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Biomedical subjects

S Weitzman

Publications and source records attributed to S Weitzman.

At least 91 records · Page 5Linked to original sources
PubMed1991

Complications of indwelling venous access lines in the pediatric hematology patient: a prospective comparison of external venous catheters and subcutaneous ports.

Since 1984, 316 subcutaneous ports (SP) and 339 external venous catheters (EC) [Roko Catheter, The Hospital for Sick Children (HSC)] have been inserted in hematology/oncology patients at HSC. During a 22-month period (July 1987 to April 1989), a committed central line nurse (J.I.) prospectively collected clinical and microbiologic data on 144 consecutive SPs and 130 consecutive ECs. Children with the SP had 0.6 infected lines and 0.7 infectious episodes per 1,000 patient days compared to 2.9 infected lines and 4.3 infectious episodes per 1,000 patient days with the EC (p less than 0.001). This lower infectious complication rate with SP was demonstrated in the entire group of unselected patients and in a cohort of children with acute lymphoblastic leukemia (ALL) receiving intensive chemotherapy, and it was evident in all age groups. In view of the other advantages of SP--normal activity, absence of the need for home maintenance, improved body image, less expense--these data suggest that SPs are the preferred device in pediatric patients and provide effective venous access with acceptable complication rates.

Adolescent↗
PubMed1991

Extrarenal Wilms' tumor: staging, treatment, and prognosis.

Extrarenal Wilms' tumors are rare and have mainly been the subject of isolated case reports. This retrospective evaluation of 34 patients suggests a clinical course very similar to that of renal Wilms' tumor. While clinical presentation varies according to the extrarenal localization, investigations to determine the size of the primary tumor (T), regional lymph node involvement (N), and the occurrence of distant metastasis (M) are very similar, ie, chest x-ray, abdominal ultrasound (US), and computed axial tomographic (CAT) scan of the abdomen and chest. Stage grouping according to the pathologic TNM classification showed stage I in 30%, stage II in 10%, stage IIIa in 34%, stage IIIb in 23%, and stage IVa in 3%; four patients could not be staged. Evaluation of therapy and survival indicate the need for postoperative chemotherapy (CT) to all patients, while the same data suggest that the drugs used for renal Wilms' tumor are equally effective for extrarenal Wilms' tumor. Radiotherapy (RT) probably should be reserved for those patients with unresectable gross residual disease and for metastatic disease. The radiation dose used in the reviewed cases varied from 2,000 to 5,000 cGy. However, recent experience suggests that high doses are not justified in renal Wilms' tumor. The estimated overall 2-year survival of the 34 patients is 82% (95% confidence interval, 63% to 92%).

Adolescent↗
PubMed1990

[Prevalence of type 2 diabetes in the Negev].

10,578 medical records of patients 30 years and older, registered in 3 representative primary care clinics, were reviewed in 1984. 705 diabetics were identified. The prevalence rate was 6.7%: 5.9% among men and 7.1% among women. The male/female ratio was 46/54. In both sexes rates increased with age. The highest age-adjusted rate was among Jews of North African origin (7.5%).

Adult↗
PubMed1990

[A simple qualitative method for assessing microalbuminuria in diabetics].

Diabetes mellitus is one of the most important causes of kidney diseases, the first sign of which is albuminuria. It is now possible to detect microalbuminuria before the appearance of larger quantities. We compared a simple qualitative test for microalbuminuria (change in color of a tablet containing bromphenol blue on addition of urine) with a more elaborate quantitative immunoturbidometric method. Of 109 samples tested 31 were positive by the quantitative method and 29 of these were positive by the tablet method. Out of the 78 negative by the quantitative method only 4 were positive by the qualitative test. The sensitivity of the tablet test was 93.5%, specificity 94.0%, positive predictive value 87.9%, negative predictive value 97.4%, false positive rate 5.2%, and false negative rate 6.2%. We conclude that the tablet test is simple and accurate and is suitable both for screening of large populations and for the diagnosis of individual cases of microalbuminuria.

