Search PubMed⌕ Search

Biomedical subjects

M Modan

Publications and source records attributed to M Modan.

At least 91 records · Page 5Linked to original sources
PubMed1986

Does complete revascularization by the conventional method truly provide the best possible results? Analysis of results and comparison with revascularization of infarct-prone segments (systematic segmental myocardial revascularization): the Sheba Study.

Myocardial revascularization is usually considered "complete" if all stenosed major coronaries are bypassed. Attempts were made to compare the results of this method with an approach by which each of the following five left ventricular infarct-prone segments is revascularized if ischemic: anteroseptal, anterolateral, posterosuperior, posteroinferior, and diaphragmatic. Two subsets of patients were studied. A total of 366 patients (Group A) who underwent aortacoronary bypass operations from 1980 to 1982 were followed up for a mean of 16.3 (6 to 43) months and were retrospectively divided into two groups: Group A1 (120 patients) had incomplete segmental revascularization (mean of 3.4 grafts per patient) and Group A2 (246 patients) had complete segmental revascularization (4.0 grafts per patient) (p less than 0.0001). Groups A1 and A2 were identical in all clinical and angiographic parameters: unstable angina, 60%; previous myocardial infarction, 70%; left main stenosis, 10%; and ejection fraction less than 30%, 2%. Overall operative mortality was 2.3%. Results in Groups A1 and A2, respectively, were as follows: operative mortality, 5.8% versus 0.8% (p less than 0.005); perioperative myocardial infarction, 6.9% versus 0.8% (p less than 0.0005); 35 month survival rate, 93.3% versus 97.9% (p less than 0.02); total freedom from symptoms, 54.1% versus 68.3% (p less than 0.025). In addition, 151 patients operated on in 1984 (Group B) were studied prospectively with regard to operative mortality and perioperative myocardial infarction, and the results were identical to those in Group A. Compared to conventional complete revascularization, complete segmental revascularization provides better results.

Adult↗
PubMed1986

Determination of fetal lung maturity by fluorescence polarization of the amniotic fluid lamellar bodies.

High-speed centrifugation of amniotic fluid enables separation of surfactant-containing lamellar bodies. Fifty-three amniotic fluid samples from pregnancies of 28 to 39 weeks' gestation were examined for fetal lung maturity by measuring fluorescence polarization (P). For each sample the P value was determined at 37C on both the whole amniotic fluid and on the surfactant-containing lamellar bodies obtained by centrifugation at 10,000 X g. A close linear correlation (r = 0.80) was found between the P value of the amniotic fluid samples and that of the lamellar bodies. There was no difference in the specificity for discrimination of hyaline membrane disease cases by both methods (93.5%) with 95% confidence limits of 82.1 to 98.6%. Because high-speed centrifugation enables the selective sedimentation of pulmonary surfactant, determination of the lamellar body P value may offer a practical solution for the estimation of fetal lung maturity in amniotic fluid samples contaminated with blood.

Amniotic Fluid↗
PubMed1985

Spermarche--the age of onset of sperm emission.

Gonad maturation in boys is not characterized by a critical visible event such as menarche in girls. Establishing spermatogenesis by masturbation in maturing boys may be considered inappropriate. In order to estimate the median age of spermarche, a group of 155 normal schoolboys were examined twice (ages 12 and 13 years) for the occurrence of sperm in the first voided morning urine. The boys were requested to bring a daily sample for 10 consecutive days. Over 90% brought at least two samples and 50% brought 5-10 samples. The rate of boys with spermaturia at each age was calculated by the life-table method to adjust for the varying number of samples. New spermaturia was detected with each additional sample in the boys who brought in a greater number of samples. The urine examination carried a considerable false negative rate; even in boys who brought five or more samples, over 40% of boys positive at age 12 were negative at age 13. The rate of spermaturia at age 12 years was 37.5%, and at age 13 it was 68.9%. Our previous report showed the rate at age 11 years to be less than 1%. Because of an uncertain number of false negatives, these are probably under estimates of the true rate of spermatogenesis. The occurrence of spermarche was significantly associated with maturation of secondary sex characteristics.

