[New attitudes to pain control in multiple myeloma].
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Biomedical subjects
Publications and source records attributed to E Dolev.
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The status of osteoarticular tuberculosis in recent years was studied. 82 cases diagnosed here between 1951-1985 were surveyed. The disease was more common among East European Jews (38%) and among young people: the mean age was 36 years and the highest incidence was in the third decade. A secular tendency to "aging" was noted, as in later years the mean age increased. However, there was also a secular decrease in incidence, explained by a progressive decrease in immigration to Israel. The disease affected most commonly the spinal vertebrae and the weight-bearing joints. There was an average delay of 19 months between onset of symptoms and/or signs of the disease and its diagnosis.
Hypocalciuria is a feature of preeclampsia. The roles of parathyroid hormone (PTH) and vitamin D 1,25(OH)2D3 (calcitriol) in its pathogenesis have not yet been determined. Fourteen preeclamptic women were compared with 12 women with chronic hypertension and 11 normotensives, all in the third trimester. Preeclamptics had the lowest urinary calcium excretion rate (62.1 +/- 32.8 mg/24 hours) compared with chronic hypertensive women (162.6 +/- 97.8 mg/24 hours) and normotensive controls (225.6 = 146.9 mg/24 hours) (P less than .05). Serum PTH was lowest in preeclamptics (9.8 +/- 5.5 pg/mL), in contrast to the chronic hypertensives (18.5 +/- 2.7 pg/mL) and normotensives (16.4 +/- 3.2 pg/mL) (P less than .005). Similarly, urinary cyclic adenosine monophosphate (cAMP) excretion was 2.9 +/- 1.4 mumol/24 hours in the preeclamptics, 5.1 +/- 1.7 mumol/24 hours in the chronic hypertensives, and 4.6 +/- 1.3 mumol/24 hours in the normotensive group (P less than .05). These data suggest that the mechanism of hypocalciuria in preeclampsia is independent of the PTH-calcitriol axis. Therefore, it is suggested that the hypocalciuria of preeclampsia is due to intrinsic renal tubular dysfunction.
The efficiency of preoperative radioactive toluidine blue (RTB) scintigraphy for the localization of parathyroid pathology was evaluated prospectively in 69 patients (age range, 15 to 81 years; mean, 56 years) with primary hyperparathyroidism. Four patients have previously undergone negative exploratory surgery. Patients underwent preoperative dual radionuclide parathyroid-RTB/technetium 99m (Tc 99m)-thyroid scintigraphies with a computer-interfaced gamma-camera with a pinhole collimator. Computer-acquired scintigraphic data were analyzed for parathyroid localizations by an RTB-parathyroid/thyroid superposition technique. At surgery, parathyroid adenomas were found in 64 patients (single adenomas in 60 patients; two adenomas in four patients), nine of these adenomas were mediastinal. Four patients had parathyroid hyperplasia. One patient had no parathyroid pathology (negative exploratory surgery). Correlation between the surgical-pathologic findings and the scintigraphic RTB localization studies disclosed a sensitivity of 87%, with a specificity of 94%, and an overall accuracy of 92%. The routine use of preoperative scintigraphic parathyroid-RTB/Tc 99m-thyroid localization has proved to be highly effective, enabling detection of small hyperfunctioning parathyroid glands in normal and ectopic locations in a wide range of weights. In this series a success rate of 98% was achieved on initial and reexploratory surgery for primary hyperparathyroidism.
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Several zinc parameters were assessed in 13 patients with essential hypertension who were chronically taking only captopril (six subjects) or enalapril (seven subjects), as well as in six untreated hypertensives, and nine healthy controls. Serum zinc levels were comparable in all groups. Twenty-four-hour urinary zinc excretion was significantly increased in the captopril-treated patients compared with the other three groups. The zinc:creatinine ratio in 24-hour urine was significantly increased in both captopril and enalapril groups, but was significantly greater in the former. Although plasma zinc concentrations were comparable in all groups, red blood cell (RBC) zinc values were significantly decreased in the captopril group compared with the other three groups. We conclude that (1) although both captopril and enalapril produce renal zinc loss, this loss is far greater in patients receiving captopril; and (2) captopril administration over 3 months or more generates RBC zinc depletion.