Albuminuria↗
PubMed1990

[Assessment of diabetic autonomic neuropathy by heart rate monitoring].

Assessment of diabetic autonomic neuropathy in a representative sample of 91 noninsulin-dependent diabetics was performed in 3 community clinics. A difference of less than 10 beats/min in heart rate between deep inspiration and deep expiration determined by ECG recording served as the criterion for autonomic neuropathy. By this test, 86% of the patients had diabetic autonomic neuropathy, a slightly higher proportion than that reported by others using similar criteria in more selected populations. The test is very sensitive and can be used for screening.

Adult↗
PubMed1990

The prevalence of cardiovascular risk factors among male Bedouins: a population in transition.

Accumulating evidence suggests that cardiovascular disease which was very rare among Negev Bedouins until the 1970's is now on the increase. The Bedouin nomads are being settled in townships and are changing habits and lifestyles as a result. The aim of this study was to determine the prevalence of known cardiovascular risk factors in Bedouins at different levels of lifestyle changes. To do so, the prevalence of the risk factors was examined in a traditional tribal group and in a settled Bedouin group. Among settled Bedouins, 15% were obese (BMI greater than 30) and a further 35% were overweight (BMI 25-29.9), as compared with no obesity and only 23% of overweight in the tribal group. The differences were most marked in the younger age group. Mean LDL-cholesterol levels also differed between the two study groups, being significantly higher in settled than in tribal Bedouins (113.9 mg% +/- SD 28.6 vs 96.9 mg% +/- SD 27.1 respectively, p less than 0.05). High BMI and LDL-cholesterol were both significantly and independently associated with being settled. No differences between the groups were found in relation to blood pressure, smoking and fasting blood glucose. It appears therefore that settlement of nomadic Bedouins and the changes associated with it, alter the pattern of cardiovascular risk factors in this population.

Adult↗
PubMed1990

Factors influencing birth weight in newborns of diabetic and non-diabetic women. A population based study.

Maternal diabetes is known to be related to an increase in birth weight of the offspring. However, the mechanism of the association is not entirely clear. In addition, the contribution of the demographic, obstetric and metabolic factors to birth weight in diabetic mothers is not well defined. All the diabetic women (68 requiring insulin-treatment and 403 on diet alone) and a random sample of 1 in 12 of all non-diabetic women (893 women) who delivered in one regional hospital between March 1987 and June 1988 inclusive, were included in the study. Tests for gestational diabetes are routinely performed in our pregnant women population, thus, the study is a population based one. The mean birth weight of infants of diabetic mothers adjusted for gestational age was higher than in those of non-diabetic mothers. However, no relationship was found between maternal glycosylated hemoglobin measured at delivery and the infants birth weight. Furthermore, at each week of gestation, infants born to diabetic mothers were heavier than the infants of non-diabetic mothers (for weeks 37 to 40, p less than 0.05), while no differences were found in glycosylated hemoglobin levels between the two groups at any time. In a multivariate model we showed that after controlling for gestational age, the only factors which independently and significantly affected birth weight in our population were diabetes, ethnic origin, and the parity of the mother. Our findings support the possibility that substances which induce hyperinsulinemia, other than glucose, may be related to the higher birth weight of infants of diabetic mothers.

Adult↗
PubMed1990

Pineal region germinomas in childhood treatment considerations.

From 1967-1986, 21 children were treated for pineal germinoma, including 16 biopsy-proven, 2 biopsy non-diagnostic, and 3 metastatic unbiopsied (marker negative) patients. Ten of 18 (56%) biopsied patients underwent partial or sub-total tumor resection. Twenty patients were irradiated, 19 of whom are alive. No irradiated patient died of progressive germinoma, but two patients relapsed in the spinal cord and required treatment intensification for salvage. Long-term survivors have significant morbidity. Determination of the minimum effective treatment remains the chief therapeutic challenge.

Adolescent↗
PubMed1990

Juvenile chronic myelogenous leukemia: differentiation from infantile cytomegalovirus infection.

