Biomedical subjects
Publications and source records attributed to A Leibovitz.
After her daughter died, depression developed in a 93-year-old woman with congestive heart failure receiving digoxin therapy. After treatment with fluoxetine hydrochloride she became anorexic and her serum digoxin level increased. A possible interaction, which has not been reported in the literature, may have occurred between fluoxetine and digoxin.
OBJECTIVE: Primary generalized osteoarthritis (OA), the most prevalent joint disease, is usually symmetric. Sporadic case reports mention decreased OA manifestations in limbs in which there are neurologic deficits, but no systematic research has been published. The aim of the present study was to examine these observations in a planned and controlled survey in a group of patients with OA. METHODS: Seventy-five geriatric patients with a history of stroke and hemiparalysis were studied clinically and radiographically (hand radiographs; graded according to a modified Altman method) for the presence and the degree of OA in the hands. Detailed clinical and radiologic scores were calculated for each hand. Demographic, occupational, and neurologic data were collected. Patients with other joint or neurologic conditions were excluded. A group of 55 elderly patients without stroke were similarly studied (controls). Scores in the paralyzed hand were compared with those in the nonparalyzed hand in the stroke patients and subgroups (by Student's paired t-test and Wilcoxon test). Scores in the dominant hands were compared with those in the nondominant hands in stroke patients and control subjects (by Student's paired t-test and Mann-Whitney test). Correlation between the degree of neurologic damage and OA asymmetry (Pearson's correlation coefficient) was also sought. RESULTS: Paralyzed hands showed significantly fewer OA changes than nonparalyzed hands, both clinically and radiologically. This trend, accentuated in patients with more severe paralysis, disappeared in those with mild residual paresis. Asymmetry of OA was more pronounced in patients with flaccid, compared with spastic, paralysis. The degree of paralysis and loss of muscle strength correlated with the degree of OA asymmetry. Women had significantly higher OA scores than men. In the control group, dominant hands had higher OA scores, but this finding was concealed among hemiparalyzed patients. Lifetime gross occupational load and present grip strength did not correlate with the degree of OA. CONCLUSION: In elderly patients, hemiparalysis reduces ipsilateral hand expression of OA, while OA is accentuated (or increased) in the dominant hand of patients without paralysis. This first systematic study confirms the findings of previous case reports and lends support to the role of biomechanical factors in the development of OA.
BACKGROUND: We evaluated psychiatrically 100 subjects, who were referred to a sleep laboratory in a general hospital because of sleep complaints. METHODS: All subjects were interviewed using a Structured Clinical Interview for DSM-III-R and underwent one night of standard polysomnography (PSG) examination. RESULTS: Forty three percent of the population had at least one Axis I DSM-III-R disorder. High rate of depressive mood disorder (24%) was observed in our sample, in contrast to low prevalence of alcohol and drug abuse (4%). Our results of a Israeli population are different from the United States studies in respect to alcohol and drug abuse. Furthermore, 11% of patients with PSG diagnosis exhibited comorbid psychiatric disorder. CONCLUSION: it appears that individuals with sleep complaints have high rate of psychiatric morbidity, especially mood disorders. LIMITATION: The rapid eye movement (REM) latency, a biological marker for depression, was not investigated. CLINICAL RELEVANCE: it seems that both PSG and psychiatric evaluation of sleep disturbance are of importance for appropriate therapeutic strategy for individuals with sleep complaints, especially in those with features of suspected depressive mood disorders.
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The increasing numbers of the elderly admitted to general hospitals, and the complexity of their problems, has increased the need for geriatric consultations. We evaluated geriatric consultations given at the Wolfson Medical Center by the geriatricians of Shmuel Harofeh Hospital. Data on 6-months of consultations in medical, surgical, urologic, neurologic, orthopedic and intensive care departments were evaluated. 7,910 elderly (65 years and over) were admitted during this period, representing 58% of all admissions; 742 (9.4%) were targeted for geriatric consultation. The largest number of consultations (525) were in the medical wards, but the highest rate of consultations was in the orthopedic ward for rehabilitation after operations for hip fractures. The selection of patients for geriatric consultation at Wolfson Hospital was done by the staff of each ward. This method differs from that in most general hospitals abroad, where selection is by geriatric teams. Despite this difference, our data show that the rates of consultations were similar. Also, the multidisciplinary teams consisted of members of the staff of each ward and the geriatric consultant. The method of geriatric consultations presented is easy to set up, simple to operate, efficient and appreciated by the medical staff of the departments.
