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Biomedical subjects

M Moshkowitz

Publications and source records attributed to M Moshkowitz.

At least 19 recordsLinked to original sources
PubMed1996

Increased leukocyte adhesiveness/aggregation in patients with inflammatory bowel disease during remission. Further evidence for subclinical inflammation.

PURPOSE: We have used a novel leukocyte adhesiveness/aggregation test (LAAT) to show that many patients with inflammatory bowel disease (IBD) in clinical remission have a subclinical low grade inflammation. METHODS: Included in the study are 500 controls, 96 patients with IBD in remission, and 106 patients in relapse. RESULTS: The percent of aggregated white blood cells detected in the peripheral blood was 5.9 +/- 3.9, 9.1 +/- 5.9, and 18.8 +/- 9.4, respectively. The difference between each group and any other was significant at P < 0.0001. Similar results were obtained when other acute phase reactants like the erythrocyte sedimentation rate, white blood cell count, differential count, and C-reactive protein level were examined. However, in a linear regression analysis, LAAT was the only significant (P < 0.0006) variable that could classify correctly each subject to the appropriate category of control and IBD in remission or relapse. CONCLUSIONS: Identification of patients with IBD in clinical remission who have ongoing inflammation may be of clinical-therapeutic relevance. The LAAT is a simple, rapid, and convenient test. The present study indicates that it is also very sensitive.

Adolescent↗
PubMed1996

Methotrexate in chronic active ulcerative colitis: a double-blind, randomized, Israeli multicenter trial.

BACKGROUND & AIMS: Uncontrolled studies have suggested that methotrexate may be effective in patients with active ulcerative colitis. The aim of this study was to evaluate the effectiveness of oral methotrexate in chronic steroid-dependent ulcerative colitis in a randomized, double-blind multicenter trial. METHODS: Patients with active ulcerative colitis who have received steroids and/or immunosuppressives for at least 4 months during the preceding 12 months with a current Mayo Clinic score of > or = 7 were included in the study. Methotrexate (12.5 mg) or placebo was added to their treatment once weekly for 9 months. RESULTS: Sixty-seven patients were included (methotrexate, 30 patients, placebo, 37 patients). The proportion of patients entering first remission (methotrexate, 46.7%; placebo, 48.6%), the time to reach first remission (methotrexate, 4.1 +/- 1.9 months; placebo, 3.4 +/- 1.7 months), as well as the proportions of patients having a relapse after first remission (methotrexate, 64.3%; placebo, 44.4%) were not significantly different between the two groups. The mean Mayo Clinic score, the mean monthly steroid dose, and the proportion of abnormal laboratory results during the study were also similar. CONCLUSIONS: Methotrexate at a weekly oral dose of 12.5 mg was not found to be better than placebo in the induction or maintenance of remission in patients with chronic active ulcerative colitis.

Administration, Oral↗
PubMed1995

Elevated serum iron predicts poor response to interferon treatment in patients with chronic HCV infection.

To date, there are no firm clinical, demographic, biochemical, serologic, or histologic features predicting which patients with chronic hepatitis C are more likely to respond to therapy with interferon-alpha. Serum iron, total iron-binding capacity, transferrin saturation, and ferritin were measured in the fasting state. The amount of stainable iron in liver biopsy specimens was evaluated histochemically as well. All patients received subcutaneous recombinant human IFN-alpha 2a three million units thrice weekly by self-administration. Eleven of 13 (84%) responders had low to normal serum iron levels as compared to one of 26 (4%) nonresponders (P < 0.001). The serum transferrin was similar in both groups, but iron saturation was significantly lower in responders (30 +/- 10%) than in nonresponders (53 +/- 12%) (P< 0.001). Serum ferritin and hepatic iron content were higher in nonresponders (NS). It is suggested that increased serum iron and transferrin saturation blunt the action of interferon, as they have opposite effects on the immune system. Iron overload can thus lead to a poor response to interferon. It remains to be seen whether reducing iron overload will improve the response to interferon therapy.

Chronic Disease↗
PubMed1995

A controlled double blind multicenter study of the effectiveness of 5-aminosalicylic acid in patients with Crohn's disease in remission.

