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        תוצאת חיפוש

        מרץ 1998

        קלאודיו קריסטל, יפתח שמש, יוסף מישעל ואברהם בורבין
        עמ'

        Cardiac Failure following Sting of Yellow Scorpion in an Adult

         

        C. Kristal, I.Y. Shemesh, Y. Mishal, A. Bourvin

         

        Intensive Care Unit, Dept. of Anesthesia and Medical Dept., Barzilai Medical Center, Ashkelon

         

        3 men, aged 18, 29, and 47 had severe cardiovascular disturbances following the sting of the yellow scorpion (Leiurus quinquestriatus hebraeus), which is considered the most dangerous scorpion in Israel. Cardiovascular complications are common in children after scorpion sting, but are rare in adults. Pulmonary edema developed in 1 of those being reported and hypertension and arrhythmias in the other 2. Severe deterioration in left ventricle function was confirmed by echocardiographic measurement of diminished ejection fraction. All patients recovered completely. This is the first report of severe cardiac involvement in adults following scorpion sting. We therefor recommend that even adults who develop cardiac symptoms after scorpion sting, particularly those with chronic cardiac disease, be monitored and treated in an intensive care unit.

        א' כרמל, ה' עמיטל, י' שמר וא' שחר
        עמ'

        Clinical Characteristics of those who Leave the Emergency Room Against Advice

         

        A. Carmel, H. Amital, Y. Shemer, A. Sahar

         

        Emergency Dept. and Dept. of Medicine B, Gertner Institute for Medical Service Research, Chaim Sheba Medical Center, Tel Hashomer and Sackler Faculty of Medicine, Tel Aviv University

         

        The object of this study was to characterize those who leave the emergency department agmedical advice and to examine the short-term consequences. The study was conducted retrospectively 1992 and prospectively during May-August 1993 by telephone interviews. About 0.5% of all the patients who applied to the emergency department left against medical advice. Their main characteristic was that they were mostly young, single men. A wide range of complaints had brought them to the emergency department, very similar to that of the control group, but with a higher tendency to abuse drugs and alcohol. Most of those who left against medical advice had less severe disease than the controls. However 10% of them had to be hospitalized within the subsequent 2 weeks, in comparison with 4% of the controls. This study suggests that improving the efficiency of the emergency department will decrease the number leaving against advice.

        יוסף רוזנמן, חיים לוטן, הישאם נסאר ומרוין ש' גוטסמן
        עמ'

        Percutaneous Revascularization of the Left Main Coronary Artery as Coronary Artery Bypass in High Surgical Risks

         

        Yoseph Rozenman, Chaim Lotan, Hisham Nassar, Mervyn S. Gotsman

         

        Cardiology Dept., Hadassah-University Hospital (Ein Kerem) and Hebrew University-Hadassah Medical School, Jerusalem

         

        Coronary artery bypass grafting is the treatment of choice for obstructive disease of the left main coronary artery. Its proximal location and easy accessibility make the left main artery an inviting target for percutaneous intervention, an approach contraindicated by the high associated risk. We describe 2 patients at high operative risk in whom the obstructed main coronary artery was successfully revascularized percutaneously. Coronary stenting and rotational ablation of calcified arteries are essential for successful outcome and minimize complications.

        יעקב גורביץ, יוסי פז, מנחם מצא, אמיר קרמר, דימיטרי פבני, אורן לב-רן, חיים לוקר ורפאל מור
        עמ'

        Skeletonized Internal Mammary Arteries for Coronary Bypass Grafting

         

        Jacob Gurevitch, Yosef Paz, Menachem Matsa, Amir Kramer, Dimitri Pevni, Oren Lev-Ran, H. Locker, Raphael Mohr

         

        Dept. of Thoracic and Cardiovascular Surgery, Sourasky-Tel Aviv Medical Center

         

        The skeletonized internal mammary artery (IMA) is longer, and its immediate spontaneous blood flow is greater than that of the pedicled IMA, thus providing increased versatility for complete, arterial myocardial revascularization without the use of saphenous vein grafts. From April 1996 to May 1997, 583 patients underwent coronary artery bypass grafting here and in 415 (71%) complete arterial revascularization was achieved using bilateral skeletonized IMA. The right gastroepiploic artery was used in 57 (13%); there were 329 males (79%) and 86 women (21%); average age was 64 (30-87) and 175 (36%) were older than 70; 131 (32%) were diabetics. Average number of grafts was 3.2 (range 2-6 grafts). At 30 days, 5 (1.2%) had died and there had been 6 perioperative infarcts (1.4%), 5 CVA's (1.2%), and 6 had sternal wound infections (1.4%). Up to 1-12 months of follow-up was achieved in 409 (99%). Late mortality was 1.4% (of which 3 were noncardiac). 394 (97%) were angina-free at latest follow-up. We conclude that arterial revascularization using bilateral skeletonized IMA is safe, as postoperative morbidity and mortality are low, even in old and diabetic patients.

