Does transcervical intra-fallopian insemination improve pregnancy rates in cases of oligoteratoasthenozoospermia? A prospective, randomized study.

The relatively low pregnancy rates (PR) after treatment of patients with oligoteratoasthenozoospermia (OTA) result in a search for different treatment modalities. The objective of this study was to assess the efficacy of transcervical intrafallopian insemination (IFI) with husband's semen in comparison to intrauterine insemination (IUI) in couples with OTA. A prospective, randomized study included 30 couples with OTA-related infertility (according to WHO criteria). The female patients underwent individually adjusted controlled ovarian stimulation by gonadotropins. Spermatozoa was prepared using the Percoll 70% technique and insemination was performed 36-40 h after human chorionic gonadotropin (HCG) administration. The Tomcat Catheter was used for IUI and the Jansen-Anderson Catheter for IFI to the fallopian tube leading to the ovary that contained more dominant follicles. The couples were divided according to sperm count, into group A (9 couples): < 10 mill ml-1 and group B (21 couples): > 10 mill ml-1. Within the groups the patients were randomly assigned for IUI or IFI treatment. Among group B couples, two pregnancies out of 15 IUI cycles (13.3% PR) and two pregnancies out of 18 IFI cycles (11.1% PR) were achieved. Group A patients completed 7 IUI and 9 IFI treatment cycles with no pregnancies observed. These data did not demonstrate a statistically significant advantage for either technique.

Variability in management of symptomless microhaematuria in schoolchildren.

The evaluation of incidentally detected symptomless microhaematuria in schoolchildren is controversial. Some authors advocate varying numbers of immediate tests, while others recommend investigations only in cases who develop systemic symptoms or signs, or a decline in renal function. The objective of this study was to estimate the extent to which this uncertainty affects the declared habits of practising physicians. A sample of 16 family physicians, 42 primary care paediatricians and 26 full-time hospital-based paediatric nephrologists in Israel were asked to complete a survey using a written case of a hypothetical eight-year-old boy with incidentally detected symptomless microhaematuria. Responses were received from 16 (100%), 18 (43%) and 18 (69%), respectively. The mean number of requested tests, other than follow-up examination of the urine, were 1.5 (range 0-5) for family physicians, 2.5 (1-5) for primary care paediatricians and 5.3 (2-12) for paediatric nephrologists, at an average cost of NIS 408 (US$ 136), NIS 454 (US$ 151) and NIS 860 (US$ 286), respectively. There was also a marked variability within subspecialty groups, so that some family physicians recommended more tests at a higher cost than some of the paediatric nephrologists. There was a marked and unexplained variability within and among the three groups of respondents regarding the extent of the evaluation. The main reason for this variability is probably the uncertainty about the scientifically appropriate way to approach this condition in a symptomless child.

Effect of prolonged use of inhaled steroids on the cellular immunity of children with asthma.

BACKGROUND: Systemic corticosteroids may affect the cellular immunity, but there is no available controlled data on such effects associated with a prolonged use of inhaled corticosteroids. OBJECTIVE: The investigation was designed to study the effect of long-term inhaled beclomethasone dipropionate in daily doses of up to 600 micrograms on cellular immune functions. METHODS: Twenty-four children with asthma treated with inhaled beclomethasone dipropionate for a mean of 22.6 months were compared with 16 children with asthma not treated with an inhaled steroid and with 20 healthy adults. Cellular immune parameters included differential white blood count, T- and B-cell numbers, T helper and suppressor counts, T-cell mitogenic transformation, and interleukin-1 and interleukin-2 secretion. RESULTS: There was no difference in any of the studied cellular immune functions among the three study groups. CONCLUSION: Long-term use of inhaled beclomethasone dipropionate by children with asthma, at daily doses of up to 600 micrograms, has no effect on certain parameters of cellular immunity.

Treatment of psoriasis at a Dead Sea dermatology clinic.

