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        תוצאת חיפוש

        ינואר 1998
        אפרים תבורי וסוזן סרד

        Accessibility of Information and Informed Consent: Experiences of Breast Cancer Patients

         

        Ephraim Tabory, Susan Sered

         

        Dept. of Sociology and Anthropology, Bar-Ilan University, Ramat Gan

         

        We studied the social and cultural frameworks that impact on breast cancer patients in the medical system. The subjects were 98 Jewish women who had undergone mastectomy or lumpectomy for cancer 6 months to 3 years prior to the interview. They emanated from a variety of socioeconomic and ethnic backgrounds, and reflected the age range of women with breast cancer in the general Jewish population of Israel. Patients were asked about each stage of the medical process they had experienced: diagnosis, surgery, oncological care, and follow-up care. The interview revealed a general perception of having received insufficient information regarding their medical condition and treatment. The problem tended to be most severe during the diagnostic stage, when women had not yet been officially included as patients within the system. The problem was relatively severe during follow-up care, when they often did not have an address for their questions. Few women received a schedule of follow-up care that allowed them to carry on with the many necessary tests in an orderly and comprehensive manner. Most important, systematic absence of informed consent also characterized the decision-making process regarding surgery and oncological treatment. Few women felt they had been informed about treatment options, side-effects, or long-term implications of the treatment offered. We found no indication of inequitable medical treatment that would suggest a manifest pattern of discrimination, but we did find some social variables related to a feeling of insufficient personal care and information. In particular, older women said they received less attention, support, and information from the medical staff relative to the younger women.

        א' פרסמן, י' קנדליס, י' בכר וג' מוגילנר

        Onchocerca in Israel

         

        A. Pressman, Y. Kandelis, Y. Bachar, G. Mogilner

         

        Depts. of Pediatric Surgery and Pathology, Bnei-Zion Medical Center and Bruce Rappaport Faculty of Medicine, The Technion, Haifa

         

        The parasite Onchocerca volvulus is well-known in its endemic areas in South and Central America and West Africa. It is transmitted to man by simulium flies and causes systemic infection with skin, lymphatic and ophthalmic manifestations and can cause blindness (river blindness). Treatment with Ivermectin is effective but sometimes there is need for surgical intervention to prevent or treat complications. We describe an 11-year-old girl, a new immigrant from Ethiopia, who had a firm mass in her left thigh, caused by Onchocerca volvulus. It was completely excised. This is a very rare condition in Israel, which must be considered in patients coming from endemic areas.

        מירית הרשמן-סרפוב, אורורה טובי, יצחק סרוגו ודוד בדר

        Fungus-Ball in a Preterm Infant Successfully Treated with Fluconazole

         

        Mirit Hershman-Sarafov, Orora Tubi, Isaac Srugo, David Bader

         

        Neonatal and Radiology Depts., and Microbiology Laboratory, Bnai-Zion Medical Center and Bruce Rappaport Faculty of Medicine, The Technion, Haifa

         

        Very-low-birth-weight premature infants are at high risk for invasive candidiasis. The most commonly involved organ is the kidney. Renal candidiasis may present as fungus-ball obstructive uropathy. We describe unilateral renal obstruction secondary to fungus-ball in a premature infant. Noninvasive, systemic antibiotic treatment, including amphotericin B and fluconazole, resulted in disappearance of the finding.

        צבי שטיינר, יפים קנדליס, ג'ורג' מוגילנר, דינה אטיאס ויצחק סרוגו

        Conservative Approach in Children with Central Line Infection 


        Zvi Steiner, Yafim Kandelis, George Mogilner, Dina Atias, Isaac Srugo

         

        Dept. of Pediatric Surgery, and Hematology and Clinical Microbiology Units, Bnei-Zion Medical Center, and Bruce Rappaport Faculty of Medicine, The Technion, Haifa

         

        In 1994-1995, central venous lines were placed in 47 children. All except 1 were of the Broviac type, with subcutaneous tunneling via the internal or external jugular vein. Ages were between 7 days and 16 years. Indications for central venous cannulation were chemotherapy (35 cases), TPN (5), prolonged parenteral antibiotics (4), and repeated blood transfusions (3). The catheter was the source of infection in 13 children (28%), 11 of whom were immunocompromised. The commonly identified bacteria were Staphylococcus aureus (4 cases), Pseudomonas aeruginosa (4), coagulase-negative Staphylococcus (2), and various gram-negative rods (3). All cases were treated with antibiotics through the catheter. The most commonly used were oxacillin (4), ceftazidime (4), and amikacin (4). In 10, treatment succeeded without having to remove the line. In 2 others, tunnel infection developed and the catheter had to be removed. 1 child forcefully removed his catheter before treatment could be started. There were no further complications in the group treated conservatively, except for a case of superior vena cava thrombosis in a girl with recurrent infection of the tunnel. In 7 out of 13 treatment was continued and completed at home. This saved 65 days of hospitalization out of 210. We conclude that the conservative approach to treatment is feasible in most cases of infection when the source is the central venous catheter itself. However, when the tunnel is infected, conservative treatment may be ineffective. Treatment can be carried out in the home, with economy in cost and in use of hospital beds, and is preferred by patients and their parents.

