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Rambam Maimonides Medical Journal

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https://www.readbyqxmd.com/read/27824553/systemic-sclerosis-and-the-gastrointestinal-tract-clinical-approach
#1
REVIEW
Yolanda Braun-Moscovici, Rita Brun, Marius Braun
Systemic sclerosis (SSc) is a multisystem disease characterized by functional and structural abnormalities of small blood vessels, fibrosis of the skin and internal organs, immune system activation, and autoimmunity. The gastrointestinal tract is involved in nearly all patients and is a source of significant morbidity and even mortality. The aim of this review is to summarize the pathogenesis and to provide a clinical approach to these patients.
October 31, 2016: Rambam Maimonides Medical Journal
https://www.readbyqxmd.com/read/27824552/ehlers-danlos-syndrome-hypermobility-type-a-much-neglected-multisystemic-disorder
#2
REVIEW
Yael Gazit, Giris Jacob, Rodney Grahame
Ehlers-Danlos syndrome (EDS)-hypermobility type (HT) is considered to be the most common subtype of EDS and the least severe one; EDS-HT is considered to be identical to the joint hypermobility syndrome and manifests with musculoskeletal complaints, joint instability, and soft tissue overuse injury. Musculoskeletal complaints manifest with joint pain of non-inflammatory origin and/or spinal pain. Joint instability leads to dislocation or subluxation and involves peripheral joints as well as central joints, including the temporomandibular joints, sacroiliac joints, and hip joints...
October 31, 2016: Rambam Maimonides Medical Journal
https://www.readbyqxmd.com/read/27824551/cocaine-induced-vasculitis
#3
REVIEW
Mark Berman, Daphna Paran, Ori Elkayam
The use of cocaine continues to grow worldwide. One of the possible side-effects of cocaine is vasculitis. Two distinct vasculitic syndromes have been described due to cocaine. One is cocaine-induced midline destructive lesion, secondary to a direct vasoconstrictor effect of cocaine, inducing ischemic necrosis of the septal cartilage and perforation of the nasal septum, mimicking findings of granulomatosis with polyangiitis in the upper airways. The other is ANCA-associated vasculitis, attributed to the levamisole component that contaminates about 70% of the cocaine...
October 31, 2016: Rambam Maimonides Medical Journal
https://www.readbyqxmd.com/read/27824550/chikungunya-virus-infection-an-update-on-joint-manifestations-and-management
#4
REVIEW
Maria Krutikov, Jessica Manson
The advent of sophisticated diagnostics has enabled the discovery of previously unknown arthropod-borne viruses like Chikungunya. This infection has become increasingly prevalent in the last 10 years across the Indian Ocean and has been brought to media attention by a recent outbreak in the Caribbean. The outbreak has been aided by a drastic rise in air travel, allowing infected individuals to transport the virus to previously unaffected regions. In addition, a recently documented viral mutation has allowed its transmission by the Aedes albopictus mosquito, therefore facilitating outbreaks in Southern Europe and the USA...
October 31, 2016: Rambam Maimonides Medical Journal
https://www.readbyqxmd.com/read/27824549/acpas-are-much-more-than-diagnostic-autoantibodies
#5
REVIEW
Abdulla Watad, Howard Amital
Anti-citrullinated protein autoantibodies (ACPAs) are the major autoantibodies in rheumatoid arthritis (RA). Anti-citrullinated protein autoantibodies are directed against different citrullinated antigens, including filaggrin, fibrinogen, vimentin, and collagen. Presence of ACPA is associated with joint damage and extra-articular manifestations, suggesting that ACPAs are most likely pathogenic autoantibodies in RA. In vitro, ACPAs induce macrophage tumor necrosis factor alpha (TNF-α) production, osteoclastogenesis, and complement activation...
