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        תוצאת חיפוש

        דצמבר 1998

        אילן שלף, אבי כהן ויחיאל ברקי
        עמ'

        Ultrasonographic Imaging of Superior Sagittal Thrombosis

         

        Ilan Shelef, Avi Cohen, Yehiel Barki

         

        Depts. of Radiology and Neurosurgery, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba

         

        Ultrasonographic findings of superior sagittal sinus thrombosis include dilated and hyperechoic sinus (direct imaging of the thrombus). No flow should be demonstrated by the various Doppler techniques. In the deeper sinuses, if the thrombus can not be visualized after a negative Doppler study, MR imaging is recommended. Recanalization and reflow can be demonstrated on follow-up study.

        עמוס כץ, אנגל קנטור ואלכסנדר בטלר
        עמ'

        Serotonin Re-Uptake Inhibitors as Primary Therapy for Carotid Sinus Hypersensitivity

         

        Amos Katz, Angel Kantor, Alexander Battler

         

        Cardiology Dept., Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba

         

        Carotid sinus syndrome is a well-recognized cause of unexplained syncope in older patients, and may lead to significant morbidity due to trauma from falls. Dual chamber pacing has been shown to be effective in relieving symptoms due to bradycardia, but not due to vasodepressor response. We report an 84-year-old man with recurrent syncope due to carotid sinus hypersensitivity. He was treated only with a serotonin re-uptake inhibitor and was symptom-free after 3 weeks of therapy. He has remained symptom-free for the past year.

        דורון זמיר, רסמי מג'דלה ופלטיאל וינר
        עמ'

        Normotensive Hydrocephalus Complicating Recurrent E. Coli Meningitis

         

        Doron Zamir, Rasmi Magadle, Paltiel Weiner

         

        Dept. of Medicine A, Hillel Yaffe Medical Center, Hadera

         

        E. coli meningitis is a disease that occurs in predisposed patients, either as a result of trauma or in neonates after neurosurgery. Recurrent E. coli meningitis in an adult without any apparent predisposition is uncommon, and hydrocephalus complicating bacterial meningitis is even more rare. We report a unique case of a 67-year-old alcoholic man who had had 2 consecutive episodes of E. coli meningitis within 2 months. In both episodes there was a favorable response to ceftriaxone. However, normotensive hydrocephalus appeared a few weeks later, with mental and physical deterioration.

        יהונתן פינטהוס, יורם מור ויעקב רמון
        עמ'

        The Mitrofanoff Pouch in Lower Urinary Tract Reconstruction

         

        J.H. Pinthus, Y. Mor, J. Ramon

         

        Urology Dept., Chaim Sheba Medical Center, Tel Hashomer

         

        The Mitrofanoff principle, first described in 1980, consists of implanting a tubular organ such as the appendix, ureter, or fallopian tube into the wall of the bladder (or urinary reservoir) to create a non-refluxing, catherizable urinary conduit. Between 1993-1996, 7 men and 1 woman (aged 48-64, average 59) underwent radical cystectomy and urethrectomy combined with the creation of a MAINZ I urinary reservoir (based on the Mitrofanoff principle). In men the indication for the procedure was the diagnosis of invasive transitional cell carcinoma of the bladder with involvement of the prostatic urethra. All patients had refused urinary diversion to an ileal conduit because of its deleterious effect on the quality of life.

         

        In all patients the postoperative course was uneventful, apart from intraperitoneal urinary leakage from the reservoir in 1, successfully managed conservatively. The patients have gained full control of urinary drainage, performing intermittent self-catheterizations every 4-5 hours. In 3 patients there were difficulties with catheterization due to stenosis of the conduit, usually at the skin level. None have suffered leakage from the reservoir, during the day, even when it was full.

        Our experience shows that creation of a continent urinary reservoir according to the MAINZ I technique is an excellent surgical solution for patients in whom the creation of an orthotopic reservoir is impractical. The use of the umbilicus as a stomal site preserves normal body image and thus does not interfere with quality of life as in those undergoing radical cystectomy.