We evaluated the efficacy of an oral formulation of 5-amino-salicylic acid in lowering the relapse rate after remission of Crohn's disease. Included were 59 patients who had proven Crohn's disease of at least 1 year's duration, and who had been in continuous remission for at least 6 months, while taking only 5-aminosalicylic acid or no therapy at all. Remission was defined as a Harvey Bradshaw index score (Softley-Clamp modification) of < 4. Patients were given coded mesalzaine 250 mg or placebo tablets (2 x 2 day). They were seen at 0, 1, and 2 months, and then every 2 months until the end of the study. Trial endpoints were 1 year of follow-up, or clinical relapse results. After randomization, 31 patients were included in the placebo arm, and 28 in the treatment arm. There were no significant differences between the two groups at entry. Ten patients were withdrawn from the trial because of noncompliance, loss of follow-up, or headache. There were more clinical relapses in the placebo arm (15 patients, 55%) than in the treatment arm (6 patients, 27%) (p < 0.05). Mesalazine had a significant advantage over placebo (p < 0.05) only in the subgroups of patients with ileal Crohn's disease and in those older than 30 years. We conclude that mesalazine has a moderate but significant benefit in preventing relapse in Crohn's disease in remission; this occurred only in patients with small-bowel involvement or in those older than 30 years.

Adolescent↗
PubMed1995

High Helicobacter pylori numbers are associated with low eradication rate after triple therapy.

This study tested the influence of pretreatment bacterial density on the eradication rate of Helicobacter pylori with triple therapy. One hundred and thirty two patients with endoscopically confirmed H pylori positive, duodenal ulcer or antral gastritis were treated with triple therapy (colloidal bismuth/metronidazole/amoxicillin) for two weeks. Pretreatment urease activity was assessed by the 14C-urea breath test (UBT) in all patients. The mean (SD) pretreatment UBT concentration was similar in patients with duodenal ulcers (318.4 (175.0)) and patients with antral gastritis (288.9 (165.5)). Overall eradication of H pylori was achieved in 85 of 132 patients (64.4%), but was significantly different between patients with high, intermediate, or low pretreatment urease activity (37.5%, 69.5%, and 87.8% respectively). The mean post-treatment UBT value of patients in whom eradication failed was in direct correlation with the pretreatment UBT values. In conclusion, bacterial density, as assessed by urease activity, is an important factor in predicting H pylori eradication. It is suggested that the pretreatment UBT has the potential to identify patients who require modification of the standard therapeutic regimen.

Amoxicillin↗
PubMed1995

Increased leucocyte adhesiveness/aggregation is a most useful indicator of disease activity in patients with inflammatory bowel disease.

The aim of the study was to determine the comparative usefulness of inflammatory markers, in evaluating disease activity in patients with inflammatory bowel disease. Disease activity was assessed by the Mayo Clinic score for ulcerative colitis, and Harvey-Bradshaw score for Crohn's disease. Five hundred normal blood donors who had no underlying inflammatory condition served as controls. The erythrocyte sedimentation rate, platelet and white blood cell count, C reactive protein, and the leucocyte adhesiveness/aggregation test (LAAT) were determined in each patient. One hundred and twenty four patients with inflammatory bowel disease were tested while in remission and 128 in relapse. Their mean (SD) per cent of aggregated white blood cells in the peripheral blood was 8 (5) and 17 (10) respectively compared with controls 6 (4) (p < 0.0001). Moreover, the LAAT could effectively discriminate between various grades of disease activity, the values in patients with active disease being 13 (6)% in mild, 17 (10)% in moderate, and 26 (10)% in severe disease (p < 0.0001). Other acute phase reactants including the erythrocyte sedimentation rate, the white blood cell count, the platelet count, neutrophil count, as well as, the C reactive protein concentration did not differentiate as well between the various groups. Using logistic regression analysis to differentiate between inflammatory bowel disease patients in remission or relapse, the LAAT was the single best indicator. The addition of any other test did not contribute to the discrimination. Among the different laboratory variables tested only the LAAT significantly discriminated between the five different subgroups of controls, remission and mild, moderate or severe disease activity.