October 31, 2016: Rambam Maimonides Medical Journal
https://www.readbyqxmd.com/read/27824548/the-role-of-%C3%AE-%C3%AE-t-cells-in-fibrotic-diseases
#6
REVIEW
Ilan Bank
Inflammation induced by toxins, micro-organisms, or autoimmunity may result in pathogenic fibrosis, leading to long-term tissue dysfunction, morbidity, and mortality. Immune cells play a role in both induction and resolution of fibrosis. γδ T cells are an important group of unconventional T cells characterized by their expression of non-major histocompatibility complex restricted clonotypic T cell receptors for non-peptide antigens. Accumulating evidence suggests that subsets of γδ T cells in experimentally induced fibrosis following bleomycin treatment, or infection with Bacillus subtilis, play pro-inflammatory roles that instigate fibrosis, whereas the same cells may also play a role in resolving fibrosis...
October 31, 2016: Rambam Maimonides Medical Journal
https://www.readbyqxmd.com/read/27824547/atypical-femur-fractures-in-patients-treated-with-bisphosphonates-identification-management-and-prevention
#7
REVIEW
Judith Sarah Bubbear
Osteoporosis is a common condition with significant health care costs. First-line therapy is with bisphosphonates, which have proven anti-fracture efficacy. Around 10 years after the introduction of bisphosphonates reports began to be published of atypical femoral fractures (AFFs) that may be associated with this therapy. These fractures are associated with significant morbidity although lower mortality than the more common osteoporotic neck-of-femur fractures. A case definition has been described to allow identification of this class of fracture...
October 31, 2016: Rambam Maimonides Medical Journal
https://www.readbyqxmd.com/read/27824546/citrullination-in-rheumatoid-arthritis-a-process-promoted-by-neutrophil-lysis
#8
REVIEW
Tal Gazitt, Christian Lood, Keith B Elkon
Anti-citrullinated protein antibodies (ACPAs) are highly specific serologic markers for rheumatoid arthritis (RA) and can pre-date clinical disease onset by up to 10 years, also predicting erosive disease. The process of citrullination, the post-translational conversion of arginine to citrulline residues, is mediated by peptidylarginine deiminase (PAD) enzymes present in polymorphonuclear cells (PMNs). Calcium ions (Ca(2+)) are required for PAD activation, but the intracellular Ca(2+) concentration in normal cells is much lower than the optimal Ca(2+) concentration needed for PAD activation...
October 31, 2016: Rambam Maimonides Medical Journal
https://www.readbyqxmd.com/read/27824545/targeted-therapy-in-systemic-sclerosis
#9
REVIEW
Murray Baron
Targeted therapies use an understanding of the pathophysiology of a disease in an individual patient. Although targeted therapy for systemic sclerosis (SSc, scleroderma) has not yet reached the level of patient-specific treatments, recent developments in the understanding of the global pathophysiology of the disease have led to new treatments based on the cells and pathways that have been shown to be involved in the disease pathogenesis. The presence of a B cell signature in skin biopsies has led to the trial of rituximab, an anti-CD20 antibody, in SSc...
October 31, 2016: Rambam Maimonides Medical Journal
https://www.readbyqxmd.com/read/27824544/radionuclide-methods-in-the-diagnosis-of-sacroiliitis-in-patients-with-spondyloarthritis-an-update
#10
REVIEW
Karina Zilber, Miguel Gorenberg, Doron Rimar, Nina Boulman, Lisa Kaly, Michael Rozenbaum, Itzhak Rosner, Gleb Slobodin
Sacroiliitis, inflammation of the sacroiliac joint (SIJ), is the hallmark of ankylosing spondylitis and spondyloarthritis (SpA) in general. The arsenal of recommended diagnostic modalities for imaging of the SIJ is scanty and, in practice, includes only conventional X-rays and magnetic resonance imaging (MRI). This review suggests that bone scintigraphy, particularly single-photon emission computed tomography (SPECT) with calculation of indices, or SPECT in combination with low-dose computed tomography (CT) can be a sensitive and specific tool for the diagnosis of sacroiliitis and can be used as part of the individualized approach to the diagnosis of axial SpA...
