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        תוצאת חיפוש

        פברואר 1997
        חן גרינברג, שמואל אביטל, חנוך קשתן ויהודה סקורניק

        Diverticular Disease of the Appendix


        R. Greenberg, Shmuel Avital, Hanoch Kashtan, Yehuda Skornik


        Dept. of Surgery A, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University


        The incidence of appendiceal diverticulosis in pathologic specimens is 0.004-2.1%. Diverticular disease of the appendix is classified as congenital (true) or acquired (false). The clinical presentation differs from that of acute appendicitis. The average age is older, the pain is often intermittent, and while localized in the right lower abdominal quadrant, is of longer duration. No further treatment besides appendectomy is needed. Since a high rate of perforations, peritonitis and lower gastrointestinal bleeding have been reported as complications, it is recommended that in those with an incidental finding of diverticula of the appendix during surgery, that appendectomy be performed. It is not recommended to perform prophylactic appendectomy when diverticula of the appendix are found on barium enema.

        י' קלוגר, ד' סופר, ב' שגיא, א' אבלאי, ד' אלג'ם ומ' רבאו

        Blunt Perineal Injuries


        Y. Kluger, D. Soffer, B. Sagie, O. Abllay, D. Aladgem, M. Rabau


        Depts. of Surgery B and C and Division of Trauma and Proctology, Tel Aviv Medical Center, Tel Aviv


        Blunt perineal and anal injuries are rare. We describe 2 patients who suffered injury to the perineum and anal canal due to blunt force. New surgical techniques for the reconstruction of the sphincteric mechanism are promising and should be used by the initial treating surgeon as minimal procedures in the perineal region. Anal tagging, minimal debridement, approximation of the edges of perineal laceration, repeated irrigation and loop-colostomy for fecal diversion should be the only initial surgical procedures.

        צבי גרינולד ויעקב כץ

        Separation of Conjoined Twins: The Anesthesiologist's Perspective


        Zvi Grunwald, Yacov Katz


        Dept. of Anesthesiology, Rabin Medical Center, Beilinson Campus and Schneider Children's Hospital, Petah Tikva


        Managing anesthesia care for separation of conjoined twins poses a special challenge for the anesthesia team. Early preparation, thorough understanding of the anatomical and the physiological consequences of this complex anomaly, as well as careful coordination with the teams of surgeons, nurses and operating room personnel are mandatory to assure successful separation of the conjoined twins. It is recommended that the mother be transferred to and the babies be delivered at a tertiary care medical center, like the Children's Hospital. Special attention is devoted during the surgical procedure to cardiovascular stability, drug disposition, fluid balance and temperature control. The multidisciplinary team approach makes this complex surgery a success. When postoperative survival cannot be guaranteed for both twins, close contact and consultation is mandated with the parents, medical personnel and religious and legal advisors.

        רפאל נגלר, מיכה פלד ודב לאופר

        Facial Trauma: Characteristics and Therapy


        R. Nagler, M. Peled, D. Laufer


        Depts of Maxillofacial and Oral Surgery, Rambam Medical Center, Haifa


        This department was established 35 years ago. Since then, many patients with facial trauma, both soldiers and civilians, have been treated and extensive experience has been accumulated. From 1990 to 1995, 487 patients with facial trauma (18.6% of the patients in the department) where hospitalized and treated. 88.5% suffered from injuries which included facial bones, and the others from soft tissue injuries only. We summarize our experience, analyzing both the demographic and clinical characteristics of the injuries and the treatment administered. Based on our experience and the current literature, we present an overview of the issue.

        ג' סוירי, א' סהר ומ' פיינסוד

        Radiation-Induced Meningioma: The Changing Pattern of the Disease


        G. Sviri, A. Sahar, M. Feinsod


        Depts of Neurosurgery, Rambam and Sheba Medical Centers, Haifa and Tel Hashomer; and The B. Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, and the Sackler Faculty of Medicine, Tel Aviv University


        In this country radiation-induced meningiomas were usually associated with low-dose irradiation of the scalp of immigrants from North Africa, given as part of the treatment of tinea capitis. An Ashkenazi patient developed meningiomas 15 years after high-dose irradiation for a benign lesion in the parasellar region. The accumulating literature about high-dose radiation-induced meningiomas is reviewed and attention is drawn to the ever increasing number of meningiomas observed in immigrants from the former Soviet Union.

