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Biomedical subjects

J Bernheim

Publications and source records attributed to J Bernheim.

At least 109 records · Page 6Linked to original sources
PubMed1996

Increased prevalence of HCV antibodies in dialyzed Ashkenazi Jews--a possible ethnic predisposition.

BACKGROUND: The prevalence of hepatitis C (HCV) antibodies in dialysis patients is considerably higher than that found among healthy blood donors. This increased seroprevalence has been correlated to increased duration of dialysis, mode of dialysis and to the number of blood transfusions administered. However, factors other than nosocomial ones also seem to play a part in disease transmission. The role of the patient's ethnic origin, possibly reflecting on his/her genetic makeup has received scant attention. In this study, HCV seroprevalence in our dialysis population, which consists of three major ethnic subgroups (Ashkenazi Jews, Sephardi Jews and Arabs), was examined. METHODS AND RESULTS: Altogether HCV seropositivity was determined in 120 dialysed patients--65 males/55 females (76 hemodialysis, 44 CAPD), using second generation ELISA confirmed by RIBA-2. Mean age was 59.7 +/- 15.7 (range 16-86 years). Patients had to have been on dialysis for a minimum of 3 months (mean duration 45.2 +/- 44.5 months). Patients whose end-stage renal disease was due to diabetic nephropathy (DN) or those who had previously been transplanted (TP) were considered as separate groups and compared to the group as a whole. Of the 120 patients, there were 49 Ashkenazi Jews (40.8%), 57 Sephardi Jews (47.5%) and 14 Arabs (11.7%). Overall HCV prevalence was 21.7% (26/120) with a significantly greater prevalence in HD compared to CAPD (30.3 vs. 6.8%, P < 0.01). Respective values for Ashkenazi Jews, Sephardi Jews and Arabs were 30.6, 15.8, and 14.3% (P < 0.01, Ashkenazi Jews vs. Sephardi Jews and Arabs). DN had a lower 3.7% while TP had a higher 46.1% prevalence compared to the group as a whole (P < 0.01). In general, the increased frequency of anti HCV antibodies was significantly correlated to the duration of dialysis and the number of blood transfusions administered. This, however, was not the case in the greater prevalence of HCV found in Ashkenazi Jews compared to Sephardi Jews and Arabs which was independent of the above factors and the mode of dialysis. CONCLUSION: Our results showing increased HCV seropositivity in Ashkenazi Jews compared to Sephardi Jews and Arabs, suggest that ethnic factors might predispose to HCV transmission and infectivity.

Adolescent↗
PubMed1996

Nonocclusive mesenteric infarction in continuous ambulatory peritoneal dialysis.

Nonocclusive mesenteric infarction has recently been diagnosed with increasing frequency in dialysis patients. Although most reports have concerned patients on hemodialysis, the condition has also been reported to occur in patients on continuous ambulatory peritoneal dialysis. This report describes such a case developing in a woman whose end-stage renal failure was due to adult polycystic kidney disease. Associated predisposing factors were the presence of orthostatic hypoxemia, postural hypotension and extensive atheromatous changes of the abdominal aorta. In keeping with the known difficulty of establishing the diagnosis of mesenteric ischemia, the diagnosis in our patient was also delayed. She was initially thought to suffer from an episode of peritonitis and/or colonic perforation secondary to the performance of a cleansing enema. Only upon showing pneumatosis coli of the right colon on abdominal computerized tomography was the correct diagnosis made. Laparotomy revealed extensive necrosis of the ascending and transverse colon. A total colectomy and ileorectal anastomosis were performed. The patient died on the 17th day following surgery. This case serves to illustrate that mesenteric infarction should be considered in predisposed patients on continuous ambulatory peritoneal dialysis. The presence of peritonitis may mask the underlying pathology and waylay the unwary physician.

Adult↗
PubMed1996

Efficacy of low felodipine dose monotherapy in mild-to-moderate hypertension: a comparison between office and ambulatory blood pressure monitoring.

The efficacy and tolerability of felodipine, in a low dose of 5-10 mg daily was assessed in 32 patients with mild-to-moderate hypertension, aged 53 +/- 11 years. The results of office vs 24 h ambulatory blood pressure measurements (ABPM) were compared. Inclusion criteria included an office systolic and diastolic blood pressure (SBP/DBP) > 140/90 mm Hg and a 24 h ABPM SBP/DBP > 135/85 mm Hg. Felodipine was initiated at a dose of 5 mg daily. At day 28 of the study, if office DBP > 90 mm Hg, the dose was doubled to 10 mg daily. At the end of the study (day 84), 24 h ABPM was done again. Side effects were noted throughout the study. Four patients dropped out during the study (two due to headache, one due to pedal edema and one rejected further participation). Of the remaining 28 patients, at day 28, 12 required an increased dose of 10 mg/day. At the end of the study, office BP was below 140 90 mm Hg in 71% of the patients. In the whole group BP decreased from 158 +/- 15/101 +/- 8.4 to 138 +/- 9/85 +/- 5 mm Hg, P < 0.001. ABPM showed that BP was normalized in 82% of the patients. It decreased from 146.8 +/- 9.56/94.8 +/- 7.4 to 130.2 +/- 10.6/83 +/- 6.3 mm Hg, P < 0.001. BP was similarly reduced in working and sleeping hours, with preservation of the circadian rhythm. Heart rate was unaffected by the drug. Five patients showed persistently elevated SBP on office measurements while on ABPM, the values were within normal limits. This finding confirms the existence of a white coat effect in patients with proven hypertension and the superiority of ABPM over office BP measurements in clinical investigations. In summary, ABPM showed that the antihypertensive effect of felodipine was sustained throughout normal 24 h, including the critical (as regards cardiovascular morbidity) awakening hours.

