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Biomedical subjects

A Lavy

Publications and source records attributed to A Lavy.

At least 19 recordsLinked to original sources
PubMed2000

Severe pulmonary disease in association with Crohn's disease in a 13-year-old girl.

Pulmonary manifestations of Crohn's disease are infrequent in adults and even less common in children. Our literature search found only a few cases of Crohn's disease causing pulmonary manifestations in children. We report on the case of a 13-year-old girl in whom severe pulmonary disease was found four years after the onset of Crohn's disease. Open lung biopsy uncovered bronchiolitis obliterans and granulomatous lung disease. Aggressive treatment has yielded gradual improvement. This case emphasizes the importance of recognizing the association, the differential diagnosis, and treatment implications.

Adolescent↗
PubMed2000

Linear EUS for bile duct stones.

BACKGROUND: Radial scanning endoscopic ultrasonography (EUS) has been shown, in experienced hands, to be a safe and accurate means of detecting bile duct stones. We compared linear array EUS with endoscopic retrograde cholangiopancreatography (ERCP), in our first 50 cases, to evaluate efficacy of this examination as well as the learning curve for this indication. METHODS: A retrospective study was conducted on 50 patients with suspected choledocholithiasis. We compared results of EUS with those of ERCP as a reference. First a linear EUS examination was performed followed by ERCP, at a median interval of 31 days (range 3 to 162 days). RESULTS: The average age of patients was 56 years (range 26 to 76); 48% were women. Fifteen (30%) had undergone cholecystectomy, a mean of 8.5 years (range 1 to 22) before the EUS. EUS compared with ERCP had a 97% sensitivity, 77% specificity, and 90% accuracy. In 14% of patients EUS provided an additional or alternative diagnosis: chronic pancreatitis (n = 3), duodenitis (2), bile duct stricture (1), chronic gastritis (1). No complications were encountered due to EUS. CONCLUSIONS: We found in this early experience that linear array EUS is a reasonably safe and accurate means of detecting choledocholithiasis. Linear array EUS, despite the learning curve, seems to be about equivalent to radial EUS in accuracy. Appropriate use of this less invasive technique may possibly replace the use of diagnostic ERCP.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed2000

Lack of association between smoking and Crohn's disease but the usual association with ulcerative colitis in Jewish patients in Israel: a multicenter study.

OBJECTIVE: The association between smoking and inflammatory bowel disease (IBD) is well established, but data in Jewish patients in Israel were discrepant. The aim of this study was to examine the smoking habits of Jewish IBD patients in Israel in a large scale, multicenter study. METHODS: Patients with established IBD aged 18-70 yr were interviewed in relation to smoking and other habits. Two controls (one clinic and one neighborhood control matched by age, sex, community group, and education) were sought for each subject. RESULTS: A total of 534 patients (273 ulcerative colitis [UC], and 261 Crohn's disease [CD]), along with 478 clinic controls and 430 neighborhood controls, were interviewed. There was no significant difference in the smoking habits between CD patients and their controls. Of patients with CD, 24.5% were current smokers, as compared to 19.9% of clinic controls and 25.2% of neighborhood controls (NS). The odds ratio for CD in current smokers was 1.30 (95% confidence interval 0.85-1.99) versus clinic controls, and 0.96 (0.63-1.46) versus neighborhood controls. There were also no significant differences in the proportion of ex-smokers between the groups. Only 12.9% of UC patients were current smokers versus 21.9. % Clinic controls, and 26.4% community controls (p<0.005). The proportions of ex-smokers were higher in UC patients 29.7% versus 25.9%, and 19.5% in their respective controls (p<0.001 vs. community controls). No significant differences were found in the proportions of never-smokers between IBD patients and controls. All the above trends were similar in four different parts of the country. The proportion of current smokers in UC decreased with the extent of disease (19.7% in proctitis, 13.6% in left-sided, and 4.5% in total colitis) (p<0.05). Patients with UC were more likely to be light smokers(1-10 cigarettes/day), whereas patients with CD were more likely to be moderate smokers (11-20 cigarettes/day) in comparison to their controls. CONCLUSIONS: The lack of association between smoking and CD has now been established in Jewish patients in Israel. The association was found in UC. The stronger genetic tendency in CD may contribute to this discrepancy.