Thirty patients > or = 80 years of age (mean 86) underwent diagnostic and/or therapeutic endoscopic retrograde cholangiopancreatography (ERCP). The low mortality (6.6%) and complication (6.6%) rates lead us to believe that ERCP in octogenarians provides an acceptable route for diagnosis and treatment of biliary and pancreatic disorders.
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Cancer is an age-associated disease, and 55% of newly diagnosed cases and 67% of cancer deaths are in those above 65 years. There has recently been increasing interest in geriatric oncology, and more of the elderly are being screened for early cancer detection. Elderly cancer patients present problems not only because of their primary disease, but also because of comorbidity, reduced functional reserve, and diminished social support. Because of this combination of factors many of them need the specially skilled nursing care available in special units. 304 elderly cancer patients were admitted to our "skilled nursing division" of 156 beds during the 6 years 1987-1992. They represented 16% of all admissions and their average age was 78 +/- 0.4 (SD). Mean survival after admission was 4.1 +/- 0.4 months. In the 143 men it was 3.1 +/- 0.4 months and in the 161 women, significantly longer, 4.9 +/- 0.5. The most common location in men was colorectal (22.6%), followed by prostate (16%), while in women it was breast (25.4%), followed by colorectal (16.0%). The longest survival was for women with breast cancer (9.1 +/- 1.3 months) and the shortest for women with gastric cancer (1.9 +/- 0.6). On admission 81% had more than 1 comorbid condition: 91% had restricted mobility, 215 urinary incontinence and 12% various kinds of stomas. Serious conditions were urinary tract infections in 40%, sepsis 20%, pneumonia 12%, gastrointestinal bleeding 10% and bedsores in 7%. 77% needed intravenous fluids and/or drugs for infections, 50% narcotics for analgesia, 27% nasogastric tubes, 20% blood transfusions, 6% debridement, and 5% paracentesis. The elderly with cancer are the most difficult long term patients to treat, since their conditions are dynamic, continuously deteriorating, and they require intensive medical, nursing and psychological care.
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A cell-line (UACC 2561), was established from a biopsy specimen of a lung carcinosarcoma. The patient had Stage III non-small cell lung cancer. Characterization of this cell line revealed highly aneuploid cells containing multiple clonal chromosome alterations with growth in nude mice within 3 weeks following subcutaneous injection. The cell line UACC 2561 stained positive for vimentin and displayed resistance to a variety of chemotherapeutic agents. Polymerase chain reaction followed by single-strand conformational polymorphism analysis revealed the presence of a K-ras 12 codon mutation. This mutation was confirmed by mutation specific PCR analysis for mutant K-ras alleles and direct DNA sequencing to be a GGT to GTT at codon 12 of the K-ras gene. Examination by PCR-SSCP for p53 mutations did not reveal any point mutations in exon 5-8 of the p53 gene. This relatively rare cell line may represent a useful model to investigate human lung sarcomas.
The nasogastric tube (NGT) not only provides nutritional support, but is also an effective diagnostic and therapeutic aid. We present the profile of the geriatric patient who needs the NGT, the reasons for its use, and mortality in these patients. 25 women (aged 83.9 +/- 5.5) and 25 men (aged 79 +/- 7.7) required the NGT, 15 of them only temporarily (TNGT) and 35 permanently (PNGT). The percentage of those with chronic neurologic disorders and/or incontinence (fecal or urinary), was highest in the PNGT group, as was the number of drugs used per patient (4.2 +/- 1.8 vs. 2.9 +/- 1.4). Laboratory studies showed no differences between the groups. PNGT was used in those whose conditions were chronic and progressive (inability to swallow or not sufficiently alert for oral nutrition). TNGT was used commonly as a diagnostic or therapeutic aid. During the study 20 patients died (40%), all in the PNGT group. Pneumonia was the main cause of death (18%), followed by decubitus ulcer (14%) and urinary tract infections (8%).
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The authors present a case of gastric angiodysplasia with upper gastrointestinal bleeding, associated with severe ischemic congestive cardiomyopathy.
A fifty-four-year-old woman from a high socioeconomic class developed acute isolated tuberculous pericarditis, three years after her sister had recovered from such disease. She was treated successfully by a triple drug regimen including isoniazid, rifampin, and ethambutol.
The authors describe a patient with hyperparathyroidism and Raynaud's phenomenon. This association was hitherto undescribed.
The authors describe a variant of Noonan's syndrome hitherto undescribed. The special findings in this case were anomalous origin of the aortic arch vessels and focal glomerulonephritis.