[Suspected airport malaria in Israel].
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Biomedical subjects
Publications and source records attributed to Y Samra.
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One hundred and fourteen hospitalized patients with moderate or severe infections were assigned at random, in four medical centers, to receive either ceftizoxime or cefotaxime, administered intravenously in a dosage of 1 to 2 g every 8 h. Of 96 patients evaluable for efficacy, 24 (25%) had bacteremia, 46 (48%) had urinary tract infections and 9 (9%) had pneumonias. Half the patients had been treated ineffectively by other antibiotics prior to the study drug treatment. The overall clinical efficacy was 90% in both treatment groups and 83% in both groups with bacteremia. All patients with urinary tract infection were cured by both agents. Bacteriological eradication rate was 95% in both groups. Adverse reactions, though mild, were more frequent in the cefotaxime group (13.5%) than in the ceftizoxime group (6.8%); superinfection rate was higher in the ceftizoxime group. Both antibiotics were highly and equally efficacious in the therapy of severe infections in hospitalized patients.
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Twenty-three subjects who had a splenectomy as a result of trauma underwent scintigraphic evaluation with a sensitive heat-denatured 99mTc-labeled red blood cells (DRBC). This method enabled detection of ectopic splenic tissue foci (ESTF) as small as 1 X 1 cm in diameter. ESTF splenosis or accessory spleen was detected in 15 cases (65%), a higher incidence than previously reported. The size of the ESTF ranged from 1 X 1 to 5 X 10 cm (0.8-40 cm2), and 53% were less than 2 X 2 cma (3 cm2). A new multiparametric scintigraphic evaluating technique is described, which estimates the quantity of ESTF and its grade of activity, relative to that of the liver. The technique is a highly efficient assessor of ESTF function. Good correlation was found between the size and activity of the ESTF and the presence of Howell-Jolly bodies (HJB), but with a low sensitivity for detecting small ESTF. Correlation was low between residual splenic tissue and concentrations of IgM, IgA and IgG immunoglobulins. The 99mTc-DRBC method described is recommended for verification of ESTF existence, localization, and function.
The association of acne conglobata and arthritis is rare and has been reported in only single case reports in the literature. We describe a patient whose associated arthropathy appeared 21 years after the onset of the skin disease. The relevant literature is reviewed.
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Two cases of pyrexia of unknown origin are described in which no cause was found despite exhaustive inpatient investigation until occult dental infection was detected: extraction of the teeth involved was followed by resolution of the pyrexia. Dental infection should be considered as an unusual but eminently treatable cause of pyrexia of unknown origin.
Ciprofloxacin's in vitro activity was tested against 385 hospital isolates originating from three geographically distinct regions. Of all strains tested, only three (1 Acinetobacter sp. and 2 Pseudomonas aeruginosa) were ciprofloxacin resistant. Ciprofloxacin was more active against Escherichia coli, Enterobacter cloacae, Enterobacter aerogenes, Acinetobacter sp., Proteus sp., Shigella sp. than gentamicin, mezlocillin and cefotaxime. It was more active than azlocillin and cefsulodin against P. aeruginosa. It was more active than cloxacillin and cefamandole against staphylococci. It was as active as cefotaxime against Klebsiella pneumoniae, Citrobacter freundii and Serratia marcescens. Ciprofloxacin demonstrated similar activity in broth and solid agar. The minimal inhibitory concentrations (MIC's) of all strains were similar to the minimal bactericidal concentrations (MBC's). Ciprofloxacin's MIC was not influenced by increase of the inoculum or addition of human serum and only slightly influenced by anaerobic conditions. Decrease of the medium pH increased the MIC substantially. Ciprofloxacin exhibited a rapid bactericidal effect and had only a minimal post-antibiotic effect. These favorable in vitro characteristics of ciprofloxacin warrant further studies.