Adolescent↗
PubMed1999

Drug-resistant pulmonary tuberculosis in Israel, a society of immigrants: 1985-1994.

SETTING AND OBJECTIVES: Drug-resistant tuberculosis was uncommon in Israel until 1985, when the waves of immigration began. We studied the incidence and clinical course of resistant pulmonary tuberculosis nationwide. DESIGN: Isolates of Mycobacterium tuberculosis between 1985 and 1994 were surveyed. Data on 150 patients with resistance and 110 patients with drug-sensitive disease were reviewed. Ethnic origin, type of resistance, radiological findings and outcome were analysed. RESULTS: In total, 16.7% of the isolates showed resistance to at least one drug; 58% had resistance to multiple drugs. In 67% of the patients the resistance was primary. Most patients were immigrants from the former USSR and from Ethiopia; none were Israeli-born Jews. Mortality with resistance was 10%, and was highest (14%) with multiple drug resistance. Mortality among drug-resistant cases was lowest (3%) among Ethiopian Jews. Cavities and extensive disease were more common with drug resistance. CONCLUSION: Drug resistance has become relatively common in Israel due to immigration from the former USSR and Ethiopia. It is more extensive radiologically and carries a poorer outcome.

Drug Resistance, Microbial↗
PubMed1998

Budesonide versus prednisone in the treatment of active Crohn's disease. The Israeli Budesonide Study Group.

BACKGROUND & AIMS: Budesonide (BUD) is a potent steroid that undergoes extensive first-pass metabolism. BUD incorporated in a pH-dependent formulation has been proposed as an alternative treatment for Crohn's disease (CD). The aim of this study was to compare the efficacy and safety of BUD and prednisone (PRED) in the treatment of active CD involving the terminal ileum and/or the colon. METHODS: Patients with mild to moderately active CD were included in a randomized, double-blind, double-dummy controlled trial. Patients received either 9 mg BUD once daily for 8 weeks or 40 mg PRED once daily for the first 2 weeks tapered gradually to 5 mg/day by the end of the study. Disease activity, quality of life, and laboratory parameters were recorded. RESULTS: One hundred patients received BUD, and 101 patients received PRED. By intention-to-treat analysis, treatment efficacy defined as Crohn's Disease Activity Index of <150 at completion was 51% and 52.5% for the BUD and PRED groups, respectively. Twice as many responded to treatment with no side effects in the BUD compared with the PRED group (30% vs. 14%) (P = 0.006). Most of the decrease in CDAI scores occurred during the first 2 weeks. CONCLUSIONS: BUD is as effective as PRED in the treatment of CD involving the terminal ileum and right colon. BUD has significantly fewer steroid-related adverse reactions.

Adult↗
PubMed1997

Triamcinolone improves outcome in Crohn's disease strictures.

PURPOSE: This study was undertaken to examine the effect of local injection of potent steroids on recurrence of Crohn's disease strictures. METHODS: Ten patients with colonic strictures attributable to Crohn's disease were treated by dilation and injection of triamcinolone. Five of them had postoperative strictures. RESULTS: Patients were followed for 1.5 to 3 years. Two patients required additional dilation and injection of steroids after one year. Eight patients remained well. CONCLUSION: Local injection of steroids improves outcome in strictures caused by Crohn's disease.

Administration, Topical↗
PubMed1997

Modification of in vivo and in vitro TNF-alpha, IL-1, and IL-6 secretion by circulating monocytes during hyperbaric oxygen treatment in patients with perianal Crohn's disease.

