תוצאת חיפוש

יהושע (שוקי) שמר (1,2,3), ברכה רגר (1,4)

משרד הבריאות, ישראל (1), המרכז הישראלי להערכת טכנולוגיות בשירותי הבריאות, מכון גרטנר, תל-השומר (2), הפקולטה לרפואה, אוניברסיטת תל-אביב (3), המחלקה למיקרוביולוגיה ואימונולוגיה, הפקולטה למדעי הבריאות, אוניברסיטת בן-גוריון בנגב (4)

מחקר רפואי הוא תהליך שימיו כימי ההיסטוריה המתועדת. כבר לפני שלושת אלפים שנה, הוקדשו מאמצים ואמצעים לרפא מחלות ולגרום לבריאות טובה יותר, אולם רק בשלוש מאות השנים האחרונות, רתם האדם לרשותו את המדע כדי להשיג מטרות אלה ולהבין את מהות המחלות. בחמישים השנים האחרונות, הביא המחקר הרפואי לפריצות דרך שהתבטאו בהארכת תוחלת החיים ובשיפור חיי האדם. אולם, קיימת עדיין שורה ארוכה של מחלות חשוכות מרפא המחייבות להעמיק במחקר ויש צורך בהשקעות ואמצעים כדי להבין את התהוותן, מהלכן ודרך הטיפול בהן. שינויים חברתיים עולמיים מציבים אתגרים חדשים בפני מערכות הבריאות. מחלות זיהומיות כמו איידס או אבולה (ebola), התפרצות מחודשת של מחלת השחפת, העלייה בשיעור חולי הסרטן, העלייה בשכיחות השיטיון (dementia) כתוצאה מהארכת תוחלת החיים והשיעור העולה של נפגעים מנטילת סמים והגברת האלימות בחברה המודרנית, כל אלה, כמו מחלות אחרות, מחייבים הגברה והרחבה של המחקר הרפואי עם תחילת המילניום השלישי.

רונית חיימוב-קוכמן, שמחה יגל

המח' לרפואת נשים ויולדות, ביה"ח האוניברסיטאי, הסתדרות מדיצינית הדסה, הר הצופים, ירושלים

חקר גנום האדם החל לפני למעלה מ-40 שנה בתגלית, שתאים סומטיים מכילים 46 כרומוסומים. בין השנים 1956 ל-1960, הוגדר הבסיס הגנטי לתיסמונות שונות שהיו ידועות זה מכבר. כל סטייה במספר הכרומוסומים מ-46 (23 זוגות כרומוסומים) קרויה אנאפלואידיות, והיא מהווה את הליקוי הגנטי הנפוץ ביותר. אנאפלואידיות נגרמת בדרך כלל מהפרעה בצימוד הכרומוסומים במהלך החלוקה התאית במיטוזה ובמיוזה.

שרון ארליך(1), דלית מודן(1) וגדעון פרת(2)

(1) היח' לאנדוקרינולוגיה, (2) המח' לטיפול נמרץ ילדים, מרכז רפואי שיבא, תל-השומר, רמת-גן

לפטין הוא חלבון בעל 167 חומצות-אמינו ומשקלו המולקולתי הוא כ-16kDa. שמו נגזר מהמלה היוונית leptos, שמשמעותה "רזה". ללפטין מספר תפקידים, שהעיקרי ביניהם הוא ויסות מאזן האנרגיה על ידי דיכוי תיאבון והגברת הוצאת אנרגיה. כמו-כן, הוא מהווה סמן למאכת הרבייה וכהורמון המשפיע על מיגוון תהליכי חילוף-חומרים, כגון הפרשת אינסולין וליפוליזה. קיימות עדויות לכך, שללפטין יש גם תפקיד מרכזי בתגובה למצבי דחק והוא מצוי ביחסי גומלין הדוקים עם ציר ההיפותאלאמוס-היפופיזה-טוחה (adrenal). המטרה בסקירה זו לסכם בקצרה את הידע הקשור בלפטין, בהסתמך על הספרות העכשווית.

שמואל ארגוב, אלגה לבנדובסקי

בתי החולים "אלישע" ו"חורב", חיפה

הוראת "צום מחצות הליל" היא שיגרה נפוצה, הנרשמת בגיליון כל חולה במחלקות רבות לכירורגיה, לקראת הניתוח למחרת בוקר. חולים רבים עלולים לצום לפי הוראה זו במשך 10-12 שעות לפני הגעת תורם לניתוח. נשאלת השאלה, האם יש צורך בצום ממושך כל כך, מהם נזקיו ומהו משך הצום המיקטי לפני ניתוח, הרדמה כללית ופעולה פולשנית תחת סמי הרגעה. מובא בזה נסיוננו בלמעלה מ-5,000 ניתוחים פרוקטולוגיים אמבולטוריים בהרדמה מקומית, בתנוחת trendelenburg, עם צום "מקוצר" לפני הניתוח.

