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        תוצאת חיפוש

        יוני 1997
        י' דומניץ, ל' חפץ, ד' חביב, י' קיברסקי, ד' קרקובסקי, פ' נמט

        Laser photorefractive surgery

         

        Y. Domniz, L. Hefetz, D. Haviv, U. Kibersky, D. Karkovski, P. Nemet

         

        Dept. of Ophthalmology, Assaf Harofeh Medical Center, Zerifin and Sackler Faculty of Medicine, Tel Aviv University

         

        As photorefractive keratectomy (PRK) with excimer laser gains world-wide acceptance, more patients are able to discard their spectacles. Our study comprised 611 eyes which underwent PRK and were followed for at least a year. Those with myopia up to -6.00D had better post-operative visual acuity and refraction, than patients with higher grades of myopia. They had less corneal haze and a greater proportion were satisfied with their results. Complaints of halos and glare were similar at all degrees of myopia up to -10.00D.

        איריס ברשק, מאיר קרופסקי, מרינה פרלמן ויורי קופולוביץ

        Pulmonary Alveolar Micro-Lithiasis Presenting With Prolonged Cough

         

        I. Barshack, M. Krupsky, M. Perelman, J. Kopolovic

         

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

         

        A 40-year-old man had been followed in the pulmonary clinic for prolonged cough. Chest X-ray showed bilateral diffuse interstitial infiltrates with accentuation toward the bases. CT-scan demonstrated a fine diffuse reticulonodular pattern. Transbronchial lung biopsy showed pulmonary alveolar microlithiasis, a rare disease characterized by the presence of concentric calcifications within the pulmonary alveoli. This is the second case of the disease reported in Israel.

        אמיר ויזרי, אלי מימון, משה מזור, אילנה שוהם-ורדי, טלי זילברשטיין, ארנון ויז'ניצר ומרים כץ

        Effect of the Yom Kippur Fast on Parturition

         

        A. Wiser, E. Maymon, M. Mazor, I. Shoham-Vardi, T. Silberstein, A. Wiznitzer, M. Katz

         

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

         

        Food-withdrawal has been proposed as a possible mechanism for initiating the onset of labor in animals and humans. The hypothesis was based upon the reported increase in deliveries of infants during the Yom Kippur fast. We studied the effect of the fast on full term deliveries of Jewish women, with non-fasting Bedouin women as controls (1988-1995, 1,313 Jewish and 1,091 Bedouin deliveries). To determine the effect of Yom Kippur itself, delivery rates on Sukkot and Yom Kippur were compared in both groups. The mean delivery rate in the Jewish population was significantly higher during Yom Kippur and the day after, than during the 7 days before Yom Kippur (15.1±5.1 and 14.6±4.7 vs 10.7±3.5, p<0.04 and p<0.01, respectively). There was an increase in delivery rate during the 6 hours before the end of the fast. In the Bedouin women there were no changes in delivery rate during any of these periods. There were no significant differences in the rates of deliveries during the Sukkot festival between Jewish and Bedouin women. We conclude that fasting is associated with a significant increase in the rate of deliveries at term.

        מאי 1997
        נטליה בילנקו, עמליה לוי ודרורה פרייזר

        Reporting Maternal Behavior during Diarrhea in Bedouin Children

         

        Natalya Bilenko, Amalia Levy, Drora Fraser

         

        Epidemiology and Health Services Evaluation Unit, S. D. Abraham International Center for Health and Nutrition, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba

         

        Diarrhea is still a major cause of morbidity and mortality among children in developing countries. The Bedouin population of southern Israel is in transition from a nomadic to a settled life-style. We examined maternal knowledge and reported behavior when their children had diarrhea. Mothers defined diarrhea as the passing of 4-5 stools per day. The most frequent signs of the illness were an increased number of watery stools with changes in either color or form. The most frequent symptom that prompted mothers to seek medical aid was blood in the stool. All mothers reported increasing fluid intake in their children during diarrhea, and most reported giving herbal tea. About half of the women avoided milk products and used special for the treatment of diarrhea. A quarter of the women reported stopping or decreasing the frequency of breast feeding during diarrhea. Reported cessation of breast feeding during diarrhea was associated with changing to special foods, and failure to note the onset of diarrhea or to recognize signs of dehydration. The withdrawal of breast feeding during episodes of illness and diarrhea is related to lack of knowledge regarding diarrhea. These data indicate that even in this population, with free access to preventive and curative medical care, there should be greater efforts to educate mothers to detect diarrheal disease and to maintain breast feeding during the diarrhea.

