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        תוצאת חיפוש

        מאי 1998
        ד' רוזין, י' קוריאנסקי, מ' שבתאי וע' אילון

        Laparoscopic Approach to Perforated Duodenal Ulcer


        D. Rosin, Y. Kurianski, M. Shabtai, A. Ayalon


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


        As laparoscopy becomes more prevalent, it is being used for a growing variety of abdominal operations, both electively and as emergency treatment. We describe our preliminary experience in laparoscopic repair of perforated duodenal ulcer. 2 women and 2 men, aged 40-78 were operated over a period of 4 months and in all laparoscopic suture and omentopexy were performed with meticulous abdominal lavage. Despite somewhat longer operative time but a similar period of hospitalization, the easier post-operative course and fewer wound complications justify this technique. The effectiveness of medical treatment of peptic disease, and especially the anti-Helicobacter pylori regimen, supports the view that closure of the perforation is usually enough, and vagotomy is not needed.

        א' הלוי, א' עופר וב' גרטי

        Benign Intracranial Hypertension following Minocyclin


        A. Halevy, I. Offer, B. Garty


        Pediatric Depts. A and B, Schneider Children's Hospital, Petah Tikva and Sackler School of Medicine, Tel Aviv University


        A 15-year-old girl, who had been treated with minocyclin for acne for 2 months, was admitted for investigation of headache, nausea and papilledema. A space-occupying lesion was ruled out by computerized brain tomography. The diagnosis of benign intracranial pressure (pseudo-tumor cerebri) was made because of elevated cerebrospinal fluid pressure with normal biochemistry and cytology. Tetracyclines, especially minocyclin, commonly used for treating acne in adolescents, can cause benign intracranial pressure.

        רותי מרגלית-סטשפסקי, אברהם לורבר ואיל מרגלית

        Familial Occurrence of Ebstein Anomaly


        Ruti Margalit-Stashefski, Avraham Lorber, Eyal Margalit


        Family Practice Unit, Kupat Holim Klalit, Haifa, Pediatric Cardiology Unit, Rambam Hospital, Haifa and Ophthalmology Dept., Hadassah--University Hospital, Jerusalem


        Ebstein anomaly is a rare congenital disease which affects location, structure and mobility of the tricuspid valve, and right atrium and ventricle. Although most cases are sporadic, familial occurrence has been reported. We report 2 brothers born with Ebstein anomaly. The parents were first degree cousins and there were 8 other children. 2 daughters were born with other congenital heart anomalies, 1 with ventricular septal defect and the other with severe pulmonary artery stenosis. We suggest that in some families, Ebstein anomaly is an autosomal dominant disease with different expression in the sexes.

        אהוד ראט, אילן שלף, טיבריו כץ, אליעזר אבינוח, יעקב ליכטמן, עפר לוי ודן עטר

        Necrotizing Soft Tissue Infection


        E. Rath, I. Shelef, E. Avinoah, Y. Lichtman, O. Levy, D. Atar


        Depts. of Orthopedics, Diagnostic Radiology and General Surgery C, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba


        The dramatic course of necrotizing soft tissue infection represents a medical emergency, since it is limb - and life-threatening. Most necrotizing soft tissue infections are caused by mixed aerobic and anaerobic Gram-negative and Gram-positive organisms. Most case have been reported in immunocompromised hosts after penetrating trauma or surgery. We describe a unique series of cases of necrotizing soft tissue infection. The mainstay of treatment is early and daily debridement of devitalized tissue and broad-spectrum antibiotics. Hyperbaric oxygen therapy should be considered.

        צבי ויצמן, ילנה ברוטמן, דרורה לידר וחיים זגרמן

        Evaluation of a Local Infant Formula Enriched with Polyunsaturated Fatty Acids


        Zvi Weizman, Elena Brutman, Drora Leader, Chaim Zegerman


        Pediatric Gastroenterology Dept. and Nutrition Unit, Faculty of Health Sciences, Ben-Gurion University of the Negev and Soroka Medical Center, Beer Sheba;

        and Ma'abarot Products Industry, Kibbutz Ma'abarot


        Polyunsaturated fatty acids (PUFA) are vital for the normal development of the brain and the eye retina in infancy. Breast milk contains significant amounts of PUFA, and compensates for their low production in infancy. Only recently a few companies with worldwide product distribution have started to enrich infant formula with PUFA. We evaluated the safety and clinical efficacy of a locally made PUFA-enriched infant formula, produced for the first time in Israel.

        50 normal, full term infants participated in a prospective, randomized double-blind study. Half received a regular whey-predominant infant formula (Materna Plus), and the other half a PUFA-enriched formula (Materna Premium), both produced in Israel, for 30 days. Evaluation included physical examination, growth parameters, stool analysis, daily parental questionnaires regarding infant behavior and defecation, and developmental assessment.

        There were no significant differences on comparing growth parameters, infant behavior, attacks of restlessness, gas severity, or stool characteristics in the 2 groups. There were no side effects or abnormal stool findings in either group, and no differences in developmental assessment at 3 months of age.

