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        תוצאת חיפוש

        יוני 1997
        איתי שביט, יהודית דימנט, שרית רביד ונעים שחאדה

        Hyponatremia due to Prolonged Excessive Ingestion of Water


        I. Shavit, J. Diment, S. Ravid, N. Shehadeh


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


        We report a 1.5-year-old boy admitted for restlessness and constipation. He was found to have hyponatremia caused by voluntary drinking of excessive amounts of water. Although unusual in children, intoxication by oral water is a recognized clinical syndrome in infants, 3-6 months old, fed with dilute formula. Water intoxication in older children is rare. The diagnosis was established by the water deprivation test.

        עדי רחמיאל, דינה לוינזון, דרור איזנבוד, דורון רוזן ודב לאופר

        Distraction Osteogenesis for Hypoplastic Facial Bones


        Adi Rachmiel, Dina Lewinson, Dror Eizenbud, Daren Rosen, Dov Laufer


        Dept. of Oral and Maxillofacial Surgery, and Orthodontics and Cleft Palate Unit, Rambam Medical Center; and Division of Morphological Sciences, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa


        Distraction osteogenesis is a well-known method for bone lengthening which stretches callus to generate new bone in the distracted area. The method was developed by Ilizarov for the lengthening of long enchondral bones. In recent years the method has also been applied to the facial bones and to the jaw.

        שמואל ארגוב

        Habitual Dependence on Modern Imaging Modalities: The New Golem


        Samuel Argov


        Elisha Hospital, Haifa


        Modern imaging techniques have been taking over our medical life, but none denies the progress that has followed introduction of modern imaging modalities. For the generation of younger physicians who entered the profession after the introduction of these techniques, use of US, CT, MRI and the like is natural and often applied. But the patient is not computerized and medicine is far from being a pure science. 3 cases of common surgical problems are presented in which excessive use of diagnostic modalities resulted in unnecessary operations, thus leading to unnecessary morbidity.


        In these days of soaring medical expenses, many unnecessary imaging and laboratory studies are done for reasons of "defensive" medicine. It is important to fortify the position of clinical diagnosis, but making clinical decisions without requiring expensive and sometimes misleading imaging studies significantly reduces costs. Admittedly, courage and firm professional backbone are required to face a lawyer or a judge and say: "This CT or US study would not have changed my clinical decision; it would have made no positive contribution to it, and might even have mislead me." This paper comes to remind physicians of the importance of clinical diagnosis and the need to develop and rely on primary medical skills. Machines and laboratory tests are aids to diagnosis, they do not make the diagnosis.

        שאול מ' שאשא, נועם גולדשטיין ואברהם אופק

        International Quality Assurance Standards (ISO 9002) in an Israeli Hospital


        Shaul M. Shasha, Noam Goldstein, Abraham Ofek


        Western Galilee Hospital, Nahariya and Ofek Institute, Ramat Hasharon


        This hospital has been certified by the Israel Standards Institute as having a quality assurance system fulfilling the requirements of the international standard, ISO 9002. This is the first hospital in this part of the world to be certified as fulfilling this standard. Its adoption is one of several accepted approaches to quality assurance in medicine. World-wide, very few health organizations, including hospitals, have implemented this system successfully. Opinions regarding its importance are divided, mostly because of lack of experience in its application. We describe its features, goals and structure, and its implementation in various sectors, including health organizations. The process of its adoption, application and implementation is described, and the problems which arose are discussed.

        ר' מושיוב, ד' סגל ומ' ליברגל

        Immediate Orthopedic Surgery in Multiple Trauma


        R. Mosheiff, D. Segal, M. Liebergall


        Orthopedic Dept., Hadassah Medical Center, Jerusalem


        The increase in mortality and morbidity from multiple trauma due to road accidents, industrial trauma and combat injuries obligates treatment based on emergency systems and trauma centers. Follow-up of the frequency of different types of injury calls attention to increasing involvement of the orthopedic surgeon in primary treatment. This situation calls for appropriate deployment of immediate surgical treatment which will rapidly enable mobility. We present several methods for immediate orthopedic treatment of multiple-trauma patients.

