• כרטיס רופא והטבות
  • אתרי הר"י
  • צרו קשר
  • פעולות מהירות
  • עברית (HE)
  • מה תרצו למצוא?

        תוצאת חיפוש

        דצמבר 1999

        ששון נקר, שלמה וינקר, יעקב אור, מרדכי שדל, יוסי נייגו וגבריאל פלוטקין
        עמ'

        Referrals and Self-Referrals to an Emergency Department

         

        Sasson Nakar, Shlomo Vinker, Yaacov Or, Mordechai Schadel, Yosi Niego, Gavriel Plotkin

         

        Central District of General Sick Fund and Family Medicine Dept., Sackler Faculty of Medicine, Tel Aviv University, and Emergency Dept., Kaplan Medical Center, Rehovot (Affiliated with Hebrew University-Hadassah Faculty of Medicine, Jerusalem)

         

        The Israeli health system has been undergoing major changes in recent years. Considerations of cost containment have led sick funds to open new out-of-hours services in the community to reduce visits to hospital emergency departments.

        Referred and self-referred visits to our emergency department during a 1-month period were studied. Patients after trauma or whose visits resulted in hospitalization were excluded. Of the 505 encounters 56.3% were of women; the average age was 52.5±19.3 years (range 18-96). 57.4% visits were during working hours of primary care clinics ("working hours"), while the others were "out-of-hours" visits. Only 52.7% had a referral letter, 75% of them from the family physician. The quality of the handwriting in 46% was good, in 44% fair and the remaining 10% were illegible. A specific clinical question was asked in only 16% of the letters. A third of "working-hours" visits were self- referrals, rising to 64% in "out-of-hours" visits (p<0.001).

        The most common diagnoses in discharge letters were: chest or abdominal pain, asthma, back pain, headache, nephrolithiasis and upper respiratory tract infection. The rate of self-referrals was relatively high throughout the day. Cost-containment efforts did not seem to eliminate self-referrals with "primary care" problems. The quality of referral letters should be improved both with regard to format and content.

        יצחק שושני, נבות גבעול ושלמה טייכר
        עמ'

        Sport-Related Maxillofacial Fractures

         

        Yitzhak Shoshani, Navot Givol, Shlomo Taicher

         

        Dept. of Oral and Maxillofacial Surgery, Sheba Medical Center, Tel Hashomer and Faculty of Dental Medicine, Tel Aviv University

         

        The records of 537 patients with 750 maxillofaciafractures were reviewed and analyzed. 55 (10.2%) had sport-related injuries and the rest were due to othercauses. The sport-related group was predominantly male (ratio 9:1) with a mean age of 24.5 years. The mandible was most commonly injured (52.5%), followed by the zygomatic complex (32.8%). The incidence of complicated mid-facial fractures was only 2.8%, and of comminuted fractures 9%. This distribution of injuries is most likely due to the relatively low-energy of trauma associated with many sport activities. The relatively low mean age of the patients, most of whom had full dentition, allowed for conservative treatment of most of the mandibular fractures, using closed reduction.

         

        Injuries were caused by 11 different sports. The highest incidence was soccer (45%), followed by skating (15%), basketball (9%) and horse-riding (9%). Contact sports were the cause of injuries in 72.2%, with the highest incidence of trauma due to impact with another player (60%). Better protection of the oral and maxillofacial region is needed, especially during high-contact sport.

        נובמבר 1999

        עידו וולף ומאיר מועלם
        עמ'

        Multiple Organ Damage due to Cholesterol Embolization

         

        Ido Wolf, Meir Mouallem

         

        Dept. of Medicine E, Sheba Medical Center, Tel Hashomer, and Sackler Faculty of Medicine, Tel Aviv University

         

        Cholesterol crystal embolization can affect multiple organ systems and mimic other systemic diseases. We describe a 65-year-old woman who had renal failure, diarrhea, transient ischemic attacks and purple toes due to spontaneous cholesterol crystal embolization.