Actuarial Analysis↗
PubMed1985

Erysipelas. Changing faces.

A retrospective study of 526 adult patients admitted to the Sheba Medical Center for treatment of erysipelas during the period 1972-1982 showed a steady increase in the number of cases admitted as well as a striking change in its classical pattern of distribution, with 86% of the lesions occurring in the lower extremities opposed to 5.9% in the face. Local trauma and superficial abrasions were identified as the major predisposing factors, whereas upper respiratory tract infection was almost negligible among the patients. Peripheral vascular disease, diabetes, and prolonged treatment with corticoids, immunosuppressants, or radiation were less frequently associated with the development of the disease. New trends were also observed for the age groups and seasonal distribution of the population studied.

Adolescent↗
PubMed1985

Hyperinsulinemia. A link between hypertension obesity and glucose intolerance.

Hypertension and glucose intolerance, determined in a random population sample (n = 2,475), showed a highly significant (P less than 0.001) association from the mildest levels of both conditions, independent of the confounding effects of age, sex, obesity, and antihypertensive medications. Summary rate ratios for hypertension were 1.48 (1.18-1.87) in abnormal tolerance and 2.26 (1.69-2.84) in diabetes compared with normal tolerance. Altogether, 83.4% of the hypertensives were either glucose-intolerant or obese--both established insulin-resistant conditions. Fasting and post-load insulin levels in a representative subgroup (n = 1,241) were significantly elevated in hypertension independent of obesity, glucose intolerance, age, and antihypertensive medications. The mean increment in summed 1- and 2-h insulin levels (milliunits per liter) compared with nonobese normotensives with normal tolerance was 12 for hypertension alone, 47 for obesity alone, 52 for abnormal tolerance alone, and 124 when all three conditions were present. The prevalence of concentrations (milliequivalents per liter) of erythrocyte Na+ greater than or equal to 7.0, K+ less than 92.5, and plasma K+ greater than or equal to 4.5 in a subsample of 59 individuals with all combinations of abnormal tolerance obesity and hypertension was compared with those in 30 individuals free of these conditions. Altogether, 88.1% of the former vs. 40.0% of the latter group presented at least one of these three markers of internal cation imbalance (P less than 0.001). We conclude that insulin resistance and/or hyperinsulinemia (a) are present in the majority of hypertensives, (b) constitute a common pathophysiologic feature of obesity, glucose intolerance, and hypertension, possibly explaining their ubiquitous association, and (c) may be linked to the increased peripheral vascular resistance of hypertension, which is putatively related to elevated intracellular sodium concentration.

Adult↗
PubMed1985

Determination of amniotic fluid microviscosity at body temperature: a predictor of fetal lung maturity.

One of the most convenient ways to determine fetal lung maturity is by measuring the fluorescence polarization (P) of the amniotic fluid at room temperature. With sensitivity fixed on 100%, specificity is relatively unsatisfactory. The present study compared the predictive power of fluorescence polarization measured at temperatures 25C (P25), 37C (P37), and 40C (P40) among 195 consecutive samples tested at both 25C and 37C, with a subgroup of 86 samples tested also at 40C. A better separation between the results for fetuses with and without hyaline membrane disease is attained at P37, demonstrated by a greater mean standardized distance (distance between P values for those patients with and the mean P value for those patients without hyaline membrane disease in unit of standard deviation of the latter; 1.597 +/- 0.528 for P25 versus 2.332 +/- 0.591 for P37). Fixing the sensitivity at 100%, the specificity of P25 and P37, were 68.9 and 94.9%, respectively; a highly significant difference (P less than .001). The specificity of P40 was 90.5%, lower than that of P37. P37 is the best predictor and adding either P25 or P40 does not improve the prediction of lung maturity. It is concluded that P37 should replace P25 as the definite index for fetal lung maturity.

