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Biomedical subjects

L Neumann

Publications and source records attributed to L Neumann.

At least 91 records · Page 5Linked to original sources
PubMed1995

Musculoskeletal manifestations of brucellosis: a study of 90 cases in Israel.

Rheumatological manifestations are frequently reported in patients with brucellosis. In a retrospective study of 90 patients diagnosed with brucellosis over a period of 18 years, 83 (92%) patients were Bedouins, 55 of whom (61%) reported ingestion of unpasteurized goat milk and goat milk products. The male/female ratio was 1:1, and the adult to child ratio was 3:2. The mean age of the patients was 25 years (range, 1-72 years). Rheumatological manifestations (myalgia, arthralgia, and arthritis) were reported in more than half of the patients. These manifestations started on days 3 and 4 of the disease and were mild to moderate in severity. Myalagia was evident in 49 (54%) patients and was more common in adults than in children (67% versus 37%; P < .01) and in men (67%) than in women (42%; P < .01). Arthralgia was the most common musculoskeletal manifestation, found in 55 (61%) patients, and occurred more often in children than in adults (74% versus 52%; P < .05). Arthritis was detected in 37 (41%) patients. The hip and knee joints were the most common sites of arthritis (31% each) followed by sacroiliac involvement (17%) and shoulder or spine involvement (5% each). Arthritis was also more common in children (63% versus 29%; P < .01). The prevalence of arthritis was similar in men and women. Cure was achieved in all patients after antibiotic therapy.

Adolescent↗
PubMed1995

Plasma lipids and the progression of nephropathy in diabetes mellitus type II: effect of ACE inhibitors.

Ninety-four normotensive type II diabetics with normal renal function and microalbuminuria were randomized to receive enalapril 10 mg/day or placebo and were followed for five years. In the patients treated by enalapril plasma creatinine values and albuminuria remained stable throughout the observation period. Their plasma total cholesterol decreased from an initial value of 245 +/- 27 mg/dl to mean study value of 236 +/- 29 mg/dl, and to a fifth year value of 232 +/- 27 mg/dl (P < 0.001). The changes in HDL cholesterol and triglyceride values were nonsignificant. In the placebo group there was a significant increase in albuminuria and a mean decline of 13% in reciprocal creatinine values during the five years. Plasma total cholesterol increased from an initial mean value of 246 +/- 24 to a mean study value of 252 +/- 25 mg/dl, and to a fifth year mean value of 259 +/- 32 mg/dl (P < 0.001). There was a significant correlation between both initial and mean plasma total cholesterol values, and the decline in renal function and the rise in albuminuria in the placebo treated patients. This correlation persisted after stratification for blood pressure. Treatment with enalapril did not eliminate these correlations. Cholesterol may be an additional risk factor for diabetic nephropathy. ACE inhibitors may have a modest cholesterol lowering effect in diabetic patients mediated, in part, through the decline in albuminuria.

Adult↗
PubMed1995

Case report: lipoma arborescens of the sub-deltoid bursa.

Lipoma arborescens is a rare synovial disorder which principally affects the knee joint. We describe an unusual case of lipoma arborescens arising within the sub-deltoid bursa in association with a rotator cuff tear. Pre-operative diagnosis was made by magnetic resonance imaging.

Aged↗
PubMed1995

Bone buttress operation for recurrent anterior shoulder dislocation in epilepsy.

Patients suffering from generalised convulsions may dislocate their shoulders either anteriorly or posteriorly. Those with anterior dislocation are likely to have recurrent episodes because of secondary bony damage to the anterior rim of the glenoid and head of the humerus. In such patients there is high rate of failure of the standard soft-tissue stabilisation procedures. We have therefore devised a bone buttress operation in which autograft or allograft is secured to the deficient anterior glenoid and shaped to form an extension of its articular surface. We report our experience in 14 patients with grandmal epilepsy and recurrent anterior dislocation of the shoulder. After the bone buttress operation there were no further dislocations and all patients were satisfied despite a small restriction in their range of movement. We believe this to be the operation of choice for patients with this difficult problem.