Adult↗
PubMed1995

Safety of coronary ultrasound angioplasty: effects of sonication on intact canine coronary arteries.

The purpose of this work was to examine in vivo the safety of sonication in the coronary arteries in a live animal model. In intact dogs (n = 8), balloon dilatation was performed on the proximal left anterior descending artery (LAD) followed by sonication to the left circumflex artery (LCX) in power levels found to be optimal for thrombus ablation. Post-dilatation and post-ultrasound coronary angiography, echocardiography, histopathology, CK-MB, indices of hemolysis, and coagulation were compared. Sonication did not induce changes in the ECG or blood pressure. Coronary angiography revealed no adverse side effects or change in arterial diameter (2.3 +/- 0.7 vs. 2.4 +/- 0.3 mm). Echocardiography showed transient opacification of the myocardium. Histopathology revealed a comparable minimal degree of endothelial denudation. After sonication there were no changes in the level of CK-MB (312 +/- 168 vs. 283 +/- 207 IU), hemoglobin (11.3 +/- 0.9 vs. 12.7 +/- 1.1 gr%), haptoglobin (479 +/- 136 vs. 451 +/- 121 mg/dL), fibrinogen (142 +/- 18 vs. 165 +/- 28 mg%), partial thromboplastin time (17.3 +/- 3.2 vs. 17.6 +/- 3.4 sec), prothrombin time (13.3 +/- 7.8 vs. 11.5 +/- 2.9 sec), and degree of platelet aggregation (55 +/- 17 vs. 62 +/- 8%). Thus, the data suggest that transluminal coronary sonication exerts no overt adverse effects in vivo.

Angioplasty, Balloon↗
PubMed1995

Reduced ambulatory heart rate response to physical work and complaints of fatigue among hypertensive males treated with beta-blockers.

Treatment with beta-blockers affects oxygen metabolism and lipolysis during physical exertion. Together with possible central nervous system effects, this may impair the work capacity of treated hypertensive subjects. In a study of 1619 male employees, aged 45-64 years, mean resting and ambulatory heart rate (HR) and complaints of fatigue were compared between hypertensive workers treated with beta-blockers and untreated hypertensives and normotensives under low and high workload conditions. Treated hypertensives had lower mean resting HRs compared with normotensives and untreated hypertensives. Their change from resting to ambulatory HR during low and high workload was also lower than normotensives and untreated hypertensives, and they had higher fatigue scores than their untreated counterparts at both workload levels. The highest fatigue score was reported by treated subjects under high workload. These findings demonstrate a reduced HR response to physical work accompanied by more symptoms of fatigue during treatment with beta-blockers. When hypertensives are engaged in physically demanding work, other classes of antihypertensive therapy should be considered.

Adrenergic beta-Antagonists↗
PubMed1995

Superficial hemosiderosis in a second trimester fetus: pathological and clinical manifestations.

Prenatal brain hemorrhages are associated with considerable morbidity and mortality in neonates. They appear predominantly as bleeding into periventricular germinal matrix with subsequent hemorrhages into lateral ventricles and subarachnoid space. Other patterns of brain hemorrhage are not widely documented in second trimester fetuses. We report a case of hemorrhage presenting as extensive hemosiderin deposits in leptomeninges and adjacent brain parenchyma, as observed in superficial hemosiderosis. The lesion was associated with substantial tissue damage. Clinically, it was diagnosed during the second half of second trimester by successive ultrasound examinations. If differs from germinal matrix hemorrhage and other forms of hemorrhage in origin, pathogenesis, morphology, and probably in clinical manifestations.

Adult↗
PubMed1995

Successful treatment of Finnish congenital nephrotic syndrome with captopril and indomethacin.

Two infants with biopsy-proven microcystic Finnish congenital nephrotic syndrome (onset at birth) were treated with a combination of captopril and indomethacin for 2 1/2 and 2 years, respectively; they had a marked reduction of urinary protein excretion without further need for albumin infusions. One infant has end-stage renal disease; the other infant's glomerular filtration rate has remained within normal limits.

Captopril↗
PubMed1995

Adriamycin-related hypertension in pregnant rats: response to a thromboxane receptor antagonist.

