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Biomedical subjects

R Kitzes

Publications and source records attributed to R Kitzes.

At least 19 recordsLinked to original sources
PubMed2000

Routine two-step skin testing for tuberculosis in the staff of a geriatric hospital in Israel: booster and conversion rates.

The objective of this study was to determine the prevalence of positive skin tests amongst the staff of a 200 bed geriatric hospital in Haifa, Israel. By comparing the findings with those of a study performed five years previously, we hoped to ascertain the number of conversions which had occurred in the period studied. This was undertaken in order to assess a new policy from the Israel Ministry of Health regarding skin testing for health care workers. We also hoped to decide upon the frequency of skin testing required and to compare data from recent immigrants from countries with a high prevalence of TB. In 1997, we performed two-step skin testing (TSST) on 318 health care workers. We ascertained the number of positive reactions on the first and second testing and calculated the number of subjects who showed significant boosting. We also compared the results to those obtained in a study in 1992 and calculated the rate of conversion. We used multivariate analysis to examine the effects of age, gender, country of origin, years in Israel, previous BCG vaccination, previous exposure to contagious TB, work site and area of residence in the city, on the response to TSST. Between 1990 and 1996, 655 000 immigrants from the former USSR arrived; 'recent immigration' was defined from that date onward. The final number of positive reactions out of 282 subjects, who were either positive or negative on step 1 and presented for step 2, was 171 (60%). Booster effect was not significantly associated with any of the variables examined. The size of reaction in TSST was related to country of origin and recent immigration. The 83 recent immigrants from the former USSR had more frequent (61%) and larger reactions (mean (sd): 9.0 (6.46) mm) than the 114 native-born Israelis with 39% positive reactions (6.2 (5.89) P= 0.009). Comparison with 1992 revealed 26 (31%) of previous negatives as positive. Conversion was associated with age. All conversions save one were in individuals younger than 50 years (P= 0.07). In conclusion, TSST, performed to enable detection of recent infection after exposure to contagious TB, was relevant for 40% of health care workers (HCWs). Second step testing contributed an additional 23% positive reactions. New immigrants had larger initial reactions. Conversion occurred mostly in younger workers and could be either due to unrecognized TB in the hospital or to exposure in the community.

Adult↗
PubMed1999

Pelvic actinomycosis. Is long-term antibiotic therapy necessary?

OBJECTIVE: To describe 11 cases of actinomycosis and analyze whether long-term antibiotic use in necessary. STUDY DESIGN: Analysis of 11 cases of pelvic actinomycosis diagnosed and treated during the last nine years. Four patients had an intrauterine device (IUD) for 6-20 years, three patients had an IUD for 3-5 years, and four patients had no known etiology. In most patients the symptoms lasted from several days to one month. The actinomycotic lesions involved one or both ovaries in all 11 cases. In five patients the lesion extended to other areas, such as the uterus, omentum, parametrium, pelvic walls, colon, bladder, cul-de-sac and gallbladder. RESULTS: All patients underwent surgery that included removal of the lesions with the ipsilateral or both adnexa and, in specific cases, with extension of the lesions, hysterectomy, omentectomy, hemicolectomy and cholecystectomy. Confirmation of the diagnosis of actinomycosis was done by histology in all cases, and antibiotic treatment usually began 1-14 days after surgery. The drug of choice was penicillin. The duration of treatment was 12 months in 6 patients, 6 months in 3 and < or = 3 months in two. All patients were alive and well after two to nine years of follow-up. CONCLUSION: In contrast to actinomycosis at other sites, where the literature recommends antibiotic therapy for 6-12 months, pelvic actinomycosis could be a limited disease. We propose that in cases of pelvic actinomycosis where the abscess can be completely removed surgically, a shorter period of antibiotic therapy can be effective.

Actinomycosis↗
PubMed1997

Pneumococcal bacteremia in hospitalized Israeli adults: epidemiology and resistance to penicillin. Israeli Adult Pneumococcal Bacteremia Group.