Activities of Daily Living↗
PubMed1995

Balneotherapy for rheumatoid arthritis at the Dead Sea.

Thirty-six patients with active rheumatoid arthritis were treated for 12 days at the Ein Gedi Spa. The patients were allocated randomly to four study groups. Group 1 (n = 9) was treated with daily baths in the Dead Sea, group 2 (n = 9) was treated with daily sulphur baths, group 3 (n = 10) was treated with a combination of daily Dead Sea bathing and sulphur baths, and group 4 (n = 8) served as a control group. All patients were assessed by a rheumatologist who was blinded to the treatment modalities and group allocation. Clinical parameters assessed included: duration of morning stiffness, 15 m walk time, grip strength, activities of daily living, patient's assessment of disease severity, number of active joints, and the Ritchie articular index. Statistically significant improvement lasting up to 3 months was observed only in the three treatment groups.

Activities of Daily Living↗
PubMed1995

Demographic data from a hospital case series of endoscopically-diagnosed benign peptic ulcer in southern Israel, 1989-1990.

BACKGROUND: A knowledge of the clinical and epidemiological features of duodenal and gastric ulcer is of importance to clinicians and other health care providers. These aspects of ulcer disease have not been studied previously in the Negev region of southern Israel, which is home to 300,000 Jews and 60,000 Bedouin Arabs. METHODS: Clinical, demographic and risk factors were analyzed in a case series of benign duodenal and gastric ulcers (first or recurrent attack) diagnosed at endoscopy at the Soroka Medical Center in the years 1989-1990. RESULTS: There were 336 cases of duodenal ulcer (321 cases in Jews, 15 in Bedouins) and 79 cases of gastric ulcer (all in Jews). The annual rate of endoscopically-detected duodenal ulcer was 54/10(5) in Jews and 13/10(5) in Bedouins. The annual ratio of endoscopically-detected gastric ulcer in Jews was 13/10(5). The ratio of male to female patients was 2.7 for duodenal ulcer in Jews and Bedouins, and 1.9 for gastric ulcer in Jews. The mean age +/- standard deviation at diagnosis was 48 +/- 17 years for duodenal ulcer and 63 +/- 15 years for gastric ulcer (p < 0.001). Duodenal ulcer was significantly commoner than gastric ulcer at all ages, but the ratio DU:GU decreased with increasing age, so that by age 48 years, 20% of all endoscopically-diagnosed ulcers were GU. Of several risk factors examined, smoking was associated with duodenal ulcer (p < 0.05) but not gastric ulcer. Occupation was not a risk factor. Duodenal ulcer was 1.3 times more frequent in winter than summer. CONCLUSIONS: Endoscopically-diagnosed duodenal and gastric ulcer is commoner in Jews than Bedouins and in men than women. Duodenal ulcer is commoner than gastric ulcer and presents at a younger age. Smoking is a risk factor for duodenal ulcer, and European and American ethnic origin is a risk factor for duodenal and gastric ulcers. Bleeding is associated with one-third of endoscopically-diagnosed ulcers in this institution.

Adolescent↗
PubMed1995

Fibromyalgia syndrome in children--an outcome study.

