Bobble-head doll syndrome: a surgically treatable condition manifested as a rare movement disorder.
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Arachnoid Cysts↗
Biomedical subjects
N Peled
Publications and source records attributed to N Peled.
Antibiotic resistance pattern of enterotoxigenic Escherichia coli isolated from infants and young adults in Israel.
The aim of this study was to describe antibiotic resistance rates of enterotoxigenic Escherichia coli in Israel in order to facilitate the empirical choice of antibiotic treatment or prophylaxis for traveler's diarrhea and infantile diarrhea in our region. A total of 281 enterotoxigenic Escherichia coli isolates were tested: 144 from Bedouin infants and 137 from Israeli soldiers. Antibiotic-resistant isolates were prevalent in both groups, but higher resistance rates were found in the pediatric group. Strains producing heat-labile toxin showed higher resistance rates than strains producing heat-stable toxin. The results obtained in Israel preclude the use of many commonly used antibiotics for the treatment of traveler's diarrhea. Quinolones, however, are still effective.
Adolescent↗
Enterococcus hirae septicemia in a patient with end-stage renal disease undergoing hemodialysis.
Enterococcus hirae, member of the Enterococcus genus known to cause infection in animals, is rarely encountered in clinical practice. There are no published reports describing clinical features of Enterococcus hirae infection in humans. A case of Enterococcus hirae septicemia in a 49-year-old patient with end-stage renal disease undergoing hemodialysis is reported here. A review of the available literature regarding the clinical spectrum of Enterococcus hirae infection in humans and the antimicrobial susceptibility of Enterococcus hirae is also included.
Bacterial Infections↗
Contributions of hypoxia and respiratory disturbance index to sympathetic activation and blood pressure in obstructive sleep apnea syndrome.
Hypertension is a common finding among obstructive sleep apnea (OSA) patients, and is thought to be caused by sympathetic hyperactivity. The present study compares the contributions of the respiratory disturbance index (RDI) as a reflection of sleep fragmentation, and the magnitude of oxygen desaturation, to sympathetic activation as indexed by urinary norepinephrine concentrations, as well as to morning and evening blood pressure in sleep apnea syndrome patients. Data (polysomnography, blood pressure [BP], and urine catecholamines) of 38 consecutive OSA patients (age, 46+/-14.5 years) were analyzed. Stepwise logistic regression analysis revealed that minimal oxygen saturation level (SaO2min) was a significant predictor of both morning and evening norepinephrine levels, and that 37% of morning systolic BP variance could be accounted for by a combination of age and norepinephrine, while 20% of the diastolic BP variance was accounted for by SaO2min alone. In contrast, RDI entered the prediction equation only when minimal oxygen saturation was rejected first. Our results indicate that the degree of nocturnal hypoxia is more closely associated with the level of sympathetic activation and with daytime level of blood pressure than with sleep fragmentation.
Adult↗
[Trichobezoars].
Trichobezoars are accumulations of hair casts in the stomach associated with trichophagia. The typical patient is an adolescent female who presents with alopecia and an upper abdominal mass which on moving can cause intermittent gastric outlet obstruction. Only a minority of patients have severe psychiatric disorders. When hair strands extend from the main mass in the stomach, all along the small bowel and reaching the cecum, the condition is termed the Rapunzel syndrome. In about 5% of patients there are separate hair masses in the stomach. The clinical presentation includes abdominal pain, loss of appetite, weight-loss, vomiting, loose stools, pancreatitis, jaundice, anemia and hypoalbuminemia. These signs and symptoms raise the suspicion of malignancy. Complications of bezoars include ulcers, perforation of the bowel, obstruction and intussusception. Diagnosis can be established either by barium swallow or by CT scan. Ultrasound might suggest the diagnosis, but sonographic features are definitely not pathognomonic. Treatment is surgical, as endoscopic removal is usually unsuccessful. We present 2 children in whom trichobezoars were found.
Adolescent↗
[Gram-negative enteric bacteremia in children in the Negev (1989-1994)].
During 1989-1994, there were 322 episodes of Gram-negative enteric bacteremia in 308 children. The incidence increased from 31/100,000 in children younger than 15 years of age during 1989-1991, to 50/100,000 during 1992-1994. The most common pathogens were Klebsiella, E. Coli, Salmonella and Enterobacter. 39% of episodes were nosocomial and a significant increase was recorded for each species during the last 3 years of the study. Klebsiella represented the most common pathogen causing nosocomial bacteremia, while E. coli and Salmonella were the main pathogens causing community-acquired bacteremia. In this study in southern Israel, the incidence of Gram-negative enteric bacteremia was significantly higher in Bedouin children, with the exception of bacteremia due to Salmonella, which occurred mainly in Jewish children.