October 31, 2016: Rambam Maimonides Medical Journal
https://www.readbyqxmd.com/read/27824543/giant-cell-arteritis-and-polymyalgia-rheumatica-2016-update
#11
REVIEW
Gideon Nesher, Gabriel S Breuer
Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are both more common among people of North European decent than among Mediterranean people. Women are 2-3 times more commonly affected. Giant cell arteritis and PMR are extremely rare before age 50 years. Polymyalgia rheumatica may be "isolated" or associated with GCA. There is increased expression of inflammatory cytokines in temporal arteries of PMR patients, without overt histological evidence of arteritis. One-third of "isolated" PMR patients have vascular uptake in positron emission tomography (PET) scans, suggesting clinically unrecognized, "hidden" GCA...
October 31, 2016: Rambam Maimonides Medical Journal
https://www.readbyqxmd.com/read/27487311/transversus-abdominis-plane-versus-ilioinguinal-and-iliohypogastric-nerve-blocks-for-analgesia-following-open-inguinal-herniorrhaphy
#12
Anatoli Stav, Leonid Reytman, Michael-Yohay Stav, Anton Troitsa, Mark Kirshon, Ricardo Alfici, Mickey Dudkiewicz, Ahud Sternberg
OBJECTIVES: We hypothesized that preoperative (pre-op) ultrasound (US)-guided posterior transversus abdominis plane block (TAP) and US-guided ilioinguinal and iliohypogastric nerve block (ILI+IHG) will produce a comparable analgesia after Lichtenstein patch tension-free method of open inguinal hernia repair in adult men. The genital branch of the genitofemoral nerve will be blocked separately. METHODS: This is a prospective, randomized, controlled, and observer-blinded clinical study...
July 28, 2016: Rambam Maimonides Medical Journal
https://www.readbyqxmd.com/read/27487308/remembering-more-jewish-physicians
#13
George M Weisz, Andrzej Grzybowski
The history of medicine has been an intriguing topic for both authors. The modern relevance of past discoveries led both authors to take a closer look at the lives and contributions of persecuted physicians. The Jewish physicians who died in the Holocaust stand out as a stark example of those who merit being remembered. Many made important contributions to medicine which remain relevant to this day. Hence, this paper reviews the lives and important contributions of two persecuted Jewish physicians: Arthur Kessler (1903-2000) and Bronislawa Fejgin (1883-1943)...
July 28, 2016: Rambam Maimonides Medical Journal
https://www.readbyqxmd.com/read/27101216/comparison-of-the-supraclavicular-infraclavicular-and-axillary-approaches-for-ultrasound-guided-brachial-plexus-block-for-surgical-anesthesia
#14
Anatoli Stav, Leonid Reytman, Michael-Yohay Stav, Isaak Portnoy, Alexander Kantarovsky, Offer Galili, Shmuel Luboshitz, Roger Sevi, Ahud Sternberg
OBJECTIVE: We hypothesized that ultrasound (US)-guided technique of the supra- and infraclavicular and axillary approaches of brachial plexus block (BPB) will produce a high quality of surgical anesthesia for operations below the shoulder independently of the approach and body mass index (BMI). Intercostobrachial and medial brachial cutaneous nerves will be blocked separately because they are not a part of the brachial plexus. METHODS: This is a prospective randomized observer-blinded study...
April 19, 2016: Rambam Maimonides Medical Journal
https://www.readbyqxmd.com/read/27487314/should-sabbath-prohibitions-be-overridden-to-provide-emotional-support-to-a-sick-relative
#15
REVIEW
Chaya Greenberger, Pnina Mor
BACKGROUND: There is a consensus among the halachic authorities that life-saving actions override Sabbath prohibitions. They are painstaking in securing that the sanctity of the Sabbath is maintained but that not a single life be lost. OBJECTIVE: This manuscript examines if and when a relative's presence at the bedside of a seriously ill individual is potentially life-saving against the backdrop of the scientific literature. It specifically addresses the permissibility of traveling in a motorized vehicle, generally prohibited on the Sabbath, to be with one's relative in hospital for the provision of emotional support...
2016: Rambam Maimonides Medical Journal
https://www.readbyqxmd.com/read/27487313/cancer-of-the-throat-a-physician-s-experience-as-a-patient
#16
Itzhak Brook
The author, a practicing physician, was diagnosed with throat cancer and lost his vocal cords. He endured the side effects of radiation, repeated surgeries, and the effects of prolonged hospitalizations; confronted medical mistakes and discrimination after losing his vocal cords; and struggled to regain his speech and find new meaning and purpose for his life. Facing the hardship and trials of becoming a laryngectomee illustrated to him how dependent and helpless a patient can become. Being unable to speak, eat, and breathe normally, while dealing with a potentially terminal illness, makes the patient very vulnerable, both physically and emotionally...
