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Biomedical subjects

B Rudensky

Publications and source records attributed to B Rudensky.

At least 19 recordsLinked to original sources
PubMed1992

Occult elevation of CK as a manifestation of rhabdomyolysis in the elderly.

OBJECTIVE: To evaluate the incidence, etiology and clinical course of rhabdomyolysis in hospitalized elderly patients. DESIGN: Retrospective case series. SETTING: Acute geriatric department of a university-affiliated teaching hospital. PATIENTS: Twenty-three patients who fulfilled our criteria of rhabdomyolysis. Criteria for inclusion were the finding of elevated serum creatine kinase of five-fold or greater above the upper reference limit and greater than 97% MM isoenzyme. RESULTS: In a 3-year period 23 patients out of 2,870 admissions fulfilled the criteria for rhabdomyolysis, an incidence rate of 0.8%. Diseases or insults associated with rhabdomyolysis were, in order of frequency, acute immobilization, infectious disease, cerebrovascular accident, hyperosmolar state, hyponatremia, hypernatremia, hypothermia, and a fall. Twenty-two patients recovered from the acute illness; one patient died from respiratory failure. Seventeen patients had renal failure (serum creatinine greater than 180 mumol/L), none necessitating dialysis. Serum creatinine always declined following recovery. CONCLUSION: Elevation of CK with few other clinical features of rhabdomyolysis is common in admissions to a geriatric service. It is due to complete immobilization resulting from acute illness. Renal failure is mild and reversible, and the prognosis for recovery is excellent.

Acute Disease↗
PubMed1992

Brucellosis with nephrotic syndrome, nephritis and IgA nephropathy.

A patient with systemic brucellosis due to Brucella melitensis had severe renal involvement. Clinical features included hypertension, macroscopic haematuria, massive proteinuria of 10 g per 24 hours and azotaemia. Following treatment with antibiotics, the azotaemia resolved and proteinuria decreased to less than 0.5 g per 24 hours, but microscopic haematuria and hypertension persisted. Renal biopsy during recovery revealed IgA nephropathy with minimal mesangial changes, suggesting a causal relation between brucellosis and IgA nephropathy with a reversible nephrotic syndrome.

Adult↗
PubMed1992

Infected pressure sores: comparison of methods for bacterial identification.

Diagnosis of the bacterial component of pressure sores is notoriously difficult. We comparatively studied three methods of specimen collection from 72 pressure sores. Specimens taken by swab or by needle aspiration were compared with deep biopsy specimens as to diagnostic reliability. We found that swab specimens reflected surface colonization and that needle aspiration seemed to underestimate bacterial isolates as compared with deep tissue biopsy specimens. We recommend that antibiotics not be routinely used for treatment of colonization in pressure sores; in patients with sepsis, deep biopsy specimens can accurately diagnose infection.

Aged↗
PubMed1990

Epidemiology of group B streptococci colonization and disease in mothers and infants: update of ongoing 10-year Jerusalem study.

A study in 1984 of the colonization rates of Group B beta hemolytic streptococci (GBS) in 257 Jewish and 189 Arab parturient women revealed rates of 5.4 and 1.6% respectively. In 1987, a study of 116 Jewish women noted a rte of 3.5%. GBS colonization rates in the newborns of the three groups were 1.8, 1.3 and 1.1% respectively. No statistically significant differences were noted between any of the maternal or neonatal groups. A review of the period 1982-87 revealed a GBS neonatal sepsis attack rate of 0.2/1,000 live births. These data confirm the persistent low incidence of GBS colonization and disease in the Jerusalem area.

Carrier State↗
PubMed1990

Campylobacter pylori in Israel: prospective study of prevalence and epidemiology.

Antral biopsy samples were taken from 147 patients undergoing gastroscopy. Campylobacter pylori was cultivated from 100 of these patients. C. pylori was isolated from 76% of the specimens showing any degree of histologic gastritis, but from only 11% of specimens with completely normal histology. A questionnaire was completed on all patients and included demographic, epidemiologic and clinical information. Sephardic origin, smoking, and a bad taste in the mouth were more prevalent in the campylobacter-positive group. Previous use of antibiotics was negatively associated with the presence of C. pylori. Histologically confirmed gastritis was highly associated with the presence of C. pylori, especially in the moderate or severe grades in which 84% of biopsy specimens were positive. C. pylori was also cultivated from 50% of patients with mild gastritis, in 88% of patients with duodenal ulcer and in 71% of patients with gastric ulcer. The presence of C. pylori in 11% of normal specimens and the absence of C. pylori in 24% of specimens with gastritis further raises the question of the exact role played by C. pylori in the etiology of gastritis.

Adult↗
PubMed1989

Vaccination against hepatitis B in children and adolescent patients on dialysis.

Twenty-one children and adolescent patients, 2-19 years of age, on renal replacement therapy were immunised at monthly intervals with three doses of 20 micrograms hepatitis B vaccine (Heptavax B, Merck Sharp & Dohme). In the absence of seroconversion, vaccination was continued with monthly doses of 40 micrograms hepatitis B vaccine until antibody to hepatitis B surface antigen became positive. The rate of seroconversion increased from 33.3% (7 of 21) to 76.1% (16 of 21) and 85.6% (18 of 21) with three, four and five vaccine injections respectively. Three patients had no immune response despite six to seven vaccine dosages; they had previously received immunosuppressive therapy. Antibody titres measured 1 year after seroconversion were found to be within the protective range (85-2500 mIU/ml). These results show that the impaired immune response to hepatitis B vaccination in young dialysis patients can be overcome by increasing the number of injections and the dose of the vaccine. Protective antibody titres are maintained for at least 1 year after vaccination. Immunosuppressive therapy may interfere with the vaccine response.

Adolescent↗
PubMed1987

Pneumococcal bacteremia--no change in mortality in 30 years: analysis of 104 cases and review of the literature.

We evaluated 104 cases of pneumococcal bacteremia retrospectively: 55 adults and 49 children. The overall mortality rate was 33% in adults, and 6% in children. Mortality was associated with old age, severe underlying disease, vague clinical presentation, multilobar pneumonia, leukopenia and metabolic acidosis. Both vigorous treatment with mechanical ventilation devices, vasopressors and steroids, and sophisticated monitoring in the Intensive Care Unit did not improve survival. In six cases (5.8%) the pneumococcus was resistant to penicillin G. In reviewing the literature of the last 30 years, no change in mortality rate was noted. Vaccination of population at risk is highly recommended.

Adolescent↗
PubMed1987

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↗