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        תוצאת חיפוש

        דצמבר 1997
        פסח שורצמן

        Sunscreen Use in an Urban Negev Population


        Pesach Shvartzman


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


        The use of sunscreen in the Negev population was assessed. The study population included 1458 subjects, mean age 35.5‏±14.2 years, half born in Israel and 25% in East Europe. Two-thirds were exposed to the sun 1-2 hours a day and 13% 4 hours a day or more. Only about 15% used sunscreen while shopping, 69% used it at the beach, and less than half applied it to children being sent to school. Sunscreen use was greater in women (p<0.000001), especially those with sensitive skin (p<0.0001) and red hair (p<0.0001). No significant association was found with age, education or country of birth.

        ר' דורסט, א' טייטלבאום, י' בר-אל, מ' שלפמן וי' גינת

        Compulsory, Ambulatory Psychiatric Treatment


        R. Durst, A. Teitelbaum, Y. Bar-El, M. Shlafman, Y. Ginath


        Arie Jaros Jerusalem Mental Health Center and Talbieh Mental Health Center (Affiliated with the Hebrew University-Hadassah Medical School, Jerusalem) and Israel Ministry of Health, Jerusalem District


        The Treatment of Mentally Sick Persons Law of 1955, was repealed and replaced by the Law of 1991. Under the latter, the Order for Compulsory Ambulatory Treatment (OCAT) was addressed for the first time (Section 11, a-d). According to this law, the district psychiatrist instead of issuing a hospitalization order, may issue an OCAT, under which the required treatment is given within the scope of a clinic which he designates, for up to 6 months and under conditions which he specifies. This is done on the basis of psychiatric examination, or an application in writing from the director of a hospital or clinic, when continued ambulatory treatment is needed after discharge from hospital or instead of compulsory hospitalization. The district psychiatrist may extend the period of treatment for further periods, none of which is to exceed 6 months. Compulsory ambulatory treatment is to enable patients to benefit from the positive aspects of living freely in the community, while receiving prompt treatment under compulsory conditions. The concept offers a partial solution, achieving a balance between civil liberties and clinical needs, between over-confinement and under-treatment which might be dangerous or neglectful. The clinical impression has been that the OCAT has not fulfilled expectations. The purpose of this study was to examine the topic in a systematic way in Jerusalem and the soutern districts for the 4 years since inception of the law. In 44.4% of cases OCAT was proven to be effective, while in 33.1% it was found to be ineffective and did not prevent compulsory hospitalization, one of its main goals. It was partially effective in the rest of the cases. It is recommended that suitable means for the enforcement of the law be allocated and that the subject of forceful hospitalization and OCAT be made a mandatory subject in the residency program of psychiatrists.

        אליהו גז, יעל נצר-הורוביץ, עינת וימן, רפאל רובינוב, יורם כהן ואברהם קוטן

        Radiotherapy of Localized Prostatic Carcinoma


        Eliahu Gez, Yael Netzer-Horowitz, Einat Waiman, Raphael Rubinov, Yoram Cohen, Abraham Kuten


        Northern Israel Oncology Center and Oncology Dept., Rambam Medical Center and Lin Medical Center, Haifa; and Soroka Medical Center, Beer Sheba


        112 patients with localized prostate cancer, clinical stage A2-C, were treated by definitive radiotherapy between 1982-1988. Radiation volume encompassed the prostate, seminal vesicles and pelvic lymph nodes. The 10-year actuarial survival figures were: overall 51%; stage A2 87%; stage B 50%; stage C 36%; well differential tumors 67%; moderately differentiated 50%; poorly differentiated 32%; patients with local tumor control 55%; and patients with minimal local control 36%. It is concluded that external beam irradiation is effective in localized prostatic cancer. Stage and grade are prognosticators of survival.

        שלום שטהל, דורון נורמן וחיים צינמן

        Postoperative Ulnar Nerve Palsy of the Elbow


        Shalom Stahl, Doron Norman, Chaim Zinman


        Hand Surgery Unit and Dept. of Orthopedic Surgery B, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa


        Ulnar nerve neuropathy of the elbow is a recognized complication of surgery involving general anesthesia. In 13 patients, aged 21-76 years, ulnar nerve palsy developed at various times and of varying degrees of severity during the postoperative period. Diagnosis was based on clinical and electrophysiological findings. 3 patients had subclinical entrapment of the ulnar nerve. All were treated conservatively by rest, splinting and physical therapy: 10 improved slowly with time and 3 were operated on, but only 1 recovered fully. Preventive measures, such as proper positioning on the operative table, use of elbow pads, avoiding adduction of the arm, pronation of the forearm and prolonged elbow flexion, may reduce the incidence of ulnar nerve palsy. Unfortunately, treatment of established lesions has yielded mixed results.

