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Biomedical subjects

Z Greif

Publications and source records attributed to Z Greif.

At least 19 recordsLinked to original sources

Transient mitral regurgitation in acute glomerulonephritis.

During an epidemic of acute glomerulonephritis (AGN) 15 patients were studied by M-mode, cross-sectional, and Doppler echocardiography. All 15 patients had the classical signs of the disease including hematuria, proteinuria, edema, and consistent laboratory findings. There were 10 boys and five girls with a mean age of 8 years. Ten of the 15 patients had an enlarged left atrium and five of these 10 also had transient mild to moderate mitral regurgitation. In the five patients with mitral regurgitation the ratio of left atrium/aorta was 1.48; in the five patients with an enlarged left atria without evidence of mitral regurgitation the left atrium/aorta ratio was 1.34. All the patients had normal left ventricular dimensions, as well as ejection and shortening fractions. The findings of left atrial enlargement and mitral regurgitation disappeared gradually in all patients within 3 months. There was no correlation between the level of systemic blood pressure and the development of mitral regurgitation. A possible cause for these changes is fluid overload in the oliguric phase of the acute glomerulonephritis. The changes are transient and probably functional. There was no significant mitral valve or left atrial anomaly 3 and 6 months after hospital discharge.

Acute Disease

Re-emergence of meningococcal carriage on three-year follow-up of a kibbutz population after whole-community chemoprophylaxis.

A long-term study was conducted to determine the rate of re-emergence of throat carriage of meningococci in a semi-closed kibbutz community after the administration of chemoprophylaxis to all its members. Serotype B:4 was selected as marker organism since it was isolated from a fatal case and was the most frequently occurring strain (80%) among serogroup B isolates, which themselves comprised 54% of all meningococci. The carriage rate among Israeli residents (volunteer workers were analyzed separately) before treatment was 6.6% (49/748) overall, with 4.3% group B strains. Three weeks after treatment, in most cases with rifampicin (whereby three persistently positive persons were retreated with minocycline), no meningococci were recovered. Six months later, 1.9% of a population sample aged < or = 30 years were positive, while before treatment and one and three years later, 9.4%, 8.6% and 4.6% respectively were positive in this age group. Serotype B:4 comprised 81.3% of group B strains before prophylaxis, 5.3% after one year, and 28.6% after three years, thus possibly re-establishing itself as the single dominant serotype. The marked suppression of carriage after mass chemoprophylaxis appeared to last at least six months, with the meningococcal population being re-established within a year.

Adolescent

Diagnostic value of late cutaneous response to Casoni test in patients operated for echinococcus cyst.

Thirty-eight patients with confirmed Echinococcus cysts were evaluated postoperatively. RAST as well as early and late skin responses to Echinococcus antigen were assessed. Early skin responses were positive in most of the patients even 10 years or more postoperation. Late skin responses were positive in 42% of the patients, and the younger the patient, the greater the likelihood of occurrence. In patients who had late skin responses, the reactions were similar at 4 to 8 and 24 hours following the antigen. These results suggest that late skin responses seen at 24 hours are part of the immediate hypersensitivity reaction to the antigen.

Adolescent

[Meningococcal disease in western Galilee].

79 patients with meningococcal disease were evaluated retrospectively between 1972-1986. All the neisseria isolated were sensitive to penicillin but resistant to sulphonamides. Most of the infections (54%) were caused by serogroup B strains. Clinical features included fever (98%), vomiting (65%), and headache (60%). Purpura appeared in 95% and severe neurological features in 25%. Most patients (83%) were children less than 10 years old. The incidence was 1.4/100,000 in the non-Jewish population and 2.3/100,000 in the Jewish population. The overall mortality was 23%, but about 50% in the Jewish population (10 deaths in 18 cases). In kibbutzim the incidence (7.5/100,000) and mortality were especially high. The need for awareness of the disease and the importance of early diagnosis and aggressive treatment are emphasized.

Adolescent

Blood transfusion and lung function in children with thalassemia major.

Pulmonary function tests were performed at rest and following blood transfusion on 17 patients with thalassemia major. At rest, diffusion capacity was significantly reduced (mean of 57 percent), and forced vital capacity was mildly reduced (mean of 85 percent). In two of the patients, arterial oxygen tension was low. Other pulmonary function results were in the normal range. Following blood transfusion, a significant drop was seen in arterial oxygen tension (PaO2 of 22 mm Hg) and in forced vital capacity (FVC) of 32 percent. These changes were dramatic and require further explanation.

Adolescent

[Autoimmune enteropathy causing protracted diarrhea].

A 3-month old female infant was transferred from another hospital where she had been hospitalized from the age of 1 month for protracted secretory diarrhea. The diarrhea had begun at birth and was unresponsive to various therapeutic formulas and to total parenteral nutrition (TPN). The parents were consanguineous. There were 6 normal siblings, while 3 siblings had died in infancy, including a sister who had succumbed to protracted diarrhea at the age of 6 months. In our patient duodenal biopsy showed flattening of villi and proliferation of mononuclear cells in the lamina propria. Specific circulating IgG antibodies against gut epithelium were found, as well as thyroglobulin antibodies. Repeated trials of oral feeding were unsuccessful and TPN was required for 8 months. Complications included septicemia, osteomyelitis and acute renal failure. Therapeutic trials with intravenous hydrocortisone, zinc sulphate and metronidazole were unsuccessful and the infant died at the age of 11 months. Intestinal tissue taken postmortem showed nearly absolute flattening of intestinal villi. This is the first report in Israel of intractable infantile diarrhea due to autoantibodies to intestinal epithelium.

Autoantibodies

Acute focal bacterial nephritis: emphasis on imaging.

