel, dual-photon (DPA) and dual-energy x-ray absorptiometry (DXA) of the spine and hip, quantitative computed tomography (QCT) of the spine or forearm, and radiographic absorptiometry (RA) of the hand. Part I of this report addresses important technical considerations of bone densitometers, including radiation dose, site selection, and accuracy and precision, as well as cost and charges. Part II evaluates the clinical utility of bone densitometry in the management of patients with ESRD. End-stage renal disease affected more than 242,000 Americans in 1992, and each year 10,000 to 20,000 new cases are diagnosed. Although the survival rate of ESRD patients has improved, metabolic bone diseases that fall under the generic term "renal osteodystrophy" represent abnormal development of bone and major long-term complications. Issues addressed are the type and extent of bone loss associated with ESRD and whether these patients have an increased risk for fracture. The other assessments in this series address the clinical utility of bone densitometry for patients with asymptomatic primary hyperparathyroidism, steroid-dependent patients, estrogen-deficient women, and patients with vertebral abnormalities.

Absorptiometry, Photon↗
PubMed1996

Bone densitometry: patients receiving prolonged steroid therapy.

Bone mass loss and osteoporosis are associated with various conditions, such as asymptomatic primary hyperparathyroidism, and treatments, such as prolonged steroid therapy. Bone densitometry is used to measure bone mass density to determine the degree of osteoporosis and to estimate fracture risk. Bone densitometers measure the radiation absorption by the skeleton to determine bone mass of the peripheral, axial, and total skeleton. Common techniques include single-photon absorptiometry (SPA) of the forearm and heel, dual-photon (DPA) and dual-energy x-ray absorptiometry (DXA) of the spine and hip, quantitative computed tomography (QCT) of the spine or forearm, and radiographic absorptiometry (RA) of the hand. Part I of this report addresses important technical considerations of bone densitometers, including radiation dose, site selection, and accuracy and precision, as well as cost and charges. Part II evaluates the clinical utility of bone densitometry in the management of patients receiving prolonged steroid therapy. Steroids have broad effects on both immune and inflammatory processes and have been used to treat a wide variety of immunologically mediated diseases. Osteoporosis and vertebral compression fractures have been considered major complications of prolonged steroid therapy. Bone loss is also a direct result of many of the diseases treated with steroids. Issues addressed are the type and extent of bone loss associated with steroid therapy, risk for fracture, whether steroid dose reduction or alternative therapy is an option, and whether osteoporosis associated with prolonged steroid use can be prevented or treated. The other assessments in this series address the clinical utility of bone densitometry for patients with: asymptomatic primary hyperparathyroidism, end-stage renal disease, vertebral abnormalities, and estrogen-deficient women.

Absorptiometry, Photon↗
PubMed1995

Bone densitometry: patients with asymptomatic primary hyperparathyroidism part I. Technical report.

Many studies document bone loss at diagnosis in patients with PHPT (including mild PHPT) that is greater than would be expected in comparable persons without this condition. However, there is no general agreement regarding the severity of bone mass loss in these patients and the rate at which it progresses. A few studies suggest that such accelerated osteoporosis may be self-limited, with patients showing no further decline in BMD after diagnosis. There is insufficient evidence to conclude that PTH-related bone loss is associated with an increased risk of fracture. The few studies that have evaluated the risk of fracture in these patients are conflicting. Some evidence also suggest that, like bone loss in these patients, fracture risk may change during the course of the disease. One study found that patients with PHPT (including those with mild hypercalcemia) were more likely than matched controls to have a history of fractures prior to diagnosis, but that both groups had similar rates of fractures during followup. Moreover, the studies of fractures suffer from several limitations, such as nonrandomization of patients, different definitions of vertebral fractures, small study populations, and short followup times. There is also insufficient evidence to determine the effect of parathyroidectomy on the incidence of fractures in patients with mild PHPT, partly because the natural history of this condition is incompletely understood. Although studies demonstrate that patients with PHPT gain bone mass following parathyroidectomy, the bone reparation is incomplete and bone mass density remains below normal, even though the hyperparathyroidism is cured. Currently, decisions to perform parathyroidectomy are based on signs and symptoms of bone disease, metabolically active renal stones, decreased renal function, fatigue and/or depression, and high levels of serum calcium. Although the use of bone mass measurements has been advocated to aid clinical decisions regarding the risks and benefits of surgery, specific bone changes that indicate the need for parathyroidectomy have not been clearly established. There are virtually no prospective data that evaluate decisions to operate based upon bone mass measurements nor randomized clinical trials comparing the outcome of surgically treated patients with those who have not had surgery. Based on the literature, bone mass measurements cannot predict who among asymptomatic patients will require parathyroidectomy. There is some evidence that nonsurgically treated patients and those who remained hypercalcemic after unsuccessful surgery lost bone at the same percentage rate as normal control subjects.

