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Biomedical subjects

D Mevorach

Publications and source records attributed to D Mevorach.

At least 37 records · Page 2Linked to original sources
PubMed1996

Antiphospholipid syndrome manifested by ischemic stroke in a patient with Crohn's disease.

Cerebrovascular accidents are rare but well documented in patients with Crohn's disease. Up to 10% of hypercoagulable state manifestations reported in association with inflammatory bowel disease are ischemic strokes. However, no clear mediating factor has thus far been suggested. A 44-year-old woman with Crohn's disease for 25 years developed a left temporal stroke associated with anticardiolipin antibody and lupus anticoagulant suggesting antiphospholipid syndrome. A thorough evaluation did not reveal any other risk factor for ischemic stroke. No possible sources of emboli were found in the carotids and heart, and no deficiencies of protein C and activated protein C, protein S, and anti-thrombin III leading to hypercoagulable state were present. There may be a possible association between antiphospholipid syndrome and hypercoagulable state in Crohn's disease.

Adult↗
PubMed1995

Group A streptococcus bacteremia at the Hadassah Medical Center in Jerusalem.

Streptococcus pyogenes bacteremia occurred in 104 patients over a 6-year period, during which time the annual incidence remained constant. The clinical and epidemiologic characteristics are described for 90 of these patients. Of the 90 patients, 90% had community-acquired infection, and 77% had an underlying illness predisposing them to infection. Skin infection was the cause of bacteremia in 61% of the cases. Septic shock developed in 13 patients. The overall mortality rate was 15%. An increased likelihood of death was associated with septic shock and diabetes mellitus.

Bacteremia↗
PubMed1995

Appearance of systemic lupus erythematosus after thymectomy: four case reports and review of the literature.

The appearance of systemic lupus erythematosus (SLE) after thymectomy (or thymomectomy) is presented in four patients together with a comparative review of additional reports found in a Medline search for the years 1966-94 in the English and French literature. Fourteen women and two men of average age of 39 years (range 11-66 years) at presentation, developed SLE after thymectomy (11 patients) or thymomectomy (five patients). Half developed SLE within 3 years after surgery (range 3 months to 18 years). The most common SLE manifestation was polyarthritis occurring in 15 of 16 patients either at presentation or during the first year. Other frequent manifestations included skin rashes, fever, cytopenias and pleuritis. Two rare manifestations of SLE, optic neuritis and transverse myelitis, were reported in two patients. Thymic hormone activity was measured in one patient and was undetectable compared with normal controls. HLA studies in eight patients showed the combination of A1, B8 in four. In conclusion, the appearance of SLE after thymectomy or thymomectomy appears to be more than a coincidence. It may provide insights into the pathogenesis of SLE.

Adolescent↗
PubMed1995

Anti-neuronal antibodies in antiphospholipid syndrome with central nervous system involvement: the difference from systemic lupus erythematosus.

The presence of antineuronal antibodies was compared in 43 patients with primary aPLS and 57 patients with neuropsychiatric SLE. Fifty-eight patients with Guillain-Barré syndrome and 72 normal healthy donors served as control groups. Seventeen patients in the study group had aPLS associated with CNS involvement. Antineuronal antibodies were studied in the sera employing a novel flow cytometric assay. The frequency of antineuronal antibodies in patients with aPLS and CNS involvement was not significantly different from that of patients with aPLS without CNS disease or from that found in the control groups (12%, 19% and 7%, respectively). However, it was significantly different from that found in SLE patients with CNS involvement (60%) (P < 0.001). Our results provide further evidence that unlike CNS-SLE, the major mechanism of CNS involvement in patients with primary aPLS might not be autoantibody (antineuronal) mediated, but rather 'thrombotic' in origin, or due to yet unknown factors.

Antiphospholipid Syndrome↗
PubMed1994

Regression of Kaposi's sarcoma after intravenous immunoglobulin treatment for polymyositis.

The authors report on the case of a patient with polymyositis who was given immunosuppressive therapy and then developed Kaposi's sarcoma. Subsequently, the polymyositis was treated with high dose intravenous immunoglobulin, and the Kaposi's sarcoma regressed abruptly. The association between these two diseases and the beneficial effect of intravenous immunoglobulin on Kaposi's sarcoma are discussed.

Humans↗
PubMed1994

Antibiotic induced meningitis.

