[Quality assurance in primary care].
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Humans↗
Biomedical subjects
A Porath
Publications and source records attributed to A Porath.
Risk indicators after envenomation in humans by Echis coloratus (mid-east saw scaled viper).
To determine the frequency, severity and predictors of bleeding and azotemia after envenomation in humans by Echis coloratus, a retrospective survey of 68 cases in Israel between 1970 and 1989 was carried out. We used univariate and multivariate analyses of clinical variables on admission for the outcome variables of bleeding, hemoglobin and platelet levels, and blood urea. Within hours or days after envenomation, a major bleeding episode occurred in 18% of the victims, a drop in hemoglobin to 10 g/dliter or less in 14%, and an increase in blood urea to 9 mmole/liter or more in 15%. These complications correlated with time interval between envenomation and hospital admission, and the following admission variables: degree of bleeding, hemoglobin level, platelet and white blood cell counts, blood urea and proteinuria. Complications were unlikely in patients who were presented with all of the following: a hemoglobin level of 13 g/dliter or more, a platelet count of 100,000/mm3 or more, a blood urea level of 7 mmole/liter or less, no proteinuria and no bleeding. Treatment on admission with a specific monovalent antiserum was associated with a shorter duration of hemostatic failure and a reduced incidence of anemia and thrombopenia. Infusion of fresh frozen plasma on admission did not appear to be effective in preventing complications.
Adult↗
First derivative of right ventricular pressure, dP/dt, as a sensor for a rate adaptive VVI pacemaker: initial experience.
Ten patients underwent implantation of a rate adaptive ventricular pacing system with a new pulse generator and lead. The unipolar lead has a steroid eluting tip and a pressure sensor. The first derivative of the signal from this sensor, dP/dt, is determined and the pacemaker rate is varied in response to changes in the right ventricular dP/dtMAX. During implantation, dP/dt values were in the range of 180-720 mm Hg/sec. The autothreshold for pacing at 2.5 V remained unchanged 1 month after implantation (0.065 +/- 0.045 msec, range 0.05-2.00 msec) and only slightly increased after 3 months (0.075 +/- 0.045 msec, range 0.05-2.00 msec). A significant correlation existed between the dP/dt measured during implantation and the right ventricular pressure measured by telemetry at follow-up visits (r = 0.93, P = 0.0001). Initial pacemaker programming was performed on the second day after implantation following a short walk and was adjusted subsequent to follow-up visits according to the patient's subjective assessment and in accordance with the results of exercise tests and Holter monitoring. Exercise and Holter tests did not significantly change initial programming. There was a significant correlation between right ventricular systolic pressure and the rate response setting (r = -0.66, P less than 0.05). During dP/dt pacing, all patients felt well, and eight of these reported an improvement compared to nonrate adaptive pacing. The heart rate response to effort and recovery was appropriate. It was concluded that: (1) right ventricular dP/dt is a suitable parameter for controlling the pacing rate; (2) appropriate programming of the dP/dt pacemaker results in a suitable heart rate response to exercise and recovery.
Aged↗
Radiological assessment of a modified anterior drawer test of the ankle.
Chronic ankle instability is a common complication of ankle sprain. The clinical assessment of ankle instability is usually incomplete and difficult to interpret. Recently, more attention has been paid to the value of the anterior drawer test of the ankle. We assessed the accuracy of a modification of the anterior drawer test, comparing it with radiological stress view of the ankle in 25 patients with recurrent ankle sprain. The radiological examinations were performed by a TELOS instrument and included lateral and anteroposterior stress views. We found that the modified anterior drawer test correlated with the posterior opening of the tibiotalar joint and with the lateral tilt of the talus. We conclude that a slightly positive modified anterior drawer test may indicate injury to the anterior talofibular ligament. A significant movement of the ankle elicited by the modified anterior drawer test may indicate combined injury to anterior talofibular and calcaneofibular ligaments.
Adult↗
Secondary prevention of coronary heart disease in patients after acute myocardial infarction at the Soroka Medical Center.
