Biomedical subjects
Publications and source records attributed to Y Almog.
Acute hepatitis B virus (HBV) infection has very rarely been associated with glomerulonephritis. We describe a case of post-infections glomerulonephritis associated with acute HBV infection. The kidney disease resolved concomitantly with the hepatitis, and the patient recovered from acute HBV infection.
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An unusual case of cervical emphysema and pneumomediastinum following a blowout fracture of the medial orbital wall is presented. Severe pulmonary distress did not occur, and the trapped air rapidly absorbed. The source of the emphysema and its progression is discussed considering the anatomic relations of the facial and cervical subcutaneous space and the mediastinum. To our knowledge, this complication is rare and has been documented only once before in an isolated blowout fracture of the orbit.
The occurrence of respiratory failure as a result of a large diaphragmatic hernia is a well-described entity in infants with congenital hernias. On reviewing the literature, the authors did not find a similar clinical presentation in the adult population. They report the case of an elderly patient with a large hiatus hernia who developed recurrent episodes of life-threatening respiratory failure and hemodynamic compromise due to recurrent gastric dilatation. Decompression with nasogastric suction resulted in dramatic and immediate relief of the respiratory distress. One should keep in mind the possibility of intrathoracic gastric dilatation as a cause of acute respiratory insufficiency in patients with hiatal hernia.
A patient presented with fever, haemoptysis and large bilateral perihilar masses. Histology proved that these were pulmonary artery aneurysms due to pulmonary vasculitis, as a manifestation of Behçet's disease. It is suggested that a routine dynamic computed tomographic (CT) scan should be performed in the evaluation of such cases.
Hormones are known to regulate both viral and cellular genes. It has been shown previously that estrogen has an effect on liver gene transcription and mRNA stability. Sex hormones might have a role in the chronic persistence of hepatitis B virus (HBV) infection. In fact, there is a male preponderance in the incidence of chronic HBV infection, and HBsAg expression was reported to be much higher in male transgenic mice than in the females. We investigated the effect of estrogen on HBV gene expression and regulation in athymic mice bearing 2.2.15 cells, a human hepatoblastoma cell line derived from Hep G-2 transfected with HBV sequences. Both male and female mice were treated with estradiol after tumors could be observed. Episomal DNA was extracted from the tumors and hybridized with 32P-labelled HBV DNA. Southern blot and slot blot analyses demonstrated that male mice had higher expression of HBV DNA. Estrogen treatment suppressed HBV DNA expression in males, but had only a minor effect on females. HBeAg production in male mice was also inhibited by estrogen treatment. HBV RNA extracted from 2.2.15 cells showed 2-3-fold reduction following beta-estradiol treatment. Moreover, inhibition of HBV transcription by estrogen was demonstrated by an RNA pulse-labelling experiment. These data indicate that estrogen inhibits HBV expression in the in vivo model presented in this study. These results might contribute to a better understanding of the effect of sex hormones on the pathogenesis of HBV-induced liver disease.
A case of proliferative vitreoretinopathy that spontaneously regressed, leading to reattachment of the retina, is presented. The importance of such a spontaneous resolution in terms of understanding the pathogenesis, and planning a treatment, is discussed.
The incidence of lower urinary tract infection in 120 women with rheumatoid arthritis and secondary Sjögren's syndrome was evaluated retrospectively. Thirty one patients (26%) had secondary Sjögren's syndrome. Recurrent urinary tract infection was significantly more common in these patients (11/31) than in patients without Sjögren's syndrome (4/89). Habitual leucocyturia was also more common in patients with secondary Sjögren's syndrome (18/31) than in patients with rheumatoid arthritis without Sjögren's syndrome (8/89). Of seven patients with vaginal sicca symptoms, six had recurrent urinary tract infection. Urinary 24 hour mucopolysaccharide excretion in 20 patients with Sjögren's syndrome was similar to the excretion in 10 patients without Sjögren's syndrome. These results show that recurrent urinary tract infection is significantly more common in women with rheumatoid arthritis and secondary Sjögren's syndrome. A local deficit in protective urinary mucosal secretion or other immune mechanisms may be responsible for this susceptibility.
