Esophagogastric mucosal junction (EGMJ): its location as measured by endoscopy.

The "esophageal" length, i.e., incisors-esophagogastric mucosal junction distance, was measured endoscopically in 758 patients, retrospectively. Two hundred twenty-five additional patients were evaluated prospectively and their height and weight were measured. All patients were analyzed according to their age and sex, indication for the procedure, and its endoscopic diagnosis. "Esophageal" length was found to be significantly longer in male patients. Fifty-three percent of the examined population had "esophageal" length shorter than 38 cm, whereas 99% of patients with normal endoscopy had "esophageal" length of 38-40 cm. Linear correlation was found between "esophageal" length and height, but not with weight. Patients with dyspepsia and esophagitis had a "shorter" esophagus, whereas those with tumors of the upper gastrointestinal tract and those with duodenal ulcer had a "longer" esophagus.

Vaccination against hepatitis B in a general hospital in Israel: antibody level before vaccination and immunogenicity of vaccine.

We offered hepatitis B vaccine (Heptavax B) to 809 of the health care personnel of a 650-bed regional hospital; 290 accepted the offer. Anti-HBs measurement was done by enzyme immunoassay (AUSAB EIA, Abbott, UK) and expressed in mIU/ml. Seroconversion was determined at a level of 2.1 mIU/ml. Of 290 employees 58 (20%) were found positive for hepatitis B antibodies before vaccination. Of the laboratory technicians, 40.9% were found positive for antibodies before vaccination, as were 26.5% of nurses and 10.9% of physicians. Among vaccine recipients 35.8% responded after the first dose, 86.6% after the second and 92.7% after the third. Seventeen workers (7.3%) were nonresponders, of whom 14 received the whole vaccine series. There was no difference in immune responses to the vaccine between men and women. The present study confirms the relatively high prevalence of HBV infection in health care workers. Furthermore, vaccination of employees has been highly effective and well tolerated. The present data, therefore, support the introduction of active vaccination against HBV in health care workers in Israel.

Appreciation of pain in the elderly.

Pain was evaluated in 333 duodenal ulcer patients, and 86 myocardial infarction patients by the verbal rating scale method. We compared older patients (greater than 65 years of age) to younger controls and found a highly significant association between old age with mild pain and young age with moderate or severe pain in both diseases. We investigated two totally different diseases and got similar results. Thus, it could be concluded that age itself might be the underlying reason for the association with pain severity and not the character or origin of the pain.

Amniotic fluid components and changes due to storage conditions.

The composition of amniotic fluid was found to vary in dependence on storage conditions. Catalytic concentrations of creatine kinase and lactate dehydrogenase were considerably decreased after storage at -20 degrees C, and the decreases were less marked after storage at -70 degrees C. Other analytes were more stable. Consequently, the optimal storage conditions for amniotic fluid samples may differ for various analytes. The low inter-individual variability of some analytes (Na, K, Ca, Cl) suggests that their concentrations are homeostatically controlled during the gestational period studied. In contrast, the high variability of enzyme activities may be due to more rapid quantitative changes during normal gestation; in addition, enzyme activities may be affected by certain pathological and non-pathological conditions of the fetus.

Acute exacerbation of bronchial asthma in children associated with afternoon weather changes.

We studied the effect of the weather on acute exacerbations of bronchial asthma in children by comparing records of 8,657 admissions for five acute respiratory diseases (3,064 for asthma) with concurrent meteorologic data. These diseases were classified according to their interrelations and distinct meteorologic patterns into two groups: (1) acute asthma and acute laryngitis, which are correlated with the afternoon gradients of air temperature, heat content (the thermal energy of the ambient air), and modified heat content factor (the energy required to heat the air water vapor to the ambient temperature), but not correlated with the absolute values of air temperature and water content: and (2), bronchopneumonia/pneumonia and upper respiratory infections, which are correlated only with the absolute values of the meteorologic parameters (air temperature, water content, heat content, and modified heat content factor), but not with their afternoon gradients. Admissions for bronchiolitis revealed an age-related pattern: up to 1 yr they resembled Group 2 and from 1 to 2 yr, Group 1. It follows that the admission rates of acute exacerbation of bronchial asthma in childhood are linked both to the afternoon weather gradients and to some of the acute respiratory infections.

Hepatotoxicity induced by the Oriental hornet (Vespa orientalis) venom sac extract.

