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        תוצאת חיפוש

        דצמבר 1997
        דרור רובינסון, לנה פנקס, ליליה מינדלין, נחום הלפרין ותפחה הורן

        Technetium 99-M Sestamibi Bone Scan in Musculo-Skeletal Neoplasms


        Dror Robinson, Lena Pinkas, Lilia Mindlin, Nahum Halperin, Tifha Horn


        Dept. of Orthopedics and Nuclear Medicine, Assaf Harofeh Medical Center, Zerifin


        It is often difficult to assess accurately the nature of a skeletal lesion. Problems include differentiating a malignant from a benign bone tumor, as well as determining the cause of a pathologic fracture. Such fractures may occur through osteoporotic bone as well as through neoplasm-affected bone. Thus, development of an imaging modality capable of distinguishing between such lesions is of importance. During 1996, we ran a prospective study in which results of Tc-99m-methyl-diphosphate (MDP) bone scans were compared with those of sestamibi (MIBI) bone scans and with subsequent biopsy and clinical course. The results of the bone scans were assessed by 2 independent "blinded" observers, and the ratios of counts in lesions to those in normal tissue (L/N ratios) were calculated. In cases of malignant (7) and benign (8) tumors, intensity of uptake in MDP scans were not predictive of degree of aggressiveness. On the other hand, MIBI bone scans demonstrated significant difference in intensity of uptake between benign and malignant bone tumors (L/N ratios 2.05 vs 2.75). In 5 of 8 benign lesions the L/N ratio was 1. In the others, increased uptake was minimal. In 2 patients changes in uptake in MIBI bone scan following chemotherapy appeared to be related to the degree of tumor necrosis achieved. While the MIBI bone scan cannot replace tissue biopsy as a definitive diagnostic modality in bone neoplasms, it does appear to allow better preoperative assessment and prognosis.

        שרה כרמל ואלון לזר

        Telling the Bad News: do the Elderly Want to Know Their Diagnoses and Participate in Medical Decision Making?


        Sara Carmel, Alon Lazar


        Sociology of Health Unit, Faculty of Health Sciences, and Dept. of Behavioral Sciences, Ben-Gurion University of the Negev, Beer Sheba


        In view of reported changes in western countries in the preferred model of doctor-patient relations, we evaluated the wishes of elderly persons for open doctor-patient communication with regard to terminal disease. Data was collected in 1994 from 987 elderly persons (70+) by structured interviews. Most of respondents wanted open communication and wished to be involved in medical decisions regarding life-sustaining treatment. However, only a minority tell their physicians and/or family members of their wishes. This suggests that most of the elderly expect physicians to be the first to initiate discussions of these issues. The results also indicate that among the elderly, those more educated, less religious, and those living in Israel longer, are more likely to want open communication with their physicians. This is explained by the relationship of these characteristics with the dominant cultural values of this group, and its acceptable models of relations in other areas of life.

        נובמבר 1997
        תמר טלמון, יצחק בירן ובנימין מילר

        Traumatic Hyphema*


        Tamar Talmon, Itzchak Beiran, Benjamin Miller


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


        Traumatic hyphema usually occurs in young men at the rate of 17-20/1000,000. Major complications include secondary hemorrhage, glaucoma, corneal staining and disturbances in visual acuity. Final visual acuity is predominantly the outcome of all the ocular injuries occurring during the trauma, mainly to the posterior segment of the eye. We describe all cases of traumatic hyphema treated in our department over a period of 3.5 years. Antifibrinolytic treatment is recommended in the literature in traumatic hyphema to prevent secondary hemorrhage. Our findings differ from those in the literature in that they show a lower prevalence of more severe hemorrhages and of secondary hemorrhage. In light of these differences, and with regard to possible side effects of such treatment, we suggest that antifibrinolytic treatment not be used in our population. We recommend that treatment for traumatic hyphema should include restricted activity, local corticosteroidal preparations, frequent follow-up visits and vigorous diagnostic work-up in order to find any additional eye damage. We strongly recommend the use of preventive measures (eye-shields) in high risk activities such as sports, house-hold work and military training.