In April 1993 a national survey of pneumococcal bacteremia in hospitalized Israeli adults was started, and this survey covered 23 of the 24 Israeli medical centers. During the first 2 years, 603 episodes of pneumococcal bacteremia were recorded. The overall annual incidence of pneumococcal bacteremia in Israeli adults was 14.5 episodes per 100,000 inhabitants, and the overall mortality rate was 27.8%. Pneumonia was the source of bacteremia in 70.8% of cases, primary bacteremia was the source in 17.5%, meningitis was the source in 7.5%, and otitis media/sinusitis was the source in 4.2%. Of the 258 pneumococcal isolates for which an MIC was determined, 88.8% were susceptible to penicillin, 9.3% were partially resistant, and only 1.9% were highly resistant. Twenty-four serogroups were identified from 398 strains tested. The highest percentage of penicillin-resistant strains belonged to serogroups 23, 19, 9, 4, and 6. Although only 13 of these 24 serogroups correspond to the serotypes included in the 23-valent pneumococcal vaccine, they accounted for 94% of all isolates.

Adolescent↗
PubMed1997

Cost-minimisation analysis of sequential treatment with ofloxacin or ciprofloxacin in hospitalised patients.

This study evaluated the cost of sequential treatment with once-daily ofloxacin or twice-daily ciprofloxacin in 474 hospitalised patients in different countries. The patients were treated intravenously for at least 3 days, then orally for 7 to 10 days or for 3 days beyond the disappearance of infection-related symptoms. The overall clinical cure rate (86.8% with ofloxacin and 89.6% with ciprofloxacin) and the overall bacteriological response rate (89.9 and 89.0%, respectively) were similar, and a cost-minimisation analysis was conducted. The acquisition costs for ofloxacin and ciprofloxacin in Greece, Israel, Slovenia and Turkey were used and converted to Deutschmarks (DM), and the costs of administration were analysed for each hospital. The different cost categories for oral and intravenous (IV) treatment (e.g. antimicrobial acquisition, drug monitoring, drug delivery costs) were used to identify any differences. The total costs per patient varied between the countries involved, but were higher for ciprofloxacin (ofloxacin: DM239 to DM724; ciprofloxacin: DM540 to DM976). In a sensitivity analysis using identical daily acquisition costs for the 2 fluoroquinolones, the total cost of treatment was higher for ciprofloxacin, as a result of the lower cost of administration of ofloxacin in the once-daily regimen. Continuing IV therapy would be approximately 50% more expensive than switching to oral administration; however, whenever possible, both drugs can be switched from IV to oral treatment.

Anti-Infective Agents↗
PubMed1996

Single-dose intramuscular ketorolac versus diclofenac for pain management in renal colic.

A double-blind controlled study was designed to compare the effective- ness of a single intramuscular dose of 60 mg ketorolac with that of 75 mg diclofenac in the treatment of renal colic and to monitor side effects. Fifty-seven patients completed the study, 27 in the ketorolac group and 30 in the diclofenac group. Effectiveness of treatment was monitored by pain relief reported on a 4-point verbal scale at different time points. At 60 minutes 77.8% and 86.6% (P = 0.4) of patients, and at 120 minutes 81.5% and 96.6% (P = .1 5) of patients, reported significant pain relief following ketorolac and diclofenac doses, respectively. Both groups had an equal 92% significant pain relief at discharge from the emergency department. Both drugs were well tolerated by the patients. Ketorolac therefore, seems as effective as diclofenac in the treatment of renal colic.

Adult↗
PubMed1994

Comparative serum bactericidal activities of three doses of ciprofloxacin administered intravenously.

