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Biomedical subjects

Z Fireman

Publications and source records attributed to Z Fireman.

At least 37 records · Page 2Linked to original sources
PubMed1998

Cyclosporine-induced optic neuropathy, ophthalmoplegia, and nystagmus in a patient with Crohn disease.

PURPOSE: To report the cyclosporine-induced complications of optic neuropathy, partial external ophthalmoplegia, and other neurologic abnormalities. METHODS: Case report. A 22-year-old man with severe active Crohn disease developed bilateral optic neuropathy, nystagmus, external ophthalmoplegia, and ataxia on the fifth day of cyclosporine A (CyA) parenteral therapy. RESULTS: Cyclosporine therapy was discontinued as soon as toxic clinical manifestations appeared. Cyclosporine blood level detected then was 1,290 ng/ml (therapeutic level: 150 to 300 ng/ml). Partial external ophthalmoplegia improved dramatically; however, the patient's optic neuropathy progressed to optic atrophy, leaving the patient visually impaired. Various possible mechanisms for cyclosporine-induced neurotoxicity are discussed. CONCLUSION: It is important to closely monitor neuro-ophthalmologic and neurologic signs of patients treated with cyclosporine.

Adult↗
PubMed1998

Is gastro-oesophageal reflux a factor in exercise-induced asthma?

Exercise-induced bronchoconstriction (EIB) occurs in the majority of patients with asthma. The relationship between asthma and gastro-oesophageal reflux (GER) is well defined, and the reports of exertional gastro-oesophageal acid reflux in healthy subjects, prompted us to study the relationship between EIB and GER. Following an overnight fast and medication withholding, 15 asthmatics and 15 normal subjects were placed on continuous monitoring of oesophageal pH and ECG. After baseline monitoring of oesophageal pH, at rest, for 30 min, spirometry was performed. Thereafter, the subjects underwent rigorous treadmill exercise for 8 min followed by spirometry, 10 min after running. Twelve out of 15 asthmatics and none in the control group demonstrated significant fall in FEV1 in response to exercise. However, only six out of 15 normal subjects and three in the asthmatic group had evidence of GER during or following exercise. We concluded that there is no significant correlation between EIB and GER in patients with asthma.

Adolescent↗
PubMed1998

Helicobacter pylori and peptic ulcer disease therapies: a survey of gastroenterologists in Israel.

BACKGROUND: Eradication of Helicobacter pylori has become a therapeutic option in the treatment of patients with peptic ulcer disease. The aim of this study was to evaluate the current management strategies of Israeli gastroenterologists in the diagnosis and treatment of H. pylori-related peptic ulcer disease, 14 years after the discovery of H. pylori. MATERIALS AND METHODS: A questionnaire was mailed to all specialists in gastroenterology, members of the Israel Gastroenterological Association (IGA). Replies were received from 60% of Israel Board-certified gastroenterology specialists. RESULTS: Over 89% of the gastroenterologists (89.1%) noted that they recommend anti-H. pylori treatment. 94.5% said that they treat duodenal ulcer in the first presentation with anti-H. pylori medication and 75% said that they do so in cases of recurrent duodenal ulcer. According to the replies received, there is a strong consensus towards triple treatment as the favored anti-H. pylori treatment; no one noted the use of dual treatment. Seven-day triple treatment was prescribed by 83.6% of the gastroenterologists who responded. Of these, the great majority, 89.1%, stated that they use proton pump inhibitors (PPI) in combination with any two of the following antibiotics: metronidazole (47.3%), tinidazole (29.1%), clarithromycin (61.8%), and amoxicillin (40%). CONCLUSION: At the time of the survey, most Israel Board-certified gastroenterology specialists prescribed triple anti-H. pylori treatment of one-week's duration.

Amoxicillin↗
PubMed1997

Multiple antral ulcers in gastric sarcoid.

