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        תוצאת חיפוש

        דצמבר 1998

        יהונתן פינטהוס, יורם מור ויעקב רמון
        עמ'

        The Mitrofanoff Pouch in Lower Urinary Tract Reconstruction

         

        J.H. Pinthus, Y. Mor, J. Ramon

         

        Urology Dept., Chaim Sheba Medical Center, Tel Hashomer

         

        The Mitrofanoff principle, first described in 1980, consists of implanting a tubular organ such as the appendix, ureter, or fallopian tube into the wall of the bladder (or urinary reservoir) to create a non-refluxing, catherizable urinary conduit. Between 1993-1996, 7 men and 1 woman (aged 48-64, average 59) underwent radical cystectomy and urethrectomy combined with the creation of a MAINZ I urinary reservoir (based on the Mitrofanoff principle). In men the indication for the procedure was the diagnosis of invasive transitional cell carcinoma of the bladder with involvement of the prostatic urethra. All patients had refused urinary diversion to an ileal conduit because of its deleterious effect on the quality of life.

         

        In all patients the postoperative course was uneventful, apart from intraperitoneal urinary leakage from the reservoir in 1, successfully managed conservatively. The patients have gained full control of urinary drainage, performing intermittent self-catheterizations every 4-5 hours. In 3 patients there were difficulties with catheterization due to stenosis of the conduit, usually at the skin level. None have suffered leakage from the reservoir, during the day, even when it was full.

        Our experience shows that creation of a continent urinary reservoir according to the MAINZ I technique is an excellent surgical solution for patients in whom the creation of an orthotopic reservoir is impractical. The use of the umbilicus as a stomal site preserves normal body image and thus does not interfere with quality of life as in those undergoing radical cystectomy.

        סרגיי גולדשטיין, יאיר לוי ויהודה שינפלד
        עמ'

        Pulmonary Hypertension and Multi-Valvular Damage Caused by Anorectic Drugs

         

        Serge E. Goldstein, Yair Levy, Yehuda Shoenfeld

         

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

         

        Marked obesity is an independent risk factor for multisystem morbidity. The use of anorectic drugs is an aggressive strategy for weight reduction. It appears to be an easy way of dealing with the problem, because the patient needn't change his behavior. However, such treatment is not harmless. At the end of the 60's an outbreak of pulmonary hypertension was associated with the drug aminorex, and it was soon withdrawn from the market. 30 years later it became clear that new-generation anorectic drugs (fenfluramine, dexfenfluramine, phentermine), which were being used world-wide, lead to both pulmonary hypertension and valvular damage.

         

        We describe a woman of 70 with both these complications which developed after prolonged anorectic therapy with a fenfluramine-phentermine combination.

        נובמבר 1998

        יונית גולד ושמעון רייף
        עמ'

        Aphthous Stomatitis as a First Manifestation of Crohn's Disease in a Child

         

        Y. Gold, S. Reif

         

        Dana Children's Hospital, Tel Aviv Medical Center

         

        The incidence of Crohn's disease has risen dramatically over the past few years. The peak age of onset is in late adolescence, but it rarely occurs in the first few years of life. We describe a 5-year-old boy with recurrent bouts of fever, aphthous stomatitis, and anemia which did not respond to routine antibiotic therapy. It was only after a few months, when the characteristic symptoms of inflammatory bowel disease (IBD): abdominal pain and diarrhea appeared, that the diagnosis of Crohn's disease was made.

        This case illustrates the difficulty in diagnosing IBD in young children. The presenting symptoms of IBD in children are often nonspecific and extra-intestinal. There is usually a low index of suspicion by the physician as to the possibility of IBD in a young child.

        מאיר כהן, ערן תמיר, סובחי אבו-עאיד, יאיר גלילי, מיכאל גלעדי, שמואל אביטל, רפאל שפיר ויוסף קלאוזנר
        עמ'

        The Diagnosis and Treatment of Fournier's Gangrene

         

        M. Cohen, E. Tamir, S. Abu-Abid, Y. Galili, M. Giladi, S. Avital, R. Shafir, Y. Klausner

         

        Surgery and Infectious Disease Depts. and Division of Surgery, Tel Aviv-Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University

         

        We treated 2 women and 8 men suffering from Fournier's gangrene during 1990-96. 2 had diabetes, 1 suffered from ulcerative colitis and 1 was an alcoholic. In 8 of them the infection was triggered by a mixture of aerobic and anaerobic bacteria. Treatment consisted of repeated wide debridement and early colostomy. This aggressive approach resulted in relief of the septic signs within 24 hours and permitted early skin grafting of the wounds. 2 patients died due to sepsis that caused multiple organ failure. The 8 who survived were hospitalized for an average of 35 days. On follow-up examination 1-5 years later all patients had undergone closure of the colostomy and were completely rehabilitated.