        א' רווה, ר' סדוב, ב' נגריס ור' פיינמסר

        The Parapharyngeal Space: Tumors and Surgical Approaches


        E. Raveh, R. Sadov, B. Nageris, R. Feinmesser


        Dept. of Otolaryngology and Head and Neck Surgery, Rabin Medical Center, Petah Tikva


        The potential parapharyngeal space contains the great vessels of the neck, cranial nerves IX-XII, the sympathetic chain and lymph nodes. Surgical access is difficult and the infrequency of tumors in it make surgery of this part of the head and neck a challenge. 8 women and 2 men (mean age 54.7, range 31-70 years) with tumors of the parapharyngeal space operated on during the past 6 years are presented. The most common surgical approach was the cervical submandibular, used in 6 of our patients with relative ease and minimal complications. Tumors of deep lobe parotid origin should be operated through a transparotid approach. Large benign or malignant tumors have a better prognosis when the transcervical transmandibular approach is used, providing wider access.

        ראובן מדר

        Bromocriptine for Refractory Rheumatoid Arthritis


        Reuven Mader


        Rheumatic Disease Unit, HaEmek Medical Center, Afula


        In recent years prolactin (PRL) has emerged as an important immunomodulator in various autoimmune disorders. Bromocriptine (BRC) is a dopamine agonist that suppresses secretion of PRL. Good clinical response to BRC has been reported in patients with psoriatic arthritis, Reiter's syndrome, and systemic lupus erythematosus. 5 mg of BRC at bedtime were given to 5 patients (aged 35-50) with refractory rheumatic arthritis (RA) who had failed to respond to previous treatment with at least 2 disease-modifying antirheumatic drugs. Patients were assessed at 4-6 week intervals for 6 months. 3 showed more than 25% improvement in the number of tender and swollen joints at 12 weeks of treatment. However, in only 2 of them was improvement maintained till the end of the 6 months. There were no changes in other measures of disease activity. 1 patient dropped out of the study due to acute exacerbation of her disease 4 weeks after initiation of BRC and required intra-articular injections of corticosteroid. The remaining patient did not show any significant clinical changes. No correlation was found between serum PRL levels and disease activity over time. It is suggested that some patients with refractory RA might improve with BRC. Its use in larger doses in larger groups of patients may help elucidate its role in the treatment of RA.

        הרברט פרוינד, דן צרור, דני אימרל ועודד זמיר

        Preliminary Experience with Laparoscopic Repair of Inguinal Hernias


        Herbert R. Freund, Dan Seror, Dan Eimerl, Oded Zamir


        Surgery and Anesthesiology Depts., Hadassah-University Hospital, Mount Scopus, Jerusalem


        During 1992-1996 we performed 163 laparoscopic hernia repairs in 100 men and 2 women. The mean age was 50.6; and in 61 the operation was bilateral. 66 were by transabdominal preperitoneal approach and 36 btotal extra-peritoneal approach. There were only a few minor complications and total recurrence rate was only 4.3%, partly attributable to our learning curve. Laparoscopic inguinal herniorrhaphy reduces postoperative incisional and muscular pain and causes less disruption in the postoperative period than open repair. Return to normal activity and work is faster for laparoscopic than for open repair, but operating room costs are higher (time and equipment). However, economic advantages for the national economy should be considered.

        ד' ליבוביץ, ב' יפה וא' זיסמן

        Incomplete Penile Amputation: Diagnostic and Therapeutic Challenge


        D. Leibovici, B. Yaffe, A. Zisman


        Urology Dept., Assaf Harofeh Medical Center and Microsurgery Dept., Chaim Sheba Medical Center, Tel Hashomer


        Traumatic penile amputation is a severe injury associated with a potential for multidisciplinary dysfunction. Since such injuries are rare, diagnostic and therapeutic experience is minimal. While complete penile amputation is a straight-forward diagnosis, incomplete amputations are not as evident and diagnosis may be delayed. The therapeutic endpoint includes restoration of an acceptable appearance of the phallus and a urethral meatus that allows normal voiding. Other objectives include re-establishment of sexual potency and fertility. As in other amputations, the treatment of choice is meticulous microsurgical replantation, including re-anastomosis of dorsal and cavernosal arteries, the deep dorsal vein, the urethra and nerves, as well as suturing the tunica albuginea. While appropriate cosmetic results and normal voiding can be achieved in most cases, potency is less frequently achieved due to neurological deficit leading to impaired erection and loss of sensation. Penile amputation is thus a complex therapeutic challenge, as meticulous anatomic reconstruction of blood vessels and nerves is essential for restoration of function. Since incomplete penile amputation may be overlooked when other more obvious injuries draw attention, this injury should be suspected in all cases of penetrating injury of the male genitalia. We present a 17-year-old man who sustained an incomplete penile amputation in a traffic accident.

