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Biomedical subjects

M Modan

Publications and source records attributed to M Modan.

At least 55 records · Page 3Linked to original sources
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↗
PubMed1988

Antibiotic cost reduction by providing cost information.

Antibiotic cost information was added to the computerized print-out for each patient of microbiology culture results, next to the antibiotic susceptibility list. During the first six months of this addition, the average monthly cost of antibiotics decreased by 16.5% ($7636) compared to the 12 months period preceding the study period. The average antibiotic cost per admission decreased by 15.7% ($1.61) and the average antibiotic cost/hospital day decreased by 10.6% ($0.23). Antibiotic savings were highest in the Department of Obstetrics and Gynaecology (21.7%) and lowest in the Department of Paediatrics (10.8%). Two-thirds of the average savings were initiated by the house-staff and the remainder by infectious disease consultants. The effect of this system on the level of medical care remains to be studied.

Anti-Bacterial Agents↗
PubMed1988

Peritonsillar abscess in children and its indication for tonsillectomy.

38 children aged 1-15 years treated for peritonsillar abscess (PTA) between 1976 and 1986 have been reviewed. The patients were divided into those with a history of recurrent tonsillitis prior to developing PTA (T+) (10 patients = 26.3%) and those without such history (T-) (28 patients = 73.4%). 19 patients were surgically drained, 2 abscesses ruptured spontaneously, 2 patients were treated by repeated needle aspirations and 15 patients were treated by medication only. Neither the pre-PTA history (T+ versus T-) nor the mode of treatment during the acute event showed any significant differences in comparing the recurrency rate of PTA or tonsillitis. Therefore, it seems that a single event of PTA among pediatric population should not be considered an indication for tonsillectomy.

Adolescent↗
PubMed1988

The Israeli Study of Surgical Infections (ISSI): I. Methods for developing a standardized surveillance system for a multicenter study of surgical infections.

The postoperative wound infection experience in 11 Israeli hospitals was investigated with two objectives: (1) to utilize the variability among hospitals for a better understanding of the determinants of these infections, and (2) to present surgeons and infection control teams with information upon which they can take action. This article summarizes the methods that were applied to maximize the uniformity of information obtained from hospitals. (1) The same kind of patients were sampled in every hospital. (2) The data collection system was standardized, and analyzed for errors. The overall error rate was small (2%) but there were potential problem areas, such as missing information on underlying diagnoses (12%). Few errors (1%) were found in the nurses' observations of the wounds. (3) All wound infections were diagnosed in a uniform manner by convening a panel of four specialists at the central Israeli Study of Surgical Infections (ISSI) office. (4) The definition of infection that was finally chosen for this multicenter study had to be broadened to include, in addition to pus, "discharge other than pus," because of the higher reliability among panel members. This definition was also clinically valid in terms of morbidity. (5) The rate of postdischarge infections was estimated and was not found to be related to the discharge policies in the various hospitals.

Data Collection↗
PubMed1988

Platelet parameters and aggregation in essential and reactive thrombocytosis.

Platelet characteristics were assessed in 15 patients with essential thrombocytosis (ET), 89 patients with reactive thrombocytosis (RT), and 23 normal controls. A platelet volume distribution width (PDW) greater than or equal to 10.5 was found in 50%, 21%, and 14% of the three groups, respectively (P = 0.01 between patients with ET and patients with RT; P = 0.02 between patients with RT and controls), reflecting an excess of extreme values at both ends of the distribution. Compared with controls, the increase in platelet number in patients with RT was about twofold throughout the platelet volume range, whereas ET was characterized by a fivefold increase in small platelets less than 7.5 fL and threefold increase in larger size platelets. Mean platelet volume (MPV) was significantly lower in patients with ET versus patients with RT and in patients with RT versus controls (mean +/- SD 7.5 +/- 1.2 vs. 8.8 +/- 0.1 and 10.2 +/- 1.8 fL, respectively, P less than 0.01). Rate of in vitro platelet aggregation greater than or equal to 50% was significantly lower in patients with ET versus patients with RT and in patients with RT versus controls (0%, 23%, and 45%, respectively, P less than 0.01). Aggregation rate was positively correlated with MPV (r = 0.54; P less than 0.0001). Aggregation rate in patients with ET was significantly lower (P = 0.01) than expected from their reduced MPV alone. Despite these group differences, the overlap of individual platelet characteristics between the three groups precludes their usefulness for diagnostic purposes.