        נובמבר 1998

        מיכאל קראוס וסימון-דניאל דואק
        עמ'

        Is Ileostomy Necessary In Surgical Treatment of Ulcerative Colitis and Familial Polyposis?

         

        Michael M. Krausz, Simon Daniel Duek

         

        Dept. of Surgery A, Rambam Medical Center, Bruce Rappaport Faculty of Medicine, The Technion, Haifa

         

        Proctolectomy with ileal pouch anal anastomosis (IPAA) has become the procedure of choice for the surgical treatment of ulcerative colitis (UC) and familial polyposis (FP). Ithas traditionally been performed in 2 stages, but recently the necessity for an ileostomy hbeen challenged by several authors who recommend a 1-stage procedure.

         

        5 years ago we started to test this policy for treatment of UC and FP. In 48 patients (Group A), 45 with UC, the 2-step procedure, and in 17 of the 27 in Group B with FP, the 1-stage procedure were performed. The indications for surgery were intractable UC in 37 patients in group A and in 5 patients in Group B (p<0.01).

         

        Postoperative infection due to bowel leakage developed in 2 in Group A and in 6 in Group B (p<0.01). Reoperation was necessary in 4 patients (15%) in Group B and only 1 (0.9%) in Group A (p<0.01). Bowel leakage in Group B occurred in 5 (19%) with UC and in only 1 with FP (p<0.05), which responded to medical treatment. All those with UC who developed this complication were relatively malnourished, with serum albumin levels lower than 3.0 g% and were regulated with corticosteroids.

         

        We therefore conclude that the 2-stage IPAA is feasible and safe for the treatment of UC and FP. The 1-stage IPAA should be limited only to FP or good risk UC patients.

        ארנה גייר
        עמ'

        Nonpenetrating Deep Sclerectomy

         

        Orna Geyer

         

        Ophthalmology Dept., Tel Aviv-Sourasky Medical Center

         

        This is the first report from Israel of nonpenetrating deep sclerectomy (DS), a new operation for the surgical management of glaucoma. It facilitates ocular fluid drainage without entering the eye. It involves performance of a conjunctival flap and creation of a 565 mm superficial scleral flap. A deeper scleral flap is dissected off the scleral bed together with the roof of the canal and corneal stroma, leaving behind the wall of the canal and membrane. Aqueous will flood the dissected area. A collagen device is then sutured to the scleral bed, the superficial scleral flap sutured into position and the conjunctiva closed. With this procedure, the surgeon can avoid the common complications of conventional glaucoma surgery.

         

        We report a 6-month follow-up of 15 patients after DS. Mean preoperative intraocular pressure was 26.7+2.5 mm Hg, which decreased to 15.5+4.7. After 6 months there was no change in visual acuity after surgery. DS is associated with good middle-term intraocular pressure control and a low rate of postoperative complications. It is therefore a good alternative to standard glaucoma surgery.

        חגית כהן, אורי לונטל, מיכאל מטר, חנוך מיודבניק, זאב קפלן, יאיר קסוטו ומשה קוטלר
        עמ'

        Autonomic Dysregulation in Post-Traumatic Stress Disorder: Power Spectral Analysis of Heart Rate Variability

         

        Hagit Cohen, Uri Loewenthal, Mike A. Matar, Hanoch Miodownik, Zeev Kaplan, Yair Cassuto, Moshe Kotler

         

        Mental Health Center, Israel Ministry of Health; Anxiety and Stress Research Unit, Faculty of Health Sciences; Dept. of Life-Sciences, Ben-Gurion University of the Negev, Beer Sheba

         

        Spectral analysis of heart rate variability (HRV) has been shown to be a reliable noninvasive test for quantitative assessment of cardiovascular autonomic regulatory response, providing a dynamic map of sympathetic and parasympathetic interaction. In a prior study exploring the state of hyperarousal that characterizes the post traumatic stress disorder (PTSD) syndrome, we presented standardized heart rate analyses in 9 patients at rest, which demonstrated clear-cut evidence of a baseline autonomic hyperarousal state.


