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Biomedical subjects

M Ehrenfeld

Publications and source records attributed to M Ehrenfeld.

At least 37 records · Page 2Linked to original sources

[Situation of Mepraia spinolai, a wild vector for Chagas disease in Chile, in relation to others vectors from the perspective of their feeding profile].

BACKGROUND: Three triatomine species, Triatoma infestans, Mepraia spinolai and Mepraia gajardoi, are vectors for Chagas disease in Chile. AIM: To compare the alimentary profile of Mepraia spinolai, the Chilean wild vector of Chagas disease, with that of the several other triatomines. MATERIAL AND METHODS: The alimentary profile of Mepraia spinolai was compared with that of other triatomines using cluster analysis (Q and R techniques) with the Jaccard index. RESULTS: Three basic groups of triatomines were identified: domestic, wild and specialists, such as P. coreodes and C. pilosa. Our wild vector M. spinolai was in an intermediate position between wild and domestic clusters, grouping with T. rubrovaria, T. sordida and P. megistus. The feeding sources, animals of the domestic and peri-domestic habitat and wild animals, corresponded to the clusters of the two groups. CONCLUSIONS: Mepraia spinolai, being a preponderantly wild species, approaches human dwellings and obtains food from domestic animals and eventually, from human blood (Rev Méd Chile 2000; 128: 1108-12).

Animals↗

[A new experimental model for repetitive osseous blood supply measurement].

The aim of this study was to establish a novel model permitting repetitive analysis of osseous perfusion over a period of 33 days using the fluorescent microsphere technique. After implantation of two port systems into the right and left carotid artery in New Zealand rabbits (n = 3), fluorescent microspheres were injected into the left ventricle, while blood samples for reference probes were taken from the descending aorta. Using seven different fluorescently labeled microspheres, injections were repeatedly performed starting 3 days after implantation (t = 0) at days 1, 3, 5, 12, 19, 26, and 33. Osseous blood flow was semiquantitatively analyzed by counting the number of trapped microspheres within the bone sections performed through the distal femur condyle (n = 8) using a fluorescence microscope. Over the entire observation period of 33 days, intraindividual variance in the number of trapped microspheres was low while there were marked interindividual differences between animals. The mean osseous perfusion in the three animals evaluated so far remained constant over the observation period of 33 days. The present model is the first to allow repetitive analysis of osseous perfusion over an observation period of 33 days. Using this model, the role of regional osseous perfusion can be studied under conditions such as impaired bone healing following radiotherapy- and/or chemotherapy, implantation of biomaterials, and transplantation of bone.

Animals↗

Nabumetone induces less gastrointestinal mucosal changes than diclofenac retard.

The aim of the study was to compare the efficacy and the effects on the mucosa of the gastrointestinal tract (GIT) of nabumetone and diclofenac retard in patients with osteoarthritis (OA). An open, multicentre, randomised, comparative, endoscopy-blind parallel group study included 201 patients with nabumetone and 193 patients with diclofenac retard suffering from moderate to severe OA of the knee or hip joint. Twelve clinical efficacy variables were assessed and a portion of the population underwent gastroduodenoscopy. All patients exhibited significant improvement in pain severity and pain relief (p < 0.001 and p < 0.0001, respectively) but there were no differences between the groups for all the efficacy variables. Eleven per cent of patients on nabumetone and 19% on diclofenac experienced GIT side-effects. Sixty-nine patients with nabumetone and 61 with diclofenac underwent gastroduodenoscopy. The differences in the mucosal grade for the oesophagus, stomach and duodenum at baseline were not significant. In the oesophagus there were significantly less changes after treatment with nabumetone (p = 0.007) than with diclofenac; there were similar findings in the stomach (p < 0.001) but the difference in the duodenum was not significant. This study indicates that nabumetone and diclofenac retard have similar efficacy in the treatment of OA, but nabumetone has significantly fewer GIT side-effects.

Adolescent↗

Rheumatologic features of hematologic disorders.

