• כרטיס רופא
  • אתרי הר"י
  • צרו קשר
  • פעולות מהירות
  • עברית (HE)
  • מה תרצו למצוא?

        תוצאת חיפוש

        אוגוסט 1997
        חן בן אברהם, ערן סגל, יזהר הרדן, עופר שפילברג, סלומון שטמר, אנג'לה שטרית, יצחק בן בסט, ועזריאל פרל

        Hemato-Oncology Patients in Acute Respiratory Failure in the ICU

         

        R. Ben-Abraham, E. Segal, I. Hardan, D. Shpilberg,S. Stemer, A. Shitrit, I. Ben-Bassat, A. Perel

         

        Depts. of Anesthesiology and Intensive Care, Hematology, Oncology and Clinical Epidemiology; Chaim Sheba Medical Center, Tel Hashomer and Sackler Faculty of Medicine, Tel Aviv University

         

        Hemato-oncology patients needing mechanical ventilation for acute respiratory failure (ARF) have an extremely poor prognosis, with a mortality of more than 90%. Over an 18 month-period 17 such patients were admitted to our ICU. Diagnoses included leukemia (11 cases), lymphoma (1), and status post bone marrow transplantation for leukemia, lymphoma or breast cancer (5). Of 8 whose ARF was associated with septic complications due to neutropenia following chemotherapy, 6 survived. Of 9 who developed ARF due to toxic damage to vital organs following high-dose chemotherapy, 2 survived. Those who develop ARF during chemotherapy are expected to have an increase in granulocyte count within days, and have a surprisingly good prognosis. They should be admitted to the ICU and treated aggressively. Those who develop sepsis due their primary disease and whose general condition contraindicates chemotherapy, have an extremely grave prognosis and admission to the ICU may not be warranted.

        רן כץ, עמוס שפירא, שמעון מרטיק, יחזקאל לנדאו ודב פודה

        Radical Retropubic Prostatectomy

         

        Ran Katz, Amos Shapiro, Shimon Meretyk, Ezekiel H. Landau, Dov Pode

         

        Urology Dept., Hadassah,University Hospital and Hebrew University,Hadassah Medical School, Jerusalem

         

        Radical prostatectomy may cure most patients in whom the malignant tumor has not invaded through the prostatic capsule. Advances in surgical technique and accumulation of experience have decreased the complication rate significantly. Long-term results of surgical treatment are now better than those of other forms of treatment; hence radical prostatectomy is now recommended for men with life expectancies longer than 10 years. Between 1988 and 1995, 164 men with clinical stages T1 or T2 adenocarcinoma were admitted for radical prostatectomy. Most were not offered a nerve-sparing procedure, so as to allow wider, more complete resection. Those who wanted preservation of sexual function underwent the nerve- preserving procedure. In 6 patients operation was discontinued when metastases to the iliac lymph nodes were detected and in 1 when invasion of the pelvic wall was found. 157 underwent radical prostatectomy. Preoperative biopsy revealed a low-grade lesion (Gleason 2-4) in 19.1%, intermediate grade (Gleason 5-6) in 61.8% and high-grade (Gleason 7-9) in 19.1%; however, pathologic grading revealed that only 7.0% had grade 2-4 tumor, 60.5% grade 5-6 and 32.5% grade 7-9. Pathologic staging revealed T2 tumor in 58%, T3 in 38.8% (including microscopic invasion of the capsule or seminal vesicles); microscopic lymph node metastases were found in 3.2%. Tumor invasion through the capsule was found in only 2 of 13 treated with neoadjuvant androgen blockade, compared with 40% in those who did not receive this treatment. There was no operative mortality and only 14.7% has complications. All had urinary incontinence immediately after operation, but regained continence after an average of 4-5 months. 24 were incontinent for more than 12 months, but most of them had only mild stress incontinence. Most patients were impotent after the procedure. There was tumor recurrence, diagnosed by rise in serum PSA, in 26 during an average follow-up of 26.4 months (range 3-93). Cure rate of prostatic cancer by radical prostatectomy may be increased by improved preoperative staging methods and better patient selection; long term follow up is required for determining cure rate.