        י' שויד, א' אנגל ומ' הלברטל

        Effectiveness of Selective Hepatic Artery Embolization in a Child after Blunt Hepatic Trauma


        Y. Sweed, A. Engel, M. Halberthal


        Depts. of Pediatric Surgery and Radiology and Pediatric Intensive Care Unit, Rambam Medical Center, Bruce Rappaport Faculty of Medicine, The Technion, Haifa


        A 9-year-old boy was admitted after a bicycle fall. Abdominal CT-scan revealed severe liver injury (stage IV according to the liver injury scale of the American Association for Surgery Trauma), including ruptured intraparenchymal hematoma with active bleeding. The patient was hemodynamically stable and was treated conservatively for the first 2 days. On the 3rd day selective hepatic artery angiography was performed because of abdominal distension and the need for 7 pints of packed red blood cells. Active right hepatic artery bleeding was identified and treated successfully by embolization. We think that early angiography and selective embolization should always be considered for acute or continuous bleeding after liver injury.

        אשר ברק, לידיה גביס, בנימין מוגילנר ושולמית גלמן-קוהן

        "Charge" Association


        Asher Barak, Lidia Gabis, Biniamin Mogilner, Shulamit Gelman-Kohan


        Pediatric and Neonatal Depts., and Clinical Genetic Unit, Kaplan Hospital, Rehovot


        CHARGE association represents a group of congenital anomalies with no clear etiology. The broad array of abnormalities, which involves several systems, has been the basis for the acronym CHARGE: coloboma, heart anomaly, choanal atresia, retarded growth and development, hypoplastic genitalia and ear malformation. We present 3 children with CHARGE association to illustrate the phenotypic variability and note the multidisciplinary treatment they received. It is recommended that this entity be approached in an interdisciplinary, integrated way to allow for faster diagnosis and better prognosis.

        חוליו וינשטיין ומדינה ידווב

        Efficacy and Safety of Acarbose Treatment of Niddm


        Julio Wainstein, Medinah Jedwab


        Dept. of Medicine C and Diabetes Unit, Wolfson Medical Center, Holon


        An uncontrolled multicenter study of the efficacy and safety of treatment of diabetes with acarbose was conducted on 169 NIDDM patients in 12 medical centers in Israel. Acarbose was administered for 19 weeks, and the patients were followed for an additional 12 weeks. A substantial decrease in HbA1c levels from 8.5% to 7.5% (p<0.001) and in postprandial serum glucose levels from 283.6 mg/dl to 248.5 mg/dl (p<0.01) was seen during treatment. On follow-up, HbA1c levels increased by 0.45% and postprandial serum glucose rebounded from 256.4 mg/dl to 287.9 mg/dl. Acarbose was shown to be effective in treating NIDDM and to be safe and well-tolerated.

        ינואר 1997
        ג'ני פוזן, נעמה תנאי, שמעון שפירו ודפנה פרומר

        The Homeless and The Health System: Profile of the Homeless Patient


        J. Posen, N. Tanai, S. Spiro, D. Frumer


        Social Work Dept., Ichilov Hospital, Tel Aviv and Faculty of Social Work, Tel Aviv University


        The homeless population is mobile and does not use ambulatory health care services. Thus the major contact between the homeless and the medical establishment occurs primarily when they are treated for acute symptoms in hospital. We describe the clinical and sociodemographic profile of the homeless who require hospital services. The research population included 50 homeless treated in the emergency room and various departments of our medical center between October 1994 and August 1995. Social workers used a questionnaire relating to clinical, sociodemographic and social factors. Most patients were men, 76% under the age of 50. The most common diagnosis was alcoholism; other diagnoses included back, limb and joint injuries, infections, skin diseases, and general exhaustion. There were subgroups with differing needs within this homeless population for which appropriate rehabilitation programs are proposed.

        ג'מאל זידאן, סאמר קאסם, דרומאה קרן, אברהם קוטן ואליעזר רובינזון

        Differentiated Thyroid Cancer In Arabs In Northern Israel


        J. Zidan, S. Kassem, D. Karen, A. Kuten, E. Robinson


        Northern Israel Oncology Center, Rambam Medical Center, and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa


        Prognostic factors and survival rate of 53 Arabs with differentiated carcinoma of the thyroid treated here were reviewed. Papillary carcinoma was diagnosed in 35 (66%) and follicular carcinoma in 18 (34%); the female/male ratio was 2.3/1 and the median age 32. Age, gender, tumor size, histology and tumor stage were important prognostic factors. The 20-year actuarial survival rate of the entire group was 96%. The probable reason for the high survival rate was the low median age.