        To examine the dynamics of this hyperarousal state, standardized heart rate analysis was carried out in 9 PTSD patients, compared to a matched control group of 9 normal volunteers. 20-minute ECG recordings in response to a trauma-related cue, as opposed to the resting state, were analyzed. The patients were asked to recount the presumed triggering traumatic event, and the control subjects recounted a significant stressful negative life event.

        Whereas the control subjects demonstrated significant autonomic responses to the stressogenic stimulus of recounting major stressful experiences, the patients demonstrated almost no autonomic response to the recounting of the triggering stressful event. The patients demonstrated a degree of autonomic dysregulation at rest comparable to that seen in the control subjects' reaction to the stress model.


        The lack of response to the stress model applied in the study appears to imply that PTSD patients experience so great a degree of autonomic hyperactivation at rest, that they are unable to marshal a further stress response to the recounting of the triggering trauma, as compared to control subjects. A subsequent study of the effect of medication on these parameters showed that they are normalized by use of selective serotonin re-uptake inhibitors (SSRI's).


        Neither the clinical implications of these findings, nor their physiological mechanisms are clear at present. We presume that they reflect a central effect, as the peripheral automatic effects of SSRI's are relatively negligible.

        יונית גולד ושמעון רייף
        עמ'

        Aphthous Stomatitis as a First Manifestation of Crohn's Disease in a Child

         

        Y. Gold, S. Reif

         

        Dana Children's Hospital, Tel Aviv Medical Center

         

        The incidence of Crohn's disease has risen dramatically over the past few years. The peak age of onset is in late adolescence, but it rarely occurs in the first few years of life. We describe a 5-year-old boy with recurrent bouts of fever, aphthous stomatitis, and anemia which did not respond to routine antibiotic therapy. It was only after a few months, when the characteristic symptoms of inflammatory bowel disease (IBD): abdominal pain and diarrhea appeared, that the diagnosis of Crohn's disease was made.

        This case illustrates the difficulty in diagnosing IBD in young children. The presenting symptoms of IBD in children are often nonspecific and extra-intestinal. There is usually a low index of suspicion by the physician as to the possibility of IBD in a young child.

        יצחק סרוגו, אירנה צ'יסטיאקוב, אלה כהן, יורם טל ומיכאל יפה
        עמ'

        Nasopharyngeal Colonization with Streptococcus Pneumoniae in Pediatric Respiratory Infections

         

        Isaac Srugo, Irena Chystiakov, Ella Cohen, Yoram Tal, Michael Jaffe

         

        Clinical Microbiology and Pediatric Depts., Bnai Zion Medical Center and Technion Faculty of Medicine, Haifa

         

        During the winter of 1995, nasopharyngeal colonization of Streptococcus pneumoniae was evaluated in 204 children with respiratory infection and 107 normal control children. There was no difference in gender or mean age between the groups, and no difference in carrier rate between sick (24.5%) and normal (22%) children (p=0.6). Carrier rates were 19%, 32%, 31% and 17% at 6, 12, 24 and 48 months, respectively. Penicillin-resistant pneumococci (PRP) were found in 42% of sick and 16.6% of normal children, (p<0.05). Resistance to more than 2 antibiotics was found in 28% of sick and in 12.5% of normal children. PRP were found in 67% and 34% of sick children with and without prior antibiotic treatment (p<0.05). We conclude that there is no difference in the carrier rate of Streptococcus pneumoniae between sick and normal children. However, the high prevalence of PRP in children with respiratory infections is probably due to prior antibiotic treatment.