OBJECTIVE: To assess the outcome of fibromyalgia syndrome (FM) in a 30-month followup study of children with FM. METHODS: In the original study to assess the prevalence of FM in healthy schoolchildren, we found 21 children with FM and an additional 7 fulfilling the point count criterion only (11 of 18). Fifteen of the 21 and all 7 were recruited for a 2nd assessment in our present study. In all children, a count of 18 tender points (TP) was conducted by thumb palpation. Tenderness of 9 of the TP sites as well as 4 control point sites was further assessed using a Chatillon dolorimeter. All children were questioned concerning the presence of widespread pain or aching. Children were considered to have FM if they met the American College of Rheumatology criteria for diagnosis. RESULTS: After 30 months, 11 of the 15 children with FM (73%) were no longer fibromyalgic. The mean point count of the 15 children significantly decreased from 12.5 to 4.6 (p < 0.001). The mean tenderness threshold of the 9 tender sites increased from 2.4 to 3.4 kg (p < 0.01), and the mean tenderness threshold of the 4 control sites increased from 4.1 to 5.6 kg (p < 0.05). Of the 7 children initially fulfilling the point count criterion only, none had developed FM. Their mean point count decreased from 11.4 to 3.4 (p = 0.001), and their mean tenderness thresholds increased from 2.7 kg to 3.9 kg (p = 0.001) at tender sites and from 4.3 kg to 6.8 kg (p < 0.001) at control sites. CONCLUSION: We suggest that the outcome of FM in children is more favorable than in adults. More followup studies are needed to clarify the longterm outcomes of FM in children and adults.

Adolescent↗
PubMed1995

[Dead Sea bath salts for osteoarthritis of the knee].

26 patients with osteoarthritis of the knees were randomly divided into 2 groups of 13 each with patients of similar ages, sex distribution and duration and severity of disease. All were treated with daily baths at 34-35 degrees C for 20 min. containing Dead Sea bath salts (Group I) or sodium chloride (Group II). The study was double-blind and of 2 weeks duration. Patients were evaluated by a rheumatologist before, at the end of treatment and 1 month later. Clinical parameters evaluated included index of severity of osteoarthritis, patient's assessment of disease severity, range of movement of knees, soft tissue swelling, effusion and crepitus. There was significant improvement in the index of severity of osteoarthritis at the end of the treatment in both groups (p < 0.01). 1 month later, in Group I the significance of the index was still p < 0.01, but p < 0.05 in Group II. Patient's assessment of improvement was significant only in Group I at the end of the treatment period (p < 0.01). There was no statistical improvement in either group in the other parameters assessed.

Balneology↗
PubMed1994

Compression neuropathy of the common peroneal nerve caused by a ganglion.

A case of compression of the common peroneal nerve caused by a ganglion herniating from the superior tibio-fibular joint is reported. MR imaging was partially helpful in making the diagnosis. The patient has made an almost complete recovery 3 months after excision of the lesion. Early diagnosis and treatment is required to ensure recovery.

Ganglia↗
PubMed1994

Increasing serum creatinine and age reduce the response to hepatitis B vaccine in renal failure patients.

The relationship between diminished response to hepatitis B vaccine in renal failure patients and serum creatinine level, age and other factors is unknown. The immune response of patients with renal failure of varying severity to hepatitis B vaccine was determined in this study. Sixty-eight patients with renal failure of varying severity who were negative for hepatitis B markers received four doses of hepatitis B vaccine, and anti-HBs titers were determined at 0, 1, 2, 3, 6, 8 and 12 months. Maximum anti-HBs titers were seen at 8 months. At this time 86% of patients with creatinine < or = 4 mg/dl but only 37% with creatinine > 4.0 mg/dl had a protective titer of > or = 10 mIU/ml (p < 0.002). Age was inversely related to anti-HBs titer (p = 0.045) and was independent of serum creatinine in predicting antibody response. We conclude that all patients with chronic renal failure should be immunized against hepatitis B as early as possible in the development of their disease, to ensure maximum response, and to minimize the effects of elevated serum creatinine and increasing age.

Adult↗
PubMed1994

Prognostic value of the immediate response to surfactant.

AIM: To evaluate the association between the immediate response to surfactant treatment and morbidity and mortality in infants with severe respiratory distress syndrome. METHODS: The response to surfactant was defined as the difference in the arterial:alveolar (delta a:A) ratio before and one hour after the first surfactant dose. Measurements were obtained from 253 Israeli infants participating in the multi-centre Curosurf 4 trial of surfactant replacement therapy. RESULTS: Delta a:A ratios ranged from -0.115 to 0.8 and were significantly related to both birth weight and gestational age. Among infants weighing 1001-1500 g mortality decreased from 40% among very bad responders to zero among good responders. The incidence of pneumothorax decreased with better response. Logistic regression analysis showed a hierarchy of predictive power for mortality: birth weight or gestational age; immediate response to surfactant; severity of initial disease. CONCLUSION: The immediate response to surfactant treatment is a significant prognostic indicator for mortality and morbidity.