        We conclude that the locally-produced PUFA-enriched infant formula is safe and clinically efficient. We assume that the lack of any effect on developmental indices is due to the relatively short exposure to the PUFA-enriched diet. Nevertheless, based on the recent literature, there is no doubt that PUFA supplementation isvital in improving infant brain and eye development.

        אפריל 1998
        גלית בן אמיתי, יורם נבו, דבורה ליברמן, רוברטו מסטר ושאול הראל

        Cyclic Vomiting Syndrome in Children


        G. Ben-Amitay, Y. Nevo, D. Lieberman, R. Mester, S. Harel


        Ness Ziona Mental Health Center, Institute for Child Development and Pediatric Neurology Unit, Tel Aviv-Sourasky Medical Center, and Tel Aviv University Medical School


        Cyclic vomiting syndrome in children is a manifestation of various etiologies, including gastroenterological and renal disorders, central and autonomic nervous system abnormalities, as well as metabolic and endocrine dysfunction. Frequently no organic cause is found. Personality profiles of children with cyclic vomiting reveal perfectionism, competitiveness, and aggressive behavior. Vomiting attacks have been induced by anxiety and excitement in patients with cyclic vomiting. We describe an 8-year-old girl with cyclic vomiting, frequently associated with occipital headaches, photophobia or dizziness. Psychiatric evaluation indicated a generalized anxiety disorder.

        רני גולדמן, גיורא קפלן, רחל גורביץ וויטה בראל

        Drowning in Israel: 1990-1992


        R. Goldman, G. Kaplan, R. Gurvich, V. Barell


        Pediatric Division, Sheba Medical Center, Tel Hashomer; and Health Services Research Unit, Israel Ministry of Health


        There are no epidemiolostudies of drowning in Israel in the scientific literature, despite prominent reports in the media. We analthe extent of mortality from drowning in Israel during 1990-92, attempting to identify and characterize groups at high risk, and to determine trends and differences between Israel and other countries. Computerized death certificate files were provided by the Israel government Central Bureau of Statistics; deaths from drowning were included among external causes codes E-830, 832, E-910, E-954, E-964, E-984.

        In Israel, as in the United States, mortality from drowning is the fourth cause of death among all unintentional causes, and the second cause in age-groups 1-24, ranking after transport accidents. During 1990-92 there were 1.2 drownings a year/100,000 population. The highest rates were found among young non-Jews 15-24 years old (7.8/100,000) and among elderly Jews (3.5/100,000). Unintentional drowning accounted for 89% of all deaths; while about 10% were defined as suicides. Males had a rate almost 3 times greater than females, and the among Arabs was 2.4 times greater than among Jews. The 1990-92 drowning rate was slightly lower than in previous years.

        Drowning rates in Israel are lower than in the United States, except in the elderly. Apparently the principal reason for this difference is difference in sites of drowning. In Israel most drownings occur in the sea, so site data are unavailable for international comparisons. Careful consideration of the categories (E-codes) included in the rates, and of local registration procedures, is necessary for international comparisons.

        Foreign workers, tourists and other nonresidents are not included in national vital statistics. But estimations based on Ministry of Interior sources show that foreign workers (most, recent arrivals) during the last few years are an extremely high risk group. Population-based drowning rates are not an accurate estimation of drowning risk, since universal exposure to the "opportunity to drown" is assumed.

        יצחק גילת וצבי גיל

        Suicidal Calls to a Telephone Emergency Service


        Itzchak Gilat, Zvi E. Gil


        ERAN (Israel Association for Emotional First Aid)


        Suicidal threats and suicidal ideation among callers to the Israeli hot-line (ERAN) were investigated, using 2 methods of analysis. The first, an epidemiological survey based on 8,272 calls received by all 8 ERAN posts during 2 years, reported on their standard form for recording interactions with suicidal callers. The second is content analysis of 42 detailed reports of interactions with such callers. Epidemiological analysis revealed a higher rate of suicidal ideation among callers with a psychiatric history, compared with those without a history. However, the 2 groups did not differ in rate of suicidal threats. In addition, suicidal threats of adolescents were related mainly to problems of identity and self-image, while mental disorders were the main problems among adults. Content analysis identified 2 patterns of terminating the interaction, which represent 2 strategies of intervention to prevent suicide. The first is establishing a contact between the caller and an appropriate individual in the caller's environment who undertakes responsibility to help the caller. The second strategy is reducing the caller's tension, leading to a withdrawal of the suicidal threat. The first pattern is more characteristic of interactions with psychiatric callers, while the second is more frequent among non-psychiatric callers to ERAN. The hot-line makes a unique contribution in helping those threatening suicide, which constitutes a real emergency.

        ישראל פריאל, רמה כץ וערן דולב

        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.

        מרץ 1998
        רון בן אברהם, מיכאל שטיין, יורם קלוגר, גדעון פרת, אברהם ריבקינד ויהושע שמר

        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

        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.