Adolescent↗
Changing trends in frequency and antimicrobial resistance of urinary pathogens in outpatient clinics and a hospital in Southern Israel, 1991-1995.
In order to monitor changes in the frequency and antimicrobial resistance of urinary pathogens over several years, urinary cultures received from outpatient clinics and from a hospital during a period of one month each in 1991 and 1995 were analyzed at a clinical microbiology laboratory. In 1991 and 1995, 1366 and 1534 significant monomicrobic cultures respectively were reviewed. The frequency of Escherichia coli dropped significantly in the outpatient clinics from 70.5% to 61.2% (p < 0.0001). The frequency of Proteus mirabilis, Morganella morganii, Pseudomonas aeruginosa and other gram-negative bacteria also decreased, but the frequency of Klebsiella spp. and Enterobacter spp. increased from 2.6% to 5.8% (p < 0.0001). In the hospital, the frequency of Enterobacter spp. (p < 0.04), Escherichia coli and Morganella morganii declined from 1991 to 1995, whereas the frequency of Pseudomonas aeruginosa (p = 0.001), Acinetobacter spp. (p < 0.05), Klebsiella spp., Proteus mirabilis and other gram-negative rods increased considerably. The frequency of gram-positive aerobic bacteria rose markedly in outpatient specimens from 6.1% to 13.5% (p < 0.0001), while a decline from 14.4% to 9.3% was noted in hospital specimens (p < 0.02). A significant rise in the resistance of Escherichia coli to gentamicin and ciprofloxacin (p < 0.0001) was detected in outpatient isolates. In the hospital, gram-negative urinary pathogens demonstrated increased resistance to ampicillin (p = 0.042), cefuroxime (p = 0.005), gentamicin (p = 0.002) and ciprofloxacin (p < 0.0001) during the study period. The changing etiology of urinary tract infections and the increasing resistance of organisms indicate that periodic monitoring and possibly also modification of empirical therapy are required.
Ambulatory Care Facilities↗
Rapid increase in the prevalence of antimicrobial drug resistance among enterococcal blood isolates in southern Israel.
A prospective surveillance was conducted to monitor the prevalence and dynamics of antimicrobial resistance among enterococci isolated from blood cultures in southern Israel. A total of 242 organisms isolated between 1993 and 1996 were studied. The prevalence of Enterococcus faecalis significantly decreased during the study period, whereas that of Enterococcus faecium doubled. Antimicrobial drug resistance increased steadily among Enterococcus faecium isolates: resistance to ampicillin increased from 19% in 1993-1994 to 53% in 1995, and to 67% in 1996 (p = 0.005); during the same period, resistance to vancomycin increased from 0% to 20%, and to 50% (p = 0.002), and combined resistance to ampicillin and vancomycin and high-level resistance to gentamicin from 0% to 20% and to 38% (p < 0.02).
Ampicillin Resistance↗
Rapid detection of Brucella melitensis from blood cultures by a commercial system.
To assess the capability of the Peds Plus medium of the Bactec 9240 blood culture system to recover Brucella melitensis within the routine seven-day protocol used by most clinical microbiology laboratories, inoculated blood culture bottles were monitored by the Bactec 9240 instrument for four weeks, and blind subcultures were performed once a week. A total of 2579 blood cultures were drawn, 42 (1.6%) of which were positive for Brucella melitensis. Forty-one of the 42 (97.6%) positive cultures were detected by the Bactec 9240 instrument within two to six days; a single positive culture was missed by the instrument and detected by blind subculture performed on day 7.
Adolescent↗
Antimicrobial resistance and typing of pneumococci in Gaza Strip children.
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Anti-Bacterial Agents↗
Comparison of BACTEC 9240 Peds Plus medium and isolator 1.5 microbial tube for detection of Brucella melitensis from blood cultures.
The sensitivity and time to detection of Brucella melitensis by the BACTEC 9240 and the Isolator blood culture systems were compared in a prospective volume-controlled study. Blood sample aliquots, obtained from children with suspected brucellosis, were inoculated into a BACTEC 9240 Peds Plus bottle and into an Isolator 1.5 Microbial Tube. Overall, 122 pairs of blood samples for culture were obtained, and 28 (23%) were positive by at least one method. The BACTEC 9240 system detected all 28 positive cultures (sensitivity, 100%), and the Isolator system detected 22 positive cultures (sensitivity, 79%) (P = 0.023). Among those 22 cultures positive by both methods, 21 (95%) and 15 (68%) were found to be positive within 3 days by the BACTEC and the Isolator systems, respectively; 8 (36%) were found to be positive at least 1 day earlier by the BACTEC instrument, and the remaining 14 were found to be positive by the two systems on the same day (P = 0.045). The BACTEC 9240 blood culture system is more sensitive than the Isolator system for the detection of B. melitensis and is superior in terms of time to detection of the organism.
