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עמוד בית
Wed, 19.06.24

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December 2016
Claudia Brogna MD, Raffaele Manna MD PhD, Ilaria Contaldo MD, Domenico M. Romeo MD, Maria Chiara Stefanini MD, Antonio Chiaretti MD, Eugenio Mercuri MD PhD and Paolo Mariotti MD
May 2012
A. Zamora-Ustaran, R.O. Escarcega-Alarcón, M. Garcia-Carrasco, E. Faugier, S. Mendieta-Zeron, C. Mendoza-Pinto, Á. Montiel-Jarquin, M. Muñoz-Guarneros, A. Lopez-Colombo and R. Cervera

Background: Data on pediatric antiphospholipid syndrome (APS) are very sparse.

Objectives: To describe the main clinical characteristics, laboratory data and complications of pediatric APS patients, and to analyze the differences between primary APS and APS associated with systemic lupus erythematosus (SLE).

Methods: We retrospectively reviewed clinical and laboratory data of 32 children at “Federico Gomez,” the children’s hospital of México. Nineteen patients had SLE, 12 (37.5%) had primary APS and 1 (3%) had immune thrombocytopenic purpura. We collected information on sociodemographic variables, vaccinations, age at onset, and family history of rheumatic disease, hematological disorders, skin disorders and non-thrombotic neurological disorders. Immunological features included immunoglobulin (Ig) G and M aCl antibodies, IgG and IgM b2 glycoprotein I, lupus anticoagulant, anti-dsDNA and antinuclear antibodies.

Results: The patients included 24 females and 8 males. The most common thrombotic events were small vessel thrombosis (44%), venous thrombosis (28%) mainly deep venous thrombosis (DVT) in lower extremities, and arterial thrombosis (25%). The most common clinical non-thrombotic manifestations were hematological (53%) and neurological disorders (22%). There were no significant differences between groups with regard to the site of thrombosis, non-thrombotic clinical manifestations or laboratory features.

Conclusions: There were some important differences between the clinical manifestations of APS in children compared with adults, but we found no significant differences between patients with primary and APS associated with SLE. Larger studies in Latin American APS children are necessary to determine whether there are differences between ethnic groups.

 


June 2011
M. Garcia-Carrasco, C. Mendoza-Pinto, C. Riebeling, M. Sandoval-Cruz, A. Nava, I. Etchegaray-Morales, M. Jimenez-Hernandez, A. Montiel-Jarquin, A. Lopez-Colombo and R. Cervera

 Background: The prevalence of vertebral fractures in systemic lupus erythematosus (SLE) ranges between 20% and 21.4%, and patients with these fractures have impaired walking and activities of daily living. Moreover, clinical and radiological vertebral fractures have been associated with increased mortality.
 Objectives: To compare the quality of life of patients with SLE[1] with and without vertebral fractures.

Methods: The study group comprised 140 women with SLE undergoing screening for vertebral fractures using a standardized method. SLE disease activity and organ damage were measured by the Mexican Systemic Lupus Erythematosus Disease Activity Index (MEX-SLEDAI) and Systemic International Collaborating Clinics/American College of Rheumatology damage index (SLICC), respectively. The QUALEFFO and Center for Epidemiologic Studies Depression Scale were used to measure health-related quality of life and depression, respectively.

Results: The median age of the 140 patients was 43 years (range 18–76); disease duration was 72 months (range 6–432); 49.7% were menopausal. Thirty-four patients (24.8%) had vertebral fractures (≥ 1), mostly in the thoracic spine. Patients with vertebral fractures had a higher mean age (49.5 ± 13.4 vs. 41 ± 13.2 years, P = 0.001) and disease damage (57.1% vs. 34.4%, P = 0.001). The global QUALEFFO score was not different between the vertebral fractures group and the non-vertebral group. The only significant difference in the QUALEFFO items was in physical function (P = 0.04). A significant correlation was found between the severity of vertebral fractures and the QUALEFFO pain (r = 0.27, P = 0.001) and physical function (r = 0.37, P = 0.02) scores. The number of vertebral fractures correlated only with physical function (r = 0.01).

Conclusions: The HRQOL of women with SLE is low, regardless of whether they have vertebral fractures or not, but patients with vertebral fractures have worse physical function compared to those without. Strategies to improve the HRQOL of patients with SLE with or without vertebral fractures are necessary.






[1] SLE = systemic lupus erythematosus



 
October 2010
R.O. Escarcega, J. Carlos Perez-Alva, M. Jimenez-Hernandez, C. Mendoza-Pinto, R. Sanchez Perez, R. Sanchez Porras and M. Garcia-Carrasco

Background: On-site cardiac surgery is not widely available in developing countries despite a high prevalence of coronary artery disease.

Objectives: To analyze the safety, feasibility and cost-effectiveness of transradial percutaneous coronary intervention without on-site cardiac surgery in a community hospital in a developing country.