2016: Rambam Maimonides Medical Journal
https://www.readbyqxmd.com/read/27487312/safety-of-completion-thyroidectomy-for-initially-misdiagnosed-thyroid-carcinoma
#17
Gangiti Kranthikumar, Nusrath Syed, Hemantkumar Nemade, Satish Pawar, L M Chandra Sekhara Rao, T Subramanyeshwar Rao
INTRODUCTION: Completion thyroidectomy is defined as the surgical removal of the remnant thyroid tissue following procedures of less than total or near-total thyroidectomy. Whether thyroid reoperations are associated with an increased complication risk is controversial. OBJECTIVE: A retrospective analysis was done of patients undergoing completion thyroidectomy for cancer of the thyroid who had undergone surgery elsewhere for solitary thyroid nodule. The incidence of surgical complications in these patients after reoperation was investigated in this study...
2016: Rambam Maimonides Medical Journal
https://www.readbyqxmd.com/read/27487310/effectiveness-of-inferior-vena-cava-filters-without-anticoagulation-therapy-for-prophylaxis-of-recurrent-pulmonary-embolism
#18
Miri Zektser, Carmi Bartal, Lior Zeller, Roman Nevzorov, Alan Jotkowitz, Vered Stavi, Vitaly Romanyuk, Gregory Chudakov, Leonid Barski
OBJECTIVE: The optimal treatment of deep vein thrombosis (DVT) is anticoagulation therapy. Inferior vena cava filter (IVC) placement is another option for the prevention of pulmonary embolism (PE) in patients with deep vein thrombosis. This is used mostly in patients with a contraindication to anticoagulant therapy. The purpose of the present study was to compare the two options. METHODS: A retrospective cohort study of two groups of patients with DVT: patients who received an IVC filter and did not receive anticoagulation due to contraindications; and patients with DVT and similar burden of comorbidity treated with anticoagulation without IVC insertion...
2016: Rambam Maimonides Medical Journal
https://www.readbyqxmd.com/read/27487309/acrolein-an-%C3%AE-%C3%AE-unsaturated-aldehyde-a-review-of-oral-cavity-exposure-and-oral-pathology-effects
#19
REVIEW
Dror Aizenbud, Itay Aizenbud, Abraham Z Reznick, Katia Avezov
Acrolein is a highly reactive unsaturated aldehyde widely present in the environment, particularly as a product of tobacco smoke. Our previous studies indicated the adverse consequences of even short-term acrolein exposure and proposed a molecular mechanism of its potential harmful effect on oral cavity keratinocytic cells. In this paper we chose to review the broad spectrum of acrolein sources such as pollution, food, and smoking. Consequently, in this paper we consider a high level of oral exposure to acrolein through these sources and discuss the noxious effects it has on the oral cavity including on salivary quality and contents, oral resistance to oxidative stress, and stress mechanism activation in a variety of oral cells...
2016: Rambam Maimonides Medical Journal
https://www.readbyqxmd.com/read/27487307/for-better-orchiopexy-processus-vaginalis-should-be-dissected-and-a-high-ligation-should-be-performed
#20
Kaan Sonmez, Ramazan Karabulut, Zafer Turkyilmaz, Cem Kaya, Yildiz Pehlivan, A Can Basaklar
OBJECTIVE: Data on the prevalence of patent processus vaginalis (PPV) and hernia in patients with cryptorchidism are controversial. While some pediatric surgeons do not dissect the processus vaginalis (PV), most prefer to do so to prevent hernia formation and to achieve an effective orchiopexy outcome. This study was performed to evaluate the importance of dissection and high ligation of the PV during treatment of undescended testis (UT). METHODS: The clinical findings and surgical procedures of 55 patients with UT were retrospectively investigated...
2016: Rambam Maimonides Medical Journal
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