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        תוצאת חיפוש

        יוני 1997
        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.

        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.

        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.

        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.

        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.

        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.

        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.

        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. 

        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.

        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.

        מאי 1997
        ולאדימיר קורן, רוברט קולדנוב, עדנה פלג, אווה איזאק, מאיר ברזין ותלמה רוזנטל

        Red Cell Na+/H+ Exchange and Role of Protein Kinase C in its Stimu-Lation in Diabetes Mellitus, Essential Hypertension and Nephropathy

         

        Wladimir Koren, Robert Koldanov, Edna Peleg, Eva Izsak, Meir Berezin, Talma Rosenthal

         

        Dept. of Medicine C, Hypertension Unit and Endocrinology Institute, Chaim Sheba Medical Center, Tel Hashomer

         

        Na+/H+ exchange (NHE) was measured as maximal initial velocity of pH-dependent H+ efflux from red cells into an alkaline medium containing Na+ in patients with insulin-dependent or noninsulin-dependent diabetes, with and without hypertension and in normoglycemic, essential hypertensives and normal controls (50 subjects in each subgroup). Maximal velocities of NHE were found in microalbuminuric patients in all subgroups, and NHE correlated with the rate of microalbuminuria (r=0.61, p=0.02). Daily insulin requirements were greater in those with elevated NHE (84±8 vs 42±4 U/day). There was no correlation between NHE and levels of plasma glucose, HbA1 and plasma aldosterone and lipid profile and PRA. NHE was correlated with plasma prolactin (r=0.51, p=0.02) and PTH r=0.24, p=0.05). In uremic patients, NHE was inversively correlated with creatinine clearance (r=-0.48, p=0.03). Since calphostin C, a selective inhibitor of protein kinase C, lowered increased NHE in vitro, the protein kinase C-dependent pathway of the exchanger regulation was concluded to be responsible for NHE activation in diabetes mellitus and essential hypertension.

        דוד ב' ויס, שושנה גוטשלק-סבג, אלחנן בר-און, צבי צוקרמן, יגאל גת ובנימין ברטוב

        Seminiferous Tubule Cytological Pattern in Infertile, Azoospermic Men in Diagnosis and Therapy

         

        David B. Weiss, Shoshana Gottschalk-Sabag, Elchanan Bar-On, Zvi Zukerman, Yigal Gat, Benjamin Bartoov

         

        Male Infertility and Cytology Units, Shaare Zedek Medical Center, Jerusalem; Andrology Unit, Rabin Medical Center (Beilinson Campus), Petah Tikva and Male Infertility Laboratory, Dept. of Life Sciences, Bar-Illan University, Ramat Gan

         

        We determined spermatogenic patterns of seminiferous tubules in azoospermic infertile men and evaluated the prevalence of bilateral testicular homogeneity. 185 azoospermic men underwent bilateral testicular fine-needle aspiration (TFNA) in which each testis was punctured at 3 different positions. Aspirated material was stained and classified according to the most mature spermatogenic cell type present or whether only Sertoli cells were present. 35.7% had spermatozoa in their testes, 36.2% had spermatogenic maturation arrest, and 28.1% had only Sertoli cells in their seminiferous tubules. In 15.6% of all patients, the diagnosis in 1 testis differed from that in the other. In only 73.2% of those with testicular spermatozoa was it bilateral. In the remaining 26.9%, only Sertoli cells, spermatocytes or spermatids were found as the most mature cell type in the other testis. The study definitely indicates that fertilization with retrieved testicular spermatozoa should not be offered to azoospermic patients without prior evaluation of the seminiferous tubue spermatogenic pattern in both testes.

        ר' דורסט ופ' רבאודנגו-רושקה

        Attention Deficit Hyperactivity Disorder, Facilitating Alcohol and Drug Abuse in an Adult

         

        R. Durst, P. Rebaudengo-Rosca

         

        Talbieh Mental Health Center, Jerusalem (Affiliated with the Hebrew University-Hadassah Medical School)

         

        Attention-deficit hyperactivity disorder (ADHD) has been considered a mental and behavioral disorder of childhood and adolescence. It is being increasingly recognized in adults, who may have psychiatric co-morbidity with secondary depression, or a tendency to drug and alcohol abuse. We describe a 32-year-old woman known for years as suffering from borderline personality disorder and drug dependence (including hasshish, marijuana, LSD and "exstasy'") and alcohol abuse that did not respond to treatment. Only when correctly diagnosed as ADHD and appropriately treated with the psychotropic stimulant, methylphenidate (Ritalin), was there significant improvement. She succeeded academically, which had not been possible previously, the craving for drugs diminished and a drug-free state was reached. Although administration of psychostimulants to drug abusers is controversial, as they are addictive, in cases of ADHD they have promoted drug abstinence.

        גדי פישמן ודב אופיר

        Toxic Shock Syndrome

         

        Gadi Fishman, Dov Ophir

         

        ENT and Head Neck Surgery Dept., Meir Hospital, Kfar Saba

         

        Toxic shock syndrome (TSS) is a rare, life-threatening, acute multisystem illness usually characterized by sudden onset of high fever, diffuse sunburn-like erythroderma and a variety of other signs and symptoms. It may progress rapidly to hypotension and shock with multiple organ failure. Its exact cause is unknown, but in almost all cases there has been an infection with exotoxin-producing strains of phage group I Staphylococcus aureus. Although initially described in association with the use of super-absorbent tampons in menstruation, TSS has complicated a variety of surgical procedures. Recently in head and neck surgery attention has focused on absorbent packing materials, such as those used in postoperative nasal care.

        TSS developed in a 12-year-old 28 hours after tonsillectomy, nasal septoplasty and inferior turbinectomy in which absorbent packing material was used. It is important to maintain a high index of suspicion for TSS in all postoperative patients with fever, hypotension and erythroderma.

        א' שחר, ר' שרון, מ' לורבר וש' פולק

        Angioedema Caused by Splenectomy with Malignant Lymphoma Foll-Owed by Multiple Myeloma 7 Years Later

         

        A. Shahar, R. Sharon, M. Lorber, S. Pollack

         

        Institute of Allergy, Clinical Immunology and AIDS and Institute of Hematology, Rambam Medical Center and B. Rappaport Technion- Faculty of Medicine, Haifa

         

        Acquired C1-inhibitor (C1-INH) deficiency has been reported in patients with immunoglobulin abnormalities and lymphoproliferative disorders, and angioedema has appeared simultaneously with the lymphoproliferative disease. We present a 50-year-old woman with acquired C1-INH deficiency and angioedema which preceded by 7 years the diagnosis of malignant mantle cell lymphoma. During the interval she was treated with Danazole and there were no attacks of angioedema. When routine follow-up bone marrow aspiration revealed infiltration of nonspecified lymphoma cells, exploratory laparotomy and splenectomy were performed. A month later Danazol was stopped, C1-INH levels returned to normal and there were no attacks of angioedema. Mantle cell lymphoma consisting of lymphocytes with cytoplasmic IgM-lambda was diagnosed in the excised spleen but chemotherapy was not initiated. 6 months later, a second lymphoproliferative disorder, multiple myeloma IgA kappa, was diagnosed.

        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