Amniotic Fluid↗
PubMed1985

Multivariate analysis of prognostic factors in chronic lymphocytic leukemia.

Prognostic factors in a group of 90 patients with chronic lymphocytic leukemia were studied by methods of survival analysis. The relationship between survival and a set of demographic, clinical and laboratory variables, and identification of subsets of variables that are associated with survival, was tested by multivariate analysis, which is based upon Cox proportional hazards regression models in a stepwise procedure. Six variables showed significant correlation with survival: lymph node enlargement, splenomegaly, hepatomegaly, increased percentage (greater than 80%) of lymphocytes, hyperuricemia, and anemia. Stepwise analysis showed that the number of coexistent risk factors was a better predictor of survival than any single risk marker (P less than 0.001). Median survival of patients with 0 or 1 risk marker was 120 months; with 2 or 3, 96 months; with 4, 36 months; and with 5 or 6, only 24 months. Comparison of staging by number of risk markers with staging of the same patients by the Rai system showed a significant trend of decreasing survival with increasing number of risk markers within the same Rai stage. Staging by the number of coexistent risk markers is a simple and readily available method, which may complement existing methods to provide a more accurate assessment of prognosis in patients with chronic lymphocytic leukemia.

Adult↗
PubMed1984

A comparison of postoperative radiotherapy with postoperative chemotherapy in stage II-IV ovarian cancer patients.

A retrospective comparison between 28 stage II-IV ovarian cancer patients who received postoperative abdominopelvic irradiation and 15 such patients who received postoperative cis-platinum, Adriamycin, and Cytoxan chemotherapy was made. In both treatment groups there was a trend for a longer progression-free interval and 3-year survival in patients with residual tumor masses of less than 2 cm in diameter. In these patients there was also a trend favoring radiotherapy. However, all differences were not significant. Criteria for the choice of either modality of postoperative therapy of ovarian cancer patients remain to be determined. Nevertheless, the efficacy of both modes of treatment does not differ greatly.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1984

The epidemiology of childhood acute lymphoblastic leukemia and non-Hodgkin's lymphoma in Israel between 1976 and 1981.

n epidemiologic survey of childhood acute lymphoblastic leukemia (ALL) and non-Hodgkin's lymphoma (NHL) occurring in Israel, Judea, Samaria and the Gaza Strip between the years 1976 and 1981, revealed 205 cases of ALL and 69 of NHL. The mean annual incidence of lymphatic malignancies was 3.1/10(5) in the Israeli Jews, 2.3/10(5) in the Israeli Arabs and 2.5/10(5) in the Gaza Strip. In the Jewish population there was a peak in the incidence of lymphatic malignancies at the 2-5 years age group, while in the Israeli Arabs this was less prominent. There were no significant differences in the incidence or type of lymphatic malignancies in the various Jewish or Arab groups but there was a trend for a high leukemia to lymphoma ratio (LLR) in the patients from the Gaza Strip. A relatively higher LLR was observed in families of a high socioeconomic status, but it did not reach statistical significance. T-cell ALL comprised about a third of the typed ALL cases. A high proportion of the patients with ALL belonged to the high-risk category: 46% of the Jewish children and 76% of the Gaza Strip children. White blood cell count above 100,000/mm3 were found at presentation in 36.7% of the Gaza Strip patients but only in 9.4% of the Jewish patients. In spite of that, the survival at 4 years of the Jewish and Arab patients was similar. However, the patients with T-cell ALL had a significantly worse survival than the standard risk or the non-T high-risk group: 43.3 +/- 9.7, 66.6 +/- 7.1 and 63.6 +/- 10.4%, respectively. Compared to a previous study conducted in this country in the sixties it appears that the epidemiologic differences that were observed at that time between the various Jewish ethnic groups have practically disappeared.

Adolescent↗
PubMed1984

Effectiveness of glycosylated hemoglobin, fasting plasma glucose, and a single post load plasma glucose level in population screening for glucose intolerance.

