• כרטיס רופא
  • אתרי הר"י
  • צרו קשר
  • פעולות מהירות
  • עברית (HE)
  • מה תרצו למצוא?

        תוצאת חיפוש

        מאי 1997
        מרדכי קליגמן, בני ברנפלד ומשה רופמן

        Recurrent Chronic Multifocal Bone Infection

         

        Mordechai Kligman, Benny Bernfeld, Moshe Roffman

         

        Dept. of Orthopedic Surgery, Carmel Medical Center, Haifa

         

        We present a 9-year-old girl who had chronic recurrent multifocal osteomyelitis. The bones involved were: right clavicle, distal fibula (bilateral), left sacroiliac and right wrist. After 10 years of follow-up, she is asymptomatic but presents radiological evidence of lesions in the right clavicle and left sacroiliac joint. The diagnosis was made by exclusion criteria. The biopsy and results of cultures from various bones were negative 4 times. Although chronic recurrent multifocal osteomyelitis is rare, it should be considered in the differential diagnosis of acute or chronic osteomyelitis and neoplasms. Its recognition avoids unnecessary laboratory tests and antibiotic therapy.

        דוד ב' ויס, שושנה גוטשלק-סבג, אלחנן בר-און, צבי צוקרמן, יגאל גת ובנימין ברטוב

        Seminiferous Tubule Cytological Pattern in Infertile, Azoospermic Men in Diagnosis and Therapy

         

        David B. Weiss, Shoshana Gottschalk-Sabag, Elchanan Bar-On, Zvi Zukerman, Yigal Gat, Benjamin Bartoov

         

        Male Infertility and Cytology Units, Shaare Zedek Medical Center, Jerusalem; Andrology Unit, Rabin Medical Center (Beilinson Campus), Petah Tikva and Male Infertility Laboratory, Dept. of Life Sciences, Bar-Illan University, Ramat Gan

         

        We determined spermatogenic patterns of seminiferous tubules in azoospermic infertile men and evaluated the prevalence of bilateral testicular homogeneity. 185 azoospermic men underwent bilateral testicular fine-needle aspiration (TFNA) in which each testis was punctured at 3 different positions. Aspirated material was stained and classified according to the most mature spermatogenic cell type present or whether only Sertoli cells were present. 35.7% had spermatozoa in their testes, 36.2% had spermatogenic maturation arrest, and 28.1% had only Sertoli cells in their seminiferous tubules. In 15.6% of all patients, the diagnosis in 1 testis differed from that in the other. In only 73.2% of those with testicular spermatozoa was it bilateral. In the remaining 26.9%, only Sertoli cells, spermatocytes or spermatids were found as the most mature cell type in the other testis. The study definitely indicates that fertilization with retrieved testicular spermatozoa should not be offered to azoospermic patients without prior evaluation of the seminiferous tubue spermatogenic pattern in both testes.

        ולאדימיר קורן, רוברט קולדנוב, עדנה פלג, אווה איזאק, מאיר ברזין ותלמה רוזנטל

        Red Cell Na+/H+ Exchange and Role of Protein Kinase C in its Stimu-Lation in Diabetes Mellitus, Essential Hypertension and Nephropathy

         

        Wladimir Koren, Robert Koldanov, Edna Peleg, Eva Izsak, Meir Berezin, Talma Rosenthal

         

        Dept. of Medicine C, Hypertension Unit and Endocrinology Institute, Chaim Sheba Medical Center, Tel Hashomer

         

        Na+/H+ exchange (NHE) was measured as maximal initial velocity of pH-dependent H+ efflux from red cells into an alkaline medium containing Na+ in patients with insulin-dependent or noninsulin-dependent diabetes, with and without hypertension and in normoglycemic, essential hypertensives and normal controls (50 subjects in each subgroup). Maximal velocities of NHE were found in microalbuminuric patients in all subgroups, and NHE correlated with the rate of microalbuminuria (r=0.61, p=0.02). Daily insulin requirements were greater in those with elevated NHE (84±8 vs 42±4 U/day). There was no correlation between NHE and levels of plasma glucose, HbA1 and plasma aldosterone and lipid profile and PRA. NHE was correlated with plasma prolactin (r=0.51, p=0.02) and PTH r=0.24, p=0.05). In uremic patients, NHE was inversively correlated with creatinine clearance (r=-0.48, p=0.03). Since calphostin C, a selective inhibitor of protein kinase C, lowered increased NHE in vitro, the protein kinase C-dependent pathway of the exchanger regulation was concluded to be responsible for NHE activation in diabetes mellitus and essential hypertension.

        אפריל 1997
        רות אברמוביץ ונטע נוצר

        Use of Student Feedback by Pre-Clinical and Clinical Course Directors

         

        Ruth Abramowitz, Netta Notzer

         

        Medical Education Unit, Sackler Faculty of Medicine, Tel Aviv University

         

        We examined the conceptual and instrumental uses of student feedback on teaching by 2 preclinical and clinical course directors with authority to change structure and content of the courses, assess suitability of instructors and to change methods of student feedback questionnaires have been collected systematically for over 2 decades. A report based on this feedback is sent to course directors, the dean, his assistants and the head of the curriculum committee. Course directors from both groups made broad use of the feedback but made greater use of the report than preclinical course directors. Students had greater regard for individual teaching by clinical course directors than by preclinical course coordinators. No relationship was found between the degree of use of feedback by members of either group and their level of teaching. We conclude that senior faculty use student feedback in their decisions regarding the structure and teaching methods of their courses and are not influenced by individual assessments, positive or negative, by their students.