The pharmacokinetics and serum bactericidal activities of three intravenous doses of ciprofloxacin were studied comparatively in 30 patients. Single 200-, 300-, and 400-mg intravenous doses of ciprofloxacin were given over 30 min to 10 patients each, and serum samples were obtained at 0.5, 1, 2, 3, 4, 8, and 12 h after the start of the infusion. Serum drug concentrations were determined by high-pressure liquid chromatography. Pharmacokinetic parameters were estimated by using noncompartmental analysis methods. Serum bactericidal activity against clinical isolates of Escherichia coli, Enterobacter cloacae, Pseudomonas aeruginosa, Acinetobacter calcoaceticus, and Staphylococcus aureus was determined for samples obtained at 0.5, 4, 8, and 12 h. Excellent activity was demonstrated up to 12 h by all doses against E. coli and E. cloacae. Much poorer titers were observed for the remaining organisms, although the 400-mg dose prompted improved results against P. aeruginosa with a mean bactericidal titer of 1:2.9 at 8 h. In conclusion, while the 200-mg dose appears to be largely adequate for infections caused by members of the family Enterobacteriaceae, it seems that when P. aeruginosa is involved, 400 mg twice a day or even three times a day is more appropriate. Intravenous ciprofloxacin performs poorly against A. calcoaceticus and S. aureus, even at a higher dose.

Adult↗
PubMed1993

The penetration of ciprofloxacin into bronchial mucosa, lung parenchyma, and pleural tissue after intravenous administration.

We have studied the concentrations of ciprofloxacin in serum, bronchial mucosa, lung parenchyma, and pleural tissue after a single intravenous dose of 200 mg in 20 patients subjected to lung surgery. The concentrations of ciprofloxacin in the tissues exceeded that in the serum by 3-fold to 7-fold: serum 0.6 micrograms.ml-1, bronchial mucosa 1.9 micrograms.g-1, lung parenchyma 3.4 micrograms.g-, and pleural tissue 1.7 micrograms.g-1. The achievable concentrations of ciprofloxacin in the tissues of the lower respiratory tract are above the MICs for most lung pathogens.

Adult↗
PubMed1992

Effect of histamine H2 receptor antagonists on the secretion of cerebrospinal fluid in the cat.

Following a recent report that epithelial cells of the choroid plexus possess histamine H2 receptors, the effect of cimetidine and ranitidine, histamine H2 receptor antagonists, on the secretion and electrolyte content of CSF was examined. Fifty cats were divided into one control (n = 6) and six experimental groups. CSF was collected by puncture of the cisterna magna following pentobarbital anesthesia, and its volume, concentrations of Na+, K+, Cl-, and pH were determined. Cimetidine or ranitidine (50, 20, or 10 mg/kg) was injected intravenously 2 h after the start of the test, and their concentrations were measured in hourly blood samples and in 30-min aliquots of CSF in the 50 mg/kg experimental groups. Whereas the secretion of CSF did not change over 6 h in the control group, it decreased significantly by 30-60 min after injection of cimetidine or ranitidine and remained low for the following 6 1/2 h in all experimental groups except the 10-mg ranitidine group. Peak cimetidine and ranitidine concentrations in CSF in the 50-mg experimental groups were noted 60 and 90 min, respectively, after intravenous injection. CSF electrolyte concentrations and pH did not change during the test in any group. We conclude that intravenous cimetidine or ranitidine can significantly reduce CSF secretion in the cat, possibly by competitive inhibition of the histamine effect on H2 receptors located on the choroid plexus epithelial cell, or by a direct effect on the capillaries of the choroid plexus.

Animals↗
PubMed1988

Ceftizoxime vs. cefotaxime--a comparative randomized multicenter study.

One hundred and fourteen hospitalized patients with moderate or severe infections were assigned at random, in four medical centers, to receive either ceftizoxime or cefotaxime, administered intravenously in a dosage of 1 to 2 g every 8 h. Of 96 patients evaluable for efficacy, 24 (25%) had bacteremia, 46 (48%) had urinary tract infections and 9 (9%) had pneumonias. Half the patients had been treated ineffectively by other antibiotics prior to the study drug treatment. The overall clinical efficacy was 90% in both treatment groups and 83% in both groups with bacteremia. All patients with urinary tract infection were cured by both agents. Bacteriological eradication rate was 95% in both groups. Adverse reactions, though mild, were more frequent in the cefotaxime group (13.5%) than in the ceftizoxime group (6.8%); superinfection rate was higher in the ceftizoxime group. Both antibiotics were highly and equally efficacious in the therapy of severe infections in hospitalized patients.

