Biomedical subjects
Publications and source records attributed to S Atar.
Intravascular ultrasound demonstrated plaque ruptures that occurred in regions involved with large complicated atherosclerotic plaques in the coronary artery. Because intravascular ultrasound evaluates both plaque and luminal dimensions, it contributes to our understanding of the pathophysiology of coronary artery disease.
The purpose of this study was to evaluate the modification of the saline echo contrast method by mixing blood with agitated saline before intravenous injection. In 20 patients, contrast echocardiography was performed with a conventional technique from the apical 4-chamber view. We used 2 techniques: (1) the combination of blood (1 mL) withdrawn from the patients and air-agitated saline agitated, (2) air-agitated. In all patients, the blood combination technique was judged to make a greater contrast, with the agreement of all 3 reviewers. Peak echo intensity of the right ventricular cavity by the blood combination technique was significantly higher than that by agitated saline alone. In conclusion, the use of the combination of blood and agitated saline is superior to agitated saline alone for the opacification of the right atrium and ventricle in routine echocardiography.
Ultrasonic thrombolysis has been proved to be an efficient and safe modality for the treatment of acute arterial occlusions in vitro and in vivo in animal studies. There have been and are ongoing parallel improvements in ultrasound technology and adjuvant pharmacological treatments for therapeutic applications. Thus therapeutic ultrasound for thrombolysis holds great promise in overcoming the limitations of current available therapies.
STUDY OBJECTIVES: The decrease in incidence of tuberculosis, along with the increase in invasive cardiovascular procedures, may have changed the frequency of causes of bloody pericardial effusion associated with cardiac tamponade, although this is not yet recognized by medical textbooks. We analyzed the causes of bloody pericardial effusion in the clinical setting of cardiac tamponade in the 1990s; patients' survival; the effect of laboratory results on discharge diagnosis; and how often bloody pericardial effusion is a presenting manifestation of a new malignancy or tuberculosis. DESIGN: Retrospective, observational, single-center study. SETTING: A community hospital. PATIENTS: The charts of all patients who underwent pericardiocentesis for cardiac tamponade and had bloody pericardial effusion were retrospectively reviewed. RESULTS: Of 150 patients who had pericardiocentesis for relieving cardiac tamponade, 96 patients (64%) had a bloody pericardial effusion. The most common cause of bloody pericardial effusion was iatrogenic disease (31%), namely, secondary to invasive cardiac procedures. The other common causes were malignancy (26%), complications of atherosclerotic heart disease (11%), and idiopathic disease (10%). Tuberculosis was detected as a cause of bloody pericardial effusion in one patient and presumed to be the cause in another patient. Bloody pericardial effusion was found to be a presenting manifestation of a newly diagnosed malignancy in two patients. The patients in the idiopathic and iatrogenic groups were all alive and had no recurrence of pericardial effusion at 24 +/- 27 and 33 +/- 21 months after hospital discharge, respectively, whereas 80% of patients with malignancy-related bloody effusions died within 8 +/- 6 months. CONCLUSIONS: In a patient population that is reasonably representative of that in most community hospitals in the United States, the most common cause of bloody pericardial effusion in patients with signs or symptoms of cardiac tamponade is now iatrogenic disease. Of the noniatrogenic causes, malignancy, complications of acute myocardial infarction, and idiopathic disease predominated. Hemorrhagic tuberculous pericardial effusions are uncommon and may likely reflect a low incidence of cardiac tuberculosis in community hospitals in the United States.
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Hypokalemic periodic paralysis is an uncommon complication of thyrotoxicosis, and very rare as a presenting symptom. It is most frequent in east Asian and Japanese males, but extremely rare in others. Only 1 case has previously been reported from Israel. We present a 29-year-old Arab man who presented with sudden paralysis of both legs. Physical examination revealed signs of thyrotoxicosis, and laboratory tests showed profound hypokalemia. Oral potassium resulted in rapid disappearance of symptoms, and after restoration of the euthyroid state, there were no further attacks. This case shows that thyrotoxic hypokalemic periodic paralysis is not confined to males of east Asian and Japanese origin, and that adequate treatment with oral potassium and antithyroid drugs is successful, and should be given as soon as possible.
