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        תוצאת חיפוש

        פברואר 1997
        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.

        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.

        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.

        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.

        רפאל סטרוגו, גבריאלה גייר ודוד אולחובסקי



        R. Strugo, G. Gayer, D. Olhovsky


        Dept. of Internal Medicine and Dept. of Radiology, Chaim Sheba Medical Center, Tel Hashomer


        Typhlitis (from Greek, "typhlon", cecum) is an inflammatory process involving the cecum and ascending colon צ in neutropenic patients after chemotherapy. Early diagnosis and treatment is of great importance, since the mortality is high. In the past decade there has been an increasing number of reports, as well as impressive improvement in diagnosis, and treatment. We describe 2 patients treated in our department. We emphasize the evolving changes in the management of these patients, from early surgical intervention to conservative treatment, and the problem of prophylactic treatment for those who survive an episode of typhlitis.

        יורם שיר, ויקטור שולזון, גילה רוזן ושמאי קוטב

        An In-Hospital Pain Service: Present Activity and Future Trends


        Y. Shir, V. Shavelzon, G. Rosen, S. Cotev


        Anesthesia Dept. and Intensive Care Unit, Hadassah Hospital, Jerusalem


        Although significant progress has been made in the past 2 decades in our understanding of pain pathophysiology and in the development of new analgesic drugs and techniques, many patients still experience considerable pain during hospitalization. Unrelieved pain is common not only among patients undergoing surgery, but also in those with a variety of other medical problems. These findings led to the development of our in-hospital acute pain service. This in-hospital pain service has been active since the late eighties, treating both postoperative pain and non-surgical pain in hospitalized patients. During 1995, 2140 patients were treated totaling 8717 treatment days in 18 different medical units and departments. Overall success was more than 75%. We review our experience in treating in-patients who suffer from pain and discuss future trends and need for such a specialized service.

        פסח ליכטנברג

        On the Value of the Placebo: Reflections on Homeopathy


        Pesach Lichtenberg


        Dept. of Psychiatry, Herzog Hospital, Jerusalem


        A case is presented in which homeopathic "treatment" helped, despite the fact that the patient did not take the medication. The author surveys research which has been conducted on homeopathy and concludes that its benefits derive from non-specific influences of the healer upon the patient, similar to a placebo effect. The importance of this influence is stressed, and its wider application in conventional medicine is urged.

        איה פלג, פסח שוורצמן ורוני פלג

        Drinking and Driving


        A. Peleg, P. Shvartzman, R. Peleg


        Dept. of Family Medicine, and Dept. of Epidemiology, Ben-Gurion University of the Negev, Beer Sheba


        A worrisome connection between driving and drinking was found in 166 people randomly surveyed in public places in Beer Sheba. 80% of the study population stated that they drink alcoholic beverages. Of these, 45% reported drinking at least once a week, and 21% drank 3 glasses/cans at each drinking bout. We noted a trend among those who drank frequently to drink greater amounts. Of the sample, 110 interviewees stated that they had a driver's license and that they drank alcoholic drinks. 39% reported driving after a number of alcoholic drinks, and 23% of them did so invariably or frequently. 5% drank while driving. The drinkers exhibited a high-risk behavioral pattern, remaining in the car with friends (53%) or relatives (16%) also under the influence of alcohol. Those who are aware of the influence of alcohol on their driving skills and the danger of being involved in car accidents, moderate their consumption of alcohol. The results of the study confirm our hypothesis that there is an upswing in the phenomenon of high-risk driving connected with drinking alcoholic beverages.

        מיכה רזאל

        Evidence For Casual Household Transmission Of Hiv: Review And Analysis


        Micha Razel


        School of Education, Bar-Ilan University, Ramat-Gan


        All reported case-studies in which the author-described route of infection was deemed to be casual household contact were reviewed and analyzed, as well as all sample-based studies designed to estimate the frequency of casual household transmission. Several recurring biased mechanisms of interpretation were found in the studies, the use of which made it impossible to obtain evidence for casual household transmission. After correcting for these interpretations 8 documented cases of casual household transmission were found. Analysis of the sample-based studies indicated 10 cases of casual household transmission, which occurs at a risk of 0.4% per year of contact (95% confidence interval: 0.20 to 0.66).

