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Biomedical subjects

M Modan

Publications and source records attributed to M Modan.

At least 37 records · Page 2Linked to original sources
PubMed1990

[Skin cancer risk of Israeli workers exposed to sunlight].

To assess the number and types of workers occupationally overexposed to sunlight, we interviewed a national sample of 450 employers in occupational categories involving outdoor work and 5000 of their workers. The workers were assigned to 5 overall risk levels, according to combinations of skin sensitivity to ultraviolet radiation (UVR), total weekly hours of outdoor occupational sun-exposure between 0800 and 1400, and percent of skin surface exposed during outdoor work in the summer. Based on this information it was estimated that out of a total of 379,000 Israeli workers in outdoor occupations, 167,000 (44%) are at increased risk for skin cancer (risk levels 1-3) due to occupational exposure to solar UVR. Their estimated lifetime skin cancer risk is 1.5- to 20-fold higher than that of workers at low or minimal risk levels (4-5). The characteristics of those interviewed with regard to occupation, duration of solar exposure, demographic traits, geographic location, degree of risk awareness and protective measures undertaken, provide a data base for effective intervention to reduce the hazards of occupational solar exposure in Israel. We estimate that an appropriate preventive program may reduce skin cancer in Israeli men to half its current rate.

Humans↗
PubMed1990

Should thrombolytic therapy be administered in the mobile intensive care unit in patients with evolving myocardial infarction? A pilot study.

The growing recognition of the importance of early thrombolysis in evolving myocardial infarction was the basis for the present study, which evaluated the effectiveness, feasibility and safety of prehospital thrombolytic therapy. In a relatively small study, 118 patients were allocated to receive either prehospital treatment with recombinant tissue-type plasminogen activator (rt-PA) in the mobile intensive care unit (group A, 74 patients) or hospital treatment (group B, 44 patients). A total of 120 mg of rt-PA was infused over a period of 6 h. All patients were fully heparinized and underwent radionuclide left ventriculography and coronary angiography during hospitalization. Although group A was treated significantly earlier than group B after onset of symptoms (94 +/- 36 versus 137 +/- 45 min, respectively; p less than 0.001), no significant differences were observed between the groups in 1) extent of myocardial necrosis, 2) global left ventricular ejection fraction at discharge, 3) patency of infarct-related artery, 4) length of hospital stay, and 5) mortality at 60 days. However, a trend to a lower incidence of congestive heart failure at hospital discharge was observed in the prehospital-treated compared with the hospital-treated group (7% versus 16%, respectively; p = NS). No major complications occurred during transportation. It is concluded that myocardial infarction can be accurately diagnosed and thrombolytic therapy initiated relatively safely during the prehospital phase by the mobile intensive care team, thus instituting a beneficial clinical trend in favor of prehospital thrombolysis.

Aged↗
PubMed1990

Rapid resolution of ST elevation and prediction of clinical outcome in patients undergoing thrombolysis with alteplase (recombinant tissue-type plasminogen activator): results of the Israeli Study of Early Intervention in Myocardial Infarction.

Alteplase (recombinant tissue-type plasminogen activator (rt-PA)) was infused within four hours of onset of symptoms in 286 patients with acute myocardial infarction. Delayed coronary angiography was performed 72 hours after admission with coronary angioplasty if indicated. Electrocardiographic monitoring was continuous during the first hour of treatment. The sum of the ST segment elevations (sigma ST) was calculated on electrocardiograms recorded at entry and an hour later. ST elevations resolved rapidly within one hour of treatment in 189 patients and persisted in 97 patients. Rapid resolution of ST elevation correlated with angiographic coronary patency as determined by coronary angiography 72 hours after admission. The patients with rapid resolution of sigma ST had significantly smaller infarcts and a better clinical outcome than the patients with persistent ST elevation. sigma ST values at entry and one hour after treatment had no additional independent predictive value. Rapid resolution of ST elevations in patients undergoing thrombolysis with alteplase was associated with a significantly smaller release of creatine kinase, better preservation of left ventricular function, lower morbidity, and less short and long term mortality. Rapid resolution of sigma ST elevation is an efficient indicator of clinical outcome in groups of patients with acute myocardial infarction undergoing thrombolysis with alteplase.

Aged↗
PubMed1990

[Epidemiology of basketball injuries].

The players of an elite basketball team were followed during the course of a season which included 71 games and 250 training sessions. All injuries were noted and were correlated with age, height and other physical parameters of the players, as well as with degree of fatigue during games and during training sessions. The lower extremity was the most common site of injury. Ligamentous injuries of the knee are more common in basketball than in soccer players, but they have fewer meniscal injuries than the latter. However, the upper extremity, especially the hand, is more frequently injured in basketball than in other sports. The age, height and personality of the player affect the injury pattern.