Methods: Of the 174 patients who underwent PCI[1] for the first time in our center, we analyzed two groups: stable coronary disease and acute myocardial infarction. The primary endpoint was the rate of complications during the first 24 hours after PCI. We also analyzed the length of hospital stay and the rate of hospital readmission in the first week after PCI, and compared costs between the radial and femoral approaches.

Results: The study group comprised 131 patients with stable coronary disease and 43 with acute MI[2]. Among the patients with stable coronary disease 8 (6.1%) had pulse loss, 12 (9.16%) had on-site hematoma, and 3 (2.29%) had bleeding at the site of the puncture. Among the patients with acute MI, 3 (6.98) had pulse loss and 5 (11.63%) had bleeding at the site of the puncture. There were no cases of atriovenous fistula or nerve damage. In the stable coronary disease group, 130 patients (99%) were discharged on the same day (2.4 ± 2 hours). In the acute MI group, the length of stay was 6.6 ± 2.5 days with at least 24 hours in the intensive care unit. There were no hospital readmissions in the first week after the procedure. The total cost, which includes equipment related to the specific approach and recovery room stay, was significantly lower with the radial approach compared to the femoral approach (US$ 500 saving per intervention).

Conclusions: The transradial approach was safe and feasible in a community hospital in a developing country without on-site cardiac surgery backup. The radial artery approach is clearly more cost effective than the femoral approach.






[1] PCI = percutaneous coronary intervention



[2] MI = myocardial infarction


March 2010
M. Sofer, G. Lidawi, G. Keren-Paz, R. Yehiely, A. Beri and H. Matzkin

Background: Tubeless percutaneous nephrolithotomy is defined as PCNL[1] without postoperative nephrostomy tubes. It is reported to reduce postoperative pain, hospital stay and recovery time. To date the procedure has been reserved for selected patients.

Objectives: To assess our initial experience in extending the implementation of tubeless PCNL without preoperative patient selection.

Methods: All consecutive PCNLs performed during 2004–2008 were evaluated. Tubeless PCNL was performed when residual stones, bleeding and extravasation were excluded intraoperatively. Staghorn stones, stone burden, supracostal and multiple accesses, anatomic anomalies, solitary kidneys and operative time were not considered contraindications. We analyzed the clinical data and the choice of tubeless PCNL over time.

Results: Of 281 PCNLs performed during the study period, 200 (71%) were tubeless. The patients' average age was 53 years (range 28–82 years), the stone burden was 924 mm2 (400–3150 mm2), operative time was 99 minutes (45–210 min), complication rate was 14% and immediate stone-free rate 91%. There were 81 conversions to standard PCNL (29%) due to expected second-look (n=47, 58%), impression of bleeding (n=21, 26%), suspected hydrothorax (n=7, 9%) and extravasation (n=6, 7%). The transfusion rate was 1%. The median hospital stay was 1 day (1–15 days) and recovery time 7 days (5–20 days). The rate of implementing the tubeless procedure increased steadily along time from 46% to 83% (P = 0.0001). 

Conclusions: Tubeless PCNL can be safely and effectively performed based on intraoperative decisions, without preoperative contraindications. They are easily accommodated by experienced endourologists and provide real advantages.

 






[1] PCNL = percutaneous nephrolithotomy

 



August 2009
M. García-Carrasco, C. Mendoza-Pinto, R.O. Escárcega, M. Jiménez-Hernández, I. Etchegaray Morales, P. Munguía Realpozo, J. Rebollo-Vázquez, E. Soto-Vega, M. Delezé and R. Cervera

In recent years the survival of patients with systemic lupus erythematosus has increased markedly. Consequently, long-term complications, such as osteoporosis, are currently of paramount importance. SLE[1] is known to increase the risk of bone fractures, and numerous studies have found that SLE patients have osteoporosis. Of the various risk factors associated with osteoporosis in SLE, disease duration, the use of corticosteroids and chronic disease-related damage are consistently reported, with differences between studies probably due to the different populations studied. The role of chronic inflammation in osteoporosis is also important. On the other hand, little attention has been paid to osteoporotic fractures, especially of the vertebra, which are associated with reduced quality of life, increased mortality rates and increased risk of new vertebral and non-vertebral fractures in the general population.






[1] SLE = systemic lupus erythematosus



 
August 2007
M. Garcia-Carrasco, R.O. Escarcega, C. Mendoza-Pinto, A. Zamora-Ustaran, I. Etchegaray-Morales, J. Rojas-Rodriguez, L.E. Escobar-Linares and R. Cervera
May 2007
A. Wincewicz, M. Sulkowska and S. Sulkowski

Ludwik Zamenhof (1859-1917) lived in Poland under Russian and later German rule. He invented and propagated Esperanto – an artificial, easy-to-learn language. Literally meaning “language of hope,” Esperanto was constructed to avoid misunderstandings, establish communication and facilitate harmony among different nationalities. Simply, he wanted people to accept one another despite observed differences. He was a skilled ophthalmologist, but figuratively, he wished to heal the eyes of humankind to look without hate, just as the biblical Tobias removed the cataract from the corners of his father’s eyes to restore his sight.