        אבישי גולץ, בתיה אנגל-יגר, הנרי צבי יואכימס, אבירם נצר ושולה פרוש

        Balance Disturbances in Children with Middle Ear Effusions


        Avishay Golz, Batia Angel-Yeger, Henri Zvi Joachims, Aviram Netzer, S. Parush


        Dept. of Otolaryngology and Head and Neck Surgery, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa


        Vertigo and dizziness are not common complaints in childhood, but probably present more often than has been thought. These symptoms, caused mainly by otitis media (OM) and middle ear effusion (MEE), are 2 of the most common diseases in children, and until recently had long been neglected in the literature and in practice. We determined objectively the incidence of balance-related symptoms in children with long-lasting MEE, and resolution following insertion of ventilation tubes (VT). 36 children, aged 4-9 years, were studied using electronystagmography (ENG) and the Bruininks-Oseretsky tests for motor proficiency, before and after ventilation of the middle ear. Results were compared to those in 74 healthy children with no history of middle ear disease. Abnormal ENG findings were found in 58%, and 71% had low Bruininks-Oseretsky (BO) test scores. The ENG was abnormal in only 3 of the controls, 1 of whom also had low BO test scores. The symptoms and signs of balance disturbances resolved in 96% following VT insertion. These results indicate that balance-related symptoms often encountered in young children may result from chronic MEE, and that they resolve following evacuation of the effusion and ventilation of the middle ear.

        א' אדונסקי, ח' סמו וש' לבנקר

        Central Cord Syndrome in the Elderly Who Fall: a Diagnostic Trap


        A. Adunsky, H. Semo, S. Levenkrohn


        Geriatric Rehabilitation Dept., Chaim Sheba Medical Center, Tel Hashomer


        Acute post-traumatic spinal injury is common and usually poses no diagnostic difficulties. Following a low-energy fall, the onset of acute central cord syndrome in the elderly is not common and is frequently misdiagnosed. Men aged 60 and 81, and a woman aged 75 are described, in whom central cord syndrome was overlooked. Awareness of this condition is important to avoid incorrect diagnosis and hazardous management.

        יוסף חייק, אריה יודיץ, איריס ברשק, מנחם בן חיים, משה שבתאי ועמרם אילון

        Surgical Approach to Benign Cecal Ulcer


        J. Haik, A. Judich, I. Barshack, M. Ben-Haim, M. Shabtai, A. Ayalon


        Dept. of Surgery B and Pathology Institute, Chaim Sheba Medical Center, Tel Hashomer and Sackler Faculty of Medicine, Tel Aviv University


        Benign cecal ulcer is a rare lesion, usually diagnosed during operation for suspected acute appendicitis or peritonitis of unknown origin. In the past, right hemicolectomy was recommended as the treatment of choice because of the difficulty in differentiating malignant lesions from benign cecal ulcers. However, in recent reports a more conservative approach has been suggested, consisting of selective colectomy followed by frozen section biopsy. This approach is aimed at preventing unnecessary excision of the colon and conserving the ileocecal valve. We present a 47-year-old woman operated for right lower quadrant peritonitis, believed to be due to acute appendicitis. On exploration, a biopsy-proven benign cecal ulcer was found and resected.

