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ABSTRACT: Abstract A new oscillatory device administers predetermined pressure oscillation sequences into the chest cavity over inhaled/exhaled air streams at low positive pressure. We assessed device safety and effect on 6MW performance, pulmonary function, and health-related quality-of-life (HRQOL) in moderate-to-very severe COPD in a randomized, double-blind, controlled, crossover study. Outcomes with an oscillatory device (Pulsehaler(TM), Respinova Ltd, Herzliya, Israel) and a "muted" sham device (control) of identical appearance that delivered continuous positive air pressure were compared in two groups receiving opposite treatment sequences: 2-week oscillatory device/control, 2-week washout, 2-week control/oscillatory device, 2-week washout. The clinical trial was registered ( www.clinicaltrials.gov , NCT00821418) and approved by the Hadassah-Hebrew University Medical Center Institutional Review Board (08-608). All participants signed informed consent; 22 patients completed the study with no marked differences in COPD exacerbations or side effects. A total of 91% of patients treated with the oscillatory device had a clinically significant improvement (increase >40 m) in 6MW performance. The 6MW distance with the oscillatory device increased significantly after 1 week of treatment (51.6 ± 7.6 m, +13.5 ± 2.3%, p < 0.001), and more after 2 weeks (61.8 ± 9.0 m, 16.3 ± 2.7%, p < 0.001). This increase with the oscillatory device was significantly greater (p < 0.001) than the 15.4 ± 10.4 m increase (4.2 ± 2.6%, NS) with control. FVC and inspiratory capacity (IC) improved significantly (p = 0.03 for each) with the oscillatory device but not with control. HRQL improved markedly (≥1 point) for dyspnea and mastery with the oscillatory device (p = 0.02) but not control. Treatment with a new oscillatory device appears to be safe, and to improve 6MW performance, pulmonary function, and HRQL in COPD. Further evaluation is warranted.
COPD Journal of Chronic Obstructive Pulmonary Disease 12/2012; · 1.79 Impact Factor
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ABSTRACT: Although the etiology of sarcoidosis is unknown, genetic susceptibility has been demonstrated. Granuloma formation is a key feature in the pathophysiology of sarcoidosis and Crohn's Disease, raising the possibility that these diseases share common pathogenetic pathways. An association between sarcoidosis and the protein "CD14", a molecule that is part of the lipopolysaccharide (LPS) cell surface receptor complex, has been suggested. In the current study we evaluated the CD14 gene promoter 159 C-->T polymorphic site and soluble CD14 levels in a cohort of 74 sarcoidosis patients compared to 85 healthy controls. We further sought to identify correlations between clinical phenotype, specific genotypes and soluble CD14 levels. We found the TT genotype to be more prevalent in the sarcoidosis patient group than in controls (p=0.03). Serum levels of soluble CD14 were higher in the sarcoidosis patients (p=0.001). Within the patient cohort, CC homozygous patients presented at an older age with milder disease as assessed with the SAC score, longer time to diagnosis, and less impairment of pulmonary function tests. Our study suggests a role of CD14 in the pathogenesis of sarcoidosis, and a clinical phenotype-genotype association. Further mechanistic and epidemiologic studies are needed in order to establish the specific role of CD14 in the etiology, pathogenesis and clinical phenotype of sarcoidosis.
Respiratory medicine 09/2010; 104(9):1336-43. · 2.33 Impact Factor
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ABSTRACT: Paraffin has characteristics that make it popular among fire breathers.
To describe a case of paraffin-induced lipoid pneumonia in a fire breather.
The patient was evaluated clinically in relation to his occupational history.
A 32-year-old man presented with dyspnoea, tachypnoea and non-productive cough of 2 h duration that started immediately following an attempt to blow fire using paraffin as the volatile substance. He was discharged from the emergency ward but returned the next day presenting again with dyspnoea accompanied by mid-sternal pain, fever (38.1 degrees C) and leucocytosis. Chest radiography showed perihilar punctuate infiltrations. A diagnosis of exogenous lipoid pneumonia caused by paraffin was made, and the patient was treated, with full recovery within a week.