BACKGROUND: The Dead Sea, with its unique optical, chemical, and atmospheric properties, provides an effective alternative treatment for psoriasis. METHODS: The records of 1448 consecutive psoriasis patients treated at a Dead Sea psoriasis clinic were retrospectively evaluated concerning their treatment response and demographic characteristics. RESULTS: Clearing of 80-100% was observed in 88% of the patients treated, including almost 58%, who had complete clearing. The demographic data studied that included gender, previous treatment at the Dead Sea, prior history of hospitalization for psoriasis, prior PUVA treatment, or a history of arthritis did not reveal any significant relationships, although overseas patients responded considerably better than Israelis. CONCLUSIONS: The overall response in a large cohort of psoriasis patients treated at the Dead Sea was excellent. Further prospective studies and basic investigations are essential to understand the mechanism(s) involved and the relationships between other demographic data and the treatment response.

Demographic aspects of Paget's disease of bone in the Negev of southern Israel.

In a mainly retrospective but partly prospective survey of the period 1968-1993 in southern Israel, 61 cases of Paget's disease of bone were identified. Fifty six percent were of non-Afro-Asian origin and 44% originated from Afro-Asia, which is approximately the inverse of the ratio in the local general population. The largest single groups from non-Afro-Asia and Afro-Asia originated, from Romania and Tunisia, respectively, and Australia and Argentina were also disproportionately prominent as countries of origin. Israel itself was the origin of few patients. All the patients were Jews except for one Bedouin Arab, which is far different from the distribution of Bedouins and Jews in both the surveyed area and the hospital population. The differences between these groups numerically and against the background local population may well have been statistically significant had the circumstances enabled greater randomness in the collection of the data analyzed. It is surmised that in southern Israel the prevalence of Paget's disease of bone is about 1%, similar to that in southern Europe.

A multidimensional autoantibody analysis specifying systemic lupus erythematosus patients with neuropsychiatric symptomatology.

Utilizing a newly perfected multiple-response permutation procedure, we analyzed the autoantibody titer of systemic lupus erythematosus (SLE) patients during active and convalescent periods of disease, SLE patients without neurological involvement, and three other comparison groups (patients with active tuberculosis, patients with multiple sclerosis, and healthy normal controls). The multidimensional analysis we used distinguished those SLE patients with neurological involvement from the other SLE patients. Differences were noted by a univariate analysis measuring antibodies to single- and double-stranded DNA, poly (G), Sm, RNP, Ro, La, and gangliosides. Elevated concentrations of the common anti-DNA idiotype 16/6 were also noted among SLE patients with neuropsychiatric illness. This report stresses that increased disease activity in SLE patients with neuropsychiatric phenomena is reflected by their autoantibody profile.

Lipoprotein profile of children with asthma receiving long-term theophylline therapy: a preliminary study.

Lipid profiles were determined in three groups of children: children with asthma receiving long-term therapy with slow-releasing theophylline, children with asthma not treated with theophylline, and a control group of children without asthma. Total cholesterol, high-density lipoprotein cholesterol, and apolipoprotein A levels and the high-density lipoprotein/low-density lipoprotein ratio were significantly higher among theophylline-treated children. The observed changes do not seem to increase the risks of atherosclerotic coronary artery disease.

The hypocholesterolemic effect of an antacid containing aluminum hydroxide.

STUDY OBJECTIVE: To evaluate the efficacy, safety, and hypocholesterolemic effect of an aluminum hydroxide-containing antacid in hypercholesterolemic individuals. DESIGN: A prospective, randomized, double-masked, placebo-controlled phase of 2 months' duration, followed by an open-design treatment phase of 2 months' duration and a washout phase of 2 months' duration. SETTING: Family practice clinics of two rural communities (kibbutzim) in Israel. PATIENTS: Fifty-six men and women with hypercholesterolemia (type IIa or IIb). Fifty individuals completed the study. INTERVENTION: After 2 months of dietary modification (low-fat, low-cholesterol diet), the participants were randomized into two matched groups. Group 1 (28 participants) was treated for 2 months with a chewable antacid tablet containing simethicone, magnesium hydroxide, and 113 mg of aluminum hydroxide per tablet, at a dose of two tablets four times daily. Group 2 (22 participants) was given a similar number of placebo tablets for 2 months. During the following 2 months, both groups received the antacid at the above dose. MEASUREMENTS AND MAIN RESULTS: Lipoprotein levels were evaluated at baseline and every 2 months thereafter for 6 months. Compared with pretreatment levels, Group 1 experienced a decrease in low-density lipoprotein cholesterol (LDL-C) of 9.8% after 2 months (p less than 0.001) and 18.5% after 4 months (p less than 0.001). Compared with Group 2, the decrease in LDL-C in Group 1 was 6.2% at the end of the 2-month double-masked, placebo phase. Although the high-density lipoprotein cholesterol (HDL-C) was also reduced in Group 1 at the end of 4 months of therapy (10.2%), the HDL-C/LDL-C ratio increased by 13% during the same interval (p less than 0.05). The treatment was well tolerated, with minimal side effects. CONCLUSIONS: An aluminum hydroxide-containing antacid reduces LDL-C in hypercholesterolemic individuals. Although HDL-C was also reduced to a lesser extent, the overall atherogenic index was improved. Further studies should be conducted to evaluate the long-term safety and efficacy of antacids containing aluminum hydroxide in hypercholesterolemic patients.

