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Biomedical subjects

M Shapiro

Publications and source records attributed to M Shapiro.

At least 253 records · Page 14Linked to original sources
PubMed1984

A multivariate analysis of risk factors for acquiring bacteriuria in patients with indwelling urinary catheters for longer than 24 hours.

Data related to risk factors for catheter-acquired bacteriuria were collected prospectively on 112 patients consecutively catheterized for greater than 24 hours at the Hadassah University Hospital. Logistic regression analysis indicated that factors independently associated (p less than or equal to 0.05) with a higher risk of catheter-acquired bacteriuria were as follows: hospitalization in orthopedics or urology, ethnic origin (Arabs greater than Jews), insertion of a catheter after the sixth day of hospitalization, catheterization outside the operating theatres, lack of administration of systemic antibiotics, unsatisfactory catheter care, and prolonged duration (greater than or equal to 7 days) of catheterization before infection occurred. The risk associated with catheterization outside the operating theater could be explained by its correlate, that is, catheterization for incontinence/obstruction as opposed to output measurement. Life-table analyses demonstrated that the daily risk for acquiring bacteriuria during the first six days of catheterization was higher among patients ultimately catheterized for greater than or equal to 7 days than among those ultimately catheterized for less than 7 days (P less than 0.05).

Aged↗
PubMed1984

Determinants of wound infection after colon surgery.

Over a period of 54 months, every patient undergoing colon surgery at the Hadassah University Hospital in Jerusalem was followed up prospectively by the same nurse epidemiologist. A total of 403 patients completed the analysis. Risk factors for postoperative wound infection were explored in an epidemiological study, using both single and multivariate analysis. Of the 13 potential risk factors investigated, the four showing the highest association with wound infection were: the performance of more than one operation during a single admission; Arab ethnicity; the use of open drains; and the performance of a colostomy. In patients undergoing more than one operation, the risk for infection was greater if the second operation followed a surgical complication than if it was performed as an elective second procedure; whether the first operation was elective or not did not affect the infection rate. Second operations performed within 7 days of the first carried a higher risk for infection than those performed later. The different prophylactic protocols used during the period of investigation did not have an independently significant contribution to the risk of infection.

Aged↗
PubMed1984

Adrenal insufficiency in a general hospital over a 14-year period.

Over a 14-year period, 26 patients with adrenal insufficiency of multiple etiology were evaluated. Eight were diagnosed at autopsy, six of whom had acute bilateral adrenal hemorrhage. Nine had chronic adrenal insufficiency. Of these, five were idiopathic and three had polyglandular disorders. Four others had tuberculosis. Six of nine patients with chronic adrenal insufficiency were hyperpigmented. Unusual manifestations of adrenal hypocorticism included hypercalcemia, flaccid paralysis, and joint contractures. The presence of multiple hormonal deficiencies focused the diagnosis on hypopituitarism. Two cases of isolated ACTH deficiency were detected. Patients with familial Mediterranean fever with amyloidosis commonly presented with reduced adrenal reserve rather than overt insufficiency. Metastatic cancer of the adrenal glands was a rare cause of reduced adrenal reserve.

Adolescent↗
PubMed1983

Benefit-cost analysis of antimicrobial prophylaxis in abdominal and vaginal hysterectomy.

We performed a benefit-cost analysis of antimicrobial prophylaxis for hysterectomy using data from a randomized, placebo-controlled clinical trial of the efficacy of three doses of cefazolin sodium. The excess cost per patient with either operative site or urinary tract infection, or febrile morbidity diagnosed during hospitalization, was +1,777 for vaginal and +716 for abdominal hysterectomy. In patients undergoing vaginal hysterectomy, prophylactic cefazolin reduced in-hospital infectious morbidity from 52% to 23% (preventive fraction, 56%), resulting in an average net benefit of +492 per patient. In abdominal hysterectomy, cefazolin decreased in-hospital morbidity from 43% to 25% (preventive fraction, 42%), resulting in an average net savings of +102 per patient. These benefits would be eroded by use of newer, more expensive cephalosporins unless they were considerably more effective than cefazolin. The benefits also would be diminished by inappropriate prolongation of the duration of prophylaxis.

Cefazolin↗
PubMed1983

Aberrant rearrangement of the kappa light-chain locus involving the heavy-chain locus and chromosome 15 in a mouse plasmacytoma.

The creation of a functional antibody gene requires the precise recombination of gene segments initially separated on the chromosome. Frequently errors occur in the process, resulting in the formation of a non-functional gene. The non-functional genes can be generated by incomplete rearrangements, frameshifts, or the use of pseudo V or J joining segments. It is likely that these aberrant rearrangements arise by the same mechanism as is used in generating functional genes, a process which we have suggested may involve unequal sister chromatid exchange. Aberrant rearrangements of immunoglobulin genes occur in normal lymphocytes and play a major part in allelic exclusion. However, it has recently been suggested that aberrant rearrangements involving immunoglobulin and non-immunoglobulin genes may be involved in tumorigenesis. This suggestion has been stimulated by the frequent occurrence of translocations involving chromosomes known to carry immunoglobulin genes in B-cell malignancies. The rearrangement of non-immunoglobulin DNA to the heavy-chain locus has recently been reported. Some aberrant rearrangements of the kappa locus appear to be due to rearrangements to sites that do not include the conventional sequence for V gene segment joining. Here we describe an aberrant kappa rearrangement that has led to the joining of DNA from chromosomes 15, 6 and 12, and so appears to be the result of chromosomal translocations or transpositions. As 15/6 or 15/12 translocations have frequently been found in mouse plasmacytomas (as have analogous translocations in human lymphocyte tumours) this aberrant kappa rearrangement may be unique to the plasmacytoma from which it was isolated.