        Fournier's gangrene is not rare in the geriatric population. We believe that early diagnosis and aggressive wide debridement, combined with early colostomy, are the keys to successful treatment.

        נאסר גטאס, נורמן לוברנט ודוד רמון
        עמ'

        Miliary and Reticulo-Nodular Pulmonary Brucellosis

         

        Nasser Gattas, Norman Loberant, David Ri

         

        Medical Dept. B and Radiology Depts., Western Galilee Regional Hospital, Nahariya and Rappaport Faculof Medicine, The Technion, Haifa

         

        Brucellosis is a classical zoonosis caused by a Gram-negative bacillus of the genus Brucella. Human brucellosis can either be acute or chronic and present with a variety of manifestations, mostly with fever and signs of musculo-skeletal involvement. It may be complicated by involvement of the cardiovascular, central nervous or genito-urinary systems. However, pulmonary brucellosis is a rare complication.

        We report a case of miliary and reticulo-nodular brucellar pneumonia with positive blood and sputum cultures and positive serological tests. To the best of our knowledge this is the first case to be reported from Israel of miliary pneumonia with sputum positive for brucellosis.

        יצחק סרוגו, אירנה צ'יסטיאקוב, אלה כהן, יורם טל ומיכאל יפה
        עמ'

        Nasopharyngeal Colonization with Streptococcus Pneumoniae in Pediatric Respiratory Infections

         

        Isaac Srugo, Irena Chystiakov, Ella Cohen, Yoram Tal, Michael Jaffe

         

        Clinical Microbiology and Pediatric Depts., Bnai Zion Medical Center and Technion Faculty of Medicine, Haifa

         

        During the winter of 1995, nasopharyngeal colonization of Streptococcus pneumoniae was evaluated in 204 children with respiratory infection and 107 normal control children. There was no difference in gender or mean age between the groups, and no difference in carrier rate between sick (24.5%) and normal (22%) children (p=0.6). Carrier rates were 19%, 32%, 31% and 17% at 6, 12, 24 and 48 months, respectively. Penicillin-resistant pneumococci (PRP) were found in 42% of sick and 16.6% of normal children, (p<0.05). Resistance to more than 2 antibiotics was found in 28% of sick and in 12.5% of normal children. PRP were found in 67% and 34% of sick children with and without prior antibiotic treatment (p<0.05). We conclude that there is no difference in the carrier rate of Streptococcus pneumoniae between sick and normal children. However, the high prevalence of PRP in children with respiratory infections is probably due to prior antibiotic treatment.

        פטר יעקובי, אורלי גולדשטיק, רנטו פינקלשטיין ויוסף איצקוביץ-אלדור
        עמ'

        Empirical Treatment of Urinary Tract Infections in the Delivery Room

         

        Peter Jakobi, Orly Goldstick, Renato Finkelstein, Joseph Itzkovitz-Eldor

         

        Obstetrics and Gynecology Dept. and Infectious Disease Unit, Rambam Medical Center, Haifa

         

        Urinary tract infection (UTI) is the most common bacterial infection during pregnancy. In prenatal and delivery wards treatment is usually started at once in pregnant women with symptoms suggesting UTI, but there is no uniformity as to treatment. We surveyed such treatment in the delivery rooms throughout Israel, and whether the treatment differed in simple cystitis as opposed to pyelonephritis. Results of positive urine cultures from symptomatic parturients admitted here during 1995-1996 were examined.


        There were 17 different empiric treatment protocols in 28 delivery rooms, whose daily cost ranged from 1-119 NIS. We present the antimicrobial sensitivity of 156 bacteria isolated from the urinary cultures from pregnant women in our prenatal ward. Based upon urinary flora, sensitivity and daily cost, we suggest a protocol for empiric treatment. We recommend first and second generation cephalosporins for treatment of simple lower (UTIs), while gentamicin is suggested for treatment of clinical pyelonephritis during pregnancy. There is no medical nor economic justification for the multiplicity of empiric treatment protocols currently used. Considering our results, our protocol is cost-effective for the empiric treatment of UTI in hospitalized parturients and in the community as well.

