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

        תוצאת חיפוש

        אפריל 1998

        חיים ביבי, ג'מאל מחמיד, דויד שוסיוב, מיכאל ארמוני, צביקה ליס, שלמה פולק ומנחם שלזינגר
        עמ'

        Fatal Asthma in Children: Preventable?

         

        Haim Bibi, Jamal Mahamid, David Shoseyov, Michael Armoni, Zvika Liss, Menachem Schlesinger

         

        Pediatrics Dept., Barzilai Medical Center, Ashkelon (Affiliated with the Faculty of Health Sciences, Ben-Gurion University of the Negev); Pediatric Intensive Care Unit, Bikur Holim Hospital, Jerusalem, and Kupat Holim Klalit, Darom District

         

        Sudden death from asthma is rare but occurs in the young age group. We recently faced this rare situation, when 3 asthmatic children were dead on arrival at the local emergency room. All 3 had been treated with beta-2 agonist inhalation on a regular basis, without anti-inflammatory treatment. 2 of the children died while inhaling the beta-2 agonist. It is important that there be clear guidelines and full education about the management of asthma, during and between exacerbations, to prevent such deaths.

        דורון מרקוביץ, מיכאל רוזנבאום, יצחק רוזנר ואלי רוטנשטרייך
        עמ'

        Chemical Synovectomy in Arthritis by Intra-Articular Injection of Osmic Acid

         

        D. Markovits, M. Rozenbaum, I. Rosner, E. Rottenstriech

         

        Dept. of Medicine A, Carmel Hospital; Rheumatology Unit, Bnai Zion Hospital; and Zevulun Medical Clinic, Haifa

         

        18 patients suffering from persistent synovitis despite medical therapy were treated with an intra-articular injection of osmic acid. After 1 year of follow-up, 68% had good results and there were no complications nor detectable radiographic evidence of disease progression. Because osmic acid is almost as effective as surgical synovectomy and is cheap and easy to administer, it can be recommended as the first choice for treatment of corticosteroid-resistant arthritis in the early stages of the disease.

        ישראל פריאל, רמה כץ וערן דולב
        עמ'

        Acute Hyperparathyroidism Caused by Hemorrhage into a Parathyroid Adenoma

         

        I.E. Priel, Rama Katz, E. Dolev

         

        Depts. of Medicine E and Radiology, Wolfson Medical Center, Holon and Sackler School of Medicine, Tel Aviv University

         

        Acute hyperparathyroidism is a rare and dangerous condition. It is supposed to result from transformation of a mild chronic form into an acute and stormy illness. The causes and the mechanism of such a transformation are usually unknown. A case of acute hyperparathyroidism is presented in which hemorrhage into a parathyroid adenoma was recognized and diagnosed as the immediate cause of the transformation from the mild long-standing form of the disease into the severe acute form.

        א' ירצקי, ק' ויגדר וי' פלדמן
        עמ'

        Nursing Home-Acquired Pneumonia: Guidelines for Hospitalization

         

        A. Yaretzky, C. Vigder, I. Feldman

         

        Geriatric Dept., Meir Hospital, Kfar Saba, and Sackler Faculty of Medicine, Tel Aviv University

         

        To determine if there are any specific features of nursing-home acquired pneumonia we carried out a retrospective study in a nursing home between 1995-1996, based on clinical and laboratory data. We found no correlation between these findings and the severity of pneumonia, so it would be hazardous to determine rigid guidelines. These patients should be treated in the nursing home as long as conditions allow, in order to avoid hospitalization.

        גריגורי-צבי יזרעאלב
        עמ'

        Delirium Tremens in Israel

         

        G.-Z. Ezrielev

         

        Mental Health Center, Beer Sheba

         

        We discuss pathogenetic aspects (biochemical, pharmacological) of delirium tremens (DT) in accordance with the acute clinical processes, the development of psychosis, and preventive treatment used in the various stages. A typical patient, a 33-year-old man, and the difficulties in diagnosis and treatment are presented and conclusions from the dangerous behavior of the patient are drawn.

        מרץ 1998

        א' כרמל, ה' עמיטל, י' שמר וא' שחר
        עמ'

        Clinical Characteristics of those who Leave the Emergency Room Against Advice

         

        A. Carmel, H. Amital, Y. Shemer, A. Sahar

         

        Emergency Dept. and Dept. of Medicine B, Gertner Institute for Medical Service Research, Chaim Sheba Medical Center, Tel Hashomer and Sackler Faculty of Medicine, Tel Aviv University

         

        The object of this study was to characterize those who leave the emergency department agmedical advice and to examine the short-term consequences. The study was conducted retrospectively 1992 and prospectively during May-August 1993 by telephone interviews. About 0.5% of all the patients who applied to the emergency department left against medical advice. Their main characteristic was that they were mostly young, single men. A wide range of complaints had brought them to the emergency department, very similar to that of the control group, but with a higher tendency to abuse drugs and alcohol. Most of those who left against medical advice had less severe disease than the controls. However 10% of them had to be hospitalized within the subsequent 2 weeks, in comparison with 4% of the controls. This study suggests that improving the efficiency of the emergency department will decrease the number leaving against advice.

