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        תוצאת חיפוש

        מאי 1998
        א' הלוי, א' עופר וב' גרטי

        Benign Intracranial Hypertension following Minocyclin


        A. Halevy, I. Offer, B. Garty


        Pediatric Depts. A and B, Schneider Children's Hospital, Petah Tikva and Sackler School of Medicine, Tel Aviv University


        A 15-year-old girl, who had been treated with minocyclin for acne for 2 months, was admitted for investigation of headache, nausea and papilledema. A space-occupying lesion was ruled out by computerized brain tomography. The diagnosis of benign intracranial pressure (pseudo-tumor cerebri) was made because of elevated cerebrospinal fluid pressure with normal biochemistry and cytology. Tetracyclines, especially minocyclin, commonly used for treating acne in adolescents, can cause benign intracranial pressure.

        רותי מרגלית-סטשפסקי, אברהם לורבר ואיל מרגלית

        Familial Occurrence of Ebstein Anomaly


        Ruti Margalit-Stashefski, Avraham Lorber, Eyal Margalit


        Family Practice Unit, Kupat Holim Klalit, Haifa, Pediatric Cardiology Unit, Rambam Hospital, Haifa and Ophthalmology Dept., Hadassah--University Hospital, Jerusalem


        Ebstein anomaly is a rare congenital disease which affects location, structure and mobility of the tricuspid valve, and right atrium and ventricle. Although most cases are sporadic, familial occurrence has been reported. We report 2 brothers born with Ebstein anomaly. The parents were first degree cousins and there were 8 other children. 2 daughters were born with other congenital heart anomalies, 1 with ventricular septal defect and the other with severe pulmonary artery stenosis. We suggest that in some families, Ebstein anomaly is an autosomal dominant disease with different expression in the sexes.

        הניה ליכטר, קרול סגל, סיליה מור ורפאל פיינמסר

        Kimura's Disease and Angio- Lymphoid Hyperplasia


        Henia Lichter, Karol Segal, Celia Mor, Raphael Feinmesser


        Depts. of Ophthalmology, Otolaryngology and Pathology, Rabin Medical Center (Beilinson Campus), Petah Tikva, and Sackler Faculty of Medicine, Tel Aviv University


        Kimura's disease is a rare angiolymphoid proliferative disorder of soft tissue characterized by subcutaneous swelling and a predilection for the head and neck. There are usually enlarged regional lymph nodes, eosinophilia and elevated sedimentation rate and IgE levels. A 26-year-old women with subcutaneous masses in the submandibular area is reported. The diagnosis of Kimura's disease versus angiolymphoid hyperplasia is discussed.

        ששון מנחם ופסח שורצמן

        Management of Malignant Bowel Obstruction in Home Care


        Menahem Sasson, Pesach Shvartzman


        Dept. of Family Medicine, Kupat Holim Klalit and Ben-Gurion University of the Negev, Beer Sheba


        Malignant bowel obstruction occurs in about 10% of those with advanced abdominal cancer and in about 25% of those with advanced pelvic cancer. Such patients usually develop nausea, vomiting, constipation, abdominal dilatation and colicky pain. Traditional therapy consists of intravenous fluids and decompression by duodenal tube, gastrostomy or operation but postoperative mortality is high. Treatment requires hospitalization and therefor such patients have not been considered candidates for home care.

        Palliative medical techniques can cope with this syndrome and allow home care. Hypodermoclysis, non-prokinetic anti-emetics like haloperidol and scopolamine, octeotride, corticosteroids, and narcotics for severe abdominal pain can alleviate symptoms. Medications can be combined and infused subcutaneously in a syringe driver and patients can remain with their families in their natural environment. Such techniques can give these patients who have short life expectancies reasonable quality of life.

        דודי ברגמן ולי-און לוי

        Use of Intranet in the Hospital Setting


        David Bregman, Leon Levi


        College of Administration, Tel Aviv and Rambam Medical Center, Haifa


        In the Intranet system, the organization uses technologies developed and applied in the Internet network world-wide. Hospitals can use Internet technologies to make hospital information systems more efficient by improving use of existing systems and by adding additional possibilities. Furthermore, the hospital can improve its relations with its customers and also bring the organization additional customers. Intranet implementation can be divided into the areas of: communication, managing and distributing information, and application linkage. Implementation must be modular, gradual and planned according to economic, technological and organizational aspects of the hospitals. By the Intranet, organizations can achieve benefits that include: improving communication array, availability of data and information, using existing information systems and their applications, enhancing customer satisfaction and saving costs of manual application systems.