        מ' פיינסוד
        עמ'

        The Surgeon and the Emperor: a Humanitarian on the Battlefield

         

        M. Feinsod

         

        Dept. of Neurosurgery, Rambam (Maimonides) Medical Center; B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa

         

        The Baron Dominique-Jean Larrey, one of the greatest names in military surgery, participated as Chief Surgeon in all the Napoleonic campaigns. He developed the concept of early evacuation from the battlefield, and of immediate treatment of the wounded, even under fire. He implemented improved surgical techniques and improved wound care that were followed by surgeons all over Europe. His devotion to wounded soldiers crossed national boundaries and became a way of life. Here is an account of Larrey's involvement in the aftermath of the Battles of Lutzen and Bautzen (May-June 1813), when many soldiers were accused of self-mutilation and were about to be executed. He dared to oppose, singlehanded, the Emperor, the highest military authorities and their concurring physicians and surgeons, armed only by his undisputed honesty, professional authority and exceptional reputation won over years of devotion to wounded soldiers. Larrey saved the lives of many soldiers and set an example of unbent ethical integrity.

        יוסף משעל, חיים יוספי, אמיל חי, דליה כץ, אליסה אמבון ורוזה שניידר
        עמ'

        Risk of Transmission of Viral Disease by Needle Puncture in Health Care Workers

         

        Yosef Mishal, Chaim Yosefy, Emil Hay, Dalia Catz, Elisia Ambon, Roza Schneider

         

        Infectious Disease Unit, Emergency Dept. and Microbiology Lab, Barzilai Medical Center, Ashkelon (Affiliated with Ben-Gurion University of the Negev)

         

        The accidental exposure of the health care workers (HCW) to blood and blood products constitutes a danger for transmission of blood-borne pathogens and the development of severe diseases. Most attention is focused on exposure to the viruses of hepatitis B, C and human immunodeficiency. The objectives of this prospective study were to determine the rate of exposure of our HCW to blood and blood products; to define the high risk groups; and to establish recommendations to prevent transmission or reduce the risk of exposure to these viruses.

        During the year 1996, 103 injuries from needle-puncture or other sharp objects were reported to our infectious diseases control unit. Most of those injured were women. 58.4% of the events occurred in the vicinity of the patient. The source of exposure was known in 60% of the cases. 73.8% of those injured had already been immunized against hepatitis B. The departments in which most exposures occurred were the operating theater (12.5%), medical departments A (10.6%) and B (9.6%), and the emergency department (7.7%). Nurses were at highest risk, constituting 47% of those injured.

         

        Our recommendations are that a continuous teaching program be established for the high risk groups; that HCW be urged to report every event of exposure; and to encourage HCW to undergo active immunization against hepatitis B.

        אוקטובר 1998

        שחר צימנד, עינת בירק, מירה פרנד, פטרישה בנימין ויוליוס הגש
        עמ'

        Transcatheter Closure of Atrial Septal Defects: Initial Clinical Applications

         

        Shahar Zimand, Einat Birk, Mira Frand, Patricia Benjamin, Julius Hegesh

         

        Dept. of Pediatric Cardiology, Sheba Medical Center, Tel Hashomer and Schneider Medical Center, Petah Tikva

         

        The incidence of congenital heart defects is 0.8% of live-born infants. Of these 13% are ostium secundum atrial septal defects (ASD) which can be successfully repaired by open heart surgery with less than 1% mortality. However, morbidity associated with cardiac surgery is universal. Transcatheter closure of ASDs was introduced 2 decades ago to decrease surgical complications, hospital stay and cost. Few devices have undergone clinical trials but all of them have been associated with instances of failure and complications. The most important mechanism for acute failure was selection of cases with too large a defect or selection of a defective device. In the past decade great progress has been made with the aid of transesophageal echocardiography (TEE) and modifications of the device. We present our experience in our first 5 patients. They ranged in age from 4 to 27 years; the ASD diameter was 11-15 mm and the device diameter was 17-33 mm. All transcatheter closures were performed on the same day without any complications, and all patients were discharged home after 2 days of hospitalization. We conclude that transcatheter occlusion of ASDs up to 15 mm is feasible, relatively safe and effective. This transcatheter method appears to be a viable alternative to surgery for some patients with secundum atrial septal defects.

        בנימין זאבי, מיכאל ברנט, רמי פוגלמן, גלית בר-מור ולאונרד בלידן
        עמ'

        Transcatheter Closure of Atrial Septal Defect

         

        Benjamin Zeevi, Michael Berant, Rami Fogelman, Galit Bar-Mor, Leonard Blieden

         

        Cardiology Institute, Schneider Children's Medical Center, Petah Tikva and Sackler School of Medicine, Tel Aviv University

         

        Isolated secundum atrial septal defect is one of the most common congenital heart defects. Surgical closure is the treatment of choice but is associated with a chest scar, some morbidity and a relatively long recovery and the use of cardiopulmonary bypass. Transcatheter closure of secundum atrial septal defect is therefor an attractive approach.