This review focuses on the various rheumatologic manifestations of hematologic diseases and is based on the English literature published over the past year. Interrelationships between leukemia, lymphoma, POEMS syndrome, multiple myeloma, hemophilia, and rheumatic manifestations are discussed. Other less common associated conditions dealt with include the RS3PE syndrome, large granular lymphocyte syndrome, and interferon-related arthritis. Finally, therapeutic measures, such as bone marrow transplantation and the use of granulocyte colony-stimulating factor, are reviewed.

Antineoplastic Agents↗

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↗

Sexuality among institutionalized elderly patients with dementia.

The subject of sexuality among elderly patients with dementia was examined, focusing on two main aspects: the sexual behaviour of institutionalized elderly people with dementia; and the reactions of other patients, staff and family members to this behaviour. The behaviour was found to be mostly heterosexual and ranged from love and caring to romance and outright eroticism. Reactions varied, being accepting of love and care but often objecting to erotic behaviour. Understanding of the sexual needs of elderly people should become an integral part of the training and continued education of health care staff, thus helping to resolve conflicts and clarify common misconceptions.

Aged↗

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↗

A comparison of autoantibody production in asymptomatic and symptomatic women with silicone breast implants.

OBJECTIVE: We previously reported an increased preponderance of a broad range of autoantibodies in symptomatic women with silicone breast implants. The objective of this study was to investigate the frequency of autoantibody production in asymptomatic compared to symptomatic women with silicone implants. One hundred twenty-two asymptomatic women were recruited to our center for autoantibody detection through an advocate dealing with breast implant liabilities. METHODS: Autoantibody detection in 86 asymptomatic women was done blindly on a panel of 15 different antibodies (dsDNA, ssDNA, histones, SSA/Ro, SSB/La, RNP, cardiolipin, phosphatidylserine, pyruvate dehydrogenase, Scl-70, NC-1, silicone, collagen I, II, and IV). Clinical variables, specific questioning about related silicone implant symptoms, and a rheumatological examination were performed blindly by a certified rheumatologist. The findings were recorded and at a later stage compared with positive autoantibody detection. The normal control group consisted of age and sex matched Israeli women without known autoimmune disease. In the positive control group were symptomatic women previously tested for antibody production. The autoantibodies were assessed by ELISA. Values from individual patients were considered positive only when greater than 3 standard deviations above the control mean. RESULTS: The mean ages of 86 asymptomatic and 116 symptomatic women were 46.2+/-11.2 and 45.7+/-8.3 years, respectively. Breast implants were in place for a mean period of 8.2+/-5.0 years in the asymptomatic group and 15.0+/-5.6 years in the symptomatic group. The incidence of increased titers of autoantibodies ranged from 2 to 13% for 13 different autoantibodies among asymptomatic women. Among symptomatic women, 20% harbored 4 autoantibodies and 8% had 6 autoantibodies. The most common antibodies in the asymptomatic group were: dsDNA 8%; ssDNA 9%; SSB/La 13%; silicone 9%; collagen II 9%. No autoantibodies were found for NC-1, Scl-70, or RNP. Among the symptomatic group, the most common autoantibodies were histone ribosomal phosphate, SSA, SSB, Scl-70, cardiolipin, phosphatidylserine, GM2-ganglioside, and NC-1. Comparison of autoantibody incidence in asymptomatic and symptomatic women with silicone breast implants revealed an increased incidence of anti-SSB/La and anticollagen II in both groups. Polyclonality was more prominent in the group of symptomatic women with silicone breast implants, but also evident in 3 asymptomatic women. CONCLUSION: The mean duration of implant in the asymptomatic group was significantly less compared with the symptomatic group (p<0.01). The development of autoantibodies may be related to implant duration.

Adult↗

[3-D imaging of the facial surface by topometry using projected white light strips].

