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        תוצאת חיפוש

        מרץ 2001
        אברהם יצחק, גד שקד, ליליאנה לופו, סולי מזרחי ויורם קלוגר

        Selective Embolization of Hepatic Arteries in the Management of Severe Liver Trauma

         

        Avraham Yitzhak1, Gadi Shaked2, Liliana Lupu3, Soli Mizrahi, Yoram Kluger4

         

        1Department of Surgery A, 2Trauma Service, 3Interventional Radiology, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, and Trauma Service4, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel

         

        Two cases of severe hepatic injury in which selective hepatic artery embolization was used to control hemorrhage are presented. The first case is that of a 35 year old patient who sustained a severe liver injury after a car accident. A CAT scan of the abdomen revealed an AAST grade 5 liver injury, pooling of contrast material within the liver parenchyma, and blood within the peritoneal cavity. The patient was given fluid resuscitation and taken to angiography where bleeding from branches of the right hepatic artery was demonstrated. While angiography was being undertaken the hemodynamic status of the patient deteriorated, blood transfusion was started, and a selective embolization of the right hepatic artery was performed. The bleeding stopped promptly and hemodynamic stability was regained.

        The second case is that of a 40 year old pedestrian run over by a car. Abdominal ultrasound revealed free fluid in the peritoneal cavity and the patient was rushed to the O.R. Crushed right lobe of the liver, and inferior vena cava and bowel tears were found. After perihepatic packing and resection of the right and sigmoid colons retrohepatic vena cava tear was repaired and perihepatic packing restored. The abdominal cavity was closed and the patient was taken to the ICU for the correction of hypothermia, metabolic acidosis, and coagulopathy that had developed during the surgery. After 8 hours in the ICU the patient was transferred for angiography and a selective embolization of branches of the right hepatic artery was performed.

        The clinical course of the patients after angiographic embolization of the hepatic arteries is described and the literature that discusses the use of angiography and embolization of hepatic arteries after traumatic hepatic bleeding is reviewed.

        דצמבר 2000
        מוחמד עבדולגני, רימה פלדמן, משה שי ויעקב וורקל

        Atrophic Gastritis Presenting with Pulmonary Embolism

         

        Muhammad A. Abdul-Ghani, Rima Feldman, Moshe Shai, Jacob Varkel

         

        Dept. of Medicine C, Western Galilee Hospital, Naharia

         

        Atrophic gastritis is an autoimmune gastropathy in which there is destruction of gastric parietal cells. This results in intrinsic factor deficiency and disturbance in vitamin B12 absorption. Its clinical manifestationa are therefore the consequences of B12 deficiency and include anemia and neurological defect. In addition, lack of B12 results in metabolic changes, including disturbances of methionine metabolism and accumulation of homocysteine.

        In recent years, there has been increasing evidence suggesting that hyperhomocysteinemia is a risk factor for thrombo-embolic disease. We describe a 51-year-old man with atrophic gastritis, severe B12 deficiency and hyperhomocystein-emia. The initial clinical manifestation was pulmonary embolism, without either anemia or neurological signs. B12 deficiency should therefore be considered in patients being investigated for hypercoagulability.

        דצמבר 1999
        א' חורי, ר' מושיוב ומ' ליברגל

        Thromboembolism in Orthopedic Trauma

         

        A. Khoury, R. Mosheiff, M. Liebergall

         

        Orthopedic Surgery Dept., Hadassah University Hospital and Hebrew University - Hadassah Medical School, Jerusalem

         

        Trauma increases risk of thromboembolic complications. Thus, in pelvic fractures and spinal injuries the incidence of deep vein thrombosis (DVT) is about 35-60%. Half occur in the pelvic veins and are the most likely to result in pulmonary embolism. While symptomatic pulmonary embolism occurs in 2-10% of patients, more have silent pulmonary embolism. 0.5-2% of pulmonary embolisms are fatal. In lower extremity trauma the incidence of DVT is about 58%, with 18% of them in the proximal veins. Thromboembolic complications are the prime cause of morbidity and mortality among trauma patients, yet they can be prevented efficiently and cost-effectively. The arsenal of prophylactic agents includes heparin, low molecular weight heparin, and mechanical devices including inferior vena cava filters.

        נובמבר 1999
        עידו וולף ומאיר מועלם

        Multiple Organ Damage due to Cholesterol Embolization

         

        Ido Wolf, Meir Mouallem

         

        Dept. of Medicine E, Sheba Medical Center, Tel Hashomer, and Sackler Faculty of Medicine, Tel Aviv University

         

        Cholesterol crystal embolization can affect multiple organ systems and mimic other systemic diseases. We describe a 65-year-old woman who had renal failure, diarrhea, transient ischemic attacks and purple toes due to spontaneous cholesterol crystal embolization.

        מאי 1999
        הראל גילוץ, אהרון גבריאל ושמואל יורפסט

        Accidental Severance of a Venous Catheter: Diagnostic and Therapeutic Approach

         

        Harel Gilutz, Aharon Gavriel, Shmuel Yurfest

         

        Cardiology, Heart and Lung, and Vascular Surgery Depts., Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba

         

        The most common invasive procedure performed in hospitals ithe insertion of a vascular access device. This procedure has the rare complication ofcatheter emboli. Accidental cutting of a peripheral catheter, the use of duplex ultrasound to locate the cut and the extraction of the catheter through a venesection is described. If peripheral extraction fails, percutaneous extraction or thoracotomy should be tried, in that order. The immediate precautions have an impact on the final results.

        יוני 1998
        רון בן אברהם, ערן סגל, דב פריימרק, אלינור גושן, חנוך הוד, יעקב לביא, צבי זיסקינד ועזריאל פרל

        Massive Pulmonary Embolism

         

        Ron Ben Abraham, Eran Segal, Dov Freimark, Elinor Goshen, Hanoch Hod, Jacob Lavee, Zvi Ziskind, Azriel Perel

         

        Depts. of Anesthesiology and Intensive Care, Cardiology, Nuclear Medicine and Cardiac Surgery, Sheba Medical Center, Tel Hashomer and Sackler Faculty of Medicine, Tel Aviv University

         

        Pulmonary embolism is a common event in hospitalized patients. In some cases it presents with hemodynamic collapse, indicating massive obliteration of the pulmonary vasculature and has a very grim prognosis; 2/3 of such patients die within 2 hours of onset of symptoms. We describe our experience in 13 patients with massive pulmonary embolism. An aggressive diagnostic and therapeutic approach, utilizing sophisticated imaging techniques, thrombolytic therapy and surgery, led to the survival of 8 of the patients. Our experience supports an aggressive approach in these seriously ill patients.

        פברואר 1998
        עאיד מחאג'נה, דאוד שריף, בועז וולר, אדוארד אבינדר ובנימין שרף

        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.

        יוני 1997
        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.

        פברואר 1997
        י' שויד, א' אנגל ומ' הלברטל

        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.

        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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