        דרור רובינסון, לנה פנקס, ליליה מינדלין, נחום הלפרין ותפחה הורן

        Technetium 99-M Sestamibi Bone Scan in Musculo-Skeletal Neoplasms


        Dror Robinson, Lena Pinkas, Lilia Mindlin, Nahum Halperin, Tifha Horn


        Dept. of Orthopedics and Nuclear Medicine, Assaf Harofeh Medical Center, Zerifin


        It is often difficult to assess accurately the nature of a skeletal lesion. Problems include differentiating a malignant from a benign bone tumor, as well as determining the cause of a pathologic fracture. Such fractures may occur through osteoporotic bone as well as through neoplasm-affected bone. Thus, development of an imaging modality capable of distinguishing between such lesions is of importance. During 1996, we ran a prospective study in which results of Tc-99m-methyl-diphosphate (MDP) bone scans were compared with those of sestamibi (MIBI) bone scans and with subsequent biopsy and clinical course. The results of the bone scans were assessed by 2 independent "blinded" observers, and the ratios of counts in lesions to those in normal tissue (L/N ratios) were calculated. In cases of malignant (7) and benign (8) tumors, intensity of uptake in MDP scans were not predictive of degree of aggressiveness. On the other hand, MIBI bone scans demonstrated significant difference in intensity of uptake between benign and malignant bone tumors (L/N ratios 2.05 vs 2.75). In 5 of 8 benign lesions the L/N ratio was 1. In the others, increased uptake was minimal. In 2 patients changes in uptake in MIBI bone scan following chemotherapy appeared to be related to the degree of tumor necrosis achieved. While the MIBI bone scan cannot replace tissue biopsy as a definitive diagnostic modality in bone neoplasms, it does appear to allow better preoperative assessment and prognosis.

        שרה כרמל ואלון לזר

        Telling the Bad News: do the Elderly Want to Know Their Diagnoses and Participate in Medical Decision Making?


        Sara Carmel, Alon Lazar


        Sociology of Health Unit, Faculty of Health Sciences, and Dept. of Behavioral Sciences, Ben-Gurion University of the Negev, Beer Sheba


        In view of reported changes in western countries in the preferred model of doctor-patient relations, we evaluated the wishes of elderly persons for open doctor-patient communication with regard to terminal disease. Data was collected in 1994 from 987 elderly persons (70+) by structured interviews. Most of respondents wanted open communication and wished to be involved in medical decisions regarding life-sustaining treatment. However, only a minority tell their physicians and/or family members of their wishes. This suggests that most of the elderly expect physicians to be the first to initiate discussions of these issues. The results also indicate that among the elderly, those more educated, less religious, and those living in Israel longer, are more likely to want open communication with their physicians. This is explained by the relationship of these characteristics with the dominant cultural values of this group, and its acceptable models of relations in other areas of life.

        נובמבר 1997
        תמר טלמון, יצחק בירן ובנימין מילר

        Traumatic Hyphema*


        Tamar Talmon, Itzchak Beiran, Benjamin Miller


        Dept. of Ophthalmology, Rambam Medical Center and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa


        Traumatic hyphema usually occurs in young men at the rate of 17-20/1000,000. Major complications include secondary hemorrhage, glaucoma, corneal staining and disturbances in visual acuity. Final visual acuity is predominantly the outcome of all the ocular injuries occurring during the trauma, mainly to the posterior segment of the eye. We describe all cases of traumatic hyphema treated in our department over a period of 3.5 years. Antifibrinolytic treatment is recommended in the literature in traumatic hyphema to prevent secondary hemorrhage. Our findings differ from those in the literature in that they show a lower prevalence of more severe hemorrhages and of secondary hemorrhage. In light of these differences, and with regard to possible side effects of such treatment, we suggest that antifibrinolytic treatment not be used in our population. We recommend that treatment for traumatic hyphema should include restricted activity, local corticosteroidal preparations, frequent follow-up visits and vigorous diagnostic work-up in order to find any additional eye damage. We strongly recommend the use of preventive measures (eye-shields) in high risk activities such as sports, house-hold work and military training.


        * Based on work submitted to the Faculty of Medicine, Technion-Israel Institute of Technology, by Tamar Talmon in partial fulfillment of the requirements for the MD degree.

        מיכה שמיר וצ'רלס ספרונג

        Fatal Multiple Organ System Dysfunction Associated with Germanium Metal


        Micha Shamir, Charles L. Sprung


        Dept. of Anesthesiology and Critical Care Medicine, Hadassah--University Hospital and Hebrew University-Hadassah Medical School, Jerusalem


        The element germanium is widely distributed in nature. It is used in industry as a semiconductor and there have been a few attempts to use it in medicine. In the past few years 20 patients have been described in the literature as suffering from germanium overdosage. Like laboratory animals affected by the element, they suffer from renal failure and injury to other organs. We describe a 52-year old man given germanium to prevent recurrence of a brain tumor. He developed multiple organ dysfunction syndrome and died of intractable hyperdynamic shock. We call for caution regarding morbidity resulting from treatments believed safe.

        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