Three-dimensional registration of the facial surface by methods which are currently in use is difficult because of the long measuring times required by point-based imaging systems. Artifacts caused by movement appear, e.g., blinking. Also the production of a facial plaster-cast model for measuring is not an adequate solution. In order to acquire data of the facial surface in a contact-free manner, a system is needed that has short measuring times, is able to record data of complex surfaces and at the same time does no harm to the open eyes. The method described here represents a new development of an industrial high tech CAD/CAM system. Unlike customary point-based imaging systems, the stripe projection method works using entire planes. Structured light is aimed at the surface to be measured, recorded by videocamera and calculated by triangulation; then the different views are combined by computer. The system has an optic sensor that can record approximately 500,000 measuring points within seconds (ca. 1.7s). Test persons' faces and plaster-cast models of them (n = 15) were measured comparatively and serially (n = 5) to test the validity and reliability of the method for maxillofacial procedures. These investigations show that this method is appropriate for recording three-dimensional soft-tissue profiles. First studies on patients before and after dysgnathia operations were undertaken. A prospective long-term study for collecting data on pre- and postoperative dysgnathia patients has been begun. Initially, it will record the changes in facial soft tissue on the basis of skeletal displacement. Later, predictions about the soft-tissue changes subsequent to dysgnathia surgery can be worked out on the basis of stored data matched with three-dimensional bone data.

Adolescent↗

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↗

Complications after microsurgical tissue transfer in the head and neck region.

In recent years, the use of microsurgically re-anastomosed free transplants has become a proven technique for the reconstruction of defects in the head and neck region, which is demanding from both aesthetic and functional points of view. A retrospective catamnestic study on 227 free tissue transfers in the Department for Oral and Maxillofacial Surgery at the University of Tübingen showed good healing with relatively low failure rates of the transplants used. A significant proportion of local complications, arising postoperatively, was to some degree due to pre-existing medical conditions, tumour-specific pretreatments and the particular wound-healing situation found in head and neck interventions. The highest relative rate of complications at the site of origin was seen amongst osteomuscular transplants (20%) whilst (fascio) cutaneous and visceral transplants were found to result in a low percentage of problems (4%). In contrast, the healing of iliac crest transplants was accompanied by various local complications in 12% of the cases, slightly higher than 20% amongst (fascio) cutaneous and abdominal transplants and well above 30% for latissimusdorsi and scapular transplants. General complications, in particular of a respiratory and/or psychiatric nature, were found in 23% of the patients.

Adult↗

Absorption of nursing students: new immigrants in the general academic nursing programme in Israel.

Two years after upgrading its nursing programme to university level, Israel experienced a massive wave of immigration from the former Soviet Union. Previous studies have shown that Russian immigrants in general, and in nursing in particular, have several unique characteristics that need to be taken into consideration in planning curricula and absorption programmes. The aim of the present work was to update these data, focusing on the reasons new immigrants choose nursing as a career, their image of the profession and their satisfaction with it. The study population consisted of 302 students attending five major academic schools of nursing in Israel. Students were divided into two groups: new immigrants (less than 4 years in Israel) and long-time Israelis (more than 4 years in Israel). All completed a 30-item questionnaire of proven validity and reliability. Findings were analysed by length of time in Israel and year of study. Using a series of statistical tests, we found that compared with the long-time Israelis, the new immigrants came from a higher socio-economic/professional stratum (in their mother country), had a less 'technical' perception of nursing, and were attracted to the profession primarily for extrinsic reasons ('close to medicine', economics). Both groups showed highest satisfaction in the clinical domain; however, the difference was significant only in the long-time Israeli group, even though the new immigrants had rated this domain highest in importance. The new immigrants showed least satisfaction in the academic domain. These results could be explained by several factors: the financial and housing problems that accompany immigration; the higher proportion of married students in the new immigrant group; and especially language difficulties, which are multiplied in Israel, where mastery in both Hebrew and English is necessary. Of particular interest was the fact that many of the immigrant students had already begun or completed medical school in their old country but were forced to compromise their dreams on immigration. This affected both their image of nursing and their reasons for choosing it as a career. We believe these findings will help nurse educators identify areas in which they can help ease the absorption process for maximal benefit to both the students and the profession.

Adolescent↗