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        תוצאת חיפוש

        מרץ 1997
        מ' סקלייר-לוי, א' בלום, י' שרמן, ס' פילדס, י' בר-זיו וי' ליבסון

        Ct-Guided Core Needle Biopsy Of Abdominal, Pelvic And Retroperitoneal Masses

         

        M. Sklair-Levy, A.I. Bloom, Y. Sherman, S. Fields, J. Bar-Ziv, Y. Libson

         

        Depts. of Radiology and Pathology, Hadassah-University Hospital, Jerusalem

         

        CT-guided core needle biopsy of abdominal, pelvic and retroperitoneal masses is accurate and safe and can be performed on an outpatient basis. Between 1987 and 1995, 809 patients (age range 1-87 years) underwent 851 biopsies (minimal lesion diameter 1 cm). Cutting needles were always used, facilitating both cytological and histological diagnosis while minimizing risk of complications. A positive result (malignant, inflammatory or infectious) was obtained in 69% of the 809 and a negative result (normal tissue) in 17.4%, while in 13.6%, material for diagnosis was insufficient. Biopsy was repeated in 42 of them in whom radiological or clinical suspicion of malignancy was high. In 24 (60%) a positive result was obtained after the second biopsy.

         

        Significant complications occurred in 7 (0.8%). 1 hemo-rrhaged following liver biopsy and required blood transfusion. Pancreatitis occurred in 6 (2.6%) following pancreatic biopsy. An intra-abdominal fluid collection in 1 necessitated percutaneous drainage. There was no mortality following the procedure and no documented case of needle-tract seeding of tumor. All outpatients were discharged within 3 hours of completion of the biopsy, without ill effects.

        דוד אדלר, יונה מהלר ואבי ישראלי

        Cellular Phone Interference with Medical Instruments

         

        David Adler, Yona Mahler, Avi Israeli

         

        Medical Engineering Dept., and Administration, Hadassah-University Hospital, Ein Kerem, Jerusalem

         

        Cellular telephones and other telecommunication equipment occasionally cause malfunctioning of medical equipment, including life-support equipment. We review such malfunctioning and relate it to Israeli and worldwide standards, analyzing the characteristics of the interference in terms of amplitude and frequency. The results of a controlled study of interference by cellular telephones and portable 2-way radios with medical devices in our clinical departments are also presented. The levels of background environmental electromagnetic noise at several sites in both Hadassah hospitals (Ein Karem and Mount Scopus) were measured, as well as signal levels of cellular telephones and other communication equipment at various distances and in various areas. We recommend 2 different levels of restrictions on the use of this equipment within the hospital.

         

        These include prohibition of the use of wireless telecommunication equipment in intensive care areas and operating theaters. In all other areas it is recommended to turn off the cellular telephone within 1 meter of medical devices and not to transmit (but only to receive) calls with a portable 2-way radio within a 5 meter distance of medical devices.

        פברואר 1997
        חוליו וינשטיין ומדינה ידווב

        Efficacy and Safety of Acarbose Treatment of Niddm

         

        Julio Wainstein, Medinah Jedwab

         

        Dept. of Medicine C and Diabetes Unit, Wolfson Medical Center, Holon

         

        An uncontrolled multicenter study of the efficacy and safety of treatment of diabetes with acarbose was conducted on 169 NIDDM patients in 12 medical centers in Israel. Acarbose was administered for 19 weeks, and the patients were followed for an additional 12 weeks. A substantial decrease in HbA1c levels from 8.5% to 7.5% (p<0.001) and in postprandial serum glucose levels from 283.6 mg/dl to 248.5 mg/dl (p<0.01) was seen during treatment. On follow-up, HbA1c levels increased by 0.45% and postprandial serum glucose rebounded from 256.4 mg/dl to 287.9 mg/dl. Acarbose was shown to be effective in treating NIDDM and to be safe and well-tolerated.

        אשר ברק, לידיה גביס, בנימין מוגילנר ושולמית גלמן-קוהן

        "Charge" Association

         

        Asher Barak, Lidia Gabis, Biniamin Mogilner, Shulamit Gelman-Kohan

         

        Pediatric and Neonatal Depts., and Clinical Genetic Unit, Kaplan Hospital, Rehovot

         

        CHARGE association represents a group of congenital anomalies with no clear etiology. The broad array of abnormalities, which involves several systems, has been the basis for the acronym CHARGE: coloboma, heart anomaly, choanal atresia, retarded growth and development, hypoplastic genitalia and ear malformation. We present 3 children with CHARGE association to illustrate the phenotypic variability and note the multidisciplinary treatment they received. It is recommended that this entity be approached in an interdisciplinary, integrated way to allow for faster diagnosis and better prognosis.