Treatment of perianal inflammatory lesions in Crohn's disease (CD) is unsatisfactory and novel treatment modalities are pursued. We have recently reported a good clinical effect of hyperbaric oxygen (HBO) treatment in perianal CD. In the present study, seven patients with perianal CD were subjected to daily sessions of HBO in a multiplace hyperbaric chamber. Each patient received a total of 20 sessions during a time period of 1 month, and IL-1, IL-6, and TNF-alpha measurements were done several times during the initial sessions and after completing therapy. Pretreatment cytokine levels were elevated in patients compared to age-matched 10 normal controls. During the first 7 days of treatment, IL-1, IL-6, and TNF-alpha levels in supernatants of LPS-stimulated monocytes derived from patients' peripheral blood were decreased compared to pretreatment levels. Parallel measurements of serum IL-1 levels revealed an initial elevation and thereafter decreased levels, which remained low throughout the first week of HBO treatment. After completion of therapy, cytokine levels increased to pretreatment values. We conclude that alterations in secretion of IL-1, IL-6, and TNF-alpha may be related to the good clinical effect of HBO treatment in CD patients with perianal disease.

Adult↗
PubMed1997

Methotrexate in chronic active Crohn's disease: a double-blind, randomized, Israeli multicenter trial.

BACKGROUND: At present only one large controlled study has indicated that parenteral methotrexate may be effective in chronic active Crohn's disease (CD). AIM: To evaluate the effectiveness of oral methotrexate in chronic steroid-dependent CD. PATIENTS: Patients with active CD, who have received steroids and/or immunosuppressives for at least 4 months during the preceding 12 months and with a current Harvey-Bradshaw index of > or = 7 were studied. METHODS: Methotrexate (12.5 mg weekly) or 6-mercaptopurine (50 mg daily), or placebo were given during the 9 months of the trial in addition to steroids and 5-aminosalicylic acid as clinically indicated. RESULTS: Eighty-four patients were included (methotrexate, 26 patients; 6-mercaptopurine, 32 patients; placebo, 26 patients). The proportion of patients entering first remission as well as the proportions of patients relapsing after first remission were not significantly different between the groups. The mean Harvey-Bradshaw index and the mean monthly steroid dose were also similar. However, when each patient was evaluated as his or her own control, the reduction in steroid dose, the general well being, and the reduction in abdominal pain were significantly better in the methotrexate treated patients. CONCLUSIONS: Methotrexate at a weekly oral dose of 12.5 mg was found to be moderately better than 6-mercaptopurine and placebo in patients with chronic active CD.

Abdominal Pain↗
PubMed1996

Methotrexate in chronic active ulcerative colitis: a double-blind, randomized, Israeli multicenter trial.

BACKGROUND & AIMS: Uncontrolled studies have suggested that methotrexate may be effective in patients with active ulcerative colitis. The aim of this study was to evaluate the effectiveness of oral methotrexate in chronic steroid-dependent ulcerative colitis in a randomized, double-blind multicenter trial. METHODS: Patients with active ulcerative colitis who have received steroids and/or immunosuppressives for at least 4 months during the preceding 12 months with a current Mayo Clinic score of > or = 7 were included in the study. Methotrexate (12.5 mg) or placebo was added to their treatment once weekly for 9 months. RESULTS: Sixty-seven patients were included (methotrexate, 30 patients, placebo, 37 patients). The proportion of patients entering first remission (methotrexate, 46.7%; placebo, 48.6%), the time to reach first remission (methotrexate, 4.1 +/- 1.9 months; placebo, 3.4 +/- 1.7 months), as well as the proportions of patients having a relapse after first remission (methotrexate, 64.3%; placebo, 44.4%) were not significantly different between the two groups. The mean Mayo Clinic score, the mean monthly steroid dose, and the proportion of abnormal laboratory results during the study were also similar. CONCLUSIONS: Methotrexate at a weekly oral dose of 12.5 mg was not found to be better than placebo in the induction or maintenance of remission in patients with chronic active ulcerative colitis.