        יורם שיר, ויקטור שולזון וגילה חזן
        עמ'

        Treating Hospitalized Children in Severe Pain with Oral Methadone

         

        Yoram Shir, Victor Shvelzon, Gila Rosen

         

        Pain Treatment Service, Dept. of Anesthesiology, Hadassah University Hospital, Jerusalem

         

        Pain relief is usually inadequate in hospitalized patients, especially in children, either after surgery or with various medical conditions. Among other reasons, this is due to suboptimal use of available analgesic drugs. In the past 2 years oral methadone has become our opioid of choice for severe pain in hospitalized children who can take oral medication. More than 70 babies and children, aged 8 months to 9 years, who suffered mainly from pain due to burns or cancer, were treated by the in-hospital pain service. They received 0.1% methadone syrup, 0.2-0.4 mg/kg/day, for from a few days to more than a month. In most there was significant pain relief with no serious side-effects. In some, treatment could be changed to parent-controlled analgesia after a few days, with no adverse effects. We describe 5 of the children who present the advantages of oral methadone over other opioids.

        יוסף רוזנמן, חיים לוטן, הישאם נסאר ומרוין ש' גוטסמן
        עמ'

        Percutaneous Revascularization of the Left Main Coronary Artery as Coronary Artery Bypass in High Surgical Risks

         

        Yoseph Rozenman, Chaim Lotan, Hisham Nassar, Mervyn S. Gotsman

         

        Cardiology Dept., Hadassah-University Hospital (Ein Kerem) and Hebrew University-Hadassah Medical School, Jerusalem

         

        Coronary artery bypass grafting is the treatment of choice for obstructive disease of the left main coronary artery. Its proximal location and easy accessibility make the left main artery an inviting target for percutaneous intervention, an approach contraindicated by the high associated risk. We describe 2 patients at high operative risk in whom the obstructed main coronary artery was successfully revascularized percutaneously. Coronary stenting and rotational ablation of calcified arteries are essential for successful outcome and minimize complications.

        יעקב גורביץ, יוסי פז, מנחם מצא, אמיר קרמר, דימיטרי פבני, אורן לב-רן, חיים לוקר ורפאל מור
        עמ'

        Skeletonized Internal Mammary Arteries for Coronary Bypass Grafting

         

        Jacob Gurevitch, Yosef Paz, Menachem Matsa, Amir Kramer, Dimitri Pevni, Oren Lev-Ran, H. Locker, Raphael Mohr

         

        Dept. of Thoracic and Cardiovascular Surgery, Sourasky-Tel Aviv Medical Center

         

        The skeletonized internal mammary artery (IMA) is longer, and its immediate spontaneous blood flow is greater than that of the pedicled IMA, thus providing increased versatility for complete, arterial myocardial revascularization without the use of saphenous vein grafts. From April 1996 to May 1997, 583 patients underwent coronary artery bypass grafting here and in 415 (71%) complete arterial revascularization was achieved using bilateral skeletonized IMA. The right gastroepiploic artery was used in 57 (13%); there were 329 males (79%) and 86 women (21%); average age was 64 (30-87) and 175 (36%) were older than 70; 131 (32%) were diabetics. Average number of grafts was 3.2 (range 2-6 grafts). At 30 days, 5 (1.2%) had died and there had been 6 perioperative infarcts (1.4%), 5 CVA's (1.2%), and 6 had sternal wound infections (1.4%). Up to 1-12 months of follow-up was achieved in 409 (99%). Late mortality was 1.4% (of which 3 were noncardiac). 394 (97%) were angina-free at latest follow-up. We conclude that arterial revascularization using bilateral skeletonized IMA is safe, as postoperative morbidity and mortality are low, even in old and diabetic patients.

        רון בן אברהם, מיכאל שטיין, יורם קלוגר, גדעון פרת, אברהם ריבקינד ויהושע שמר
        עמ'

        Israel's ATLS Program: Summary and Outlook

         

        Ron Ben Abraham, Michael Stein, Yoram Kluger, Gideon Paret, Avraham Rivkind, Joshua Shemer

         

        Medical Dept., Israel Defense Forces and Israel Trauma Society

         

        In recent years a vigorous effort has been made to improve quality of primary trauma care in Israel. Advanced trauma life support courses (ATLS) were given to physicians throughout the country, regardless of their specialties. In 7 years 4229 physicians participated in 202 courses with an average success rate of 76%. In the future, issues such as mandatory vs. voluntary training, language barriers, and continuous decline of knowledge should be addressed if momentum is to be maintained.

