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Biomedical subjects

M Moskovitz

Publications and source records attributed to M Moskovitz.

At least 19 recordsLinked to original sources
PubMed2000

Primary peritonitis due to group A streptococcus.

Primary peritonitis is a rare condition occurring, by definition, in patients without underlying causes, such as perforated viscus, pre-existing ascites, or nephrosis. We report a case of primary peritonitis and shock due to group A beta-hemolytic streptococcus, a rare etiology. A review of the world's literature shows a predilection for women to have this condition. The entry site is obscure in most cases. Asymptomatic genital tract colonization may be a portal of entry in some women. Shock or toxic shock syndrome often accompany the abdominal findings. Laparotomy to exclude a perforated viscus may be unavoidable. Despite the significant morbidity, expeditious and appropriate antibiotic therapy is curative.

Adult↗
PubMed2000

Rabeprazole for the prevention of pathologic and symptomatic relapse of erosive or ulcerative gastroesophageal reflux disease. Rebeprazole Study Group.

OBJECTIVE: We evaluated the effectiveness and safety profile of 10 and 20 mg of rabeprazole, a new proton pump inhibitor, once daily versus placebo in preventing endoscopic and symptomatic relapse for up to 1 yr among patients with healed erosive or ulcerative gastroesophageal reflux disease (GERD). METHODS: The 52-wk trial used a multicenter, randomized, double-blind, parallel-group design in which 209 men and women were assigned to 10 or 20 mg of rabeprazole once daily in the morning or placebo. RESULTS: Both rabeprazole doses were significantly superior to placebo in preventing endoscopic relapse (p < 0.001), and 20 mg was significantly more effective than 10 mg (p < 0.04). Both doses were also significantly superior to placebo in reducing the frequency and severity of heartburn relapse (p < 0.001). When adjusted for differences in exposure to study medication, no significant differences were found in the incidence of adverse events. No clinically significant changes were found regarding clinical laboratory parameters, vital signs, electrocardiograms, ophthalmological evaluations, body weight, serum gastrin, and enterochromaffin-like cell histology. CONCLUSIONS: Once-daily therapy with 10 or 20 mg of rabeprazole effectively prevents pathological and symptomatic GERD relapse. The 20-mg dose is significantly more effective than the 10-mg dose in preventing endoscopic recurrence. Treatment was well tolerated, and no clinically significant safety findings emerged. Our findings support rabeprazole's efficacy in preventing GERD recurrence with excellent tolerability and a short-term favorable safety profile.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2000

[Testicular cancer--self-awareness and testicular self-examination in soldiers and physicians in the Israeli army].

Testicular cancer is the most common malignancy in young men. To evaluate knowledge and awareness of that cancer, and of the practice of testicular self-examination (TSE), we developed a questionnaire which was distributed to 717 male soldiers and 200 of their military physicians. 21% of the soldiers had received some explanation of the importance of TSE, but only 16% were actually instructed how to perform TSE, and only 2% practiced it regularly. 24% had never examined their testicles before, 185 only rarely, and 6% often. With increased age, TSE frequency increased, but previous education, type of military unit, and ethnic origin had no affect. 99% of military physicians had been taught how to examine breasts, but only 70% had been taught routine testicular examination. 22% performed it, but 27% never did. 84% had never taught their soldiers the importance of TSE, although 51% taught female soldiers breast self-examination. There was a significant lack of awareness of the importance of regular practice of TSE among both soldiers and their army physicians.

Adolescent↗
PubMed1996

[Percutaneous feeding gastrostomy].

In the past 3 years 71 procedures for insertion of a percutaneous gastrostomy for enteral feeding were performed under X-ray control. The indication for gastrostomy was inability or refusal of the patient to swallow food, in the absence of mechanical obstruction of the gastrointestinal tract. The age range was 66-93 years (mean 82). Most patients had suffered strokes and some had dementia or Parkinson's disease. The procedure was successful in 69/71 patients (97%). 9 (12.6%) died within 30 days of causes related to their underlying condition, rather than to the procedure; 1 developed peritonitis and 6 (8.4%) developed minor infections at the site of entry of the gastrostomy tube. This is the first account of this technique to appear in the Hebrew medical literature. In our opinion the technique should be adopted as the preferred method for forming a gastrostomy, as it is quicker, safer and cheaper than the operative method, and even easier to perform than endoscopic percutaneous gastrostomy.

