[Toxic hepatitis due to the use of Ruta herbal medicine].

In recent years, the use of herbal medicine by the general population is increasing. There are many known side effects resulting from these treatments. Despite the known side effects, physicians tend to neglect the anamnesis details regarding this issue and research budgets of these drugs are relatively low compared with conventional medicine, thus causing a lack of updated information. In this case report, we present an example of toxic hepatitis due to use of Ruta herbal medicine, an unfamiliar side effect of the common herbal medicine Ruta.

Sigh syndrome: is it a sign of trouble?

OBJECTIVE: The goal of this study was to identify the characteristics and clinical course of patients presenting with considerable stress regarding irrepressible persistent sighing, and to determine whether any association exists between this syndrome and respiratory or other organic disease, during the acute or follow-up period. STUDY DESIGN: We conducted a case series review of patients diagnosed with a defined symptom complex and gathered relevant data. POPULATION: Forty patients who presented to 3 family practice clinics in Israel met our 10 criteria for sigh syndrome: recurrent sighing; shallow respiration; conviction that deep breaths are obstructed; intensity of episodes provokes stress leading to consultation; no obvious trigger; episodes last a few days to several weeks; no interference with speech; sighing absent during sleep; no correlation with physical activity or rest; self-limited. OUTCOMES MEASURED: We assessed demographic and health status information, as well as recent circumstances that could have served as triggers for the symptoms. We also performed systematic diagnoses of acute or chronic organic disease. RESULTS: Physicians diagnosed "sigh syndrome" in 40 subjects (19 men [47.5%], 21 women [52.5%]), mean age 31.8 years, during the 3-year study period. All patients conformed to 10 sigh syndrome criteria. In 13 patients (32.5%), a significant traumatic event preceded onset of symptoms. Ten (25%) had previous anxiety or somatoform-related disorders. For 23 patients (57.5%), the episode repeated itself after the initial event. We found no association in any of the cases with any form of organic disease. Likewise, during the follow-up period (on average, 18 months), we did not observe the development of a specific organic disorder in any case. CONCLUSIONS: The "sigh syndrome" runs a benign course; it mainly demands the support and understanding of the treating physician to allay any patient concerns.

Target organ damage in hypertensive patients of different ethnic groups.

BACKGROUND: Hypertension is associated with involvement of target organs which varies among the different ethnic groups. The multiplicity of the population in Israel offers an opportunity for evaluating target organ damage in hypertensive patients of different ethnic origins. METHODS AND RESULTS: Data were collected from the computerized medical files of hypertensive patients in primary care clinics. The analysis was done on 576 hypertensive patients: 138 Bedouins (Arab residents), 141 Sephardic Jews (immigrants from North Africa and the Middle East), 152 Asian-Indian Jews (immigrants from India) and 145 Ashkenazi Jews (immigrants from Europe and North and South America). In multivariable logistic regressions adjusted for known risk factors and ethnicity, the prevalence of cerebrovascular disease was the highest among the Asian-Indian Jews (OR=3.09, p value=0.009). Renal damage was highest among the Bedouins (OR=4.54, p value<0.0001) and Asian-Indian Jews (OR=2.88, p value=0.005). The differences in the prevalence of renal damage among the various ethnic groups were even more pronounced among patients without diabetes (OR=8.31, p value<0.0001 in Bedouins and OR=7.46, p value=0.001 in Asian-Indian Jews). The prevalence of ischemic heart disease did not differ significantly among the four ethnic groups. CONCLUSIONS: The prevalence of cerebrovascular and renal diseases are both significantly associated with ethnic origin of Asian-Indian Jews and Bedouins. However, the multivariate analysis shows that the prevalence of ischemic heart disease is not associated with ethnicity.

The subcutaneous loop: a single suture technique for skin closure after superficial and subcutaneous surgery.