        ג'וליה ברדה, דינו ברנשטיין, שגית ארבל-אלון, חיים זכות ויוסף מנצ'ר

        Gynecologic Problems of the Lower Genital Tract in Children and Young Adolescents

         

        Giulia Barda, Dino Bernstein, Sagit Arbel-Alon, Haim Zakut, Joseph Menczer

         

        Dept of Gynecology and Obstetrics, Edith Wolfson Medical Center, Holon and Sackler Faculty of Medicine, Tel Aviv University

         

        Hospital records of 46 girls under the age of 17 years, hospitalized for lower genital tract problems in 1986-95 were reviewed. The most common conditions were results of unintentional injuries (43.5%), imperforate hymen (28.2%) and infections (19.6%). The median age for unintentional injuries was significantly lower than for other conditions (7.0 vs 11.4; p<0.001). Most injuries were external and occurred during outdoor activities. Mean volume of estimated bloody fluid drained in those with imperforate hymen was greater when the diagnosis was made after the age of 12 (783 vs 433; not significant). It has been suggested that hematocolpos and hematometra should be prevented, but the possible unfavorable sequelae have not been documented. The relative order of frequency of the various diagnostic groupings and the diagnoses of labial adhesions and imperforate hymen are specific for the age of the study group.

        יאיר בר-אל, משה קליאן, יוסי מר, הילה קנובלר, יעקב לרנר וחיים קנובלר

        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.

        יולי 1997
        קרלוס כפרי, ראובן איליה ובנימין גולפרב

        Left Atrial Ball Thrombus

         

        Carlos Cafri, Reuben Ilia, Benjamin Goldfarb

         

        Cardiological Services, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba

         

        An 80-year-old hypertensive woman with chronic atrial fibrillation was hospitalized because of recurrent syncope. Echocardiography revealed a large left atrial ball thrombus. Operative findings confirmed the echocardiographic diagnosis.

        אורי ספרן, רמי מושיוב, יואל מתן ומאיר ליברגל

        Surgical Repair of Fractures of the Clavicle

         

        O. Safran, R. Mosheiff, Y. Mattan, M. Liebergall

         

        Orthopedic Dept., Hadassah-University Hospital, Jerusalem

         

        Clavicular fractures make up 45% of shoulder girdle fractures. The clavicle's susceptibility to injury is due to its subcutaneous position and its role as the bony connection between the thorax and the shoulder. In 95% of cases the mechanism of injury is a direct blow to the shoulder. These fractures are usually treated conservatively without surgery. But there are a few such fractures that require surgical repair in order to unite well. 9 patients were operated on for clavicular fractures during 1991-1995. The indications for surgical repair were lateral-third fracture, floating shoulder, neurovascular deficit or nonunion. The methods used were open reduction and fixation with either plate and screws, Kirchner wires, cerclage or a combination. All fractures united well, with no infections or new neurovascular deficits. Good range of shoulder motion and acceptable cosmetic results were achieved in all. 1 patient had functional limitation due to brachial neuritis caused by brachial damage at the time of injury. Indications for surgical repair and the methods used in these cases are similar to those described in the literature. The high rate of union and absence of complications support surgical repair for the few clavicular fractures that are not likely to unite properly.

        ד' זמיר, ק' זינגר, י' ירחובסקי, צ' פיירמן, ר' מג'דלה, ל' זליקובסקי, ג' ברטל ופ' וינר

        Gastrointestinal Angiodysplasia

         

        D. Zamir, C. Zinger, J. Jarchovski, Z. Fireman, R. Magadle, L. Zelikovski, G. Bartal, P. Weiner

         

        Depts. of Medicine A and B, and Gastroenterology and Nuclear Institutes, Hillel Yaffe Medical Center, Hadera

         

        Gastrointestinal angiodysplasia is a cause of gastrointestinal bleeding in the elderly, for which surgery has been the only treatment. Estrogen has been reported beneficial in some cases in the past decade. Recurrent bleeding due to angiodysplasia occurred from the small intestine in a 75-year-old woman, and from the right colon in a 91-year-old man. The diagnoses were made by angiography in the first case and colonoscopy and erythrocyte- scanning in the second. There was aortic stenosis in both, a combination which has been reported in other cases. Both patients improved with estrogen therapy. However, after temporary stabilization, gastrointestinal bleeding recurred in the second patient and he was successfully operated on.