Five shortcut methods of population screening for glucose intolerance (impaired glucose tolerance and non-insulin-dependent diabetes mellitus) were assessed for effectiveness: 1) glycosylated hemoglobin concentration (HbA1), 2) fasting plasma glucose level, 3) combinations of fasting plasma glucose and HbA1, 4) plasma glucose one hour post oral glucose load, and 5) plasma glucose two hour post oral glucose load. In a sample of the Israeli Jewish population aged 40-70 years, 2040 participants in the Israel Study of Glucose Intolerance, Obesity and Hypertension, who were not known to be diabetic, underwent an oral glucose tolerance test based on three blood samples (fasting, one hour, and two hour post oral glucose load). In 1058 of the subjects, HbA1 was also measured, and was found to increase significantly (P less than 0.001) with increasing glucose intolerance, but with extensive overlap of ranges, even between normals and newly found diabetics. Fasting plasma glucose was more effective than HbA1 in screening for both impaired glucose tolerance and diabetes by its higher specificity and predictive value of a positive test at comparable sensitivity levels. Combinations of HbA1 and fasting plasma glucose did not improve prediction over fasting plasma glucose alone. As observed in other studies, the screening effectiveness of fasting plasma glucose was also unsatisfactory, either post load glucose level being more effective. Plasma glucose level two hour post load was better for detection of diabetes alone. Plasma glucose level one hour post load was more effective at detecting the total group of glucose intolerance, but did not discriminate well between impaired tolerance and diabetes. A cost-risk-benefit evaluation suggests that a full three-sample oral glucose tolerance test is the best method in screening for both intolerance categories.

Adult↗
PubMed1984

Hereditary factor XIII deficiency: report of four families and definition of the carrier state.

Definition of the carrier state of hereditary factor XIII deficiency was attempted by a study of four unrelated families with patients affected by the disease. Ten homozygotes, 14 obligatory carriers and 20 suspected carriers were available for determination of plasma factor XIII subunits A and B levels (by electroimmunoassay) and for assay of factor XIII enzymatic activity (by 14C-putrescine incorporation into casein). Evaluation of the ability of seven variables related to these tests to discriminate between healthy controls and obligatory carriers disclosed that two variables related to the enzymatic assay classified correctly 92.9% of the carriers and 73.3% of the controls, whereas the variables related to subunit A had a lower discriminative ability. Entering both enzymatic and immunologic variables into the discriminant function did not improve the result of the former. A classification function was established from which the posterior probability of suspected carriers can be determined by measuring the incorporation of 14C-putrescine into casein at 90 min after adding the labelled amine.

Caseins↗
PubMed1984

The diagnostic value of sperm in post-ejaculatory urine.

Post-ejaculatory urine samples ( PEUS ) were obtained from patients undergoing semen analysis. The samples were examined for the presence, number and morphology of sperm. Spermatozoa were found in PEUS of 84.8% of 171 patients whose semen contained sperm. The presence of sperm after, but not before, ejaculation and their concentration in the first part of the void indicated the spermaturia to be the result of urethral washing after ejaculation. The number of sperm in PEUS was a small and variable fraction of the ejaculated sperm. A significant positive correlation was found between the PEUS and the semen sperm count, but there was a considerable overlap of PEUS counts between oligospermic and normospermic individuals. The percentage of sperm with normal morphology in PEUS reflected that in semen. It is concluded that although PEUS reflects some of the semen characteristics, a single PEUS cannot serve as a precise substitute for a direct semen analysis in the individual patient. It can, however, be used for establishing whether populations exposed to dangerous ecological conditions or to drugs which are known to adversely affect spermatogenesis, have reduced sperm count by comparison to appropriate control groups.

Ejaculation↗
PubMed1984

Evaluation of the morphology of sperm in urine of adolescent boys.

The morphology of spermatozoa in the first morning void of boys aged 12-16 years was evaluated. The results suggest that the number of cells having normal morphology increases with advancing age. Thus, the percentage of boys with greater than 45% normal sperm was 26% at the age of 12-13, increasing to 51% at the age of 15-16.