Adenosine Diphosphate↗
PubMed1988

Altered erythrocyte and plasma sodium and potassium in hypertension, a facet of hyperinsulinemia.

Red blood cell sodium and potassium, plasma potassium, glucose and insulin responses to oral glucose load, serum urate, and plasma triglycerides were determined in a stratified subsample (n = 89) of a representative population sample (n = 1211), comprising 30 nonobese normotensive subjects with normal glucose tolerance (reference group) and 59 subjects representing each of the seven possible combinations of abnormal glucose tolerance, obesity, and hypertension. Rate of cation imbalance (red blood cell sodium greater than or equal to 7.0 mEq/L, potassium less than 92.5 mEq/L, or plasma potassium greater than or equal to 4.5 mEq/L) was 88.1% in subjects with abnormal tolerance, obesity, or hypertension, as compared with 40.0% in the reference group (p less than 0.001). These subjects were also characterized by significantly greater rates of insulin response: 60- and 120-minute postload levels of 100 mU/L or more (88.1 vs 46.7%), plasma triglycerides of 80 mg/dl or more (89.8 vs 53.3%) and serum uric acid of 5.5 mg/dl or more (61.0 vs 26.7%; p less than 0.001 for all). The rate of cation imbalance was significantly associated with each of these three biochemical correlates: insulin response (p less than 0.01), triglycerides (p less than 0.001), and urate (p less than 0.001). In the total population sample, the rate of untreated hypertension increased from 18% to 35% to 55.3% (p less than 0.001), with an increase in the number of biochemical correlates of cation imbalance in combination with glucose intolerance and obesity.(ABSTRACT TRUNCATED AT 250 WORDS)

Erythrocytes↗
PubMed1988

Significance of high HbA1 levels in normal glucose tolerance.

The significance of high hemoglobin A1 (HbA1) levels (greater than or equal to 8.0%) found in 12.1% of 648 individuals with normal glucose tolerance constituting a part of a representative population sample was examined. Measurement error in HbA1 and/or glucose-tolerance levels was precluded by HbA1 remaining in the same range over 3.5 yr in 89.7% of 29 individuals with initially high and 68.1% of 22 individuals with initially low (less than 6.5%) HbA1. Rate of deterioration to glucose intolerance (6.9%) in the high group during that period resembled the rate (11.8%) in a control group (n = 279). Fasting plasma glucose significantly accounted for only 2.4% of total HbA1-population variance. No correlation of HbA1 was found with other correlates of glucose tolerance or with daily caloric intake and physical activity. A small but significant increment in HbA1 was associated with smoking (7.1 vs. 6.8%, P less than .01) and with clinically overt atherosclerosis (7.3 vs. 6.9%, P less than .01). We conclude that factors unrelated to glucose metabolism are the main determinants of HbA1 level in normal glucose tolerance and play an important role in diabetes as well. These factors have bearing on evaluation of diabetic control by HbA1 and possibly on risk for diabetic complications.

Arterial Occlusive Diseases↗
PubMed1988

The influence of abnormal pregnancies on fluorescence polarization of amniotic fluid lipids.

The fluorescence polarization of amniotic fluid, a measure of fetal lung maturity, was determined in 518 amniotic fluid samples obtained by amniocentesis. The subjects were divided into seven clinical groups: premature contractions, premature rupture of the membranes, pregnancy-induced hypertension, diabetes, intrauterine growth retardation, vaginal bleeding, and "other" for gestational-age groups of 30 weeks or less, 31-36 weeks, and 37 or more weeks. The proportion of mature values (fluorescence polarization 0.285 or lower) increased progressively from 12.5% at 27-28 weeks to 100% at 39-40 weeks. In the 31-36-week gestation group, the proportion of mature values in subjects with premature rupture of the membranes (84.6%) was significantly higher than in those with premature contractions (60%), severe pregnancy-induced hypertension (50%), mild pregnancy-induced hypertension (55.2%), diabetes class A (50%), insulin-dependent diabetes (60%), and other (63.5%). The mean +/- SD fluorescence polarization value was significantly lower in premature rupture of the membranes (0.256 +/- 0.030) than in premature contractions (0.274 +/- 0.032), mild and severe pregnancy-induced hypertension (0.280 +/- 0.027 and 0.280 +/- 0.035, respectively), and class A and insulin-dependent diabetes (0.285 +/- 0.018 and 0.277 +/- 0.030, respectively). The severity of pregnancy-induced hypertension and diabetes did not appear to influence either the fluorescence polarization value or the proportion of mature results. With the exception of a marked influence of premature rupture of the membranes, abnormal pregnancy conditions did not appear to have a significant effect on fluorescence polarization of amniotic fluid.