Twenty-five patients with psoriatic arthritis were studied by echocardiography in view of the known association of related seronegative arthropathies with aortic-valve lesions. The study group included 15 men and ten women with a mean age of 46.5 +/- 14.6 years. Twenty-two patients suffered from peripheral disease whereas three also had axial involvement. No aortic-valve lesions were found; however, mitral-valve prolapse (MVP) was detected in 14 patients (56%), nine men and five women. The mean age, mean duration of psoriasis, and mean duration of arthritis were similar in patients with and without MVP. HLA tissue typing, which was done in nine patients with MVP, revealed only one patient with HLA-B27. There was no predominance of any of the typical antigens found in psoriasis (HLA-B13, HLA-Cw6). In a control group of 32 psoriatic patients without arthritis, only two (6.4%) suffered from MVP.
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Sterile hemorrhagic cystitis following cyclophosphamide (Cph) therapy is a relatively frequent and well-documented phenomenon. On the other hand, cancer of the urinary bladder associated with Cph therapy is rarely observed. We present two cases and summarize 32 patients reported in the literature. Thirty patients had malignant disease elsewhere, 27 of them nonsolid tumors. The other four patients received treatment with Cph for nonmalignant disease (systemic lupus erythematosus--3; rheumatoid arthritis--1). The bladder tumor developed several months to years after treatment. In 20 patients hemorrhagic cystitis antedated the tumors. We conclude that hemorrhagic cystitis in patients on Cph therapy should indicate at least temporary withdrawal of the drug. The decision to resume treatment should be taken with extreme caution considering the risk of the development of bladder cancer.
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One hundred and twenty-one cases of murine typhus and spotted fever in Israel between 1976 and 1985 in the Chaim Sheba Medical Center are reviewed. Clinical manifestations of murine typhus were similar to those described previously, but those of spotted fever were different from classical Mediterranean spotted fever: rash was present in 87% but eschar was noted in only two out of 38 patients. The occurrence of relapse in eight of the 16 patients treated with chloramphenicol (seven cases of murine typhus and one case of spotted fever) was striking, particularly since none occurred in 86 patients treated with tetracycline hydrochloride (p less than 0.01). Relapses were milder than the primary illness, except for one which did not receive specific therapy and was fatal.
Q fever is an zoonosis caused by Coxiella burnetti, the clinical features of which are often nonspecific and self-limited. Involvement of the central nervous system is rare and is usually seen as a complication of endocarditis caused by this rickettsial organism in the chronic disease. Specific neurological manifestations in the course of the acute illness aseptic meningitis, encephalitis, toxic confusional states, extrapyramidal signs, dementia and behavioral disturbances. We describe a patient who developed reversible bilateral abducens nerve paralysis and bilateral optic neuritis in the course of acute Q fever meningoencephalitis.
Five cases of nontyphoid salmonella infection among renal transplant recipients are reported, and 32 cases from the literature are reviewed. Contrary to the nontyphoid salmonella infection in normal hosts, such infection in renal transplant recipients manifested as bacteremia (62%) and in extraintestinal foci (35%). Asymptomatic bacteriuria, at times prolonged, was common, whereas gastrointestinal symptoms were noted in only 19%. The course of infection may be prolonged, with relapse occurring in 43.2% and death in 5.4%. Extraintestinal manifestations were located at very unusual sites, such as testes, maxillary sinus, axillary vein thrombus, and hemodialysis fistula. Because relapses were so frequent, the suggestion is made that every effort be made to find silent foci of infection after clinical recovery and to eradicate such foci with prolonged antibiotic therapy and with surgical measures, if necessary. Stool and urine should be screened for nontyphoid Salmonella before and after transplantation.
Five episodes of nontyphoid salmonella infection following total hip replacement in four patients were studied. In three patients the infection occurred in the immediate postoperative period while prophylactic antibiotics were being administered. The fourth patient had bilateral total hip replacements five years apart with two nontyphoid salmonella infections, one immediately after the first operation (during antibiotic prophylaxis) and the second four years after the second operation. In addition to local infection, clinical manifestations included fever (all patients), diarrhea (three patients), deep prosthetic infection (two patients), and shock with disseminated intravascular coagulation and acute renal failure (one patient). In addition to antibiotic therapy, removal of the prosthesis was necessary for cure in three patients. All patients recovered. Hematogenous spread was thought likely in all cases. Four of five salmonella isolates were resistant to ampicillin and chloramphenicol. A review of the English-language literature yielded information on five additional cases of nontyhpoid salmonella infection after total hip replacement in four patients.