Search PubMed⌕ Search

Biomedical subjects

Stephen D H Malnick

Publications and source records attributed to Stephen D H Malnick.

14 recordsLinked to original sources
PubMed2006

A cost-effective method for reducing the volume of laboratory tests in a university-associated teaching hospital.

BACKGROUND: Laboratory tests comprise a significant portion of hospital expenditure. Attempts to reduce their use have had mixed results. OBJECTIVE: To investigate the effect of an intervention based on a simple form-based system for ordering laboratory tests by physicians, on both use of laboratory resources and diagnostic accuracy. DESIGN: At Kaplan Medical Center in Rehovot , Israel , there are 4 similar Internal Medicine departments. In one department (C), the new system was initiated, whereas in the other 3 departments (A, B and D), the traditional method of ordering blood tests was continued. The intervention used was a requirement for tests to be specifically requested by residents following unbundling of test panels, with hands-on supervision by a senior physician. In addition, the residents attended a series of lectures on the economic implications of laboratory testing. The intervention study lasted for 3 years. MEASUREMENTS: Total number of tests performed in each department, number of tests per admission and total cost of each test at Medicare reimbursement prices. RESULTS: The number of tests per admission prior to the intervention was 1.91 +/- 0.89; it decreased for each of the next 3 years: 0.76 +/- 0.61, 0.80 +/- 0.62 and 0.78 +/- 0.63 respectively. There was a total decrease of 97,365 tests during the 3-year period, saving 1,914,149 dollars. There was no difference in the readmission rate or in the number of diagnoses of conditions based primarily on blood tests such as hypokalemia or hyponatremia, between department C and the other departments. CONCLUSIONS: The intervention developed here produced significant and sustained reduction of financial savings in the number of laboratory tests ordered, without negatively impacting diagnostic capability or patient care.

Cost-Benefit Analysis↗
PubMed2006

Splenic embolus: 13 cases from a single medical department.

BACKGROUND: Despite the spleen having a very rich blood supply, there is a paucity of reports of splenic emboli. OBJECTIVES: To investigate the incidence of splenic emboli treated in a single general internal medicine department over the last 3 years. METHODS: We examined the records of a 35 bed internal medicine department in a hospital in the center of Israel. RESULTS: Over a period of 3 years 13 patients admitted to one internal medicine department developed acute abdominal pain and areas of hypoperfusion in the spleen on contrast computed tomography imaging. The patients were treated with anticoagulants, their course was benign and there were no long-term sequelae. CONCLUSIONS: Embolus to the spleen is not rare in an internal medicine department. Diagnosis can be easily made by contrast CT scanning, and treatment with anticoagulants results in a good prognosis.

Adolescent↗
PubMed2005

Fatal ventricular arrhythmia as a complication of transesophageal echocardiography.

AIM: To report a case of serious ventricular arrhythmia during transesophageal echocardiography. METHODS AND RESULTS: A 58-year-old woman with previous mitral and tricuspid valve replacement and permanent pacemaker implantation suffered from recurrent fever and Staphylococcus aureus bacteremia. Transesophageal echocardiography was performed as part of the assessment for infective endocarditis. During this procedure the patient developed sustained ventricular tachycardia and subsequently ventricular flutter. She was successfully resuscitated. Subsequently the procedure was undertaken under general anesthesia with no complications. CONCLUSION: The increasing use of TEE in a wider spectrum of patients, many of whom are seriously ill, may result in serious side-effects.

Anesthesia, General↗
PubMed2005

Chronic ischaemic bowel diseases in the aged--go with the flow.

BACKGROUND: Intestinal ischaemia is caused by a reduction in intestinal blood flow. This entity is being increasingly recognised as a cause of abdominal symptoms but is often not diagnosed accurately. Chronic mesenteric ischaemia (intestinal angina) refers to chronic post-prandial abdominal pain caused by intestinal hypoperfusion usually related to atherosclerosis. Colonic ischaemia refers to colonic injury as a result of hypoperfusion and is also referred to as ischaemic colitis. METHODS: Review of the English-language medical literature, with the key words diagnosis, treatment, chronic mesenteric ischaemia and colonic ischaemia. CONCLUSION: There is a lack of evidence based on randomised controlled clinical trials for both the diagnosis and treatment of mesenteric ischaemia. A high index of clinical suspicion is important to facilitate rapid diagnosis. Chronic mesenteric ischaemia can be accurately diagnosed by non-invasive CT and MRI techniques, and less so by duplex ultrasound. In order to confirm the diagnosis, demonstration of the involvement of at least two of the main splanchnic vessels is required. Successful treatment involving both percutaneous and surgical revascularisation is available. Colonic ischaemia requires sequential diagnostic techniques and the majority of cases resolve with supportive treatment. More severe cases may require surgical intervention.