        יוני 1999

        ח' סמו, צ' צבס, א' גושן, ש' לבנקרון וא' אדונסקי
        עמ'

        Sacral Insufficiency Fractures - A Frequent Cause of Low Back Pain in Elderly Women

         

        H. Semo, Z. Zwas, A. Goshen, S. Levenkrohn, A. Adunsky

         

        Depts. of Geriatric Medicine and Nuclear Medicine, Sheba Medical Center, Tel Hashomer

         

        Sudden low back pain is common in elderly women. It causes physical and mental stress, and results in deterioration of functional movement and in activities of daily living. Awareness of possible sacral insufficiency fracture is important; they may be demonstrated by imaging modalities, mainly radionuclide bone scan. Prognosis is good and accurate diagnosis serves to exclude malignancy and relieve fear of chronic pain and disability. We describe 4 women, aged 84, 82, 71 and 77 who illustrating the clinical and imaging findings of this disorder.

        ינואר 1999

        אהוד לבל ומנחם יצחקי
        עמ'

        Lymphoma of the Knee Joint Simulating Patellar Fracture

         

        E. Lebel, M. Itzchaki

         

        Orthopedics Dept., Shaare Zedek Medical Center, Jerusalem

         

        Fracture of the patella is not uncommon after direct anterior knee trauma. However, there are other medical situations that resemble it radiologicaly. We present a patient mistakenly diagnosed as having a patellar fracture who had primary, solitary, malignant B-cell lymphoma of the knee space eroding the lower pole of the patella. We have found no reports of such a lesion in the literature. Another commbenign condition that might erode adjacent bone is chronic synovitis. Our patient was treated withchemo- and radiotherapy and the lesion fully regressed with no evidence of local or systemic recurrence 1.5 years after diagnosis.
         

        א' אורנוי, ס' שכטמן וג' ארנון
        עמ'

        The Israel Teratogen Information Service: A 10-Year Report 


        A. Ornoy, S. Shechtman, J. Arnon

         

        Hebrew University - Hadassah Medical School and Israel Ministry of Health, Jerusalem

         

        The Israel Teratogen Information Service (TIS) was established 10 years ago with the help of the Ministry of Health and the Hebrew University-Hadassah Medical School. During these 10 years we have had 20,631 calls. We describe the results of our experience in counseling.

        There was a gradual increase in the number of calls, which in 1997 reached 4,447. Most calls (84.5%) were during pregnancy, while 12% were prior to pregnancy. In 75.7% the calls were due to drug exposure during pregnancy; 10.9% were due to exposure to X-rays; there was maternal infection in 6.6% and in 5% immunization during pregnancy. The callers were: physicians in 46.6%, nurses 18.9%, pregnant women 39.5%, and 4.8% others.

        In 76.6% there was no additional risk to the embryo or fetus and in 17.4% there was a small additional risk of less than 1%; a significant additional risk to the fetus was expected in only 6%. In 3625 pregnant women with known outcome there were 8.9% spontaneous and 9.2% induced abortions. Of the 2968 live-born children, 2.3% were malformed, a rate similar to that among controls.

        The information provided by the TIS alleviated the fears most pregnant women have, and reduced unnecessary terminations of pregnancy planned because of unjustified fear of the teratogenic effects of agents to which women were exposed. It reduced the number of children born with congenital anomalies, since pregnancies were interrupted whenever there was a high risk for congenital anomalies.

        דצמבר 1998

        ה' פרוינד, י' שיפמן, נ' בגלייבטר וי' השכל
        עמ'

        Thoracoscopic Surgery for Spon-Taneous Pneumothorax

         

        H.R. Freund, O. Zamir, Y. Shifman, N. Beglaibter, Y. Haskel

         

        Hadassah University Hospital, Mount Scopus and Hebrew University-Hadassah Medical School, Jerusalem

         

        We report our initial experience with thoracoscopic surgery in the treatment of spontaneous pneumothorax in 14 patients, mean age 30.7 years. 7 were operated following 2 episodes of spontaneous pneumothorax, 6 after their first episode, and 1 after multiple episodes.

         

        All underwent bleb resection, pleurodesis and tube thoracostomy; in 1 we converted to a limited thoracotomy (93% success rate). Only oral analgesia was required for postoperative pain control and patients were discharged 2.6 days after surgery, on average.

         

        The apparent superiority of thoracoscopic over conventional, even limited, thoracotomy seems to justify such therapy even during the first episode.

        נובמבר 1998

        י' קלוגר, י' פז, נ' גברט, ב' שגיא וא' קרמר
        עמ'

        Open Reduction and Internal Sternal Fracture Fixation

         

        Y. Kluger, Y. Paz, N. Gebart, B. Sagie, A. Kremer

         

        Rabin Trauma Center and Dept. of Cardiothoracic Surgery, Tel Aviv-Souraski Medical Center and Sackler Faculty of Medicine, Tel Aviv University

         

        We describe a 63-year-old woman who sustained a sternal fracture after a motor vehicle crash. Due to persistent pain, open reduction and internal fixation of the sternal fracture were performed; recovery was uneventful.