        ד' רוזין, מ' בן חיים, א' יודיץ וע' אילון
        עמ'

        Abdominal Compartment Syndrome

         

        D. Rosin, M. Ben Haim, A. Yudich, A. Ayalon

         

        Dept. of General Surgery and Transplantation, Chaim Sheba Medical Center, Tel Hashomer and SacSchool of Medicine, Tel Aviv University

         

        Abdominal compartment syndrome refers to a complex of negative effects of intra-abdominal hypertension. Its most common cause is complicated abdominal trauma. The syndrome includes mainly hemodynamic and respiratory manifestations but may involve other systems as well. It may present as a life-threatening emergency in the multi-trauma patient. Awareness of the syndrome may enable the surgeon to take preventive measures or to diagnose it earlier and to treat it effectively. We describe a 21-year old man who developed this syndrome after multiple gunshot wounds, with severe liver injury. After 2 operations the typical manifestations of the syndrome were diagnosed. He was re-operated to release intra-abdominal hypertension and then slowly recovered.

        פברואר 1998

        עאיד מחאג'נה, דאוד שריף, בועז וולר, אדוארד אבינדר ובנימין שרף
        עמ'

        Diagnosis of Cerebral Embolism by Transesophageal Echocardiography

         

        A. Mahagney, D. Sharif, B. Weller, E. Abineder, B. Sharf

         

        Depts. of Neurology and Cardiology, Bnai Zion Hospital, Haifa

         

        Cerebrovascular events have high mortality and morbidity, especially in the elderly. Ischemia is the main cause and 30% of the ischemic events are embolic and of cardiac origin. The clinical picture is not always typical of the type of stroke, but diagnosis of the mechanism of the event determines treatment. Transesophageal echocardiography (TEE) is a sensitive procedure more appropriate for diagnosing emboli of cardiac origin than transthoracic echocardiography (TTE). We therefor compared TEE and TTE in the determination of the source of emboli in 65 patients with ischemic stroke but without significant atherosclerotic changes in their carotid arteries, and compared these findings with those in 50 patients without stroke. 68% of the patients had potential sources of emboli according to TEE, compared to only 15% according to TTE. In the control group only 24% had potential sources of emboli by TEE. The findings were: clots in the left atrium, severe aortic atheroma, patent foramen ovale with paradoxical shunt, spontaneous echocardiography contrast, vegetations and mitral valve prolapse. The study showed that TEE is better than TTE in detecting the etiology of embolic stroke in those with normal carotid arteries, thus determining appropriate management.

        ינואר 1998

        אהוד גולדהמר, ואדוארד אבינדר
        עמ'

        Circadian Fluctuations of the Signal-Averaged ECG

         

        Ehud Goldhammer, Edward Abinader

         

        Cardiology Dept., Bnei-Zion Medical Center and Bruce Rappaport Faculty of Medicine, The Technion, Haifa

         

        Circadian periodicity for the time of onset of acute myocardial infarction has been shown; the early morning peak of infarction coincides with the onset of other related phenomena, including sudden cardiac death, ventricular arrhythmias, thrombotic stroke, etc. Late potentials detected by the signal-averaged ECG are considered to be independent markers of vulnerability to ventricular arrhythmias. The signal-averaged ECG enables the amplifying and recording of small bioelectric signals of cardiac origin, while eliminating extraneous electrical "noise." To determine whether late potentials are themselves subject to circadian influence, 31 patients (age range 41-79) who had had an old or recent myocardial infarction underwent late potential assessment by the signal-averaged ECG. 4 indices were studied: duration of late LPD potentials (LPD), total QRS duration (TQRS), and root mean square voltage of the last 40 msec, and of the last 50 msec (RMS 40 and RMS 50). These indices were assessed 3 times, during the early morning hours, at noon and during the evening. Morning LPD differed significantly from noon and evening LPD and the morning RMS 40 similarly differed from noon and evening values. TQRS and RMS 50, even though remaining in the normal range, also showed a tendency to abnormal values during morning hours. These findings could possibly be related to the early morning incidence peaks of severe ventricular arrhythmia and sudden cardiac death, since abnormal late potentials constitute the physiopathological basis for certain ventricular arrhythmias.

        ספטמבר 1997

        ירון שפירא, רפאל הירש, רות יורטנר, משה ניל"י, ברנרדו וידנה, אליק שגיא
        עמ'

        Prosthetic Heart Valve Thrombosis: A 3-Year Experience

         

        Yaron Shapira, Rafael Hirsch, Ruth Jortner, Moshe Nili, Bernardo Vidne, Alex Sagie

         

        Sheingarten Echocardiography Unit and Cardiology Dept., Rabin Medical Center (Beilinson Campus), Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University

         

        A series of 12 patients with 16 episodes of prosthetic heart-valve thrombosis over 3 years is presented. Most episodes affected mitral or tricuspid bileaflet prostheses. All patients were inadequately anticoagulated at the time of thrombosis. The clinical presentation was acute and severe in 6 patients, and subacute or chronic in the rest. Physical examination was suggestive of stuck valves in most cases. Transthoracic echocardiography revealed increased transvalvular gradients in most. However, clearer evidence of valve thrombosis was obtained from transesophageal echocardiography or fluoroscopy. 9 patients eventually had their valves re-replaced successfully, and the preoperative diagnosis was confirmed in all. 5 patients were operated as soon as the diagnosis was established, and an additional 4 were operated after failure of anticoagulation. In 4 patients the valve leaflets became completely mobile after a course of thrombolysis. Prosthetic valve thrombosis is a severe and potentially fatal complication in patients with mechanical heart valves. Alertness of physicians at all levels- the general practitioner, the internist and the cardiologist- to the possibility of valve thrombosis and to its clinical presentation may lead to prompt and earlier diagnosis and to comprehensive therapy.