Amniotic Fluid↗
PubMed1987

Detection and quantitative evaluation of lupus circulating anticoagulant activity.

Sixty-six SLE patients were studied for the presence of lupus type circulating anticoagulant. Forty-nine percent of them showed activity of this anticoagulant. The sensitivity of various coagulation tests was compared. Recalcification time was found to be the most sensitive screening test and the kaolin clotting time mixture test, the best for determining the presence of the anticoagulant. Tissue thromboplastin inhibition test detected only half of the patients in whom the anticoagulant was found by recalcification time and kaolin clotting time mixture test. APTT, using 2 different reagents, resulted in 73% and 52% false negatives. A numerical index for determining the presence of the anticoagulant and its quantitative evaluation is suggested. The association between thromboembolic events, recurrent abortions and the different coagulation tests is shown.

Blood Coagulation Factors↗
PubMed1987

Lymphocyte urosynthase in non-Hodgkin's lymphoma. An indicator of disease extensiveness.

The activity of lymphocyte uroporphyrinogen synthase (URO-S) was examined in 51 non-Hodgkin's lymphoma (NHL) patients at various follow-up periods. Mean +/- SD activity (pmol porphyrin/mg protein/hr) at diagnosis (n = 24), on relapse (n = 14) and during active disease (n = 14) were 31.7 +/- 19.8, 31.7 +/- 27.2 and 29.4 +/- 18.5, respectively. These values were significantly higher than the enzyme activity during remission (14.1 +/- 4.0), which was in the normal range (14.5 +/- 3.8). Abnormally high activity was found in 65.4% of determinations at diagnosis, on relapse and during active disease, compared to 5.5% during remission (P less than 0.001). Significant association of abnormal URO-S activity was found with advanced clinical stage (P less than 0.01), spleen enlargement (P = 0.048), involvement of bone marrow (P = 0.02), as well as lymphoma cell spread to peripheral blood (P = 0.03). Highly significant correlation (r = 0.65, P less than 0.001) was found between URO-S activity and serum lactic dehydrogenase (LDH) levels. Excessively high levels of URO-S activity were found only in patients with lymphoma cells in peripheral blood. No association was found with histopathologic classification and liver size. The authors conclude that URO-S activity is a biochemical indicator for patients in all stages of NHL and seems to be a specific marker for the extensiveness of the disease.

Adolescent↗
PubMed1987

Elevated serum uric acid--a facet of hyperinsulinaemia.

In a representative sample of the adult Jewish population in Israel (n = 1016) excluding known diabetic patients and individuals on antihypertensive medications, serum uric acid showed a positive association with plasma insulin response (sum of 1- and 2-hour post glucose load levels) in both males (r = 0.316, p less than 0.001) and females (r = 0.236, p less than 0.001). This association remained statistically significant in both sexes (p less than 0.001) after accounting by multiple regression analysis for age and major correlates of serum uric acid i.e. body mass index, glucose response (sum of 1- and 2-hour post load levels), systolic blood pressure and total plasma triglycerides. The net portion of the variance of serum uric acid attributable to insulin response was 12% in males and 8% in females, the total variance accountable by all these variables being 17% and 19% respectively. We conclude that elevated serum uric acid is a feature of hyperinsulinaemia/insulin resistance.

Adult↗
PubMed1987

A more reliable index of sunscreen protection, based on life table analysis of individual sun protection factors.

The efficacy indices of two representative sunscreen preparations were determined using life table analysis of individual sun protection factors (SPF), obtained by exposing a group of subjects to ultraviolet radiation (UVR) doses from 4 to 20 multiples of the control minimal erythema dose (MED). The ultimate efficacy index is expressed as the UVR dose under which a selected percentage of the population is safely protected by a sunscreen. This method takes into account several sources of bias in the current test procedure, in particular the considerable variability in individual responses. It also takes into account subjects in whom the MED of the protected skin is either higher or lower than the range of challenge doses to which they were exposed, thereby increasing the effective sample size. This method provides a more precise and comprehensive index of sunscreen protection, and enables statistical comparison of different preparations, or of the effect of other factors on their efficacy.

Actuarial Analysis↗