Experiments were performed to investigate the nature of the in vitro and human liver damage exposed to hornets' acute or repeated stings. The hornet investigated is the one ubiquitous in Israel - Vespa orientalis. Experiments were performed in living cats and rats, after single or multiple exposures to venom-sac extracts (VSE) and in various doses. The injury was demonstrated by the increased levels of enzymes, bile acids and cholesterol in serum. Also measured was Beta-N-acetyl hexosaminidase (BNAH) which probably is the only biochemical indicator available of Kupffer-cell function. This, too, was found increased. Other experiments consisted of perfusion of the isolated, intact, rat liver in situ with measurements of enzyme leakage into perfusate and of bile flow. Another set of experiments involved the effects of VSE on in vitro monolayer tissue culture of rat embryos' livers. We examined damage to organelles and compared the damage produced by intact VSE with that produced by the venom sac extract after treatment by heat or dialysis. Light morphology, special stains, electron microscopy and morphometry were all performed. In the first set of experiments no shock was observed in cats and rats exposed to VSE. The increases in enzymes' activity in serum and liver perfusion fluid were significant. Histochemistry indicated decrease of hepatic glycogen and of cellular succinic dehydrogenase as well as hepatic fat infiltration and an increase of alkaline phosphatase activity in liver cells close to the bile capillaries.(ABSTRACT TRUNCATED AT 250 WORDS)

Hepatotoxic effects of repeated administration of oriental hornet (Vespa orientalis) venom.

Venom sac extract (VSE) of the Oriental hornet (Vespa orientalis) has been shown to exert a toxic effect on hepatic cells. The present work set out to examine its effect on liver cells using serum levels of a lysosomal hydrolase as a marker of injury in rats. Serum activities of beta-N-acetyl hexosaminidase (BNAH; EC 3.2.1.30) were found to be positively correlated with the number of treatments received by the rats. The maximal elevation occurred from the third to the sixth day and comprised a 2-3-fold increase over the control mean level. This enhancement effect was reversible. The rat envenomend for 2 wk showed 3.5 times as much BNAH activity as in control rats. Biochemical analysis revealed increased specific activity of the lysosomal enzyme in rats treated repeatedly with VSE.

Duodenal ulcer in the elderly.

Of 333 duodenal ulcer (DU) patients 75 (22.5%) were aged 65-93 years (study group). Ninety-two percent (306 patients) of the entire group were diagnosed endoscopically, and all were followed prospectively. In the study group of the older patients there were fewer smokers, but more patients used steroids and other nonsteroidal antiinflammatory drugs (NSAIDs) and had more arteriosclerotic heart disease than the younger control group. Presenting signs and symptoms were similar in both age groups, although painless upper gastrointestinal bleeding was more common in the elderly, and pain, when present, tended to be milder. Bleeding episodes were more prevalent in the older age group. Another difference between the groups was the larger incidence of concurrent gastric ulcer and DU observed endoscopically in the study population. Steroids and NSAIDs could be etiologically connected to bleeding in the older patients, as well as to their relative lack of pain. We conclude that DU in the elderly tended to present atypically and that pain was not the major symptom of activity. This places a different emphasis on diagnostic and therapeutic criteria.

Attitude of hospital personnel toward hepatitis B vaccination.

During a 1-yr period (November 1985-86), a free-of-charge vaccination program against hepatitis B was offered to 809 of the 1200 medical workers in a 650-bed general and regional hospital in Israel. Three hundred and eighteen (39.3%) accepted the offer and were vaccinated. The higher rates of acceptance were among cleaning personnel (96.3%) and student nurses (63.9%). The lower rates of acceptance were among physicians (46.5%) and nurses (24.9%). Different types of fear, as well as lack of knowledge, were the reasons responsible for 73.3% of all refusals. More specific and continuous health educational efforts among high-risk groups should be initiated for voluntary vaccination programs in Israel.

Intraocular pressure in cats is lowered by drops of hornet venom.

1. Nine cats were given an intravenous injection of the Oriental hornet (Vespa orientalis, Vespinae; Hymenoptera) venom sac extract (VSE) and seven cats had the same VSE administered as eye drops. 2. When injected intravenously, the hornet VSE decreased the intraocular pressure in both eyes sharply during the first 20 min and with a slower rate later on until the end of the 3 hr experiment. The intraocular pressure dropped to zero in some cases. 3. VSE eye drops decreased the intraocular pressure only in the treated eye, while in the second eye (left as a control) the intraocular pressure remained the same throughout the experiment. 4. The decrease in the intraocular pressure was sharp during the first 20 min and slowed down afterwards until the end of the experiment. 5. The intraocular pressure did not reduce to zero. 6. This study shows that the active components of the hornet venom which caused a decrease in the intraocular pressure can cross the cornea and exert a hypotensive effect in the eye.

Vertical banded gastroplasty for the treatment of morbid obesity.

We report the technique and results of vertical banded gastroplasty in 86 morbidly obese patients. At 12 months, the patients had lost a mean of 57% of their excess body weight; 36 months, they had lost 70%. The most severe early complication was perforation of the esophagus. Other complications included disruption of the vertical staple line in three cases and migration of the mesh band. We were able to achieve satisfactory weight reduction in all patients over a period of 36 months. In view of the good results, reduced morbidity, and absence of mortality, we feel that vertical banded gastroplasty is the surgical treatment of choice for morbid obesity at present.