Methylprednisolone therapy for acute asthma in infants and toddlers: a controlled clinical trial.

A controlled double-blind trial was carried out to assess the effect of the early introduction of combined corticosteroid and beta-adrenergic drugs for the treatment of acute asthma in infants and toddlers. Seventy-four emergency room patients (aged 7 to 54 months) who were treated for acute asthma were studied. Treatment included, in addition to salbutamol inhalations, a single dose of intramuscular methylprednisolone (4 mg/kg) or normal saline as placebo. The patients were reevaluated 3 hours after initiation of treatment. At that time, patients were either admitted or discharged based on a clinical decision. Only 8 (20%) of 39 patients treated with steroids were admitted, compared with 15 (43%) of 35 in the placebo group (P less than .05). Sequential analysis of 33 pairs, matched by age and severity of symptoms, revealed statistically significant reduced admission rates in patients treated with steroids. In the younger patients (6 to 24 months), admission rate was significantly lower for those treated with steroids (18%) as compared with those treated without steroids (50%) (P less than .05). In the older group (24 to 54 months), the trend was similar but not statistically significant: 23% vs 31% in the steroid and placebo groups, respectively. These data indicate that corticosteroid treatment combined with an adrenergic agent, given early during an acute asthmatic episode, significantly reduces the hospital admission rate of infants and toddlers.

The rate of gastrointestinal bleeding in a general ICU population: a retrospective study.

We retrospectively reviewed 298 charts in order to evaluate the efficiency of a protocol used to prevent gastrointestinal bleeding among ICU patients. The protocol included the use of an antacid (186 patients), iv administration of cimetidine (66 patients), or both drugs when the combination was needed because of a persistently low gastric pH after antacid (28 cases). In 18 cases the implementation of this protocol was stopped when enteral feeding through a nasogastric tube was started. All four groups were homogenous for average age and the presence of risk factors at admission as well as at the time of bleeding. Nevertheless the percentage of gastric bleeding during ICU stay (coffee-ground vomitus haematemesis and/or melaena) widely varied: 5% for the antacid group; 15% in the cimetidine group; 25% in the "both" group and 56% in the "enteral" group. Possible explanations for these differences are discussed. The results support the use of treatment protocols in order to prevent gastrointestinal bleeding in patients with risk factors who are admitted to ICU.

A possible harmful late effect of methylprednisolone therapy on a time cluster of optic neuritis.

Clinical records of all patients (n = 26) suffering from optic neuritis during the last 16 years re-evaluated in relation to treatment. The patients were treated in 3 ways: with prednisone; with "pulse" megadoses of methylprednisolone; and untreated. A possibly frightening conversion to multiple sclerosis was seen in the group of patients with methylprednisolone, compared with the other 2 groups.

Early vs. late refeeding in acute infantile diarrhea.