Animal Models of Psychiatric Diseases: Possibilities, Limitations, Examplesand Demonstration of Use

Haim Einat, RH Belmaker

Beer Sheva Mental Health Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel

Animal models of psychopathology serve as a central tool for psychopharmacologists in their attempts to develop new, more efficient medications for psychiatric disorders, and in the efforts to explore the mechanisms of conventional and novel drugs. The development of efficient models for psychiatric diseases is complicated since the mechanisms of the disorders are not clear, major parts of the diagnosis depend on verbal communication with the patient and many of the symptoms are expressed mainly through the subjective experiences of the afflicted individual.

Inspite of these difficulties, effective models were developed for most psychiatric diseases. The development of such models is based on their validation in three different dimensions: face validity - behavioral similarities between the model and the disorder; construct validity - similarities between the mechanisms related to the model and a mechanistic theory of the disease; predictive validity - that the model response to the conventional medications that are effective in the disease and will not respond to drugs that are not effective in the disease.

The present paper presents three known models of depression; each induced in a different way and therefore represents a group of models:

*     Reserpine-induced hypoactivity - represents the group of pharmacologically induced models.

*     Forced swim test - represents the group of behaviorally induced models.

*     Flinders Sensitive Line - represents the group of genetically induced models.

The use of these models in an attempt to examine the range of action of a new potential antidepressant and its mechanisms of action is demonstrated with a recent set of experiments with inositol.

Intravenous Immunoglobulins Treatment of Patients with Graves' Ophthalmopathy

Adi Leibe, Yair Levy, Yehuda Shoenfeld

Department of Medicine B and Research Unit of Autoimmune Diseases, Chaim Sheba Medical Center, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University

Graves' ophthalmopathy is an autoimmune disease manifested as exophthalmus, lid lag and diplopia. As in the accompanying autoimmune thyroid disease, there is an autoimmune homoral and cellular attack on the orbita, mainly the retro-orbital tissues.

Steroids are the comerstone of therapy. We reviewed the evidence for a similar therapeutic effect of I.V., immunoglobulins (IVIGs) and their better side affect profile as compared to steroids. We also described an impressive therapeutic success with IVIG given to a patient with resistant ophthalmopathy. The clinical picture of Graves' ophthalmopathy is attributed to a pathologic hyper - activation of orbital fibroblasts, deposition of collagen and glycosaminoglycans in the extra-cellular matrix and eventually fibrosis. These are mediated by leucoregulin, IL-1, IFN-gamma, and TGF-beta - all secreted by lymphocytes and mast cells in the retorbital space.

Another mode of cell activation is by binding of autoantibodies (presumably thyroid stimulating Ab's) to an antigenic determinant on the surface of fibroblasts.

I.V. immunoglobulins, known today to be active in a variety of autoimmune processes, exert their effect on autoantibodies, complement, phagocytic cells etc. IVIGs also inhibit orbital lymphocytes and fibroblasts through inhibition of IL-1 or/and TGF-beta.

יעקב ברקון ומאיר שליט

היח' לאלרגיה ואימונולוגיה קלינית, האגף לרפואה פנימית, ביה"ח הדסה, ירושלים

בשנים האחרונות, הצטבר מידע רב על מעורבות ליקוטריאנים בגנחת הסימפונות ובמחלות דלקתיות למיניהן. במטרה למנוע את פעולתם בתהליך האלרגי-דלקתי, פותחו תרופות נוגדות ליקוטריאנים (נלק"ט), ולאחר שהוכחה יעילותן, הן הוכנסו לשימוש נרחב בטיפול בחולי גנחת. לאחרונה התברר, שתרופות אלו פעילות גם בנזלת אלרגית וכעת נערכים מחקרים רב-מרכזיים במטרה לבדוק את יעילותן כנגד מחלה זו. כן דווח בשנתיים האחרונות על הצלחות טיפוליות של נלק"ט בחולים הלוקים בחרלת כרונית (ח"כ). המטרה בסקירה זו היא לעמוד על תפקיד הליקוטריאנים בחרלת כרונית ולסכם את הידוע לגבי יעילות תרופות נלק"ט בטיפול בלוקים במחלה זו.