        מ' קליגמן ומ' רופמן

        Magnetic Resonance Imaging for Suspected Femoral Neck Fractures

         

        M. Kligman, M. Roffman

         

        Dept. of Orthopedic Surgery, Carmel Medical Center, Haifa

         

        Painful hip as a result of injury, with or without a history of trauma, is a common reason for referring elderly patients to the emergency room. The diagnosis of femoral neck fracture requires the combination of a physical examination, X-rays, and in problematic cases, a bone scan. However, even this combination does not always provide a diagnosis. We present 50 patients with painful hip who complained of limp and reduced hip joint motion, but had no evidence of fracture, either on X-ray or bone scan. After conservative treatment, 5 patients with no history of trauma underwent hemiarthroplasty of the hip for displaced subcapital fracture. In addition, we present a case of subcapital fracture which was diagnosed only by MRI, in whom both X-rays and bone scan were considered normal.

        רון בן-אברהם, מיכאל שטיין, יורם קלוגר, אמיר בלומנפלד, אברהם ריבקינד ויהושע שמר

        ATLS Course in Emergency Medicine for Physicians?

         

        Ron Ben-Abraham, Michael Stein, Yoram Kluger, Amir Blumenfeld, Avraham Rivkind, Joshua Shemer

         

        Medical Corps, Israel Defense Forces; and Trauma Units of Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, and of Hadassah Hospital, Jerusalem

         

        Implementation of Advanced Trauma Life Support (ATLS) skills among practicing physicians and its perceived utility in their civilian practices, as well as in their potential army combat assignments, was evaluated. 177 physicians in various subspecialties, who were graduates of ATLS training courses, answered a specially designed telephone questionnaire. An unexpectedly high percentage of physicians (47%) had used their ATLS training when called to treat trauma victims. 67% of physicians stressed the contribution of the ATLS course to enhancing their skills. We believe that a properly designed ATLS course for general practitioners would be very beneficial for trauma victims.

        עודד נחליאלי, אברהם מ' ברוכין, הנרי ליברוס ודניאל לונדון

        Salivary Gland Endoscopy: a New Technique for Diagnosis and Treatment of Sialolithiasis

         

        O. Nahlieli, A.M. Baruchin, H. Librus, D. London

         

        Oral and Maxillofacial Surgery Unit, Plastic Surgery Service and Radiology Institute, Barzilai Medical Center, Ashkelon

         

        The use of an endoscopic, minimally invasive technique for the removal of salivary gland stones from the submandibular or parotid duct is described. A 2.0-2.7 mm endoscope is inserted into an incision in the parotid or submandibular duct. When the stone is visualized through the endoscope it is removed using suction and forceps. We used this technique in 45 cases for removal of calculi, screening the ductal system to rule out residual calculi. and determination of ductal dilatation. The success rate was 80% and there were no major postoperative complications. To the best of our knowledge these are the first such cases reported in Israel.

        ראובן איליה, שרה כרמל, קרלוס כפרי ומשה גירון.

        Angina Pectoris and the Severity of Coronary Artery Stenosis

         

        Reuben Ilia, Sara Carmel, Carlos Cafri, Moshe Gueron

         

        Dept. of Cardiology, Soroka Medical Center, and Dept. of the Sociology of Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba

         

        The relationship between angina pectoris and the severity of coronary artery disease was evaluated in 146 patients with normal segmental and global, left ventricular, systolic performance. None had unstable angina or a previous myocardial infarction. A strong relationship was found between angina and the severity of coronary artery disease (p<0.005). Significant, stable, angina pectoris as a clinical symptom indicated advanced coronary artery disease in this selected group of patients.

