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עמוד בית
Sat, 20.07.24

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April 2019
Noam Rosen MD, Ofir Chechik MD, Yariv Goldstein MD, Oleg Dolkart PhD, Gavriel Mozes MD, Ofer Rak MD, Alison Dalich BSc, Yossi Geron MD and Eran Maman MD

Background: The number of patients undergoing shoulder arthroplasty is increasing yearly.

Objectives: To evaluate the results of a consecutive series of patients who underwent shoulder replacement for a variety of indications in a single medical center in Israel.

Methods: All shoulder arthroplasties performed in our institution between 2006 and 2015 were retrospectively reviewed. The functional outcomes and satisfaction of 180 shoulder arthroplasties were evaluated for objective and subjective parameters using the American Shoulder and Elbow Surgeons Shoulder Score (ASES), the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure, and the Short Form Health Survey (SF-12).

Results: The indications for surgery were osteoarthritis (n=35), rotator cuff arthropathy (n=32), fractures (n=99), and other reasons (n=14). The mean follow-up was 52 months. The scores improved markedly among the patients who underwent surgery later in the study period. The mean DASH score before 2012 was 48.8 and improved to 37.2 after 2013. The respective ASES also improved from 54.2 to 68.6. The use of hemiarthroplasty decreased from 85% to 33% as of 2013, while the use of total shoulder arthroplasty increased.

Conclusions: Shoulder arthroplasty represents an effective treatment modality with satisfactory functional outcomes. Our current study demonstrates a shift from hemiarthroplasty to total shoulder arthroplasty, with the number of procedures increasing yearly. Surgeon experience and the expanding volume of operations had a direct positive effect on the functional outcomes of shoulder arthroplasties.

January 2016
Yariv Goldstein MD, Oleg Dolkart PhD, Ehud Kaufman MD, Eyal Amar MD, Zachary T. Sharfman MSc, Ehud Rath MD, Gavriel Mozes MD and Eran Maman MD

Background: The popularity of bicycle riding for recreation, exercise and transportation has grown enormously in recent years, which has led to an increased incidence of bicycle-related injuries. While these injuries involve mainly the musculoskeletal system, data on shoulder-specific injuries incurred while bike riding are lacking. Classifying these shoulder injuries may provide insight and assistance in the creation and implementation of effective protective gear and measures. 

Objectives: To investigate the types and mechanisms of shoulder injuries among cyclists.

Methods: This study retrospectively examined all cyclists who incurred shoulder injuries while riding and were admitted to the emergency department and shoulder clinic between January 2008 and November 2013. The study included 157 subjects with various bicycle-related shoulder injuries treated with either conservative or surgical measures. 

Results: Eighty-four percent of injuries were caused by a direct blow to the shoulder, 7% by falling on an outstretched hand, 6% were traction injuries, and 3% were due to hyper-abduction. Nine different clinical types of injury were observed; the most common injuries were clavicle fractures (32%), followed by acromioclavicular joint dislocations (22%), rotator cuff tears (22%), and humeral fractures (8%). Fifty-one percent of subjects were managed with conservative care and the remaining patients required surgical interventions. 

Conclusions: The shoulder injuries incurred while riding a bicycle span the entire spectrum of shoulder injuries and often result in debilitating conditions. Although the use of helmets is increasing, there is currently no effective protective gear or measures to prevent riders from suffering shoulder injuries. 

 

June 2014
Ephraim Eviatar MD, Koby Pitaro MD, Haim Gavriel MD and Daniel Krakovsky MD

Background: Over the past 20 years, advances in endoscopic sinus surgery (ESS) techniques have led to widespread applications of this technology in both adult and pediatric populations with better results and lower morbidity.

Objectives: To update data regarding the rate of minor and major complications following ESS procedures that used powered instrumentation.

Methods: We retrospectively reviewed the charts of all patients who, with general anesthesia, underwent ESS utilizing powered instrumentation between January 1996 and December 2006. Age, gender, indication for surgery, length of hospitalization, and type and rate of surgical complications were recorded.

