Possible prevention of tick-borne relapsing fever in patients infected with Borrelia recurrentis.
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Biomedical subjects
Publications and source records attributed to E Ben-Chetrit.
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A patient with agnogenic myeloid metaplasia (AMM) associated with an ill-defined autoimmune disease is described and the literature on autoimmunity in AMM is reviewed. In view of the available data, it seems that the association between AMM and autoimmunity observed in our patient is not fortuitous.
The present study is an attempt to define the uncommon bacteria (UB) causing endocarditis and to evaluate their prevalence and clinical significance. Review of 13 series (including ours) revealed that UB were the infecting organisms in 105/1989 patients (5.3%). The leading bacteria were: Pneumococcus, Haemophilus sp., Corynebacterium sp., Neisseria sp., Streptobacillus moniliformis, Cardiobacterium hominis and Erysipelothrix sp. These data are similar to those obtained from 111 sporadic case reports published in English during the last 6 yr and cited in the Index Medicus. Infection by UB usually resembles that by the common bacteria. However, Haemophilus sp. seems to affect mainly the young and is associated with major arterial occlusions, and Brucella is claimed to have a greater affinity to the aortic valve. UB are more frequent in patients with polymicrobial infections and their diagnosis is often delayed. Greater awareness to the possibility of infections with UB is needed for early diagnosis and improved prognosis.
A young woman with celiac disease presented with fever, headache, diffuse myalgia, vomiting, diarrhea and hypotension during a menstrual period in which tampons were used. The clinical picture and laboratory data were typical of toxic shock syndrome. This recently defined entity is rare outside of the United States, and has not been previously reported in a menstruating woman in Israel. The clinical and laboratory characteristics of the syndrome are discussed.
The case of a patient with Kaposi's sarcoma and paraproteinemia is described and the relevant literature is reviewed. It is suggested that Kaposi's sarcoma is part of the spectrum of the lymphoproliferative diseases, and that both the marked angiogenesis and the synthesis of paraproteins in this disease are different expressions of the same proliferative process.
Seven patients with prolonged atypical illness were followed up for more than a year. Sera taken during that period showed significantly increased titres of IgM antibodies against the viral capsid antigen (VCA) of Epstein-Barr virus (EBV). In four of the patients antibodies to the R component of the early antigen (EA) complex of EBV were clearly detectable. Only one of these seven patients had presented with symptoms of classic infectious mononucleosis. Serological and clinical observations in these patients suggest that the prolonged atypical illness was probably the result of persistent EBV infection.
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A patient with allergy to insulin experienced reactive lymphadenopathy and, later, angioimmunoblastic lymphadenopathy; all occurred within 18 months. It is suggested that insulin may be added to the list of drugs associated with the appearance of angioimmunoblastic lymphadenopathy.
The sialic acids content of glycophorin of thalassemic erythrocyte membranes is about 25% lower than in glycophorin of normal erythrocyte membranes. Glycophorin extracted from old thalassemic erythrocytes separated by density centrifugation, has about half the sialic acids content found in glycophorin extracted from young thalassemic erythrocytes. Possible sialidase activty was sought in the plasma and erythrocyte membranes of thalassemic erythrocytes. No increased sialidase activity was detected in the plasma of the patients as compared to that of normal donors. Thus, other sites for sialidase activity, or other possibilities have to be explored to account for the increased sialic acid hydrolysis of glycophorin of the thalassemic erythrocytes.
Familial Mediterranean fever (FMF) also known as hereditary polyserositis, is an inherited disorder commonly found in Armenians, Turks, Arabs, Balkans, and Jews originating from North African countries. The diagnosis of FMF is based on clinical findings and family history, as no specific diagnostic test is yet available. One of its main clinical features is recurrent acute episodes of peritonitis. During such an episode, physical examination and laboratory findings may be similar to those for acute appendicitis. Therefore up to two-thirds of FMF patients undergo emergency appendectomy, with the appendix being normal in most cases. As laparoscopic appendectomy has proved to be safe and advantageous, and to prevent misdiagnosis and unnecessary emergency surgery, we performed elective laparoscopic appendectomy in 13 FMF patients ranging in age from 8 to 32 years. They had been suffering from the disease for 1 to 12 years (mean 3.8) and had had an average of 3.5 yearly episodes of FMF peritonitis. All procedures were concluded by laparoscopy without conversion to open surgery. The average postoperative hospital stay was 3.07 days. The only complication was superficial wound infection in one patient (7.6%), and the mean time to regain full normal activity was 8.5 days. We conclude that elective laparoscopic appendectomy in FMF patients is safe. It helps to exclude appendicitis as a cause for peritonitis in these patients and may prevent unnecessary emergency surgery.
The SSA/Ro and SSB/La antigens are polypeptides which serve as autoantigens in systemic lupus erythematosus and Sjogren's syndrome. The SSA/Ro contains two major isoforms of 60 kD and 52 kD. The former is the main native antigen while the latter is a major autoantigen in its denatured form. The SSB/La is a single phosphorylated protein of 48 kD. Recently a new protein of 46 kD, termed calregulin, was suggested as an additional component of the SSA/Ro antigens. However, extensive investigations failed to confirm its relation to the SSA/Ro system. Based on molecular techniques and cDNA cloning of these antigens, it was demonstrated that the 60 kD protein is capable of binding RNA and DNA molecules, suggesting a regulatory role in transcription for this antigen. The 52 kD polypeptide contains multiple zinc finger motifs and its sequence is homologous to the mouse rptl protein, which is a T-cell regulating peptide. The SSB/La is associated with precursors of 5S RNA and tRNA, implying that it has a role in the synthesis and maturation of RNA polymerase III transcripts. The 60 kD and 52 kD SSA/Ro components may be associated within the cell. The SSA/Ro and SSB/La may also be in complex in some points of the cell cycle.
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