        י' שויד, א' אנגל ומ' הלברטל

        Effectiveness of Selective Hepatic Artery Embolization in a Child after Blunt Hepatic Trauma

         

        Y. Sweed, A. Engel, M. Halberthal

         

        Depts. of Pediatric Surgery and Radiology and Pediatric Intensive Care Unit, Rambam Medical Center, Bruce Rappaport Faculty of Medicine, The Technion, Haifa

         

        A 9-year-old boy was admitted after a bicycle fall. Abdominal CT-scan revealed severe liver injury (stage IV according to the liver injury scale of the American Association for Surgery Trauma), including ruptured intraparenchymal hematoma with active bleeding. The patient was hemodynamically stable and was treated conservatively for the first 2 days. On the 3rd day selective hepatic artery angiography was performed because of abdominal distension and the need for 7 pints of packed red blood cells. Active right hepatic artery bleeding was identified and treated successfully by embolization. We think that early angiography and selective embolization should always be considered for acute or continuous bleeding after liver injury.

        ג' סוירי, א' סהר ומ' פיינסוד

        Radiation-Induced Meningioma: The Changing Pattern of the Disease

         

        G. Sviri, A. Sahar, M. Feinsod

         

        Depts of Neurosurgery, Rambam and Sheba Medical Centers, Haifa and Tel Hashomer; and The B. Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, and the Sackler Faculty of Medicine, Tel Aviv University

         

        In this country radiation-induced meningiomas were usually associated with low-dose irradiation of the scalp of immigrants from North Africa, given as part of the treatment of tinea capitis. An Ashkenazi patient developed meningiomas 15 years after high-dose irradiation for a benign lesion in the parasellar region. The accumulating literature about high-dose radiation-induced meningiomas is reviewed and attention is drawn to the ever increasing number of meningiomas observed in immigrants from the former Soviet Union.

        רפאל נגלר, מיכה פלד ודב לאופר

        Facial Trauma: Characteristics and Therapy

         

        R. Nagler, M. Peled, D. Laufer

         

        Depts of Maxillofacial and Oral Surgery, Rambam Medical Center, Haifa

         

        This department was established 35 years ago. Since then, many patients with facial trauma, both soldiers and civilians, have been treated and extensive experience has been accumulated. From 1990 to 1995, 487 patients with facial trauma (18.6% of the patients in the department) where hospitalized and treated. 88.5% suffered from injuries which included facial bones, and the others from soft tissue injuries only. We summarize our experience, analyzing both the demographic and clinical characteristics of the injuries and the treatment administered. Based on our experience and the current literature, we present an overview of the issue.

        צבי גרינולד ויעקב כץ

        Separation of Conjoined Twins: The Anesthesiologist's Perspective

         

        Zvi Grunwald, Yacov Katz

         

        Dept. of Anesthesiology, Rabin Medical Center, Beilinson Campus and Schneider Children's Hospital, Petah Tikva

         

        Managing anesthesia care for separation of conjoined twins poses a special challenge for the anesthesia team. Early preparation, thorough understanding of the anatomical and the physiological consequences of this complex anomaly, as well as careful coordination with the teams of surgeons, nurses and operating room personnel are mandatory to assure successful separation of the conjoined twins. It is recommended that the mother be transferred to and the babies be delivered at a tertiary care medical center, like the Children's Hospital. Special attention is devoted during the surgical procedure to cardiovascular stability, drug disposition, fluid balance and temperature control. The multidisciplinary team approach makes this complex surgery a success. When postoperative survival cannot be guaranteed for both twins, close contact and consultation is mandated with the parents, medical personnel and religious and legal advisors.

        י' קלוגר, ד' סופר, ב' שגיא, א' אבלאי, ד' אלג'ם ומ' רבאו

        Blunt Perineal Injuries

         

        Y. Kluger, D. Soffer, B. Sagie, O. Abllay, D. Aladgem, M. Rabau

         

        Depts. of Surgery B and C and Division of Trauma and Proctology, Tel Aviv Medical Center, Tel Aviv

         

        Blunt perineal and anal injuries are rare. We describe 2 patients who suffered injury to the perineum and anal canal due to blunt force. New surgical techniques for the reconstruction of the sphincteric mechanism are promising and should be used by the initial treating surgeon as minimal procedures in the perineal region. Anal tagging, minimal debridement, approximation of the edges of perineal laceration, repeated irrigation and loop-colostomy for fecal diversion should be the only initial surgical procedures.