Adolescent↗
PubMed1995

Post-transfusion etiology and non-cirrhotic histology improve the remission rate of chronic hepatitis C during interferon treatment.

During a 29 month period, 46 patients with chronic hepatitis C virus (HCV) received recombinant human interferon alpha-2a for 6 months and were followed for another 6 months. The dose of interferon was three million units thrice weekly and was increased to six million units if amino transferase levels failed to return to normal after 2 months of therapy. At the end of the treatment 19 patients had a complete response, 6 had a near complete response, 2 patients had breakthrough during treatment, and the remaining 19 did not respond at all. Six months after treatment only 10 of the 19 responders remained in remission. Post-transfusion disease was associated with a significantly higher remission rate than sporadic disease (9/22 vs. 1/24, P < 0.001), as was also found in non-cirrhotic compared to cirrhotic patients (9/27 vs. 1/19, P < 0.001). Age, sex, duration of disease, serum aminotransferase, albumin, bilirubin, alkaline phosphatase, or Child's classification did not correlate with treatment response. Severe side effects necessitating cessation of treatment occurred in six patients, four of whom had major autoimmune phenomena. We conclude that careful selection of HCV patients with favorable response characteristics (post-transfusion etiology and non-cirrhotic liver) and without autoimmune manifestations can improve the remission rate and decrease the complication rate during interferon treatment.

Adult↗
PubMed1994

[Antimicrobial sensitivity and treatment of Helicobacter pylori infections].

Helicobacter pylori (HP) is considered the etiological agent of chronic active gastritis and suspicion is strong that it plays an important role in duodenal ulcer. Recently, several clinical studies reported that eradication of HP markedly reduces the frequency of ulcer relapse. Triple-drug treatment, including a bismuth salt and 2 antibiotics (usually metronidazole with either amoxycillin or tetracycline) is considered the treatment of choice. It has been shown that the most important factor for predicting success of treatment is the sensitivity of HP to metronidazole, which varies considerably. In the present study we evaluated antimicrobial susceptibility of 18 HP clinical isolates, as well as effectiveness of triple therapy for eradicating HP infections in 65 patients. In vitro, HP was highly sensitive to amoxycillin, erythromycin and tetracycline (100%), and also to metronidazole and tinidazole (94%). Sensitivity to chloramphenicol was low (50%). In our clinical study, the overall eradication rate was 66%; it was higher among women (80%) than men (54%), probably due to better compliance. It is concluded that HP strains in Israel are highly sensitive to metronidazole and that triple therapy is effective, providing compliance is good.

Amoxicillin↗
PubMed1994

Increased serum iron and iron saturation without liver iron accumulation distinguish chronic hepatitis C from other chronic liver diseases.

One hundred twenty-three patients with chronic liver diseases of various etiologies were evaluated for their iron status. The patients were divided into four distinct groups: chronic hepatitis C (63), chronic hepatitis B (14), B + C (3) and nonviral chronic liver diseases (43). In 107 patients (87%) the chronic liver disease was confirmed by biopsy. Mean serum iron (+/- SD) levels in the above four groups were: 166 +/- 62, 103 +/- 52, 142 +/- 48, and 115 micrograms/dl; iron-binding capacity was 346 +/- 80, 325 +/- 72, 297 +/- 27, and 374 +/- 75 micrograms/dl, and iron saturation 50 +/- 18, 32 +/- 16, 48 +/- 16, and 28 +/- 10%, respectively. Serum ferritin, increased in all four groups, was highest in HCV; however, no evidence of hepatic iron accumulation could be found in any of the patients. There were no significant differences in liver function parameters measured in the four groups. We conclude that serum iron, iron saturation, and ferritin are increased in patients with hepatitis C in comparison to hepatitis B or other nonviral, nonhemochromatotic liver diseases. The increased iron status in hepatitis C patients is not manifested by increased liver iron. Awareness of these distinct features of chronic hepatitis C is essential in the diagnosis and treatment of chronic liver diseases.

Biopsy↗
PubMed1994

Morphological transformation of Helicobacter pylori during prolonged incubation: association with decreased acid resistance.