Aged↗
PubMed1990

Patient selection criteria for electrostimulation of salivary production in the treatment of xerostomia secondary to Sjogren's syndrome.

Electrostimulation has been introduced as a technique for increasing salivary output in the treatment of patients with xerostomia (dry mouth) secondary to Sjogren's syndrome. The procedure uses an electrostimulation device (salivation electrostimulator) to increase salivary production from existing glandular tissue. The device delivers a low-voltage electrical stimulus to the mouth via a probe. Patients with residual salivary tissue in the oral and pharyngeal regions who demonstrate a decrease in the flow rate of saliva are potential candidates for this procedure. It is estimated that more than one million people in the United States, predominantly middle-aged and elderly women, suffer from Sjogren's syndrome. Patients with chronic xerostomia complain of a continual feeling of oral dryness and have difficulty eating dry foods. These patients are susceptible to increased caries, oral pain, infection, and have difficulty speaking, chewing, and swallowing. The approach to the treatment of xerostomia in Sjogren's patients is usually determined by the level of severity of the symptoms. Appropriate management of patients with xerostomia requires that those patients whose salivary flow can be increased by means of sialagogues be distinguished from those patients whose salivary flow is either unaffected or insufficiently stimulated. To alleviate some of the complications due to salivary dysfunction in those patients who respond to stimuli, pharmacologic sialagogues as well as sialagogues that include sugarless gums, mints and candies are prescribed in order to increase salivary flow. Recently, electrostimulation via a hand-held stimulus probe has been introduced as a method of treatment in xerostomia secondary to Sjogren's syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

Electroencephalographic (EEG) video monitoring.

Electroencephalographic (EEG) video monitoring is the simultaneous documentation of the clinical and electroencephalographic manifestations of seizures. The video recording permits repeated viewing of the clinical sequence and enables comparisons with recordings of known seizures. Epilepsy is a clinical diagnosis in which most cases can be characterized with the standard clinical history, examination, and EEG. Studies of the treatment of intractable seizures (unsatisfactory control of seizure) indicate that more complex cases may require the data obtained with EEG video monitoring. For patients with intractable seizures, EEG video monitoring may help to confirm or support a diagnosis of epilepsy or confirm or support a differential diagnosis of physiologic or psychogenic seizures (nonepileptic attacks) from epilepsy. Monitoring also may provide a more accurate classification of the epileptic seizures and, for patients evaluated for surgical treatment, establish clinical focality. Estimates of the percentage of epilepsy patients requiring EEG video monitoring range from 5 to 30 percent. The average length of monitoring is approximately 10 to 16 days. In some cases outpatient monitoring in conjunction with activation procedures provides patient evaluation in only 6 to 8 hours.

Attitude of Health Personnel↗
PubMed1990

Surface/specialty coil devices and gating techniques in magnetic resonance imaging.