339 adult immigrants from Ethiopia were surveyed 1 year after arrival. They were screened for diabetes mellitus and impaired glucose tolerance by measurement of serum HgbA1C levels. The levels were higher than normal in 35 subjects (10.3%), and were significantly higher in immigrants consuming the Israeli diet, which is richer in proteins and carbohydrates, than in those on the Ethiopian diet. Oral glucose load was abnormal in 7 subjects. 3 had overt diabetes mellitus with absent serum insulin response to glucose load. 4 had glucose intolerance with normal insulin secretion. However, clinical appearance of diabetes was incidental and diabetes ketoacidosis was not detected. The overall prevalence of diabetes mellitus and glucose intolerance in this ethnic group (2.1%) is similar to that in the general population of Israel. Longitudinal studies would indicate the exact prevalence and type of diabetes mellitus among the Ethiopian immigrants.
1131 immigrants from Gonder, Ethiopia were surveyed a year after arrival in Israel. The overall prevalence of goiter was 46.1%; the lowest rates (6.7%) were in infants (aged 1-2 years) and the peak prevalence in males was 56.7% (in those aged 12-14 years) and in females, 77.7% (in those aged 35-40). A significant decrease in goiter prevalence was observed after the age of 60 for both men (7.2%) and women (35%). The prevalence of hypothyroidism was 1.1%, 2% in children and 0.2% in adults. That of hyperthyroidism was 1.7%, 0.8% in children and 2.4% in adults. The high prevalence of goiter and hyperthyroidism with low prevalence of hypothyroidism probably resulted from the combined effects of food goitrogens and iodine deficiency in Ethiopia, with the latter playing only a minor role. Neither factor was in effect after arrival in Israel. Genetic and hormonal factors may contribute to the low prevalence of both goiter and hypothyroidism in the adult males. In view of the high prevalence of hyperthyroidism, iodine enrichment is not recommended for Ethiopian immigrants.
Kimura's disease (KD) is an angiolymphoid proliferative disorder of soft tissue with eosinophilia, with a predilection for head and neck regions in young Oriental men. Renal disease is rarely associated with it. We describe a young non-Oriental male with KD and relapsing steroid-responsive minimal-change nephrotic syndrome. This case of KD associated nephrotic syndrome is unique in the relapsing nature of the nephropathy and the non-Oriental origin of the patient. We comment on KD and nephrotic syndrome and on treatment strategy.
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A survey study was performed to assess the prevalence of goiter and thyroid dysfunction in a population of 534 Ethiopian children, one year after arrival in Israel. The overall prevalence of goiter was 43.6%. Children in the age group 1-2 years had the lowest prevalence of goiter (6.7%). A progressive increase in goiter prevalence and size with age was observed, with peak occurrence around puberty for both boys (56.7%) and girls (72.2%). Serum FT4 levels were elevated in 4 children; elevated serum TSH levels (above 4.5 mIU/l) were found in 11 children, all of them had normal FT4 levels. Thus the prevalence of hypothyroidism and hyperthyroidism was 2% and 0.8%, respectively, with an even distribution across the various age groups. All the children were clinically normal. The high prevalence of goiter in this group of Ethiopian children with the low frequency of hypothyroidism may be attributed to the combined effects of food goitrogens and iodine deficiency prevailing in Ethiopia. The standard Israeli diet seems to be adequate in respect to iodine requirements, and no iodine enrichment is needed for children immigrating from Ethiopia.
The characteristics of 193 legally blind children ranging in ages from birth to 4 years were analyzed. The overall incidence was 1/1000 live births; however, the ethnic specific incidence varies. All children were diagnosed before the age of 20 months and the most frequent alerting sign was lack of visual tracking. In 33.3%, the deficit was first suspected by a family member. A genetic etiology accounted for 38% of the cohort. The relative risk for an associated handicap was significant as well as the rate of hospitalizations for apparently unassociated diseases. It appears that both prevention and early detection could be achieved by a risk index.
Goiter size, thyroid function tests and thyroid cytology were studied in 100 immigrant Ethiopian Jews, 1-12 months after arrival in Israel on Operation Solomon (1991), who were referred for evaluation of goiter. Female-to-male ratio was 2.2:1. Hypothyroidism was rare (1%) whereas hyperthyroidism was frequently diagnosed (11%). Elevated thyroglobulin (TG) serum levels were found in 36% of the patients. Antithyroid antibodies were not detected. Thyroid cytology revealed rich colloid goiters in all patients. Thyroid carcinomata and chronic lymphocytic thyroiditis were not diagnosed. Both hyperthyroidism and elevated TG levels were found only in female patients and were equally distributed in patients maintained on either Israeli or Ethiopian diets. It is suggested that the major factors in the pathogenesis of endemic goiter in Ethiopian Jews are genetic and/or food goiterogens, with only a minor role for iodine deficiency.