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        תוצאת חיפוש

        מרץ 1997
        קוסטה י' מומצ'וגלו, מרדכי ליפו, אינה יופה-אוספינסקי, ג'קלין מילר ורחל גלון

        Maggot Therapy for Gangrene and Osteomyelitis

         

        K.Y. Mumcuoglu, M. Lipo, I. Ioffe-Uspensky, J. Miller, R. Galun

         

        Dept. of Parasitology, Hebrew University-Hadassah Medical School, Jerusalem

         

        5 patients with diabetic-foot were treated by maggot therapy. The most serious case was in a 75-year-old man who had gangrene and osteomyelitis of the right foot. Proteus mirabilis, Enterococcus sp., Providencia stuartii and Staphylococcus spec. (coagulase positive) were isolated from lesions which did not respond to antibiotic therapy. The patient had twice refused amputation but agreed to maggot therapy. Larvae of the sheep blowfly Phoenicia (Lucilia) sericata were used for twice-weekly treatment over a period of 7 months. Sterile larvae were applied to the wound and replaced every 3-4 days. After 4 months of treatment, the necrotic tissue around the toes and on the sole of the foot detached from the healthy tissue. During the last 3 months of treatment the larvae removed the remaining infected tissue. As therapy progressed, new layers of healthy tissue covered the wound. The offensive odor associated with the necrotic tissue and the intense pain in the foot decreased significantly. At the end of therapy, during which there were no complaints of discomfort, he was able to walk. In the 4 other patients who had relatively superficial gangrene, the maggots debrided the wounds within 2-4 weeks. Thereafter treatment was continued with antibiotics. Maggot therapy can be recommended in cases of intractable gangrene and osteomyelitis, when treatment with antibiotics and surgical debridement have failed.

        דוד הנדל וגד ולן

        Recurrent Late Hemarthrosis after Total Knee Replacement

         

        David Hendel, Gad J. Velan

         

        Dept. of Orthopedics, Rabin Medical Center, Golda Campus, Petah Tikva

         

        A patient who had a successful total knee replacement for severe degenerative osteoarthritis of the right knee had an excellent functional result. 2 years after the operation there was spontaneous intra-articular bleeding that was treated successfully conservatively. Recurrent hemarthrosis 2 months later was treated similarly and also resolved without residual functional impairment after a follow-up of over 1 year. Recurrent late hemarthrosis in the knee is a fairly rare complication following total knee arthroplasty, but is amenable to conservative measures. Frequently, persistent recurrent hemarthrosis requires debridement of the bleeding synovium of the knee.

        קליגמן, רופמן, שבר, עצם הירך, מיפרק, femoral, hip

        Femoral Fracture following Total Hip Replacement

         

        M. Kligman, M. Roffman

         

        Dept. of Orthopedic Surgery, Carmel Medical Center, Haifa

         

        Between January 1990 and May 1996 we performed 500 total hip replacements, 6 of which were complicated by ipsilateral femoral fracture. Treatment was either by skeletal traction or by internal fixation, with or without revision-total hip replacement. Results of surgical treatment were superior to those of conservative treatment. This study supports use of Mennen plate-fixation. Further studies are necessary for final evaluation of the efficacy of this method.

        אפריים זנגרייך, סלומון ישראלוב, יוסף שמואלי, אוה ניב וצ'יריו סרודיו

        Gonadotropin-Releasing Hormone (GNRH) in Selecting Patients for Varicocelectomy

         

        Ephraim Segenreich, Solomon Israilov, Joseph Shmueli, Eva Niv, Ciro Servadio

         

        Andrology Unit, Institute of Urology, Rabin Medical Center, Beilinson Campus, Petah Tikva; and Sackler School of Medicine, Tel Aviv University

         