1. In previous works we have described the development of hypertension and aggravation of proteinuria in rats who became pregnant after the administration of Adriamycin. This was associated with an increase in the glomerular thromboxane B2-prostaglandin E2 ratio. 2. To assess the pathogenetic role of thromboxane in this model, female Wistar rats were mated 2 weeks after receiving Adriamycin (3.5 mg/kg intravenously). Rats were then treated with the thromboxane-receptor antagonist daltroban, 60 mg day-1 kg-1 orally, beginning on day 11 of pregnancy. Systolic blood pressure, proteinuria and the urinary excretion of thromboxane B2, 6-keto-prostaglandin F1 alpha and prostaglandin E2 were measured serially before mating, and on days 14 and 21 of pregnancy. The results were compared with those in Adriamycin-(treated) pregnant rats not treated with daltroban, Adriamycin-treated virgin rats and normal virgin or pregnant rats either treated or untreated with daltroban. 3. In daltroban-treated pregnant and virgin rats treated with Adriamycin, systolic blood pressure remained normal, whereas it increased significantly (P < 0.05) in untreated animals. On day 14, blood pressure was higher in non-daltroban-treated Adriamycin-treated pregnant rats than in non-daltroban-treated Adriamycin-treated virgin rats. Treatment had no effect on blood pressure in normal virgin or pregnant rats. Proteinuria was higher in pregnant rats treated with Adriamycin than in Adriamycin-treated virgin rats, but it was not reduced by daltroban.(ABSTRACT TRUNCATED AT 250 WORDS)

6-Ketoprostaglandin F1 alpha↗
PubMed1995

Multicentricity in renal cell carcinoma.

In the era of ultrasound and computerized tomography, when more than 50% of renal cell carcinomas are detected incidently, with a high proportion of small tumors, the standard treatment of radical nephrectomy in the presence of a normal contralateral kidney should be questioned. The main objection against conservative surgery for renal cell carcinoma has been the concern about satellite small renal cell carcinomas, which have been reported in 7% and 19.7% of 100 and 66 kidneys, respectively. We studied the incidence of multicentric neoplasms in 50 kidneys: 27 with renal cell carcinoma and 23 autopsied normal kidneys. The incidence of small renal cell carcinoma in the kidneys with a tumor was 11.1% and that of small nodules in normal autopsied kidneys was 13% (none of them was malignant). The incidence of satellite malignant nodules in patients with renal cell carcinoma 3 cm. or smaller was 3.7% in our series, and 0% and 3% in other series. Therefore, patients who undergo nephrectomy for tumors up to 3 cm. in diameter may be considered as overtreated in 96 to 100% of the cases. We conclude cautiously that partial nephrectomy should be widely accepted in patients with small renal carcinoma and in the presence of a normal contralateral kidney.

Carcinoma, Renal Cell↗
PubMed1995

Eosinophilic granuloma presenting as chronic otitis media: pitfalls in the diagnosis of aural polyps in children.

The case of a 7-year-old boy with multifocal eosinophilic granuloma, initially presumed to be chronic otitis media, is presented. A review of other similar cases in the literature reveals that a delay in diagnosis is not uncommon, and a high index of suspicion is necessary to avoid an unfavourable outcome. Early in the evaluation of an aural polyp, sufficient biopsies should be performed and computerized tomography scanning should be considered.

Biopsy↗
PubMed1995

Effect of diltiazem and methyldopa on gestation-related renal complications in rats with adriamycin nephrosis. Relationship to glomerular prostanoid synthesis.

BACKGROUND: In the presence of pre-existing renal disease, occurrence of hypertension during pregnancy may compromise renal function and aggravate proteinuria. In pregnant rats with early adriamycin nephropathy, this is associated with an increase in the glomerular TxB2:PGE2 ratio. In the present study we evaluated the effect of blood-pressure control on renal function and its relationship with glomerular prostanoid synthesis. DESIGN OF THE STUDY: Pregnant Wistar rats with adriamycin nephropathy received diltiazem, 30 mg/kg/day or methyldopa, 400 mg/kg/day from mid-gestation. Mean arterial pressure (MAP), inulin clearance (CIN), urine protein excretion (UP) and glomerular prostanoid synthesis were measured. Results were compared with (i) untreated pregnant rats with adriamycin nephropathy, (ii) virgin rats with adriamycin nephropathy, and (iii) normal virgin or (iv) pregnant normal rats. RESULTS: MAP increased in untreated pregnant rats with adriamycin nephropathy (P < 0.01 versus virgin rats with adriamycin nephropathy), contrasting with the physiological decrease observed in normal pregnant rats. Diltiazem and methyldopa decreased MAP to normal values. In untreated pregnant rats with adriamycin nephropathy CIN decreased and proteinuria increased significantly at the end of gestation. Treatment with diltiazem and methyldopa augmented GFR, but only diltiazem decreased UP significantly. It was associated with an increased glomerular PGE2 synthesis. CONCLUSION: We conclude that in rats with adriamycin nephropathy, antihypertensive treatment improved GFR. Diltiazem also decreased urinary protein excretion, associated with a normalization of the glomerular TxB2:PGE2 ratio.

Animals↗