Fire breathers must be viewed as a population at risk of paraffin-induced lipoid pneumonia.
Occupational Medicine 03/2010; 60(3):234-5. · 1.14 Impact Factor
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Age and Ageing 07/2008; 37(6):710-3. · 3.09 Impact Factor
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ABSTRACT: It has been suggested that cytomegalovirus (CMV) infection may be associated with thrombosis in immunocompromised patients. In addition, an association between CMV infection and thrombotic events in immunocompetent hosts has been sporadically reported. We report on 1 immunocompromised and 8 immunocompetent adults who were admitted to a tertiary medical center and experienced a venous thromboembolic event during CMV infection. None reported previous thromboembolic events. All patients were diagnosed as suffering from acute CMV infection. Seven of the patients had vein thromboses. Significant additional thrombophilia was identified in 5 patients; 1 had 15.3 U/mL anti-cardiolipin IgM antibodies (elevated >7), 2 others were not evaluated for genetic procoagulant tendency. The exact nature of the procoagulant effect of CMV has not yet been clarified. Even though these mechanistic studies are incomplete, we suggest that from the clinical perspective, the presence of CMV infection should be considered a possible risk factor for thrombophilia, justifying a high index of suspicion for possible thrombotic events and subsequent decisions regarding prophylactic anticoagulation.
The American Journal of the Medical Sciences 08/2007; 334(2):111-4. · 1.39 Impact Factor
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ABSTRACT: Primary biliary cirrhosis (PBC) and systemic sarcoidosis are granulomatous diseases of unknown etiology whose hepatic manifestations may infrequently be imitative of one another. Described herein is the first reported case in the medical literature of systemic sarcoidosis developing after liver transplantation for PBC. The presented patient, who suffered from typical clinical, laboratory, and pathologic manifestations of PBC, developed decompensated liver cirrhosis within a course of 8 years, necessitating orthotopic liver transplantation. A year and a half after transplantation, the patient developed diffuse, biopsy-proven, dermatologic and pulmonary manifestations of systemic sarcoidosis, which promptly responded to corticosteroid treatment. In retrospect, the patient's longstanding liver disease was probably caused by an unrecognizable, isolated hepatic form of sarcoidosis or an overlap between PBC and sarcoidosis. This patient illustrates the complexity that may be rarely encountered in differentiating between PBC and hepatic sarcoidosis. Discussed are the clinical, laboratory, and pathologic overlaps between hepatic sarcoidosis and PBC, and clues that may aid in the diagnosis and differentiation between the 2 disorders. Hepatologists and liver transplantation specialists should be aware of the rare possibility of hepatic sarcoidosis imitating PBC, and exacerbating systemically after liver transplantation.
Journal of Clinical Gastroenterology 03/2007; 41(3):329-32. · 3.16 Impact Factor
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ABSTRACT: Pulmonary Langerhans cell histiocytosis, also known as eosinophilic granuloma, is an uncommon interstitial lung disease. A solitary nodule, usually parenchymal, may rarely be the only manifestation of the disease. We describe a case of Langerhans cell histiocytosis presenting as an obstructing tracheal lesion in a 55-year-old woman. Following complete resection of the lesion via flexible bronchoscopy, full recovery was achieved. This case represents a unique cause for tracheal obstruction, as well as an unreported manifestation of pulmonary Langerhans cell histiocytosis.
Chest 09/2005; 128(2):1057-8. · 5.25 Impact Factor
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ABSTRACT: To report a case of recurrent infusion phlebitis during cyclosporine treatment, which, as of October 14, 2004, is a previously unreported adverse effect of this drug.