Biological Products↗
PubMed1994

Epidemiology of Crohn's disease in southern Israel.

OBJECTIVES: Crohn's disease in Israel was described in the past as being of low incidence, more common in Europe-America-born Jews than other Jews, and of uncharacteristically low morbidity. However, recent experience has suggested that these premises are no longer correct. METHODS: The records of all hospital and outpatient cases of Crohn's disease in southern Israel for the period 1968-1992 were reviewed. Private family practitioners and specialists were contacted to assure complete case ascertainment. RESULTS: The prevalence rate of Crohn's disease among Jews on December 31, 1992, was 50.6/10(5) (Asia-Africa-born Jews 55.0/10(5), Europe-America-born Jews 58.7/10(5), and the rate was 8.2/10(5) among Bedouin Arabs. The annual incidence rate (1987-1992) was calculated as 4.2/10(5)/yr in Jews (Asia-Africa-born 4.6/10(5)/yr, Europe-America-born 3.9/10(5)/yr). The age of presentation declined progressively over the study period, was lower in Israel-born patients than immigrants, and was lower in ileocolonic versus other sites of disease. CONCLUSIONS: The data show that Crohn's disease has become more common in Jews in Israel, losing ethnic differences of frequency, and that it occurs at a younger age than before. In Arabs, the disease is more rare.

Crohn Disease↗
PubMed1994

Treatment of psoriatic arthritis at the Dead Sea.

OBJECTIVE: To evaluate the effectiveness of balneotherapy (mud packs and sulfur baths) on patients with psoriasis and psoriatic arthritis (PsA). METHODS: One hundred and sixty-six patients with psoriasis and PsA were treated at the Dead Sea for a period of 3 weeks. The patients were divided into 2 groups. Both groups had the regular regimen of bathing in Dead Sea water and exposure to the sun's ultraviolet rays. The study group, which consisted of 146 patients also was treated with mud packs and sulfur baths. The control group, which had no additional therapy, consisted of 20 patients. The main clinical variables assessed were duration of morning stiffness, grip strength, activities of daily living, subjective patient assessment of disease severity, number of active joints, number of effluent joints. Ritchie index, psoriasis area and severity index score, cervical, thoracic, and lumbar spine pain and limitations of movement. RESULTS: Statistically significant improvement was found in most variables in both groups. However, better results were observed in the study group. In 2 variables, reduction of spinal pain and range of movement in the lumbar spine, significant improvement (p < 0.001 and p = 0.022, respectively) was observed in the study group only. CONCLUSION: Treatment of psoriasis and PsA at the Dead Sea area is very efficacious and the addition of balneotherapy can have additional beneficial effects on patients with PsA. Other controlled studies with longer followup periods are needed to verify our results.

Adult↗
PubMed1994

Long-term results of Charnley total hip replacement. Review of 92 patients at 15 to 20 years.

We made a prospective study of 241 Charnley total hip replacements performed between 1968 and 1974. In 1990, we reviewed 92 patients with 103 hips (96.3% of surviving hips) at a mean follow-up of 17.6 years (15 to 20.6) The clinical results were excellent, with Charnley scores of 4 or more for pain in 95% of the patients, for function in 73% and for movement in 93%. Of the whole series, 8.3% had been revised, and Kaplan-Meier survival analysis showed a probability of revision at 20 years of 10.7%. These results are similar to those from the few other series with extended follow-up, and make it difficult to justify the present widespread use of uncemented hip prostheses. It would seem that some aspects of the design of the first-generation Charnley stem were beneficial for long-term survival of the arthroplasty. We found no correlation between the clinical results and radiological loosening on the Harris scale.