The survival of clinical isolates of H pylori at two cultural ages (two and four days) at pH 2, in the presence of different buffers, with and without urea, was investigated. It was found that the morphological changes which occur with longer incubation of H pylori have an inverse correlation with its resistance to an acidic environment. The finding that the addition of urea almost reversed this phenomenon and prolonged survival of the cultures emphasises the role of urea in the survival of H pylori in acidic environments.

Acids↗
PubMed1994

An eight year experience with upper gastrointestinal bleeding: diagnosis, treatment and prognosis.

Bleeding from the upper gastrointestinal tract is one of the most common medical emergencies. Admission of patients to a specialized care unit may reduce morbidity and mortality. All patients admitted to the Tel Aviv Medical Center, between January 1, 1983 and December 31, 1990 with acute upper gastrointestinal bleeding, or those who bled while in the hospital, were seen and assessed by a senior member of the gastrointestinal service. Endoscopy was performed within 24 hr of admission. A total of 1110 endoscopies were performed. Duodenal ulcer was the main source of bleeding (40.0%). Injection of a vasoconstrictor was used for very small blood vessels. Thermal methods were used for small or medium sized vessels, or for oozing from a margin ulcer; both with equal rates of success. 153 (13.8%) surgical procedures were performed. Three (0.37) patients had endoscopic cardiovascular complications; one of them died. The in-hospital mortality was 5.9%. Increasing age, other medical problems, rebleeding and an admission hemoglobin of 8 g/dL or less, were associated with increased mortality. Our policy of early clinical and endoscopic assessment, and rapid surgical intervention in those at high risk, markedly improved survival.

Adolescent↗
PubMed1994

Seasonal variation in the frequency of Helicobacter pylori infection: a possible cause of the seasonal occurrence of peptic ulcer disease.

OBJECTIVES: The seasonal variation of duodenal ulcer disease and its complications have been repeatedly demonstrated in Israel by several independent studies. The aim of this study was to determine possible seasonal variations in the occurrence of H. pylori infection among dyspeptic patients in Israel. METHODS: All 14C-urea breath tests performed in dyspeptic patients at the gastroenterology department in the Tel Aviv Medical Center from January 1991 to December 1992 were reviewed. The monthly variation in the proportion of patients with H. pylori infection was determined, and compared with that of an unrelated 14C-cholyl-glycine breath test. RESULTS: Altogether, 702 patients were examined, and 371 (52.8%) of them were found to be infected with H. pylori. During summer months (July-September), a significant decrease in the percentage of patients infected with H. pylori was found, compared with winter months (December-January, 42.3% vs. 60.9%, p < 0.007). No seasonal variation was found in the results of 14C-cholyl-glycine test. The fluctuations in H. pylori infection were highly correlated with the seasonal occurrence of peptic ulcer disease in Israel. CONCLUSIONS: The frequency of H. pylori infection in dyspeptic patients in Israel is significantly increased during the winter months and decreased in the summer. This seasonal variation is identical to that found in duodenal ulcer disease. Thus, the seasonal variation of peptic ulcer disease could be explained by H. pylori infection, as seen in other communicable infectious diseases.

Breath Tests↗
PubMed1993

Success of estrogen-progesterone therapy in long-standing bleeding gastrointestinal angiodysplasia. Report of a case.

Gastrointestinal angiodysplasia is a common cause of occult bleeding. Surgical and endoscopic treatments are often ineffective. Recently, estrogen-progesterone therapy proved to be effective in these patients. We describe herein an 84-year-old man who presented with prolonged gastrointestinal bleeding, in whom treatment with estrogen-progesterone stopped the bleeding. We suggest that hormonal therapy should be considered in cases of prolonged obscure gastrointestinal bleeding thought to be due to angiodysplasia. This therapy should be instituted intermittently for a prolonged period. The role of progesterone, especially in men, should be reconsidered.

Aged↗
PubMed1993

Effect of phospholipids and their molecular species on cholesterol solubility and nucleation in human and model biles.