Results: A total of 1190 patients were included in our study (1309 surgeries). The male:female ratio was 1.7:1.0 and the average age was 39 years (range 4–86 years). The most common indication for surgery was chronic rhinosinusitis. The rate of major complications was 0.31% and that of minor complications 1.37%. The only major complication that occurred was cerebrospinal fluid leak. The minor complications included epistaxis, periorbital emphysema, ecchymosis and mucocele formation.

Conclusions: Compared to previously published series, the rate of major and minor complications in our study was low. The results indicate that the use of powered instruments during ESS is safe.

December 2009
A. Avriel, U. Fainberg, L. Fuchs, A. Jotkowitz, A. Smoliakov, L.S. Avnon and E. Shleyfer
February 2009
G. Sherman, L. Zeller, A. Avriel, M. Friger, M. Harari and S. Sukenik

Background: Balneotherapy, traditionally administered during a continuous stay at the Dead Sea area, has been shown to be effective for patients suffering from knee osteoarthritis.

Objectives: To evaluate the effectiveness of an intermittent regimen of balneotherapy at the Dead Sea for patients with knee osteoarthritis.

Methods: Forty-four patients with knee osteoarthritis were included in a prospective randomized single-blind controlled study. The patients were divided into two groups: a treatment group (n=24), which were treated twice weekly for 6 consecutive weeks in a sulfur pool heated to 35–36°C, and a control group (n=20) treated in a Jacuzzi filled with tap water heated to 35–36°C. Participants were assessed by the Lequesne index of osteoarthritis severity, the WOMAC index, the SF-36 quality of health questionnaire, VAS scales for pain (completed by patients and physicians), and physical examination.

Results: A statistically significant improvement, lasting up to 6 months, was observed in the treatment group for most of the clinical parameters. In the control group the only improvements were in the SF-36 bodily pain scale at 6 months, the Lequesne index at 1 month and the WOMAC pain score at the end of the treatment period. Although the patients in the control group had milder disease the difference between the two groups was not statistically significant.

Conclusions: Intermittent balneotherapy appears to be effective for patients with knee osteoarthritis.

March 2008
January 2007
avital avriel, daniel flusser, mahmoud abu shakra, sima halevi, shaul sukenik, avriel, flusser, abu shakra, halevi, sukenik, psoriasis, psoriatic arthritis, systemic lupus eythematosus
June 2005
A. Kessler, H. Gavriel, S. Zahav, M. Vaiman, N. Shlamkovitch, S. Segal and E. Eviatar
 Background: Fine-needle aspiration biopsy has been well established as a diagnostic technique for selecting patients with thyroid nodules for surgical treatment, thereby reducing the number of unnecessary surgical procedures performed in cases of non-malignant tumors.

Objectives: To evaluate the sensitivity, specificity, accuracy, and positive and negative predictive values of FNAB[1] in cases of a solitary thyroid nodule.

Methods: The preoperative FNAB results of 170 patients who underwent thyroidectomy due to a solitary thyroid nodule were compared retrospectively with the final postoperative pathologic diagnoses.

Results: In cases of a solitary thyroid nodule, FNAB had a sensitivity of 79%, specificity of 98.5%, accuracy of 87%, and positive and negative predictive values of 98.75% and 76.6% respectively. All cases of papillary carcinoma diagnosed by FNAB proved to be malignant on final histology, while 8 of 27 cases of follicular adenoma detected by preoperative FNAB were shown to be malignant on final evaluation of the surgical specimen.

Conclusions: FNAB cytology reduces the incidence of thyroidectomy since this method has excellent specificity and sensitivity and a low rate of false-negative results. It proved to be cost-effective and is recommended as the first tool in the diagnostic workup in patients with thyroid nodules.


 





[1] FNAB = fine-needle aspiration biopsy


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