        אלכס כהנא, ויקטור שולזון, אורית דולברג, פלורלה מגורה ויורם שיר

        Intravenous Lignocaine for Chronic Pain


        Alex Cahana, Victor Shvelzon, Orit Dolberg, Florella Magora, Yoram Shir


        Pain Treatment Services, Depts. of Anesthesiology of Sheba Medical Center, Tel Hashomer and of Hadassah-University Hospital, Jerusalem


        Intravenous injection of lignocaine relieves pain in animals with experimentally induced pain, and in man, mainly those with neuropathic pain. 106 patients were treated with intravenous lignocaine during a period of 18 months (212 treatment sessions). Blood pressure, heart rate and pain scores were continuously monitored after an intravenous bolus of lignocaine, 1 mg/kg, followed by continuous infusion of lignocaine, 5 mg/kg during 1 hour. There was significant pain relief after each session in most patients, lasting from a few hours to 4 weeks. There were no significant side effects. We present 2 of our patients. Due to its simplicity, efficacy and safety, intravenous lignocaine injection is recommended for those with neuropathic pain unrelieved by other therapeutic modalities.

        מ' קליגמן ומ' רופמן

        Conversion Total Hip Replaceafter Failed Internal Fixation of Intertrochantric Fracture


        M. Kligman, M. Roffman


        Dept. of Orthopedic Surgery, Carmel Medical Center, Haifa


        Between 1933-1995, 16 patients underwent conversion-total hip replacement after internal fixation of an intertrochanteric fracture failed. Clinical results were unsatisfactory compared to primary total hip replacement. There was a high incidence of intra- and postoperative complications, including femoral fracture, wound infection, and aseptic loosening. This study should increase the surgeon's awareness of the difficulties encountered in conversion of failed intertrochanteric fractures to total hip replacement.

        צבי ויצמן, ילנה ברוטמן, דרורה לידר וחיים זגרמן

        Evaluation of a Local Infant Formula Enriched with Polyunsaturated Fatty Acids


        Zvi Weizman, Elena Brutman, Drora Leader, Chaim Zegerman


        Pediatric Gastroenterology Dept. and Nutrition Unit, Faculty of Health Sciences, Ben-Gurion University of the Negev and Soroka Medical Center, Beer Sheba;

        and Ma'abarot Products Industry, Kibbutz Ma'abarot


        Polyunsaturated fatty acids (PUFA) are vital for the normal development of the brain and the eye retina in infancy. Breast milk contains significant amounts of PUFA, and compensates for their low production in infancy. Only recently a few companies with worldwide product distribution have started to enrich infant formula with PUFA. We evaluated the safety and clinical efficacy of a locally made PUFA-enriched infant formula, produced for the first time in Israel.

        50 normal, full term infants participated in a prospective, randomized double-blind study. Half received a regular whey-predominant infant formula (Materna Plus), and the other half a PUFA-enriched formula (Materna Premium), both produced in Israel, for 30 days. Evaluation included physical examination, growth parameters, stool analysis, daily parental questionnaires regarding infant behavior and defecation, and developmental assessment.

        There were no significant differences on comparing growth parameters, infant behavior, attacks of restlessness, gas severity, or stool characteristics in the 2 groups. There were no side effects or abnormal stool findings in either group, and no differences in developmental assessment at 3 months of age.

        We conclude that the locally-produced PUFA-enriched infant formula is safe and clinically efficient. We assume that the lack of any effect on developmental indices is due to the relatively short exposure to the PUFA-enriched diet. Nevertheless, based on the recent literature, there is no doubt that PUFA supplementation isvital in improving infant brain and eye development.

        אלברטו הנדלר ואורן אגרנט

        Emergency Stenting for Acute Left Main Coronary Artery Closure during Cardiac Catheterization


        Alberto Hendler, Oren Agranat


        Catheterization Laboratory, Rama Marpeh Hospital, Petah Tikva


        We report a case of acute closure of the left main coronary artery, a rare complication of diagnostic cardiac catheterization, treated by emergency stenting prior to aorto-coronary by-pass surgery. We suggest encroachment of the Judkins catheter into a calcified left main ostium, with dissection and acute thrombosis of this segment, as the possible mechanism.