A 28-year-old man previously diagnosed with ulcerative colitis was admitted to the internal medicine department due to exacerbation of the condition and treated with intravenous hydrocortisone, followed by treatment with intravenous cyclosporine. During this treatment, the patient experienced quick, recurrent, and significant infusion phlebitis. The intravenous catheter and its site needed to be replaced repeatedly during the continuum of treatment, eventually leading to complete remission of the ulcerative colitis. After 8 months, the patient was still in remission, with no permanent signs of damage to the involved phlebitic veins.
Infusion phlebitis induced by drugs is a common phenomenon that causes pain and difficulty in a patient's treatment. Many drugs, mainly antibiotics and cytotoxic drugs, have previously been reported to induce infusion phlebitis. We describe the first report of a patient with cyclosporine-induced recurrent infusion phlebitis. According to the Naranjo probability scale, the relationship of the encountered phlebitis to cyclosporine therapy is probable.
Recurrent infusion phlebitis is a previously unreported adverse effect encountered during treatment with cyclosporine. This important adverse effect must be considered when treating patients with this unique drug.
Annals of Pharmacotherapy 01/2005; 38(12):2071-3. · 2.13 Impact Factor
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ABSTRACT: Thalassemia is the most common hereditary anemia throughout the world. Survival in its most severe long-term form, beta-thalassemia major, has significantly risen in the last decades. Cardiac morbidity-heart failure and dysrhythmias-is still the most common cause of mortality in these patients. We describe herein a case of myocardial infarction with normal coronary arteries in a 48-year-old patient with beta-thalassemia and no other recognized risk factors for coronary artery disease. Thromboembolic phenomena, a known situation in these patients, occur at a frequency of 4-5%. However, as far as we know, this is the first report in the literature of myocardial infarction in association with beta-thalassemia. With the notable improvement in the life expectancy of thalassemia patients, ischemic heart disease may become an important complication encountered in these patients.
American Journal of Hematology 02/2004; 75(1):52-5. · 4.67 Impact Factor
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ABSTRACT: A case of a 58-year-old female patient who presented with significant blood eosinophilia and thromboembolic events is described. The patient was eventually diagnosed as suffering from a disseminated malignancy of gastrointestinal origin. Immunohistochemical studies of the tumor are presented. These studies show that tumor cells produce interleukin-3 and -5 and granulocyte macrophage-colony stimulating factor. These cytokines are known to support differentiation, proliferation, and survival of eosinophils. Their secretion is the probable explanation for the appearance of high blood eosinophilia in this patient. To the best of our knowledge, combined blood eosinophilia and thromboembolism as presenting manifestations of a solid tumor have never been reported.
The American Journal of the Medical Sciences 09/2003; 326(2):98-101. · 1.39 Impact Factor
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ABSTRACT: Adjuvant arthritis (AA) is an experimental model of autoimmune arthritis that can be induced in susceptible strains of rats such as inbred Lewis upon immunization with CFA. AA cannot be induced in resistant strains like Brown-Norway or in Lewis rats after recovery from arthritis. We have previously shown that resistance to AA is due to the presence of natural as well as acquired anti-heat shock protein (HSP) Abs. In this work we have studied the fine specificity of the protective anti-HSP Abs by analysis of their interaction with a panel of overlapping peptides covering the whole HSP molecule. We found that arthritis-susceptible rats lack Abs to a small number of defined epitopes of the mycobacterial HSP65. These Abs are found naturally in resistant strains and are acquired by Lewis rats after recovery from the disease. Active vaccination of Lewis rats with the protective epitopes as well as passive vaccination with these Abs induced suppression of arthritis. Incubation of murine and human mononuclear cells with the protective Abs induced secretion of IL-10. Analysis of the primary and tertiary structure of the whole Mycobacterium tuberculosis HSP65 molecule indicated that the protective epitopes are B cell epitopes with nonconserved amino acid sequences found on the outer surface of the molecule. We conclude that HSP, the Ag that contains the pathogenic T cell epitopes in AA, also contains protective B cell epitopes exposed on its surface, and that natural and acquired resistance to AA is associated with the ability to respond to these epitopes.
The Journal of Immunology 07/2002; 168(12):6463-9. · 5.79 Impact Factor