        The gonadotropin-releasing hormone (GnRH) test was performed on 182 patients with various degrees of varicocele before and after low, inguinal, spermatic vein ligation, and on 18 controls. The levels of follicle-stimulating hormone (FSH) and luteinizing hormone, a synthetic GnRH (LH), were evaluated before and 45 minutes after intravenous injection of 100 mcg relisorm L. FSH levels increased more than 2-fold in 118 patients [64.8%] and LH levels increased more than 5-fold in 135 patients [74.1%]). In the control group the increase was less in all cases. Therefor, whenever FSH increased more than 2-fold and LH more than 5-fold, we considered the test positive (pathologic); On this basis the GnRH test was positive in 126 (69.2%) and negative (normal) in 56 (30.7%). Of the 126 with positive tests, only 32 (27.3%) still had a positive result 5-6 months after operation. There was correlation between a positive GnRH test and significant improvement in sperm parameters after varicocelectomy: of the 126 with positive tests before operation, sperm parameters improved in 87 patients (69%), while in the 56 patients with negative tests before operation, in only 7 (12.5%) was there improvement after correction. We conclude that a positive GnRH test indicates impairment of the hypothalamic-pituitary-gonadal axis caused by varicocele and could serve as a marker for surgical intervention with good prediction of outcome.

        סודי נמיר ואלכסנדר לוין

        Esophageal Carcinoma Presenting as Fever of Unknown Origin

         

        Sody Naimer, Alexander Levine

         

        Depts. of Family Medicine, Beer Sheba, and Gush Katif Medical Center

         

        Fever of unknown origin presents both a clinical and diagnostic challenge and is usually caused by inflammatory and neoplastic diseases. We present a unique case of a previously healthy 77-year-old woman whose sole complaint was fever. Complete hospital investigation failed to reveal the underlying process. 4 months after the onset of fever, dysphagia appeared and she was then diagnosed as suffering fsquamous cell carcinoma of the esophagus. The question of early barium swallow X-ray in such cases is raised.

        י' קלוגר, ר' חדאד, ד' סופר, ד' אלג'ם וי' לאוזנר

        Whipple Operation in Trauma

         

        Y. Kluger, R. Hadad, D. Soffer, D. Aladgem, J.Y. Klausner

         

        Depts. of Surgery A, B, C and Trauma Service, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University

         

        Pancreato-duodenectomy is a formidable operation for the critically injured patient. We describe a patient who sustained a stab wound to the stomach and duodenum. At operation this injury could not be reconstructed. A Whipple operation was performed in which the pancreatic stump was stapled and recovery was uneventful, although there was a low output fistula from the pancreatic stump. Limited indications for the Whipple procedure in trauma patients are suggested.

        א' ביטון, ס' נמיר, ב' מוסוביץ וד' ורדי

        Cutaneous Leishmaniasis: Incidental Outbreak in a New Endemic Area?

         

        A. Biton, S. Namir, B. Mosovich, D. Vardi

         

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

         

        In the autumn of '94 we saw 32 patients with cutaneous leishmaniasis from a newly populated area south of Yerucham. Yerucham had never previously been reported as a focus of leishmaniasis. Ongoing construction in the town and the health hazards that resulted may play a part in this new situation. There are a number of ways of controlling and preventing outbreaks of leishmaniasis. They include elimination of the vector, Phlebotomus and its host, the gerbils as well as their food supply, "maloach" bushes, other health hazards and vaccination of the population. Patients were treated according to the severity of disease. It is still too early to determine whether our efforts to limit the spread of the outbreak have been successful.

        אלי עטר, אלכסנדר גרניאק, עיסאם ראבי, בנימינה מורג וזלמן רובינשטיין ז"ל

        Angioplasty and Stenting of the Carotid Artery

         

        Eli Atar, Alexander Garniek, Issam Rabi, Benymina Morag, Zallman Rubinstein

         

        Dept. of Diagnostic Imaging, Interventional Radiology Unit, and Dept. of Vascular Surgery; Chaim Sheba Medical Center, Tel Hashomer (Affiliated with the Sackler Faculty of Medicine, Tel Aviv University)

         

        Percutaneous endovascular techniques are well established procedures in the management of peripheral vascular disease and visceral arterial stenosis. They are now being adapted for use in the carotid artery as well. 8 patients with 9 extracranial carotid artery stenoses were successfully treated by percutaneous angioplasty, following which in 4 of them 5 stents were inserted. The stenotic lesions were situated in the proximal internal carotid artery and in its bifurcation and also in the common carotid artery. The indications for angioplasty in these patients were the same as for surgery. There were no major complications. 1 patient had transient hemiparesis lasting a few hours, and another had bradycardia following balloon dilatation in the region of the carotid body. Percutaneous endovascular treatment of carotid artery stenosis is becoming a safe, feasible alternative to surgery.