        Clinically, the patient's condition deteriorated to cardiogenic shock and loss of consciousness. Remarkably, there was no angiographic evidence of significant left main coronary artery disease, besides the presence of calcification in the proximal part of the left coronary system and ventricularization of coronary pressure at the time of engagement. We chose to slide quickly the angioplasty guidewire through the left main coronary artery, which allowed prompt mechanical recanalization and rapid restoration of coronary flow, with dramatic clinical and hemodynamic improvement. This relatively simple procedure allowed stenting the left main artery after brief predilation, and the patient came to by-pass surgery in excellent condition. The rationale for surgery in this case was the need for complete coronary revascularization because of significant 3-vessel coronary artery disease.

        יעקב פלדמן, אברהם ירצקי וקרולה ויגדר

        Community-Acquired Pneumonia in the Elderly: Guidelines for Hospitalization


        Jacob Feldman, Abraham Yarezky, Carola Vigder


        Geriatric. Dept., Meir Hospital, Kfar Saba and Sakler Faculty of Medicine, Tel Aviv University


        A prospective study was carried out among elderly patients with community-acquired pneumonia to determine if there are any specific features that could help in deciding whether to hospitalize, or to treat in the community. We concluded that there is no correlation between clinical presentation of pneumonia and outcome, except for impairment of consciousness. Laboratory data showed a correlation between oxygen saturation in arterial blood, levels of hemoglobin and albumin, and outcome. Sputum culture was not helpful in deciding about diagnosis and treatment, which remain empiric. These patients should be treated at home if conditions permit. Recommendations are made for improving such conditions.

        דניאל לזר, נעמי וינטרוב, נטלי אברמוב, שרה אסא, קונסטנטין בלוך, רגינה אופן, הדסה בן-זקן ופנינה ורדי

        Islet Autoantibody Assays in Type I Diabetes can Replace ICA Test


        Daniel Lazar, Naomi Weintrob, Natalia Abramov, Sara Assa, Konstantin Bloch, Regina Ofan, Hadassa Ben-Zaken, Pnina Vardi


        Institute for Pediatric Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva and Felsenstein Medical Research Center, Tel Aviv University


        Islet cell antibodies (ICA) continue to serve as the basis of the principal serological test for definition of active autoimmunity of beta-cells. Its disadvantages are the need for human pancreatic tissue and difficulty in obtaining quantitative results. In the past decade biochemically-defined beta-cell antigens were described, leading to the development of sensitive and specific autoantibody assays, to predict insulin-dependent diabetes mellitus (IDDM). We examined the value of combined biochemically-based serological assays, such as autoantibodies to insulin (IAA), glutamic acid decarboxylase (GADA) and ICA512 (ICA512A) to replace the traditional ICA assay.

        Blood samples of 114 newly diagnosed IDDM patients, aged 12‏5 yrs (range 2 months - 29 years) were tested for ICA (indirect immunofluorescence), IAA, GADA and ICA512A (radiobinding assay). The latter 2 assays were performed using recombinant human [35S]-labeled antigen produced by in vitro transcription/translation. We found that fewer sera scored positive for ICA and/or IAA (80.7%, 92/114) than for 1 or more of IAA, GAD, or ICA512 (88.6%, 101/114). We conclude that combined testing for IAA, GAD and ICA512 can replace the traditional ICA/IAA test to predict IDDM and is helpful in the differential diagnosis of insulin-dependent and noninsulin-dependent diabetes.

        אפרים זגנרייך, סולומון ישראלוב, יוסף שמואלי, דן סימון, ג'ק בנאל ופנחס לבנה

        Combinations of Vasoactive Agents by Penile Injection for Erectile Dysfunction


        E. Segenreich, S. Israilov, J. Shmueli, D. Simon, J. Baniel, P. Livne


        Andrology Unit, Institute of Urology, Rabin Medical Center (Beilinson Campus), Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University


        In the past 15 years there has been continuous increase in the use of injections into the corpora cavernosa of different vasoactive drugs for treatment of erectile dysfunction (ED). However, some of these drugs are very expensive, are not available everywhere, and have side effects. We therefore compared the success rate of the most widely used compounds, papaverine and regitine, in 452 patients (age range 26-85) with different types of ED. Each patient received in the clinic injections of papaverine, 6-25 mg, and regitine, 0.05-1.5 mg. When maximal rigidity of the penis (MRP) was >80%, we instructed the patient to self-inject the drug at home, 5-30 minutes before coitus. If after 3 injections MRP was not >80%, prostaglandin E1 (PGE1) in an average dose of 10-25 mcg was added. If there was no response, papaverin+regitine+PGE1 were given in higher dosage, and atropine sulfate, 0.02+0.06 mg, was added if necessary.