        נטע בנטור, ג'ני ברודסקי ובני חבוט

        Prevalence Rate, Place of Hospitalization and Source of Referral of Complex Nursing Care Patients in Geriatric Hospitalization

         

        Netta Bentur, Jenny Brodsky, Beni Habot

         

        JDC-Brookdale Institute of Gerontology and Human Development, Jerusalem; Shmuel Harofeh Geriatric Medical Center; Rishon Lezion Geriatric Center; and Sackler Faculty of Medicine, Tel Aviv University

         

        For the past several years, the hospitalization and care of complex nursing care patients (CNCP) has caused concern among organizers, funders and care-givers of the geriatric hospitalization system (GHS). To assist in improving efficiency of the GHS and to address the lack of comprehensive, empirical and up-to-date information on these patients, we conducted a survey to characterize CNCP, to assess their medical problems and to determine their prevalence among the patients in GHS. The survey was conducted in 1994 using a day census. Data were collected on the 2,319 patients in geriatric beds in all the general hospitals and geriatric hospitals in Israel on the day of the survey.

        28% of the patients in the GHS were CNCP and a quarter of them (7% of all patients) suffered from more than 1 medical condition. Tube feeding was the most prevalent condition (13% of all patients), followed by terminal illness (9%), deep pressure sores (7%) and intravenous transfusion for more than 3 days (6%). The 80% of the CNCP were hospitalized in geriatric hospitals, primarily in geriatric rehabilitation wards. Their average length of stay was over a year. Internal medicine wards of general hospitals were the most frequent source of patient referral. The survey's findings raise issues related to the organization of care of CNCP. They may serve as a basis for the reorganization of the geriatric hospitalization system in order to improve efficiency and quality of care for the benefit of patients, their families and services providers.

        אורה שובמן, יעקב ג'ורג' ויהודה שינפלד

        Ischemic Hepatitis in Congestive Heart Failure after an Episode of Hypotension

         

        Ora Shovman, Jacob George, Yehuda Shoenfeld

         

        Dept. of Medicine B and Autoimmune Disease Clinic Research Unit, Sheba Medical Center, Tel Hashomer and Sackler Faculty of Medicine, Tel Aviv University

         

        Ischemic hepatitis can occur as an acute episode in advanced congestive heart failure (CHF). The mechanism is massive necrosis of the central lobules resulting from acute hypoxia when low cardiac output further reduces oxygen supply, aggravating underlying congestion due to poor venous outflow. We describe a 70-year-old woman with congestive heart failure for 7 years who was admitted with jaundice, vomiting, abdominal pain and oliguria after an episode of hypotension. The diagnosis of ischemic hepatitis was established by a documented episode of severe hypotension, followed by elevation of serum transaminases, a rise in serum bilirubin and LDH levels, prolonged prothrombin time and acute renal failure. Other causes of acute hepatitis, such as a virus or drugs were excluded, and improved liver and renal function followed hemodynamic stabilization. We conclude that ischemic hepatitis should be considered whenever acute hepatitis follows a recent episode of systemic hypotension, especially in the context of concomitant CHF.

        אלי קונן, אלכס גרניאק, בנימינה מורג, יזהר הרדן וזלמן רובינשטיין ז"ל

        Insertion of Hickman Catheters in an Interventional Radiology Suite

         

        Eli Konen, Alex Garniak, Binyamina Morag, Izhar Hardan, Zalman Rubinstein

         

        Depts. of Radiology and Hemato-oncology, Chaim Sheba Medical Center, Tel Hashomer

         

        In the past 20 years Hickman catheters have gained increasing acceptance for many uses, including bone marrow transplantation, long-term chemotherapy, total parenteral nutrition, dialysis, and administration of antibiotics and fluids. Until the past decade these catheters were inserted in the operating room. We present our experience in the percutaneous placement of 203 Hickman catheters in an interventional radiology suite in 190 consecutive patients within a period of 30 months. Catheter placement was successful in 202 (99.5%). The main complications were infections, necessitating removal of the catheter in 11 cases (5.4%) and unintentional dislodgement of the catheter in 8 (3.9%) - all in women and most on the right side. Pneumothorax and thrombosis in the catheter each occurred once. In another patient the guide wire broke during insertion and had to be percutaneously removed from the pulmonary artery. Late fracture of the catheter occurred in 2 others in whom the intravascular fragment was removed percutaneously. We believe that percutaneous Hickman catheter placement in the radiology suite offers advantages over traditional surgical placement.

        מויסי מולדבסקי, אלכסנדר סזבון, נינה קוצ'רסקי וחנה טורני

        Urinary Bladder Transitional Cell Carcinoma with Trophoblastic Differentiation

         

        M. Moldavsky, A. Sazbon, N. Kuchersky, H. Turani

         

        Cytology Division, Dept. of Pathology and Dept. of Urology, Rebecca Sieff Government Hospital, Safed

         

        Transitional cell carcinoma (TCC) with trophoblastic differentiation (TD) is a newly recognized variant of urothelial cancer which produces placental proteins, predominantly beta-human chorionic gonadotropin (HCG). It has a poor prognosis. About 210 cases were described, mostly from North America, Europe and Japan. This is the first report of TCC TD in a resident of Israel's upper Galilee. A 69-year-old man whose urinary papillary bladder tumor was established cystoscopically, refused treatment and stopped follow-up. 3.5 years after his last visit, he returned and cytologic examination revealed malignant urothelial cells, while intravenous pyelography disclosed a urinary bladder defect. Cystoscopy showed numerous papillary masses dispersed over the bladder mucosa, which were resected transurethrally. Histopathologic examination revealed TCC grade III, stage A. Tumor cells were immunopositive for beta-HCG and human placental lactogen. 4 transurethral resections of large masses were performed within 2 months. Pulmonary metastases developed and the patient died 4 years after the detection of the urinary bladder tumor.

        מרץ 1997
        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.

        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.

        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.

        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.

        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.

        פברואר 1997
        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.

        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