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        תוצאת חיפוש

        אפריל 1997
        דורה סגל-דופרשמיט, אורנה דלי-גוטפריד ואנטוני לודר

        Water Intoxication following Desmopressin Overdose

         

        D. Segal-Kuperschmit, O. Dali-Gotfrid, A. Luder

         

        Pediatric Dept., Rebecca Sieff Hospital, Safed

         

        Water intoxication is a serious condition which may be caused by desmopressin overdose, with reversible or irreversible neurological complications. In the past, desmopressin was used in endocrinological centers for the treatment of anti-diuretic hormone deficiency (central diabetes insipidus). Indications for hormone treatment have since widened, especially as an effective solution for nocturnal enuresis. It is now often prescribed in community clinics, and its use has been encouraged by extensive promotion. We describe a 15-year-old boy with primary nocturnal enuresis who started treatment with desmopressin 1 year prior to admission. He was allowed to use the drug without supervision, and drank excessively. The result was water intoxication which required admission for intensive care because of loss of consciousness and convulsions for 36 hours.

        א' דימנט, מ' ליברגל, ש' פורת ור' מושיוב

        Treatment of Open Fractures due to Dog Bite

         

        A. Dimant, M. Liebergall, S. Porat R., Mosheiff

         

        Orthopedic Dept., Hadassah-University Hospital, Ein Kerem, Jerusalem

         

        2 patients aged 12 and 19, respectively, sustained open fractures of the wrists due to dog bites. Both were bitten on a wrist by Rotweiller dogs, but with different magnitudes of injury to bone and soft tissue. Treatment, clinical course and recovery are described, together with recommendations for dealing with open fractures due to animal bites. In the presence of considerable injury to soft tissue and bone, and of exposure to canine oral flora, open fractures due to dog bites should be dealt with as high grade open fractures.

        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.

        יובל מלמד, עמי לוי והנרי שור

        Between "Transparent Room" and "Sealed Room:" Professional Confidentiality and Therapeutic Judgement

         

        Yuval Melamed, Ami Levy, Henry Szor

         

        Abarbanel Mental Health Center, Bat Yam and Shalvata Mental Health Center, Hod HaSharon

         

        Patients and therapists are concerned with the complexities of protecting medical confidentiality. The traditional perception of protection of patient confidentiality is that the individual's interest in protecting his confidentiality may conflict with the public's need for information, especially in cases involving possible danger. In fulfilling his dual role of representing both the patient and the public, the therapist acts according to existing laws and regulations. We describe 3 cases in which refraining from providing the Army with information in accordance with the law was recognized in retrospect as having caused the patient suffering, and even danger. It is recommended that the therapist's judgement be considered in addition to other legal criteria for determining whether or not to protect patient confidentiality.

        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.

        בני קליין ונתן רוז'נסקי

        Biological Test for Menopausal Osteoporosis

         

        Benjamin Klein, Nathan Rojansky

         

        Depts. of Experimental Surgery and of Obstetrics and Gynecology, Hadassah- Hebrew University Medical Center, Ein Kerem, Jerusalem

         

        Osteoporosis has become a major public health problem in many western countries in which about 25% of women by the age of 65 will have had osteopenic fractures. The most important contributing factor to this condition is loss of gonadal function. This progressive disease, characterized by reduction in bone mass, may be prevented by estrogen replacement therapy. While there are several methods of diagnosing the disease when already established, there is no method that can identify women at high risk of developing osteoporosis. We have developed a biological test in which the serum of postmenopausal women is added to rat osteoprogenitor cell culture and its influence on proliferation, differentiation and mineralization of bone cells is determined. The serum of 20 menopausal women was examined by the biological test and the results compared to the findings of dual photon absorptiometry. This showed that rapid bone-losers had a significantly lower mineralization index as compared to nonosteopenic women (p<0.0001). The proliferation index (cell count) and alkaline phosphatase activity did not show significant differences between osteopenic and nonosteopenic groups. This preliminary study showed that a test based on serum reacting with a culture of bone cells to induce mineralization may be of value in the diagnosis of osteoporosis.

        מרץ 1997
        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.

        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.

        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.

        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.

        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.

        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.

        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.

        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