        Of 452 patients, 305 (67.4%) had MRP >80% after 3 injections of papaverine plus regitine. The other patients received PGE1 in addition. This was helpful in 61 patients (41.5%), while 55 (63.9%) required papaverine + regitine + prostin in higher doses. Of these, only 31 received papaverine + regitine + PGE1 + atropine sulfate. Of these, 20 (64.5%) reached MRP >80%, and 11 (2.4%) MRP <60. For these 11 patients, we recommended a penile prosthesis. Thus in 67.4% of the 452 patients, papaverine + regitine injections were effective; in 41.5%, PGE1; in 63.9%, papaverine + regitine + prostin + atropine sulfate. Only 11 (2.4%) did not react to intracorporeal injection.

        This progressive method of treatment enabled us to select the optimal dosage and combinations of compounds in 441/452 patients (97.5%) according to the severity of their dysfunction. During follow-up of 6 months, spontaneous erections without injection were achieved in 115 (26.0%).

        אפריל 1998
        רפאל יוסף חרותי, רון בן-אברהם, מיכאל שטיין, יניר אברמוביץ, יהושע שמר וברוך מרגנית

        Changes in Structure and Process Components of Trauma Care in Emergedepartments


        Rephael Joseph Heruti, Ron Ben-Abraham, Yanir Abramovitch, Michael Stein, Joshua Shemer, Baruch Marganit


        Trauma Control, Israeli Center for Disease Control (ICDC), Israel Ministry of Health and Sackler School of Medicine, Tel Aviv University


        In recent years there have been tremendous efforts to improve primary trauma care. The Ministry of Health and other authorities have invested in new trauma facilities in various hospitals. A nationwide survey with regard to structure and function of emergency departments was carried out. Compared to a similar survey conducted in 1992, significant progress in quality and quantity of equipment at various emergency departments was demonstrated. However, there are still differences between various hospitals. A drive to standardize trauma care will undoubtedly contribute to improvement in care of the injured.

        ריבה בורוביק, מריאנה שטיינר, יעקב אטד, בוריס שניידרמן, טלי רוזנברג ושולה פלטי

        Taxol as Second-Line Therapy in Recurrent Breast and Ovarian Cancer


        R. Borovik, M. Steiner, J. Atad, B. Sneiderman, T. Rosenberg, S. Palti


        Oncology Depts., Lin Medical Center and Carmel Medical Center, Haifa


        Results of chemotherapy with Taxol (paclitaxel) in 55 patients with recurrent breast and ovarian cancer were reviewed. Taxol was given as a 3-hour infusion, every 3 weeks, on an outpatient basis. There was complete or partial response in 8 patients (23%) with breast cancer and 10 (50%) with ovarian cancer. Performance status and previous response to adriamycin were important prognostic factors. Toxicity was manageable. Treatment had to be stopped for hypersensitivity reactions in only 2 patients. Taxol given in an ambulatory clinic is safe and effective.

        יורם הרט וברנרד הירשוביץ

        Topical Photodynamic Therapy in Basal and Squamous Cell Carcinoma and Penile Bowen's Disease


        Yoram Harth, Bernard Hirshovitz


        Photodynamic Therapy Unit, Elisha Medical Center, Haifa


        Photodynamic therapy (PDT) is a noninvasive selective therapy for a specific group of skin tumors. 5-aminolevulinic acid 20% in a water-in-oil cream base was applied to the tumors as a photosensitizer and was followed after 12 hours by exposure to a high output light source emitting red (585-720 nm; 150 mW/cm²) and near infrared irradiation (1.25-1.6 mm; 50 mW/cm²) for 10-15 minutes (VersaLight, incoherent filtered light source). Complete responses were achieved after 1-3 treatments in 26/31 lesions of superficial or small nodular basal cell carcinoma (BCC) and 4/5 in superficial, squamous cell carcinoma (SCC) lesions. There was a patient with Bowen's disease of the penis. Follow-up was for 12-24 months. This noninvasive, nearly painless treatment gives excellent therapeutic and cosmetic results. Our data show its efficacy for certain subtypes of BCC, SCC and Bowen's disease. Further studies will determine the exact cure and recurrence rates with this modality and compare it to other modes of skin cancer therapy.

        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