        צביה בורגנסקי, אברהם גנאל ואורי גבעון

        Leg-Lengthening For Length Inequality

         

        Zvia Burgansky, Abraham Ganel, Uri Givon

         

        Pediatric Orthopedics Unit, Chaim Sheba Medical Center, Tel Hashomer (Affiliated with the Sackler Faculty of Medicine, Tel Aviv University)

         

        32 patients (age range 1.5-22 years) were treated for leg-length discrepancy. 39 lengthening procedures were performed of which 36 involved gradual distraction, in 2 cases chondrodiasthesis was used, and 1 had 1-step elongation. Gradual distraction was done according to Ilizarov, including corticotomy and a 1-week delay before the initiation of distraction. In 33 cases Wagner's external fixator was used, in 2 an Ilizarov frame and in 1 an orthofix fixator. There was complete clinical and radiological union in all but 1 case. Significant correction of leg-length discrepancy and equalization of leg-length was achieved in most patients. In some growing patients over-correction was successfully achieved. The most prevalent complications were pin-site problems, axis deviation, joint subluxation and joint contractures. At latest follow-up most of these complications had disappeared. 91% of the patients either functioned normal or were only mildly limited.

        נחום נשר, אלון ארז, דורון נצר, רנטו פנקלשטיין וירון בר-אל

        Acute Fungal Endocarditis Due To Trichosporon Beigelli

         

        Nahum Nesher, Alon Erez, Doron Nezer, R. Finkelstein, Y. Barel

         

        Dept. of Cardiac Surgery, Rambam Medical Center, Haifa and Technion Faculty of Medicine

         

        We report a 59-year-old woman with acute fungal endocarditis of a prosthetic valve caused by the endogenic organism, Trichosporon beigelli. This slowly developing disease mainly effects drug addicts who use intravenous narcotics. In nonaddicts it is rare, with mortality as high as 50%. There are only sporadic reports of T. beigelli as a complication long after open heart surgery. The ongoing infection is undetected for even several years after the primary infection, due to its prolonged latent phase. We present the difficulties of diagnosis, and of treating the disease with a combination of surgery and of long-term chemotherapy.

        חיים ביבי, דויד שוסייב, מיכאל ארמוני, מלי אוהלי, שלמה פולק ומנחם שלזינגר

        Pediatric Flexible Bronchoscopy

         

        Haim Bibi, David Shoseyov, Michael Armoni, Melly Ohali, Shlomo Pollak, Menachem Schlesinger

         

        Pediatric Dept., Pediatric Emergency Room, Pediatric Day Care Hospital and Immunology and Clinical Allergy Unit, Barzilai Medical Center, Ashkelon; and Bikur Holim Hospital, Jerusalem (Affiliated with the Faculty of Health Sciences, Ben-Gurion University of the Negev)

         

        Between 1993-1996, 200 pediatric flexible bronchoscopies were performed. Indications were: chronic cough (158 children), persistent pulmonary infiltrates (89), recurrent stridor (28), suspected tracheobronchial foreign body (20), suspected tuberculosis (17) and hemoptysis (3). Some children had more than 1 indication. 124 patients were boys (mean 4.18+2.86 years; range 1 month-15 years) and 76 were girls (mean 4.39+2.7 years; range 4 months-15 years). The procedure included direct vision recorded by video-camera and broncho-alveolar lavage; the lavage fluid was sent for culture, Gram and Ziehl-Nielsen stains and for cytology. There were a few minor side effects: mild stridor which resolved within a few hours (10 children) and transient fever (3). This simple, flexible instrument was effective and helpful in the diagnosis and treatment of children with respiratory symptoms in a secondary hospital facility.