Aged↗
PubMed1995

Hemodynamic study of different angled end-to-side anastomoses.

This study assessed the postoperative microvascular hemodynamics in end-to-side arterial anastomoses of varied angles in order to determine whether the angle of the anastomosis affects arterial flow. Thirty male rats were divided into three groups of ten. Carotid to carotid end-to-side anastomoses were performed with anastomotic angles of 45, 90, and 135 degrees. Postoperative flow was assessed using high frequency pulsed Doppler ultrasound (HFPDU) at 30 and 120 min postoperatively. Measurements at 30 min demonstrated significant differences in flow, with the 45 degrees grafted vessels utilizing 56.5% of total carotid flow, and the 90 degrees and 135 degrees anastomoses appropriating 46.5% and 43.2% of flow, respectively (comparing 45 degrees to both 90 degrees, P < 0.05, and 135 degrees, P < 0.002). The change from baseline in 45 degrees and 90 degrees groups dissipated over a 2 hr postoperative period, but flow in the grafted vessels in the 135 degrees group continued well below 50% at 39.9% (comparing to both 45 degrees and 90 degrees, P < 0.001), thereby displaying a significant difference in the postoperative arterial flow of varied angled microanastomoses.

Anastomosis, Surgical↗
PubMed1995

Different types of sleeve anastomosis.

Microvascular techniques are important in making routine anastomoses quicker and difficult anastomoses easier. The authors have developed three types of sleeve anastomoses for different size vessels: a three-stitch sleeve anastomosis, four-stitch sleeve anastomosis, and sidecut sleeve anastomosis. Arteriography, in vivo observation, pulsed ultrasound Doppler hemodynamic study, histology, and ultrastructural examination with scanning electron microscopy at 2 to 90 days demonstrated that all three groups of sleeve anastomoses do not stenose, do not show hemodynamically significant vasospasm, and are not complicated by aneurysm formation by 90 days. The hemodynamics were comparable to control sutured anastomoses at 2 to 4 hr postoperatively. The sleeve anastomoses left no suture material within the vessel lumen. Reendothelialization was comparable with controls at 14 days, and the long-term patency rates were similar (p > 0.05). The operative times for all three types of sleeve anastomoses were significantly shorter than sutured control anastomoses (p < 0.001). Although limited by available vessel length and diameter, the sleeve anastomosis is a useful technique for the microsurgeon.

Anastomosis, Surgical↗
PubMed1993

A modified technique of micro-arteriography utilizing dental X-ray equipment.

We report on the use of dental x-ray equipment for micro-arteriography in 18 rat arterial anastomoses. Our experience has shown that an exposure of 70 kV, at 7mA, for 0.17 seconds, gives excellent results. This is an easy and useful technique for evaluating the patency and stenosis of microvascular anastomoses.

Angiography↗
PubMed1993

Testicular carcinoma: a study of knowledge, awareness, and practice of testicular self-examination in male soldiers and military physicians.

Multiple-choice questionnaires devised to evaluate knowledge and awareness of testicular carcinoma and the practice of testicular self-examination (TSE) were distributed to 717 male soldiers and 200 military physicians in the Israeli army. Twenty-one percent of the soldiers had received explanations about the importance of TSE; 16% actually received instruction on TSE; yet only 2% practiced TSE regularly. Seventy percent of physicians had been taught how to examine testicles, but only 10% of physicians examined testicles in their routine physical exams. TSE was practiced most frequently among soldiers who had received instruction in the technique. Physicians should encourage their young male patients to practice TSE.

Adolescent↗
PubMed1992

Large hiatal hernias, anemia, and linear gastric erosion: studies of etiology and medical therapy.