Much research in the pathophysiology of gall stones has been devoted to various molecular species of bile salts. Recent findings have shown the importance of phospholipids in biliary pathophysiology. In the present study the addition of increasing doses of egg lecithin to human and model biles progressively prolonged the nucleation time. Concurrently biliary cholesterol was shifted from the vesicular to the non-vesicular carrier(s) while the cholesterol/phospholipid ratio of the remaining vesicles was progressively lowered. Model bile solutions of identical lipid concentration were prepared using phosphatidylcholine, phosphatidylserine, and phosphatidylethanolamine as the only phospholipid. With phosphatidylethanolamine most of the cholesterol was shifted to the vesicular carrier while phosphatidylserine shifted most of the cholesterol to the non-vesicular carrier(s). With phosphatidylcholine the cholesterol was distributed in both carriers. Phosphatidyl choline species composed of various acyl fatty acids in the sn-1 and sn-2 positions were used as the sole phospholipid in otherwise identical model bile solutions. With palmitic acid in the sn-1 position and arachidonic acid in the sn-2 position most of the cholesterol was found in the non-vesicular carrier. When stearic acid was used in sn-2 position instead of arachidonic acid most of the cholesterol was found in the vesicular carrier. These and other variations in phospholipid molecular species shifted cholesterol among its carriers and also modified the nucleation time of model biles. Most of these effects were also found upon addition of the various phospholipid species to human biles. These findings show the importance of phospholipid species in biliary pathophysiology and may be useful when trying to manipulate cholesterol carriers and solubility in bile.

Bile↗
PubMed1993

Extracorporeal shock wave lithotripsy of gallstones: early experience in an Israeli population.

Fifty-four patients with symptomatic gallbladder stones were treated by extra-corporeal shock wave lithotripsy (ESWL) and oral bile acids on an outpatient basis. In 49 patients (90%), the stones were successfully fragmented to fragments < 5 mm on follow-up ultrasonography. Patients underwent 1-3 lithotripsy sessions with 7,500-9,750 shock waves per session. The gallbladder clearance rate of fragments was dependent mainly on the number of stones and reached 59% for patients with one or two stones, compared to 34% for patients with more than two stones after 9 months follow-up. The only side effects noted were mild abdominal pain, transient microscopic hematuria and minimal impairment in liver function tests. There were no serious complications such as cholecystitis, bile duct obstruction, or pancreatitis. These results, which are comparable with those of other groups using the same shock wave lithotriptor, indicate that this therapy may become an alternative treatment for selected patients with symptomatic gallbladder stones, especially those who are at high risk for surgical treatment.

Administration, Oral↗
PubMed1993

Gastric polypoid lesions--an eight-year study.

We have reviewed the eight years of experience with gastric polypoid lesions of a university hospital serving the Tel Aviv area, and analyzed 188 polyps. No clinical or endoscopic findings were able to distinguish the polyp variants prior to histological examination. The most frequent type of polyp was the hyperplastic polyp (45.2%), followed by the inflammatory type (29.3%). There were six cases of adenoma and ten cases of gastric carcinoma. The polyps were distributed equally within the body (44.7%) and antrum (48.9%), while the fundus was rarely involved (6.3%). Our findings are compatible with the statement that in general there is no distinction between the histological types classified by sex, age, location, symptoms or endoscopic appearance. Nevertheless, this is the first report of a higher incidence of gastric polyps among Ashkenazi Jews than non-Ashkenazi Jews with identical sex distribution.

Adult↗
PubMed1992

A prospective analysis of liver biopsies in rheumatoid arthritis patients receiving long term methotrexate therapy.

Baseline and sequential liver biopsies were performed in ten patients with rheumatoid arthritis (RA) treated with methotrexate (MTX) for more than 4 years. Liver biopsies were performed in all patients before the initiation of MTX therapy and were repeated after reaching a cumulative dose of 1500 mg or more. In four patients a third biopsy was performed 3 years after the first one. No significant worsening of hepatic architecture was found in any of our patients after 4 to 7 1/2 years of MTX therapy. No correlations between histologic findings and various clinical or pharmacological variables could be found. Our results suggested that prolonged MTX administration in RA patients did not cause severe hepatic abnormalities.

Adult↗