Surface and other specialty coil devices and gating techniques are used in conjunction with MRI procedures to enhance image quality. Surface coils improve image quality by virtue of the improved signal-to-noise ratio, which results in better anatomic detail and tissue contrast. These coils may be advantageous for many kinds of imaging procedures, particularly for small structures that require greater spatial resolution. Although safety is not considered an issue, certain precautions must be taken to avoid skin burns. Gating techniques have been used to eliminate movement artifacts and associated image blurring. Cardiac-gated imaging has enabled the acquisition of high resolution diagnostic quality cardiac images with conventional MRI. Studies of gated cardiac imaging have demonstrated the technical capacity of MR scanning for evaluating ischemic heart disease, cardiomyopathy, pericardial diseases, intracardiac and paracardiac masses, thoracic-aortic diseases, and congenital heart disease. Cardiac imaging also has been found valuable in reducing motion artifacts in MRI of the chest, brain, spine, and liver. Gated imaging studies demonstrated that MRI respiratory gating improves thoracic and abdominal imaging; however, inherent time delays limit its usefulness. No patient-related risks appear to be involved when gating procedures are used appropriately. The use of gating techniques may add substantial time to the imaging procedure. Surface coil and gated MRI techniques have been found to be better than the conventional MRI studies when they improve the quality of the exam and its diagnostic capabilities.

Evaluation Studies as Topic↗
PubMed1989

The role of speech language pathologists in the management of dysphagia, 1989.

Speech-language pathologists involved in the management of patients with dysphagia provide services that include evaluation, diagnosis, and rehabilitation. Dysphagia is a swallowing disorder that may be due to various neurological, structural, and cognitive deficits. While dysphagia can afflict any age group, it most often presents among the elderly. Rehabilitation efforts by the speech-language pathologist are undertaken after a medical diagnosis and referral have been made. The dysphagia evaluation begins with a bedside examination that is sometimes followed by a video-fluoroscopic study. The information obtained by the evaluation results in a feeding recommendation by the speech-language pathologist that includes appropriate diet level, amount of intake per swallow, positioning and other facilitating techniques, and swallowing exercises. Patients who are motivated, moderately alert, and have some degree of deglutition are appropriate candidates for dysphagia therapy. Elements of the therapy program can include thermal stimulation to heighten the sensitivity of the swallowing reflex, exercises to improve oromotor control, training in laryngeal adduction and compensatory swallowing techniques, positioning, and dietary modifications. Significant improvement in the swallowing disorder of appropriately selected patients cna be obtained in a rehabilitation program with properly trained and experienced speech-language pathologists.

Deglutition Disorders↗
PubMed1983

Buschke's scleredema with right-sided heart failure. Echocardiographic and clinical observations.

Heart failure as a complication of Buschke's scleredema was not reported in the literature on this rare disease. A young girl with a severe form of Buschke's disease is described. She developed severe right-sided heart failure--proven by the typical clinical, auscultatory, electrocardiographic and echocardiographic findings; was treated successfully with penicillin, anticongestive measures and steroids, and showed a remarkable complete recovery.

Child, Preschool↗
PubMed1983

Cytomegalovirus infection and disease in the Jerusalem area.

We studied the epidemiology of cytomegalovirus (CMV) infection in women and neonates in the Jerusalem area. During the 6-month period from January to June 1982, we recorded the presence of antibody to CMV in pregnant and parturient Jewish and Arab women from West and East Jerusalem, respectively, in 18- to 22-year-old female students at a religious college, in female university students, in 18- to 22-year-old student nurses, and in the nursing staff of the Neonatal Intensive Care Unit in our hospital. In the 18- to 22-year-old age-group, the religious college students not working in a medical setting had the lowest rate of seropositivity. No difference in the rate of CMV infection was found between Jewish and Arab parturient women. In five cases of congenital CMV infection, representing different clinical aspects of the disease, a comparative study of diagnostic procedures for congenital CMV infection was performed.

Adolescent↗
PubMed1981

Infantile flexural seborrhoeic dermatitis. Neither biotin nor essential fatty acid deficiency.

The allegedly beneficial effect of biotin in the treatment of infantile 'flexural' seborrhoeic dermatitis was evaluated in a double-blind controlled study. No beneficial effect could be confirmed, and it is therefore unlikely that this disease is caused by biotin deficiency. Nor could this scaly dermatitis be ascribed to an essential fatty acid deficiency. Serum and adipose tissue fatty acids resembled each other and reflected the fatty acid composition of the diet.

Adipose Tissue↗