Aged↗
PubMed2004

Hemochromatosis mutations are not linked to dilated cardiomyopathy in Israeli patients.

AIMS: Hemochromatosis is a condition in which iron loading impairs the function of many organs, including the heart. Congestive heart failure with left ventricular dilatation is commonly found in patients with hemochromatosis. Two missense mutations (C282Y and H63D) have been shown to be responsible for the majority of cases of hemochromatosis. METHODS AND RESULTS: We examined 156 patients with congestive heart failure due to dilated cardiomyopathy. Details were recorded of clinical and echocardiographic parameters. DNA was extracted from peripheral blood and checked for the presence of the C282Y and H63D mutations by a commercially available single nucleotide primer extension assay. A control group of 98 healthy blood donors was also checked for the presence of these mutations. Of the 157 patients, 42 (26.75%) had at least one mutation. Five (3.65%) were homozygotic for the H63D mutation and 37 (23.6%) were heterozygotic for the H63D mutation. The C282Y mutation was not present. In a control population of 98 healthy blood donors, 27 (27.6%) were heterozygous for the H63D population and none had the C282Y mutation (no significant difference between the patients with cardiomyopathy and the healthy blood donors, chi(2) test 0.754). There was a non-significant trend to a difference in the prevalence of homozygotic H63D between the cardiomyopathy patients and the healthy blood donors (3.18% vs. 0%, P=0.076, chi(2) test). There was no statistically significant difference between the cardiomyopathy patients with and without the mutations in terms of age, gender, hemoglobin, iron, transferrin, ferritin, presence of diabetes mellitus, hypertension and previous coronary artery bypass grafting. CONCLUSION: In our population of patients with dilated cardiomyopathy, there was no evidence for hemochromatosis being an important etiology.

Aged↗
PubMed2002

Murine monoclonal anti-tNF antibody administration has a beneficial effect on inflammatory bowel disease that develops in IL-10 knockout mice.

Although the etiology of inflammatory bowel disease (IBD) is unknown, there is increasing evidence for the pivotal role played by tumor necrosis factor-alpha (TNF-alpha). Recent work has shown an increased concentration of TNF-alpha in both the bowel wall and in the stools of patients with IBD, and in children with that disease there are increased serum levels. Coincidental studies have shown that IL-10 knockout mice have increased levels of TNF-alpha and are known to develop a syndrome of stunted growth, anemia, bloody diarrhea, and colon tumors that mimics IBD. By injecting monoclonal antibodies intraperitoneally into IL-10 knockout mice, we were able to demonstrate significant histologic improvement of inflammation that correlates well with a resolution of diarrhea and rectal bleeding. This finding is consistent with a role for anti-TNF-alpha in the pathogenesis of IBD and suggests that this model may be of use for examining the effects of anti-TNF-alpha antibody administration.

Animals↗
PubMed2002

Acute cholestatic hepatitis after exposure to isoflurane.

OBJECTIVE: To report a case of acute cholestatic hepatitis following exposure to the inhalational anesthetic isoflurane. CASE SUMMARY: A 70-year-old healthy woman from Iraq developed acute cholestatic hepatitis 3 weeks following repair of the right rotator cuff under general anesthesia. There was no evidence for viral, autoimmune, or metabolic causes of hepatitis. No other medications were involved except for dipyrone for analgesia. The alanine aminotransferase was elevated to a peak concentration of 1533 U/L and the serum bilirubin reached a peak of 17.0 mg/dL. There was slow improvement over 4 months. Accidental reexposure by the patient to dipyrone was uneventful. DISCUSSION: The clinical and histologic picture of this case resembles halothane hepatitis, which has a significant mortality rate. CONCLUSIONS: Isoflurane, a common anesthetic agent, can cause severe cholestatic hepatitis.

Acetylcysteine↗
PubMed2002

Treatment of Clostridium difficile-associated diarrhea.

OBJECTIVE: To review the literature related to the treatment and infection control of Clostridium difficile-associated diarrhea (CDAD). DATA SOURCES: A MEDLINE search (1966-August 2001) of the English literature was conducted. DATA SYNTHESIS: C. difficile is a leading cause of antibiotic-related diarrhea. The clinical spectrum extends from simple diarrhea to fulminant colitis. Cessation of antibiotic therapy alone is sufficient for mild cases; however, the majority of cases require oral metronidazole as the drug of choice. Vancomycin orally is reserved for patients who have failed to respond to metronidazole, are pregnant, or are severely ill. There is an important role for infection control interventions. CONCLUSIONS: CDAD is a common infection. Appropriate antibiotic treatment and infection control policies can prevent the spread and reduce the morbidity associated with this disease.

Anti-Bacterial Agents↗