Arm Injuries↗
PubMed1990

Transfusion of fresh whole blood stored (4 degrees C) for short period fails to improve platelet aggregation on extracellular matrix and clinical hemostasis after cardiopulmonary bypass.

It has recently been shown that the hemostatic effect of 1 unit of fresh whole blood is equivalent to the effect of 8 to 10 platelet units. This study was designed to evaluate the effect of short periods of cold (4 degrees C) storage on the hemostatic effect of fresh whole blood transfusion in 36 patients immediately after cardiopulmonary bypass. Twelve patients (group A) received unrefrigerated fresh whole blood, 12 (group B) received fresh whole blood after 5 hours' storage at 4 degrees C, and 12 (group C) after 24 hours' storage at 4 degrees C. For evaluation of platelet function, a method with an extracellular matrix and an electron microscope was used. The platelet function was graded from 1 to 4, with grade 4 being normal aggregation. Postoperatively, group A patients bled less than groups B and C (267 +/- 42 versus 397 +/- 72 and 601 +/- 172 ml/24 hr, respectively, p less than 0.001) and therefore received fewer blood units (1.4 +/- 0.5 versus 2 +/- 0.9 and 3 +/- 1.4, respectively, p less than 0.01). Five patients of group A (42%) reached grade A aggregation after transfusion of unstored fresh whole blood, compared with two (17%) of group B and none (0%) of group C (p less than 0.01). Posttransfusion platelet count and mean platelet volume were not significantly different in the three groups. We conclude that storage at 4 degrees C, even for a short period of 5 hours, diminishes the hemostatic effect of fresh whole blood by decreasing platelet aggregability.

Blood Physiological Phenomena↗
PubMed1989

Correlation of baseline plasminogen activator inhibitor activity with patency of the infarct artery after thrombolytic therapy in acute myocardial infarction.

Increased levels of plasminogen activator inhibitor (PAI) have recently been described in patients with acute myocardial infarction (AMI). To correlate PAI levels to patency of infarct arteries after thrombolytic therapy with recombinant tissue-type plasminogen activator (rt-PA), 125 consecutive patients with AMI were examined. Blood levels of fibrinogen, plasminogen, tissue plasminogen activator (t-PA) and PAI were measured before treatment initiation, 10 minutes after completion of rt-PA infusion and 24 and 48 hours after treatment. Coronary angiography, performed in all patients 72 hours after beginning rt-PA infusion, revealed patent infarct arteries in 97 patients and occluded infarct arteries in 28 patients. Pretreatment levels of PAI were significantly higher in patients with occluded infarct arteries (18.0 +/- 11.5 vs 10.5 +/- 9.3 IU/ml, p less than 0.01). Conceivably, higher levels of PAI may interfere with the natural thrombolytic process and make pharmacologic thrombolytic intervention less effective.

Arteries↗
PubMed1989

[Standard meal substitute for oral glucose tolerance test in pregnancy].

The oral glucose tolerance test (OGTT) has been the recommended method of screening for the diagnosis of gestational diabetes. Based on the glycemic index of common foods, a standard meal was designed as a substitute meal test (SMT). It consisted of 3 slices of toast (75 g) with 60 g of jam, 11 g of sugar in a cup of tea, and 150 g of canned puree sweetened with sugar (8%), for a total of 118 g of available carbohydrate and a total of 518 cal. Plasma glucose concentrations of 46 pregnant women in the 2nd and 3rd trimesters were determined at 20 minute intervals for 3 hours after ingestion of this SMT, and were compared with those after a 100 g OGTT meal. There was a high correlation (r = 0.96, p less than 0.001) between comparable glucose concentrations after the 2 tests. With the SMT there were significantly fewer side-effects (nausea and vomiting), a higher level on preference scoring and reduced interassay variability of glucose levels after 2 hours. 6 gestational diabetics were diagnosed by the OGTT. In these patients glucose concentrations were higher than 3 standard deviations above the mean 2 hours after ingestion of the SMT. We propose the SMT as a side-effect-free, reliable and convenient alternative to the OGTT in pregnancy.

Blood Glucose↗
PubMed1989

Intraperitoneal cisplatin chemotherapy versus abdominopelvic irradiation in ovarian carcinoma patients after second-look laparotomy.