A case of acute focal bacterial nephritis in a child is presented. Imaging findings for various modalities are discussed (nuclear medicine, ultrasound, computed tomography, and conventional radiology) with a suggestion for optimal imaging strategy in these cases.

Acute Disease

[Spermatic cord hematoma simulating torsion of testis in Henoch-Schönlein syndrome].

Henoch-Schönlein syndrome (HSS) is a systemic disease of young children characterized by colicky pain, with melena, vomiting and damage to the joints, kidneys and other organs. Surgical problems involving the gastrointestinal tract include bleeding, intussusception and perforation. Uncommon complications, caused by bleeding into brain tissue and into the scalp, muscles, chest and scrotum, are real challenges for the physician. Spermatic cord hematoma is a rare complication of HSS. Other complications of HSS mentioned in the literature which affect the male genital system include edema of the spermatic cord or testis, epididymitis, orchitis, bleeding, Morgagni cyst, or hematoma surrounding the testis. Considering the low incidence of testicular torsion in HSS, we believe that when a patient with HSS develops acute testicular pain, noninvasive diagnostic procedures such as Doppler, ultrasound and radioisotope scans should be performed in the hope of avoiding unnecessary surgical interventions. A 2-year-old boy with HSS in whom torsion of the testis developed is reported.

Child, Preschool

Infant mortality in the Western Galilee, 1964-86.

The infant mortality rate (IMR) in the Jewish and Arab populations in the Western Galilee was studied during the 2-year period 1985-86, and compared with those of previous surveys conducted since 1964-65. The IMR declined steadily during the two decades, from 33.6 to 8.5/1,000 in the Jewish population and from 49.2 to 18.2/1,000 in the Arab population. The decline was noted in both neonatal and postneonatal periods. Analysis of the causes of death showed that enteric and respiratory infections ranked high in the first and second surveys (1964-65 and 1970) and decreased to a low level in both population groups in recent years, but were still relatively high among Arab infants living in villages. The decrease in the IMR seems to be the result of an improvement in the general living conditions of the population and the efficiency of the health services.

Ethnicity

Hereditary complement deficiency in survivors of meningococcal disease: high prevalence of C7/C8 deficiency in Sephardic (Moroccan) Jews.

The prevalence of complement deficiency was studied among 111 survivors of sporadic meningococcal disease located through the medical records of 10 Israeli hospitals. There were 11 patients with CH50 = 0: one with systemic lupus erythematosus and 10 with hereditary terminal complement deficiency (four with homozygous C7 and six with C8 deficiency). There was no hereditary complement deficiency among 39 Ashkenazi subjects as against 18 per cent among 38 Sephardi subjects and 40 per cent among 15 of Moroccan ancestry (p less than 0.05). The age at first presentation of meningococcal disease in complement deficient patients was 14.7 +/- 7.6, years compared with 8.1 +/- 10.9 in the non-deficient patients (p less than 0.025). None of the complement deficient patients had meningitis below the age of 5 years vs. 49 per cent of non-deficient subjects. Recurrent meningitis was observed in 40 vs. 4 per cent (p less than 0.01) and meningitis in siblings in 40 vs. 2 per cent respectively (p less than 0.001). In addition to the 10 propositi, 11 non-propositus siblings were identified with severe complement deficiency (six with homozygous C7 and five with C8 deficiency). Seven of the non-propositi had no history at all of meningitis or any other serious systemic disease, underlining the relatively favourable prognosis of terminal complement deficiency. With increasing familiarity with the clinical features of this hereditary disease, it is possible now to identify on clinical grounds patients with meningococcal disease with a high likelihood of terminal complement deficiency.

Adolescent

Puerperal Pasteurella multocida septicemia.

A case of Pasteurella multocida infection in a puerperal healthy young women is reported. The agent was isolated from vaginal discharge and blood cultures of the patient, and also from pets and poultry with which the patient was in contact. Although Pasteurella multocida septicemia is rare, awareness of this infection and adequate intensive antibiotic therapy may improve its prognosis.

Adult

Growth enhancement induced by prolonged L-dopa administration in rats.

To follow growth of rats, in which growth hormone secretion has been chronically stimulated, L-Dopa (5 mg/kg) was injected subcutaneously twice daily for 70 days to growing rats. A control group, matched for sex and sibship, pair fed with the treatment group was given saline injections. At 10-day intervals, the rats were weighed and measured. At 90 days of age the rats were ether anesthesized, bled for growth hormone determination, and internal viscera weighed. Weight gain and length in the L-Dopa-treated group was found to be significantly greater. A mean weight gain of 6% and 12% in the male and female rats, respectively, and a mean length gain of 5% in both male and female rats was observed at 90 days of age. The thymus, thyroid, adrenals, uterus, and gonads all tended to be heavier in the L-Dopa-treated group. Significantly heavier kidneys were found in the L-Dopa group. Serum growth hormone was found to be 8.44 +/- 1.4(SE) ng/ml in the L-Dopa group and 4.6 +/- 0.9 ng/ml in the control group. It is concluded that the continuous administration of L-Dopa produces an increase of circulating serum growth hormone levels, and this in turn enhances growth.

Animals

Pseudomonas septicemia in childhood.

A 5-year study of Pseudomonas aeruginosa septicemia in children was conducted in two large hospitals. The average age of the patients was 20 months. Fourteen (93%) of the 15 patients were debilitated by underlying diseases or by a major invasive procedure. Most of the patients had received broad-spectrum antibiotic therapy prior to the development of Pseudomonas septicemia. The overall mortality was 53%. Ecthyma gangrenosum appeared in only three cases. The serotype H-11 was found in 53% of the septicemic patients, suggesting that Pseudomonas septicemia was a nosocomial disease in most of these cases. The adequate evaluation of the patient at risk, prevention, and early therapy are essential.

Child