        ניר הילזנרט, עידית ליברטי ולונה אבנון
        עמ'

        Spontaneous Internal Jugular Vein Thrombosis Complicating Chronic Pulmonary Disease

         

        Nir Hilzenrat, Edit Liberty, Luna Avnon

         

        Depts. of Medicine B and E, and Pulmonary Disease Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheba

         

        Spontaneous internal jugular thrombosis is a rare vascular disorder. It usually occurs as a result of external pressure due to a tumor, infection or as a result of damage to the vessel wall after trauma or central venous catheterization. We report a 35-year-old woman who suffered from severe pulmonary hypertension due to chronic cystic lung disease. She was admitted due to sudden, severe, right-sided neck pain. Internal jugular occlusion by a thrombus was demonstrated by ultrasound and CT-scans but no apparent cause was found. We postulated that the important factors in the development of her thrombosis were stasis due to pulmonary hypertension and high blood viscosity.

        אוגוסט 1998

        שלמה וינקר, ששון נקר, זהבה אלון, חאמד אבו-עמר, גד סדובסקי ואיתן חי-עם
        עמ'

        Urgent, Unscheduled Self-Referrals by Ambulatory Patients

         

        S. Vinker, S. Nakar, Z. Alon, H. Abu-Amar, G. Sadovsky, E. Hyam

         

        General Sick Fund, Central District and Dept. of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University

         

        Direct self-referral to a consultant is common in the Israeli health system. Yet patients' reasons for their urgent, unscheduled self-referrals for ambulatory consultations (UUSR) have not been explored. We studied such consultations in an urban multi-disciplinary consultation center serving a population of approximately 100,000. Over a 3-month period such consultations in ophthalmology, ear-nose-and-throat and dermatology clinics were treated by a duty family physician (FP). The FP was instructed to focus on the urgent complaint and either to give definitive treatment and schedule a consultation when needed, or refer the patient for immediate specialist consultation. Patients treated by the FP were asked to fill an anonymous questionnaire, which 347/645 (55.4%) did.

         

        Among the reasons for UUSR were that the patient thought that his/her complaints should be treated by a consultant (29%), the patient was sent by the FP without a consultation note (13.9%), the FP was not available (10.4%), or the patient wished to see the consultant for a second opinion (8.2%). In only 7.8% had the patient noted that his complaint needed urgent consultation. Duration of complaints, but not prior efforts to schedule a consultation, were associated with different reasons for asking for an UUSR. For various reasons patients preferred an UUSR rather than seeing their own FP. Patients' opinions regarding self-referrals are important in planning primary care facilities and FP training.

        יוני 1998

        נחום רוזנברג ושלום שטהל
        עמ'

        Osteoid Osteoma of the Hand: a Rare Location

         

        Nahum Rosenberg, Shalom Stahl

         

        Dept. of Orthopedics A, and Hand Surgery Unit, Rambam Medical Center, Haifa

         

        Osteoid osteoma is a benign bone tumor. It is rare in the hand where it may cause local swelling and pain. Marginal resection is almost always curative, without residual functional disability. Because it is rare in this location, osteoid osteoma is not usually considered in the differential diagnosis of painful lesions of the hand, which may delay treatment. Osteoid osteoma in the hand has characteristic clinical, roentgenologic and scintigraphic features. Early diagnosis of this lesion may be improved by recognition of these features. An algorithm for decision-making that may help is proposed. We describe our experience in 3 cases involving, respectively, the capitate bone, a proximal, and a distal phalanx, in which cases marginal resection was curative.

        ר' אברהמי, מ' חדד, ס' וטמברג, א' שטלמן, א' קורן, ג' דהן וא' זליקובסקי
        עמ'

        Popliteal Vascular Trauma

         

        R. Avrahami, M. Haddad, B. Watemberg, E. Stelman, A. Koren, J. Dahn, A. Zelikovski

         

        Dept. of Vascular Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva

         

        6 cases of popliteal vascular trauma are presented, 3 due to posterior dislocation of the knee and 3 due to crush injury. The patients were referred from another hospital and some had undergone unnecessary angiography when ischemia was present, leading to delay in surgery. All patients presented with distal ischemia and underwent reconstructive surgery; 2 subsequently underwent below-knee amputation because of irreversible ischemia and sepsis.