        שלמה מור-יוסף, רלו אברהם ויוסף שנקר

        Ovarian Cancer In Israel, 1960-1989


        Shlomo Mor-Yosef, Relo Avraham, Joseph G. Schenker


        Dept. of Obstetrics and Gynecology, Hadassah-University Hospital, Ein Kerem, Jerusalem


        In Israel ovarian cancer ranks among the most common malignant diseases in women. It is also one of the main causes of death from cancer in females in this country. Our population is composed of immigrants from diverse social, cultural, and geographical backgrounds, and only a sector of the inhabitants, mainly the younger generation, is Israeli-born. This study evaluates the trends of epidemiological and clinical data on ovarian cancer during 3 decades, 1960-1989, and includes a total of 5,786 cases of ovarian cancer. Information was obtained from the Central Israel Cancer Registry of the Ministry of Health and from the Central Bureau of Statistics. The incidence was stable during the survey period and was about 15-17/100,000 in women over the age of 15. Most (90%) were diagnosed over the age of 40. In women of European/American origin the incidence of ovarian cancer is 3 times greater than in women of Asian/African origin. The rate in the Israeli-born is between those of the other 2 groups, but closer to that of the European/American group. Over 70% were diagnosed with advanced disease (stage III-IV).


        Prognosis improved during the period of the study: 5-year survival was 19% in the early 60's and 31% in the 80's. During the last decade of the survey improvement was mainly in 2-year survival (from 38.5% to 60%).

        ינואר 1997
        י' קלוגר, ע' רביד, ר' בן-אברהם, ד' סופר וד' אלג'ם

        Kapoera - Popular Dance or Martial Art?


        Y. Kluger, A. Ravid, R. Ben Avraham, D. Soffer, D. Aladgem


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


        Kapoera, a combination of acrobatics and coordinated athletic movement, is believed to have been introduced to South America during the 19th century by transported African slaves. The dance does not involve intentional physical contact, but during 6 months, 3 patients were admitted here for injuries induced by the forceful movements of this dance. 2 underwent exploratory laparotomy that revealed bowel perforations and 1 suffered a comminuted nasal bone fracture. Medical personnel should be familiar with the potential hazards of this dance and martial art.

        נגה רייכמן, נתן קאופמן ועדית פלטאו

        Acute Effusive Constrictive Pericarditis in Influenza A


        N. Reichman, N. Kaufman, E. Flatau


        Dept. of Medicine B, Central Emek Hospital, Afula and Technion Faculty of Medicine, Haifa


        Constrictive pericarditis may complicate the course of several viral infections, mainly Coxsackie virus group B, as well as in rheumatoid disease, radiation and neoplasm. Perimyocardial involvement during influenzal infections is usually mild and does not progress to constriction or tamponade. A single case of cardiac tamponade caused by influenza A was reported in 1986. We report a case of acute effusive-constrictive pericarditis due to influenza A infection. Corticosteroids resulted in some benefit, but did not relieve constriction, which required extensive pericardiectomy.

        יצחק פפו, עודד זמיר והרברט פרוינד

        Is Crohn's Disease Different In The Elderly?


        Itzhak Pappo, Oded Zamir, Herbert R. Freund


        Dept. of Surgery, Hadassah-University Hospital, Mount Scopus, Jerusalem


        We reviewed the records of 22 patients hospitalized at onset or first presentation of Crohn's disease after age 50. There were 12 females and 10 males, and the mean age was 64.5 years. The most common presenting symptoms were: abdominal pain, fever, diarrhea and weight loss. The disease was located in the small bowel in 14, in the ileo-colic region in 3 and in the colon in 5. The median interval from onset of symptoms until diagnosis was 42 months. 12 (54%) underwent surgery. All 5 patients with colonic disease were operated. 6 patients underwent small bowel resections, mostly terminal ileum, while 1 had resection of both terminal ileum and left colon. The recurrence rate was 70% in the medically treated and 50% in those operated. 1 patient died after surgery for Crohn's disease (4.5%), and 3 others died of unrelated causes. Compared to younger patients, the symptomatology, clinical course, need for and response to surgery, and its complications, did not differ in these older patients, but the recurrence rate seemed to be higher.