        לביא אוד, שלי קרימרמן ויצחק סרוגו

        Incidence, Antimicrobial Resistance and Mortality in Bloodstream Infections in the Critically Ill

         

        Lavi Oud, Shelly Krimerman, Isaac Srugo

         

        General Intensive Care Unit and Clinical Microbiology Dept., Bnai-Zion Medical Center, Haifa

         

        Bloodstream infections (BSI) are 7-fold more common in patients admitted to the intensive care unit (ICU) rather than to other hospital wards. The epidemiology of BSI in critically ill patients in Israel has not been systematically addressed. We examined the annual trends in BSI in patients in a general ICU of evolving patterns of antimicrobial resistance and associated mortality rates for the years 1994-1996. The presence of the systemic inflammatory response syndrome (SIRS) when the first positive blood cultures are taken was a prerequisite for its definition as clinically significant. The unit site, staff, practice guidelines, and type of patient were unchanged during the study period. Blood cultures were positive in 220.7-332.0 patients per 1000 ICU admissions, 18-22-fold more common than in regular ward patients. SIRS was a universal finding in these ICU patients. There was multi-drug resistance for the majority of species cultured, reaching 100% in some cases. Crude hospital mortality of ICU patients, with and without positive blood cultures, was 31-54% and 5-14%, respectively. The introduction of a new blood culture system (Bactec 9240) in 1996 was associated with a 61% increase in the rate of patients with positive blood cultures, accounted for mostly by increased isolation of coagulase-negative staphylococci. However the mortality rate for the latter decreased by 59%, suggesting the possibility of a selective increase in detection of contaminated cultures. Although highly prevalent in the study population and generally defining a patient group with high mortality risk, the specificity of SIRS-associated positive blood cultures may be species and culture-system dependent. These findings re-emphasize the need for both improved control measures for the epidemic proportions of BSI and multi-drug antimicresistance, as well as more specific indicators of the clinicaof positive blood cultures in critically ill patients.

        יהודית רניאל, יהודה טייכנר וצבי פרידמן

        Progression of Diabetic Retinopathy after Cataract Extraction

         

        Y. Raniel, Y. Teichner, Z. Friedman

         

        Annette and Aron Rozin Dept. of Ophthalmology, Bnai-Zion Medical Center and Bruce Rappaport Faculty of Medicine, The Technion, Haifa

         

        A prospective study of the effect of cataract extraction with intraocular lens implantation on the course of diabetic retinopathy (DR) in 44 patients (59 eyes) was carried out. It showed that in the 1-3 years following surgery, there was progression of DR (including development of newly formed retinopathy) in 35% of the patients (28.8% of eyes). Progression was more marked in patients with pre-operative bilateral DR compared to those without bilateral DR (77% and 16% respectively). Insulin dependence did not play a role in progression. Final visual acuity was better in patients without pre-operative DR, as well as in eyes without progressive retinopathy.

        נובמבר 1997
        משה צ' פפא, דפנה ברסוק, משה קולר, אהוד קליין, מירב שראלי וגור בן-ארי

        Identification of Sentinel and Axillary Node Involvement in Breast Cancer

         

        M.Z. Papa, D. Bersuk, M. Koler, E. Klein, M. Sareli, G. Ben-Ari

         

        Dept. of Surgical Oncology and Breast Unit, Chaim Sheba Medical Center, Tel Hashomer

         

        Axillary node dissection for breast cancer is important for staging and prognosis. "Sentinel nodes" are the first nodes into which primary cancer drains. Identification, removal and pathological examination of those nodes indicates whether completion of axillary lymphadenectomy is required. The sentinel nodes are identified using a vital dye injected at the primary tumor site. With this technique we were able to identify sentinel nodes in 46 of 48 (95%) women examined. An average of 2.7‏1.2 nodes were identified as sentinel nodes. In 81% of cases there was a correlation between involvement of sentinel nodes and of other axillary nodes as well. In 10% of patients sentinel nodes were involved with tumor while other axillary nodes were negative. The major problem in routine application of this is relationship in surgical decisions is reliable real time pathological identification of lymph node involvement by tumor.

        מ' בירגר, ר' שאנני ופ' פבלוצקי

        Biofeedback Treatment of Raynaud's Disease

         

        M. Birger, R. Sha'anani, F. Pavlotzki

         

        Psychiatric Day Care and Dermatology Depts., Chaim Sheba Medical Center, Tel Hashomer and Psychiatric Service of Leumit Health Insurance Company

         

        Raynaud's disease is characterized by intermittent peripheral vasoconstriction leading to pallor, cyanosis and reactive vasodilation of the arterioles of fingers and toes. These phenomena are accompanied by sensations of cold or warmth, pain and difficulty in manipulating the palms. Ulcerations of the fingertips can occur in severe cases. Since conservative medical treatment, consisting of preventive measures and changing various habits, results in alleviation in only half the patients, sympathectomy is often required. Psychological intervention, including biofeedback, also has a significant role. Biofeedback involving relaxation techniques, guided imagination, and in parallel, computer-assisted monitoring of sympathetic arousal, might lead to symptom reduction as a unique treatment or in conjunction with other treatment modalities.

        יולי 1997
        יצחק בן-ציון, פנחס דגטיאר ויעקב קנטי

        Bacterial Culture of Chip Tissue of Enucleated Prostates

         

        I.Z. Ben-Zion, P.M. Dagtyar, J. Kaneti

         

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

         

        To assess the prevalence of infection and colonization of the prostate by bacteria, chip tissue samples from 166 patients undergoing retropubic prostatectomy were submitted for bacterial tissue culture. In 28 patients with an indwelling catheter before surgery, E. coli, Klebsiella, Pseudomonas and Enterobacter were the commonest species encountered, the first the most common. In only 7 patients (20%) who didn't have an indwelling catheter before operation was the culture positive. We confirmed that the longer the time the catheter was indwelling before surgery, the greater the likelihood of positive cultures. However, postoperative outcome and morbidity were not related to culture results. We conclude that even though it is worth trying to sterilize the urine and prostate before prostatectomy, the effect on the postoperative outcome is minimal when proper antimicrobial therapy is given perioperatively.

        יוני 1997
        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.

        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.

        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.

        אפריל 1997
        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.

        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.

        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
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