Characteristics of Nasopharyngeal Carriage of Streptococcus Pneumoniae in Children During Acute Respiratory Disease

A. Aran¹, D. Fraser², R. Dagan¹

Pediatric Infectious Disease Unit¹, Epidemiology Department², Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva

Streptococcus pneumoniae is an important cause of pediatric morbidity and its main reservoir is the nasopharynx, from which it can disseminate and cause invasive disease. From November 1997 through March 1998, nasopharyngeal carriage of S. pneumoniae was evaluated in 250 children under the age of 36 months: 123 Jews and 127 Bedouins with acute respiratory disease and in 980 healthy control children (852 Jews and 128 Bedouins).

Carriage rate was higher among sick children. Among Jewish children it was 57% and 35% of sick and healthy children respectively (p<0.01), and among Bedouin children it figured as 80% and 67% respectively (p=0.01). The difference in carriage rate was most prominent in infants under the age of 5 months: among Jewish children it was 60% and 27% of sick and healthy children respectively (p<0.001) and among Bedouins it was 82% and 65% respectively (p=0.05).

Higher carriage rate of penicillin resistant pneumococci (PRP) was also detected in sick children, with no relation to antibiotic treatment in the month prior to sampling. In Jewish children PRP was detected in 12%, 28% (p<0.001) and 36% (p<0.001) of healthy children, sick children with previous antibiotic treatment and sick children with no treatment, respectively.

The seroypes included in the newly developed 7-valent conjugate vaccine: 4, 6B, 9V, 14, 18C, 19F, 23F, that are highly pathogenic and often antibiotic resistant contributed 74% of isolates in sick Jewish children who had previous antibiotic treatment and 39% of isolates in healthy children (p<0.001). In Bedouin children vaccine types carriers rate among the sick children was not higher than in healthy children.

Acute respiratory disease increases the risk of pneumococcal carriage in general and carriage of resistant pneumococci in particular. Previous antibiotic treatment increases the risk of carring one of the pathogenic serotypes included in the 7-valent vaccine. The impact of disease is most prominent in infants under 5 months, since they are usually less exposed to S. pneumoniae carriers than older children.

Since the increase in carriage rate during illness is mostly due to the serotypes included in the newly developed conjugate vaccine, future immunization programme may decrease not only morbidity rate but also nasopharyngeal carriage rate of pneumococci in general and of antibiotic-resistant pneumococci in particular.

Neurological Manifestations in West Nile Fever

R. Grossman, Y. Levi

Department of Medicine B and Research Unit of Autoimmune Diseases, Chaim Sheba Medical Center (Affiliated to Tel-Aviv University), Tel-Hashomer, Ramat-Gan

The West Nile fever is a viral disease transferred by a mosquito bite. It is well known in the world for the last 70 years. Recently, there was an outbreak of this disease in Israel. We will describe case reports of 2 patients who were afflicted by the disease. The first one was hospitalized with an unusual presentation including paralysis to the lower limbs, while the second one was admitted with meningitis. In both, the course was quite dramatic, and one of them expired. Reviewing the literature revealed that neurological manifestations are quite frequent among these patients (90%), while in elder people, they were fatal.

Colonic Pseudo-Obstruction (Ogilvie Syndrome) Following Cesarean Section

Ido Solt, Peter Jakobi

Dept. of Obstetrics and Gynecology, Rambam Medical Center and Technion Faculty of Medicine, Israel Institute of Technology, Haifa

Acute colonic pseudo-obstruction, or Ogilvie syndrome can be a major surgical complication. Ogilvie syndrome, unlike adynamic ileus, is usually not self-limiting and may cause ischemic necrosis and colonic perforation, with a mortality rate as high as 50 percent. Ogilvie syndrome represents a diagnostic and therapeutic challenge that deserves a multidisciplinary approach. We present a case report and a literature review of the syndrome.

Pseudomembranous Colitis: Clinical, Endoscopic and Radiological Correlation - A 2 - Year Experience

Fabiana Benjaminov MD⁽¹⁾, Rivka Zissin MD⁽²⁾, Benjamin Novis MD⁽¹⁾

⁽¹⁾Gastroenterology Institute and ⁽²⁾CT Unit, Meir Hospital, Sapir Medical Center, Kfar-Saba, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel

Abstract: The incidence rates of pseudomembranous colitis are rising. Early diagnosis and treatment are required for management of this potentially life-threatening disease. This report outlines our 2-year experience (1997-1998) at the gastrointestinal institute with 43 patients diagnosed with pseudomembranous colitis and describes the clinical course and imaging studies.