        נ' סדן וב' וולך

        High Dose Oral Prednisone for Hemangiomas in Infants

         

        Nahum Sadan, Baruch Wolach

         

        Pediatrics Dept., Meir General Hospital, Sapir Medical Center, Kfar Saba and Sackler Faculty of Medicine, Tel Aviv University

         

        Over a 24-year period, 62 infants (47 girls) with hemangiomas were treated with an initial dose of either 3 or 5 mg/kg/day of oral prednisone for 2 weeks, after which the dose was gradually tapered off during 6-8 weeks. Few patients required longer treatment. Results were judged to be excellent in 68% of infants and good in 25%. Treatment was considered a failure in only 7%. The initial dose of 5 mg/kg/day was more effective than the smaller dose (p<0.001). Of the 62 patients, 49 received 1 course of treatment, 8 required 2 courses and 5 required 3 courses. Retreatment was given whenever significant regrowth occurred. Side-effects were not serious, and resolved when treatment was discontinued. Treatment was indicated when the location of the lesions caused interference with important functions or when the lesions were likely to damage anatomic structures. Special attention was paid to early treatment of eye and subglottic hemangiomas. In all 22 children with hemangiomas of the eye (most with an orbital component), shrinkage of the lesion was observed within 24 hours of initiating treatment. In 19 of the 22 there was no residual of the hemangioma 1-18 years later. Such lesions deserve early treatment, not just as cosmetic emergencies, but to prevent secondary amblyopia. Early treatment of subglottic hemangiomas is also mandatory because they are potentially life- threatening. We conclude that oral prednisone is very effective in the treatment of hemangiomas of infants when given at a high dose for an adequate period of time.

        איתן מור, דן שמואלי, זיו בן-ארי, נתן בר-נתן, עזרא שהרבני, אלכסנדר יוסים, בוריס דורפמן, רן טור-כספא וזכי שפירא

        Liver Allografts from Donors older than 60: Benefits and Risks

         

        Eytan Mor, Dan Shmueli, Ziv Ben-Ari, Nathan Bar-Nathan, Ezra Sharabani, Alexander Yussim, Boris Dorfman, Ran Tur-Kaspa, Zaki Shapira

         

        Transplantation Dept. and Institute of Liver Diseases, Rabin Medical Center, Beilinson Campus; and Sackler School of Medicine, Tel Aviv University

         

        With limited organ resources and an increasing number of candidates for liver transplantation, the world-wide trend is towards using liver allografts from donors older than 60 years. This strategy, however, may be hazardous because of the known correlation between advanced donor age and graft dysfunction. Since January 1996, each of 5 patients received a liver allograft from a donor older than 60 years. Preservation time in these cases was shortened as much as possible and liver allografts were used only if there were no other potential risk factors for primary nonfunction. Mean cold ischemic time was significantly shorter in this donor group (7.8 hrs) than for livers from 28 younger donors (10.2 hour; p<0.01). 3 of the 5 grafts from older donors had normal function immediately. The other 2 initially had biochemical features of preservation injury, but graft function returned to normal within the first week after transplantation. All 5 patients currently have normal graft function, with follow-up ranging from 3-8 months. There was no difference between the 5 recipients of grafts from older donors and 28 adult recipients of grafts from younger donors in extent of preservation injury and in immediate graft function. We conclude that in countries with limited organ resources, such as Israel, liver allografts from older donors can be used within defined limits and minimal preservation time.

        ד' אסטליין וי' וולוך

        Gastric Duplication Cyst in an Adult

         

        D. Estlein, Y. Wolloch

         

        Dept. of Surgery B, Rabin Medical Center (Golda Campus), Petah Tikva, and Sackler Faculty of Medicine, Tel Aviv University

         

        Gastric duplication cysts are rare in adults and usually asymptomatic. In most cases they are discovered incidentally by abdominal ultrasound, CT, or upper gastrointestinal x-rays. Most of the duplications (82%) are cystic and do not communicate with the stomach. Approximately half of the cases are associated with other congenital anomalies. We report a 59-year-old woman operated on for a pancreatic mass that proved to be a gastric duplication cyst. The cyst was resected and the postoperative course was uneventful.