        3 children, aged 5-10 years, underwent successful transcatheter closure of moderate to large central atrial septal defects with the Cardioseal device. The procedures were performed under x-ray and transesophageal echocardiographic guidance.

        Our initial experience, and that of others, indicates that transcatheter occlusion of secundum atrial septal defects is safe and effective and can be an appropriate alternative in approximately 60% of patients.

        יהודה שינפלד
        עמ'

        Kaleidoscopic Autoimmunity

         

        Yehuda Shoenfeld

         

        Unit for Study of Autoimmune Diseases and Medical Dept. B, Sheba Medical Center, Tel Hashomer, and Sackler Faculty of Medicine, Tel Aviv University

         

        We describe an 18-year-old girl with idiopathic thrombocytopenic purpura (ITP) who developed chronic active hepatitis following splenectomy that cured the ITP. This is a phenomenon in which an organ belonging to the immune system is resected, which results in cure of one autoimmune disease but in the emergence of another, apparently unrelated, second autoimmune disease. We refer to this phenomenon as kaleidoscopic autoimmunity, explaining that some autoimmune diseases are not induced by autoantigen-driven mechanisms, but rather result from immune dysregulation.

        ספטמבר 1998

        נגה רייכמן, נתן קאופמן, ראובן מדר ועידית פלטאו
        עמ'

        Purpura - an Unusual Presentation of Takayasu Arteritis

         

        N. Reichman, N. Kaufman, R. Mader, E. Flatau

         

        Dept. of Medicine B and Rheumatic Disease Unit, HaEmek Hospital, Afula and Rappaport Faculty of Medicine, The Technion, Haifa

         

        Takayasu arteritis is an uncommon vasculitis, often referred to as aortic arch syndrome. It is most prevalent in young women. Physical findings such as the combination of pulseless arms and carotid bruits suggest the diagnosis. Associated skin manifestations such as pyoderma gangrenosum and erythema nodosum have been described. We present a 27-year-old woman with diffuse purpuric eruption and Takayasu arteritis. This appears to be the first description of such an association.

        מירי קרן ושמואל טיאנו
        עמ'

        Feeding Disorders in Infancy: Feeding Interaction Concept in Diagnosis and Treatment

         

        Miri Keren, Samuel Tyano

         

        Community-based Mental Health Baby Clinic, Gehah Hospital and Sackler School of Medicine, Tel Aviv University

         

        In infancy clinical manifestations of psychological distress are mainly somatic. Feeding disorders are one of the most common and nonspecific manifestations of different kinds of disturbed parent-child relationships. These disturbances may have their origins in the baby's constitution and physical status, in the parent's personality structure, or both, as has been conceptualized in the transactional model of normal and abnormal development. Among the daily interactions a baby has with parents, feeding has special inherent impact on the early parent-child relationship because of its psychological meanings. Therefore, feeding disorders, with or without failure to thrive, often reflect various disorders of infancy, still not well recognized in the medical community, such as regulatory disorders, attachment disorders, depression of infancy, disorders of separation-individuation, and post-traumatic eating disorder. 3 clinical cases are brought to increase awareness of psychological distress in the infant, and of feeding disorders as 1 of its manifestations. Each illustrates a different kind of feeding disorder in terms of etiology and pathogenesis. Through these cases we emphasize the need for a multidisciplinary, integrative approach in diagnosis and treatment. Our conceptual background is based both on the transactional model of development (infant and parental factors impact on each other) in a very dynamic paradigm, and on psychodynamic premises. Intrapsychic conflicts and past representations impact heavily on the parenting characteristics. We emphasize the psychological significance of disturbed feeding interactions, with or without failure to thrive.

         

        איון פוקס, לאוניד אומנסקי ויעקב לרנר
        עמ'

        Folic Acid Deficiency in Chronically Hospitalized Mental Patients

         

        Ivan Fuchs, Leonid Omansky, Yaakov Lerner

         

        Eitanim Mental Health Center, Jerusalem (Affiliated with the Hebrew University-Hadassah Medical School)

         

        Studies over the past 30 years have shown a relationship between folic acid deficiency and psychopathology. FA deficiency was observed more often in depressed and in psychotic patients, in alcoholics, in those suffering from organic mental disorders and in the psycho-geriatric population. In a chronic inpatient population of 120 patients, of the 106 in whom FA serum levels were examined, only 1 had a definitely subnormal level. An additional 16 had close to the lower limit of normal (2 ng/ml) and were considered borderline cases. FA-deficient and borderline patients were then compared to matched patients with normal FA levels on the MMSE and PANSS scales by blinded raters. Small differences were found between the 2 groups. The FA-deficient and borderline patients had more organic and psychotic symptoms, but the differences were not statistically significant.

        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