        אוקטובר 1998

        ניר הילזנרט ועידית ליברטי
        עמ'

        Multiple Angiodysplastic Lesions of the Colon - a Therapeutic Challenge

         

        Nir Hilzenrat, Edit Liberty

         

        Division of Gastroenterology and Dept. of Medicine E, Soroka Medical Center and Ben-Gurion University, Beer Sheba

         

        Colonic angiodysplasia is one of the most frequent causes of recurrent lower gastrointestinal tract bleeding, mainly in the elderly. In 50% of patients multiple angiodysplastic lesions were reported when they were the cause of rectal bleeding. Bleeding from angiodysplasia is more severe and less responsive to treatment in those with coagulation disorders. A 74-year-old woman with an artificial mitral valve who was treated with coumadine is reported. A few years after operation she began to develop severe recurrent rectal bleeding because of multiple angiodysplastic lesions along the right colon, proven by colonoscopy. She was frequently hospitalized for blood transfusions; endoscopic treatment was not feasible and the surgical risk of colectomy was very high. Treatwith estrogen and progesterone significantly decreased recurrent episodes of bleeding.

        שחר צימנד, עינת בירק, מירה פרנד, פטרישה בנימין ויוליוס הגש
        עמ'

        Transcatheter Closure of Atrial Septal Defects: Initial Clinical Applications

         

        Shahar Zimand, Einat Birk, Mira Frand, Patricia Benjamin, Julius Hegesh

         

        Dept. of Pediatric Cardiology, Sheba Medical Center, Tel Hashomer and Schneider Medical Center, Petah Tikva

         

        The incidence of congenital heart defects is 0.8% of live-born infants. Of these 13% are ostium secundum atrial septal defects (ASD) which can be successfully repaired by open heart surgery with less than 1% mortality. However, morbidity associated with cardiac surgery is universal. Transcatheter closure of ASDs was introduced 2 decades ago to decrease surgical complications, hospital stay and cost. Few devices have undergone clinical trials but all of them have been associated with instances of failure and complications. The most important mechanism for acute failure was selection of cases with too large a defect or selection of a defective device. In the past decade great progress has been made with the aid of transesophageal echocardiography (TEE) and modifications of the device. We present our experience in our first 5 patients. They ranged in age from 4 to 27 years; the ASD diameter was 11-15 mm and the device diameter was 17-33 mm. All transcatheter closures were performed on the same day without any complications, and all patients were discharged home after 2 days of hospitalization. We conclude that transcatheter occlusion of ASDs up to 15 mm is feasible, relatively safe and effective. This transcatheter method appears to be a viable alternative to surgery for some patients with secundum atrial septal defects.

        בנימין זאבי, מיכאל ברנט, רמי פוגלמן, גלית בר-מור ולאונרד בלידן
        עמ'

        Transcatheter Closure of Atrial Septal Defect

         

        Benjamin Zeevi, Michael Berant, Rami Fogelman, Galit Bar-Mor, Leonard Blieden

         

        Cardiology Institute, Schneider Children's Medical Center, Petah Tikva and Sackler School of Medicine, Tel Aviv University

         

        Isolated secundum atrial septal defect is one of the most common congenital heart defects. Surgical closure is the treatment of choice but is associated with a chest scar, some morbidity and a relatively long recovery and the use of cardiopulmonary bypass. Transcatheter closure of secundum atrial septal defect is therefor an attractive approach.

        3 children, aged 5-10 years, underwent successful transcatheter closure of moderate to large central atrial septal defects with the Cardioseal device. The procedures were performed under x-ray and transesophageal echocardiographic guidance.

        Our initial experience, and that of others, indicates that transcatheter occlusion of secundum atrial septal defects is safe and effective and can be an appropriate alternative in approximately 60% of patients.