        אלי שלוח, משה הורוביץ ואליעזר זקלר

        Terbinafine-Induced Cholestatic Liver Injury

         

        E. Shiloah, M. Horowiz, E. Zecler

         

        Dept. of Medicine C, Assaf Harofeh Medical Center, Zerifin (Affiliated with the Sackler Faculty of Medicine, Tel Aviv University)

         

        A 43-year-old man presented with weakness, pruritus, skin rash and jaundice 2 weeks after treatment for onychomycosis with terbinafine (Lamisil) was started. Liver function tests showed combined hepatocellular and cholestatic injury. Ultrasound examination, computerized tomography and ERCP excluded extrahepatic obstruction. Serology was negative for HBV, HCV, HAV, CMV, and EBV. Liver biopsy was consistent with drug-induced cholestatic injury. Since the clinical picture did not improve when terbinafine was stopped, corticosteroids were started and resulted in complete clinical and laboratory recovery; liver function tests were normal 8 months after corticosteroids were discontinued.

        אלי אשכנזי, סטיבן ת' אונסטי ויוסט ו' מיקולסון

        Surgical Approach to Benign Extradural Lesions of the Thoracic Spine

         

        Ely Ashkenazi, Stephen T. Onesti, W.J. Michelsen

         

        Depts. of Neurosurgery, Hadassah University Hospital, Jerusalem and Montefiore Medical Center, Albert Einstein College of Medicine of Yeshiva University, The Bronx, New York

         

        A benign epidural lesion in the thoracic spine is rare, and usually the result of intervertebral disc herniation or infection. Not long ago patients were diagnosed late in the course of their disease and the surgical results of the standard laminectomy usually performed were grave. The development of newer imaging techniques (CT and MRI) has made diagnosis much easier, so diagnosis is often earlier, when neurological deficit is minimal. Newer neurosurgical techniques and approaches to the thoracic spoine have been developed to treat these lesions, which we describe. Clinical data on 16 patients operated from January 1996 to January 1997 are presented.

        עליזה זיידמן, יוסף גרדין, זינאידה פראידה, גרשון פינק ומשה מיטלמן

        Therapeutic and Toxic Theophylline Levels in Asthma Attacks

         

        Aliza Zeidman, Joseph Gardyn, Zinaida Fradin, Gershon Fink, Moshe Mittelman

         

        Dept. of Medicine B, Rabin Medical Center, Golda (Hasharon) Campus and Pulmonary Institute, Rabin Medical Center, Beilinson Campus, Petah Tikva; and Sackler Faculty of Medicine, Tel Aviv University

         

        Although first-line therapy for bronchial asthma has changed over the past decade to anti-inflammatory medication such as inhaled corticosteroids and cromolyn with possible addition of beta-agonists, theophylline is still useful and therefor widely used. However, several studies have raised serious questions regarding its efficacy in acute asthmatic exacerbations. These studies, the narrow therapeutic range of the drug, the frequency of side effects and interactions with common drugs, and individual variation in clearance and metabolism, have prompted its reevaluation in the management of asthma. Therapeutic serum levels of theophylline are between 10 to 20 mcg/ml. Most adults achieve these concentrations with daily slow-release oral theophylline preparations, 200-400 mg (approximately 10 mg/Kg) twice a day. However, when such a patient presents to the emergency room (ER) in an asthmatic attack, immediate intravenous theophylline is often given, regardless of maintenance treatment. Since the rationale for this common therapeutic approach has been challenged, the current study was undertaken. Serum theophylline levels were measured in 23 consecutive asthmatics presenting to the ER in an acute attack. 15 (68%) had therapeutic levels (above 10 mcg/ml) and 2 had toxic levels (above 20 mcg/ml), prior to receiving the standard intravenous theophylline dose given for an attack. These data indicate that most patients with bronchial asthma on oral maintenance theophylline do not require additional intravenous theophylline when in an attack. It probably will not benefit them and may even induce serious theophylline toxicity.