Differentiation between cytomegalovirus (CMV)-associated disease and juvenile chronic myelogenous leukemia (JCML) in infants excreting CMV may be difficult. It is important to make a prompt, definitive diagnosis since the management differs. A 3-month-old infant presented with clinical findings that mimicked both disorders and a plan was developed to make the correct diagnosis. Clonogenic assays and liquid cultures of patients' peripheral blood and bone marrow showed findings that are recognized as the hallmark of JCML, namely, impaired growth of normal hematopoietic progenitors, and excessive, autonomous proliferation of monocyte/macrophage elements. The urine was positive for CMV, and there was a significant rise in the anti-CMV antibody titer over 4 weeks, indicating a postnatal CMV infection. Despite this, freshly obtained and cultured marrow cells as well as a liver biopsy were negative for CMV by immunoassay, by anti-CMV monoclonal antibody testing, and by electron microscopy. Because of these results, the diagnosis of CMV infection was established but could not account for all of the abnormal clinical and hematological findings. Thus, the diagnosis of JCML was also substantiated and antileukemic therapy was initiated with confidence.

Antibodies, Viral↗
PubMed1989

[Long-term follow-up of prosthetic heart valves].

257 patients underwent single or double heart valve replacement between 1964-1986. In 141 (55%) after isolated mitral valve replacement, operative mortality was 14.8% and after 5, 10, 15 and 20 years, actuarial survival was 84%, 70%, 59% and 44%, respectively. In 70 who underwent isolated aortic valve replacement, operative mortality was 7.1% and after 5, 10, 15 and 20 years, actuarial survival was 85%, 85%, 72% and 72%. In 46 who underwent combined aortic and mitral replacement, operative mortality was 4.3% and after 5, 10 and 15 years, actuarial survival was 78%, 71% and 71%.

Actuarial Analysis↗
PubMed1989

Improved knowledge of diabetic patients through education of primary care staff.

A sample of 142 diabetic patients was interviewed twice, in 1984 and 1986, following an educational program administered to primary care staff. Positive changes were recorded regarding several aspects. (a) Process of care - the percentage of untreated patients decreased from 15% to 4%; the proportion of patients on diet only increased from 36% to 41%, while the insulin-treated proportion decreased from 12% to 8%; the percentage of patients treated with oral drugs went up from 36% to 46%. (b) Patient knowledge - an improvement in various aspects, such as diet and exercise. (c) Patient behavior - an improvement in adherence to diet and in compliance with medications.

Adult↗
PubMed1989

Cardiovascular disease hospitalization rates in Negev communities: are differences due to differential prevalence or differential use of health care?

Goldsmith and Pilpel found the rate of hospitalization for cardiovascular disease (CVD) in Beer Sheva in 1981 to be approximately twice that of five development towns in the Negev. In order to determine whether this difference was due to differences in the prevalence of heart disease, data on heart disease mortality hospitalization for 1981, 1983 and 1985 was studied, and hypertension prevalence in these communities were examined. From 1981 death records, age-adjusted CVD rates for the male population greater than 30 years were 397.7/100,000 in Beer Sheva and 344.4 in development towns; for women the rates were 351.5 and 411.2, respectively. Myocardial infarction rates for men were the only subset of CVD to be significantly different (Beer Sheva 174.3 vs. development towns 115.7). Beer Sheva residents with CVD were significantly more likely to die in the hospital or another health care facility than residents of development towns. The rates of emergency room use were higher in Beer Sheva than in development towns, but the proportion of those patients who came to the emergency room because of chest pain who were hospitalized was the same for both communities. Data from a sample study of hypertension recorded for patients in primary care clinics in 1983 showed no differences in prevalence or treatment status between Beer Sheva and development town residents. Overall CVD hospitalization rates were 27.7% greater for BS men and 33.3% for BS women. We conclude that: a) the higher rate for myocardial infarction in Beer Sheva merits further investigation, but cannot account for the differential rates of hospital use; and b) distance from the hospital and c) culturally associated attitudes toward hospitalization on the part of both patients and physicians are likely explanations that should be further investigated.

Adult↗
PubMed1989

Follow-up of isolated mitral valve prosthesis, 1964-86.