        יורם זולברג, אורית נחתומי-שיק, יהושע שמר ומנחם אלקלעי
        עמ'

        Terror in Japan: Mass-Intoxication with the Nerve-Agent Sarin

         

        Yoram Solberg, Orit Nachtomi-Shick, Yehoshua Shemer, Menachem Alcalay

         

        Medical Corps, Israel Defense Forces and Sheba Medical Center, Tel Hashomer

         

        During 1994/5 the Japanese civilian population suffered 2 terror attacks by the organophosphorus nerve-agent sarin. In these 2 episodes it is estimated that more than 6000 people were injured, of whom 19 died. The quick and efficient response of the civilian emergency systems to these unforseen, attacks has to be analyzed by local authorities to determine the best solutions in case of another attack. We summarize the events, and note the emergency system's response, the need for rapid and accurate chemical identification of the toxin, the necessity for decontaminating the casualties and for providing protective gear for rescue units in the contaminated area. We also describe the clinical status of the casualties and outline the mode of therapy applied.

        עדנה פינצ'ובר
        עמ'

        Art Therapy for Hospitalized Children (Inspired by Elizabeth Kuebler-Ross's Approach)

         

        Edna Pinchover*

         

        Pediatric Wards School, Hadassah Hospital (Ein Karem and Mt. Scopus), Jerusalem

         

        This paper presents a combined strategy for coping with the emotional condition of hospitalized children, and reports the results of its implementation in pediatric wards. The strategy combines art therapy methods with the spiritual-psychological approach developed by Elizabeth Kuebler-Ross. Art therapy uses art for therapeutic and diagnostic purposes; in this study it was employed to encourage the child-patients to express their feelings, and lead them to processes of understanding of and adjustment to their conditions. Kuebler-Ross' methods, known for dealing with difficult emotional situations at the bedside of the seriously ill, were enlisted to build a relationship of trust and respect between patient and therapist.

        The population dealt with consisted of children (age 3-13) injured in road accidents, and cardiac and oncological cases. 7 case studies are brought to demonstrate the integrated therapeutic process. The process starts from the child-patient's artwork, which allows the therapist better insight into emotional conditions and to relate closely to issues brought up by the work. Through conversation with the therapist in an atmosphere of empathy and honest consideration, the patient becomes aware of her/his reactions, behavior, intentions and ambitions.

        The belief underlying this study is that the patient derives from these contacts new abilities which moderate anxieties and strengthen healthy energies. Better collaboration and sounder ways of coping with intrusive medical treatment, as well as more trust and hope seem to emerge from the relationships created by these contacts.

         

        * Principal of School.

        ספטמבר 1998

        מירי קרן ושמואל טיאנו
        עמ'

        Feeding Disorders in Infancy: Feeding Interaction Concept in Diagnosis and Treatment

         

        Miri Keren, Samuel Tyano

         

        Community-based Mental Health Baby Clinic, Gehah Hospital and Sackler School of Medicine, Tel Aviv University

         

        In infancy clinical manifestations of psychological distress are mainly somatic. Feeding disorders are one of the most common and nonspecific manifestations of different kinds of disturbed parent-child relationships. These disturbances may have their origins in the baby's constitution and physical status, in the parent's personality structure, or both, as has been conceptualized in the transactional model of normal and abnormal development. Among the daily interactions a baby has with parents, feeding has special inherent impact on the early parent-child relationship because of its psychological meanings. Therefore, feeding disorders, with or without failure to thrive, often reflect various disorders of infancy, still not well recognized in the medical community, such as regulatory disorders, attachment disorders, depression of infancy, disorders of separation-individuation, and post-traumatic eating disorder. 3 clinical cases are brought to increase awareness of psychological distress in the infant, and of feeding disorders as 1 of its manifestations. Each illustrates a different kind of feeding disorder in terms of etiology and pathogenesis. Through these cases we emphasize the need for a multidisciplinary, integrative approach in diagnosis and treatment. Our conceptual background is based both on the transactional model of development (infant and parental factors impact on each other) in a very dynamic paradigm, and on psychodynamic premises. Intrapsychic conflicts and past representations impact heavily on the parenting characteristics. We emphasize the psychological significance of disturbed feeding interactions, with or without failure to thrive.

         

        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