July 2006
I. Arad, M. Baras, B. Bar-Oz and R. Gofin
 Background: Maternal transport, rather than neonatal transport, to tertiary care centers is generally advocated. Since a substantial number of premature deliveries still occur in hospitals with level I and level II nurseries, it is imperative to find means to improve their outcome.

Objectives: To compare the neonatal outcome (survival, intraventricular hemorrhage and bronchopulmonary dysplasia) of inborn and outborn very low birth weight infants, accounting for sociodemographic, obstetric and perinatal variables, with reference to earlier published data.

Methods: We compared 129 premature infants with birth weights of 750–1250 g delivered between 1996 and 2000 in a hospital providing neonatal intensive care to 99 premature babies delivered in a referring hospital. In the statistical analysis, variables with a statistical significant association with the outcome variables and dissimilar distribution in the two hospitals were identified and entered together with the hospital of birth as explanatory variables in a logistic regression.

Results: Accounting for the covariates, the odds ratios (outborns relative to inborns) were 0.31 (95% confidence interval = 0.11–0.86, P = 0.03) for mortality, 1.37 (95%CI[1] = 0.64–2.96, P = 0.42) for severe intraventricular hemorrhage, and 0.86 (95%CI = 0.38–1.97, P = 0.78) for bronchopulmonary dysplasia. The odds ratio for survival without severe intraventricular hemorrhage was 1.10 (95%CI = 0.55–2.20, P = 0.78). Comparing the current results with earlier (1990–94) published data from the same institution showed that mortality decreased in both the outborn and inborn infants (OR[2] = 0.23, 95%CI = 0.09–0.58, P = 0.002 and 0.46; 95%CI = 0.20–1.04, P = 0.06, respectively), but no significant change in the incidence of severe intraventricular hemorrhage or brochopulmonary dysplasia was observed. Increased survival was observed also in these infants receiving surfactant, more so among the outborn. The latter finding could be attributed to the early, pre-transport surfactant administration, implemented only during the current study.

Conclusions: Our data suggest that very low birth weight outborn infants may share an outcome comparable with that of inborn babies, if adequate perinatal care including surfactant administration is provided prior to transportation to a tertiary center.


 





[1] CI = confidence interval

[2] OR = odds ratio


July 2005
A. Nadu, Y. Mor, J. Chen, M. Sofer, J. Golomb and J. Ramon

Background: Data during the last decade show that laparoscopic nephrectomy is becoming an accepted and advantageous minimally invasive alternative to the open procedure.

Objective: To evaluate the efficacy, safety and reproducibility of laparoscopic nephrectomy in a series of 110 consecutive procedures.

Methods: A total of 110 patients underwent laparoscopic nephrectomy in our institution during the last 3 years. Their data were entered into a database and analyzed, including age, gender, indications for surgery, operative time, blood loss, intraoperative complications, conversion rates, and postoperative complications (defined as complications occurring up to 1 month after surgery). Histologic results and outpatient follow-up were also recorded.

Results: Mean age at surgery was 63 years (range 21–89 years). The indications for surgery included solid renal masses in 64 cases, non-functioning kidneys in 35, and collecting system or ureteral tumors in 11; and the procedures performed were radical nephrectomy, simple nephrectomy, or nephroureterectomy, respectively. The mean operative time was 125 minutes (range 70–310 minutes). Intraoperative complications were recorded in eight cases (7.3%), including vascular injuries of the renal artery in two, and of the renal vein, inferior vena cava and right adrenal vein in one case each. Injury of the large bowel and splenic hylus was recorded in one case and malfunction of the vascular endoGIA stapler leading to severe bleeding in one case. Nine cases were converted to open surgery (8.2%), four of them urgently due to intraoperative complications, while in another five cases conversions were elective following poor progression of the laparoscopic procedure. Comparison of the complication rate at follow-up between the initial 50 and the last 60 patients revealed no change. The conversion rate dropped significantly along the learning curve with 7 cases converted among the initial 50 patients, versus 2 in the last 60. There was no perioperative mortality. In two cases we recorded major postoperative complications, including pneumothorax treated by insertion of a thoracic drain and incarcerated inguinal hernia treated by surgery, while minor complications were seen in five patients. Histologic examination showed renal cell carcinoma pT1-T3a in 62 patients, oncocytoma in 5, transitional cell carcinoma T1G2-T3G3N1 in 10, renal sarcoma in 1, metastasis from lung tumor in 1, and end-stage kidney in the remainder. Negative margins were obtained in all cases.

Conclusions: Laparoscopic nephrectomy may be currently considered a routine, safe and effective procedure associated with minimal morbidity. The conversion rate seemed to drop significantly after 50 cases. In view of the inherent benefits for patients, in terms of reduced pain level, faster recovery and improved cosmetic results, the laparoscopic approach has become the standard approach for nephrectomy in our institution. 

May 2002
Aneta Lazarov, MD, Keren Moss, MD, Natalie Plosk, MD, Mario Cordoba, MD and Liliana Baitelman, Pharm
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