        א' ירצקי, י' פלדמן, פ' אלתרמן, ב' פינקלטוב

        Rheumatoid Arthritis in the Elderly


        A. Yaretzky, J. Feldman, P. Alterman, B. Finkeltov


        Dept. of Geriatric Medicine and Rheumatology Clinic, Meir Hospital, Kfar Saba and Sackler Faculty of Medicine, Tel Aviv University


        Opinions differ as to whether late onset rheumatoid arthritis (RA) represents a clinical subset and whether age at onset involves differences in therapy and prognosis. In this retrospective study we compared 23 patients with early onset RA (average onset 52.8 years; 91.3% of them women), with 36 with late onset (average onset 70.3 years; 67% of them women). No statistically significant differences were found as to demographic, clinical, laboratory or radiographic characteristics. 

        מ' זערור, ד' גולדשר ומ' פיינסוד

        Temporal Hemianopia And Diabetes Insipidus Following Head Injury


        M. Zaaroor, D. Goldsher, M. Feinsod


        Center for Treatment and Applied Research in Head Injuries, Dept. of Neurosurgery and Diagnostic Radiology Dept., Rambam Medical Center and Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa


        Bitemporal hemianopia and diabetes insipidus following head injury are caused by a lesion in the center of the optic chiasm, together with injury to the adjacent pituitary stalk or the hypothalamus. This combination was thought to be a rare complication of severe head injury. The case of a 16-year-old male is presented, which together with recent reports suggests that this relatively under-recognized syndrome is not infrequent, that it may follow even minor head injury, and that magnetic resonance imaging can demonstrate the chiasmal lesion.

        יוסף פיקל, יובל גלפנד, עידי מצר ובנימין מילר

        Motor Vehicle Accidents And Eye Injuries


        J. Pikkel, Y. Gelfand, E. Mezer, B. Miller


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


        The medical records of 24,632 patients treated in our surgical emergency service over a 3-year period were reviewed to determine the frequency and characteristics of ocular trauma caused by motor vehicle accidents (MVA). MVA-related injuries accounted for 13.9% of all visits to the service and involved 1106 of the patients (33%), of whom 77% were young males. At least 1 pathological finding was found in 858 (77.6%) and 169 (15.2%) were admitted. 16 patients sustained very severe ocular injuries which resulted in poor vision.

        יובל גלפנד, יוסף פיקל, בנימין מילר

        Prognostic Factors And Surgical Results In Traumatic Cataract


        Yuval Gelfand, Joseph Pikkel, Benjamin Miller


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


        The visual outcome in 23 men and 2 women with traumatic cataracts was analyzed retrospectively. Their average age was 33 and they ranged from 10 to 69 years. Surgical results were either very good or very poor. Associated retinal injuries significantly decreased final visual acuity (p = 0.001). Those with initial visual acuity restricted to finger counting had better visual results than those with initial visual acuity restricted to light perception (p = 0.01) and hand motions (p = 0.02). Usually the lens was removed via the pars plana; the most common mode of optical correction was contact lenses.

        אמיר אברמוביץ', אבי שצ'ופק, יצחק רמון, אורן שושני, ידידיה בנטור, גדי בר יוסף ואורי טיטלמן

        Hyperbaric Oxygen for Carbon Monoxide Poisoning


        A. Abramovich, A. Shupak, Y. Ramon, O. Shoshani, Y. Bentur, G. Bar-Josef, U. Taitelman


        Israel Naval Medical Institute, Israel Defense Forces Medical Corps, Haifa and Israel Poison Information Center, Intensive Care Unit and Pediatric Intensive Care Unit, Rambam Medical Center, Haifa


        Severe cases of carbon monoxide (CO) poisoning from all over Israel are treated at the Israel Naval Medical Institute with hyperbaric oxygen (HBO). Between 1.11.94 and 15.2.95, 24 cases of CO poisoning were treated. Poisoning was usually due to domestic gas-fired heating systems, CO being the only toxin involved. Since delay between termination of CO exposure and arrival at the emergency department averaged 55 minutes, the level of carboxyhemoglobin measured on presentation did not always reflect the true severity of the poisoning. Poisoning was defined as severe and requiring HBO treatment when 1 or more of the following indications was present: evidence of neurological involvement, cardiographic signs of acute ischemic injury, metabolic acidosis, carboxyhemoglobin level greater than 25%, and pregnancy. 20 (84%) recovered consciousness during the course of 1 session (90 min.) of HBO treatment (p2 2.8 ATA) or immediately thereafter, with resolution of other signs of CO poisoning. 3 required a second treatment session before their symptoms resolved. A patient who arrived in deep coma with severe cerebral edema died. HBO is an important element in the combined treatment of severe CO poisoning. There should be greater awareness of the danger of CO poisoning and the means of preventing it, both among medical staff and the population as a whole, mainly in areas in which cold weather requires use of heating systems, which may be gas-fired.

        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