A 33-year-old woman suffered a week of severe epigastric pain and subsequent weight loss. On upper-gastrointestinal endoscopy several superficial ulcers were evident in the antral region. Mucosal biopsies from the ulcers showed epithelial cell granulomas. Even though no hilar lymphadenopathy was present on the chest radiograph and computed tomographic scan, the patient underwent bronchoscopy and transbronchial biopsy, which showed noncaseating epithelial cell granuloma, and bronchoalveolar lavage, which showed a lymphocytic pattern suggestive of sarcoidosis. Reports of gastric involvement in systemic sarcoidosis with no bilateral hilar lymphadenopathy are rare. We believe this is the first report of symptomatic gastric ulcers leading to endoscopic diagnosis of the underlying sarcoidosis.

Adult↗
PubMed1997

Comparison of various Helicobacter pylori detection methods: serology, histology and bacteriology.

The current gold standard test for diagnosis of Helicobacter pylori involves histological staining and/or urease testing of antral biopsy specimens. However, these methods are invasive, and alternative non-invasive methods, i.e. the urease breath test and serological tests, are available. The test for H. pylori-specific serum immunoglobulin G (IgG) is now available commercially. The aim of this study was to compare the gold standard tests for diagnosis of H. pylori to the non-invasive method of detecting IgG antibody in the serum. Two hundred and twenty-five (225) subjects were tested for H. pylori by histological staining, urease testing, direct microscopy of antral biopsy specimens and quantification of serum IgG antibody. The population examined was divided into 2 groups--a group of 52 patients with no gastrointestinal symptoms and a group of 173 patients with dyspepsia. Out of 173 dyspeptic patients, 22 (12.7%) were false-positive to H. pylori. Out of 52 non-dyspeptic subjects, 30 (57.7%) were false-positive (p < 0.0001). The sensitivity and specificity were 91.6% and 51.7%, respectively. The specificity and positive predictive value increased by approximately 30% when the subjects examined were in the younger age group (< 30 years), while the sensitivity and the negative predictive value did not change significantly. This study indicates that serological testing is not recommended for diagnosis nor is it recommended for follow-up treatment, especially among the older age group (> 30 years).

Adolescent↗
PubMed1997

[Gastrointestinal angiodysplasia as a cause of hemorrhage in the digestive tract and treatment].

Gastrointestinal angiodysplasia is a cause of gastrointestinal bleeding in the elderly, for which surgery has been the only treatment. Estrogen has been reported beneficial in some cases in the past decade. Recurrent bleeding due to angiodysplasia occurred from the small intestine in a 75-year-old woman, and from the right colon in a 91-year-old man. The diagnoses were made by angiography in the first case and colonoscopy and erythrocyte- scanning in the second. There was aortic stenosis in both, a combination which has been reported in other cases. Both patients improved with estrogen therapy. However, after temporary stabilization, gastrointestinal bleeding recurred in the second patient and he was successfully operated on.

Aged↗
PubMed1996

[Gastric phytobezoar].

A case of a large gastric phytobezoar (5 x 8 cm) is presented. It was diagnosed at operation in the stomach of a post vagotomy-pyloroplasty patient, and all attempts at removal (crushing, lavage and diathermy) failed. Complete removal of the phytobezoar was accomplished in 3 endoscopy sessions using a very large snare introduced through an overtube. The patient was told to refrain from cellulose- and fiber-rich food (such as persimmons and oranges) and was given prokinetic drugs, including cisapride, domperidone and metoclopramide.

Adult↗
PubMed1996

[The buried gastrostomy bumper syndrome].

The buried gastrostomy bumper syndrome is one of the rare complications of PEG (percutaneous endoscopic gastrostomy) insertion. It develops when there is a combination of a rigid bumper and a tension build-up between internal and external bumpers. This condition is manifested by complete occlusion of the internal opening of the gastrostomy by mucosa, making it impossible to feed the patient. We report a case in which the PEG was inserted a year prior to the appearance of this rare complication. It was embedded beneath the gastric mucosa and we had difficulty in removing it to insert a new PEG. The bumpers are anchor-like attachments to each end of the gastrostomy, which keep it stationary. The rigid bumper is an integral part of the gastrostomy. However, a "soft" bumper has been developed, but its costliness has restricted its use. In our case the gastrostomy was removed with the aid of the cutting wire of a sphincterotome in light contact with the external tissue.