Adult↗
PubMed1988

Multifocal atrial tachycardia responsive to parenteral magnesium.

Two groups of patients with multifocal atrial tachycardia (MAT) were treated with the intramuscular and continuous intravenous magnesium sulphate regimens used in pre-eclampsia. Both routes of administration were successful in causing reversion to sinus rhythm but the intramuscular regimen, by attaining a higher and more sustained serum magnesium concentration, converted the arrhythmia to normal sinus rhythm in a shorter period of time (1-2 hours) than the intravenous regimen (4-8 hours). Magnesium-sparing diuretics should be used in the treatment of patients with chronic obstructive pulmonary disease and congestive heart failure, which are both conditions associated with magnesium deficiency and MAT.

Aged↗
PubMed1987

Clinical clues to magnesium deficiency.

Two cases of congestive heart failure with coexistent magnesium and potassium depletion are described. The prolonged QTc intervals and ventricular premature beats of the first patient and the idionodal tachycardia of the second patient disappeared only after magnesium repletion, which normalized both extra- and intracellular potassium and magnesium levels. The third patient had a case of urosepsis while on total parenteral nutrition. He developed diarrhea, hypocalcemia, hypokalemia, hypomagnesemia, weakness, muscular fasciculations and athetoid movements. The neurological manifestations were relieved and the biochemical abnormalities normalized only after magnesium repletion.

Aged↗
PubMed1986

Prompt termination and/or prevention of cold-pressor-stimulus-induced vasoconstriction of different vascular beds by magnesium sulfate in patients with Prinzmetal's angina.

In a group of 15 patients with Prinzmetal's angina, cold-pressor-induced anginal attacks were both promptly terminated and prevented by Mg sulfate. Cold-pressor-induced pulmonary hypertension and Raynaud's phenomenon were successfully prevented. Normalization by MgSO4 of the excessive reactive blood pressure increase in response to the cold stimulus was observed.

Aged↗
PubMed1985

Bone magnesium in chronic obstructive pulmonary disease with hypercapnia.

Serum, bone and urinary magnesium as well as bone mineral crystal size and perfection were determined in 10 chronic hypercapnic patients with chronic obstructive pulmonary disease. Decreased serum magnesium levels were found. Urinary magnesium excretion decreased while bone magnesium increased. Bone mineral crystal size and perfection decreased.

Aged↗
PubMed1985

Bioavailability of phenytoin: comparison between three preparations.

Crossover studies, following single oral doses given to 19 healthy volunteers were conducted to compare the bioavailability of three phenytoin preparations: DANTOIN and IDANTOIN (Teva, Israel) and EPANUTIN (Parke-Davis, USA). The first has recently replaced the second as the only preparation available in Israel for alleged better bioavailability. The area under the serum concentration time curve (AUCo----48), however, did not significantly differ between preparations, indicating equivalent absorption of the three preparations. These results suggest that no overall adjustments are required when switching from one preparation to another.

Adult↗
PubMed1985

Early radiation-induced proctosigmoiditis responds to magnesium therapy.

A group of 10 patients with cervical carcinoma with early radiation-induced proctosigmoiditis and low serum Mg levels was treated with low residue diet and antidiarrheals. The diarrhea cleared within a period of 2-6 weeks. A second group of 10 patients with hypomagnesemia was treated with intravenous infusion of Mg sulfate for 3 consecutive days. The diarrhea disappeared by the end of treatment, paralleling normalization of serum Mg levels.

Colitis↗
PubMed1985

Lymphocyte and bone magnesium in alcohol-associated osteoporosis.

Serum, lymphocyte and bone magnesium concentrations were determined in 5 alcoholic patients in order to assess their total body magnesium status. Decreased values confirmed the existence of magnesium deficiency in chronic alcoholism. Spinal osteoporosis on X-rays, together with magnesium deficiency and decreased bone magnesium concentration in alcohol-associated osteoporosis match similar findings in involutional osteoporosis.

Alcoholism↗