We review the data of 141 patients who underwent mitral valve replacement between 1964 and 1986. In the majority of patients, a tilting disk or a Cage ball prosthesis was implanted. Overall operative mortality was 14.8%, and 120 patients who were followed for a mean period of 4.5 +/- 2 years (540 patient years) showed a late mortality (greater than 30 days postoperatively) of 20.8%. The actuarial survival was 84% at 5 years and 44% at 20 years. Most of the late deaths were cardiac related, with sudden death as the leading cause. The incidence of prosthetic valve-related complications--thromboembolism, bacterial endocarditis and warfarin-related hemorrhage--were higher than in other series; however, long-term survival was comparable. Delay in advising mitral valve surgery is the probable cause of some of the results observed in this series.

Adolescent↗
PubMed1989

Follow-up of isolated aortic valve prosthesis, 1964-86.

Between May 1964 and November 1986, 70 patients underwent aortic valve replacement with (20%) or without (80%) additional surgical procedures. Most of the prosthetic devices were Starr-Edwards models and Björk-Shiley and Sorin tilting disks. Long-term follow-up (305 patient years) was assessed in 65 patients who survived the operation. Actuarial survival was 85 +/- 2% at 5 years and 72 +/- 6% at 20 years. The linearized rate of deaths occurring greater than 30 days postoperatively was 3.6% per patient year; sudden death was the most frequent cause of death. Preoperative functional capacity class significantly influenced the immediate outcome of surgery. Although the incidence of prosthetic valve-related complications was higher than in previous studies, survival rates were comparable.

Adolescent↗
PubMed1989

Characterization of a novel myeloma cell line, MM.1.

A myeloma cell line, MM.1, has been established from the peripheral blood cells of a patient with immunoglobulin A myeloma. MM.1 grows in suspension either singly or in small clusters and secretes lambda-light chain. Phenotypically, MM.1 cells lack most B cell antigens, but they do express human leukocyte antigen DR, PCA-1, and T9 and T10 antigens. Molecular analysis of MM.1 demonstrates that it is negative for the presence of the Epstein-Barr virus genome. Southern analysis of MM.1 detected a rearrangement of the lambda-light chain gene, and Northern analysis revealed high levels of lambda gene expression. Cytogenetic analysis of the MM.1 cell line revealed the presence of seven related chromosomally abnormal cell lines characterized by numerical and structural aberrations, and it revealed five nonclonal abnormal cells. The most notable abnormality is a reciprocal translocation involving band q24.3 of chromosome 12 and band q32.3 of chromosome 14; translocations involving 14q32 are frequently observed in neoplasms of B cell origin.

Adult↗
PubMed1988

Hypertension Control Program of the Negev: evaluation after two years of intervention.

In 1981 a nationwide effort to control high blood pressure was implemented. One of the first programs was the "Hypertension Control Program of the Negev." The program's major objective was to introduce early detection and improve diagnostic, treatment, and follow-up procedures to 27 primary-care clinics of the area. The evaluation was based on the program's three levels of intervention: (a) basic training program and written protocol, containing guidelines for diagnosis, treatment, and follow-up; (b) additional consultation in the primary-care clinics by internal medicine specialists from the regional medical center, and (c) additional consultation in the primary-care clinics by the hypertension unit's medical team. In 1981 (prior to any intervention) a random sample of 5,717 medical records of the target population (30 years or older) was reviewed. High blood pressure was found in 1,032 patients (18%); however, a written diagnosis of hypertension was recorded in only 57% of these cases, and of these only 37% were being regularly treated for high blood pressure. In 1983, a second, independent random sample of 7,791 records was reviewed. High blood pressure was again found in 18% (1,428) of the cases, but 69% of these had a recorded high blood pressure diagnosis (a relative increase of 21% from 1981), and 85% of these were treated for high blood pressure (a relative increase of 130%). Improved performance in the steps of care provided for high blood pressure was observed in all the clinics. Surprisingly, the percentage of well-controlled patients increased only in those clinics where the staff gave consultation services.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