        ד' רוזין, מ' בן חיים, א' יודיץ וע' אילון
        עמ'

        Abdominal Compartment Syndrome

         

        D. Rosin, M. Ben Haim, A. Yudich, A. Ayalon

         

        Dept. of General Surgery and Transplantation, Chaim Sheba Medical Center, Tel Hashomer and SacSchool of Medicine, Tel Aviv University

         

        Abdominal compartment syndrome refers to a complex of negative effects of intra-abdominal hypertension. Its most common cause is complicated abdominal trauma. The syndrome includes mainly hemodynamic and respiratory manifestations but may involve other systems as well. It may present as a life-threatening emergency in the multi-trauma patient. Awareness of the syndrome may enable the surgeon to take preventive measures or to diagnose it earlier and to treat it effectively. We describe a 21-year old man who developed this syndrome after multiple gunshot wounds, with severe liver injury. After 2 operations the typical manifestations of the syndrome were diagnosed. He was re-operated to release intra-abdominal hypertension and then slowly recovered.

        ג'מאל זידאן, סלינה שטיירמן וחנה טורני
        עמ'

        Perisacral Angiosarcoma after Irradiation of Carcinoma of the Sigmoid

         

        J. Zidan, C. Stayerman, H. Turani

         

        Oncology Unit and Pathology Institute, Rebecca Sieff Hospital, Safed

         

        Secondary malignancy is a well-recognized complication of radiation therapy. The risk of postirradiation sarcoma in long-term follow-up is 0.03-0.8%. We report a case of radiation-induced perisacral angiosarcoma 6 years after pelvic irradiation for sigmoid cancer in a 77-year-old man. The tumor was diagnosed postmortem and was locally advanced and metastatic. He died 6 months after onset of symptoms. This case demonstrates the importance of long-term follow-up in those given radiotherapy.

        א' ביטון, ד' ורדי וס' נמיר
        עמ'

        Primary Dermatology Who is the Gate Keeper?

         

        A. Biton, D. Vardy, S. Naimer

         

        Regional Dermatology Clinic, Kupat Holim Clalit, and Ben-Gurion University of the Negev, Beer Sheba

         

        For several years health funds in Israel have allowed patients to see dermatologists, gynecologists, orthopedic surgeons and ENT specialists without being referred by their primary care physician. There is heated debate about whether this practice is justified and if it is cost effective. Is it better medicine for the patient? What are the roles of the primary care physician and of the primary dermatologist in the care of skin diseases? What do patients want? We examined the practices of 4 dermatology clinics and discuss the issues involved.

        פברואר 1998

        ח' סמו, א' אדונסקי וא' גרוסמן
        עמ'

        Orthostatic Hypotension as a Manifestation of Malignant Lymphoproliferative Disease

         

        H. Semo, A. Adunsky, E. Grossman

         

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

         

        An 85-year-old man was admitted with 6-month history of incapacitating orthostatic hypotension. Investigation led to the discovery of sympathetic dysautonomia, sensorimotneuropathy and malignant lymphoproliferative disease. Several attempts to treat the orhypotension or the neoplastic disease failed to improve his condition. Orthostatic hypotension precipitated by sympathetic dysautonomia may be an infrequent effect of early malignant lymphoproliferative disease.

        רון בן אברהם, נח ליברמן, צבי רם, סילביה קלמפנר ועזריאל פרל
        עמ'

        Propofol Anesthesia for Craniotomy in Patients who are Awake

         

        Ron Ben Abraham, Noah Lieberman, Zvi Ram, Sylvia Klempner, Azriel Perel

         

        Depts. of Anesthesia and Intensive Care and of Neurosurgery, Chaim Sheba Medical Center, Tel Hashomer and Sackler School of Medicine, Tel Aviv University

         

        During craniotomy, the patient's cooperation is needed during procedures in which continuous neurological examination and mapping of crucial regions close to the area to be resected area are required. We report our experience in 9 patients who underwent such procedures under intravenous propofol as the main sedating agent. This short-acting hypnotic was administered prior to and during the painful stages of the procedure. Patients were fully asleep when the skull was opened and the dural flap raised or excised. During the rest of the operation patients were lightly sedated but remained responsive and cooperative. This enabled precise intra-operative mapping of the brain and surgery-related neurological deficits were avoided. Respiratory depression or hemodynamic compromise were not encountered. All patients were comfortable during the operation and there were no additional neurological deficits after operation. We believe that propofol should be the main sedating agent used for these procedures.

        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