        חן גרינברג, שמואל אביטל, חנוך קשתן ויהודה סקורניק

        Diverticular Disease of the Appendix

         

        R. Greenberg, Shmuel Avital, Hanoch Kashtan, Yehuda Skornik

         

        Dept. of Surgery A, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University

         

        The incidence of appendiceal diverticulosis in pathologic specimens is 0.004-2.1%. Diverticular disease of the appendix is classified as congenital (true) or acquired (false). The clinical presentation differs from that of acute appendicitis. The average age is older, the pain is often intermittent, and while localized in the right lower abdominal quadrant, is of longer duration. No further treatment besides appendectomy is needed. Since a high rate of perforations, peritonitis and lower gastrointestinal bleeding have been reported as complications, it is recommended that in those with an incidental finding of diverticula of the appendix during surgery, that appendectomy be performed. It is not recommended to perform prophylactic appendectomy when diverticula of the appendix are found on barium enema.

        רפאל סטרוגו, גבריאלה גייר ודוד אולחובסקי

        Typhlitis

         

        R. Strugo, G. Gayer, D. Olhovsky

         

        Dept. of Internal Medicine and Dept. of Radiology, Chaim Sheba Medical Center, Tel Hashomer

         

        Typhlitis (from Greek, "typhlon", cecum) is an inflammatory process involving the cecum and ascending colon צ in neutropenic patients after chemotherapy. Early diagnosis and treatment is of great importance, since the mortality is high. In the past decade there has been an increasing number of reports, as well as impressive improvement in diagnosis, and treatment. We describe 2 patients treated in our department. We emphasize the evolving changes in the management of these patients, from early surgical intervention to conservative treatment, and the problem of prophylactic treatment for those who survive an episode of typhlitis.

        יורם שיר, ויקטור שולזון, גילה רוזן ושמאי קוטב

        An In-Hospital Pain Service: Present Activity and Future Trends

         

        Y. Shir, V. Shavelzon, G. Rosen, S. Cotev

         

        Anesthesia Dept. and Intensive Care Unit, Hadassah Hospital, Jerusalem

         

        Although significant progress has been made in the past 2 decades in our understanding of pain pathophysiology and in the development of new analgesic drugs and techniques, many patients still experience considerable pain during hospitalization. Unrelieved pain is common not only among patients undergoing surgery, but also in those with a variety of other medical problems. These findings led to the development of our in-hospital acute pain service. This in-hospital pain service has been active since the late eighties, treating both postoperative pain and non-surgical pain in hospitalized patients. During 1995, 2140 patients were treated totaling 8717 treatment days in 18 different medical units and departments. Overall success was more than 75%. We review our experience in treating in-patients who suffer from pain and discuss future trends and need for such a specialized service.

        פסח ליכטנברג

        On the Value of the Placebo: Reflections on Homeopathy

         

        Pesach Lichtenberg

         

        Dept. of Psychiatry, Herzog Hospital, Jerusalem

         

        A case is presented in which homeopathic "treatment" helped, despite the fact that the patient did not take the medication. The author surveys research which has been conducted on homeopathy and concludes that its benefits derive from non-specific influences of the healer upon the patient, similar to a placebo effect. The importance of this influence is stressed, and its wider application in conventional medicine is urged.

        איה פלג, פסח שוורצמן ורוני פלג

        Drinking and Driving

         

        A. Peleg, P. Shvartzman, R. Peleg

         

        Dept. of Family Medicine, and Dept. of Epidemiology, Ben-Gurion University of the Negev, Beer Sheba

         

        A worrisome connection between driving and drinking was found in 166 people randomly surveyed in public places in Beer Sheba. 80% of the study population stated that they drink alcoholic beverages. Of these, 45% reported drinking at least once a week, and 21% drank 3 glasses/cans at each drinking bout. We noted a trend among those who drank frequently to drink greater amounts. Of the sample, 110 interviewees stated that they had a driver's license and that they drank alcoholic drinks. 39% reported driving after a number of alcoholic drinks, and 23% of them did so invariably or frequently. 5% drank while driving. The drinkers exhibited a high-risk behavioral pattern, remaining in the car with friends (53%) or relatives (16%) also under the influence of alcohol. Those who are aware of the influence of alcohol on their driving skills and the danger of being involved in car accidents, moderate their consumption of alcohol. The results of the study confirm our hypothesis that there is an upswing in the phenomenon of high-risk driving connected with drinking alcoholic beverages.

        מיכה רזאל

        Evidence For Casual Household Transmission Of Hiv: Review And Analysis

         

        Micha Razel

         

        School of Education, Bar-Ilan University, Ramat-Gan

         

        All reported case-studies in which the author-described route of infection was deemed to be casual household contact were reviewed and analyzed, as well as all sample-based studies designed to estimate the frequency of casual household transmission. Several recurring biased mechanisms of interpretation were found in the studies, the use of which made it impossible to obtain evidence for casual household transmission. After correcting for these interpretations 8 documented cases of casual household transmission were found. Analysis of the sample-based studies indicated 10 cases of casual household transmission, which occurs at a risk of 0.4% per year of contact (95% confidence interval: 0.20 to 0.66).

        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