Daniel Chemtob, MD, MPH, DEA, Leon Epstein, MD, MPH, Paul E. Slater, MD, MPH and Daniel Weiler-Ravell, MD
Background: Sensing an inadequacy of tuberculosis control due to an influx of TB associated with immigration, we analyzed TB treatment outcome in Israel by population groups.
Objectives: To provide an epidemiological basis necessary for any new national TB control policy, and to bring it to the attention of the medical profession in Israel and abroad since its results led to a change in Israel’s TB control policy.
Methods: We reviewed all TB cases notified during the period 1990 to September 1992. New cases” (820 cases, 93.5%) and “re-treatment cases” (57 cases, 6.5%) were analyzed according to three mutually exclusive groups: “successful outcome,” “death” and “potentially unsatisfactory outcome” (according to WHO/IUATLD definitions).
Results: Of 820 “new cases,” 26.6% had a satisfactory outcome,” 68.5% had a “potentially unsatisfactory outcome” and 4.9% died compared to 47.4%, 45.6% and 7% among 57 “re-treatment cases,” respectively. Using logistic regression analysis, outcome was associated with the district health office (P<0.0001), the TB experience” of the notifying clinic (P<0.0001), and the form of TB (P=0.02). No significant relationships were obtained for population groups, gender and age, interval between arrival in Israel and TB notification, and bacteriological results.
Dan Leibovici, MD, Amnon Zisman, MD, Yoram I. Siegel, MD and Arie Lindner, MD
Background: Cryosurgery is a minimally invasive treatment option for prostate cancer.
Objectives: To report on the first series of cryosurgical ablation for prostate cancer performed in Israel.
Methods: Cryosurgical ablation of the prostate was undertaken in 2 patients aged 53-72 diagnosed with adenocarcinoma of the prostate. The procedures were performed percutaneously and were monitored by real-time trans-rectal ultrasound. The CRYOHIT machine applying Argon gas was used with standard or ultra-thin cryoprobes. The average follow-up was 12.8 months postsurgery (range 1- 24 months).
Results: No rectal or urethral injuries occurred and all patients were discharged from hospital within 24-48 hours. The duration of suprapubic drainage was 14 days in 10 patients and prolonged in 2. Early complications included penoscrotal edema in four patients, perineal hematoma in three, hemorrhoids in two and epidydimitis in one. Long-term complications included extensive prostatic sloughing in one patient and a perineal fistula in another, both of whom required prolonged suprapubic drainage. Minimal stress incontinence was noted in two patients for the first 8 weeks after surgery. None of the patients has yet regained spontaneous potency. A prostate-specific antigen nadir of less than 0.5 ng/ml was achieved in eight patients and an undetectable PSA level below 0.1 ng/ml in five patients.
Conclusion: Cryoablation for prostate cancer is safe and feasible, and the preliminary results are encouraging. Further study is needed to elucidate the efficacy of the procedure.
Tsafra Ilan, MSc, Tamy Shohat, MD, Ana Tobar, MD, Nurit Magal, PhD, Michal Yahav, BSc, Gabrielle J. Halpern, MB, ChB, Gidi Rechavi, MD and Mordechai Shohat, MD
Background: Familial nephritis is a heterogeneous group of disorders caused by several genetic conditions such as Alport syndrome, glomerulonephritic syndromes, and unclassified nephritis without deafness or ocular defects.
Objectives: To describe a family of Iraqi Jewish origin, several of whose members suffer from non-syndromic renal failure without deafness or ocular defects and where transmission is by autosomal dominant inheritance. We present the case histories of four family members and describe the molecular analysis performed in order to seek a possible linkage to one of the genes causing Alport or Alport-like syndromes.
Methods: We investigated all family members over the age of 18 for evidence of renal failure. We also extracted DNA and carried out molecular linkage analysis with polymorphic markers in each of the known loci involved in Alport and Alportlike syndromes.
Results: Histology of the renal biopsy specimens showed non-specific findings. Linkage was excluded for all the Alport and Alport-like syndrome loci.
Conclusions: The condition suffered by several members of this family seems to represent a unique autosomal dominant type of progressive hereditary nephritis, characterized by hypertension and progressive renal failure without significant hematuria or proteinuria. The main histological changes are non-specific in the early stage of the disease. Our study rules out all the currently known genes that cause Alport syndrome as being responsible for the basic defect in this type of nephritis.
Daniel Chemtob, MD, MPH, DEA, Leon Epstein, MD, MPH, Paul E. Slater, MD, MPH and Daniel Weiler-Ravell, MD
Background: Spinal dural arteriovenous fistulae comprise the majority of spinal vascular malformations. The most common clinical presentation is that of progressive myeloradicuiopathy, probably related to venous hypertension, which may lead to permanent disability and even death.
Objective: To report our clinical experience with spinal dural arteriovenous fistulae.
Methods: Nine patients with spinal dural AVF were managed at our center during a one year period (1998-1999). The patients, eight men and one woman ranging in age from 46 to 75 years, presented with initially fluctuating and eventually permanent and progressive paraparesis, sensory disturbances and sphincter dysfunction. The neurological signs generally began symmetrically and progressed from the distal to proximal limb regions. The duration of symptoms before diagnosis ranged from 6 to 36 months during which the patients underwent an extensive but fruitless work-up and even unnecessary operations due to misdiagnosis. All patients finally underwent magnetic resonance imaging and spinal angiography, which demonstrated the pathological vascular fistula. Interruption of the AVF was achieved by embolization or by surgical resection.
Results: Following treatment, six patients experienced improvement of gait and sphincter control, and the severe neurological deficits stabilized in the other three patients with long duration of illness. There was no further deterioration in any of the treated patients.
Conclusions: The history, neurological findings and radiological changes on MRI scan should alert clinicians to the possibility of spinal dural AVF, leading to diagnostic spinal angiography. Early diagnosis and treatment may significantly improve outcome and prevent permanent disability and even mortality.
Pesach Shvartzman, MD, Howard Tandeter, MD, Aya Peleg, MD, Hava Tabenkin, MD, Nakar Sasson, MD and Jeffrey Borkan, MD, PhD
Background: Lower urinary tract symptoms are highly prevalent in older men, have been shown to affect men’s quality of life, and may be associated with more serious outcomes.
Objectives: To determine the prevalence of LUTS among men aged 50 years or older registered at family practice centers in Israel and to assess the effect of these complaints on different aspects of their life.
Methods: In a random sample cohort of men aged 50 years and older, fluent in Hebrew, drawn from those registered in four family clinics in Israel, patients identified with LUTS were interviewed by phone using a structured questionnaire.
Results: The prevalence of LUTS in our study was 21%. Less than a third of these patients had low severity LUTS (28%), 59% were rated moderate, and 13% had severe symptoms. Age had a positive correlation with the severity of LUTS, and increasing severity of symptoms had a negative effect on the daily function and quality of life of patients.
Conclusions: Our community-based study shows that LUTS is a common finding among men above the age of 50 (21%) and has a significant negative effect on their quality of life and daily function. Knowledge of these data should make primary care physicians more aware of this common problem and thus improve the treatment and quality of life of these patients by better identification and prompt treatment.
Yosef S. Haviv, MD and Jerry Blackwell, PhD
Michael Mullerad, MD, Tzipora Falik, MD, Ralph Madeb, MD and Ofer Nativ, MD