The group consisted of 25 women and 18 men, aged 34-93 years (mean: 67). Thirty-nine patients were treated with antibiotics. Twelve patients were referred directly to an endoscopic examination with a presumed clinical diagnosis of pseudomembranous colitis (diarrhea, fever and abdominal pain) that was confirmed by colonoscopy. Thirty-one were referred to colonoscopy following abdominal imaging performed to clarify cause of fever and abdominal pain. Twenty-nine patients had an abdominal CT, one had an US and one a barium follow-through. The CT finding suggesting pseudomembranous colitis included colonic mural thickening in 28 patients (71% diffuse versus 29% segmental colitis), with an average wall thickness of 16 mm. Sixteen patients (59%) had pericolonic fat changes and 15 patients (51%) had ascites. All of these patients, except one, had endoscopic findings consistent with pseudomembranous colitis.

Five patients (11.6 %) died due to the severe PMC.

To conclude, as an abdominal CT is often performed in the acutely ill patient, it may arouse the diagnosis of pseudomembranous colitis in the proper clinical setting. Such a suspected diagnosis justifies endoscopic evaluation, which is the most reliable diagnostic examination.

Eosinophilic Pneumonia induced by Minocycline

Eli Rosen

Medical Dept. B, Hillel Yaffe Hospital, Hadera

Eosinophilic pneumonia is a rare adverse effect of minocycline. To date there are about 70 chemical compounds that cause drug-induced, eosinophilic lung disease.

A 20-year-old woman who developed eosinophilic pneumonia due to minocycline is described. Diagnosis was established by history, signs and symptoms, peripheral eosinophilia, chest x-rays and response to combined cessation of treatment and a short course of steroids.

Physicians should be aware to this rare adverse effect of the drug. Attention to the possibility of minocycline-induced eosinophilic pneumonia can prevent unnecessary, expensive investigation. Cessation of intake is usually sufficient for cure.

Pneumomediastinum Following Drug Abuse

Z.G. Fridlender, A. Bloch

Medical Division, Hadassah Hospital, Ein Kerem, Jerusalem

Pneumomediastinum is termed spontaneous when not associated with trauma or other identifiable pathological process. There are several reports of pneumomediastinum following narcotic drug inhalation or smoking while applying positive pressure. We describe a 37-year-old male drug addict, hospitalized after having being found unconscious with shortness of breath. CT scan demonstrated bilateral pneumonia with pneumomediastinum. After a day of mechanical ventilation he gradually recovered and the mediastinal air disappeared.

Pneumomediastinum may occur in addicts but usually has no dangerous clinical consequences. If there is respiratory deterioration another cause should be sought.

Hemophagocytic Syndrome

I. Morag, M. Goldman, T. Bistrizer, C. Kaplinsky

Pediatric Division, Assaf Harofeh Medical Center, Zerifin and Pediatric Hematology-Oncology Dept., Chaim Sheba Medical Center, Tel Hashomer and Sackler Faculty of Medicine, Tel Aviv University

Hemophagocytic syndrome is a rare, fulminant disease characterized by generalized histiocytic proliferation associated with phagocytosis of erythrocytes, platelets, and to a lesser extent, of white blood cells. We report a 2-year-old boy admitted with high fever and irritability, with a rash, marked hepatomegaly and generalized lymphadenopathy. Liver function tests were abnormal and there was thrombocytopenia and hyperlipidemia. Bone marrow aspiration revealed hemophagocytosis. Despite intensive treatment with steroids, intravenous immunoglobulin and cytotoxic drugs, he died within 10 weeks.

Alpha-Amino Adipic Aciduria: a Rare Psycho-Motor Syndrome

Ben-Ami Sela, Tamar Massos, Dov Fogel, Joseph Zlotnik

Pathological Chemistry and Child Development Institutes, Sheba Medical Center, Tel Hashomer and Sackler Faculty of Medicine, Tel Aviv University

A 3.5-year-old boy with developmental motor retardation, hypotonicity, and severe speech disturbance had alpha-amino adipic acid in his blood and very high levels in his urine. In only 20 cases has this catabolite of lysine and hydroxylysine been found in high concentrations in urine, due to enzymatic block.

The clinical features associated with alpha-amino adipic aciduria may include mental retardation, developmental and motor delay, learning difficulties, convulsions, speech problems and ataxia. 3 siblings had milder symptoms of psychomotor delay and intermediate degrees of alpha amino-adipic aciduria, suggesting that the described developmental deficits could be related to this metabolite or its derivatives.