        * Based on work submitted to the Faculty of Medicine, Technion-Israel Institute of Technology, by Tamar Talmon in partial fulfillment of the requirements for the MD degree.

        מיכה שמיר וצ'רלס ספרונג

        Fatal Multiple Organ System Dysfunction Associated with Germanium Metal


        Micha Shamir, Charles L. Sprung


        Dept. of Anesthesiology and Critical Care Medicine, Hadassah--University Hospital and Hebrew University-Hadassah Medical School, Jerusalem


        The element germanium is widely distributed in nature. It is used in industry as a semiconductor and there have been a few attempts to use it in medicine. In the past few years 20 patients have been described in the literature as suffering from germanium overdosage. Like laboratory animals affected by the element, they suffer from renal failure and injury to other organs. We describe a 52-year old man given germanium to prevent recurrence of a brain tumor. He developed multiple organ dysfunction syndrome and died of intractable hyperdynamic shock. We call for caution regarding morbidity resulting from treatments believed safe.

        אלכסנדר נודלמן, גורדון אדלסון, עמוס לינדן וראול רז

        Fish Spine Infection


        Alexander Nudelman, Gordon Edelson, Amos Linden, Raoul Raz


        Orthopedic Dept., Poriya Hospital and Dept. of Infections Diseases, HaEmek Hospital, Afula


        Vibrio vulnificus is a Gram-negative bacterium living in warm salty water that produces a spectrum of human disease which may progress to devastating, sometimes fatal infections in susceptible individuals. Such infections have rarely been reported in Israel. However, over the past few months we have been seeing a sharp increase in V. vulnificus infections with a common history of injury to extremities by the sharp spines of Tilapia zillii, ("amnon" or St. Peter's fish). Clinical suspicion and prompt intervention prevent the untoward consequences of misdiagnosis or delay.

        ר' דורסט, ג' כץ, ק' ז'בוטינסקי-רובין וח' קנובלר

        Kleptomania: Phenomenological, Clinical and Legal Aspects


        R. Durst, G. Katz, K. Jabotinsky-Rubin, H.Y. Knobler


        Kfar Shaul Mental Health Center, Jerusalem


        Kleptomania is currently classified in psychiatric nomenclature as one of the impulse control disorders (DSM-IV, 1994). It is characterized by repeated failure to resist impulses to steal objects, not for personal use or monetary gain. The objects are therefore discarded, given away, or hoarded (ICD-10, 1992). This disorder is known since the early 18th century from the phenomenological and clinical viewpoints, yet is still debated with regard to therapeutic strategies and criminal liability. Although there are usually complications associated with the legal consequences of being caught and arrested, subjects continue to violate the law despite repeated arrests and convictions. In a 28-year old man suffering from kleptomania, years of psychodynamic psychotherapy were ineffective. Only when he was treated as suffering from an impulse control disorder or a variant of obsessive-compulsive disorder, was there significant improvement. The positive response to buspirone (5-HT1A) augmentation of fluvoxamine (SSRI) suggested that disturbed central serotonergic neurotransmission might play an important role in the pathogenesis of kleptomania. This concept is strengthened by the comorbidity of the syndrome with depression and by its compulsive traits. We stress that although kleptomaniacs cannot differentiate between right and wrong, testing shows that their sense of reality is intact, but they act under the influence of drives they cannot resist.