Administration, Oral↗
PubMed1996

Failure of cefonicid prophylaxis for infectious complications related to endoscopic retrograde cholangiopancreatography.

We performed a controlled study to evaluate the role of cefonicid in preventing infectious complications related to retrograde cholangiopancreatography (ERCP). Consecutive patients were randomized to receive prophylaxis with cefonicid (1 g intravenously) 1 hour before the procedure or to be untreated controls. During a 26-month period, 179 ERCPs, including 93 therapeutic procedures, were performed on 164 patients. Prophylaxis was administered before 88 procedures (49%). The rate of bacteremia among treated patients was similar to that among controls (3% vs. 2%, respectively; P = .4). The rate of cholangitis was also similar among both groups (8% vs. 2%, respectively; P = .07). There were no episodes of sepsis, and none of the patients died. The rate of bacteremia was also similar among patients undergoing diagnostic procedures and patients undergoing therapeutic procedures, but all cases of cholangitis occurred in the latter group (0 vs. 10%, respectively; P = .002). Nevertheless, the rate of cholangitis was not significantly changed by the use of prophylaxis (14% among treated patients vs. 5% among controls, P = .12). Therefore, infectious complications could not be prevented by cefonicid prophylaxis.

Bacteremia↗
PubMed1995

Consumption of red wine with meals reduces the susceptibility of human plasma and low-density lipoprotein to lipid peroxidation.

The effect of consumption of red or white wine (11% alcohol) with meals on the propensity of plasma and low-density lipoprotein (LDL) to undergo lipid peroxidation was studied in 17 healthy men who were divided into two groups: 8 received 400 mL red wine/d for 2 wk, and 9 received a similar amount of white wine. Red wine consumption for 2 wk resulted in a 20% reduction in the propensity of plasma to undergo lipid peroxidation (in the presence of a free-radical-generating system) as determined by the thiobarbituric acid reactive substances (TBARS) assay. In parallel, red wine consumption reduced the propensity of the volunteers' LDL to undergo lipid peroxidation (in response to copper ions) as determined by a 46%, 72%, and 54% decrease in the content of TBARS, lipid peroxides, and conjugated dienes in LDL, respectively, as well as by a substantial prolongation of the lag phase required for the initiation of LDL oxidation. On the contrary, dietary consumption of white wine for 2 wk resulted in a 34% increase in plasma's propensity to undergo lipid peroxidation and also in a 41% increased propensity of the LDL to undergo lipid peroxidation. The antioxidant effect of dietary red wine on plasma lipid peroxidation was not secondary to changes in the plasma vitamin E or beta-carotene content but could be related to the elevation of polyphenol concentration in plasma and LDL. Thus, some phenolic substances that exist in red wine, but not in white wine, are absorbed, bind to plasma LDL, and may be responsible for the antioxidant properties of red wine.

Adult↗
PubMed1994

[Plasma lipid peroxidation: inhibited by drinking red wine but stimulated by white wine].

The effects of drinking red or white wine (11% alcohol) on the propensity of plasma and low density lipoprotein (LDL) to undergo lipid peroxidation (LP) was studied. 8 healthy men drank 400 ml of red wine a day for 2 weeks and 9 drank white wine similarly. The red wine supplementation resulted in a 20% similarly. The red wine supplementation resulted in a 20% reduction in the propensity of their plasma to undergo LP (in the presence of a free radical-generating system) and a 46% reduction in that of their LDL to undergo LP (in response to copper ions). Contrarily, drinking white wine for 2 weeks resulted in a 33% increase in propensity of plasma to undergo LP and in a 57% increase in that of LDL to undergo LP. The antioxidant effect of drinking red wine on plasma LP can be related to increase in plasma high density lipoprotein concentration, as well as to increase in plasma and LDL polyphenols. We conclude that some phenolic substance present in red, but not in white wine, may be responsible for the antioxidative properties of red wine supplementation for LDL LP, and thus may possess antiatherogenic properties.