The records of 214 patients with acute myocardial infarction (AMI) admitted to Soroka Medical Center in 1989 were reviewed to assess the quality of medical treatment after AMI. Medical treatment was reviewed with respect to administration, indications, and contraindications of specific drugs. Sixty-nine percent of patients received suboptimal treatment with respect to aspirin and beta blockers, which was almost always due to undertreatment rather than overprescription. Only 23% of patients with mural thrombi, as shown by echocardiography and without contraindications to anticoagulants, received coumadin. Patients hospitalized in the Intensive Coronary Care Unit received somewhat better medical care with regard to aspirin, beta blockers and coumadin. Appropriate decisions whether to give or withhold thrombolytic therapy were made in 81% of the cases and it was given to 29% of the patients. We conclude that during the period of this study there was a considerable gap between: a) recommendations in the medical literature, and b) the quality of care provided to AMI patients with regard to medications prescribed by physicians for preventive medical therapy.
Adrenergic beta-Antagonists↗
An outbreak of penicillin-resistant Neisseria gonorrhoea in southern Israel.
Since the early 1980s the incidence of gonorrhea has been declining worldwide, as well as in Israel. This decline has been attributed to the fear of AIDS. We report an outbreak of penicillin-resistant Neisseria gonorrhoea that occurred in the last quarter of 1988 and throughout 1989 in southern Israel. During 1987 and the first three-quarters of 1988 only 13 new cases were diagnosed, all penicillin sensitive. During the epidemic, 94 new cases were diagnosed, 41% of them penicillin resistant. In March 1989, ceftriaxone was substituted for penicillin for the treatment of gonococcal urethritis. The number of cases of penicillin-resistant gonorrhea dropped dramatically. It is concluded that despite the AIDS panic, outbreaks of gonorrhea can still be encountered, as demonstrated in this study.
Adolescent↗
[Quality assurance in medicine: the next decade].
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Forecasting↗
Electrocardiographic manifestations of combined hypercalcemia and hypermagnesemia.
Near drowning in the Dead Sea is a potentially lethal accident; the swallowing of the salty water causes acute combined hypercalcemia and hypermagnesemia, and this, rather than aspiration, is considered to be the main pathogenetic fator. The authors reviewed the electrocardiographic data of 37 patients who nearly drowned in the Dead Sea. Common findings in the acute phase included P wave changes, tendency for prolongation of P-R interval, prolongation of QRS complex, infra-His conduction disturbances, tendency for broadening and inversion of T wave, and the appearance of a prominent U wave. Three patients had potentially lethal ventricular tachyarrhythmias. The QaTc interval (beginning of QRS complex to apex of T wave, corrected for heart rate), the expected QaTc calculated from calcium blood level (QaTce), and their difference (DQaTc), were measured or calculated. The QaTc was found within normal limits and did not change during recovery from the Dead Sea water poisoning. The DQaTc correlated significantly with serum magnesium level (p less than 0.001). This correlation signifies that hypermagnesemia normalizes the QaTc interval, which is usually shortened by isolated hypercalcemia. Combined hypercalcemia and hypermagnesemia can be caused by swallowing excessively salty water. The potential cardiac complications require strict monitoring and electrocardiographic follow up study.
Arrhythmias, Cardiac↗
Physiological changes in respiration associated with near drowning in the Dead Sea: a canine model.
An experimental study to elucidate the physiological changes that occur in respiration during near drowning in the Dead Sea was performed in an experimental model. Findings showed that clinical signs of respiratory failure were due to aspiration rather than ingestion of Dead Sea water and occurred within 10 min of aspiration. Physiological changes included increased ventilation, tachypnea, increased resistance, decreased compliance and hypoxia.
Airway Resistance↗
Dead Sea water poisoning.
A unique chemical intoxication by Dead Sea water and its resultant physiological effects of combined severe hypercalcemia and hypermagnesemia are described. Of 48 adult patients, 16 had at least one severe clinical manifestation of either disturbed sensorium or a syndrome similar to adult respiratory distress syndrome. The patients had tachyarrhythmias (11 of 38, 29%), conduction disturbance (nine of 37, 24%), and a normal QTc interval in the presence of severe hypercalcemia. Combined respiratory and metabolic acidosis and concomitant extreme hypercalcemia and hypermagnesemia, reaching serum levels up to 28.8 and 33 mg/dL, respectively, were responsible for most of the clinical findings. The adult mortality was 19%. Four pediatric patients with variable degrees of intoxication survived. Discriminant function analysis determined that admission serum calcium concentration of more than 15.5 mg/dL was the best predictor of mortality. In patients with severe intoxication, supportive medical treatment, including forced diuresis, was disappointing. Early dialysis for severe cases merits further study.
Adult↗
Risk factors for cardiovascular disease among 55 to 74 year-old Finnish men: a 10-year follow-up.