Three patients with antibiotic induced meningitis, one following penicillin with seven episodes, are reported on--the first well documented description of penicillin induced meningitis. In this patient episodes of headache and nuchal rigidity appeared with and without CSF pleocytosis. Two patients had a total of five episodes of antibiotic induced meningitis after trimethoprim-sulphamethoxazole (co-trimoxazole) administration. The features common to all three patients were myalgia, confusion and low CSF glucose. CSF analysis was not a reliable method to differentiate antibiotic induced meningitis from partially treated bacterial meningitis.

Adolescent↗
PubMed1994

Improved criteria for localization of coronary artery disease from the exercise electrocardiogram.

To derive better criteria for the noninvasive localization of coronary artery disease, a 12-lead computer-averaged rest and exercise electrocardiogram was examined in 44 selected patients (34 men, 10 women) with single-vessel disease who had an exercise test positive for ischemia by established criteria. Left anterior descending disease was characterized by S-T segment elevation (> or = 0.05 mV) in lead V1 [sensitivity (S) 71%, specificity (Sp) 100%], a T wave amplitude increase in V1 (S 88%, Sp 73%) and a leftward shift or no change in mean frontal plane QRS axis (AQRS; S 92%, Sp 93%). Patients with circumflex or right coronary artery disease had no S-T segment elevation in V1 and a rightward shift in the mean frontal plane AQRS.

Coronary Angiography↗
PubMed1994

Evidence for intrathecal synthesis of autoantibodies in systemic lupus erythematosus with neurological involvement.

The diagnosis of systemic lupus erythematosus (SLE) in a patient who presents with isolated central nervous system (CNS) abnormalities, is a difficult clinical challenge. The pathogenesis of such CNS involvement in SLE is unknown. Twelve patients with active SLE were examined for serum and cerebrospinal fluid (CSF) autoantibodies and compared with 21 patients with headache. Four of six patients with SLE and active CNS presentation had CSF autoantibodies while none of the other SLE patients and the controls had autoantibodies. We describe these four patients in whom immunological work-up revealed CSF antinuclear, anti-DNA, anti-SSA/Ro, anti-SSB/La and antineuronal autoantibodies. A newly devised antibody activity index provided means to demonstrate that the CSF autoantibodies in these patients were produced intrathecally. Beyond the importance of our finding of the potential role of autoantibodies in the pathogenesis of CNS damage in SLE, we propose that CSF analysis for autoantibodies should become an essential part of the diagnostic work-up in autoimmune diseases with CNS involvement.

Adolescent↗
PubMed1993

Complete heart block and seizures in an adult with systemic lupus erythematosus. A possible pathophysiologic role for anti-SS-A/Ro and anti-SS-B/La autoantibodies.

OBJECTIVE: To determine the serum autoantibody profile in an adult patient with systemic lupus erythematosus manifested by complete heart block (CHB) and seizures, and to investigate the source of autoantibodies found in the patient's cerebrospinal fluid (CSF). METHODS: The serum and CSF autoantibody profiles were determined by serologic testing and Western blot studies. An antibody activity index was devised to determine the source of the autoantibodies found in the CSF. RESULTS: The patient's serum contained anti-SS-A (52 kd and 60 kd), anti-SS-B, anti-U1 RNP, and anti-Sm autoantibodies. Studies of her CSF, however, revealed only anti-SS-A and anti-SS-B autoantibodies, with a high antibody activity index. CONCLUSION: The finding of anti-SS-A (52 kd and 60 kd) and anti-SS-B autoantibodies was similar to reported findings in congenital CHB. Intrathecal synthesis of anti-SS-A and anti-SS-B was the source of autoantibodies found in the CSF. This patient's symptoms may be pathophysiologically linked to an immune reaction between the anti-SS-A and anti-SS-B autoantibodies and neural tissue in the brain and heart.

Adult↗
PubMed1993

Thrombocytopenic purpura as a manifestation of acute hepatitis A.

Extrahepatic autoimmune manifestations are rare in patients with acute hepatitis A infection. We describe a 34-year-old man in whom severe autoimmune thrombocytopenic purpura developed as the manifestation of acute hepatitis A infection. Thrombocytopenic purpura is rarely described in association with hepatitis A, but to our knowledge has never been reported as a manifestation of acute hepatitis A.

Acute Disease↗