         

        Urgent operation for popliteal vascular trauma is necessary whenever there is ischemia and intraoperative angiography may be necessary. There should be reconstruction of the artery and vein when there is concomitant venous damage, and fasciotomy and debridement are important. The harmful potential of occult popliteal vascular injuries and their ostensible mild presentation present a challengfor the emergency room surgeon.

        מאי 1998

        דניאל לוין וחיים צינמן
        עמ'

        Importance of Internal Fixation for Talar Neck Fractures

         

        Daniel Levin, Chaim Zinman

         

        Orthopedic Dept. B, Rambam Medical Center and Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa

         

        Fracture of the talus, which articulates with 4 other bones in the ankle and foot, must be properly diagnosed, classified and treated to avoid the common complications of post-traumatic osteoarthritis and avascular necrosis. Knowledge of blood supply and anatomy is imperative, since the surgical approach must not damage the few vascular structures that remain intact after the trauma. We present 5 cases of fractures at the neck of the talus. All underwent internal fixation, 1 after closed reduction and 4 after open reduction. In all the results were satisfactory, although 1 patient developed avascular necrosis of the talar body.

        מ' קליגמן ומ' רופמן
        עמ'

        Conversion Total Hip Replaceafter Failed Internal Fixation of Intertrochantric Fracture

         

        M. Kligman, M. Roffman

         

        Dept. of Orthopedic Surgery, Carmel Medical Center, Haifa

         

        Between 1933-1995, 16 patients underwent conversion-total hip replacement after internal fixation of an intertrochanteric fracture failed. Clinical results were unsatisfactory compared to primary total hip replacement. There was a high incidence of intra- and postoperative complications, including femoral fracture, wound infection, and aseptic loosening. This study should increase the surgeon's awareness of the difficulties encountered in conversion of failed intertrochanteric fractures to total hip replacement.

        דניאל לזר, נעמי וינטרוב, נטלי אברמוב, שרה אסא, קונסטנטין בלוך, רגינה אופן, הדסה בן-זקן ופנינה ורדי
        עמ'

        Islet Autoantibody Assays in Type I Diabetes can Replace ICA Test

         

        Daniel Lazar, Naomi Weintrob, Natalia Abramov, Sara Assa, Konstantin Bloch, Regina Ofan, Hadassa Ben-Zaken, Pnina Vardi

         

        Institute for Pediatric Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva and Felsenstein Medical Research Center, Tel Aviv University

         

        Islet cell antibodies (ICA) continue to serve as the basis of the principal serological test for definition of active autoimmunity of beta-cells. Its disadvantages are the need for human pancreatic tissue and difficulty in obtaining quantitative results. In the past decade biochemically-defined beta-cell antigens were described, leading to the development of sensitive and specific autoantibody assays, to predict insulin-dependent diabetes mellitus (IDDM). We examined the value of combined biochemically-based serological assays, such as autoantibodies to insulin (IAA), glutamic acid decarboxylase (GADA) and ICA512 (ICA512A) to replace the traditional ICA assay.

        Blood samples of 114 newly diagnosed IDDM patients, aged 12‏5 yrs (range 2 months - 29 years) were tested for ICA (indirect immunofluorescence), IAA, GADA and ICA512A (radiobinding assay). The latter 2 assays were performed using recombinant human [35S]-labeled antigen produced by in vitro transcription/translation. We found that fewer sera scored positive for ICA and/or IAA (80.7%, 92/114) than for 1 or more of IAA, GAD, or ICA512 (88.6%, 101/114). We conclude that combined testing for IAA, GAD and ICA512 can replace the traditional ICA/IAA test to predict IDDM and is helpful in the differential diagnosis of insulin-dependent and noninsulin-dependent diabetes.

        הבהרה משפטית: כל נושא המופיע באתר זה נועד להשכלה בלבד ואין לראות בו ייעוץ רפואי או משפטי. אין הר"י אחראית לתוכן המתפרסם באתר זה ולכל נזק שעלול להיגרם. כל הזכויות על המידע באתר שייכות להסתדרות הרפואית בישראל. מדיניות פרטיות
        כתובתנו: ז'בוטינסקי 35 רמת גן, בניין התאומים 2 קומות 10-11, ת.ד. 3566, מיקוד 5213604. טלפון: 03-6100444, פקס: 03-5753303