Alcohol Drinking↗
PubMed1994

Hyperbaric oxygen for perianal Crohn's disease.

Perianal involvement in Crohn's disease is common (< or = 50%), distressing, and frequently refractory to treatment. Clinical features include painful induration and stenosis, discharging fistulas, and fissures. The pathogenesis of these lesions is unclear, but local ischemia and secondary anaerobic infection may play a role. Following three sporadic reports of successful treatment with hyperbaric oxygen (HBO), we undertook a trial of this method in 10 patients with refractory perianal disease. These patients' perianal Crohn's disease had not responded to treatment that included local medications, salicylates, corticosteroids, metronidazole, or 6-mercaptopurine were treated. Treatment was administered in a hyperbaric chamber at a pressure of 2.5 atm absolute. Each session lasted 90 min, and each course consisted of 20 daily sessions. Complete healing occurred in 5 patients after one to two courses. In an additional 2, after three courses, 1 patient improved but did not heal, and 2 did not improve. No adverse effects were noted by any of the 10 patients. Follow-up of 18 months did not reveal any recurrence. These preliminary results confirm that HBO therapy is a safe and efficient therapeutic option for perianal Crohn's disease.

Adult↗
PubMed1994

Effect of dietary supplementation of red or white wine on human blood chemistry, hematology and coagulation: favorable effect of red wine on plasma high-density lipoprotein.

Twenty healthy males were divided into two groups: 10 subjects were supplemented for 2 weeks with 400 ml of red wine (11% alcohol) per day and the other 10 subjects were given 400 ml of white wine (11% alcohol) per day for a similar period. Blood samples were drawn prior to wine supplementation, after 1 week and at the end of the study. No significant effects were found on plasma concentrations of urea, creatinine, bilirubin, creatine kinase, amylase, blood cell counts, platelet counts and platelet aggregation. Both red- and white-wine supplementation resulted in a transient minor reduction in plasma glucose concentration and in a minor elevation in blood coagulation properties such as prothrombin time and partial thromboplastin time. Red (but not white) wine resulted in an 11 and 26% increment in plasma triglyceride concentrations after 1 and 2 weeks of supplementation, respectively. Plasma cholesterol, as well as very-low- and low-density-lipoprotein levels did not change during the 2 weeks of red- or white-wine supplementation. The most impressive effect of red-wine intake was a significant (p < 0.01) increase in plasma high-density lipoprotein (HDL) cholesterol and in plasma apolipoprotein A-I concentrations by up to 26 and 12%, respectively. These effects were not observed after the intake of white wine. We conclude that the major effect of red-wine supplementation (about 40 g of alcohol per day for a period of 2 weeks) was a significant increase in plasma HDL concentration which may contribute to the reduced risk for cardiovascular diseases observed in red-wine drinkers.

Adult↗
PubMed1994

A 10 year survey on Mycobacterium tuberculosis isolates in Israel and their drug resistance.

An increased incidence of tuberculosis has been observed in Israel in 1985, 1986 and since 1990--years of large waves of immigrations. A very similar trend of disease was observed in the Mycobacterium Reference Laboratory of Israel, and consequently a survey was undertaken among the 1,181 bacteriologically confirmed tuberculosis cases newly registered there in 1983-92. The overall percent distribution of drug-resistant Mycobacterium tuberculosis during this period was 12.6% (7.3% resistant to one drug and 5.3% (multiple drug resistance). The highest percent distribution of drug-resistant bacilli was found among immigrants from the former Soviet Union (37.3%) and Ethiopia (16.2%). The highest incidence of disease was found in males and in patients aged > 30. Pulmonary disease was the most common form for all patients: among the extrapulmonary cases, the most frequently involved site was the genitourinary system in Israelis and the lymph nodes in Ethiopians. Most isolates fit into one variant by biochemical analysis, indicating the need for a more sensitive method to type M. tuberculosis for epidemiological purposes. The data included in this survey provide information useful for a national tuberculosis program.

Adolescent↗