Patients with large diaphragmatic hiatal hernias occasionally manifest severe iron deficiency anemia. The etiology is believed to be that of small erosions at the waist of the hernia which bleed slowly. Our study attempts to determine the incidence of this condition in clinical practice, and whether acid plays a role in the pathophysiology. Sixteen such patients were identified prospectively in a series of 5219 consecutive patients (0.31%) accrued over a 5-yr interval. Anemia was the presenting feature, rather than symptoms of gastroesophageal reflux disease. The erosions were endoscopically identified and biopsied. Anemia was treated and recurrence was prevented for a mean of 24.6 months with long-term iron replacement. Of eight patients treated with iron alone, four were willing to undergo follow-up endoscopy. Of these four, none demonstrated healing. Three of these nonhealers and eight additional patients were treated with both iron and H2 antagonists. Thus, 11 patients were treated with H2 antagonists and iron, whereas four patients were treated with iron alone. At 6 wk, reendoscopy showed healing of the erosions in seven of 11 patients on H2 antagonists, but in none of those treated with iron alone (p less than 0.05). The anemia was corrected in all patients with iron therapy. We conclude that 1) gastric acid appears to have some role in the pathogenesis of this lesion; 2) short-term therapy with H2-receptor antagonists promote healing of the erosions; and 3) long-term iron therapy alone is adequate for initial and maintenance therapy of the anemia.

Aged↗
PubMed1991

Human ehrlichiosis: a rickettsial disease associated with severe cholestasis and multisystemic disease.

We report an unusual case of a typically canine rickettsial disease, ehrlichiosis, in a 56-year-old man. Although only occasionally affecting humans with a mild illness, exposure to a tick bite in our patient led to severe multisystemic disease with intense cholestasis. Coma, acute renal failure and respiratory failure requiring mechanical ventilation ensued. Imaging procedures showed no biliary obstruction. A liver biopsy demonstrated bile stasis and sinusoidal lymphoid infiltrates. The diagnosis was confirmed serologically. Only partial improvement occurred with tetracycline therapy, but total resolution of all abnormalities eventually followed therapy with chloramphenicol.

Acute Kidney Injury↗
PubMed1990

The peritoneovenous shunt: expectations and reality.

Since the introduction of the LeVeen modification of the peritoneovenous shunt (PVS) in 1974, these devices have been placed in a relatively large number of patients. The most common indication has been for medically intractable ascites in the setting of chronic liver disease. A review of a series of studies shows that we can expect approximately an 18% perioperative overall mortality rate, a 46% survival rate at 21 months, and loss of ascites in 59% of the survivors at 18 months. The PVS has not been shown by prospective trials to prolong survival significantly in patients with either intractable ascites or the hepatorenal syndrome (HRS), although it may shorten hospitalizations, compared with medical controls. A few well-documented cases of reversal of the HRS have been documented. The best results of PVS therapy have been evident in those patients with milder liver disease. The loss of ascites need not correlate with a functioning shunt. Alcohol abstinance is associated with hepatic functional recovery and may relate to the disappearance of renal sodium retention, resulting in shunt occlusion due to low flow. A number of serious complications with the PVS have been described. Nutritional repletion follows successful shunting, but might, in part, relate to simultaneous alcohol abstention. The more common complications of coagulopathy and fluid overload are preventable by total ascitic drainage at the time of surgery. Shunt patency remains a clinical problem. Only 18.6% of the total shunts placed functioned in the survivors at 2 yr. Perioperative infections with staphylococcal and Gram-negative organisms occur. Postoperative bacterial peritonitis or septicemia requires shunt removal for cure.

Ascites↗
PubMed1989

Abnormal liver function tests in asymptomatic patients.

Liver function abnormalities are often found on routine chemical profiles. Abnormal test results are often false positive in asymptomatic patients. Repeat testing and confirmation that the liver is the source of the abnormality are the first steps of evaluation. A thorough history and physical examination may suggest reasons for the abnormalities. If no etiology for the abnormal test result is found, further testing is indicated.

Adult↗
PubMed1987

Does oral enzyme replacement therapy reverse intestinal lactose malabsorption?