        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
        דורון מרימס, דורון זילברמן, ליליאנה לופו ועמנואל סיקולר

        Embolic Splenic Infarction: A Rare Complication of Atrial Fibrillation

         

        Doron Merims, Doron Zilberman, Liliana Lupu, Emanuel Sikuler

         

        Depts. of Medicine B and Radiology, Soroka Medical Center and Ben-Gurion University of the Negev, Beer Sheba

         

        Splenic infarction is a rare disorder. The typical clinical presentation is sudden pain in the left upper quadrant of the abdomen, and awareness to this possibility is the major clue for diagnosis. We describe a 49-year-old man with chronic atrial fibrillation and splenomegaly who was treated with anticoagulants. Because of hematuria, the regular dose of anticoagulant therapy was reduced. The hematuria stopped but he complained of sudden onset of pain in the left upper quadrant. Computerized tomography and isotope scan of the spleen confirmed the clinical suspicion of splenic infarction. Treatment with anticoagulants and analgesics was followed by clinical improvement.

        ר' אברהמי, מ' לוינסון, מ' חדד וא' זליקובסקי

        Traumatic Common Carotid-Internal Jugular Fistula: Positive Aspect

         

        R. Avrahami, M. Liverson, M. Haddad, A. Zelikovsky

         

        Dept. of Vascular Surgery and Anesthesia, Rabin Medical Center, Beilinson Campus, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University

         

        A 42-year-old man presented with a penetrating neck injury from a pellet gun. Physical examination showed an open 1 cm wound on the right side of the neck, hematoma of the right sternocleidomastoid muscle, and carotid artery injury. He was hemodynamically stable and there was no neurological deficit. Arteriogram of the neck disclosed a pseudoaneurysm with an arteriovenous fistula between the common carotid artery and internal jugular vein. At surgery, the tears in the carotid artery and jugular vein were sutured and a vacuum drain was introduced. The postoperative course was uneventful, and the patient was discharged 5 days later. Instead of the expected results of a penetrating carotid artery injury, such as blood loss, airway obstruction or neurological deficit, the arteriovenous fistula caused by the pellet actually saved the patient's life. Blood flow from the artery via the pseudoaneurysm to the jugular vein kept the patient in stable condition.

        ר' בן-אברהם, ר' מ' קריווזיק-הורבר, ג' הודקר, ע' פרל ופ' ג' אדנט

        Effect of Chlorocresol VS Caffeine on Muscle Contracture in Malignant Hyperthermia Susceptible Patients

         

        R. Ben-Abraham, R.M. Krivosic-Horber, G. Haudcoeur, A. Perel, P.J. Adnet

         

        Dept. of Anesthesiology and Intensive Care, Chaim Sheba Medical Center, Tel Hashomer and Sackler Faculty of Medicine, Tel Aviv University; and Dept. d'Anesthesie-Reanimation Chirurgicale, Laboratoire de Pharmacologie Hospitaliere, et Service des Urgence, Centre Hospitalier Universitaire, Lille Cedex, France

         

        The phenotype of susceptibility to malignant hyperthermia (MHS); can only be detected reliably by the in vitro caffeine-halothane contracture test (CHCT). Enhanced sensitivity of the calcium-induced calcium release mechanism is responsible for the exaggerated contracture response of skeletal muscle fibers from MHS patients to halothane and caffeine. Chlorocresol was demonstrated to be a potent activator of Ca++release from skeletal muscle sarcoplasmic reticulum. This effect is probably mediated through action on a ryanodine sensitive Ca++ release channel known to be more sensitive in MH. We studied the effect of chloroscresol on the mechanical contracture response of skeletal muscle from patients presenting for the in vitro CHCT. Chlorocresol induces contracture response in a concentration 1/200 of that of caffeine in muscle strips from MH patients. By adding chlorocresol to the protocol of the CHCT, there is clearer discrimination between the responses of MH patients and normal subjects can be achieved. 

        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.

        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