The current study compares the outcome within 3 years after diagnosis in two groups of histologically confirmed Stage II-IV ovarian carcinoma patients in complete clinical remission with minimal or no residual disease at second-look laparotomy, performed after completion of cisplatin-based combination chemotherapy. One group (n = 18) received after reexploration abdominopelvic irradiation (RT group), the other, diagnosed during a later period (n = 19), received three courses of intraperitoneal cisplatin chemotherapy with systemic thiosulfate protection (IP group). The two groups were comparable with regard to age, stage at diagnosis, histologic category, grade of differentiation, size of residual tumor after the initial operation, and rate of negative second-look laparotomy. The overall survival probability after diagnosis was significantly better in the IP group, the maximal difference being observed at 36 months: 76.6% versus 44.4% in the RT group (P = 0.04). This difference was mainly evident in patients with a negative second-look laparotomy in whom the respective survival probabilities were 100% versus 70% (P = 0.04). Survival was significantly shorter (P less than 0.01) in patients with a positive second-look, and there was a nonsignificant trend for better survival in the IP group. Significantly improved probability of progression-free interval after diagnosis was also found in the IP group, the maximal difference being observed at 22 months: 78.3% as compared to 50.9% in the RT group (P = 0.04). This difference was again limited to patients with negative second-look, the respective values being 100% versus 60% (P = 0.05). Our retrospective data suggest an apparent advantage to intraperitoneal cisplatin treatment in these patients which should be further explored for definite evaluation.

Adult↗
PubMed1989

The improving outcome of triplet pregnancies.

During the period 1975 to 1988, 78 triplet pregnancies that reached a gestational age greater than or equal to 20 weeks were treated in our department--a prevalence of 1/849 deliveries. A total of 69 (88%) of the pregnancies occurred after treatment with ovulation-induction agents. The most common complication of pregnancy was premature contractions. Elective cervical cerclage neither prolonged gestation nor decreased fetal loss. The mean gestational age at delivery was 33.2 weeks + 3.8 weeks and 86% of the patients were delivered of premature infants. The perinatal and neonatal mortality rates were 93/1000 and 51/1000, respectively. Our results show a higher proportion of low Apgar scores and respiratory disorders in the third vaginally delivered infants. Follow-up of very low birth weight infants revealed four infants (10.5%) with severe neurologic handicaps. Results of this study suggest that cesarean section is the preferred mode of delivery in triplet pregnancies. Maternal, fetal, and neonatal risks of triplet gestations are relatively low and compare favorably with recent reports on twin pregnancies.

Adult↗
PubMed1989

Bopindolol: long-term effects on blood pressure, renal function, plasma renin activity, and plasma aldosterone in mild-to-moderate essential hypertension.

Bopindolol was given to hypertensive patients in a single daily dose ranging from 1 to 4 mg. In 86.7% of the patients diastolic blood pressure was reduced by 10 mmHg or more, or lowered to below 90 mmHg, already during the first 4 wk of treatment. Inulin clearance decreased by 10%; PAH and creatinine clearance, blood urea nitrogen, and serum creatinine were unchanged.

Adrenergic beta-Antagonists↗
PubMed1989

Second-look laparotomy in ovarian carcinoma patients after 8 and after 12 courses of cisplatin-based chemotherapy.

Sixteen ovarian carcinoma patients who received 12 courses and 21 patients who received 8 courses of cisplatin-based combination chemotherapy were compared. The two groups showed similar rates of second-look laparotomy (10/16 vs. 14/21) and similar rates of negative second-look laparotomies (6/10 vs. 9/14). The advantages of earlier reexploration are possibly lower toxicity and earlier recognition of patients with tumors resistant to the initial chemotherapy.

Adult↗
PubMed1989

Smoking accounts for adverse effect of antihypertensive medications on plasma lipids. A population-based study.

Mean plasma levels of total cholesterol, high density lipoprotein cholesterol, total-to-high density lipoprotein cholesterol ratio, and total triglycerides were determined in a representative sample of the adult Israeli Jewish population, excluding known diabetics and individuals with overt atherosclerotic morbidity (n = 1,153). Levels were compared in normotensive and untreated and treated hypertensive individuals by glucose tolerance category and smoking, after adjustment for sex, age, and body mass index. In the presence of normal glucose tolerance, lipid levels in the nonsmoking normotensive and treated hypertensive groups were similar, whereas in the smoking, treated hypertensive group, lipids were significantly affected, as indicated by the respective adjusted mean levels (mg/dl): total cholesterol, 219, 221, and 240; high density lipoprotein cholesterol, 45.0, 43.6, and 42.0; ratio, 5.2, 5.3, and 6.0; and triglycerides, 114, 107, and 144. In individuals with glucose intolerance, trends were the same with the exception of triglycerides, which were significantly elevated in the nonsmoking, treated hypertensive group also; the respective values were 217, 225, and 257 for total cholesterol; 45.1, 44.9, and 41.4 for high density lipoprotein cholesterol; 5.2, 5.5, and 6.8 for the ratio; and 133, 152, and 187 for triglycerides. Lipid disturbances in treated smokers were not due to heavier smoking or differences in dietary intake. We conclude that disturbance of plasma lipid profile in treated hypertensive individuals may be mainly due to an interaction with smoking, with an additional effect of glucose intolerance.