        יאירה חממה-רז, זהבה סולומון ואברהם עורי

        Fear of Personal Death among Hospital Physicians


        Y. Hamama-Raz, Z. Solomon, A. Ohry


        School of Social Work and Dept. of Neuro-Rehabilitation, Chaim Sheba Medical Center, Tel Hashomer (Both affiliated with Tel Aviv University)


        Many studies have tried to explain why professionals experience difficulty when dealing with, and in treating efficiently situations connected with death. We studied levels of personal fear among physicians in general hospitals and addressed 2 questions: Does exposure to death on professional and personal levels, affect the level of the fear of personal death which physicians experience? Is there a relationship between personality variables, represented by the repression-sensitization dimension, and level of fear of personal death? A sample of 233 physicians from 22 general hospitals who specialized in oncology, internal medicine, surgery, psychiatry or pediatrics was studied. Each answered 4 questionnaires with regard to demographic information, fear of personal death, level of repression-sensitization and exposure to the death of relatives and significant others. There were no differences in level of fear of personal death of physicians according to specialization, but those who had been exposed to death on the personal level, feared less their own death. With respect to the personality variable, tendency to sensitization, it was found that those who were sensitized exhibited a higher level of the fear of their own death compared to those who were repressive. Of the various demographic variables examined (sex, level of religiouobservance, age, number of children, health, professional experience) it was found that those: with many years of professional experience, who were relatively older, who were nonobservant religiously and who were in good health, had lower levels of personal fear of death; gender was not a factor.

        אודי צינמון ויונה קרוננברג

        Choanal Atresia: 13 Years of Experience


        U. Cinamon, J. Kronenberg


        Depts. of Otolaryngology and Head and Neck Surgery, Chaim Sheba Medical Center, Tel Hashomer


        Choanal atresia is uncommon and consists of congenital blockage between the nasal cavity and the nasopharynx. The anomaly presents either immediately after birth as respiratory distress, or as a coincidental finding at an older age. Treatment is usually surgical. The approaches are transnasal, transseptal, transpalatal and transantral. Different types of stents are used and for various periods after each type of correction. Between 1983-1996, 20 patients with choanal atresia were operated on, in 12 of whom it was bilateral. The youngest was 3 days old and the oldest 22 years (average 6 years). The 20 patients underwent a total of 29 operations of which all were transnasal except for 2 corrected through a transseptal approach; 3 had their primary operation elsewhere. In all cases the atresia was bony or combined bony and membranous, except for 2 in whom there was combined atresia on 1 side and membranous on the other. The success rate was 75% in those first operated on here, in whom stents were employed. In our last 5 cases we used the endonasal approach and a rigid endoscope, a safe technique that has the advantage of direct unobscured vision.

        זאב קריסטל וישעיהו כץ

        Analgesia in Breast Surgery with Interpleural Bupivacaine


        Z. Crystal, Y. Katz


        Dept. of Anesthesiology, HaEmek Medical Center, Afula and B. Rappaport Faculty of Medicine, Technion, Haifa


        A control group of 15 patients undergoing breast surgery was given general anesthesia. In 15 other patients an interpleural block with 0.4 ml/kg bupivacaine, 0.5%, was performed 20 minutes before induction of general anesthesia for pre-emptive analgesia. This was extended further by continuous administration of bupivacaine 0.25%, 0.125 ml/kg/hr by automatic infusion pump, with supplements of opiates for postoperative pain management. The combined technique was associated with significantly reduced perioperative opiate requirement with better emergence from anesthesia, fewer side effects, a prolonged pain-free period, and overall better quality of postoperative recovery.

        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.

        מרינה שנק, שמעון וייצמן, טובה ליפשיץ ובן ציון ביידנר

        Penetrating Ocular Injuries: a Retrospective Study


        M. Schneck, S. Weitzman, T. Lifshitz, B. Biedner


        Dept. of Ophthalmology, and Epidemiology and Health Services Evaluation Unit, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba


        Penetrating injuries of the eye are an important cause of unilateral visual loss. We studied a series of 82 cases of penetrating injuries treated here from 1987 through 1993. The injuries were caused by sharp objects in 66% and blunt trauma in 6%. The prognosis after a penetrating injury is greatly influenced by the nature of the injury and the extent of the initial drainage. Among factors associated with an unfavorable visual outcome were diminished preoperative visual acuity and scleral wounds with dense vitreous hemorrhage.