Reactivity of IgM-rheumatoid factors of human, feline and bovine sera.

The reactions of IgM-rheumatoid factors (IgM-RFs) from human, feline and bovine sera were examined with their homologous monomeric IgGs and with IgGs of other species. Cross-reactivities with IgGs of other species were observed in each separate system. By the use of an enzyme-linked immunosorbent assay (ELISA), measurable differences in reactivities were obtained. The results suggest that IgM--RFs of human and feline origin recognize a similar determinant on the Fc region of IgG. A different moiety on the latter molecule appears to be involved in the reactivity of bovine IgM-RF.

Chylous ascites and chylothorax as presenting manifestations of stomach carcinoma.

Chylous ascites and chylothorax appeared as the presenting symptoms of metastatic carcinoma of the stomach in a 69-year-old male. Although in the last decade malignancies, predominantly lymphomas, have been responsible for most cases of spontaneous chylous ascites or chylothorax, carcinoma of the stomach was very rarely described as the cause of this entity. The criteria for diagnosis of chylous fluid and the etiology and treatment of this condition are reviewed.

Sarcoid nephrocalcinotic renal failure reversed by sodium cellulose phosphate.

A case of renal failure due to sarcoidosis with hypercalciuria and nephrocalcinosis is described. Prolonged treatment with inorganic absorbable phosphate significantly deteriorated the patient's renal function. After a sodium cellulose phosphate treatment, renal failure was completely reversed. We suggest that sodium cellulose phosphate is the treatment of choice in sarcoidotic renal failure induced by nephrocalcinosis.

Rheumatoid factors in natural retrovirus infections of the cat and cattle.

The occurrence of IgM-rheumatoid factors (RFs) was investigated in natural retrovirus infection of cats with feline leukaemia virus and of cattle with bovine leukaemia virus. IgM-RFs of polyclonal character were detected. No significant differences were observed between the amounts of IgM-RFs in the retrovirus-infected animals and their respective controls.

Intravesical chemotherapy of superficial bladder tumors in a controlled trial with cis-platinum versus cis-platinum plus hyaluronidase.

Twenty-three patients with superficial transitional cell carcinoma of the urinary bladder were randomized for intravesical chemotherapy with either cis-platinum or cis-platinum plus hyaluronidase, an enzyme promoting diffusion factor. Treatment was administered at 3-week intervals and checked for efficacy by repeated cystoscopies after every three instillations. Hematologic and biochemical tests were repeated prior to each treatment and, these, in additional to the cystoscopic findings, served for final evaluation of results and toxicity. The complete response rate was found to be superior with cis-platinum than with cis-platinum plus hyaluronidase. The complete plus partial response rates were equal in both groups. We conclude that the addition of hyaluronidase to cis-platinum revealed no superiority to cis-platinum alone, and both modes of treatment showed similar clinical efficacy as other drugs previously used for intravesical chemotherapy.

Septicemia due to Corynebacterium haemolyticum.

A 65-year-old man in generally good health presented with symptoms of sepsis and mental confusion. Corynebacterium haemolyticum was isolated from three blood cultures, and a significant increase in the titer of immunofluorescent antibodies to the infecting organism was observed. Antigen of C. haemolyticum was demonstrated by double immunodiffusion in samples of cerebrospinal fluid and urine. The patient recovered after i.v. administration of 20 Mu/day penicillin. This is, to the best of our knowledge, the third reported human infection with C. haemolyticum with involvement of the central nervous system.

Ceruloplasmin as a marker of neoplastic activity in rabbits bearing the VX-2 carcinoma.

The establishment of an experimental model with rabbits in which VX-2 carcinoma was implanted in the gastrocnemius muscle and subsequently successfully cured by a second tumor cell inoculation has been reported previously. Tumor growth and regression could be followed by manula palpation. The changes in serum ceruloplasmin (CP, EC 1.10.3.2) levels of individual rabbits during tumor development and regression were followed. CP levels increased 4- to 8-fold of normal during the progression of the malignant process, often before tumors could be detected by palpation. With tumor regression CP levels returned to normal. When metastasis developed, the CP levels remained high. This phenomenon seems to be related to the VX-2 carcinoma, since CP levels in rabbits challenged with various antigens and suffering from induced multiple s.c. abscesses did not change significantly, while in pregnant rabbits CP levels increased up to at most 3-fold. It is concluded that serum CP level can serve as a reliable biochemical marker of the activity of this malignant process. The practical application of this finding lies in the follow-up of malignant processes in humans and is now under investigation.