The importance of serum total cholesterol, systolic blood pressure, and smoking as predictors of cardiovascular (CVD) disease were studied in 867 men aged 55 to 74 years belonging to the Finnish cohorts of the Seven Countries Study. Men had no definite history of myocardial infarction nor any signs of cerebrovascular disease at baseline in 1974. During the 10-year follow-up 248 men either died from CVD or had non-fatal CVD event, including a total of 188 fatal and nonfatal coronary heart disease (CHD) events. Age-adjusted relative risk of CVD event for men aged 55 to 64 with cholesterol over 7.4 mmol/l compared to below 6.0 mmol/l was 2.6, with systolic blood pressure over 159 mmHg vs. below 135 mmHg 1.8, and smoking over 19 cigarettes per day vs. never smoker 1.7. Corresponding relative risks for men aged 65 to 74 were 1.0, 1.4 and 1.2, respectively. The results for CHD events were closely similar. The results indicate that, in terms of relative risk, systolic blood pressure retains its importance as risk factor for CVD and CHD from late middle age to old age, whereas the importance of smoking is diminished, and serum cholesterol is of little importance in old age.
Aged↗
[Inappropriate antidiuretic hormone secretion as a complication of preparation for pelvic ultrasonography].
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Adult↗
Virus-specific serum IgG, IgM, and IgA antibodies in cytomegalovirus mononucleosis patients as determined by immunoblotting technique.
The immune response to individual human cytomegalovirus (CMV) structural polypeptides was studied in paired sera from 15 adult CMV mononucleosis (CMV-MN) patients and healthy controls by immunoblotting technique (IB). IgM and IgG antibodies to at least 11 structural polypeptides with molecular weights of 28K, 49K, 55K, 57K, 66-70K, 82K, 87K, 110K, 150K, 205K, and 235K were detected in the patients' sera in the serum sample obtained in the acute phase of the disease. IgA antibodies to polypeptides with molecular weights of 66-70K, 82K, 110K, and 150K were also detected in these sera. In healthy seropositive adults, IgG antibodies with the same molecular weight polypeptides, excluding the 205K and 235K polypeptides, were detected as in convalescent CMV-MN patients. A prominent reactivity of IgM and IgA antibodies to the 66-70K and 150K polypeptides was noted in the acute sera from all the CMV-MN patients examined, but not in a number of late convalescent sera. The potential implications of these findings in the development of specific serological tests are discussed.
Acute Disease↗
Right atrial thrombus and recurrent pulmonary emboli secondary to permanent cardiac pacing--a case report and short review of literature.
A patient with a right atrial thrombus and recurrent pulmonary emboli secondary to permanent pacemaker insertion is described. Possible precipitating factors were damage to the subclavian vein, congestive heart failure, paroxysmal atrial fibrillation, and immobilization. Venography demonstrated a large atrial thrombus in the superior vena cava and right atrium. The patient was successfully treated with heparin and subsequently with warfarin and dipyridamole.
Aged↗
Cytomegalovirus mononucleosis--a report of 70 cases in a community hospital.
Seventy consecutive cases of cytomegalovirus mononucleosis (CMV-MN) were examined retrospectively from their clinical, epidemiological and serological aspects. The mononucleosis syndrome was complicated by various specific organ involvement in 15 (21%) of the patients. Serial serum samples were examined for specific CMV IgG, IgA and IgM antibodies by either the immunoperoxidase or enzyme-linked immunoassay techniques, or both. Specific anti-CMV IgM antibodies were found in 57 patients whose blood samples were collected for the first time at the second week of illness. In seven patients, CMV infection was diagnosed by a rise of specific IgG antibodies and the presence of specific IgA antibodies. These seven patients were generally older (mean age 68 years); four of them had a malignant disease and probably represent cases of recurrent CMV infection. An association between malignancy and recurrent CMV infection in the older age-group is suggested. Prompt diagnosis of CMV infection may exclude CMV-MN from the list of fevers of unknown origin, thus avoiding laborious patient workups.
Adolescent↗
Cerastes vipera envenoming--a report of seven cases.
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Adolescent↗
Endocarditis caused by Haemophilus aegyptius.
Endocarditis due to Haemophilus is uncommon. This is the first reported case caused by Haemophilus aegyptius. The course of the disease was complicated by pericarditis, congestive heart failure, and myocardial abscess formation. Surgical removal of the damaged aortic valve was not beneficial. The biologic properties of the organism included urea degradation, absence of indole metabolism, and absence of the enzyme ornithine decarboxylase.
Abscess↗