BACKGROUND: Removal of subcutaneous skin masses and certain deep skin injuries results in defects, which demand immediate closure. Although primary closure of these defects in 2 layers is an acceptable solution, this technique has a number of drawbacks, such as extended time consumption upon performance, demand for additional suture material and occasional tissue response or foreign body reaction to retained absorbable stitches leading to infection and its sequelae. OBJECTIVE: We describe an approach intended to furnish a satisfactory solution to the needs of tissue closure in such cases. The significant innovation of this technique is the closure of both deep and superficial layers of skin in one single suture. MATERIALS AND METHODS: Our suture combines the advantages of the classic mattress suture together with those of the buried subcutaneous suture. We performed the vertical mattress suture with 3/0 polypropylene or monofilament suture and added a subcutaneous loop to achieve sufficient approximation of deep tissue surfaces. This suture technique was applied in our first 50 cases. The defects were closed without adverse sequelae. No tissue infections were observed. Wound dehiscence occurred in one case after premature suture removal. The stitches were slightly more difficult to remove than regular sutures. Review of the resulting scars exhibited acceptable results similar to those of parallel closure techniques. CONCLUSIONS: This easily performed technique yields the benefits of reducing suture cost, annulling foreign body reaction, and resulting in both a functional and aesthetically pleasing outcome. The subcutaneous loop technique has become our standard closure of choice for wounds demanding simultaneous cutaneous and subcutaneous repair.

Neuropathic scrotal pruritus: anogenital pruritus is a symptom of lumbosacral radiculopathy.

BACKGROUND: Anogenital pruritus is defined as an itch localized to the anus, perianal, and genital skin. Anogenital pruritus is usually a symptom of an underlying disorder of the skin or mucosa or a consequence of anorectal pathology. When no demonstrable cause is found, anogenital pruritus is often described as "idiopathic". OBJECTIVE: To investigate the role of lumbosacral radiculopathy in the pathogenesis of anogenital pruritus. METHODS: Included in the study were consecutive patients with anogenital pruritus. Radiographs and nerved conduction studies were performed in all patients. Needle electromyography studies and computerized tomography were performed when necessary. Nerve conduction studies included measurement of distal sensory and motor latency, conduction velocity, and F-responses of the peroneal and tibial nerves. Patients with confirmed radiculopathy were treated with paravertebral injection of a mixture of triamcinolne acetonide and lidocaine. Response to the injections was assessed using visual analogue scales by the patients. Mean scores before and after treatment were compared using paired t tests. RESULTS: Included in the study were 20 patients with anogenital pruritus. There were 18 men (90%) and 2 (10%) women. The mean age was 52.7 years (standard deviation [SD] 11.7 years). In 16 patients (80%), radiographs demonstrated degenerative changes of the lower spine. In 16 patients (80%) the presence of lumbosacral radiculopathy was confirmed by nerve conduction studies. Fifteen patients (75%) were treated with paravertebral injections, with significant decrease in mean pruritus score as assessed by the patients (6.3 [+/-2.8]; 4.5 [+/-2.7], before and after treatment, respectively, P = .033). CONCLUSION: "Idiopathic" anogenital pruritus may be attributable to lumbosacral radiculopathy. Paravertebral blockade may be used for alleviation of symptoms in patients with anogenital pruritus.

Office treatment of congenital ankyloglossia.

BACKGROUND: Congenital oral adhesions may pose both aesthetic and functional disturbing ailments to wary parents. Most of these as we have experienced, are benign, easily cured and may be treated as soon as possible in the office. A local survey elucidated that these youngsters are usually advised to wait until one year of age and then taken into the operating room and incision of the adhesion is performed under general anesthesia. We assessed the benign nature of this ailment and relative avascularity of the tissue involved and concluded that with minimal risk an office procedure under local anesthesia can replace current practice. We also found that most referrals with this condition present with the lowest grade of severity of ankyloglossia, amenable to a very brief intervention. MATERIAL/METHODS: During the period 1998-2002 we diagnosed nineteen congenital lesions in thirteen patients. All children were treated in a community clinic setting using electrocautery under local anesthesia. Surgical success was defined as significant improvement in the ability to protrude the tongue outwards beyond the gums and teeth. Gingival adhesions were judged by release of soft tissue adhesions. RESULTS: Tongue Surgical success was accomplished in all cases with minimal discomfort and without complications. In one single case the previous functional limitation was not relieved. CONCLUSIONS: Our experience indicates that office-based electrocautery dissection is an efficacious economical and safe treatment of mild congenital oral adhesions. We recommend this method as therapy of choice for such lesions.