        מאת א' עסליה, ד' קופלמן, ה' בחוס, י' קליין ומ' חשמונאי

        Gastrografin for Mechanical Partial, Small Bowel Obstruction due to Adhesions

         

        A. Assalia, D. Kopelman, H. Bahous, Y. Klein, M. Hashmonai

         

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

         

        The therapeutic effect of astrografin is occasionally mentioned in the literature. However, this effect has not been objectively evaluated. We studied prospectively the effect of Gastrografin in cases of adhesive, simple, partial, small bowel obstruction (SBO) compared to conventional management. During 3 years, a total of 137 episodes of simple, partial SBO in 127 patients (10 recurrent episodes) were treated. The episodes were randomized into a control group(80 episodes) treated conventionally, and a trial group (77 episodes), which received in addition 100 ml of Gastrografin administered through the nasogastric tube. The two groups were well-matched with regard to age, gender, weight, medical and surgical background and duration of complaints before admission. Time to first stool and resolution of obstruction, complications, need for surgery, and hospital stay were noted. Mean time to first stool was significantly shorter in the trial group: 6.2±3.9 hours vs 23.5±12.7 (p<.0001). Mean hospital stay for unoperated patients was also shorter in the trial group: 2.7±2 days vs 5.5±2 days, (p<.0001). In addition, significantly fewer episodes in the trial group required operation, 10.4 vs 26.7% (p<0.013). 1 patient in each group died following operation. There were no Gastrografin-related complications and it was effective and safe for adhesive, partial, simple SBO. It significantly speeds resolution of obstruction, reduces the need for operation, and shortens convalescence.

        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.

        א' שחר, ר' שרון, מ' לורבר וש' פולק

        Angioedema Caused by Splenectomy with Malignant Lymphoma Foll-Owed by Multiple Myeloma 7 Years Later

         

        A. Shahar, R. Sharon, M. Lorber, S. Pollack

         

        Institute of Allergy, Clinical Immunology and AIDS and Institute of Hematology, Rambam Medical Center and B. Rappaport Technion- Faculty of Medicine, Haifa

         

        Acquired C1-inhibitor (C1-INH) deficiency has been reported in patients with immunoglobulin abnormalities and lymphoproliferative disorders, and angioedema has appeared simultaneously with the lymphoproliferative disease. We present a 50-year-old woman with acquired C1-INH deficiency and angioedema which preceded by 7 years the diagnosis of malignant mantle cell lymphoma. During the interval she was treated with Danazole and there were no attacks of angioedema. When routine follow-up bone marrow aspiration revealed infiltration of nonspecified lymphoma cells, exploratory laparotomy and splenectomy were performed. A month later Danazol was stopped, C1-INH levels returned to normal and there were no attacks of angioedema. Mantle cell lymphoma consisting of lymphocytes with cytoplasmic IgM-lambda was diagnosed in the excised spleen but chemotherapy was not initiated. 6 months later, a second lymphoproliferative disorder, multiple myeloma IgA kappa, was diagnosed.

        גדי פישמן ודב אופיר

        Toxic Shock Syndrome

         

        Gadi Fishman, Dov Ophir

         

        ENT and Head Neck Surgery Dept., Meir Hospital, Kfar Saba

         

        Toxic shock syndrome (TSS) is a rare, life-threatening, acute multisystem illness usually characterized by sudden onset of high fever, diffuse sunburn-like erythroderma and a variety of other signs and symptoms. It may progress rapidly to hypotension and shock with multiple organ failure. Its exact cause is unknown, but in almost all cases there has been an infection with exotoxin-producing strains of phage group I Staphylococcus aureus. Although initially described in association with the use of super-absorbent tampons in menstruation, TSS has complicated a variety of surgical procedures. Recently in head and neck surgery attention has focused on absorbent packing materials, such as those used in postoperative nasal care.

        TSS developed in a 12-year-old 28 hours after tonsillectomy, nasal septoplasty and inferior turbinectomy in which absorbent packing material was used. It is important to maintain a high index of suspicion for TSS in all postoperative patients with fever, hypotension and erythroderma.

        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