Sophia Zlatkin MD, Suhail Aamar MD, MSc, Galia Specter MD, David Leibowitz MD, Natalia Simanovsky MD, Dror Yeshurun MD and Samuel N Heyman MD
Background: Takayasu's arteritis is a rare, probably underdiagnosed disorder in Israel.
Objective: To evaluate the contribution of computerized tomography to the diagnosis of Takayasu's arteritis.
Methods: A retrospective analysis of the diagnostic process was recently conducted in three consecutive patients diagnosed over the last 3 years.
Results: Three females of Arab origin with Takayasu's arteritis were recently identified by CT. In two of the three patients the imaging procedure was performed for different working hypotheses, and the radiological findings (wall thickening, perivascular edema, and segmental intraluminal obliteration of the aorta and its major branches) were unexpected. In these two patients, repeated physical examination following the imaging procedure disclosed initially missed findings that could have led to an earlier consideration of Takayasu's arteritis (bruits above the epigastrium, subclavian and carotid arteries, and absent brachial pulses). Retrospective analysis of the patients' symptoms following CT revealed the true nature of the patients' misinterpreted complaints (e.g., typical abdominal angina replaced a faulty obtained history compatible with renal colic or dyspepsia). In the third patient CT was performed for the evaluation of an epigastric bruit associated with constitutional complaints. The diagnosis of aortitis, based upon the presence of diffuse aortic wall thickening and edema of the surrounding fat, without intraluminal narrowing, could have been missed by angiography, the traditional "gold standard" diagnostic procedure. All three patients complained of ill-defined epigastric abdominal pain and had epigastric tenderness during examination.
Conclusions: CT has the potential for detecting Takayasu's disease and may be superior to angiography, particularly at the early non-obliterative stage. Since the diagnosis of Takayasu's disease is rarely considered, the expanding use of CT and MRI technologies may reveal missed cases that are evaluated for other plausible diagnoses. The true incidence of Takayasu's arteritis in Israel may be much higher than reported, particularly in the Arab population. Our findings suggest that epigastric tenderness, originating from active inflammatory reaction in the abdominal aortic wall, should be considered as a diagnostic criterion of Takayasu's aortitis.
Yona Amitai MD, Daniel Katz MD, Matityahu Lifshitz MD, Rosa Gofin MD, Maya Tepferberg MSc and Shlomo Almog PhD, published in IMAJ.
Background: Prenatal lead exposure (umbilical cord blood lead concentration 10 (μg/dl) may impair cognitive development. Childhood lead poisoning is infrequent in Israel, and there are no data on lead exposure in immigrants to Israel from the former Soviet Union.
Objectives: To evaluate prenatal blood lead concentrations in Israeli newborns whose mothers were born in Israel and in those whose mothers recently immigrated from Russia, and to compare data of prenatal lead exposure in Israel with those reported from other countries.
Methods: We compared the UCBLC of 35 newborns of new immigrants from Russia with a group of 35 newborns whose mothers were born in Israel. Venous BLC was also measured in 50 mothers. Data are compared with similar reports on prenatal lead exposure internationally.
Results: The UCBLC in all 70 newborns (mean±SD) was 3.53±1.6 μg/dl, and mothers' BLC (mean±SD) was 3.90±1.39 μg/dl. UCBLC and BLC in the 50 mother-newborn pairs correlated (γ=0.36, P<0.01). All newborns except one had UCBLC<8.0 μg/dl. There was no significant difference between UCBLC in the two groups.
Conclusions: Prenatal lead exposure among the study subjects in both groups was low. In this sample the newborns of mothers born in Israel and those whose mothers recently immigrated from Russia were not found to be at risk for lead poisoning. Prenatal lead exposure in this sample was low compared to that reported from various parts of the world.
Hagith Nagar, MD
Background: Gastrointestinal duplications are rare, benign congenital lesions that may occur at any location along the alimentary tract and generally require surgical intervention. Presenting symptoms may be quite varied even among patients with the same anomaly.
Objective: To review the clinical presentation of gastrointestinal duplications and present our experience with such lesions over the past decade.
Methods: The records of all patients treated for gastrointestinal duplications at a tertiary hospital during 1987 through 1996 were collected, and relevant published literature reviewed.
Results: In the nine patients with gastrointestinal duplications, six were in the small bowel and one each in the cecum, colon and esophagus. Presenting clinical features were varied and often subtle. Perinatal ultrasonography, radioscintography and computerized tomography were useful in some cases, while in others the correct diagnosis was established only at surgery.
Conclusions: Alimentary tract duplications are uncommon, and may present as solid or cystic tumors, intussusception, perforation or gastrointestinal bleeding. A high index of suspicion is required when dealing with such cases. Appropriate investigations, including imaging techniques, should be directed toward adequate and planned surgery.
Uri Farkash, MD and Mauricio Lynn, MD
Ehud Lebel, MD, Menachem Itzchaki, MD, Deborah Elstein, PhD, Irit Hadas-Halpern, MD, Ayala Abrahamov, MD, and Ari Zimran MD.
Manuel Mayr, MD, Qingbo Xu MD PhD and Georg Wick MD,
Revital Kariv, MD, Yechezkel Sidi, MD, Stephen Malnick MD, and Hanan Gur, MD.
Tsila Hefer, MD, Henry Zvi Joachim, MD, Joshua Danino MD, and Jacob Brown MD
Ram Dickman, MD, Chana Turani, MD, Elimelech Okon, MD, Gerald M. Fraser MD, and Yaron Niv, MD.
Ryoyu Takeda, MD, Yoshihiro Takayama, MD, Syuichiro Tagawa a MD, and Ludwig Kornel MD, PhD.
Bezalel Peskin, MD, Michal Soudack, MD, and Alon Ben-Nun, MD.