        מאי 1997

        ראובן איליה, שרה כרמל, קרלוס כפרי ומשה גירון.
        עמ'

        Angina Pectoris and the Severity of Coronary Artery Stenosis

         

        Reuben Ilia, Sara Carmel, Carlos Cafri, Moshe Gueron

         

        Dept. of Cardiology, Soroka Medical Center, and Dept. of the Sociology of Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba

         

        The relationship between angina pectoris and the severity of coronary artery disease was evaluated in 146 patients with normal segmental and global, left ventricular, systolic performance. None had unstable angina or a previous myocardial infarction. A strong relationship was found between angina and the severity of coronary artery disease (p<0.005). Significant, stable, angina pectoris as a clinical symptom indicated advanced coronary artery disease in this selected group of patients.

        אפריל 1997

        אורה שובמן, יעקב ג'ורג' ויהודה שינפלד
        עמ'

        Ischemic Hepatitis in Congestive Heart Failure after an Episode of Hypotension

         

        Ora Shovman, Jacob George, Yehuda Shoenfeld

         

        Dept. of Medicine B and Autoimmune Disease Clinic Research Unit, Sheba Medical Center, Tel Hashomer and Sackler Faculty of Medicine, Tel Aviv University

         

        Ischemic hepatitis can occur as an acute episode in advanced congestive heart failure (CHF). The mechanism is massive necrosis of the central lobules resulting from acute hypoxia when low cardiac output further reduces oxygen supply, aggravating underlying congestion due to poor venous outflow. We describe a 70-year-old woman with congestive heart failure for 7 years who was admitted with jaundice, vomiting, abdominal pain and oliguria after an episode of hypotension. The diagnosis of ischemic hepatitis was established by a documented episode of severe hypotension, followed by elevation of serum transaminases, a rise in serum bilirubin and LDH levels, prolonged prothrombin time and acute renal failure. Other causes of acute hepatitis, such as a virus or drugs were excluded, and improved liver and renal function followed hemodynamic stabilization. We conclude that ischemic hepatitis should be considered whenever acute hepatitis follows a recent episode of systemic hypotension, especially in the context of concomitant CHF.

        מרץ 1997

        אלי עטר, אלכסנדר גרניאק, עיסאם ראבי, בנימינה מורג וזלמן רובינשטיין ז"ל
        עמ'

        Angioplasty and Stenting of the Carotid Artery

         

        Eli Atar, Alexander Garniek, Issam Rabi, Benymina Morag, Zallman Rubinstein

         

        Dept. of Diagnostic Imaging, Interventional Radiology Unit, and Dept. of Vascular Surgery; Chaim Sheba Medical Center, Tel Hashomer (Affiliated with the Sackler Faculty of Medicine, Tel Aviv University)

         

        Percutaneous endovascular techniques are well established procedures in the management of peripheral vascular disease and visceral arterial stenosis. They are now being adapted for use in the carotid artery as well. 8 patients with 9 extracranial carotid artery stenoses were successfully treated by percutaneous angioplasty, following which in 4 of them 5 stents were inserted. The stenotic lesions were situated in the proximal internal carotid artery and in its bifurcation and also in the common carotid artery. The indications for angioplasty in these patients were the same as for surgery. There were no major complications. 1 patient had transient hemiparesis lasting a few hours, and another had bradycardia following balloon dilatation in the region of the carotid body. Percutaneous endovascular treatment of carotid artery stenosis is becoming a safe, feasible alternative to surgery.

        דוד הנדל וגד ולן
        עמ'

        Recurrent Late Hemarthrosis after Total Knee Replacement

         

        David Hendel, Gad J. Velan

         

        Dept. of Orthopedics, Rabin Medical Center, Golda Campus, Petah Tikva

         

        A patient who had a successful total knee replacement for severe degenerative osteoarthritis of the right knee had an excellent functional result. 2 years after the operation there was spontaneous intra-articular bleeding that was treated successfully conservatively. Recurrent hemarthrosis 2 months later was treated similarly and also resolved without residual functional impairment after a follow-up of over 1 year. Recurrent late hemarthrosis in the knee is a fairly rare complication following total knee arthroplasty, but is amenable to conservative measures. Frequently, persistent recurrent hemarthrosis requires debridement of the bleeding synovium of the knee.

        פברואר 1997

        י' שויד, א' אנגל ומ' הלברטל
        עמ'

        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.

        ינואר 1997

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

        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.

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

        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. 

        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
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