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Secretory diarrhea can be seen in a variety of pathologic states; however, intermittent colonic obstruction usually is not considered as a possible cause. We report a 68-yr-old patient with chronic secretory diarrhea and hypokalemia due to intermittent sigmoid volvulus. Because the volvulus was not originally diagnosed, the patient was treated with the long-acting somatostatin analogue octreotide for 1 yr, with marked clinical improvement. Surgical resection of the redundant sigmoid responsible for the volvulus resulted in prompt and complete resolution of all signs and symptoms. Detailed macroscopic and microscopic examination of the resected specimen was normal. The patient continues to be asymptomatic 12 months after surgery. Increased colonic fluid and electrolyte secretion was caused by intermittent sigmoid volvulus and resulted in chronic secretory diarrhea.
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A 27-year-old woman experienced hemorrhagic shock after delivery. One week later she was seen in an obtunded state of consciousness. The results of laboratory evaluation were consistent with the syndrome of inappropriate antidiuretic hormone secretion caused by hypopituitarism. Hydrocortisone rapidly corrected sodium levels. Syndrome of inappropriate secretion of antidiuretic hormone caused by Sheehan's syndrome should be considered in the differential diagnosis of postpartum hyponatremia.
We studied the ocular hypotensive efficacy and safety of 0.5% levobunolol hydrochloride and 0.5% timolol maleate administered topically once daily for 3 months in 91 patients (46 in the levobunolol group and 45 in the timolol group) with primary or secondary open-angle glaucoma or ocular hypertension. In this randomized double-masked parallel clinical study, intraocular pressure (IOP) was successfully controlled in 78% of the patients who received levobunolol and 89% of those who received timolol. The overall mean decrease in IOP was 5.6 mm Hg (decrease of 23%) in the levobunolol group and 6.7 mm Hg (26%) in the timolol group, a nonsignificant difference. In both groups the overall mean IOP during treatment was significantly lower than the pretreatment value (p less than 0.001). For both treatment groups changes in heart rate and blood pressure were minimal. We conclude that both 0.5% levobunolol and 0.5% timolol administered once daily are effective and safe in lowering IOP in most patients with ocular hypertension or open-angle glaucoma.
A 73-year-old man was treated with oral glycerol solution for elevated intraocular pressure. Forty-five minutes later, he developed severe pulmonary edema. To our knowledge, this is the first documented case of this severe complication.
Tear secretion was examined in 194 patients treated with oral beta blockers, mainly with propranolol, oxprenolol, pindolol, and atenolol, and metaprolol and in 185 healthy control subjects. Statistical analysis included the Student's t test used to compare the mean values of tear secretion and the chi square test used to compare the percentage of eyes with tear hyposecretion between treated and control groups. This statistical study showed clearly that oral beta blockers significantly reduce the tear secretion.
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The CT scans of three patients whose eyes were lacerated by trauma failed to demonstrate the lens. A slit-lamp examination of those eyes clearly indicated that the lenses were present behind the iris but that they were swollen and opaque (intumescent cataract). Apparently, a shift of water into the injured lens had reduced the expected hyperdense CT image of the lens to a level that it was no longer discernible.
A 76-year-old male was admitted to our hospital because of dermatomyositis (DM). Fourteen years earlier a transitional cell carcinoma of the bladder was diagnosed. Following repeated resections of the neoplasm, he was free of the disease for the last two years. Six weeks after starting treatment with steroids and azathioprine for DM, he has developed Kaposi's sarcoma of the skin which subsided upon discontinuation of the immunosuppressive drugs. Four months after the diagnosis of DM, a local recurrence of the bladder carcinoma was found. This patient illustrates the importance of a thorough search for neoplasms or recurrence in elderly patients with dermatomyositis. The case also emphasizes the need for caution in immunosuppressive treatment of autoimmune disorders in such patients. Still, discontinuation of these medications resulted in a significant improvement of the skin neoplasm.