Adult↗
PubMed1989

Usefulness of immediate postexercise two-dimensional echocardiography in post-myocardial infarction patients without ischemic ECG changes in stress testing: comparison with radionuclide angiography.

Of 38 post-myocardial infarction (MI) applicants for a cardiac rehabilitation program, 17 (45%) did not have ischemic ECG changes in exercise testing. Ten (59%) of these 17 patients had echocardiographic wall motion abnormalities at rest. Immediate postexercise two-dimensional echocardiography demonstrated exercise-induced changes in 8 (47%) patients (2 with normal and 6 with abnormal results from rest studies). The comparative radionuclide (RNA) examinations showed that there were 6 patients with abnormal findings from rest RNA; exercise-induced changes were detected in 7 (44%) of 16 patients (3 with normal and 4 with abnormal results from rest RNA tests). Statistical analyses, using RNA as reference point, revealed that the total correctly diagnosed cases for the echocardiographic rest studies was 13/17 (77%) and for the exercise studies, 13/16 (81%). The negative predictive values were 7/7 (100%) and 7/8 (88%), respectively. The corresponding positive predictive values were 6/10 (60%) and 6/8 (75%). The same pattern was observed when each segment (septal, apical, and posterolateral) was evaluated separately. The authors conclude that in post-MI patients with a negative stress test, the efficacy of postexercise echocardiography equals that of RNA in the identification of additional patients with ischemia.

Adult↗
PubMed1989

Evaluation of WHO and NDDG criteria for impaired glucose tolerance. Results from two national samples.

The considerable disagreement in the definition of impaired glucose tolerance (IGT) by National Diabetes Data Group (NDDG) and World Health Organization (WHO) criteria was explored in two independent representative adult population samples in Israel (n = 1119) and the United States (n = 1783). Five categories of nondiabetic glucose tolerance were defined according to fasting plasma glucose (FPG) values (mM) and 1- and 2-h plasma glucose values (PG1 and PG2, respectively) after oral glucose load: 1) normal by WHO and NDDG (FPG less than 6.4 mM, PG1 less than 11.1 mM, PG2 less than 7.8 mM), 2) Normal by WHO, nondiagnostic by NDDG (FPG 6.4-7.7 mM, PG1 less than 11.1 mM, PG2 less than 7.8 mM), 3) normal by WHO, nondiagnostic by NDDG (FPG less than 7.8 mM, PG1 greater than or equal to 11.1 mM, PG2 less than 7.8 mM), 4) IGT by WHO, nondiagnostic by NDDG (FPG less than 7.8 mM, PG1 less than 11.1 mM, PG2 7.8-11.0 mM), and 5) IGT by WHO and NDDG (FPG less than 7.8 mM, PG1 greater than or equal to 11.1 mM, PG2 7.8-11.0 mM). Established markers of abnormal glucose tolerance were also measured, including glycosylated hemoglobulin A1, insulin response, plasma triglycerides, serum uric acid, and rate of hypertension in Israel as well as rates of hypertension, peripheral vascular involvement, family history of diabetes, and history of cholelithiasis in the U.S. Accounting for potential confounders, levels of these markers in both national samples were similar in categories 1 and 2 and in categories 3-5.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Abdominopelvic radiation for stage I-II ovarian cancer. The effect of grade on outcome.

The initial postoperative treatment of 31 patients with stage I-II ovarian cancer of epithelial origin, consisted of abdominopelvic radiotherapy. The 5-year survival was significantly better in stage I as compared to stage II (81.1% vs 36.3%). There was a consistent trend in both stages for better outcome in grades 1-2. This trend, however, reached statistical significance only for PFI. Most of the patients with recurrent disease had grade 3 tumors. While satisfactory treatment results may be achieved with postoperative radiotherapy for stage I-II tumors which are well or moderately differentiated, it is not recommended for undifferentiated tumors.

Abdomen↗