        בן-עמי סלע, טלי לרמן-שגיא ומתי ברקוביץ

        Carnitine Deficiency in Inborn Errors of Metabolism


        B.-A. Sela, T. Lerman-Sagie, M. Berkovitz


        Institute of Chemical Pathology, Chaim Sheba Medical Center and Section of Clinical Biochemistry, Sackler School of Medicine, Tel Aviv University; Pediatric Neurology Unit, Wolfsohn Medical Center, Holon; and Children's Ambulatory Clinic, Assaf Harofeh Medical Center, Zrifin


        Several conditions, considered as inborn errors of metabolism, involve severe deficiencies in carnitine in both plasma and muscle. In the absence of evidence suggesting primary carnitine deficiency due to a biosynthetic enzymatic defect in the liver, the various diseases with carnitine deficiency are related to genetic defects in organic acid metabolism leading to blocked mitochondrial b oxidation. We describe a 4.5-year-old boy and 2 female infants with glutaric aciduria type I, isovaleric acidemia, and long-chain acid dehydrogenase deficiency, in whom severe carnitine deficiency was apparent. In all 3, long-term carnitine treatment proved to be vital and eliminated most of the symptoms.

        אילן בר, משה שמחה, אבירם ניסן, ירון שרגל, מרדכי קרמר וגדעון מרין

        Limited Axillary Thoracotomy for Recurrent Spontaneous Pneumothorax


        I. Bar, M. Simha, A. Nissan, Y. Shargal, M. Kramer, G. Merin


        Depts. of Cardiothoracic Surgery and of Surgery, and Pulmonary Institute, Hadassah--University Hospital, Ein Karem; and Dept. of Surgery, Hadassah--University Hospital, Mt. Scopus, Jerusalem


        Recurrent spontaneous pneumothorax often requires surgical intervention. Recently, less invasive thoracic surgical techniques, such as video-assisted thoracoscopy (VAT) and limited axillary thoracotomy (LAT), have been developed and used for different thoracic procedures. We describe our results with limited axillary thoracotomy, as compared with those of video-assisted thoracoscopy as reported in the literature. From October 1994 to May 1996, 14 patients with recurrent spontaneous pneumothorax, aged 16-33 years, underwent limited axillary thoracotomy, resection of blebs and apical pleurectomy, using multifire GIA 80 staplers (Auto Suture Inc.). There were no complications or recurrences during 5-17 months of follow-up. Mean operative time was 52.2 minutes and mean hospital stay 2.3 days postoperatively. Full activity was regained within 12.1 days. In comparison with over 75 cases of VAT from the literature, LAT is safe and offers the potential benefits of decreased operative time, hospital stay and cost.

        והיב סכראן, ראול רז, ראול קולודנר ויורם כנס

        Isolated Susceptibility of Streptococcus Pyogenes to 3 Macrolides


        W. Sakran, R. Raz, R. Colodner, Y. Keness


        Infectious Disease Unit and Microbiology Laboratory, HaEemek Medical Center, Afula


        Erythromycin is considered the drug of choice in the treatment of streptococcal pharyngitis in patients allergic to penicillin. However, in recent years several publications, especially in Finland and Italy, showed high resistance rates of S. pyogenes isolates to erythromycin and other new macrolides. To evaluate the situation in Israel, we checked the MIC of isolates from patients with tonsillitis during 1996. E-test results showed an MIC-50 of 0.23, 0.13 and 0.47 mcg/ml for erythromycin, clarithromycin and roxithromycin, respectively and a MIC-90 of 0.37, 0.23 and 0.78 mcg/ml. Only 2 isolates (2.1%) were partially or completely resistant to all 3 antibiotics. We conclude that empiric therapy with macrolides in Israel is still a viable option and can be recommended in S. pyogenes tonsillitis for patients allergic to penicillin.

        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.

        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