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Biomedical subjects

H Gur

Publications and source records attributed to H Gur.

At least 37 records · Page 2Linked to original sources
PubMed1999

Efficacy and safety of intravenous amiodarone in recent-onset atrial fibrillation: experience in patients admitted to a general internal medicine department.

We examined the efficacy and safety of intravenous amiodarone in 20 unselected patients with recent-onset atrial fibrillation who were admitted to a general internal medicine department during a 6-month period. The treatment protocol included a loading dose of 1200 mg intravenous amiodarone in 24 hours, after which amiodarone treatment was continued orally. Eleven of the 20 patients (55%) converted to sinus rhythm within 48 hours of intravenous amiodarone treatment and were discharged in sinus rhythm, while 9/20 (45%) patients failed to convert during hospitalisation. Six patients (30%) failed to convert to sinus rhythm even after one further month of oral treatment. There was one death and a high frequency (25%) of thrombophlebitis during hospitalisation. The in-hospital non-convertors had a significantly lower ejection fraction and initial low ventricular response rate than the convertors. In conclusion, the acute conversion rate by intravenous amiodarone was at best modest. It is suggested that intravenous amiodarone is probably more effective in patients with rapid recent-onset atrial fibrillation and good left ventricular function.

Aged↗
PubMed1999

Rheumatic manifestations preceding adult acute leukemia: characteristics and implication in course and prognosis.

The manifestations and outcome of adult patients with acute leukemia (AL) were examined to study the characteristics of the rheumatological prodrome of AL and to find whether it is a marker of a distinct clinical and laboratory course and whether it has any prognostic implication. During a 10-year period, 8/139 (5.8%) of AL patients presented with rheumatic manifestations. The average duration of the arthritis syndrome preceding the diagnosis of AL was 3.25 months. The most common pattern of presentation was a reactive arthritis-like syndrome involving the large joints asymmetrically and associated with low back pain. Distinctive features suggesting a paraneoplastic arthritis were severe pain disproportionate to physical findings, a poor response to conventional antirheumatic treatment, and early significant osteopenia or lytic bone lesions. The epidemiological, clinical and laboratory characteristics of patients with or without rheumatic manifestations were comparable, except for fever on presentation, the presence of transient metabolic derangement following chemotherapy, and the initial average hemoglobin, hematocrit and serum uric acid values. Moreover, the initial outcome of the two groups was similar, as the early mortality rates were comparable (42.8% vs. 45% for patients with or without arthritis, respectively). In conclusion, rheumatic syndrome presentation of adult AL is uncommon, and apparently has no deleterious effects on initial prognosis. A timely diagnosis requires an increased awareness to distinctive features.

Acute Disease↗
PubMed1999

The changing clinical presentation of temporal arteritis in Israel: a multicenter study.

OBJECTIVES: To evaluate whether the increasing incidence of temporal arteritis in Israel is associated with a changing clinical presentation. METHODS: The demographic data and clinical manifestations of 144 TA patients in this large multicenter study were recorded and compared with data obtained in a previous study. RESULTS: The patient population was older, with 24% > or = 80 years compared to 6% in the previous study. There was an increase in the number of nonspecific presenting symptoms, and less patients presented with the "classical" manifestations of headache (81% vs. 71%), fever (83% vs. 40%), jaw claudication (21% vs. 13%), and visual symptoms (47% vs. 24%). The median time from presentation to diagnosis was significantly reduced, from 5 to 1.5 months. CONCLUSIONS: There were substantial changes in the clinical presentation of TA patients in Israel during 1980-95 compared to patients diagnosed prior to 1978. It is suggested that these changes may be attributed not only to the influence of aging of the population, but are due largely to increasing physician awareness to the spectrum of manifestations of TA, which leads to earlier diagnosis.

Age Distribution↗
PubMed1998

High incidence of malignancies in patients with dermatomyositis and polymyositis: an 11-year analysis.

OBJECTIVES: Dermatomyositis and polymyositis (DM/PM) are associated with neoplasms. The aim of the present study is to compare our experience in Israel with other published data. METHODS: Thirty-five adult patients with DM/PM, admitted to Sheba Medical Center during the 11-year interval between 1984 and 1994, were studied for the prevalence and features of malignant diseases. Patients with DM/PM alone and with DM/PM and malignancy were identified by using the hospital computer system. The manifestations of DM/PM and features of the malignant diseases were abstracted from the patients' charts. The presence or absence of malignancy and the type of cancer were verified in the National Cancer Registry. RESULTS: There were 15 men and 20 women. The mean age at the onset of the disease was 53 +/- 18 years. A total of 15 had PM and 20 DM. Malignancies occurred in four patients with PM (27%) and in nine with DM (45%) a frequency 12.6 times higher than in the general population. In six patients, the malignancy and the DM/PM were diagnosed simultaneously; in four before and in three after the appearance of the DM/PM. Hematologic, gastrointestinal, breast, ovarian, and lung tumors, malignant melanoma, and metastatic carcinoma of unknown primary were found among our patients. Eight DM/PM patients with malignancy died during the study period of infection, pulmonary embolism, and tumor spread. CONCLUSIONS: Our study found that DM/PM is associated with high rates of malignancy and mortality.