Adult↗
PubMed1993

Gender differences in health perceptions and their predictors.

This study explored the degree to which risks embedded in the social construction of gender roles and personality traits explained gender differences in health perceptions and reporting among mild hypertensive patients (134 women and 104 men) under the same treatment regime. Compared with men, women were less educated, less likely to be employed, less happy, more distressed, less satisfied with family functioning, and had a weaker sense of coherence. Twice as many women as men evaluated their health as 'poor', and on average reported 2.6 more symptoms than men. These gender differences largely disappeared when unhappiness, distress, and sense of coherence were controlled. While education attainment, employment, and satisfaction with family functioning decreased gender differences in some half of the symptoms, multivariate analysis suggested that unhappiness, distress, and the sense of coherence are far better predictors of gender differential health perceptions. It is suggested that beyond biological predispositions, women's health is in double jeopardy by gender role related risks, which affect morbidity both directly through immunology system and indirectly through health perceptions.

Adult↗
PubMed1993

Assessment of nonarticular tenderness and prevalence of fibromyalgia in hyperprolactinemic women.

OBJECTIVE: To assess nonarticular tenderness and prevalence of fibromyalgia syndrome (FMS) in hyperprolactinemic subjects. METHODS: Twenty-one consecutive women with hyperprolactinemia (HPRL) and 44 consecutive women with normal prolactin levels (PRL) were examined in the fertility unit by one observer during a 24-month period. Mean age was 31 years, range 22-46 years. Hyperprolactinemia was defined as PRL levels > 24.5 ng/ml (immunoradiometric assay). In all women, a count of 18 tender points (TP) was conducted by thumb palpation. Tenderness of some of the TP sites (9 points) as well as control point sites (4 points) was further assessed using a Chatillon dolorimeter. All women were questioned about the presence of widespread pain or aching. Women were considered to have FMS if they met the American College of Rheumatology (ACR) criteria for diagnosis. RESULTS: Of the 21 women with HPRL, 15 (71%) had FMS vs only 2 of 44 (4.5%) normoprolactinemic women (p < 0.0001). Thresholds of tenderness of 9 fibrositic points were 2.7 (1.5) kg [mean (standard deviation)] for HPRL women vs 5.0 (1.4) (kg) for women with normal PRL (p < 0.0001). Thresholds of tenderness of 4 control points were 5.2 (1.5) (kg) for women with HPRL vs 6.8 (1.1) (kg) for normoprolactinemic women (p < 0.0001). The frequency of FMS was directly associated with the level of PRL. CONCLUSIONS: We suggest that FMS is very common in a subset of women with HPRL and that its frequency is directly associated with the degree of hyperprolactinemia. Women with HPRL have lower thresholds of tenderness than women with normal PRL. More studies are needed to clarify the relationships between PRL, FMS and tenderness.

Adult↗
PubMed1993

Cefuroxime prophylaxis in biliary surgery: single versus triple dose.

The standard regimen for prophylaxis in bilary surgery consists of three doses of a first- or second-generation cephalosporin (one pre- and two postoperatively). The purpose of our study was to compare a single dose of cefuroxime (1.5 gi.v. on call to surgery) with the standard regimen (1.5 gi.v. on call to surgery followed by two additional doses of 750 mg i.v. each, 8 and 16 h after surgery). One hundred patients participated in the study, 44 in the single-dose group and 56 in the triple-dose group. These two groups did not differ with regard to sex, risk factors, duration of surgery, etc. The incidence of infection was 9% in the single-dose group and 7% in the triple-dose group. We conclude that one dose of cefuroxime is as effective as three for biliary surgery. This regimen would reduce the risk of side effects and/or suprainfections and the emergence of resistant strains of bacteria. It is also more convenient for the nursing staff and reduces the cost by one-half.

Cefuroxime↗