        רות שמרת, רויטל ברוכים, ירון גלנטי, ציונה סמואל, סיריל ליגום, מיכה רבאו ופאול רוזן

        Familial Adenomatous Polyposis: Establishing a Registry and Genetic and Molecular Analysis


        R. Shomrat, R. Bruchim, Y. Galanty, Z. Samuel, C. Legum, M. Rabau, P. Rozen


        Genetic Institute and Depts. of Gastroenterology and Surgery, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University


        Familial adenomatous polyposis (FAP), a dominantly inherited disease, is caused by a mutation in the adenomatous polyposis coli gene in chromosome 5q21. The gene has 15 exons, a physical length of 10 Kb and an open reading frame of 8.5 Kb. Exon 15 codes 66% of the mRNA and has a mutation cluster region which accounts for over 50% of mutations. The disease usually leads to the appearance of hundreds of adenomatous polyps in the transverse and descending colon between puberty and age 20 years and to colon cancer before the age of 40. Early detection is essential to prevent the development of metastasizing cancer. Since 1994 we have recruited 23 families for genetic counseling. DNA was obtained from 19 unrelated FAP patients and 219 high risk relatives in 19 unrelated families following confirmation of the diagnosis. In addition to linkage studies, direct mutational analysis was performed using the protein truncation test for most of exon 15 and single strand conformation polymorphism analysis for the other exons. These exons account for most of the mutations identified to date. Of 19 unrelated probands, 14 had detectable mutations. Exon 15 accounted for 6 families, exons 5, 7 and 14 for 1 each, exon 9 for 3, and exon 8 for 2. Combined mutational and linkage analysis identified 18 presymptomatic carriers who received genetic and clinical counseling. Our FAP patients did not differ significantly from those of larger studies in other countries with regard to the distribution of the mutations, gender and genotype-phenotype correlation, or ethnic distribution.

        צבי סיימון, רותי סטלניקוביץ, רמי אליקים, צבי אקרמן ודניאל רחמילביץ

        Cyclosporin for Severe Ulcerative Colitis


        Z. Symon, R. Stalnikowich, R. Eliakim, Z. Ackerman, D. Rachmilewitz


        Dept. of Medicine, Hadassah University Hospital, Mount Scopus and Hebrew University-Hadassah Medical School, Jerusalem


        In recent years there have been numerous reports of successful treatment of resistant ulcerative colitis with cyclosporin. A series of 9 patients with moderate to severe active ulcerative colitis was treated with cyclosporin between September 1993 and October 1994. All 9 had failed to respond to conventional therapy, including salazopyrine and intravenous corticosteroids. They underwent colonoscopy and after contraindications to therapy were ruled out, received intravenous cyclosporin, 4 mg/kg/day for 7-10 days. They were discharged on oral cyclosporin with average serum levels maintained at 200 ng/ml. Response was assessed using the clinical score system of Schroeder et al. 2 out of 9 patients (22%) responded with full clinical remissions lasting more than 6 months. 6 patients had partial responses to the intravenous therapy, but symptoms resumed shortly after its cessation. Factors predicting favorable response to cyclosporin therapy were a shorter duration of disease with a fulminant clinical course. The success rate was less than that reported in the literature, possibly because of comparatively low serum cyclosporin levels. Potential complications of therapy and high cost preclude the routine use of cyclosporin in ulcerative colitis. Larger controlled studies are required to assess its efficacy and safety. Until such studies are available, cyclosporin may be tried in poor surgical risks or those not yet ready psychologically for total colectomy.

        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