An increase in endogenous androgen production has been observed following long-term physical training and the beneficial effects of training have been attributed in part to this phenomenon. Other investigators, however, found, in contrast lower testosterone levels in trained compared with untrained subjects. The purpose of the present study was to follow the long-term changes in total testosterone (T) and cortisol (C) levels in intensely training individuals. The changes in the body's anabolic state, induced by intense long-term physical training, were determined using the plasma resting T/C ratio. T and C levels of 35 young untrained subjects were measured at 6 week intervals during 18 weeks of strenuous physical training. All samples were drawn within one half hour of awaking (05.30-06.00). Mean serum T levels increased significantly at 6 weeks (28.7%, p less than 0.02) and decreased significantly at 12 weeks (20.6%, p less than 0.02), but did not differ at 18 weeks compared with levels before training was commenced (mean +/- SE, 16.9 +/- 0.2, 21.8 +/- 0.3, 12.8 +/- 0.2 and 17.3 +/- 0.2 nmol/l at 0, 6, 12, and 18 weeks, respectively). Mean serum C was increased significantly (21.3%, p less than 0.005) at 18 weeks (463.5 +/- 19.3, 507.7 +/- 22.1, 480.1 +/- 19.3, and 565.6 +/- 22.1 nmol/l). T/C ratio decreased significantly after 12 and 18 weeks of training. Our results do not support an association between reduced total testosterone levels and prolonged training. However, hypercorticolism with a relative catabolic state may occur.
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A 20-year-old woman is presented who had eosinophilic gastroenteritis of the muscularis and serosal type which involved the terminal ileum. The diagnosis was initially acute appendicitis, but clues to the correct diagnosis included the presence of malabsorption, protein-losing enteropathy, abdominal pain and ascites, and especially a history of recurrent bouts. Peripheral eosinophilia is found in most cases and biopsy, or a peritoneal tap when ascites is present, may demonstrate a predominantly eosinophilic infiltration. Radiographic findings include a rigid, open ileocecal valve. There is rapid response to corticosteroid therapy, but long term follow-up is required because the disease may run a chronic, relapsing course.
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A modular, mobile and versatile evacuation hospital evolved by the Israel Defence Forces (IDF) during the last 15 years serves as a sorting facility for the hospitals in its rear, in much the same manner as an emergency department functions within a hospital. It has extensive sorting and resuscitation capabilities, contrasting with a relatively small hospitalization potential. Surgery is performed only for resuscitation or for limb salvage. The evacuation hospital handled more than 4500 casualties during the 1973 and 1982 Arab-Israeli wars. Only 3 per cent of the wounded had to be operated on prior to further evacuation. Seventeen per cent were returned to the front lines after minor treatment and 80 per cent were sorted and stabilized and then evacuated further to rear hospitals. The eventual mortality for these 4500 casualties was 2.3 per cent.
Magnesium (Mg) and zinc (Zn) status was assessed in subjects to evaluate the effects of thyroid diseases on Mg and Zn metabolism. Plasma and red blood cell (RBC) concentration and peripheral blood mononuclear cell (MNC) content of Mg and Zn, and 24-hour urinary excretion of Mg, Zn, creatinine (Cr), calcium (Ca), sodium (Na), and potassium (K) were measured in 11 thyrotoxic, 29 hypothyroid, and 25 euthyroid control subjects. Serum albumin, alpha 2-macroglobulin, and the binding of Zn to albumin were also determined. Plasma and RBC Mg concentrations were low in half of the hyperthyroid subjects, but mean values were not significantly different from controls. Urinary excretion and clearance of Mg were lower in hypothyroid subjects, but differences were removed when expressed relative to Cr excretion and clearance. Similar patterns were noted for urinary Ca, Na, and K, suggesting that their reduced excretion reflects alterations in renal hemodynamics. Plasma Zn was lower in hypothyroid subjects and correlated with serum albumin; MNC Zn and urinary Zn were also low. Plasma Zn concentration was normal and serum albumin significantly lower in the hyperthyroid group than in the control group. Further, RBC Zn content was significantly lower in hyperthyroid subjects, and inversely related to plasma thyroxine concentration. The hyperthyroid group also excreted significantly greater amounts of Zn than controls, indicative of a catabolic process. This increased urinary loss may reflect a shift in the distribution of plasma Zn between ultrafilterable and Zn-albumin complexes. In summary, this study provides evidence for marked alterations in Zn homeostasis in persons with thyroid disease. Whether the observations indicate deficiency states and have clinical implications will require further investigation.
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Aeromedical evacuation has been extensively used by military forces for evacuation of wartime casualties, but has also proven useful in civilian disaster response. In contrast to the broad coverage of the clinical aspects of the aeromedical evacuation, the operational and management control issues have rarely been addressed. The sophisticated battlefield of the 1980s has had an impact also in air evacuation, adding to the factors to be considered before launching an evacuation mission. The professional control of aeromedical evacuation is, therefore, crucial to the efficient and smooth operation of this high-cost resource. In an attempt to shed light on some of the operational perspectives of military air evacuation, the Israeli experience in the management control of such systems is discussed.