        עמנואל תאודור ואריה רגב

        Disappointing Response of Chronic C Hepatitis to Interferon

         

        E. Theodor, A. Regev

         

        Medicine E and Liver Clinic, Beilinson Medical Center and Sackler School of Medicine, Tel Aviv University

         

        From February 1990 to August 1995 we treated 58 patients with chronic hepatitis C using alfa-interferon, 3 million units 3 times weekly for 6 months. Of the 48 patients with adequate follow-up, 34 did not respond to treatment at all. 10 patients responded, but within a few months hepatic enzymes again increased. These 2 groups can be considered failures of interferon treatment. In 4 patients enzymes remained normal for the duration of follow-up, (10-34 months). Even in this small group, 1 patient had a positive test for HCV RNA after completion of treatment. A partial explanation of our disappointing results may be the high prevalence of a subtype of C hepatitis-subtype 1b, which has recently been reported in Israel. This strain is particularly resistant to interferon. The means to define subtypes were not, and as far as we know are not yet available in Israel. Various groups have attempted to improve the outcome of treatment of hepatitis C, which in other hands too was still far from satisfactory. Thus, regimens of interferon utilizing higher doses and longer periods of treatment are being evaluated, as well as the addition of Ribavirin, which hopefully will improve results.

        דורית אלמוזנינו-סרפיאן, נתן כהן, רונית זיידשטיין, ויקטור דישי ואליעזר זקלר

        Quinidine-Induced Rheumatic Toxicity

         

        D. Almoznino-Sarafian, N. Cohen, R. Zaidenstein, V. Dishi, E. Zeckler

         

        Depts. of Medicine C, A and F, Assaf Harofeh Medical Center, Zerifin (Affiliated with the Sackler Faculty of Medicine, Tel Aviv University)

         

        2 women with quinidine-induced lupus are presented. This condition is rare; only about 30 cases have been reported in the English literature. Both our patients had arthritis of the wrist, antinuclear antibodies with homogenous pattern and elevated ESR. Anti-double stranded DNA antibodies were present in 1 patient, and a petechial rash in the other. Complete resolution of arthritis occurred within a few days after quinidine withdrawal, but antinuclear antibodies persisted for several months.

        ד' סופר, י' גלילי, נ' נסראללה, ד' אלג'ם, א' אבלאי וי' קוגלר

        Patterns of Injuries and Preventive Measures for Motorcycle Accidents

         

        D. Soffer, Y. Galili, N. Nasralla, D. Aladgem, O. Ablai, Y. Kluger

         

        Depts. of Surgery B and C, Trauma Services, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University

         

        Retrospective analysis of a series of 32 motorcyclists admitted after road accidents was performed. 62% were injured on scooters with 50 cc engine capacity and most of the combined injuries occurred in this group. Most crashes occurred at road junctions.Riders of scooters with larger engine capacities tended to wear protective garments as opposed to riders with smaller engines. There was no correlation between engine capacity and severity of injury. We conclude that motorcyclists should receive special education, especially as to behavior on entering road junctions. We recommend that taxes on protective garments should be lowered in order to encourage motorcyclists to use them.

        פברואר 1997
        שלמה מור-יוסף, רלו אברהם ויוסף שנקר

        Ovarian Cancer In Israel, 1960-1989

         

        Shlomo Mor-Yosef, Relo Avraham, Joseph G. Schenker

         

        Dept. of Obstetrics and Gynecology, Hadassah-University Hospital, Ein Kerem, Jerusalem

         

        In Israel ovarian cancer ranks among the most common malignant diseases in women. It is also one of the main causes of death from cancer in females in this country. Our population is composed of immigrants from diverse social, cultural, and geographical backgrounds, and only a sector of the inhabitants, mainly the younger generation, is Israeli-born. This study evaluates the trends of epidemiological and clinical data on ovarian cancer during 3 decades, 1960-1989, and includes a total of 5,786 cases of ovarian cancer. Information was obtained from the Central Israel Cancer Registry of the Ministry of Health and from the Central Bureau of Statistics. The incidence was stable during the survey period and was about 15-17/100,000 in women over the age of 15. Most (90%) were diagnosed over the age of 40. In women of European/American origin the incidence of ovarian cancer is 3 times greater than in women of Asian/African origin. The rate in the Israeli-born is between those of the other 2 groups, but closer to that of the European/American group. Over 70% were diagnosed with advanced disease (stage III-IV).

         

        Prognosis improved during the period of the study: 5-year survival was 19% in the early 60's and 31% in the 80's. During the last decade of the survey improvement was mainly in 2-year survival (from 38.5% to 60%).

        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