The effects of oral enzyme replacement therapy on breath hydrogen excretion and symptoms after milk ingestion were studied in lactase-deficient patients. Sixteen symptomatic patients underwent interval hydrogen breath tests using whole milk as substrate. Each study was repeated with the addition of 250 mg of beta-D-galactosidase derived from Aspergillus oryzae (Lactrase) given orally with the milk. Subsequently seven of those 11 patients who did not normalize their hydrogen excretion with 250 mg of Lactrase were available to be restudied with a 500-mg dose. Mean cumulative and peak hydrogen excretions were calculated for the baseline (milk alone), 250 mg, and 500 mg Lactrase groups. Significant (p less than or equal to 0.05) decreases in cumulative and peak hydrogen excretion were noted between the 500 mg Lactrase versus the baseline group, but not between the 250 mg versus baseline group. Five of the 16 (31%) symptomatic lactase-deficient patients normalized their hydrogen excretion after 250 mg of Lactrase; four of seven (57%) who had not normalized on 250 mg, normalized their hydrogen excretion with 500 mg of Lactrase. A different pattern was observed in the incidence of symptoms. Five of the nine patients (56%) whose hydrogen excretion normalized with the addition of Lactrase at either dosage became asymptomatic after milk ingestion; in addition, three patients who did not normalize their hydrogen also became asymptomatic. We conclude that oral Lactrase in sufficient dosage temporarily reverses lactose malabsorption in some patients.

Adolescent↗
PubMed1986

The microscopic examination of bile in patients with biliary pain and negative imaging tests.

We describe a 5-yr retrospective analysis of the accuracy of the microscopic examination of bile in the detection of biliary tract disease in patients with episodic upper abdominal pain who had negative imaging procedures. In 182 patients, 189 studies of bile were performed using duodenal intubation and sincalide stimulation for gallbladder contraction. The presence of cholesterol crystals, leukocytes (greater than or equal to 5/hpf) or the absence of "B" bile constituted a "positive" study. Bilirubinate sludge alone, was defined as "suspicious." Eighty-three patients underwent cholecystectomy. Among the acalculous patients who underwent cholecystectomy, 28/28 with bilirubinate sludge had symptomatic improvement as compared with the negative group of which only five of 10 improved (p less than 0.005). The sensitivity of this test for the presence of gallstones in these imaging-negative patients was 87%, while the specificity was 16%. We conclude that a single microscopic examination of bile cannot accurately predict the pathological findings or the presence of gallstones in image-negative patients with biliary pain. The presence of bilirubinate sludge may predict symptomatic improvement in those patients with acalculous gallbladder disease undergoing cholecystectomy.

Abdomen↗
PubMed1981

Recurrent pseudomembranous colitis unassociated with prior antibiotic therapy.

Fulminant and recurring pseudomembranous colitis developed in an elderly woman without prior antibiotic administration within the previous year. Stool culture yielded Clostridium difficile, and tissue cultures showed C difficile cytotoxin. Treatment with vancomycin hydrochloride was initially successful, but a serious relapse after its discontinuation necessitated low-dose long-term prophylaxis. Clostridium difficile may be responsible for pseudomembranous colitis unassociated with antibiotic therapy.

Aged↗
PubMed1980

Faecal bacterial flora in cancer of the colon.

Selective aerobic and anaerobic plate media were employed to isolate the predominant faecal flora of patients with cancer of the colon (CC), cancer with non-gastrointestinal involvement (NGI), and with non-malignant diseases (N). The CC and N groups did not differ significantly in either total aerobic or anaerobic counts. The CC group did have a significantly lower anaerobic/aerobic ratio compared with the N group (2.42 vs. 2.96, P less than 0.05). This was the result of a greater predominance of aerobic bacteria and a decrease in anaerobic cocci, Eubacterium and Fusobacterium in the CC group. Previous studies report that aerobic organisms have a greater ability to produce amines than non-spore forming anaerobes. If the intestinal flora can produce carcinogenic nitrosamines in vivo from amines and nitrites, the aerobic bacterium in the faeces may be of importance in supplying the amine substrate for nitrosation. The comparison of the NGI group with the N group showed a significant variation in the total anaerobic count (11.02 vs. 11.41, P less than 0.05) and in the composition of the faecal flora. This indicates that discretion must be used in analysing the data obtained from cancer patients, as the presence of a carcinoma may be responsible for changes in bacterial flora.

Aerobiosis↗