A randomized ambulatory trial was performed to compare early (6-h) vs. late (24-h) refeeding in acute infantile diarrhea. Ninety infants with mild dehydration were enrolled in the study. Following an initial oral rehydration period (WHO formula), refeeding was introduced using a diet based on either breast milk or cow's milk. Early (n = 53) and late (n = 37) refeeding groups were similar in ethnic background, socioeconomic level, relevant past history, nutritional and clinical state, and stool pathogens. Infants were assessed upon their initial visit, at 24 and 48 h, and at 7 and 14 days thereafter for evaluation of weight, hydration state, stool frequency and need of hospitalization. No significant differences in the above parameters were observed between the two groups. Different patterns of refeeding (breast milk vs. cow's milk) in both early and late refeeding groups showed no significant differences in the features studied. Since the short-term clinical outcome following early refeeding in acute infantile diarrhea is not different from late refeeding, we suggest that early refeeding should be preferred, particularly in developing populations, in order to minimize the adverse nutritional effects of prolonged fasting during recurrent bouts of gastroenteritis.

Comparison of two dosage schedules of doxycycline in children with rickettsial spotted fever.

We carried out a randomized clinical trial with oral doxycycline in children with Israel rickettsial spotted fever. Our purpose was to investigate whether an abbreviated course of therapy with this drug (until the patient was afebrile plus one day) would be as effective as a one-week regimen of therapy. Results with 50 pediatric patients during this three-year study indicated that the abbreviated treatment regimen was as effective. This clinical trial may serve as a model for determining shorter durations of therapy for other diseases.

Improved outcome of hypothermic infants.

Fifty-six hypothermic infants (23 to 34 degrees C), aged four to 113 days, admitted during the winter months over a three-year period are reported. Low weight and malnutrition were frequent findings on admission. One or more severe associated disturbances, including metabolic abnormalities, bleeding tendency, infection, and respiratory failure were observed in most cases. All 56 patients were closely monitored for vital signs and metabolic status. Thirty-eight received conventional slow warming, but 18 of the worst cases received rapid warming. These 18 were among the 24 cases treated in a pediatric intensive care unit. Fourteen of the 56 infants required assisted mechanical ventilation. Fifty-three of 56 infants survived. Of the three who died, none was rapidly warmed, and two of them had severe underlying central nervous system infection. Hypothermia of infancy and the associated disturbances are treatable today, on condition that modern medical facilities are available. It appears that the warming method has been overly stressed.

Post-exposure rabies prophylaxis: establishing effectiveness of abbreviated treatments.

Several publications have reported recently the apparently successful use of human diploid cell rabies vaccine (HDCV) in volumes of less than the 6 X 1.0 cm3 dosage schedule currently recommended by the World Health Organization for post-exposure rabies prophylaxis. The newer proposed treatments are advocated to economize on an expensive product that may be available rarely in many Third World areas.

Quality of life of patients on chronic dialysis.

The quality of life of 106 patients on chronic dialysis in two medical centers in Israel was studied; 97 diabetic nonuremic patients served as a control group. Of the dialysis patients, 60% were between 30 and 59 years old and 81% had less than or equal to 12 years of formal education; 53% did not work, and 53% of the married patients were not sexually active. Only 22% could engage in usual physical activity. No significant difference was found between the patients of the two centers, despite demographic and geographic differences. Patients greater than or equal to 60 years old had a poorer quality of life compared with younger patients and with the parallel control group. The group of patients with greater than or equal to 12 years of formal education had five times more full-time workers than did those with less than or equal to 8 years education. We conclude that: 1) More dialysis patients are not restored to full normal function compared with the control group of nonuremic diabetics; and 2) In terms of patient rehabilitation, dialysis achieved better results with patients who had greater than or equal to 13 years of education, and patients greater than or equal to 60 years old had poorer results than did those who were younger.

Spotted fever and murine typhus in the Negev desert region of Israel, 1981.

During 1981, 52 cases of rickettsiosis caused by the spotted fever group of rickettsiae were reported in a population of 250 000 living in the Negev desert region of Israel. Retrospectively, at least 5 of these cases were serologically shown to have been caused by Rickettsia typhi, the agent of murine typhus. Most cases of rickettsial disease occurred in the summer months and one half of all cases occurred in children aged 9 years or less. While the specificity of a physician's diagnosis of the rickettsial diseases appears to be high (i.e., few cases of other diseases are misdiagnosed as either spotted fever or murine typhus), the sensitivity of the physician's diagnosis may be lower (i.e., many cases of these diseases presenting as fevers of unknown origin are not diagnosed as rickettsial disease). These findings may also be important for other countries of the region.