Bacteremia↗
Impaired respiratory response to resistive loading during sleep in healthy offspring of patients with obstructive sleep apnea.
To evaluate the possibility that healthy offspring of patients with obstructive sleep apnea syndrome (OSAS) may have covert signs of sleep disordered breathing, we compared the respiratory response to inspiratory resistive loads (IRL) in 10 adult offspring of fathers previously diagnosed with OSAS with that of 14 offspring of healthy parents. None of the offspring in either group had any sign of OSAS, and groups were age, weight, and body mass index matched. Both ventilatory response to progressively increasing levels of IRL and the IRL required to produce severe hypopnea (tidal volume [V(T)] < 20% of unloaded magnitude) were determined, during NREM sleep. Offspring of patients with OSAS (OSAS offspring) responded to all levels of IRL with greater decreases in V(T). Their V(T) decreased in the second breath on IRL of 23 cm H2O/l/s by 39 +/- 10%, as compared with a decrease of 19 +/- 4% (mean +/- SD) in the control group (p < 0.05). Severe hypopnea occurred in the OSAS offspring in response to smaller IRL compared to controls (79 +/- 20 and 153 +/- 14 cm H2O/l/s, respectively, p < 0.005). Total upper airway occlusion in response to IRL occurred in three of the OSAS offspring, but in none of the controls. We conclude that apparently healthy offspring of patients with OSAS may inherit subtle defects that reduce their ability to compensate for increased loads and maintain upper airway patency during sleep. We speculate that offspring of OSAS patients with decreased tolerance to IRL may be prone to developing OSAS later on in life.
Adolescent↗
[Round pneumonia shadows in children suspected of indicating mediastinal tumors].
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Child↗
[Insomnia in infancy and childhood--causes, significance, assessment and approach to treatment].
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Child↗
A fibroepithelial urethral polyp protruding into the base of the bladder: sonographic diagnosis.
A case of congenital urethral polyp in a 10-month-old boy is presented. These rare congenital tumors can lead to urinary retention, hematuria, urinary tract infections, hydronephrosis and hydroureter. Traditionally the diagnosis was based either on voiding cystourethrography or cystoscopy. The sonographic features of these polyps have only been reported in a few cases in the past. This modality is not infrequently the imaging procedure of choice in the work-up of children with signs and symptoms related to the urinary system. In the case presented herein the polyp was demonstrated initially by sonography as a soft tissue mass arising at the base of the urinary bladder. The differential diagnosis of these lesions is presented.
Diagnosis, Differential↗
Radiologic features of gastric outlet obstruction in infants after long-term prostaglandin administration.
Long-term prostaglandin (PG) therapy has recently been associated with gastric mucosal hyperplasia. We reviewed the clinical and radiologic (especially sonographic) records of eight patients with complex congenital heart disease who were on PG therapy. Feeding problems, vomiting, and abdominal distension were present in six patients. Barium meal revealed antral narrowing in three patients, suggestive of hypertrophic pyloric stenosis in two. Sonography showed a variable degree of increased gastric mucosal lobulation often accompanied by a marked polypoid or lobular appearance. Cortical hyperostosis related to PG therapy was seen in three patients. PG-associated gastric mucosal hyperplasia can cause feeding problems and pronounced gastric lobulation.
Alprostadil↗
HLA class II analysis in Jewish Israeli narcoleptic patients.
HLA class II was investigated in eight Jewish narcoleptic patients, representing the total of such patients known in Israel at present, and in three patients suffering from sleep disturbances other than narcolepsy. All (11 out of 11) patients carried the serologic specificities DR2, DQ6 (DQ1). At the DNA level, all narcoleptics were found to be DRB1*1501, DQA1*0102, DQB1*0602 which indicates that the susceptibility gene may be located within the HLA class II region, DR, and/or DQ. As for the nonnarcoleptic patients with idiopathic hypersomnia, they carried different alleles of DR2 and DQ6, namely DRB1*1502, DQA1*0103, DQB1*0601. This study confirms that the incidence of narcolepsy in Israel is extremely low and that HLA class II genes or a gene(s) tightly linked to them are involved in the disease.
Alleles↗