Adolescent↗
PubMed1984

Increased rate of glucose intolerance in endometrial cancer--a community-based study.

Glycosylated hemoglobin was compared in 22 unselected endometrial carcinoma cases 1-10 years (mean +/- SD = 3.3 +/- 2.8) after diagnosis and in 939 controls, a representative population sample in the same age range tested for oral glucose tolerance. Relative weight was similar in patients and controls. Glycosylated hemoglobin was significantly increased (p less than 0.01) in the cases. The distribution of glycosylated hemoglobin indicated that most if not all of the cases had at least impaired glucose tolerance. These results support a true association of glucose intolerance and endometrial carcinoma.

Blood Glucose↗
PubMed1984

Clinical features of Jewish Israeli patients with squamous cell carcinoma of the vulva.

The clinical features of all 150 Jewish patients with squamous cell carcinoma of the vulva diagnosed in Israel during a 13-year period (1961-73) are presented. As in other studies, the frequencies of diabetes, hypertension, atherosclerosis and early onset of menopause were relatively high, and there was a long time lag from onset of symptoms to diagnosis. The most common complaint was pruritus vulvae, and the labia were the most common site of the primary lesion. The predictive value of clinical lymph node examination was reasonably good; lymph node involvement adversely affected survival. In contrast to other studies, the frequency of nulliparity and venereal diseases was low and the most common second primary malignancy was carcinoma of the breast. During the period reviewed, the surgical approach was mainly conservative and the postoperative mortality high, yielding a low 5-year survival rate. We attribute this to the lack of trained gynecologic oncologists during the period reviewed. Preliminary data indicate that in recent years a more aggressive surgical approach is being used and an improved 5-year survival rate achieved.

Adult↗
PubMed1983

Errors in computing drug doses.

The 85 members of the pediatric and neonatal divisions of a medical centre were tested for their ability to calculate the appropriate volumes of drugs commonly administered to pediatric patients. Of a total of 680 computations 43 (6.3%) were wrong. Half the errors would have led to either a 10-fold overdose or a dose a 10th of that prescribed. Significantly more of the errors (p less than 0.01) were made by the nurses in the neonatal division (11.5%) than by those in the pediatric division (3.4%). A deficiency in the in-service training of the nurses in the neonatal division appeared to contribute to the higher proportion of errors in this group. There was also a trend towards a greater chance of error as the length of professional experience increased. All medical personnel involved in the ordering and administration of drugs should be taught computing skills and be evaluated routinely.

Humans↗
PubMed1983

Viral antibodies in maternal and cord sera.

Viral antibodies were determined in paired maternal and cord blood sera of 258 consecutive deliveries. Antibodies to Epstein-Barr virus (EBV), cytomegalovirus (CMV), herpes simplex type 1 (HSV-1), adenovirus (ADV), and varicella zoster (VZV) were tested by indirect immunofluorescence and to rubella (RUB) by hemagglutination inhibition. Analysis of the overall pattern of differences between maternal and cord blood showed a highly significant difference for all six viruses. Analysis regarding individual viruses showed significantly higher titers to CMV and RUB in cord blood, a higher titer to VZV in maternal blood, and similar levels of antibodies to EBV, HSV-1, and ADV in maternal and cord blood. Infants with one or more risk indicators (weight less than 3 kg, Apgar score less than or equal to 7, clinical jaundice, meconium-stained amniotic fluid, respiratory distress syndrome) were defined as "at risk." Infants free of such indicators were defined as "normal." Significantly lower antibody levels to all six viruses were found in both maternal and cord blood of the "at risk" as compared to the "normal" group, while the ratios between the maternal and cord blood levels remained similar. Birth defects were found to have no effect on antibody titers. These results indicate an efficient and selective transfer through the placenta of certain viral antibodies and the possible association of lower antibody production with the presence of risk indicators in the infants.

Antibodies, Viral↗