Animals↗
PubMed1983

Methicillin induced drug-fever during treatment for acute post traumatic osteomyelitis and septic arthritis.

High dose intravenous methicillin therapy is a common form of treatment for post traumatic acute osteomyelitis and septic arthritis, with positive staphylococcus aureus cultures. A high and spiking fever, persisting in the face of adequate antibiotic therapy, presents a difficult diagnostic dilemma in such patients. In seven patients, methicillin induced drug fever was found to be the cause of such as persisting pyrexia, inspite of an adequate antibiotic regime. This diagnosis must be established by a cautious clinical evaluation and by a careful elimination of all other causes for fever. Upon discontinuation of methicillin, the body temperature reverted to normal within 24 h.

Accidents↗
PubMed1983

Central venous catheterization in the emergency setting.

To determine the appropriateness and rate of complications from central venous catheterization (CVC) in the emergency department of a university teaching hospital, criteria for justifiability were established and all such catheterizations during a 1-yr period were reviewed. Of 61 catheterizations in 57 patients, 41% could not be justified according to the criteria established. Eight (14%) patients had serious complications from catheter placement. This complication rate is higher than that in any previously published study, but no other study has examined only emergent catheter placement. These findings underline the importance of adhering to a limited set of indications for CVC in emergency departments.

Catheterization↗
PubMed1983

Hypophosphatemia as a reversible cause of refractory ventilatory failure.

An 81-yr-old male with pulmonary emphysema was hospitalized because of malnutrition and hypoglycemia. This patient developed ventilatory failure requiring mechanical assistance 12 h after initiation of iv hyperalimentation. Severe hypophosphatemia (0.1 mg/dl), mild hypocalcemia, hypomagnesemia, and hypokalemia were subsequently and concomitantly documented. Repeated attempts to wean him from the respirator failed until hypophosphatemia was corrected. When difficulties are encountered in weaning patients from mechanical ventilation, attention should be directed toward detection of hypophosphatemia. This may be crucial in the presence of chronic lung disease.

Aged↗
PubMed1983

Toxic shock syndrome in a patient with celiac disease.

A young woman with celiac disease presented with fever, headache, diffuse myalgia, vomiting, diarrhea and hypotension during a menstrual period in which tampons were used. The clinical picture and laboratory data were typical of toxic shock syndrome. This recently defined entity is rare outside of the United States, and has not been previously reported in a menstruating woman in Israel. The clinical and laboratory characteristics of the syndrome are discussed.

Adult↗
PubMed1983

Effects of physiological oxygen concentration on human tumor colony growth in soft agar.

Cloning efficiencies of 67 fresh human tumor specimens, consisting of 29 ovarian, 10 lung, and 7 each of colon, breast, mesenchymal, and miscellaneous tumors, from 58 patients were studied using the technique of Hamburger and Salmon to evaluate the effect of incubation in a 5% rather than 20% oxygen environment. Under the low-oxygen tension, carcinomas exhibited an average of 170% increase in cloning efficiency (p less than 0.01). The number of carcinomas forming at least 30 colonies/dish increased from 22 to 27. Mesenchymal tumors, however, exhibited a 20% decrease in cloning efficiency (not significant). A mixture of 5% oxygen, 5% carbon dioxide, and 90% nitrogen gives a higher cloning efficiency than 20% oxygen, 5% carbon dioxide, and 75% nitrogen for certain human carcinomas in semisolid agar.

Agar↗
PubMed1982

Risk factors for infection at the operative site after abdominal or vaginal hysterectomy.

We studied risk factors for postoperative infections at the operative site after hysterectomies. Data were collected prospectively on all women undergoing vaginal hysterectomies (323 patients) or abdominal hysterectomies (1125 patients) at the Boston Hospital for Women between February 1976 and April 1978. Logistic-regression analysis indicated that factors significantly associated (P less than 0.05) with a higher risk of infection at the operative site were increased duration of operation, lack of antibiotic prophylaxis, younger age, being a clinic patient, and an abdominal approach. After these variables were accounted for, the variables of obesity, preoperative functional and anatomical diagnoses, postoperative anatomical and pathological diagnoses, estimated blood loss, menopausal status, and operation by a specific surgeon did not add predictive power. An increasing duration of operation was associated with a decreasing effect of antibiotic prophylaxis, the preventive fraction of which diminished from 80 per cent at one hour to an unmeasurable effect at 3.3 hours.

Adult↗
PubMed1982

Serological and cytological evidence for increased Y-chromosome related material in Sxr,XY (sex-reversed carrier, male) mice.

In order to define the nature of the genetic lesion which gave rise to Sxr, the sex-limited autosomal dominant sex reversal condition in the mouse, cytological and serological studies were carried out comparing Sxr,XY (males carrying the sex-reversal gene) and normal XY male mice. Cytotoxic H-Y antisera were absorbed by splenocytes or sperm from both Sxr,XY and normal XY male mice. Our results indicate that for both types of tissue, Sxr,XY cells absorbed consistently greater amounts of cytotoxic activity than did normal XY cells. Whole-mount electron micrographs as well as light micrographs of silver-stained spermatocytes suggest that during meiotic prophase in Sxr,XY males, the paracentromeric region of the normal Y chromosome pairs with a supernumerary Y chromosomal fragment. This fragment can be identified as one of Y chromosomal origin by its thickened axial core. Taken together, our findings support the notion that the Sxr syndrome in the mouse can be due to a supernumerary Y chromosomal fragment containing male determining factors (including one or more H-Y structural or regulatory genes) rather than to a constitutive autosomal mutation.

Animals↗