        ריטה טוקר, דניאל פלוסר, ינקו הרצנו ושאול סוקניק

        Chronic Tophaceous Gout


        Rita Toker, Daniel Flusser, Yanku Hertzanu, Shaul Sukenik


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


        A 51-year-old immigrant from the Caucasus had had chronic tophaceous gout for over 20 years, but had never been treated with anti-hyperuricemic drugs. He had developed large, multiple tophi in many locations, including both ankles and feet. The enormous size and unique location of the tophi caused considerable pain, and difficulty in standing and on walking. Since surgical removal of the tophi was refused by the patient, a course of allopurinol, 300 mg/day, was begun.

        פלטיאל וינר, דורון זמיר ומרינלה בקרמן

        Inhaled Budesonide for Chronic Obstructive Pulmonary Disease


        Paltiel Weiner, Doron Zamir, Marinella Beckerman


        Medical Dept A, Hillel Yaffe Medical Center, Hadera


        A significant, large minority of patients with chronic obstructive pulmonary disease (COPD) respond favorably to corticosteroid treatment; but the benefit may be outweighed by its side effects. Long-term administration of inhaled steroids is a safe means of treatment. We hypothesized that treatment with inhaled budesonide would improve clinical symptoms and pulmonary function in subjects with COPD, and that the response to an inhaled B2-agonist would individualize steroid responders. In 44 patients with stable COPD in a double- blind crossover trial, we compared a 6-week course of inhalations of 800 mg/d budesonide with a placebo, separated by a 4-week interval when no medication was taken. In 33 out of 42 responders to the B2-agonist who remained in the study, there was a significant improvement in FEV1 of greater than 20% following budesonide inhalation, as compared to placebo. There was also a significant difference between the 2 periods of treatment as to the mean number of B2-agonist inhalations. We conclude that about 1/4 of patients with stable COPD respond to bronchodilators, and treatment with inhaled steroids improves spirometry data and inhaled B2-agonist consumption in about 3/4.

        שלמה וינקר, ששון נקר, סרגיי פינקל, עמנואל ניר ואיתן חי-עם

        Oral Anticoagulation Therapy in the Primary Care Setting


        Shlomo Vinker, Sasson Nakar, Sergei Finkel, Emanuel Nir, Eitan Hyam


        Family Medicine Dept., Sackler Faculty of Medicine, Tel Aviv University; and Shaaraim Clinic, General Sick Fund, Rehovot; Central Cinical Laboratories, and District Medical Director, Central District of the General Sick Fund


        The use of oral anticoagulant therapy (OAT) to prevent thromboembolism has been widespread in recent years. The concept of high- and low-intensity regimens has facilitated treatment for many, and has lowered the hazards of overly intense anticoagulation. However, a significant proportion of patients suited to the low intensity regimen are not being treated. It is not clear whether its wider use is limited by continued debate, lack of resources, lack of expertise, or other causes. We retrospectively reviewed the medical records of 32 patients treated with OAT administered in the primary care setting. The average age was 66±11 years (range 34-84). 9 were treated with high-intensity OAT: 8 due to artificial heart valves, and 1 due to a hypercoagulable syndrome with recurrent thromboembolism. 23 were treated with low-intensity OAT, 17 of whom had atrial fibrillation. 11 were also being treated continuously with other medication which interacted with OAT or interfered with other coagulation pathways. Such medication included: aspirin, dipyridamole, amiodarone, bezafibrate and allopurinol. Of 414 coagulation tests, 57% and 65% were in the therapeutic range in the high- and low-intensity OAT groups, respectively. There was no major bleeding event, but in 2 of 8 who bled, gastrointestinal bleeding led to hospitalization. Treatment was discontinued in 1 patient because of difficulties in achieving target INR, and in the 2 hospitalized for bleeding. The percentages of test results in, above and below the therapeutic range were similar to those in other large series, for both intensity regimens. We found that a significant proportion of patients were under chronic treatment with other medication which interacted with OAT. To estimate the rate of complications in primary care OAT, larger series are needed. We conclude that OAT can be given and monitored by the family physician, and that awareness of long and short term drug interactions with OAT is mandatory.

        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.

        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