Adult↗
PubMed1997

Structural analysis of class I MHC molecules: the cytoplasmic domain is not required for cytoskeletal association, aggregation and internalization.

The role of the cytoplasmic domain in a variety of the functional activities of class I MHC molecules has not been documented. To address this question, Jurkat cells were transfected with genes for either native class I MHC molecules or constructs in which all but four cytoplasmic amino acids were deleted. Antibody-induced aggregation and internalization of class I MHC molecules were examined by flow cytometry, and cytoskeletal association was determined by analysing the detergent-resistant fraction of FITC-labeled mAb to class I molecules. The results indicate that the truncated class I MHC molecules are comparable to native class I MHC molecules in the ability to move in the plane of the membrane and aggregate, to associate with the cytoskeleton and to undergo mAb-induced internalization at 37 degrees C. Thus, the cytoplasmic domain of class I MHC molecules is not required for these functional activities.

Cell Aggregation↗
PubMed1997

Common variable immunodeficiency associated with myelocathexis and altered membrane sodium-proton antiport.

Alterations in protein kinase C (PKC) activity have been implied in the pathogenesis of common variable immunodeficiency (CVID). We analyzed amiloride-sensitive red blood cell Na+/H+ exchange (sodium-proton antiport, SPA) and its response to protein kinase stimulation in a patient with CVID. Compared with healthy subjects or patients with sepsis, a unique pattern of SPA activation has been shown. The patient's SPA was decreased and unresponsive to PKC stimulation, whereas stimulation by insulin, a tyrosine kinase activator, restored SPA activity. An alteration of serine-threonine phosphorylation is suggested as a possible mechanism for the immune failure.

Adult↗
PubMed1997

Lactic acidosis and fatal myocardial failure due to clozapine.

OBJECTIVE: To describe a patient with neutropenic fever complicated by hyperglycemia, lactic acidosis, and fatal myocardial failure associated with clozapine therapy. CASE SUMMARY: A 37-year-old Ashkenazic Jewish man was admitted for agranulocytosis and fever, which developed after 11 weeks of clozapine monotherapy for drug-resistant schizophrenia. Complete blood counts and a routine serum chemical analysis had been normal before the treatment was initiated, and remained within normal limits during the first 10 weeks of the treatment. On the day of admission, the patient deteriorated rapidly and developed extreme hyperglycemia, severe lactic acidosis, recurrent cardiac arrest, cardiogenic shock, and coma. He died 36 hours later despite intensive treatment. DISCUSSIONS: Clozapine intake reduced fatal aganulocytosis, associated with hyperglycemia, lactic acidosis, and heart failure. White blood cell count monitoring was insufficient to predict these adverse effects. CONCLUSIONS: Clozapine should be avoided in high-risk patients (e.g., the elderly, women, Ashkenazic Jews).

Acidosis, Lactic↗
PubMed1996

[Progress of lymphoproliferative disease associated with disseminated Kaposi's sarcoma].

A 73-year-old woman with a lymphoproliferative disorder had successive stages of reactive lymphadenopathy in sequence, a multifocal type of Castleman's disease and angioimmunoblastic lymphadenopathy. The disease ran an aggressive course and was associated with disseminated Kaposi's sarcoma. The linkage between the various types of lymphoproliferative disorders that presented in the same patient, as well as the association with Kaposi's sarcoma, are discussed.

Aged↗
PubMed1996

Pleural effusion as a presenting manifestation of giant cell arteritis.

Pulmonary involvement is rare in giant cell arteritis (GCA). Only a few cases have been reported, manifested by interstitial infiltration, pulmonary nodules, pulmonary artery vasculitis, and granuloma formation. Moreover, only 3 previous cases of pleural effusion associated with GCA have been described. Herein we report a 67-year-old woman with biopsy-proven temporal arteritis, presented with prolonged fever, weight loss, cough and pleural effusion. ELISA test for the presence of anti- proteinase-3 antibodies was negative. The importance of the anti-neutrophil cytoplasmic-antibodies (ANCA) examination in the differential diagnosis from other vasculitides with pulmonary involvement is discussed.

Aged↗
PubMed1996

Aspergillosis in systemic lupus erythematosus.

Infection is the major cause of morbidity and mortality in systemic lupus erythematosus (SLE). Although various fungi account for a substantial number of these lethal infections, aspergillosis, an important opportunistic infection in immunosuppressed patients, is described rarely. Only 23 cases have been reported in the English-language medical literature. Risk factors for acquiring aspergillosis in these patients were high grade disease activity, granulocytopenia, use of steroids and other immunosuppressive treatment and presence of bacterial infection. The diagnosis in most patients was delayed and they died. Here, we describe three SLE patients with invasive aspergillosis. Features of our patients' diseases were similar to those reported previously. Aspergillosis appeared while they had active SLE treated with high dose corticosteroids. In 2 patients the fungal infection was systemic and diagnosed post mortem. Both were leukopenic and had concurrent bacterial infection and one received amphotericin B prior to death. In the third, the infection was localized to a transplanted kidney and was cured by nephrectomy. Aspergillosis should be suspected in patients with active SLE, who are immunocompromised and sustain concomitant bacterial infections. The currently poor prognosis may be improved with more aggressive diagnostic investigation and treatment.

Adolescent↗