        דני געתון, עדיאל ברק, שלמה שגב, יובל יסעור וגיורא טרייסטר

        Prevalence of Pigmentary Dispersion Syndrome in Israel


        D. Gaton, A. Barak, S. Segev, Y. Yassur, G. Treister


        Ophthalmology Dept., Beilinson Medical Center, Petah Tikva and Ophthalmology Dept. and Institute for Medical Screening and Assessment, Sheba Medical Center, Tel Hashomer


        Pigmentary dispersion syndrome is a precursor of pigmentary glaucoma whose prevalence in the urban population of USA was found to be 2.45%. We evaluated its prevalence during ocular screening examinations among normal Israelis. We screened for excessive pigmentation on the corneal endothelium with the slit-lamp and determined in each patient best corrected visual acuity, intra-ocular pressure (after mydriasis), condition of the anterior segment, cup-disk ratio, posterior segment abnormalities and questioned about history of any ocular disease and family history of glaucoma. 374 patients (mean age 49±11) were examined on 10 consecutive days. In 5.9% excessive corneal endothelial pigmentation was found. Intra-ocular pressure (after mydriasis) averaged 15.52±1.93 mm Hg as compared to 14.73±2.04 among the rest of our study population, (p=0.01). The prevalence of suspected pigmentary dispersion syndrome among young adults in Israelis is high.

        פברואר 1998
        אברהם זינרייך, בוריס גוחשטיין, אלכסנדר גרינשפון, מרים מירון, יהודית רוזנמן ויששכר בן-דב

        Recurrent Tuberculosis in a Psychiatric Hospital


        A. Zeenreich, B. Gochstein, A. Grinshpoon, M. Miron, J. Rosenman, I. Ben-Dov


        Pulmonary and Radiology Institutes, Chaim Sheba Medical Center, Tel Hashomer and Tel Aviv University; Israel Ministry of Health; and Gan Meged Hospital


        During 1987-1996, 39 of 720 patients hospitalized (most for severe schizophrenia) were diagnosed as having active pulmonary tuberculosis (5.4%, 975 per 105 per year). In 1992-1993, after a cluster of 5 cases was found, all patients were screened by PPD skin test and chest X-ray and 16 more cases were identified. Diagnosis was confirmed bacteriologically in only 10 of them but there were typical radiological findings in the others. 39 were treated with a multi-drug regimen. In addition, 333 exposed patients and 21% who had converted their skin tests were given isoniazid preventive therapy. A small increase in levels of liver enzymes was common, but significant abnormality (over 4 times the upper limit of normal) was found in only 7 patients, in whom therapy was therefor stopped or changed. During a follow-up period of 4 years, 2 more developed tuberculosis and 33 converted their PPD reactivity status. We conclude that an outbreak of tuberculosis in a psychiatric hospital can be controlled with a relatively low rate of side-effects by using systematic diagnostic and therapeutic measures. However, single step screening is not sufficient. Routine screening of all new patients, a high index of suspicion and contact investigation are needed.

        ינואר 1998
        ג'ורג' חביב וראמז אבו אחמד

        Six Cases of Acute Rheumatic Fever in One Year


        George Habib, Ramiz Abu-Ahmad


        Rheumatology Clinic and Dept. of Medicine, Nazareth Hospital; and Medical Dept. B, Carmel Medical Center, Haifa


        During 1995, 6 cases of acute rheumatic fever were diagnosed here. Taking into account differences in total admissions, this appears to represent an increase over 1994. Most of the cases were males, with average age at diagnosis 19.5 years. All were of low socioeconomic status. 50% had cardiac involvement, and 1 needed treatment with corticosteroids. Most had pharyngeal symptoms prior to the acute attack, and 1 patient had 2 prior episodes of rheumatic fever. A thorough epidemiological study should be done in the Nazareth area to assess the real incidence of acute rheumatic fever, and to determine whether there is a true increase in incidence.

        שמואל אריעד, אלכסנדר רבינוביץ, אילנה ינאי-עינבר ובנימין פיורה

        Mixed Uterine Mesodermal Tumors: Clinical and Pathological Characteristics


        Samuel Ariad, Alexander Rabinovitz, Ilana Yanai-Inbar, Benjamin Piura


        Depts. of Oncology and of Pathology, and Gynecology-Oncology Unit, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba


        During 1971-1996, 17 patients with mixed mesodermal uterine tumors were treated. Average age at diagnosis was 67.3 years, 12/17 were of European and 5/17 of Afro-Asian extraction. The overall 5-year survival was 21%. 10/17 patients had mixed mesodermal tumors with a heterologous mesenchy-mal element, and 7/17 had a homologous mesenchymal element (carcinosarcoma). 6/17 had another primary malignancy, including breast cancer (3/17), bilateral metachronous breast tumor (2/17), and malignant lymphoma of the neck region (2/17). All 3 with breast cancer had previously been treated with tamoxifen. 1 had simultaneous mesodermal tumor and ovarian thecoma. Simultaneous autoimmune manifestations occurred in 2/17, including thrombocytopenic purpura in 1, and myasthenia gravis in another. Mesodermal tumor of the uterus is a relatively rare malignancy with aggressive behavior and poor prognosis. It also had unusual associations with other primary tumors, hormonal treatment, and autoimmune manifestations.

        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