Female↗
PubMed1995

A controlled double blind multicenter study of the effectiveness of 5-aminosalicylic acid in patients with Crohn's disease in remission.

We evaluated the efficacy of an oral formulation of 5-amino-salicylic acid in lowering the relapse rate after remission of Crohn's disease. Included were 59 patients who had proven Crohn's disease of at least 1 year's duration, and who had been in continuous remission for at least 6 months, while taking only 5-aminosalicylic acid or no therapy at all. Remission was defined as a Harvey Bradshaw index score (Softley-Clamp modification) of < 4. Patients were given coded mesalzaine 250 mg or placebo tablets (2 x 2 day). They were seen at 0, 1, and 2 months, and then every 2 months until the end of the study. Trial endpoints were 1 year of follow-up, or clinical relapse results. After randomization, 31 patients were included in the placebo arm, and 28 in the treatment arm. There were no significant differences between the two groups at entry. Ten patients were withdrawn from the trial because of noncompliance, loss of follow-up, or headache. There were more clinical relapses in the placebo arm (15 patients, 55%) than in the treatment arm (6 patients, 27%) (p < 0.05). Mesalazine had a significant advantage over placebo (p < 0.05) only in the subgroups of patients with ileal Crohn's disease and in those older than 30 years. We conclude that mesalazine has a moderate but significant benefit in preventing relapse in Crohn's disease in remission; this occurred only in patients with small-bowel involvement or in those older than 30 years.

Adolescent↗
PubMed1995

The effect of the Gulf War on upper-gastrointestinal bleeding.

Upper-gastrointestinal bleeding may be related to tension or fear, which are commonly aggravating factors in digestive diseases. A survey was made of patients living in and around Hadera (located in Israel's central coastal region) during the Gulf War (January 18 through February 28, 1991) who suffered from upper-gastrointestinal bleeding; they were compared with patients seen during 1990 and 1992-1993 at the same time of the year. We found no appreciable difference in the rate of upper-gastrointestinal bleeding during the analogous periods covered in the survey.

Adult↗
PubMed1994

Chromosome sensitivity to bleomycin-induced mutagenesis in lymphocytes from colorectal cancer patients under 40 years of age.

PURPOSE: The incidence of colorectal cancer in young adults (under 40 years of age) is rare. The reason for the occurrence in these patients may lie in their genetic background. METHODS: We studied chromosomal fragility in peripheral blood lymphocytes of patients under the age of 40 with large bowel cancer. Lymphocytes from 24 subjects were examined: 10 untreated large bowel cancer patients under the age of 40 and 14 age-matched and sex-matched controls. RESULTS: The mean number of spontaneous chromosomal breaks per cells (b/c) was significantly higher in the right-sided large bowel cancer patients (0.23 +/- 0.12 b/c) compared with the control group (0.09 +/- 0.04 b/c; P < 0.01), but with no significant difference between the left-sided colorectal cancer patients and the control group. Lymphocytes exposed to the radiomimetic agent, bleomycin, were arrested in methaphase and analyzed for chromosome fragility. Mean chromosome breaks per cell in the left-sided colorectal cancer patients (1.60 +/- 0.49 b/c) were significantly higher than in either the controls (0.72 +/- 0.31 b/c; P < 0.001) or the right-sided, large bowel cancer patients (0.91 +/- 0.24 b/c; P < 0.05). CONCLUSIONS: The increased spontaneous chromosomal breaks in the right colon, as opposed to the increased mutagen-induced chromosomal breaks in the left colon, might indicate that in young colon cancer patients the occurrence of right-sided colon cancer is more likely to be genetically determined, whereas in left-sided colon cancer, environmental carcinogens might play a greater role.

Adenocarcinoma↗